Latest / Dr Justin Coulson's Happy Families / #1274 - What Should You Do If You Think Your Child Has ADHD?

Transcript

#1274 - What Should You Do If You Think Your Child Has ADHD? · Dr Justin Coulson's Happy Families

• 0:06
  Speaker 1: One of the most provocative topics in parenting may be
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  Speaker 1: the conversation that we have around ADHD. What it is,
• 0:14
  Speaker 1: where it comes from. What to do if you think
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  Speaker 1: your child might have an ADHD diagnosis? How do we
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  Speaker 1: figure this out? That is the conversation we're having today
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  Speaker 1: on the Happy Families podcast, Real Parenting Solutions every Day.
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  Speaker 1: This is Australia's most downloaded parenting podcast. My name is
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  Speaker 1: doctor Justin Colson and today, unfortunately without missus Happy Families,
• 0:34
  Speaker 1: Kylie couldn't be with us today. Like every Tuesday, on
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  Speaker 1: the pod, we answer your tricky questions family relationships, well being, screens, discipline,
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  Speaker 1: all that stuff, and today it's ADHD. If you would
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  Speaker 1: like to submit a tricky question, we've got a really
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  Speaker 1: super simple system that you can use at Happy Families
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  Speaker 1: dot com DOTU. Just scroll down to podcasts, click the
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  Speaker 1: record button, start talking. Alternatively, you can send us a
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  Speaker 1: voice note every now and again. Though the questions are
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  Speaker 1: so tricky that you're trying to turn it into a
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  Speaker 1: tricky question becomes cumbersome, and that's what happened to Emily
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  Speaker 1: from Auckland. So instead she sent me an email and
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  Speaker 1: this is what she said. Hi. This is Emily from Auckland,
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  Speaker 1: New Zealand. I work in youth mental health and all
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  Speaker 1: of your podcast I recently heard a mental health professional
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  Speaker 1: claim that ADHD isn't genetic but is actually caused by
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  Speaker 1: highly sensitive children being in a hypervigilant stress state, and
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  Speaker 1: that we should look for stresses rather than medicate. We
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  Speaker 1: have an almost eight year old son showing ADHD indicators
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  Speaker 1: in attention, daydreaming, getting in trouble for silly things, taking
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  Speaker 1: scary risks, and struggling with daily tasks that cause home tension.
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  Speaker 1: His occupational therapist and teachers see red flags, but he
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  Speaker 1: hasn't been formally diagnosed yet. We've been really proactive. He
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  Speaker 1: attended Nature immersed in kindergarten, now goes to Rudolph Steiner
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  Speaker 1: School to reduce academic pressure and stress. Despite all of
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  Speaker 1: our efforts to set him up well, he still struggles significantly.
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  Speaker 1: My question is should we pursue formal ADHD assessment or
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  Speaker 1: focus on addressing underlying stress and anxiety instead. This experts
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  Speaker 1: theory suggests his symptoms are essentially out responsibility as parents
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  Speaker 1: to fix in his environment, which feels overwhelming. What's the
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  Speaker 1: best approach when you've already tried to minimize stresses, but
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  Speaker 1: symptoms persist. Big question, lots to talk about HISS. Where
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  Speaker 1: we begin, first off, Emily number one. This is a
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  Speaker 1: really thoughtful question, and I think that this is touching
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  Speaker 1: on one of the most important debates, and it really
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  Speaker 1: is a debate in child development today. Something that I
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  Speaker 1: want to emphasize is that when it comes to things
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  Speaker 1: to do with parenting and even diagnosis of psychological challenge
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  Speaker 1: or in neurodevelopmental issues, there is a lot more confusion
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  Speaker 1: and contention and conflict in the scientific world than you
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  Speaker 1: might think when you pick up a book and read
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  Speaker 1: about it. Essentially, when you read what someone has to
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  Speaker 1: say about it in their book, they're saying, well, this
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  Speaker 1: is my opinion and we're not going to bring in
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  Speaker 1: all the other stuff. But the science is not settled
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  Speaker 1: around ADHD, not even remotely. In fact, a couple of
