Do you have ADHD? | Awake at the Wheel | Ep 37

Once we take that detailed history, we look at the brain and this is something that's missing from, I would say, most ADHD assessments, which is just crazy to me because ADHD is a neurological disorder. So if you’re not looking at the brain, how do we actually know what's going on? Hello and welcome to Awake at the Wheel. So in today's episode, we're going to be discussing the topic of ADHD. This is something that is currently all over the Internet and rather than taking this as a lecture style episode instead, our producer has found a few videos for us to watch. As far as what information is out there about ADHD. So in terms of, you know, what we're going to be looking at today, we don't know if it's professionals speaking, if it's laypeople speaking about it. We're going in blind, as I do with most things in my life. But in any event, we're going to be looking at these videos and giving some of our feedback in terms of whether we feel there is validity to it. Some of it's helpful, some of it's not. So without further ado, let's check out the first one. ADHD test. If you put over five fingers down, you have ADHD 100% put a finger down. If you're always moving and readjusting in your chair at school, put a finger down. If when you see something you want to go grab it. Put a finger down. If you have a hard time paying attention in class, put a finger down. If you bob your feet when sitting down, put a finger down. If you were actually diagnosed with ADHD before, put a finger down. If you randomly make noises around your friend, put a finger down. If you speak before thinking, put a finger down. If you fidget with random things, put a finger down. If the first person who pops up when you click share, then more has ADHD. And lastly, put a finger down if your room is very clean, how many fingers did you put down? Let me know in the comments below. All right, so I'll start. This is literal garbage. So the first thing that struck me was right in the beginning that you put however many fingers down, you have ADHD 100%. So at OSR Clinics, one of our specialties is ADHD. We have a whole team of individuals, including myself and Oren, who have a great deal of expertise on this topic. Even though we have such a great team, such great assessment batteries, it's still never 100%. Nothing is ever 100%. We can make, you know, strong, educated inferences based on the information that we have. But that's the first thing that struck me as ridiculous. It sounds like the goal of this video was to maybe talk about some of the atypical symptoms of ADHD, which, you know, some of those, I suppose, fit, but those also fit many other different disorders. So I would say my biggest issue with that is suggesting that anyone can have anything 100% right. And also I'm confused because at the end, because everything else was put your finger down, basically that's a symptom supposedly of ADHD. But the last one is if your room is tidy. Okay. Did he not say that? Because he did. And I wonder if that was to, like, refute the possibility of anyone having all of their fingers down from this? Yeah, because I don't know anyone with ADHD who, you know, who doesn't feel overwhelmed by just the thought of cleaning up the room. So that was bizarre. And I mean, okay, so let's let's there's so much to unpack here. So. So right. As you said, we have a team of people who have lots, lots of experience. And I will still say this myself, I am not an expert on ADHD or neuro divergence. So when I have patients who are wondering whether they may have ADHD, first of all, I refer them to the clinic because unlike most assessors and I say this as I'm not talking about the good ones, I'm talking about many others where all they do is give a self-report inventory. Right? And so, first of all, that's just because people should understand how do we arrive at a diagnosis. So let me talk about the bad one and I'll then I'll let you jump in and say what we actually do, how we know rule out other potential conditions or factors. So, yeah, so the worst type of assessment would be just self-diagnosis. You go online and they have these all over the place, answer these, ask these questions, you know, do you ever do this? How often do you do that? And people say, Well, I guess I have ADHD, which does not rule out so many other things, like most commonly anxiety. Do you have to have difficulty concentrating, let's say, in school or at work? Do you fidget? Right. Do you know, sometimes impulsively say things? People anxiety can have all of these and that's why so many children with anxiety are misdiagnosed as having ADHD. And you know what's really bad for someone who's who's a sympathetic nervous system, their fight or flight system is always fired up as it is with anxiety or certain types of anxiety. You know, it's really bad for that. Feeding them stimulants, which of course, is what the medication for ADHD is. So there's a lot of people I know I've had many patients who were misdiagnosed in, you know, childhood or teen years were on these stimulants for so many years. And then when they went off of them, they realized, oh, my gosh, life is actually much better. It's much easier. And again, we're not we're not going to dismiss everybody, you know, having been misdiagnosed. I'm just saying that this is one of the most common things that I have seen with people. And again, when we look at it, we find out, no, the only had anxiety all this time or they had trauma and that's where the symptoms were manifesting. It was not ADHD, but someone with, let's say, reckless disregard for the person's wellbeing misdiagnosed them. So I'll stop there and ask over to you. Yeah. So one of the challenges is we're hearing a lot these days that some professionals are saying that ADHD is being overdiagnosed. And my thoughts on that is that ADHD is being overly misdiagnosed because ADHD can look like so many different things, as you said. So the process that we follow at the clinic is very in-depth. So, you know, not to crap on any profession, but physicians are notorious for the five minute office visit. They go through a checklist of symptoms. You meet the criteria. Here's your stimulants. Have a great day. I'll see you in a month and see how you're doing. The challenge with that is even people without ADHD are going to feel better in many cases. On stimulants. So right. Giving them the medication and having symptom relief is not confirmation of the diagnosis. I'll say that first and foremost, and that is something that we often see when people come in to see as often as adults saying, you know, I've been on meds for a long time and it just doesn't quite seem to be addressing things or they've been diagnosed with, you know, just anxiety or just depression, which those things can coexist, but it doesn't mean that they don't have ADHD. So anyway, what we do as far as our comprehensive assessment process is we start out by taking a very detailed