Dr. Eliza (00:00:00):

The go-to that I think you can almost never fail with is exercise. So if you’re a teacher in the classroom, have that kid go do a loop if that’s permitted, have ’em go do a loop around the hallway to get their body moving and get them to neutral before you do that kind of analysis of what happens here and what can we do moving forward.

Dr. Sarah (00:00:27):

If you or your child has ADHD, you may think of it as a challenge with paying attention, staying focused, or listening and following directions, all behavioral struggles. But what if we shifted that lens to focus on what’s actually happening in the brain? What if understanding the neuroscience of ADHD could help you to parent with more empathy and fewer power struggles? Joining me this week is Dr. Eliza Barach, a cognitive psychologist board certified ADHD coach, and the owner and founder of Neural Revolution. Together we’re diving into so many powerful topics from the roles dopamine and norepinephrine play in motivation and regulation to why transitions can be so hard and what you can do to support your child through them. We’ll also talk about why meltdowns happen and how to build your child’s capacity for self-regulation in those moments, and how to make boring tasks more engaging, using your child’s unique interests. And finally, why so many girls and women go undiagnosed For far too long, this conversation is packed with science-backed insights and real world strategies. So whether you’re parenting a child with ADHD, we have ADHD yourself, or you just want to better understand how brains work, you will not want to miss this one.

(00:01:53):

Hi, I am Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I’ve taken all of my clinical experience, current research on brain science and child psychology, and the insights I’ve gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting insights so you can tune out the noise and tune into your own authentic parenting voice with confidence and calm. This is Securely Attached.

(00:02:22):

Hello, welcome back to the Securely Attached podcast. We have Dr. Eliza Barach with us today, and I am thrilled for this conversation. Thank you so much for being here.

Dr. Eliza (00:02:35):

Yeah, thank you so much for the opportunity. I’m really excited to jump into everything today.

Dr. Sarah (00:02:41):

And so I always like to start off just giving the audience a little chance to get to know you a bit and the work you do and how I know you personally. We can talk a little bit about that too, because you and I work together. You are my ADHD coach, but I wanted to, maybe you can share a little bit about how you got into this work and why it’s so personal for you.

Dr. Eliza (00:03:07):

Yeah, absolutely. So to start, I guess at the beginning, I actually have ADHD myself, and as a sneak preview, some of what we’ll be talking about, I was diagnosed early as a woman at 17, so a girl technically. And so that kind of shaped a lot of my late adolescence. And then young adulthood, I was very interested in A-D-H-D-I majored in psychology in college, thought I was going to be an attorney, and then was like, actually, I want to go into psychology and get my PhD. And so I pursued a PhD in cognitive psychology, which is basically just a really fancy way of saying that. I was studying how the brain works when it comes to things like memory, attention, perception, communication and decision making and much more, but really understanding the inner workings of the mind and how we’re able to do these kind of higher level and lower level cognitive processes in the brain.

(00:04:10):

And I always wanted to do something with ADHD. I thought maybe I would be taking the methodology from cognitive psychology and using it to answer clinical questions. How does attention work differently for people with A DHD versus those that don’t have it or how does decision making work? So things along those lines. I took a very hard pivot in my last year of my PhD and started an ADHD coaching practice. Instead, I was very, very interested in ADHD obviously, but was a bit frustrated with the systemic setup of academia and really started to see how there were differences between how my brain worked and what might’ve been needed in order to be sustainably successful in academia. And so that was a big push for starting my business neural revolution and doing this ADHD coaching because I could take the science. So really leverage an evidence-based approach, a science informed approach to help people with ADHD better understand how their brain works and then move them toward the goals that really matter for them. So that is kind of how I got started.

Dr. Sarah (00:05:25):

And I mean, have to say, I mean, we’ve been working together for over a year. The reason why I reached out to you to be my coach was because I heard you speak at, you gave this talk that I was at, and I had gone to the talk specifically as a therapist being like, oh, I wanted to get this information to use it to work with the clients that I see. And as you were talking, you were just hitting, and every single thing you said, I was like, oh my God, that’s me, that’s me, that’s me, that’s me. And I had already been diagnosed with ADHD and was treating it, but the way that you described the brain science behind it, that was for me the point where I was like, okay, the way that your brain works clearly is able to dissect really complicated neuroscientific research and translate it.

(00:06:14):

And I was like, I just need to understand this better, which is definitely one of the reasons I wanted to work with you personally. But also one of the reasons I wanted you to come on this podcast because I really wanted you to share with us some of the, there’s a lot of research. Neuroscience can get kind of overwhelming. It’s a lot of big words and brain functions. And at the same time, when we can understand what is happening in the brain and why an ADHD brain is so specifically and predictably unique compared to a neurotypical brain, we can really work with our kids’ brains or our brains instead of working kind of against it and being so confused and confounded all the time. It’s like, why is this not working? So I was thinking maybe it’d be helpful to start a little bit with just kind of a rough broad strokes picture of what are some of the unique aspects neurologically of an ADHD brain that’s just predictably different than a neurotypical brain.

Dr. Eliza (00:07:20):

Yeah, so I think if we start at the micro tiny level with an ADHD brain, one of the things that we know with decent reliability is that people with ADHD have inconsistent access or lower levels of two main neurotransmitters, dopamine and norepinephrine. And so essentially we can think of neurotransmitters as chemical messages. So they’re messengers, they send messages to different parts of the brain. And so with ADHD, sometimes it’s the case that we don’t have enough of these chemical messengers, and other times it might be the case that they don’t get a chance basically to make it all the way to the place that the message is supposed to go. So for example, there’s receptors, which is where the neurotransmitter goes, essentially. There’s receptors on different parts of the brain.

Dr. Sarah (00:08:19):

Like the mailbox basically.

