138- Ned Hallowell's Step-by-Step Guide to Adult ADHD Diagnosis and Treatment

o you've got questions O'Reilly Auto Parts has answers need a pro you can trust we've got that too no matter what you need our professional Parts people have the training and expertise to help you do things right deep Automotive knowledge just one part that makes O'Reilly stand aart the professional Parts [Music] people Auto Parts [Music] welcome to the attention deficit disorder expert podcast series by attitude [Music] magazine good afternoon and welcome I'm Wayne Ken and you're listening to attitude Magazine's weekly ADHD expert audio broadcast today's webinar is sponsored by kyos genetics being diagnosed with and

treated for ADHD can be stressful espe esally when it comes to finding the right medicine genes play a role in how you will react to ADHD medication kyos can make this process easier through genetic testing that helps you determine which treatments will work for you or your child learn more about how kyos genetics can help you understand your health at www. kyos genetics.com we all know that an adult ADHD diagnosis brings relief Clarity lots of questions and hopefully lots of answers the diagnosis puts a lot of behaviors in perspective for instance now I know why

I acted the way I did or I why I lost the job I did or why I love that project that allowed me to tap into my creative skills now I know why am I am so emotional or why I go out of my way to avoid boredom if you or a loved one has been diagnosed recently or it's been a couple of years since your evaluation and you're not satisfied with the treatment strategies you're using today's webinar will be of great interest to you you'll get a clear accurate idea of how ADHD should be

diagnosed and treated you'll also learn about the best and latest approaches for managing symptoms medication as well as nutrition and exercise and just as importantly learn how to deal constructively with shame and low self-esteem today we're very fortunate to have Dr Ned Hallowell with us Dr Hallowell a child and adult psychiatrist is author of The New York Times bestselling driven to distraction and delivered from distraction and is founder of the Hallowell centers in New York San Francisco and Sudbury Massachusetts he speaks around the world on the topic of ADHD so with that introduction let me

turn it over to Ned thanks Ned for being here thank you so much Wayne for inviting me and thank all of you for uh tuning in or logging on uh I'm glad to join you wherever you are and and I hope I can give you some useful information as as Wayne said uh I have offices in in Seattle Washington San Francisco California New York City and sodbury Massachusetts and today I'm talking to you from my office in sodbury Massachusetts which is just about 20 miles west of Boston I'm thrilled to be able to have this

chance to connect with you all just so you know I have ADHD myself I also have dyslexia and wouldn't trade either one of them for the world and I'll I'll explain why to you but I should hasten to add uh if you don't understand ADHD it can be a terrible curse and that's really what makes it so interesting this is a condition that can absolutely take you to the top of life but it can also plummet you to the bottom uh and and so we need we need to take it very seriously and and the

biggest undiagnosed group are adults which we're here to talk about uh uh today most people in the medical profession and the mental health profession really don't think of ADHD when they're evaluating an adult and as a result uh the great majority of adults estimates at least 75% and some people say more like 90% are not diagnosed uh which is which is a real shame because uh the benefit are are tremendous so how do you go about getting diagnosed well first of all you you want to know what it is you want you want to you

want to have it come to mind and that's really what doesn't happen to most people that's why it's not diagnosed they don't think of it they've never heard of it they don't think of it and their doctor doesn't think of it so so what would the telltale signs be what what should you what should you be on the lookout for in yourself and a friend and by the way you can do a tremendous favor to a friend if you say you know I heard this webinar or I read this book or what have you and

your struggles really could be explained by ADHD and they'll say well isn't that a isn't that just hyperactive boys and you say no it's a grown men and women among the adult population the biggest undiagnosed group are the the women nobody thinks of that so what are the telltale signs what are what the the most common reason uh someone comes to see me as an adult is unexplained under achievement another words they know they could be doing better they may be doing very well by the way you can be top of your field and uh

you know excelling and and still have undiagnosed ADHD uh you know I have patients who are billionaires saying you know thank God I got this diagnosis because now I'm doing even better so so you need not be failing uh but you you are underachieving and you know you know in your heart in your gut that if only you could find the key you could be doing so much better you just don't know what that key is but this unexplained underachievement in other words it's not due to some obvious reason like uh uh you're you're unable

to work or you you are limited by resources or you know you have some medical condition that's holding back you you you don't know why you're not doing well and and if you then go to someone who knows about ADHD or if you can't find such a person read my book the book John Rady and I wrote delivered from distraction driven came out in 1994 driven to distraction and delivered from distraction is new 2005 uh read that and if you can't read a whole book the first chapter is called The Skin read this if you