history. We talk about what it was like in school, what were some of the symptoms that existed, did they have any undiagnosed learning disabilities? Were they undiagnosed as gifted? Because there's also a lot of overlap in symptoms between giftedness and ADHD. Once we take that detailed history, we look at the brain and this is something that's missing from, I would say, most ADHD assessments, which is just crazy to me because ADHD is a neurological disorder. So if you’re not looking at the brain, how do we actually know what's going on? Well, we're only making an inference based on symptoms which can tell some of the story, but certainly not all of it. And then from there, depending on the individual's situation, we may do psychological testing as well. So we might look at symptoms of anxiety, of depression, of trauma, because, again, those have a great deal of overlap in symptoms as well. We look at their learning style. That plays a big role as far as, you know, let's say math, for example. Oftentimes some kids with undiagnosed ADHD may be seen as not being good at math, whereas in reality it's their difficulty in sustaining the attention required to do something complicated like math. That's actually the problem. We look at auditory processing, so sometimes people without or sorry with ADHD pardon me, may look like they're not paying attention. They're not concentrating on conversations where in reality they're having difficulty with their brain filtering words. You're dealing with competing sounds in their environment and that in turn could be what's interfering with their their attention. Or it could be both. We also look at their sustained attention, their ability to sustain concentration. Are they impulsive in their response style? Are they not able to concentrate on very boring tasks? And then from there, we also look at nutrition because nutrition is a big piece of how our brain functions as well. So point being here, we look at so many different domains and so many different factors because there are so many different things to look at, to not only diagnose ADHD but also to rule it out and see if it's something else. Right. And a few other things. So so again, the self-report for yourself is the worst. One step above that, which most doctors will do is they will have two or more people. Two people do the same readings, which is a bit better, but I've lost track of that or count of the times when, let's say a teacher is given the rating and a parent is as well, or two different parents who are separated are given them and one person says yes, yes, yes, yes, and the other person No, no, no, no. Right. Totally different. And if it's true, ADHD, you're supposed to see this dysfunction in a variety of different settings. Right? Many times what people think is ADHD is just emotion, emotional dysregulation. And so if the person has a really, let's say, oppressive parent who doesn't allow them to really be themselves or, you know, for whatever way it manifests, it might be abusive. It might just be that the parents always in their face that they shut down around that person. Then at school, you know, it's like, oh, my gosh, it's freedom. And then they're really acting out. Or with one parent, they act out with the other one. They don't write things like that, or they're the angel at school, but at home they know they can get away with it. So they're a terror. So the point is, if it's just emotional dysregulation, that's not in itself a sign of ADHD. I mean, it's a sign of ADHD, but it doesn't confirm it. And so again, so having the self-report or having the report by other people, it's helpful. But once again, it doesn't give the entire picture. And, you know, again, whether you're talking about the brain, we do brain imaging. And before when I used to do assessments for this, I didn't do brain imaging, I didn't have the technology, but I did do intelligence testing. And I won't give it the secret away. But when you do a and we do this as well, we do the intelligence testing as well at the clinic, but when you do a comprehensive IQ test, there are really reliable patterns, not 100%, but it's really, you know, quite frequent where some of the ADHD will do well in certain areas and poor in others. Right. Because of the nature of ADHD. And we get to see it there because with self-report you're biased whether you're you know, you don't see yourself as as lazy, as impaired as others do, or whether you, you know, you're feeling victimized or you're feeling, you know, they not doing so well. So you might exaggerate your system, your symptoms, unconsciously. But the point is intelligence testing is intelligence testing. Right. So you don't feel exactly right. So I used to say that that was better than most assessments because of that. Again, that let's say that psychometric type of psychometric testing that relies not on self-report but actual functionality. So I just want to do the part as well for sure. And I think to your point, that's one of the challenges with and we've spoken about this before in other contexts, that, you know, there's so much information on the Internet that information doesn't translate to knowledge. And, you know, anyone can now Google what is the DSM five to criteria for ADHD and, you know, not to speak ill of anyone who's come to our clinic, but I will say there has been a higher volume in recent years of people saying, you know, I have this ADHD symptom and that ADHD symptom, but there's a level of confirmation bias that comes along with that because they're coming in with the assumption of I'm looking for an ADHD diagnosis. So oftentimes the way that I'll phrase it is, you know, rather than telling me what ADHD symptoms you have, just tell me what your day to day looks like. Tell me what symptoms are interfering with your functioning. And then let us kind of, you know, figure out what that could mean. Right. And I'm going to throw a bunch of stuff out today for people to really consider. And some of it's going to sound very insensitive for people to understand. Like there's layers to what we say, so don't jump on something. I say, okay, So the first I'm going to say and this is going to sound really, really insensitive, but once again, because of and this is 100% because of the increase in this information on the Internet, I had so many women come to me and say, I think my husband or my boyfriend or partner has ADHD. I say, well, it's like you said. I said, don't tell me what makes you think that. And they describe it. And I said, Look, I don't mean to sound like an asshole. I said, But yes, those are symptoms of ADHD and they're also symptoms of narcissism. Okay. So that's going to sound really cruel, but the fact is, like someone who cuts in, who's impulsively saying things, oh, there's so many like, you know, but that they can't contain themselves. They're self-centered. They they don't like that. They don't have good time management and so on. Well, yes, someone who has