Dr. Eliza (00:08:21):

Yeah, exactly the mailbox. And so sometimes it’s the case that there’s not enough mail, so we don’t have enough neurotransmitters specifically like dopamine or norepinephrine or it’s like the mail never makes it to that mailbox. So dopamine doesn’t make it to the mailbox, or norepinephrine doesn’t make it to the mailbox. And so in that case, when that happens, that means that we’re not able to execute a certain behavior because we don’t have the message to tell the brain to do that thing. So when it comes to dopamine and norepinephrine, this specifically has to do with motivation and then attention. So I like to think of dopamine as the molecule of possibilities. So what we don’t quite have yet, and then norepinephrine is more about alertness and focus. And so they work very much in tandem with each other. So someone with ADHD isn’t going to have consistent access to dopamine and or norepinephrine, and as a result, it’s much more difficult for them to basically show what they know on demand.

(00:09:25):

It’s not that they don’t necessarily have the skills or the knowledge, it’s that they struggle to demonstrate it when they need to. But the key piece here though is that it’s really about context. Because if you ask someone with ADHD, the question of can you pay attention, the most common answer is going to be sometimes. And then that’s where we want to explore. Because ADHD is more about on demand problems because, and I know many of you who are listening probably have kids, and so if you have a kid with ADHD, they probably can focus on their video game all ends, right? No problem. Super, super locked in. And then you might ask them to go do their homework, and then that’s where challenges come up and maybe some arguments and all of that. And so it’s really perplexing.

(00:10:13):

Why can my kid focus for hours on end on video games, but they won’t sit down and do their homework? And really what it comes down to is that video games are very interesting for some kids. And so things that are interesting, things that they’re passionate about, it’s much more easy for them to show up than it is if they’re not interested, like their homework. And so that discrepancy, that almost paradoxical nature is so confusing. But if we’re able to understand that there are conditions that really support my kid, or if you have ADHD yourself, there’s conditions that really support you in showing what, that’s where we have some power to come in and figure out how do we support you so that you can excel.

Dr. Sarah (00:11:01):

That makes so much sense. And I’ve actually taken that idea that I got from you, and I’ve explained it to people, tell me what you think of this metaphor, but I use the Goldilocks and the three bears metaphor a lot that our brains aren’t going to produce norepinephrine, which is the focus and the sustained attention messenger at the rate that we want it to or predictably that the parent wants the kid to. But when it’s like the brain is going to also be deciding, assessing a situation for how hard or easy it’s going to be. And so if the brain decides, okay, this is going to be way too hard, I not going to want to do this, or I’m not going to succeed at this, or it’s going to cost me too much exertion, that’s like papa bear and I won’t produce norepinephrine. And then if it’s too easy, too boring, too mundane, too rote, I’ve done this a million times, it’s like the making the bed, the taking a shower that’s like baby bear or mama bear too soft, too easy. I don’t produce norepinephrine and that it’s only in the sweet spot of just challenging enough and just interesting enough and just novel enough, easy enough that I think I’ll be able to do well at it and it’s going to feel good. That’s baby bear. That’s where we produce norepinephrine. Whereas a neurotypical brain doesn’t have that same limitation. They can produce norepinephrine for all three situations given the rightm otivations.

Dr. Eliza (00:12:32):

Yeah, yeah. It’s going to be more easy for someone who’s neurotypical to show up for something that’s boring, it still will be difficult, but there’s easier workarounds to get them to show up. So we can kind of think of this as I like to call it the right level of stimulation, and that’s really what ADHD is all about. Can we bring in the right level and also the right flavor of stimulation? And the reason I say flavor is because stimulation can be things like stress and anxiety and that can bring someone with ADHD to the table. That’s why you see a lot of people who are in high crisis fields who also have a ADHD, so like ER nurses, er docs, firefighters, things like that. There’s also very much a doing aspect to those fields too. But those high stakes crisis environments are very, very stimulating. But they do take a toll over time and that kind of leads us to burnout. And there is that question just like I love the Goldilocks example, but there is that right level of stimulation that gets you to show up and doesn’t burn you out. And that’s the piece that as kids, adults, we always want to keep our finger on the pulse for that because it is very easy for us to take it too far when conditions in theory are pretty good and optimal.

Dr. Sarah (00:13:54):

Yeah, I mean I’m definitely vulnerable to that. Personally, I feel like I can become a super workaholic because work can be just that right amount of stimulating for me, and I have that sense of mastery. It’s novel enough, it’s challenging enough. And so I like to stay in that space and I don’t like to leave it. And that can be really hard for me to transition out of work or get motivated to do things that don’t give me that kind of stimulation.

Dr. Eliza (00:14:25):

And what you layered in there too though, is obviously the passion. So the stakes are pretty good for you there. You’re interested in it, you’re passionate stakes in the sense of we all kind of need to work in order to live. It’s pretty straightforward. So there’s that piece too. And so they kind of work in tandem. But one of the things we know with ADHD is that we are more prone to addiction and that includes work. Work can be an addiction.

(00:14:53):

And so that’s something again, we always need to keep a finger on the pulse about because we can get ourselves into these situations where society thinks it’s great to be a workaholic to some degree, but when it’s coming at the expense of your health, your family, then it’s like, is this really a good thing? If it was a different substance and your family was being negatively impacted, your health was being negatively impacted, we would be asking questions, how does this serve you? Does it really make sense for you to engage in this degree, in this quantity with this substance? And honestly, work is no different.

Dr. Sarah (00:15:33):

I agree. I mean that’s one of the biggest things you and I work on is how do I do things outside of work because I struggled to transition out of it and it does have negative impacts. And I want to go back to this idea of that we were talking about with kids if we’re having trouble getting them to do certain things that they need to do, but tend to live in either papa bear or a mama bear space for them helping out around the house doing chores or doing homework or engaging in tasks that they don’t want to initiate all the time. Even I see this a lot with going to activities. They love the activity when they’re doing it, but getting them to get to the activity, getting them to stop doing the video game or the building, whatever they’re building, like the play and moving into a structured activity that’s so hard sometimes. So how do we get more of the sweet spot activation? What are some of the ways that parents can help work with that brain and get them to do more of the things we need them to do with less of the frustration?