can't read the whole book A lot of people with ADD don't want to sit down and read an entire book and what you'll find uh you know you begin with unexplained underachievement then the other symptoms that that you'll see is is inconsistent Focus now attention deficit is a terrible misnomer because it's not a deficit of attention it's a Wandering of attention if anything people with ADHD have an abundance of attention what they have trouble doing is is controlling it when they're interested I should say when we're interested we pay super attention we pay hyper attention

we focus better than anyone it's like laser beam Focus the building could be burning down and you're still sitting there working on your project uh it's just that when you're not interested when the meeting is boring the conversation is boring uh the book is boring whatever you're involved in is boring your mind goes elsewhere it doesn't go empty it goes elsewhere the add mind is really like a toddler on a picnic it goes wherever curiosity leads it with no regard for danger or authority so this this add mind is just always out there exploring looking

around uh trying to you know pursue whatever seems enchanting and and um and that can lead to your missing key key important points at the meeting say or on the agenda or in the book and then that leads to underachievement because your your attention is inconsistent so your productivity will have gaps in it well with that will have holes in it because of what you've missed and and uh it's not a matter of trying harder these people get told over and over again get your act together you've got so much talent why can't you do

better uh telling someone with ADHD to try harder is about as helpful as telling someone who's nearsighted to squint harder it misses the fundamental point and and so once again you you you instead of beating up on yourself which is a terrible habit most adults with ADD have uh go go see someone who can evaluate you and offer you treatment other other symptoms that occur uh trouble with with organizing planning prioritizing what's the jargon term is executive function it means you know your your brain's capacity to plan and organize your day to have a sort

of a logical sequence of events the add brain is going off on tangents all the time so there's sort of a jumble uh go you go off in several directions simultaneously and so so so you miss meetings you you don't follow through on plans you commit to something and forget about it all of that is under the heading of executive function also trouble with time management I often say in the world of add there are basically two times there's now and not now so you say Well they're we're having a meeting next Wednesday and you

just say well not now and it's just gone it's not that you're not interested it just disappears and and what you do is you end up living a life of chronic procrastination uh you you put things off to the very last minute until uh not now is almost now and then in a panic you get it done and what you're really doing is you're self-medicating with adrenaline because in a panic you get a big bolus of adrenaline and then you can sit down and focus and and and get it done but that's not a good

way to live living from crisis to crisis and panic to panic uh also a tendency toward impulsive uh Behavior Reckless decision making shoot from the hip um this impulsivity uh you know Russ Barkley calls the Holy Trinity of ADD distractability impulsivity and restlessness or hyperactivity we usually don't see hyperactivity in adults but we certainly see restlessness trouble sitting still trouble staying put you know at a lecture you want to get up and pace around the back of the room in a restaurant you want to get up and go to the bathroom several times you you

just have trouble staying in one spot drumming your fingers um you know the legs crossed with one leg going up and down uh that that sort of thing so a a tendency toward impulsivity and impatience um those of you listening to me right now you want me to hurry it up okay got that point move it on move it on move it on and uh you know cut to the bottom line and and in a business meeting that can be adaptive but not so much in a romantic conversation you know that okay so you love

me what's your next point you know people with with ADHD have trouble lingering over the moment they have trouble savoring savoring the sunset or or lingering over the painting in the museum they want to get on to the next bit of stimulation and and that's another part of it a an appetite for high stimulation people with this kind of mind love High stimulation love danger uh love the conflict and so you'll find them in professions like trial attorney or Traders on the Commodities exchange uh or a brain surgeon uh or an airline pilot and don't

worry they pay attention in the O they have trouble with the posttop paperwork you know and um uh uh often often entrepreneurs like most entrepreneurs have have this condition because they you know they they're Their Own Boss they're free and they can they can go off and and start a new company what they really need to do is work with someone who has what I call attention Surplus Disorder so you know the ADHD person is the idea person and then the attention Surplus person is the one who sweats the details and makes the thing happen

um other other qualities low tolerance of of frustration uh tendency to have many projects going simultaneously trouble with follow through uh often a tendency to self-medicate either with substances alcohol cocaine uh or activities gambling spending sex the internet is ushered in a whole new wave of compulsive if not addictive behaviors including addiction to electronics themselves it's the newest addiction and and you can find people wasting great gobs of time doing what I call screen sucking they just glomp onto a screen and and and don't let go of it um now those are the negatives now

