Latest / Dr Justin Coulson's Happy Families / When Halloween “Hyper” Meets ADHD: What a New Study Reveals About Overdiagnosis

Transcript

When Halloween “Hyper” Meets ADHD: What a New Study Reveals About Overdiagnosis · Dr Justin Coulson's Happy Families

• 0:05
  Speaker 1: Today this is the Happy Families podcast, and tomorrow it
• 0:08
  Speaker 1: is one of the most important days on.
• 0:10
  Speaker 2: The calendar.
• 0:14
  Speaker 1: For people who love traditions like running around neighborhoods looking
• 0:19
  Speaker 1: like Goblin's guls which is skeletons and those europumpkin and
• 0:26
  Speaker 1: knocking on the doors of strangers and asking for treats.
• 0:29
  Speaker 1: Today it's a doctor's Desk episode with a difference. Recent
• 0:34
  Speaker 1: research indicates that one of the most popular, one of
• 0:37
  Speaker 1: the most common childhood diagnoses is related to Halloween. We're
• 0:45
  Speaker 1: going to explore that, what it means, what the implications
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  Speaker 1: are for us as parents, and for this specific diagnosis
• 0:51
  Speaker 1: not to mention Halloween right after the break.
• 0:54
  Speaker 2: Stay with us.
• 1:00
  Speaker 1: Real parenting solutions every day in Australia's most downloaded parenting podcast.
• 1:02
  Speaker 1: That's just one the Happy Family's podcast where Justin and
• 1:04
  Speaker 1: Kylie calls some parents of six kids.
• 1:06
  Speaker 2: I'm the co host and parenting expert.
• 1:09
  Speaker 3: Show Parental seriously slowed down, what do you mean you're
• 1:13
  Speaker 3: like and energizer Bunny.
• 1:16
  Speaker 1: It's a doctor's desk episode. I get very excited about
• 1:18
  Speaker 1: doctor's desk.
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  Speaker 3: That's one of us.
• 1:21
  Speaker 1: Yeah, I can see the enthusiasm oozing just oozing out
• 1:25
  Speaker 1: of your pause. You know it's going to be oozing
• 1:26
  Speaker 1: out of everyone's paws tomorrow. Sugar, sugar, Yeah, Halloween tomorrow.
• 1:31
  Speaker 1: Our opinion this year, like we've gone gung ho a
• 1:33
  Speaker 1: couple of times with Halloween, our opinion this year is
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  Speaker 1: not couldn't be bothered too much, sugar, too tired, too
• 1:42
  Speaker 1: much else going on too hot?
• 1:45
  Speaker 2: Can you come up with another to something just just
• 1:48
  Speaker 2: not happening?
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  Speaker 3: I came up with the best Halloween decoration. Oh yeah,
• 1:52
  Speaker 3: our new pool has colored lights. I'm just going to
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  Speaker 3: make the pool.
• 1:57
  Speaker 2: Red blood red.
• 1:58
  Speaker 3: Done.
• 1:59
  Speaker 2: That's gross, It's done, all right.
• 2:01
  Speaker 1: Today's Doctor's Desk, Kylie, you set it up because I'm
• 2:03
  Speaker 1: going to do a lot of talking in this one.
• 2:05
  Speaker 1: This is probably that's why you don't like the doctor's Desk?
• 2:07
  Speaker 1: Isn't it because I do all the talking. I get
• 2:09
  Speaker 1: science y? Is it the science or is it the
• 2:11
  Speaker 1: fact that you're not talking as much as you want to?
• 2:15
  Speaker 2: Look?
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  Speaker 3: I don't. I don't keep very quiet about the fact
• 2:17
  Speaker 3: that I don't really enjoy many of the doctor's desks.
• 2:21
  Speaker 3: But I am actually intrigued about this one.
• 2:23
  Speaker 2: This one's a cracker.
• 2:24
  Speaker 3: So there's been some research done recently that would suggest
• 2:28
  Speaker 3: that ADHD diagnoses actually increase during Halloween.
• 2:36
  Speaker 2: Correct. Okay, so this is a brand new study.