Dr. Eliza (00:16:45):

That’s a great question. And so the examples you were talking about leaving play for work, we could say kid work, homework, chores, all of that. One of the things we want to really consider is this transition. So transitions for people with ADHD, regardless of the age, they’re very difficult. And so we want to keep that in mind because essentially what we’re asking them to do in a transition is I want you to disengage with this thing that you really like. So that already is hard because it’s fun and it’s exciting. We want to stay there, but you need to stop, you need to disengage, then you need to basically pivot your attention over to something else. And this something else is most of the time very different play or playing video games is very different than doing your chores or doing your homework. So we’re asking some a little kid to let go of what they were doing, get a clean slate, and then activate the relevant information to do this other thing that’s also not fun or interesting.

(00:17:50):

So when it comes to that piece of it, we want to think about, okay, how do we give this kid a pallet cleanser so that they’re exiting the play, they’re able to kind of regulate and you can help them regulate, co-regulate, give them kind a pallet cleanser, get them prepped and ready to then go into that next thing. So maybe it’s like going for a walk outside really quickly, maybe I know some people have those mini trampolines jumping on the trampoline for a little bit. Exercise is always going to be your best friend for kids with a DHD, but really giving them space to make that transition. So you may need to adjust your expectations in terms of how quickly they leave the video game and then enter the workspace. The other piece of this though is how do we add elements of stimulation to these things that our kids don’t like or they’re not readily liking it once they get started?

(00:18:49):

As you mentioned, they actually might really like it, but it’s like that hurdle of getting into it. So I always think of different ways that we can do this. Sometimes it’s like having a reward at the end. If you do your homework, then you can get a reward of some sort. Maybe you’re doing what we call a token economy so they can earn opportunities and then cash those coins in for something bigger. That’s sometimes a great strategy or other things like adding the reward to the actual task itself. So if you have a kid who’s pretty artistic, likes colorful things, maybe giving them special pens that they can use or pencils that they can use to do the homework, that might be a fun and exciting way to show up. I get to use my new pen when I do this task. Another option too is letting your kid have some noise in the background.

(00:19:39):

Again, if your kid likes music, let them listen to music in the background. There are also some instances in which playing TV in the background can help them, but you really need to keep an eye on that to make sure that the TV is supportive and not destructive. But the general principle there is we’re adding additional stimulation. So with the pens or the pencils, there’s a little bit of excitement, there’s some fun with the tv, there’s extra kind of noise going in the background that can be stimulating. And then again, with the token economy, we’re using incentives and reward mechanisms to get them to show up. And so sometimes those things can be pretty helpful in getting an ADHD to sit down and do the thing. And then similar to the token economy, even bringing gamification to it. So this one you want to be careful with, at least with the homework. We don’t want them to rush, but seeing how fast can you get this done? So this is usually better for chores. So how fast can you race the clock for putting your clothes away? So things like that where it becomes more like a, or can

Dr. Sarah (00:20:41):

You pick up all the red things first and then we’ll do the blue things? Or I’m also thinking about scaffolding. Can we talk a little bit about where scaffolding can play a role, especially with chores? I feel like scaffolding. I think parents, the fantasy is my kids will do this on their own and I really want and need them to do it on their own. And the reality is, and I know this from personal experience because if I don’t scaffold it won’t happen, and then I just get frustrated.

Dr. Eliza (00:21:12):

One thing I was just thinking about when you mentioned that is this concept of body doubling. We see this a lot in the adult community, and it’s also used with kids. If your kid has services at school, they might have an aide and a kind of sits with them and helps ’em do their work. That essentially is basically a body double. So someone sits with you while you do the work, or someone does work while you do work too. And the idea is that it’s having that additional support or additional accountability. So as with regard to chores, it might be picking up the stuff with your kids and then maybe it’s just sitting with them while they do it. So increasing the difficulty of the task, but you’re there with them along the way. The other thing here too, in terms of some of the challenges with ADHD, we know that working memory, which is kind of like our mental scratch pad, it tends to be smaller.

(00:22:09):

So it’s like you have a smaller page in your brain than someone who doesn’t have a DHD. They might have a full big canvas and you get kind of a tiny flip book. So a much smaller page. And so because of that, we can’t write as much on that. And that’s true for kids as well. So it might be really hard for them to hold the sequence of the task of whatever the chore is. So putting your clothes away, it’s not just putting your clothes away, it might be folding them and then putting them in the right drawers. And so there’s a lot of mini steps built into it that as adults we take for granted because we’ve built that automaticity to do that thing. So for kids, it can be really helpful to have an externalized list if they tend to be very visual, which is usually the case for children.

(00:22:51):

You can have a visual chore list with the steps. So it’s like fold clothes. You might have a picture of the clothes being folded, then the clothes going in the right drawers that they can reference and check off as they move along. And that’s a way to support their brain and to basically externalize having to hold that sequence of steps in their mind and have it externalized in space so they don’t have to remember that because when we get bombarded with information, it’s very overwhelming. And so for kids, that might be where we see some of a little bit of the meltdowns or the tantrums. And part of that is because it’s just a cognitive overload. And in adults you might see them shut down and then they don’t do the thing either.

Dr. Sarah (00:23:33):

Yeah, that makes so much sense. This is a tangent, but we both have ADHD, we’re going to be tangent going on tangents today, but what you just said made me remember something else that I’ve heard you discuss, which is that ADHD is really a disability of regulating attention. It’s not a deficit of the capacity to attend. And regulation is a really big part of ADHD, and it made me think of that because talking about the cognitive overload and the meltdowns that are so frequent, and can you explain a little bit why kids who have ADHD get dysregulated so easily?

Dr. Eliza (00:24:17):

Yeah, I think there’s a couple different pieces that can be at play at any given time, but if we look at ADHD as a whole, yes, challenges with regulation, and that’s similar to what I was saying earlier about you know what to do, but you struggle to demonstrate it when you need to. That in and itself is a regulation aspect. So in situations of overwhelm, like cognitive overload, we can’t hold all the information in our mind that feels stressful, that doesn’t feel good, and then our emotions start to get kicked up. And we know that emotion dysregulation is a very big part of ADHD. Individuals with ADHD across a H span often have big emotions, very, very strong emotions. And what’s really important here to discern and dissect is that first of all, the emotion is not invalid. Meaning that, yeah, it really doesn’t feel great when I feel overwhelmed.