you also see a host of positives and this is what most people don't mention but take the that core Triad Barkley's Holy Trinity the distractability impulsivity and restlessness turn each one of those on its head and you get a positive the flip side of distractive ability is curiosity and curiosity is a very valuable quality that cannot be taught or bought uh the flips side of of impulsivity is creativity what is creativity but impulsivity going right you don't plan to have a creative idea you don't say it's 115 time for my creative idea and lay it

like an egg you know they pop creativity depends on disinhibition uh depends on spontaneity depends upon some degree of of impulse ivity if you will and then finally restlessness uh you get to be my age I'm 66 it's called Energy you know I'm really glad I've got this little turbo pack um so it's all a matter of of controlling the power you have I often say it's like you've got a Ferrari engine for a brain you've got this way powerful brain but you have bicycle brakes and and the trick is to find a Brak specialist

you know I often say to people I'm just a break specialist to help you to help you control the power that you have this tremendous uh Power of imagination of creativity of U you know the the the Pathfinders the discoverers the people who colonize this country that's the add population and it carries with it tremendous benefit and tremendous risk uh the prison population is is over represented with people with ADHD so is the addicted population so are the halls of the unemployed and the multiply divorced and the accident prone all of those are over represented

with ADHD but so are the halls of the Pulitzer Prize winners the Nobel Prize winners the self-made Millionaires and billionaires most entrepreneurs have it uh you know you find the the top of any field and I'll find you someone who has ADHD so it's it's it's high stakes poker you know getting a handle on this learning to strengthen those breaks so you can become the fabulous success you have it in you to become rather than the the disaster that this this can create in your life if if you're not aware of it uh getting a

diagnosis is so critical and the there is no test for ADHD that's one of the common misconceptions the closest thing we have to a test is your history so you go to a clinician and make sure you go to a clinici clinician who understands it and also understands the strengths associated with it you don't want to go in and get one of these uh diagnoses that's just laced in path ology and you come out thinking you've just been told you're a future Axe Murderer you're You're a worthless human being you you want to see someone

who realizes that there's a lot of talent embedded in the in the problems and uh and there are problems embedded in the talent in any case it's your history that will tell the story but you got to get the history is taken from multiple sources because we people with ADHD were not good self- observers uh so you you always want to bring along a spouse or a colleague or a friend someone who knows you well who can give their point of view on on what you're like and and if it's add it'll be in the

history it'll be right in there now we often supplement the history with neurocytes taken from uh more than one source and and if you have ADHD it will appear in your history for sure okay once you have this diagnosis the first step is to embrace it to understand it you need to learn what it is and what it isn't the people who do best with this are the people who really own their ADHD and manage it and the only way you can do that is to really understand it understand the benefits that it confers the

creativity the energy the entrepreneurialism the intuition the uh the powerful emotional uh component that most of us have and then understand the obstacles the problems with executive function the problems with focusing on boring details the problems with impulse control I mean all of that understand all of that package so education is really the the first step uh into into treatment learning about it really getting it so so that it's not just a list of symptoms that you memorize or you know some some sort of casual you know onliners uh because you want to be able

not only to explain it to yourself but to other people like your spouse now I wouldn't explain it to your employer unfortunately we're still in a world where most people don't understand add so if you say to your employer I have add your employer will likely think that means you're unreliable you're a crackpot uh it won't help you at work so you may talk about the symptoms you can say I'm a great idea guy but I'm not good on details but don't use the label because most people in the workplace still just don't get it

okay once you've embraced it once you've understood it uh there are a number of steps that you can take simultaneously uh getting a coach is a great idea this is someone who can help you get organized someone who who can help you plan follow through not get sidetracked and and coaching is a field that's really evolved over over the past 20 years um most coaches can work over the telephone so you don't have to go to someone's office um I recommend you meet the coach in person at least once so you have a feel for

that person and and it becomes a very sustaining and and constructive relationship you can meet for 10 minutes every day over the phone or for 45 45 minutes once a week whatever works for you is what you should do um in addition to coaching you want to pay close attention to Lifestyle exercise tremendously important my colleague and friend John Rady wrote a wonderful book called spark the Revolutionary new science of exercise in the brain where in which he detailed the huge amount of evidence that shows how incredibly good for your brain not to mention your