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  Speaker 1: It came out a couple of months ago, and it
• 2:41
  Speaker 1: caught my attention because over the years, ADHD, even though
• 2:45
  Speaker 1: more and more people are aware of it, more and
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  Speaker 1: more people are being diagnosed with it. ADHD has become
• 2:50
  Speaker 1: an increasingly provocative diagnosis. I mean, most diseases, as we
• 2:53
  Speaker 1: learn more about them, they become easier for us to understand.
• 2:57
  Speaker 1: But ADHD seems to be going the other way. And
• 3:00
  Speaker 1: in a recent working paper that was published in the
• 3:02
  Speaker 1: National Bureau of Economic Research, and the paper is called
• 3:06
  Speaker 1: Halloween ADHD and Subjectivity in Medical Diagnosis, some Harvard research
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  Speaker 1: has spotted an opportunity for a wonderful natural experiment that
• 3:14
  Speaker 1: the calendar provides with the Halloween holiday and kids getting
• 3:18
  Speaker 1: a little bit hyper because of all the sugar and
• 3:20
  Speaker 1: the social opportunity and the running around the neighborhood and
• 3:23
  Speaker 1: doing what they're doing. So, though, were really curious where
• 3:26
  Speaker 1: the changes in young patients' behavior related to the excitement
• 3:31
  Speaker 1: of wearing a costume and collecting lawies on Halloween might
• 3:33
  Speaker 1: influence the diagnosis of ADHD. Now analyze the data on
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  Speaker 1: more than one hundred million pediatric visits. Okay, so this
• 3:40
  Speaker 1: is no small sample. This is legitimately a serious study.
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  Speaker 1: And what they found is this, there's a fourteen percent
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  Speaker 1: increase in childhood ADHD diagnoses on Halloween compared to the
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  Speaker 1: ten surrounding weekdays. I'll say that again, a fourteen percent
• 3:58
  Speaker 1: increase on Halloween compared with the ten surrounding weekdays.
• 4:03
  Speaker 3: So when you're talking about a hundred.
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  Speaker 1: Million pediatric visits, yep.
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  Speaker 3: Fourteen percent is a big deal.
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  Speaker 2: That's a large number. That's huge.
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  Speaker 1: Yes, Yes, for that particular diagnosis on that particular day
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  Speaker 1: compared to all the other days around it. There must
• 4:21
  Speaker 1: be something particularly unique about October thirty first that makes
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  Speaker 1: for ADHD diagnoses more likely.
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  Speaker 3: As you're talking, it reminds me of a conversation I
• 4:31
  Speaker 3: just recently had with your mum. She actually was going
• 4:34
  Speaker 3: through some old journal entries and she shared the funniest one.
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  Speaker 3: She's acknowledged that she's been on a bit of a
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  Speaker 3: rampage and she was really unkind to everybody. And then
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  Speaker 3: she kind of paused and she said, I wonder if
• 4:49
  Speaker 3: it had anything to do with the fourteen Ferrera rishiance
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  Speaker 3: that I hate that day, so I don't think this
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  Speaker 3: is just a kid thing.
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  Speaker 2: Yeah, that's such a good story. I was hearing where
• 4:59
  Speaker 2: you're going there. I do remember that story. I ate
• 5:01
  Speaker 2: fourteen Ferrero risches and.
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  Speaker 1: Then I was horrible to everybody. For us today made
• 5:05
  Speaker 1: me feel good, but it made everyone else really really annoying.
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  Speaker 3: But the funniest part was she says, I'm never going
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  Speaker 3: to eat chocolate again. Right, Your mom is the biggest
• 5:14
  Speaker 3: chocoholic I know.
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  Speaker 1: I think that I've heard her say that over the
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  Speaker 1: years since I've known her at least four hundred times,
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  Speaker 1: at least probably four thousand times.
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  Speaker 3: And you tell her that you're giving up chocolate and
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  Speaker 3: she just keeps skipping.
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  Speaker 1: She yeah, that's right because when she gives up chocolate
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  Speaker 1: as meaningless. So if anyone else is giving it up,
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  Speaker 1: they mustn't be giving it up either. All right, let's
• 5:34
  Speaker 1: talk about this study. Does that spark any questions for you?