(00:25:16):

What sets this apart from maybe a neurotypical kid is the magnitude of that emotion. So if a kid’s feeling a bit overwhelmed and they have ADHD. They may act out in big bursts and it just doesn’t seem to match the situation. It’s kind of perplexing. But the reality is, is it’s normal to be frustrated. And where it’s different is that it gets carried away for someone with ADHD. And a part of that has to do with if we’re talking with that cognitive overload, example, smaller working memory capacity, and then under stressful conditions like that, we basically have a much more difficult time accessing this front part of the brain called the prefrontal cortex, which is basically like the CEO of your brain, or you can think of it as the conductor of the orchestra. And so under stressful conditions, that part of the brain is most negatively impacted.

(00:26:13):

And when you have ADHD, that area of the brain already is starting behind the starting line. So that part of the brain is affected right out of the gates, the stress then builds on it, and then it’s not able to basically speak to the woodwinds and be like, Hey, woodwinds, we actually need to calm down. This isn’t as big of a situation as it feels. And basically it’s the prefrontal cortex talking to the amygdala, which is heavily involved in emotion processing and particularly negative and fear-based emotional processing. So for a kid with ADHD and adults too, their prefrontal cortex struggles to interrupt the amygdala’s overwhelming response and say, Hey, it’s actually okay. Let’s access our regulation tools. I can go for a walk or I can talk myself down. Kids with a ADHD and adults are not able to do that interruption the way someone without a DH ADHD might be able to.

Dr. Sarah (00:27:15):

So what can a parent do to help a kid who’s getting really flooded and seems like they’re having a level 10 meltdown over a level three problem? I know I’m vulnerable of showing them the discrepancy. Like, Hey, you’re at a 10. This is a three level problem. This is not such a big deal. And trying to speak to their logic mind or their thinking brain like the prefrontal cortex in those hot moments.

Dr. Eliza (00:27:44):

So I think first and foremost, as a parent, adjust your expectations. This kid is probably not doing that thing that you want ’em to do or hard to do, and you need to really let go of that. And I’m not going to sit here and preach as if I’m good at this. I have an eight month old and that’s like they can’t do anything, right? I mean, love her, she’s wonderful. But I just say that because it’s hard. But first and foremost is letting go of the expectation. Whatever your plan was, the gold standard that you had, first figure out essentially the next best thing to adjust those expectations because your kid will start to pick up on your own stress, especially if they have a DH adhd, they tend to be very, they’re able to pick up sometimes on emotional undercurrents more easily, and that is in part due to their diffuse attention profiles.

(00:28:33):

So distractibility, one way it can actually be a strength is you pick up on things that other people don’t see. And emotional information is very sexy, as I like to say. It’s stimulating. So they might be more quick to pick up on that and then feed off of your energy. So long story short here, first and foremost, adjust your expectations and make sure you’re regulating yourself. And then next is exactly what Sarah was saying is try to tap more into the logic side of the brain. So this doesn’t mean that you’re necessarily doing this dissection right away of you’re at a 10, we need to bring it down to a five. It might be something first, like I said, that pallet cleanser, it could be something as simple as jumping on the trampoline or with kids maybe playing with blocks. And the reason I’m saying kind of playing with blocks is that we want to get them outside of themselves.

(00:29:31):

So we wanted to get something that’s more goal oriented and externalized. What happens when we do that is we move, basically we’re a different network in the brain called the task positive network. And so this network is involved in external goal-oriented actions. I think of it as being very algorithmic, but again, outside of ourselves. So if we can turn that part of our brain on that network in the brain that can help do some of that downregulation of the intense emotions and get ourselves out of that space, get to neutral, and then we could start to do some of that more retrospective analysis of like, Hey buddy, I see you were up here at a 10 and I get it. I know this is so hard for you. So really doing that validation and then opening the doors for what do you think was going on for you?

(00:30:26):

What could I have done to help you? Getting them to think about what went on for them. But we can’t ask them to do that until they’re more in a neutral space, and that’s where more externalized, goal-oriented things are going to be helpful. So like I said, the Lego blocks or something like that, if they like to draw something, and like I said, the go-to that I think you can almost never fail with is exercise. So if you’re a teacher in the classroom, have that kid go do a loop if that’s permitted, have ’em go do a loop around the hallway to get their body moving and get them to neutral before you do that kind of analysis of what happened here and what can we do moving forward.

Dr. Sarah (00:31:10):

Yeah, I really like that because I think what you’re saying is first you have to help them regulate and we really are just basically trying to calm the nervous system down, turn off the fire alarm, get their body and their amygdala to turn off the amygdala and get back into a safe safety and connection state. And then we’re going to try to shift the attention of the brain towards something that is outside of themselves. So a task that is relatively easy, but it requires some type of step-by-step really kind of concrete thing that’s manipulative with manipulatives like blocks or Legos or even just a task that they’re familiar with that requires some type of, I don’t know, putting things together is what I’m hearing. That task positive network, that gets activated when you do that,

Dr. Eliza (00:32:04):

Like a clear outcome.

Dr. Sarah (00:32:07):

And then later when they’re regulated and they’re distanced enough from the situation that was frustrating that they have the capacity to reflect again, because thinking brain, that prefrontal cortex is back on for them. Then you can do what I would refer to as the debrief where we try to connect the dots and figure out what had happened. But doing that in the hot moment is a recipe for disaster in my opinion. And I think that makes sense based on what you’re saying.

Dr. Eliza (00:32:34):

Yeah, absolutely. I mean, think about it as an adult, when have you ever been able to do that kind of problem solving that deep, emotionally charged problem solving when you are in the heat of the moment, whether you have ADHD or not. And then if you do have ADHD, it’s like that on level 3000. So it’s just basically like you’re setting yourself up for failure if you try to do it like that.