the rest of your body physical exercises and you can use it not only getting exercise regularly but also in the acute moment if you're glazing over and spacing out get up from your desk and do 25 jumping checks or run up and downstairs a few times it will instantly push the reset button on your brain you'll get a whole new set of brain chemistry and uh it it it work Works quickly and and works really well so physical exercise nutrition you know the closer you can come to vegan the better I can't come very close

at all but stay away from junk food stay away from sugar sugar is the the new poison so stay away from soda pop stay away from simple sugars in general um and and uh try to try to eat Whole Foods try not to self-medicate with too much alcohol marijuana uh sleep you know people with ADD tend to need less sleep than the average person but you do need some sleep so don't join the parade of uh underslept Americans that we we're surrounded by these days uh meditation is wonderful Lydia zowa z y l wska wrote

a marvelous book called The mindfulness cure for adult ADHD go to Amazon it's a great book and a really really solid research that they did out there at UCLA and they got results using meditation on a par with medication so if you'll do it and don't tell me people with ADD can't meditate we can uh we really can and it's a readily available it's free and it's effective you just need to do it regularly and then of course there's medication and medication is the most uh misunderstood of all the interventions we have it's unfortunate that

that's the case but you know people ask me do you believe in Rin and uh my answer is it's not a religious principle you know uh Rin is a medication and like any other medication it can be helpful or it can be dangerous if you grind it up and snort it that's dangerous if you overdose with it that's dangerous um if you take escalating doses of it that's dangerous but if you use it properly under the supervision of a doctor who knows what he or she is doing then it can be a godsent it can

be as effective as eyeglasses uh people often wonder will it take away my special sauce will it take away my Pizzazz my creativity my jat of verver no it won't and if it did if it happened to uh you just stop the medication that's the beauty of stimulants they're in and out of your system the same day uh so if if it does anything you don't like if you turn purple or you know grow a third ear you just stop the medication and you go back to the way you were uh so whatever the meds

do they're they're immediately reversible so a trial of medication is just that it's a trial of medication and if it's helpful you continue it if it's not helpful or causes side effects you stop it it's that simple I mean what we need is an attack of common sense when it comes to medication instead of these these arguments that turn it into a hot button issue which it really should not be in my own case they don't work so my medication is caffeine which is the world's medication um the the prescription stimulants just give me side

effects so so I I go through my day with my coffee um don't be afraid of medication go see a doctor who's experienced it's very important that you see someone who really has experience with these because there there are subtleties to them and complexities you you need to be in the hands of someone who understands that and before you start the meds get clear you know get emotionally clear because they'll work much better if you if you don't take them sort of with with anxious apprehension get clear that these are safe and um if if

you use them properly uh they're they're very safe and and that uh if they help you you'll continue and if they don't help you you'll stop them it's just it's just that simple uh it's a shame that an intervention that is so effective 80% of the time is so feared and and really becomes very controversial Alan Schwarz who writes for the New York Times has become a friend of mine he has a book coming out in September called ADHD nation in which he details the ways in which these meds are overprescribed misused and and dangerous

and and he's absolutely right uh you know they can be misused they are overprescribed and they and and they can be dangerous but at the same time if they're if they're used properly uh they can absolutely change your life dramatically for the better so so don't take them off your list of possibilities just work with a doctor who really knows what he or she is doing there are new treatments on the horizon and and the future really does reside in non-medication interventions uh in I'm sure before I die will'll have brain games that are very

targeted toward enhancing the attention circuitry um you know right now there are companies that offer more than they can deliver along those lines but uh uh there's one in the making called the attentive system that I've been part of the research for the past five years that I think is very promising uh there there will be others coming down the pike for sure U and um and I think we'll get more mileage out of nutrition uh the the whole field of the gut you know people are calling that the Forgotten organ and the whole field

of of of the Flora in your gut and how that inter interacts with your mental status is a vering field as is the field of epigenetics um so so the the genome and the gut genome uh is something that we're starting to assess and and intervene around as well as how the environment influences the expression of your genes and you know I think the the whole the whole thing of screen sucking of overuse of uh electronic devices influences the expression of genes and I think that's why we're seeing the sort of the the spread of

what I call Doo add it's not true add but it looks for all the world just the same and it's due to overuse of electronics and an under use of what I call the human moment the human connection I call it the other vitamin C vitamin connect and I prescribe it for all my patients and describe it for all of you listening right now make sure every day you get multiple doses of a friendly face multiple doses of a conversation multiple doses of uh just hanging out at the water cooler and talking about this and