ADHD, who's constantly trying to keep their brain in check, they can become fatigued. It's very easy to lose track of time. It's very easy to become so stressed out and fatigued mentally that they you know, they don't get there when they're supposed to. But a narcissist or someone who just doesn't care what other people and, you know, but their needs and so on will do the same thing. For example, same with cutting them off, seeming so centered and everything self-centered. So that's just one of the examples of where once again, something can look like one thing, but it doesn't mean it is for fact because it can mean something else as well. So I'm going to toss back to you because you've had several of these, you know, layers. Yeah. And I guess to kind of look at it as as the other side is that I mentioned earlier that sometimes people are diagnosed with anxiety or depression instead of ADHD. So this is a really interesting one and it's more common, at least in my observation with females. And I think the data supports that as well, that female ADHD symptoms are often dismissed or minimized. But that being said, it's not to imply that they don't have depression or anxiety. In fact, they may have been leading a life of frustration with trying to manage these symptoms and understand these symptoms, which leads to anxious distress. Or they could have been leading a life that consisted of underachievement, persistent underachievement, which can lead to depressed mood. So this is really something to understand as well that, you know, while you may not have received an ADHD diagnosis like this five minute office visit that I'm describing, depression and anxiety still very well could be a part of the picture. Right. And what you said about, you know, underachievement. So I can say a few things about that. I've had many patients who were never diagnosed with ADHD early on when they did seem to have it. And yet not only is it the know feeling themselves like, oh my God, I'm not as smart as I as others and so on. But then there's conflict within the family and that fuels a whole bunch of issues. So it's it's so important for people who have, you know, like anything that's impacting their functioning. You know, unfortunately, at least in Canada, we don't have enough services or people can't afford them. Now, if you can afford them, you can find them, but through the school system and so on, we just don't have the resources. Every level of government has failed to help, you know, the large number of students who do have some whether anxiety, depression, trauma, ADHD and so on. So I've had so many patients in there that when they're little bit older and then when they do get the proper diagnosis, it helps them make so much sense of what happened before. And at that point, it's a matter of almost rewriting history because they've spent 15, 20, 25 years believing that they were a certain way, believing that these experiences were because of A, B or C when it may have been ABC, but it was also perhaps D, E and F, and those being, you know, ADHD symptoms and so on, and even understanding that intellectually they get it. But they've had so many years of conditioning of creating a self narrative about themselves where, where they are, you know, not so smart and un achiever and so on. And one more thing that's worse than all of that, and I think we may have talked about this before. I don't I lecture about this all the time. I talk to my patients. It's incredible that someone with ADHD, even if they don't get the diagnosis somehow. I've spoken to every patient I've spoken to. You can tell me that this might be you know, historical rewriting of a fact, but they all say somehow they knew they were different from everybody else. There's just something inherent, right? I hear that all the time. All the time. And I tell me this before, if someone is gay as well, even if they're you know, when they're a child, they don't know that they're gay. But something feels a bit different somehow. They know they're different from others or they they feel that way. And that sense of otherness, exclusion, not being part of the pack that can last a lifetime, even if it's addressed in childhood or teen years still this early, early period. And I just want people to really appreciate that, that it takes a lot of either therapy or having a really good social support network where people let you become to be who you are, you know, hoping that who you're not told you're okay. But, you know, but you sort of come into yourself in a non-judgmental, safe, healthy way that can read, you know, that can help reprocess some of these issues from the past. But once that narrative is baked in, right, that self narrative, it's so hard to change it, no matter how successful, no matter how many partners you may have or simply how much you know, money you made, it doesn't matter inherently from a young age, they felt I am different and different ain’t good for most people. Yeah, and I think to that point, it is so important for there to be access to good, robust assessment services, whether it's for ADHD like we're talking about or other things. Because yeah, once that narrative has been baked in, it is incredibly difficult to make it go away and chances are it won't fully go away. The same goes for learning disorders, right? Learning disorders is something that we work with a lot at the clinic as well. And you know, luckily we're able to diagnose a lot of children in elementary school, but there's also a lot of adults that come in where they're like, you know, my entire life I just felt like something was not right with me. I didn't learn like everybody else. I was labeled as dumb and so on and so forth. But the reality is, is that they're actually quite intelligent. But there may be, you know, one piece of their learning that doesn't register the same way as it does for the average population, which is fine. But had they been taught in a manner that made sense for them and for their brain, they could have excelled. And while that's wonderful to learn in adulthood, it also creates a great feeling of regret of like, well, you know, why didn't my parents look into this or why didn't the teachers identify this? And the list goes on. And, you know, it sounds like such a small thing, but it's huge. It can really dictate the trajectory of someone's life. 100%. And when you say regret, not just a regret, but resentment, and then they carry that right. And for people to understand it, when you're a child, you believe that the system or depending on where you you're from and depending how your parents raised you. But for most kids, they need to well, all kids need to feel this way. Not all kids do, but the sense that there's a system above me that's going to protect me, that's going to guide me, is going to take care of my needs. And when that system fails from a young age, even if you don't fully understand, you don't go, well, the education system is broken. They need