Dr. Sarah (00:33:02):

That makes sense. If your child has ADHD or you suspect they might, you may find yourself feeling exhausted by their inability to get through daily tasks without constantly being reminded you having to walk on eggshells to avoid conflict and power struggles, feeling overwhelmed with all the red tape around school accommodations or simply unsure of what’s really going on beneath the surface. It can feel exhausting to parent a child whose brain works differently, especially when typical parenting strategies just don’t seem to work at ups. Sure, brand psychology group, we understand just how confusing and isolating this can feel. That’s why we created Parenting Your Child with ADHD, an 8-week virtual group designed to empower you with the knowledge, tools and support you need to better understand your child and feel more confident in your parenting. Facilitated by our director of Neurodiversity services, this group goes far beyond surface level tips. You’ll gain a deep understanding of the ADHD diagnosis biologically, neurologically, and most important practically. You’ll learn how to uncover and harness your child’s inner strengths and potential, become a more effective advocate and build a toolbox of strategies to support your child in day-to-day life. And you’ll do all of this alongside other parents who truly get what you’re going through, creating a supportive community where you don’t have to navigate this journey alone to learn more or sign up for our next cohort, visit upshurbren.com/group-adhd, or just click the link of the episode description. Okay, now let’s get back to the episode.

(00:34:52):

I want to pivot a little bit. I think this is really helpful primer and why kind of all ADHD brains are a little bit different and than neurotypical brains, but I know that there’s a growing amount of research on what is different specifically in girls versus boys. You mentioned earlier that you were diagnosed early at 17 as a girl, so why is 17 early? That sounds wild. And is that number coming down? I feel like we’re getting better at understanding the differences that have historically left girls flying under the radar and underdiagnosed.

Dr. Eliza (00:35:38):

So I can’t speak specifically as to whether that number is getting better. I haven’t seen that data quite yet. Not to say it’s not out there yet. What we do know is that I think the average diagnosis, age of diagnosis in women is somewhere around late twenties, early thirties, which is a long time to have ADHD and not know it. We’re talking about a lot of formative years there and what that’s like to essentially not know why things are harder for you, harder, it’s a lot, it’s not fair. But part of the reason why this happens is right out of the gates, if we look at the DSM-5 criteria.

Dr. Sarah (00:36:25):

The DSM-5 by the way, is the manual that we use to diagnose every current diagnosis that we have. It’s like the psychology dictionary basically.

Dr. Eliza (00:36:38):

Yeah. So the criteria and essentially criteria is just like what do you have to possess in order to be categorized as someone who has ADHD? That criteria was actually originally developed on white young boys. So right out of the gate, we have criteria that likely doesn’t reflect the experience of a young girl with ADHD. One of the things we know too is that women and girls with ADHD are more likely to present with the inattentive presentation of ADHD. So this is forgetting details, careless mistakes, trouble regulating attention sometimes the daydreamer. And so if you notice this presentation of behaviors is not very disruptive to the classroom. It’s not the little boy jumping out of the chair disrupting the lesson or anything like that. And so the lack of disruption allows girls to kind of fly under the radar because who cares if it’s just you that’s struggling, right?

(00:37:54):

No one else can see it, which is absolutely horrible. But that is a bit of it, right, is that it’s not overt. We don’t see it as much, and it’s not a problem to be remedied right in the moment, and it’s not in theory affecting other people, whereas a disruptive, a child that’s disruptive in the classroom is affecting the learning of others in that room too. So that’s one of the reasons why they may be missed. And then other aspects of hyperactive or impulsive behaviors can be manifested as being a chatty Cathy. So you might be a very sociable outgoing girl, and society very much rewards girls and women for behavior like that. There is a bit of this stereotype that women and girls are supposed to be sociable and chatty and talkative, and so that behavior is essentially kind of rewarded and can be missed in that way.

(00:38:53):

And then also girls and women are much more sensitive to societal expectations and we’re asked a lot of as girls too. And so there’s this greater, I think, drive to conform or mask your behavior in order to be successful. And so you’ll see a lot of young girls and adults masking, which basically is developing compensatory mechanisms to hide their ADHD challenges to allow them to be successful. And so that’s another piece of it is that if you’re able to figure out how to succeed regardless of the cost of the success, you’re not going to be perceived as having impairment unless someone digs much deeper and is like, okay, what is the cost of this? You are so anxious about arriving on time that you set 30 alarms, and it’s like the reason you set 30 alarms is because of your challenges with tracking time and estimating how long things take. So yeah, you may be always on time, but it’s at what cost is that happening for you?

Dr. Sarah (00:40:05):

And I think obviously there are girls that present in a more classical way, and girls definitely can have hyperactive. The ADHD stands for attention deficit and hyperactivity disorder, but there’s technically three types. There’s inattentive type, hyperactive type, and combined type, which is both. And girls can definitely have any of those three diagnoses. And what I’m also hearing you say is that even if they have perhaps the hyperactive type or combined type, they can mask some of those hyperactive symptoms or signs in a way, so pro-social that it doesn’t get flagged as a negative symptom that we want to say, Hey, something’s wrong here, we should check this out.

Dr. Eliza (00:40:56):

Absolutely. And there was a recent paper that came out I think this year, last year that basically was talking about hyperactivity and impulsivity actually may manifest differently too than boys. And so I don’t remember the specifics of the paper, but basically they were doing more what we call covert measures. So they were kind of measuring, I think it was electrical conductance on the skin, so the electrical activity that gets emanated from the body. And basically what they were finding is that women were demonstrating a similar physiological response as male individuals with ADHD showing that hyperactivity and impulsivity, but the overexpression of that was different. So internally you’re seeing the same kind of physiological response, but the external expression of it was different if you were a female or a male. So this also circles back to the inherent difficulties or flaws with the DSM-5 criteria being again, normed or created using little boys because the way a woman may express hyperactivity or impulsivity may be different than a young boy. And again, young boys are more likely to demonstrate externalized behaviors, which essentially affect those around us. And less so internalized ones which are kind of turned in unless you can’t really see it with a naked eye.