that talking about this and that small talk is anything but small it's very big it's harmonizing it's normalizing it's stabilizing make sure you get some of that don't spend your whole day in front of a screen conducting your social life via text and and and email that's not good for you uh most people don't realize this but social isolation is as dangerous a risk factor for early death as cigarette smoking Leisa Birman proved this 25 years ago it's been replicated many times social isolation is really bad for you and and short of killing you it

it puts you in sort of a less than zestful state of mind it takes the the glisten off of life it takes the sparkle out and you become kind of kind of glassy eyed and walking through your day and what you're missing you're not depressed what you're missing is is that vitamin connect you're missing the high five you're missing the laugh you're missing the pat on the back that's another thing that we we don't touch each other anymore because we're afraid you know the political correct police are out there watching you know so we've given

up uh touching we've given up face-to-face contact we've given up the the the human connection that that's right there for the taking it's it's right there readily available free and and really good for you and the other thing I'm prescribing to everyone is get a dog if you possibly can get a dog if your zoning laws allow it and if you're not allergic get a dog if you must get a cat but uh I'm giving myself away here I'm more of a dog person than a cat person but but have a pet pets are unbelievable

mental health professionals they're the best mental health professionals out there and and once again they're they're they're very inexpensive so if you possibly can uh get a pet and and the I'll close and take some questions but uh mention just a couple of other important points uh marry the right person and find the right job or if you don't marry you know hook up with connect with the right person and find the right job a lot of people with addd are in the bad habit of of living with and working for a demeaning sort of

caricature of a bad fifth grade school teacher that's not a good idea you know why do they do that because I think that's what they need they got the idea back around fifth grade that they needed lots of reprimands and redirection and and and put downs and of course that the is the last thing they need they need to find someone who really believes in them I mean my life is is made by my my wife Sue and and uh it's God you know delivered her into my life and and uh if it weren't for

her I wouldn't have been able to do anything uh so so marrying the right person and then finding the right job and the right job is a job where you can use your talents and be minimally penalized by your your shortcomings uh finding the right mate and finding the right job are are are obviously critical for anyone but particularly those of us with ADD because we tend to fall into the wrong the wrong relationship and and the wrong job well I'm going to stop here I just want to end with the uh the the reminder

that used managed properly this kind of mind is is a is a great asset in your life is a turbo pack is a is a is a ticket to very interesting places but if it's not managed properly it can cause tremendous pain uh tremendous loss and and you know take a enormous toll on your life U sometimes people misrepresent what I say I don't say add is a gift I say it is potentially a gift uh but it is also potentially a horrible horrible curse and that's why you really need to take it seriously and

work with professionals who understand it get it get the complexity of it get the multiplicity of interventions that we have uh and understand that there's far far far more to it than simply taking a pill it's really a life a lifetime of of working uh to contain manage direct uh the amazing brain that you've got well let me let me take your questions and and uh okay we have plenty of them of course and one is red flags about the actual person who's evaluating you at a certain point what you should you look for um

that would indicate that this person is not either understanding ADHD or you're not getting along with him or her uh what are the red flags of sort of a bad diagnosis as you're sort of sitting there being evaluated is there anything should be looking for absolutely right at the top of the list is what you said if you don't like the person I don't care how good they are uh if you don't like them you should see someone else and and that's not the other person it's just you're a bad match but trust your gut

because this is an intimate relationship you're entering into you need to trust this person and you get a much better outcome if you like the professional uh you should ask do you see many adults who have ADD and and uh you know if they say oh yeah I see a few that's not what you want want someone who you know who sees them regularly because you know Finding Specialists who get this it's not easy but it's worth the search it really is worth looking around the best way to get a referral is from someone else

who's been there um some people come you know to my office in New York or Boston to see me and get started and then I can refer them back to their PCP uh for followup and we can have phone appointments that's another way but the red flags are uh you don't like the person uh or they just don't have much experience in treating uh add and adults uh and obviously if they start saying things you know are wrong like well you're too successful to have ADD or well you're paying attention to me now you couldn't

have ADD those are some of the you know that clearly reflect a a poor understanding of what add is all about I would read my book delivered from distraction before you go to see a professional because it'll give you a instant of gauging is this person on the beam I know you mentioned that uh taking a history was the gold standard uh but several people have asked about additional tests such as rating scales and then uh to get a what they call a finer grain view of their ADHD and on top of that several people

have asked about should your you know provider be looking for comorbid conditions and if so should they go about doing that yeah rating scales are fine in fact almost everyone uses them and it's a way of trying to sort of standardize diagnosis uh I'm not a big fan of rating scales just because they're leading the witness you know i' I'd rather have someone describe their life or have a a teacher comment or a spouse's comment what is this person like and if the symptoms of ADD are there they'll they'll volunteer them but but I'm in

a distinct minority almost everyone uses rating scales so by all means use rating scales and and they're a way of of trying to standardize the diagnosis the other question about comorbidities I object to that term because I don't think of add as morbid so I I I prefer to say coexisting conditions but again I'm in a I'm in a minority there and so comorbidity is the standard term and the there there usually is a coexisting condition in my own case I also have dyslexia and that's pretty common and about 25 to 30% of people with