• 5:37
  Speaker 1: Is there anything that you'd like to know?
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  Speaker 3: Well, I guess let's go back to the beginning. How
• 5:41
  Speaker 3: is ADHD actually diagnosed?
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  Speaker 1: So this is really important because in medicine, the first
• 5:46
  Speaker 1: step is you've got to get the diagnosis accurate.
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  Speaker 2: And yet there's a whole lot.
• 5:51
  Speaker 1: Of conditions including attention deficit hyperactive. I can't say now
• 5:55
  Speaker 1: ADHD attention deficit hyperactive hyperactivity disorder that requires pediatricians and
• 6:03
  Speaker 1: GPS and mental health professionals to rely on much more
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  Speaker 1: subjective criteria like the observation of symptoms and behaviors. See,
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  Speaker 1: you can do a blood test and work out whether
• 6:15
  Speaker 1: somebody is diabetic. You can do an X ray and
• 6:18
  Speaker 1: work out whether somebody's broken their arm, but you cannot
• 6:22
  Speaker 1: scan a person's brain or take a blood test and
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  Speaker 1: discover whether they have ADHD. We do not have objective
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  Speaker 1: measures for it, and this is one of the major
• 6:30
  Speaker 1: criticisms of ADHD. So to diagnose ADHD, which is getting
• 6:35
  Speaker 1: to the core of the question you asked, there is
• 6:37
  Speaker 1: a formalism that goes into the diagnosis, but ultimately it's
• 6:43
  Speaker 1: a snapshot of somebody's subjective opinion. So pediatricians, shod mental
• 6:48
  Speaker 1: health specialists, whoever it is. What they do is they
• 6:51
  Speaker 1: assess a pattern of behavior across school life and life
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  Speaker 1: at home, maybe other context as well, if they're relevant.
• 6:55
  Speaker 1: They get information from parents, from teachers, and then they
• 6:59
  Speaker 1: pretty much what's going on here. But the actual diagnosis
• 7:04
  Speaker 1: will happen on a specific day, So when the doctor's
• 7:06
  Speaker 1: making that diagnosis, the conditions that are occurring on that
• 7:11
  Speaker 1: specific day could influence whether or not. Let's say that
• 7:15
  Speaker 1: mental health specialist is on the fence, but on that
• 7:18
  Speaker 1: particular day, it's Halloween and the kids are a bit
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  Speaker 1: hyper and there's a whole lot of sugar and junk
• 7:21
  Speaker 1: and costumes and excitement, and they're like, yeah, your child
• 7:24
  Speaker 1: does seem pretty edgy today. And they're not thinking hm,
• 7:26
  Speaker 1: because it's Halloween. They're just going, your child seems edgy.
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  Speaker 1: And we're talking about ADHD. So ADHD is diagnosed subjectively.
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  Speaker 1: There are no objective measures for it. The criteria are
• 7:36
  Speaker 1: loose and are becoming looser. They have become looser over
• 7:39
  Speaker 1: the last couple of decades, and that is problematic. I'm
• 7:43
  Speaker 1: not gonna lie about it, like that is a really
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  Speaker 1: big problem for ADHD diagnosis.
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  Speaker 3: Can you elaborate a bit more on the subjectivity of
• 7:52
  Speaker 3: this diagnosis.
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  Speaker 1: Yeah, So we've been through this with our own kids,
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  Speaker 1: so you.
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  Speaker 3: See, Well, I'm thinking back to that experience, and I'm
• 7:58
  Speaker 3: thinking back to the day I walked in. I mean,
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  Speaker 3: I was convinced that we had a very different child
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  Speaker 3: to the rest of our children. But that particular day,
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  Speaker 3: it was like she pulled out every conceivable behavior challenge
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  Speaker 3: that we'd had and displayed it for the psychologists. Literally,
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  Speaker 3: I had never seen her that bad before, but she
• 8:26
  Speaker 3: had displayed all of those things individually at different times.
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  Speaker 2: Yeah, that's right.