Dr. Sarah (00:42:34):

And a little kid is not as well equipped to articulate it. So if a little girl is having this physiological arousal and hyperactivity of their nervous system, but the way that that is getting expressed is inwardly in racing thoughts or negative criticisms about themselves or lots of worries or freezing even feeling like I don’t know where to go next because I’m flooded with these sort of sensory inputs that I don’t know how to organize. I might look like a kid sitting at their desk. I might not look like a kid jumping up and running around the room. And also that girl, especially if she’s young and doesn’t have a language for this, isn’t going to be necessarily that equipped to say, I’m having all these really terrible thoughts about myself, and it could just get manifested in other kinds of behaviors that we might not necessarily assume as A DHD we might assume as anxiety. I see so many kids who come to me for anxiety, but there’s actually some ADHD stuff going on underneath that’s driving I think ADHD and anxiety are really co-occurring for some of these reasons.

Dr. Eliza (00:43:52):

Yeah, absolutely. And what we do know is that women are more likely to be diagnosed with an anxiety disorder or a mood disorder before receiving an accurate ADHD diagnosis. Absolutely. And I think one of the things that’s helpful in disentangling the anxiety versus the ADHD is can you pinpoint the anxiety to a specific trigger and is it an ADHD symptom? I’m anxious because I’m always late, and that’s the executive dysfunction challenge is I can’t organize myself around time. And so I get all worked up about trying to make that happen and engage in this problem solving behavior. And this is sometimes where ADHD can look like OCD, but the reality is is that if you are able to help them develop a system that actually works or they’re open to taking the medication, the stimulants or the non stimulants that might lower the anxiety because they’re getting the appropriate levels of those neurotransmitters, that then allows them to more easily access their skillsets of, I set this one timer.

(00:45:05):

I know I’m a little bit worried about being late, but I’ve done these things. I know they work and it’s going to be okay. So it’s essentially also being able to use their self-talk in those moments where they start to maybe feel that anxiety or that stress of like, am I going to be on time or not? So I think it’s always really helpful to really dig into that because usually there can be a very clear precipitation or precipitant for the anxiety feelings or emotions or however you want to categorize it. And I know for myself, that’s especially true. I get anxious about being late. Part of that is societal expectations, but my dad very much valued being on time, and that was something he instilled in all of us. And so not that he said it like this, but it felt sometimes like a moral failing that I could never get it together to be on time. And so then it was like, well, I need to be 15 minutes early to everything and I need to have 70 alarms and all of these different things set up so that I can show up on time. And then when I got diagnosed and I was taking medication as well, I was able to use the systems a bit more. But I always say this is that I’m either 15 minutes early or 15 minutes late, and there’s nothing in between.

Dr. Sarah (00:46:35):

Those extremes are, so it’s typical with ADHD, I relate to that so much. I am very all or nothing if I’m going to be, I can only be on time. I have the same problem. Literally, I try to explain this to people who don’t have time blindness and just don’t really, my family looks at me, I’m just full of it. But if I look at the clock and it says 10:29, it will be 10:29 in my head until I look at a clock again. And I won’t really have any sense of what a minute or two or five or 10 minutes passing feels like. I just don’t have any sense of it in my body. And you’ve explained, this is also a tangent, but I think it’s helpful is you’ve explained to me kind of why that is, right? Can you explain the science of that? I just want to say it that my parents who I know are listening to this episode can hear because they want them to and my husband, please explain.

Dr. Eliza (00:47:39):

So it has to do actually, so dopamine actually influences the perceived passage of time, how quickly or slowly it is. And so because in ADHD, we have inconsistent availability to dopamine, lower levels or inconsistent access, that means that essentially our internal time clock kind of changes in terms of, it’s not like a consistent measurement of time. So because we perceive time in a nonlinear fashion essentially now or not now, it’s really hard for us to build a repertoire of time estimates for things kind of like we never know which time zone our clock is currently going to be on. And so how are you supposed to map how long something takes if your internal time clock essentially changes the metric or the time zone that it’s operating in? And so in order for someone to basically be able to estimate time, they need to be able to have a consistent measurement of that.

(00:48:38):

So that’s why we’re always saying use a timer and it’s like you use a timer, but there is some benefit in using a timer. I’m not trying to be reactive here, but we can always rely on our internal clock because it doesn’t measure consistently. And so if we don’t have the experience repeatedly of measuring the amount of time something takes, it’s really hard for us to project that. So if you don’t have a baseline measurement of a minute, which I don’t have that either, it’s really hard for you to internally know like, oh, okay, it’s been a minute. It’s time to pivot. Our brains aren’t built that our internal clock runs on a different time zone each day, moment hour. And so it’s difficult for us to be able to pull from a knowledge base of this is how much time this takes or this is how much time has passed.

Dr. Sarah (00:49:31):

And honestly, the timer thing, I can’t live without them. Literally, I have an Apple watch because I use the timer, the buzzing of the watch to tell me how much time has passed constantly. I set the timer on my watch probably 40 times a day. I’m not exaggerating to tell me different things I need to know. And it’s kind of like instead of looking at a watch and reading the time and then knowing then for a while how much time is passing, I have to constantly set the timer. And I remember my watch broke and I for a couple of weeks before I got a replacement, I was like, oh my God. I didn’t realize how much I depended on this to be functional. It was the absence of it made everything fall apart. It was wild to see how much these external compensatory systems that we create to help us become, they’re working. They become critical extensions of our functioning, and when they go away, it’s really hard.

Dr. Eliza (00:50:35):

Absolutely.

Dr. Sarah (00:50:37):

It makes me wonder, are there other things? I have Apple watch. I’m a grownup. My six-year-old daughter doesn’t my, who I have a hunch is probably going to have some of the same things that I have. And so I use a visual timer all the time in our house because I’m trying to give her tool both my kids, honestly, regardless of whether or not they’re neurotypical or neurodiverse, little kids struggle with this because they haven’t yet developed a lot of these systems just from development.