ADHD also have a reading problem other common coexisting conditions are depression and anxiety now often those two occur in the wake of the untreated add unfortunately what happens for most adults is they they get their depression and anxiety identified and they get put on an SSRI uh and they get a little bit better but they're not getting the at the root cause which is the unidentified ADHD if you have ADHD you're going to underachieve and that's depressing so you can look like you're depressed but you're not really depressed you're just bummed out because you know

you could be doing better and if you have untreated ADHD you're GNA you're going to be making these mistakes you're not going to hear something you're going to screw up you're going to speak out of turn well that's anxiety-provoking if you don't know what you're going to miss what you're going to overlook who's going to come down on you next you're walking around anxious so so the the depression and things anxiety may be artifacts of the untreated ADHD and often times when you simply uh begin the treatment of the ADHD the depression and anxiety go

away uh but sometimes not and sometimes you have both of those to deal with and then the other big one to watch out for in adults is is some kind of substance abuse or compulsive activity be it sex gambling or electronic devices very very common and and the uh the thing that's key there is to get around the shame people feel and say you know this is real normal it's just not a it's just not an Adaptive way of of what I call scratching the itch at the core of add so let's find some adaptive

ways and once again once they get get treatment they're often able to give up their substance or their bad habit how long uh a lot of people have talked about Too Short in evaluation how long realistically does it take to evaluate ADHD on average it be two sessions or could you do it in one if you see someone who really knows what they're doing and again that's an important caveat um I can certainly do it in in 45 minutes and U now I'll I'll refer them for testing often and if the case is very complex

45 minutes won't be enough but for the majority of adults 45 minutes will will certainly put us in the ballpark and and again it's not just with the with the identified patient it's with someone else along with that person um and then what I usually do is refer them to my book and have them come back and say did you see yourself in the book and and so it need not be drawn out now with a very complex case yes two or three sessions and testing and and but uh for most adults with ADD when

they walk in the door it's it's just clear you know you want to say you know praise be you finally found your way to my office where have you been all your life and um uh because it it it's such a relief when they when they get the diagnosis and a lot of the work is dealing with the emotions that the diagnosis creates uh one adult has said that the F fine Gull diet works well for him but he he has been debunked so why does it work for him I mean what is the bottom

line on the fine gold diet well fine gold should not have been debunked I mean he sort of brought it on himself cuz he he was so extreme but but uh there's no doubt that nutrition influences mentation no doubt about it and and uh a lot of people find that symptoms are reduced by cutting back on sugar and additives and that's what the fold diet was all about so I have great respect for Dr fine gold um it's too bad that uh uh he's been debunked but like so many things it's sort of fads and

Trends and and uh uh what I say to people look whatever works as long as it safe and it's legal use it uh fine gold diet is not for everyone but in fact most people find a modified version of the fine gold diet to be helpful and so I I think we should not we should not debunk him we should uh uh you know and he probably had to overstate his case to get heard which is unfortunate that's what you have to do often but I I he was a Pioneer in the field and he

really pioneered the use of nutrition in in in helping mentation in general and ADHD in particular particular so we should we should give him his proper praise and and uh and if it helps you whoever was asking that question by all means go with it and and and realize you're in good company by the way gluten-free and lactose free a lot of people with ADHD find those dietary modifications to be helpful try it be your own experimental animal as long as it's safe and it's legal uh try whatever you want I went through a phase

where I was trying all kinds of supplements and I concluded if nothing else I had the most expensive year in Boston uh someone has asked about neuro feedback any evidence for that in in uh in terms of treatments for ADHD well I think it's the coming thing I think when we get more sophisticated with neuro feedback uh it will be I think it'll be a Mainstay right now not so much uh right now what you end up doing is you get very good at playing the game but it doesn't generalize into the classroom into the