to invest more funds. It is. You're not thinking that. But somehow deep down the child knows that those things above them that are supposed to protect them, guide them and keep them safe, etc., that those things have failed and that they internalize that and then they always feel I can't rely on others. This is not safe. It's not worth to risk. It's not worth it to risk this, this or that, because some terrible consequence can happen, whether happen to them or not. Doesn't matter. That's the fear that they have because they didn't get that sense of support, security, stability. So, you know, so any of these failures on one level can have such ramifications, all the other levels. So and funny enough, as we're talking about this, Oren, I, you know, I'm reminded of, you know, my journey through the education system. So with my vision loss back when I was in elementary school, I didn't have any accommodations, didn't have any help because I didn't have a diagnosis. I wasn't diagnosed until I think I was about 20. So I went through elementary school, high school, and most of my undergraduate degree with no accommodations whatsoever. I managed to be an A, B student, but it never quite fit because the amount of effort that I put forward, I should have been an A-plus student, right? So there is this constant feeling of disappointment, frustration of like, why can't I do better than I'm doing now as an adult who works with people who have, you know, similar journeys, whether it was through learning disabilities, mental health disorder, or ADHD. It completely clicks for me of like, holy shit, I just didn't get the help that I needed. It's kind of a miracle that I did as well as I did. But it wasn't until graduate school when I was actually able to learn in a format that made sense to me that I was an A-plus student. And I don't say this to brag. You know, I am very proud of my accomplishments. But, you know, this is a real life example of my life where I didn't learn in a fashion that made sense for me. Therefore, it was incredibly difficult. And that narrative did stick for a long time of, well, I must not be that smart. Right? And again, so that goes into the self narrative, which by the way, every time there's a drinking game. So today will be internalization and self narrative. So it's not just the self narrative, but it's also the almost for some people though, you had resilience, you were able to persevere, but for many people it just breeds a sense of why bother? It's a futility, it's a hopelessness, because no matter how hard I try, for some reason, I'm just not doing that well or as well as I think I should be, or as well as other people. So now we can go on and on. And I know there's several of other videos that are queued up. And again, I've got several other things I want to throw in about this whole, let's say misdiagnosing an overlapping of certain phenomena that we can talk about, that some people who either have ADHD or these other phenomena or have family members do, they're going to nod and go, Oh, yes, 100%. Other people in they here at the can go, What are you trying to say that these are, you know, similar? And again, that's what we try to do. We try to educate and say there's so many unknowns and we are honest and humble enough to to say, let's share these unknowns, because we you know, we can't declare 100%. Is this is that not like these videos that do say, no, it is all right. Yeah. So yeah. So let's check out the next one. My two children sit in front of a TV. The left child is labeled ADHD five years old, and the right child is labeled non ADHD. Two years old. The child on the left fidgets constantly while the child on the right sits still within. If you still show. All right. So the challenge with this video is that it's putting kids into a box and the age is strike me as concerning as well three and five or was it was it two or three. Three and five. Three and five. So the three and five can be concerning because even in the DSM, if I'm not mistaken, it says that before the age of four, we shouldn't be attributing behavioral symptoms to ADHD and at the clinics we don't assess until the age of six because there is so much variance in symptoms and development and behavior. It just their development in general can vary so much in a short period of time. So that's my first concern of, okay, well, you're five and three and you've been diagnosed with ADHD. They're being put into a box. The way that ADHD presents with girls versus boys is quite different. So that's also interesting the way that they presented that. I think the boy was the younger one without ADHD and was just sitting still. I have a hard time believing that a three year old toddler boy is just going to sit there and be still. The comments on this video were weird, too, because some parents said things like, you know, I diagnose both of my kids with ADHD. Well, unless this person is a psychologist and or a physician, I question their ability to do so. And even if it even if they are, they shouldn't be diagnosing their own kid. So those are my first initial thoughts about that. And what do you think? Oren? Well, I think, you know, it's a visual representation. So as a metaphor, that would be interesting to show one part, but there's unintended consequences, like you're saying. And so people are, you know, they are, let's say, oversimplifying something, saying, Oh, my child fidgets too, and then we have the confirmation bias and then it is almost becomes a self-fulfilling prophecy. Not that you can implant ADHD in the child, but if the parent if a child is fidgeting and the parent is now thinking that maybe the child has ADHD and they start treating the child a certain way or they start taking the doctors and and they're almost insisting that, no, no, my child has it not only is there the risk of medication at a young age, again, we're talking stimulants. You're talking one molecule away from crystal meth, which if a child does have ADHD or a teenager, if they truly need the medication, I'm not going to say no to it cause I've seen it change people's lives. What if you're on the fence? If it's something that may not be ADHD, it can be dealt with with either, you know, better parenting, better emotional regulation, better, let's say athletics, get the child to sort of work out energy or dealing with anxiety or whatever it is that we should avoid, you know, giving these really powerful drugs. So I do get worried that if you add to that confirmation bias and the fact that they have the younger child, which again I looked at, I know that juxtaposing, as you say, I would find it hard to see, you know, a three year old child just sitting still the entire time. Right? Yeah, Maybe that's a sign of something. Maybe the child has something going on. That child. Right? Maybe that. Yeah, right. But I'm worried about the over pathologization the medical route to trying to treat it. And then the problem with even if it is a three year old