• 8:32
  Speaker 3: It wasn't Halloween eitherm No.
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  Speaker 1: Well, who knows it could have been, but it wouldn't
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  Speaker 1: have been a big deal for us anyway, because we
• 8:36
  Speaker 1: don't really do much about it.
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  Speaker 2: So the diagnosis, the.
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  Speaker 1: Diagnostic criteria for ADHD is literally subjectivity is baked in.
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  Speaker 1: It's part of how you assess ADHD. You cannot assess
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  Speaker 1: ADHD without the subjective responses. So, and I remember you
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  Speaker 1: saying this as we went through the checklist for our children.
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  Speaker 1: There's a question like, is this child fidgety?
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  Speaker 2: They restless?
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  Speaker 1: Do they move their bodies a lot? Do they talk
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  Speaker 1: when they should be talking? They interrupt and.
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  Speaker 3: They are all childlike behaviors.
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  Speaker 1: Well, every child does, that's right, And so to adults,
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  Speaker 1: what do you mean. I would never interrupt anybody, my goodness,
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  Speaker 1: And so obviously, when you're talking about parents, they don't
• 9:20
  Speaker 1: necessarily know how everyone else's kids are. Teachers will have
• 9:23
  Speaker 1: a much broader population to sample from and say, oh
• 9:27
  Speaker 1: my goodness.
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  Speaker 3: But I guess that's why part of that testing process
• 9:31
  Speaker 3: involves other professionals to kind of collaborate.
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  Speaker 1: Well supposedly, but they're going to be guided by what
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  Speaker 1: the parents are saying and by what the teachers are saying.
• 9:38
  Speaker 1: So that's only so helpful. But that's how the subjectivity
• 9:41
  Speaker 1: comes into play. This is the Doctor's Desk episode of
• 9:44
  Speaker 1: Heavy Families podcast. We're talking about ADHD and Halloween and
• 9:47
  Speaker 1: whether or not the diagnosis that you get are actual
• 9:50
  Speaker 1: diagnosis or whether there's too much subjectivity involved. More on
• 9:54
  Speaker 1: this in just a sex Stay with us. We're back
• 10:04
  Speaker 1: with the Happy Families podcast, Real Parenting Solutions every day
• 10:06
  Speaker 1: on Australia's most downloaded parenting podcast. You have another question
• 10:11
  Speaker 1: on the tip of your ton.
• 10:12
  Speaker 3: Well, from what you've shared previously, it would suggest to
• 10:18
  Speaker 3: me that you think that often there's misdiagnosis happen and
• 10:22
  Speaker 3: if that's the case, what is problematic with that?
• 10:25
  Speaker 1: So this is really really difficult because this whole conversation,
• 10:29
  Speaker 1: I know that we're going to get emails from people
• 10:31
  Speaker 1: who say that I'm invalidating their diagnoses or that I'm
• 10:36
  Speaker 1: giving short shrifts to ADHD. I mean, I've got a
• 10:39
  Speaker 1: course out there to help parents who are raising kids
• 10:40
  Speaker 1: who have a diagnosis. Right, So I recognize that if
• 10:43
  Speaker 1: you've got a constellation of behaviors that are challenging, then
• 10:45
  Speaker 1: you need help with them. And you can call it
• 10:47
  Speaker 1: ADHD or you can call it challenging behavior. It doesn't
• 10:49
  Speaker 1: really matter. What we've got to do is work out
• 10:51
  Speaker 1: how to help. And I'm concerned about treatment pathways. That's
• 10:56
  Speaker 1: the medical jargon, the technical term for when you get diagnosis.
• 11:00
  Speaker 1: Here are the steps that are supposed to be followed.
• 11:02
  Speaker 1: This is what most people will be focused on. So
• 11:05
  Speaker 1: let's say, in the context of this study, you take
• 11:08
  Speaker 1: your child in on the wrong day and the likelihood
• 11:11
  Speaker 1: of them getting a diagnosis is significantly higher. Let's say
• 11:14
  Speaker 1: you've got two or three kids that are being diagnosed.