Dr. Eliza (00:51:10):

I mean, I recommend having a clock in every single place in your house, even as an adult. And I think the visual timer is a great tool. And regardless of the ADHD or not, it’s just modeling good behavior to use tools that help you do the things when they need to be done. As I mentioned with clocks in every place in your house, I always make this joke of if you have ADHD, don’t create Vegas in your home. And if you notice in Vegas, there are no signals for time. There’s no windows, so there’s no natural lighting, there’s absolutely no clocks, and there’s alcohol, which completely obliterates your ability to process time or track time. And so they do that on purpose. They want you to stay there. And obviously gambling’s a very dopaminergic experience. So again, you kind of get reeled in and there’s nothing to interrupt that reeled in process. So you do not want to create that environment in your home. So clocks everywhere, open the window, try not to have your shades down so you have natural lighting in. And I even encourage clients to have clocks in the shower or in the bathroom. So you could just pull…

Dr. Sarah (00:52:24):

I do have to see it. Otherwise I’ll take a 40 minute shower and not realize it.

Dr. Eliza (00:52:29):

Yep. Yeah, I’m the same way. I mean, now that I have an eight month old, she goes into the b

Dr. Sarah (00:52:34):

throom. Oh my God, having little children is such a good external regulator of time, because literally for years I was like, I don’t have to set an alarm. I know my kid’s going to wake me up and now it’s a little different. I have to wake them up, and it’s very challenging.

Dr. Eliza (00:52:50):

Yeah. But I think that’s such a good point though, because eight months post, about eight months postpartum, and since having my daughter, I have not set an alarm in the morning because my daughter always wakes me up between right now she’s doing this 4:00 AM thing, and this needs to end, but between 4:00 AM and six 30 reliably. So I don’t need to set an alarm because she’s the alarm have one.

Dr. Sarah (00:53:19):

Yeah. It’s still not coming from the inside. It’s still external though. So funny.

Dr. Eliza (00:53:23):

Absolutely.

Dr. Sarah (00:53:24):

Oh man, there’s so many things I want to ask you, but I wonder maybe to close this out, we know that ADHD has got a big genetic loading. We know that people who, adults who have it are more likely to have kids who have it. We know that kids who have it are more likely to have an adult, a parent who might get diagnosed afterwards if they didn’t realize they had it. So one, how do we give ourselves a little more grace and understanding this is actually, it’s not a bad thing. I think it’s a superpower. I mean, we’ve been talking a lot of the ways that it shows up in challenging ways, but I also think your point about it being our ability to pick up on things that other people don’t pick up on, our ability to solve problems in really different ways, out of the box thinking, hyper focus. There’s so many superpowers that come with ADHD. So if people are listening to this being kind of a little disheartened or worried or feeling guilty, how can we kind of set that tone to a more hopeful place and reassure them that, yes, there are some challenges, but there’s so many things that you can do about those challenges, and then the ability to be expansive about it is really available.

Dr. Eliza (00:54:52):

So A DHD is one of the most treatable disorders in the DSM-5 and of physiological disorders as well. We have a lot of tools that help people. And so my one soapbox is that we need better catching of this, particularly with girls. We need better diagnostic tools that actually capture the ADHD experience for those that are not the stereotypical presentation or essentially, or what the diagnostic criteria was built on. So this also applies to marginal communities as well, because it can manifest differently, and there can be biases as well that result in them being missed. So my first thing is early diagnosis. If we can get in there and be like, okay, your brain works differently and needs different things to succeed, we’re starting out in a much better spot. Once we are able to kind of understand how that brain works, we’re able to then layer in tools and strategies that help them to be successful.

(00:55:58):

There are quite a number of successful people with ADHD. I mean, look, it’s Sarah, but also people like Adam Levine, right? He has ADHD. He is like Maroon Five nineties people. We know him, but maybe for some of the younger people out there, Simone Biles has ADHD and is an incredible gymnast. And so we are absolutely capable of succeeding if our brains receive the things that they need. And so with Simone Biles, no one was criticizing her for being short and hyper. They put her in gymnastics, and now she’s an Olympian. So I think part of this is really understanding the challenges your kid has, but also their unique strengths and the things that they’re interested in. Because if you can put them in an environment that matches how their brain works, they absolutely can be successful. And the reality is too, is that if you’re someone with ADHD and you’re in environments that really work with your brain, you have a neurodivergent brain, but in theory, you may never get diagnosed because the impairment’s not there.

(00:57:06):

ADHD is so heavily influenced by the environment. We know this. And so if we can craft environments that support how your kid’s brain works or your brain, if you have ADHD, you absolutely can be successful. And one of the areas of research that I’m still involved in is actually what do we know in the research in terms of strengths that people with ADHD may possess? And so one of the things that we see a lot of evidence for, there’s some mixed evidence too, but one of the things that we see is that people with ADHD very much excel at creativity. They’re able to see things that other people miss. They’re able to make connections that other people may not see either. And that has to do with distractibility. In order to be able to see something that others miss, you have to be able to be distracted.

(00:57:56):

Otherwise, you get that tunnel vision and nothing else can come in. You can’t consider alternatives because your brain is in such a state that it kicks them out without you even knowing. So distractibility is a huge benefit when it comes to creativity. The other piece that we talked about is like regulation. So we talk about regulation in terms of that distractibility, we can’t focus whatever that, yes, that’s a challenge, but the flip side of that is that we can also so deeply focus that we get lost and nothing else exists, but the thing at hand. And so that’s what we call hyperfocus. That’s the other end of the continuum in terms of regulation. And so we also want to be careful there, but that ability to really zero in on something, that’s the flip side of the distractibility, being able to kind of hone in and have everything else melt away.

(00:58:46):

And so in the literature, when people are able to have this hyperfocus, they are able to accomplish incredible things. They’re able to write entire books, maybe even finish book proposals, compose music, whatever it may be. And so we just always want to think about the full picture. And another thing I see with people with ADHD is that they’re very, very sensitive to hypocrisy and inconsistency. And I think this has to do with some of the emotional dysregulation, which can be flipped in terms of feeling things very deeply. And so a lot of people with ADHD are truth seekers. They want the accuracy, they want the truth. And so a strategy here is applying that to yourself. You’re not giving yourself the whole picture if you’re only focusing on the challenges that come with ADHD. And the example I always use with my clients is that in my own therapy, I literally was crying because I couldn’t get my mail.