child in people's brains, they might be going or in their minds they may be going, okay, so should I be looking at these symptoms at a younger age, Younger and younger age, and I'm going to say something is going to sound like it's coming out of left field. I told you there are layers, but a number of years ago I shouldn't throw out those people because I think especially with COVID, people are learning Trust the science is maybe a little bit too simplistic and can lead us down the wrong path. So a number of years ago there was a push by some psychiatrists to diagnose children with manic depression or bipolar disorder. And then the previously I forget what the year was, what the age was, but you know, you wouldn't diagnose still in older age. And they went younger and younger. And so there were children as young as three years old. Now, I don't know the numbers. I know there was one case in America where the child ended up dying because they had all these medications in their system. They had antipsychotic medication. They had given all those antipsychotic antidepressants. This was child was three years old, I believe, and a few other ones. And because they're so young using because they're so young, they have to take other medication to counterbalance the physiological effects of the drugs. So they having blood thinner in their in their system as well. It was just ridiculous. I believe they had at least four different medications for that mistaken, maybe more. Again, to either to treat the symptoms or to treat the the the effects of the medication that they're being given. And and, by the way, a little sidenote here to take one more layer, the doctor who who first recommended diagnosing younger and younger children with bipolar disorder never declared that the that he was funded by the drug company that, you know, that sells the medication for bipolar disorder that he was recommending to children. Oh, but that's completely ridiculous. Absolutely ridiculous. And again, disclaimer There's a time and a place for medication. I understand that even sometimes that may be the case with with little ones, but in most cases, no. Whether it's ADHD, whether it's it's bipolar disorder at that young of an age, there are strategies that can be put into place to make it more manageable. Are they going to, you know, be like Sally down the street who doesn't have that? No, But that doesn't mean that medication is the only answer. And to your point earlier about the over pathology, pathologization of symptoms, that's a big problem as well, that we are removing the uniqueness of children's development and behavior and slapping a label on it. And I want to be abundantly clear here that, you know, we of course believe in the science, we believe in the diagnostic process. But frankly, sometimes this is shitty parenting and it's not a disorder. And the number of times that I have had parents say, you know, I can't deal with this behavior anymore, we need to figure out what's going on. That does strike me, as you know, as concerning because these children are, again, six, seven, eight years old. And for the most part behaving in what is developmentally appropriate or maybe slightly outside of that, but not to the degree of severity that's being described. So I feel there's a strong disconnect between what parents are expecting and what they're seeing in their children's behavior and therefore seeking out a diagnosis. Right. I want to take that to one other level, and this is two sides to it. So when I used to do assessments of, you know, parenting capacity for the courts and for Children’s Aid Society of Ontario, one of the things that I saw and it was it happened a number of times and it was really sad. So I can say one time that one phenomenon that I understood and then the other, which is like, how can you think this way? So this is the part that can be understandable if a parent has a child and the child, let's say, is nonresponsive, not very communicative, everything the parent tries to do is just not working with the child, whether the child's acting out or they're just not really connecting with the parent, it can be so distressing for that. Of course, what have I done wrong? Right. And then when they get a diagnosis of, let's say, autism, they're not happy the child has autism, but it's a natural response. Oh. It all clicks and makes sense. It makes sense. I'm not a shitty parent right now. And now we can just try to try to do something about it. We can, you know. Right. So I understand that. That relief, of. Course. Right? Yeah. They're not happy that the kid has autism. At least they have an understanding. Right now we do stuff. But the flip side of that was when the child would be diagnosed with, let's say, oppositional defiant disorder, where some kid times the child is born a certain way, where they do have certain neurological, you know, let's say, factors or physiological, where the you know, no matter, you can have the perfect parent and the child is still going to act out. They're still going to be hard to manage to difficult to control. All right. They can be aggressive no matter how good the parent is. But in many other cases, the diagnosis is a result of shitty parenting because they were either abusive or overly intrusive in the child's resisting and so on. So when the parent got that kind of diagnosis and they were like, Wow, and it's either relief or they're explaining to me basically, it's not my fault. Like they're abdicating all responsibility, right? And even if the child does have a condition like autism or ADHD and so on, yes, that makes it harder to parent. But as parents, our job is to try to do our best to help accommodate our child's limitations or special needs and so on. So whenever a parent sees a diagnosis as an ability to again absolve themselves of any responsibility that is A just bad parenting, obviously, and B far too common. So I get concerned when we see this or when we see people commenting and everything like that. It's just it's fueling this. You know, we've talked to many times about this that so many parents are just failing in their jobs. And, you know, I want to be clear here. If you do have a child with any of these conditions, it is very, very difficult for all parties involved. So everything I'm saying is with complete empathy, it's not to tarnish or smear all parents with the same brush. I'm just saying that we need to have as always, we need to have nuance. We can't take a black and white perspective on all of this. And this is why we hope that, you know, this kind of these kind of videos, you know, we're not going to solve problems necessarily, but we hope that it's going to give people a healthier, more comprehensive, more compassionate perspective. And thanks for that clarification, because, yeah, by no means I want anyone to think that we're saying that parents that don't know that their child has an undiagnosed condition or shitty parents, absolutely not. But there