workplace what have you but but I think at its core are principles that once we learn in a more sophisticated way to take advantage of them and I think the the attentive system is is an example of this I think it will become a Mainstay so uh I wouldn't invest in it right now uh but but stay tuned because I think there's going to be headlines made by modifications of neuro feedback M several people asked what does inattentive ADHD look like in adults versus the other form um what what and this yeah sure and this

is an important point in general most adults do not have hyperactivity uh so the difference between inattentive and you know ADHD versus add so to speak is is disruptive behavior and and it's more men tend to be more disruptive and that's why they get diagnosed so the women don't get diagnosed because they're the opposite they're they're Serene they're quiet nobody thinks of add um they dismiss them as depressed or slow or just shy and you have to probe a little bit but as you probe a little bit you discover they've got so much going on

inside of themselves they're underachieving which means their self-esteem is really low they've been told they're slow and once you prime them up up a little bit and and and feed them a little bit next thing you know you you see the the full the full array of ADHD symptom ADD symptoms minus disruptive behavior they're they're quite the opposite of that so that's why female adult females don't get diagnosed because they're not causing any problems they're just quietly underachieving but on once you get them the right help oh my gosh they they can really turn things

around careers get saved marriages get saved uh they they don't present with disruptive symptomatology U it's more quiet Serene Emily Dickinson I think had had uh this kind of ADHD what about a medication trial how long should an adult keep trying a medication at different dosages or switching to another medication assuming that he or she is incapable hands uh professional hands no more than a no more than a day if you get real bad side effect so uh but what usually happens what usually happens is you start with a low dose and and you get

no response so then you gradually increase the dose uh and you can do that you know every other day I mean that's the great thing about these meds they work right away uh so you know you can go from 10 milligrams of Rin on Monday and be up to 40 milligrams by Friday uh just by increasing it in 10 milligram increments um and and and uh you know you have the built-in feedback loop of side effects so you keep increasing it until you either get Target symptom Improvement or side effects if you get side effects

you switch to a different medication or you lower the dose uh you know these trials can be fairly complicated so they can take you know a month to six weeks to find the right dose of the right medication but each change can really be made you know within 30 to 48 Hours M and on the medication note someone says do I have to take it every day or only when I'm required to multitask well you never have to take it I mean that's the whole point it's not like it's not like insulin you know where

you'll die without it and it's not like an antibiotic where you have to maintain a blood level it's more like Co it's more like coffee it's when you want it you can take it now most people get the best response if they take it regularly if they take it every day because you you're not aware of how much Focus helps you no matter what you're doing so I advise my patients to take it seven days a week and then and then try stopping it every six months or so just to see if you still need

it but you don't have to do it that way I had one patient who only took it for organic chemistry and her grade went from the D Anda and she got into medical school so I mean you know it's a uh but but but usually the reluctance to take it regularly bespeaks uh s effects it it means that the dosing is wrong there's some reason they don't want to take it regularly so I usually explore why don't you want to take it regularly uh medically speaking it's fine you can take it on Alternate Tuesdays if

you want to but but why don't you want to take it regularly is my question and and uh uh and it usually comes back to some kind of side effect that needs to be addressed right lots of questions on parents who are trying to get young adult to get some treatment one woman mother says uh my two boys are resistant to treatment and their ongoing sense of denial over the consequences of their untreated a ADHD lives is really bothers me how can I persuade them to get some treatment yeah and it should bother you and

um uh you as the mom are probably not going to have much luck uh if you can find someone else to encourage them a coach a grandfather family doctor uh uh I do a lot of this of talking to young males really it's against their code of honor they say I'd rather fail doing it my way than succeed with help and and uh so I see a lot of them and I and I try to you know kind of encourage them in a different direction uh it's hard for you as Mom one thing you should

not uh you should not throw out of your toolbox though is bribery uh bribe them to go see first find a professional you know they'll get along with and do your homework and because you only get one shot at this and then bribe them to have one appointment uh and any expert who says you shouldn't bribe children does not have children you know you can't raise children without bribery we can call it other things but it comes down to bribery so so do whatever you can to get your son to someone who you've already vetted

out who you know they'll like you know they'll relate to because it's in their manifest self-interest to take this seriously I mean as I said this is high stakes poker and if you if you don't take it seriously you're putting yourself at Great risk of drug abuse of car accidents of school failure you know all this kind of stuff that that uh some of these things can just ruin your life early early on so it really needs to be taken seriously m lot of people who feel bad about themselves they say their boss says that

they didn't get the assignment right and they're particularly tough on them they feel bad about that their family if you forget to take out the garbage their family comes down on them and they're really sort of worn out by it and what kind of strategy can you can you come up with to help them sort of avoid feeling bad about themselves 247 or if not you know at least part of the day sure well well first of all my heart goes out to all of those people and I encourage them to try to find support

groups uh either through chat or uh attitude uh organizes some of these so try to find other people who are dealing with the same issues uh then uh then you know in fact I think I just wrote something for you Wayne on on uh how to deal how to deal with you know the negative selft talk and and and all of that and and uh um try to understand it as aun fun of of you know the the world out there not getting it and so educate you know your spouse your family your boss again