• 11:19
  Speaker 1: Two might be diagnosed on in a given day, but
• 11:21
  Speaker 1: on Halloween that goes up to three because the subjective
• 11:25
  Speaker 1: cultural environment that's changing things. And the problem to answer
• 11:31
  Speaker 1: your question with misdiagnosis is that means that that's one
• 11:34
  Speaker 1: more child that's wearing a label. It means it's one
• 11:36
  Speaker 1: more child who is going to potentially end up with
• 11:39
  Speaker 1: a medication prescription, one more child that's going to end
• 11:41
  Speaker 1: up on speed, one more child who's going to now
• 11:45
  Speaker 1: feel like not only do they already feel different, but
• 11:48
  Speaker 1: now they've got a label confirming they're different. And I've
• 11:52
  Speaker 1: always been pretty clear on the podcast, I understand that
• 11:54
  Speaker 1: in some cases labels can be really, really helpful, but
• 11:57
  Speaker 1: I find all too often that labels are used to
• 12:00
  Speaker 1: explain away, rather than support change in behavior.
• 12:04
  Speaker 3: Recently, I had a conversation with a specialist in relation
• 12:08
  Speaker 3: to our daughter, and they definitely wanted to push me
• 12:13
  Speaker 3: down a specific line of treatment, and I just said
• 12:17
  Speaker 3: to her, I said, at this point in time, she's
• 12:20
  Speaker 3: completely unaware that she's different. And I said, I just
• 12:24
  Speaker 3: I'm going to bubble that for as long as I can,
• 12:27
  Speaker 3: because she doesn't think there's anything wrong with her.
• 12:31
  Speaker 1: So this goes to what I think is a much
• 12:33
  Speaker 1: deeper and broader discussion about ADHD. And it's also a
• 12:38
  Speaker 1: really hard one to talk about. And again, this is
• 12:39
  Speaker 1: the kind of thing that gets people really upset. I'm
• 12:41
  Speaker 1: not trying to be insensitive. This is a sensitive but.
• 12:44
  Speaker 3: The reality is there isn't anything wrong with her, thank you.
• 12:49
  Speaker 3: There isn't anything wrong with her, right she just doesn't
• 12:51
  Speaker 3: fit the mold of what we consider normal.
• 12:55
  Speaker 1: And there's so much variation in normal. That's exactly why
• 12:58
  Speaker 1: I'm reading this book. I'm almost finished Searching for Normal
• 13:01
  Speaker 1: by Sammy Timimi. I love this book. I also hate it,
• 13:04
  Speaker 1: but I love this book. This book is worth so
• 13:08
  Speaker 1: much in terms of the conversations and the provocations and
• 13:11
  Speaker 1: the thoughtfulness that it gives. And what this study does
• 13:15
  Speaker 1: is it reaffirms a lot of what I've been reading
• 13:17
  Speaker 1: in this book and certainly some of my own misgivings
• 13:20
  Speaker 1: about this specific diagnosis over the last decade as I've
• 13:23
  Speaker 1: learned more and more and more about it and gone.
• 13:25
  Speaker 2: Deeper and deeper into it.
• 13:26
  Speaker 1: So about ten percent of Australian kids and now being diagnosed.
• 13:33
  Speaker 1: Boys are significantly more likely to be diagnosed than girls
• 13:36
  Speaker 1: because they mature later, they learn to regulate and inhibit later.
• 13:42
  Speaker 1: And there are really big questions being asked because there
• 13:44
  Speaker 1: is no blood test and there's no brain scan, there's
• 13:47
  Speaker 1: no objective criteria here. Some people are saying, well, is
• 13:50
  Speaker 1: it really a disorder, like these are questions that we
• 13:52
  Speaker 1: were asking twenty years ago, and now we've gone really
• 13:56
  Speaker 1: hardcore for the last twenty years down this Yes it is,
• 13:58
  Speaker 1: diagnose it that path, and now we're having really really
• 14:02
  Speaker 1: smart people, really incredible people, say we need to rethink this.