is a small percentage of the population that does actually have these diagnosis conditions, but a larger percent of the population that doesn't know how to manage their children's behavior in general. So yeah, that's great clarification there. So let's watch the next one. Okay. How to spot an ADHD ear in public, the twitching ankle, the hand fidgeting, the knee bounce, the readjusting, the cheek biting. So a few problems come up for me right away with this one, that this is a perfect example of what we were speaking about before, where what some people call ADHD could actually be a number of other things. To me, that sounds and looks more like anxiety than anything else. We can't look at symptoms in isolation. There is a long list of criteria to actually meet the diagnosis for ADHD and just fidgeting. There's not sufficient. Right. And so once again, confirmation bias. Someone sees the video and they go, Yes, that's me too. And then they rush to the doctor. And you know, with that mindset, especially if the doctor's not going to give a comprehensive assessment, they could very easily be misdiagnosed. And I want to be clear here, most doctors, especially when it comes to medication and like, you know, Ritalin, Vyvanse, Adderall, they know that, you know, people can sell it on the street. And so I don't think that doing a willy nilly know they are hesitant to give out these. And in many cases, at least in Ontario, I know that a doctor will say, no, I'm not going to give you the medication you need to get a comprehensive assessment. So I don't want to make it seem like know that all the doctors are doing that. But there are doctors who do that. And I know a few years ago there was a company, I forget which one it was, but they were and it was in the States. I'm not sure if it ever got passed. I'm going to assume it did right where they were like, Do you want to do you want to bypass this whole long process of having to get a referral and then having to get the appointment and the assessment and so on, You can do this online. And they were trying to do it for students and it was sorry it was for parents or where they could diagnose their kids as long as they got two people, teacher and a parent or two different parents. If they did the checklist just on symptom presentation, then they would be able to like it was supposed to be able to get them access to medication immediately. Right. So this was so reckless. Again, this in the States. And I don't know what ever happened with that program, but they were pushing for it. And that that's absolutely nuts. This this push for a quick diagnosis. I mean, like you said in Ontario, I've even noticed in my time doing this, increasingly as the years have gone on, I am receiving or we are receiving more letters from doctors saying, hey, these are the symptoms that we're noticing. We're requesting a full assessment. So there certainly is more of a push in that direction here in Ontario. But to hear something like that, that's, you know, going backwards in time. Right. And again, we said this earlier, but the fact is assessments are not cheap. And so, so many people cannot afford a proper assessment. And the government's again, on all levels I've been saying this for so many years, have failed to take care of some of the most important issues and some of those are vulnerable members of society, a child with a neurological condition, with a mental health condition, with a learning disability. It's just the resources are not there. Well, they are there, but the government is not helping people who can't afford to get them. And I don't know, maybe because we've had three videos now, maybe I can throw in this other theme that I want. You know, this is two very, very different diagnoses and I'm going to tie it with another thing as well so I can start spinning some plates here. They hope they Don't fall down. Ready? So. Right. And I think I will. You'll get the answer. So normally I ask you the question, but okay, So so I'm just going to let the audience think about this. So with ADHD, especially females, I don't know right now, currently the last number of patients I've worked with who have a diagnosis of ADHD, I don't know how many have not very small is the number who have not had another diagnosis. I'm going to ask you to say, okay, we've had another diagnosis and either started with ADHD and then they were diagnosed with the other disorder or they had this other disorder and then it switched to ADHD or is going back and forth or they've been diagnosed with both. And again recently, especially with women, I found a lot of them have had the both. So any idea what that other disorder is? I want to say BPD? No, that's actually we'll get to that. Okay. That's that's incredible. So, no, I'm going to give another and as I said earlier in the podcast, I said, when people hear this, if they don't know about these different disorders, a very well, they go, how could this ever get mixed up? They're so different. Someone with ADHD must look very different from someone with this disorder, okay? But the people who have family members or who themselves have one or both. The owner? No, I see the overlap, though. Well, as far the overlap, like, there's there's so many that I've come across. So I'll list those ones off and you can tell me if I'm right picking the one that you're thinking of. So like I mentioned before, anxiety and depression I think are the most common ones that women are being misdiagnosed with. I think autism sometimes is one that I come across. Okay. So I'll I'll end my list there. Okay. And people, when they think autism, because they have this image once again, when you have so much information out there, as you say, information does not necessarily equal knowledge. So they have the stereotype where they saw it on a movie or TV show. They think that an autistic person presents a certain way, which they may. But there are so many varieties and so many different symptoms of autism. It's so many different degrees of functionality. So autism and ADHD. So at this point, as a saying, one, they have autism or they have ADHD or they get to bounce back and forth. And that's what I said. No, no, you need to go to a professional who has a lot of expertise in being able to discern these two different different phenomena, because ADHD, there's medication, autism, there's unfortunately nothing. Right. So so here's the thing. And I'm I've taken recently and this term way overused. I use it. I tell my patients, I say I use this out of respect for the people I'm talking to. And as a sign of my own, let's say lack of aware or all of our lack of knowledge. But I'm honest enough to admit this, or I'm saying I'm using Neurodivergent. Okay, Now I prefer specificity. I lecture about this all the time we need. We've talked about this. Well, we need to know. But what I see when I say neuro divergence, I'm basically saying, and here's why this is what I believe I could be wrong because I'm not