I would not use the term add with my boss but I would say you know I I I really have a lot to contribute and punctuality is not one of those things but I've got some great ideas now bear in mind the most important accommodation in the workplace is finding the right job people talk about getting accommodations in the workplace most of them don't amount to Hill beans compared to finding the right job now of course you have a job you don't want to quit that and and but but be be be looking for another

job if you're in a job that is less than ideal always be looking for another just the act of looking uh instills some hope uh so you know you can you can go to work saying I'm not stuck here forever and you're not and having add means you probably are pretty resilient and you probably would be able to find another another job but uh finding that right job is is tremendously important don't give up uh work with other people follow leads uh and the same thing at home you know if you've got a uh if

you've got people who are putting you down you really need to explain to them that that this this is this is bad for me but it's also bad for you because I'm not going to be uh nearly as fun to be with if you keep if you keep kicking me all the time you know and and then again as I say the time may come where you just say well goodbye uh you know the getting out of a relationship or getting out of a job should not be the first option but it should certainly be

an option uh that that you that you uh keep it keep in the back of your mind one last question n because so many people have asked about these computerized computerized tasks for diagnosis like the kova uh they're saying you they don't trust them where do they fall in the realm of uh diagnostic uh they're they're fine it's the same same thing with the checklist they're fine to use go online take a test that's fine but then use that as the prod to go see the professional uh you know uh it should be it can

it can lead you to the doctor's office uh so the tests are fine they're not definitive uh but they can they can sort of prompt you to go to the next step which is to find the expert in your area that you that you ought to go to see and uh you know a general rule of thumb is call the nearest medical school and ask for the Department of Psychiatry and most of them will have someone who deals with adults who have ADD read my book read my book first so you can go in and

educate them about the strength-based approach because you don't want to go in and have the really demoralizing experience of being told in very fancy language you know how deficient you are and what a deficit what a deficit disorder you've got you know it's a real bummer you know so you want to you want to be working with someone who can say look you're the kind of person who has built this country right now you're in a quagmire but that's because your add has not been dealt with and if we deal with it we'll get you

out of the Quagmire and we'll we'll get you to the the top one of the first people I ever treated back when I was working with Kevin Murphy and Russ Barkley at a UMass was a a guy who the only job he was able to hold was as a night Watchman uh and he get fired in one calendar year he collected 120 W2 forms so he got hired and fired from 120 jobs and that's a testament a to his ability to get fired but B to his persistence and ability to get a new job his

IQ was tested at 160 well once once he got his ADD treated his whole life changed he was able to get out of the night Watchman job and he got into a management position and and just started to thrive so so you know untreated this can be crippling treated it can be just you you can suddenly make good on the talent you've got and and that's what makes the condition so very very interesting so just keep going if one treatment doesn't work for you keep keep trying other things right absolutely I mean that that's where

you know one of my one of my watch words is never worry alone so find a professional who you can work with over the long haul you know find a professional who uh uh you know it's not instant success you know so the these things are they take time they take effort there there's a it's a twisty turny road but uh uh work with someone who you like who you can keep working with uh and and the general trajectory will be in a positive direction well thanks Ned for all of your insights and strategies this

was a great session thank you so much and I I really uh love what attitude has done for the the world of of ADHD you and Susan are doing such a tremendous Service uh it's in my waiting room and uh patients often come in and say can I take this issue can I take this issue and you you usually send us a bunch so I'm able to give them away and uh it's you know the the community of ADHD is a is a wonderful community and by the way if any of you listening would like

to email me I I I answer my emails and uh my email address is drhowell gmail.com and my website is Dr howell.com there's a lot of free information on that website so you know we're all in this together and uh right you and Susan at attitude are are doing such a tremendous service I'm thrilled to join you today well thanks n and have a great day for more attitude podcast and information on living well with attention it visit attitudemag [Music] [Music]