• 14:08
  Speaker 1: We may not have gotten this right. Is this within
• 14:11
  Speaker 1: some range of normal? To speak to your point, that's
• 14:13
  Speaker 1: what brought me back to where we are here. Medication
• 14:16
  Speaker 1: is the right answer. So this is a massive debate,
• 14:20
  Speaker 1: massive debate in educational circles, in psychological circles, in medical circles,
• 14:23
  Speaker 1: in psychiatric circles. It's a really big thing. People are
• 14:27
  Speaker 1: concerned about overdiagnosis. They're concerned about drugs, they're concerned about overtreatment,
• 14:31
  Speaker 1: they're concerned about harm, and they're also concerned about underdiagnosis
• 14:35
  Speaker 1: and undertreatment of kids in populations where help is often
• 14:39
  Speaker 1: not available. It's a really, really tricky thing to discuss
• 14:43
  Speaker 1: without upsetting people. But again, you look at what the diagnosis,
• 14:47
  Speaker 1: the diagnostic criteria are. You look at the fact that
• 14:50
  Speaker 1: you've got more kids than ever in the younger stage,
• 14:54
  Speaker 1: younger parts of the cohort getting the diagnosis, and you've
• 14:58
  Speaker 1: got to wonder if we're actually diagnosing ABA or immaturity.
• 15:01
  Speaker 3: More than that, though, when we look at the increase
• 15:05
  Speaker 3: of diagnoses over the last decade or so, would it
• 15:10
  Speaker 3: not be wise to actually question the environment our kids
• 15:14
  Speaker 3: are in.
• 15:16
  Speaker 2: You haven't read the book, but this is what sent
• 15:18
  Speaker 2: me to me.
• 15:18
  Speaker 1: Me says, He says, Let's stop saying that there's a
• 15:20
  Speaker 1: problem with this child individually, and let's start saying what
• 15:24
  Speaker 1: is going on in the environment that so many children
• 15:25
  Speaker 1: are now receiving a diagnosis that once upon a time
• 15:27
  Speaker 1: did not even exist.
• 15:29
  Speaker 3: That's exactly right. You take a child out of that
• 15:31
  Speaker 3: specific environment, and all of a sudden, their behavior changes.
• 15:36
  Speaker 2: I had this exact conversation with some parents the other day.
• 15:39
  Speaker 1: I made a glib and strong statement about ADHD, probably
• 15:42
  Speaker 1: much stronger than I really meant to. Someone got offended,
• 15:44
  Speaker 1: and then we had a much broader, in depth conversation
• 15:47
  Speaker 1: like this, And that's the point that I made. You
• 15:49
  Speaker 1: take that child out of the classroom or out of
• 15:52
  Speaker 1: a screen soap setting.
• 15:54
  Speaker 2: And put them into a play basis.
• 15:55
  Speaker 1: Or out of the dictatorship, right and give them some autonomy.
• 16:00
  Speaker 3: And all of a sudden, we see such a different
• 16:04
  Speaker 3: child presented.
• 16:06
  Speaker 2: That's right.
• 16:07
  Speaker 1: So this is an important study. I really think that
• 16:09
  Speaker 1: it's an important study because it's again raising questions and saying,
• 16:13
  Speaker 1: what are we doing here with this diagnosis?
• 16:15
  Speaker 3: So does it actually shed any light on ADHD itself?
• 16:18
  Speaker 1: I only and this is a very quick answer. It
• 16:21
  Speaker 1: just highlights how subjective the diagnosis is. To me, that's
• 16:24
  Speaker 1: the critical thing.
• 16:25
  Speaker 3: We've kind of touched on this a few times, but
• 16:27
  Speaker 3: just a little bit of clarity here. It is interesting
• 16:30
  Speaker 3: to me that with all the research we have on
• 16:35
  Speaker 3: ADHD these days, comparative to ten twenty years ago, why
• 16:39
  Speaker 3: is it that we still I feel like we've got
• 16:43
  Speaker 3: less clarity now with all the research we have than
• 16:46
  Speaker 3: we've ever had around ADHD.