an expert on this. But from what I've seen, I'm thinking that one day down the road when we have when our, let's say, brain imaging equipment is refined enough that we can really determine what's going on. Because people talk. We talk about, you know, fMRI eyes, PET scans and so on, where we can get maps of the brain. We can see where blood flow is happening and so on. But it doesn't tell us exactly what's going on. We're interpreting what in of itself isn't sufficient for the diagnosis. Exactly right. It just helps us understand a bit, but doesn't tell us exactly what's happening in the brain, because I think where it's happening and how does that translate into the person's experience of it, Right. So I believe that one day we're going to find out that there's this thing, whatever it is, that's okay. I think this and some people have these symptoms from it. Like I'm saying, it's all the same. It's all the same phenomenon. And some people have these symptoms and they get diagnosed with ADHD, Some have these symptoms and they get autism, some have a few of these, a few of these, and that's why they're bouncing back and forth. And so the manifestation, it can be very, very different. But I think neurologically it's all happening in, you know, around the same brain region. We know that it's all happening around the same brain region and we just don't know well enough what's going on. But this is why there's so much confusion. And and again, the presentation might look so differently, so different story. But the internalized experience of it. Okay, I see so many people have described the same thing. All right. And whether it's the actual physiological or neurological thing that they're experiencing or their interpretation of it, what it means to them, how they experience it, and what it means to themselves, how they feel that they fit in the world, whether it's in a job or with other people, like feeling hypersensitive to noise, to commotion and so on. People they really have that. People with autism often have that hypersensitivity to fabrics and so on. There's just so much impulsivity for some people. Autism, you know, don't express themselves. Others have poor impulse control. Is it because they have poor social skills or is it because, again, it's it's this it's the same idea of this. I just can't contain my thoughts in the moment. So I just a few things out there. But that's no and a perfect example of that is we've had a couple of cases at the clinic where teens have in for an assessment and their teachers have suspected that they have ADHD. But what it actually ended up being is that they had an undiagnosed head injury. But what's interesting is when we looked at the brain, there were indications of, you know, seeing the mechanism of their injury matching up with the dysregulation in their brain. But there is also dysregulation in the areas that are common with ADHD, which is the frontal lobe, temporal lobe, parietal lobe. So their experience of symptoms was quite similar. But the the etiology, the actual origin of it was not ADHD. Right. And that's why it's so important for again, even though I'm saying neuro divergence, you know, we need the specificity so that we can address we can help people deal with it and help them understand it at least. Yeah, right. And by the way, so I'll guess through one more thing and I noticed this, I'm going to say, but it was almost 20 years ago, 15 to 20 years ago, where I noticed all of my male patients who had ADHD and they seemed to really have ADHD, like I could see even if they were medicated, I saw, you know, certain behavioral signs or they really seemed like and we talked and everything. So every single male and I'm not I want to be very clear here. I'm not saying it's 100% in reality, but in my anecdotal experience, every single male with ADHD also had another disorder. Any idea which one it was, which is so has nothing with ADHD. But I think neurologically there's got to be an overlap. So every single male with ADHD also had this other disorder. My go to is anxiety or depression, but I sense that you're thinking something else. Yes. By the way, yes, they all had that as well. Yes, 100%. But there was one other one. Okay. So, you know. Okay. And ironically, it used to be part of the aid is be part of the anxiety family. And by the way, when I used to lecture before, it was to change the DSM five in 2013, I think it was OCD. OCD. Exactly. Every single one had OCD. Right. And it was usually symmetry because in my head it was funny because in my in my office I had a a mirror behind me also paintings, and it was slightly off. And every single male patient, they wouldn't be they'd be looking at me, looking at a couple of them, but I just get up in the middle of session and just walk on over and I have to change that. Okay? And it was incredible. And they thought I was doing some of them actually. They did on purpose, like to test them. I said, No, no, it's just this is, you know, that's assuming. So anyway. So again, and is this neuro divergence because some levels of this and we'll talk about this in a different session I guess about OCD, that's a whole other phenomenon. But, you know, there's different ways I can trace OCD back to parenting or to early experiences and so on. But there seems to also be a very powerful genetic slash neurological. Brain basis for. Yeah, right. Especially when it comes to what we call pure-O OCD, where the room, the obsessive thoughts of the ruminate over So and. I think in part that's why it was separate out as an anxiety, no longer as an anxiety disorder in the DSM. Exactly. Now, everybody with OCD also has anxiety, but we're trying to separate it. And yeah, and that's what science is supposed to be about. We're supposed to as we get more data, as we have more experience, more knowledge, we're supposed to try to refine our diagnoses because the most important thing, diagnoses in of themselves are not important. The diagnosis, though, to help people get treatment, help them get accommodations that help them understand what it. Because if you say, oh, you have OCD or ADHD or whatever, that's just a label Well, what does that mean? The name doesn't matter exactly. And then as I said earlier, you just putting people into boxes and then you make all these assumptions about the person based on this box. That's not what we're looking at. We're looking at how do we help people live with accommodate and so on. And one more. Fourth, the final thing about accommodation, just because I've heard other people, rightfully so, where they talk about they say, oh, students today, they get so many accommodations and they shit all over these students for being weak snowflakes, whatever, needing accommodations for this, you know, these small things. I think we talk about this many, many podcasts ago, right? Yes. There are some students who should not have these accommodations, you know, or get special treatment or be able to not have in papers