(00:59:45):

I still, to this day suck at getting the mail. I was so upset. It’s not that interesting. There’s never anything good in there. Almost rarely, never. But I was so upset about it and so distraught. And I was like, I just can’t do it. It’s so easy. Why can’t I do it? And so my therapist said to me, she’s like, okay, Eliza, if you had to choose between being really good at getting the mail and being really good at psychology, which thing would you choose? And I looked at her totally annoyed. I’m like, well, that’s not a fair question. Come on. And I’m like, I’m obviously going to choose the psychology, and that’s my strengths. Those problem solving, creativity, all of those things that I’m good at that happens there. And the reality is, yeah, I would way rather be very good at that than getting the mail.

(01:00:30):

And so that really helped me see the full perspective of it, of like, yeah, I probably am never going to be good at getting in the mail and don’t really, when it comes down to it, I don’t really care as long as I’m not missing things and getting fined, which has happened, I want to be really good at what matters to me. And so that same thing can be applied to kids and adults of what do you actually care about? What are you interested in? Because this is an interest-based nervous system, things that we love, things that we’re interested in, we’re better able to access those neurotransmitters, dopamine and norepinephrine. That’s that Goldilocks. It’s that sweet spot and be able to show what we actually know. And so getting that full picture, your challenges, but also alongside your strengths.

Dr. Sarah (01:01:17):

Yeah, I think that’s so critical, especially for girls because the self-esteem piece, the sense of we can be so hard on ourselves for not getting the mail and miss the fact that we are psychologists, like got doctorate. We can be so hard on ourselves for these little things that we really genuinely struggle with and get tremendous amounts of feedback from our daily environment about how bad we are at those and miss these massive capacities that make us incredibly creative and socially tuned in and have huge hearts. The kids that I work with that have ADHD care so much about the people they love. Their hearts are huge. And yes, their explosions are huge too. It comes in a package deal and we have to be mindful, I think, of balancing out what they’re going to get a lot of, which is criticism and with a lot of orienting them to take in their strengths too. It’s not just about complimenting them for all the things they do well, it’s about helping them see it and feel it because that internalized, we have to balance out the internal narrative that they’ve got going on, not just the feedback from their environment, which they’re related. Right.

Dr. Eliza (01:02:41):

Yeah, I liked what you said too though. It’s not just about complimenting them because they’ll also see right through that BS, like, so much. So it has to be something they actually care about that you’re giving them positive feedback and it can’t be that nicety stuff. And I’ve often, when I talk with clients about this, I make this joke about when my therapist would give me positive feedback, I’m like, I pay you. You have to say that. And we would joke about it totally, totally kidding. But there is a bit of that in there bit. So I think when we are giving kids or our clients positive feedback, really situating it to the data. When you give someone with ADHD, hard data, concrete proof, will this stand up in a court of law, they’re more likely to come over, which is why it’s so important to understand how the brain works and why explaining the neuroscience can be so powerful because there’s this concrete black and white explanation as to why these things are happening. So when you can see it and you have that stone, that hard proof, that helps bring people over and be like, okay, you might be right. But it does open up that acceptance and if we can’t get to a place of acceptance, we can’t access the most amazing parts of ourself.

Dr. Sarah (01:04:03):

Yeah, I love that. If people want to work with you or find out more about the work that you’re doing, where can they find you and where can they connect with you?

Dr. Eliza (01:04:12):

So my website, it’s ww dot neural revolution.com. You can check my business out there. I do a monthly newsletter that basically covers an ADHD relevant topic. It talks about the science and offers some brain-based tips for both individuals with ADHD and then practitioners who work with people with ADHD. I’m taking a bit of a break for the summer to honor my own propensity for burnout, but we will return in September with new topics, new ideas, and new tips and strategies.

Dr. Sarah (01:04:50):

Oh my God, your newsletter is so good. I always tell people to read it because you have an appendix at the end with sources, you cite your sources. It’s like if you are a psychologist listening to this, you should definitely be following Eliza’s newsletter because the amount of resources that you put into these newsletters is so rich. But even if you’re a parent, I mean, it’s totally written for absolutely anyone to get something out of it. I just appreciate it so much.

Dr. Eliza (01:05:15):

Oh, thank you. That’s one of my biggest values is accuracy and authenticity. And so other people might say, I spend too much time on it, but I can’t not do it this way. It needs to be accurate. I want the research to back it up because there’s just a lot of misinformation about ADHD out there. And so part of my hope and goal is always to make sure the most accurate information is going out there so that people with ADHD have access to accurate information to help them understand how their brain works and then make changes or make moves in their lives to help them achieve the things that they want to achieve.

Dr. Sarah (01:06:00):

That’s amazing. Well, thank you for all the work you’re doing. I love working with you. So I’m looking forward to our next session, but I will see you soon. And thank you everyone for listening, and we’ll talk to you all soon. If you are parenting a child with ADHD or you are an adult navigating life with neurodivergence, you don’t have to do this alone. My practice Upshur Bren Psychology Group offers a full range of services designed to help neurodiverse children, teens, and adults truly thrive. From group therapy that offers support and connection for parents of kids with ADHD, to executive function coaching that helps individuals build tools for focus organization and follow through, to comprehensive neuropsychological evaluations that provide insight and clarity for diagnoses. At our practice, we offer integrated evidence-based care all in one place, making it easier for individuals and families to access the comprehensive support they need. To learn more about our services, visit our website at upshurbren.com. That’s U-P-S-H-U-R-B-R-E-N dot com, or click the link in the episode description to schedule a free 30 minute consultation call where we can offer you recommendations and guidance of supportive resources that best align with your unique needs. I’ll see you right back here on Thursday for another one of our Q&A episodes. And until then, don’t be a stranger.