• 16:49
  Speaker 1: So Annaple Jenna, who was one of the researchers here,
• 16:52
  Speaker 1: wrote a book a few years ago called Random Acts
• 16:54
  Speaker 1: of Medicine, and there's a finding reported in that book,
• 16:58
  Speaker 1: but also reported in Countless of a PAS that kids
• 17:01
  Speaker 1: who are born at the late part of the year
• 17:05
  Speaker 1: tend to be much more likely to be diagnosed with
• 17:08
  Speaker 1: ADHD than kids born at the start of the year. Okay,
• 17:11
  Speaker 1: so in Australia the school year, if you're born later
• 17:14
  Speaker 1: in the year. It depends on where the cutoffs are,
• 17:16
  Speaker 1: but basically, if you're the youngest kid in the year,
• 17:17
  Speaker 1: you're much more likely to be diagnosed with it. The
• 17:20
  Speaker 1: reason is that you're the youngest person in the class,
• 17:23
  Speaker 1: so your behavior is a bit different and we start
• 17:25
  Speaker 1: to make these diagnoses. So realistically, what I think here
• 17:30
  Speaker 1: is that the implication is that a lot of the
• 17:32
  Speaker 1: kids that are getting a diagnosis may not have ADHD.
• 17:35
  Speaker 1: They're just different because they've been alive for one year
• 17:38
  Speaker 1: less than the older kids in the class. And if
• 17:42
  Speaker 1: you're a general practitioner or if you're a psychologist and
• 17:45
  Speaker 1: you're making an ADHD diagnosis, you want to make sure
• 17:48
  Speaker 1: that you're taking into account birthday, and you want to
• 17:51
  Speaker 1: take into account gender, and you want to take into
• 17:54
  Speaker 1: account what else has been going on in that child's environment.
• 17:57
  Speaker 2: There is so much other stuff that.
• 17:59
  Speaker 3: Screen and how much outdoor time and how much connective
• 18:03
  Speaker 3: time they're having, Like, there's so many factors to a
• 18:06
  Speaker 3: round out a healthy human being.
• 18:09
  Speaker 1: And that is our doctor's desk episode. I mean, I'd
• 18:11
  Speaker 1: love to keep talking about it, but our time as well,
• 18:13
  Speaker 1: and truly up, do you have any other questions?
• 18:15
  Speaker 3: No, I think we've covered it.
• 18:16
  Speaker 2: All all right, nowhere is it all?
• 18:18
  Speaker 1: So we'll link to the study in the show notes.
• 18:21
  Speaker 1: We'll also link to Sammy to Mimi's book Searching for
• 18:25
  Speaker 1: Normal in the show notes. I'm very excited. Just as
• 18:28
  Speaker 1: I started to finish the book, as I moved into
• 18:30
  Speaker 1: the last chapter, I got an email from the publicist
• 18:33
  Speaker 1: of the book and they said, would you like him
• 18:34
  Speaker 1: on your podcast? So We're going to interview him early
• 18:36
  Speaker 1: next year and I'm going to go into a lot
• 18:38
  Speaker 1: of depth on exactly this topic. It's just too important
• 18:40
  Speaker 1: to not talk about more.
• 18:42
  Speaker 3: Oh, I'm looking forward to that one.
• 18:43
  Speaker 1: I love it when you look forward to my interviews
• 18:45
  Speaker 1: with amazing people. Hey, thanks so much for listening to
• 18:48
  Speaker 1: the Doctor's Desk episode of the Happy Families podcast. The
• 18:51
  Speaker 1: podcast is produced by Justin Roland from Bridge Media. Mim
• 18:53
  Speaker 1: Hammond's provides admin, research and additional support.
• 18:56
  Speaker 2: And if you'd like.
• 18:57
  Speaker 1: More info about the stuff we've talked about, please have
• 18:59
  Speaker 1: a quick look at the show notes and we will
• 19:01
  Speaker 1: link to everything that you need there. If you'd like
• 19:03
  Speaker 1: a resource to help because you've got a child who
• 19:05
  Speaker 1: is behaving in challenging ways, check out my book Parental guidance.
• 19:09
  Speaker 1: You can get it online wherever you find books in
• 19:12
  Speaker 1: bookstores and happy families dot com, dot A, you