without any punishment, so on. But on the other hand, we have you and I have both seen so many people with all they need is just a little bit of help. Just a little bit. Just a bit. Right. And that can mean the world of difference. And so when I see people with a big platform shitting all over those students, it's like that's just the antithesis of compassion. and I hate to say, but I think that comes from a very uneducated perspective when people say that because they don't understand the nuance of some people abuse the system. But most people who need accommodations don't even want to ask for them because they feel so bad about it. So, you know, again, nuance is is so important in those cases. Exactly. So, you know, with these three examples, I think this is a good place for us. Reflect on what people can do about this. So I would say the biggest takeaway from these three is, you know, whether it's about ADHD or anything, if any piece of information purports to say that, you know, 100% accuracy of something, if there's any definite statements and you're watching a video or reading a piece of literature or whatever the case may be, nothing is ever definite. So be really careful about definite statements on one under the other. And I would also say that it's important for folks to really be aware of their confirmation biases. So, you know, going in with an idea of what you're dealing with day to day is a lot more helpful than going in with, Well, I think I have this diagnosis and X, Y and Z is the reason why. Right. And as we were saying earlier, like, what can you do about it? Well, first of all, advocate for yourself. Even though there's a lot of misinformation out there, try to educate yourself, you know, signal forums where you can feel less excluded, less alone. I think that can be very helpful. Once again, understanding that you might get sucked down a rabbit hole that has nothing to do with you. Right. And that just feels like confirmation bias. So to be mindful of that, but to be an advocate for yourself, get supports and then try your best to and unfortunately, to be prepared that you're going to in many cases, whether it's the doctors, whether it's school administrators, whether it's society or friends, you're going to have a hard time getting sometimes, sometimes sympathy, empathy, compassion and, you know, the resources for accommodate or, you know, just resources themselves. It can be a struggle. I'm going to tell you so many of my patients, whether they have ADHD or autism or many other disorders, but especially those two that, you know, we're talking about say they I'm just going to paraphrase some of them. They say that. Right, that they have to accommodate everybody else because the world is not designed for someone like them. Either they see this or I tell it to them, okay, the world is not designed. And yes, ADHD, autism, we're talking single digit percentage points of people who have them. So I can understand the world can't accommodate every single person with every single condition, but for people can have compassionate empathy, realize that every single day, whether they have true ADHD or autism is a damn struggle or OCD, take any of it or anxiety. Depression is such a struggle we take for granted. You know how easy life can be when you don't have these conditions, but when you do, right. So so what they say is that, you know, I have to always accommodate everybody else. I have to learn to live like they do. I have to socialize like they do. I have to play by the rules like everybody else does. But when I ask for a tiny little accommodation, right, you know, everyone is either resentful or they mock me or they just don't do it. So that also makes the person feel more and more excluded, isolated, unworthy, other than right. So so when it comes to this, it's just recognizing. And I say to people, I go, Yeah, it really sucks. It's really unfair that that's the way the world is. And you were unfortunately dealt this hand, right? And I say, and so I try to help them not be victims, you know, you know, I've talked about this before, right? Yeah. You unfortunately have a huge impediment or impediments. I get it. But that's and I have empathy and compassion, but I don't have pity. Pity doesn't help. And you can't be yourself, right? We need to help you find the hardiness and the resilience and the wherewithal to be able to, again, sort of forge a path that that's a much harder path than most people. But if you don't do it, no one else is going to do it for you. Right. And I say that with as much compassion, empathy as possible, just having the right mindset. It's not just that if I get this medication or that, you know that somehow it's going to fix everything. No, no. Even if you do get the medication, there's still a lot of work that you need to do. And final point about that, so many of my patients, especially extroverts, they hate the ADHD medication because they say it makes me into a totally different person. They seem subdued. My personality changes. Everybody says that right to them, to them that they're just completely different. And so it's like either I fail at school, right? And, you know, that can be my fun loving person. Or I take this medication I do okay at school or at work or wherever, and I am just not myself, the person I've always been. I'm I'm an imposter, basically. So I just want people to understand that this there are so many ramifications to having a diagnosis. And again, this is where the compassionate empathy comes in. And and people might say, Oh, I've heard people say what? Really you prioritize being a fun loving person over getting good grades. You're not flunking out of school or losing your job. It's like, well, that's they are. Yeah, right. Right. So then even so, I just I just there's so many different complex issues involved and, you know, just we're trying to help broaden perspectives, right? Yeah. Of people, again, compassion, empathy, broadening perspectives and finding the best path forward. Because once again on the Internet, there's a lot of path forward and not a lot of them are not the best. Yeah. And one last thought on medication to, you know, medication, stimulant medication isn't always the best for the specific type of ADHD, right? Depending on their brain function, depending on their brain dysregulation, stimulant medication can actually make them feel a hell of a lot worse. So point with that is, you know, don't necessarily jump to medication just because you have ADHD symptoms. Right. But I would love to do another episode on ADHD. So I hope that our listeners will, you know, put some comments and questions, specific things about ADHD they'd like us to discuss further because like I said, from the get go, this is something that I'm very interested in and I think there's a lot of misinformation, but a lot people can learn from it as well. Right. And on that note, until next time, keep your eyes on the road and your hands upon the wheel.