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  Speaker 1: new books are coming on the market just now that
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  Speaker 1: describe how psychiatry has infiltrated everything that we do and
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  Speaker 1: now we have labels for everyone and everything. And for
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  Speaker 1: a lot of people they take a lot of comfort
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  Speaker 1: and a lot of support for that, and for many people
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  Speaker 1: they need it. But many other people are getting those
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  Speaker 1: same labels and unfortunately are using them in less optimal
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  Speaker 1: ways that can, in too many cases lead to maladaptive outcomes.
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  Speaker 1: There's also the question of medication. It's a really big thing,
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  Speaker 1: and the reason that people become so inflamed about it
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  Speaker 1: is because we actually don't know. And just because something
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  Speaker 1: really works brilliantly well for one person doesn't mean it
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  Speaker 1: will work brilliantly well for another. And therefore we're in
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  Speaker 1: this quandary what do we do? So in this podcast episode,
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  Speaker 1: I'm going to try, in about ten minutes or less,
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  Speaker 1: to give you a perspective that will integrate what we
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  Speaker 1: know about human motivation as well as stress and physiology
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  Speaker 1: and neurology and healthy emotional, social, and cognitive development. That's
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  Speaker 1: a lot in a really short amount of time, all right.
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  Speaker 1: I want to start off by addressing the current ADHD
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  Speaker 1: situation as it applies across most western nations. This is
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  Speaker 1: the elephant in the room. This is not a popular
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  Speaker 1: thing to say. I recognize that it could even get
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  Speaker 1: me canceled in some circles, but I need to highlight it.
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  Speaker 1: There was a twenty twenty one systematic review in Jamma,
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  Speaker 1: which found pretty convincing evidence that ADHD is overdiagnosed in
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  Speaker 1: children and adolescents, and increasingly, although it wasn't mentioned in
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  Speaker 1: this article, in adults, particularly for individuals with milder symptoms,
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  Speaker 1: where the harm of receiving a diagnosis may actually outweigh
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  Speaker 1: any benefits of a diagnosis. Now, this is not any science,
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  Speaker 1: this is not any psychiatry. What it is is a
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  Speaker 1: recognition that we've created a that all too often pathologizes
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  Speaker 1: normal developmental variation. What do I mean by that, Well, fundamentally,
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  Speaker 1: what we find consistently in studies is that children who
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  Speaker 1: among the youngest in their class or cohort are much
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  Speaker 1: more likely to receive an ADHD diagnosis. In other words,
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  Speaker 1: we might be diagnosing immaturity rather than a neurological or
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  Speaker 1: a psychological condition. Those behavioral differences show up as symptoms
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  Speaker 1: that are actually just due to normal developmental timing. And
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  Speaker 1: let's not forget as well, sometimes kids might be older,
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  Speaker 1: but they still develop later. There's a whole lot of
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  Speaker 1: other stuff that we could talk about in terms of
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  Speaker 1: boys being more diagnosed than girls. And it's not just
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  Speaker 1: because girls are masking. It's because boys neurological development, maturity
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  Speaker 1: occurs more slowly than it does for girls, and a
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  Speaker 1: bunch more stuff. But I think that what's really missing
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  Speaker 1: from both sides of this debate and really gets to
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  Speaker 1: the core of what your question is, is just a
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  Speaker 1: deeper understanding of what children actually need to thrive. So,
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  Speaker 1: if you've been a long time listening Toppy Families podcast,
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  Speaker 1: if you've read any of my books, you will know
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  Speaker 1: that the overwhelming majority of the work that I do
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  Speaker 1: is based in this thing called self determination theory. Self
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  Speaker 1: determination theory tells us that all children, in fact, all adults,
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  Speaker 1: all of us, including those who show ADHD like symptoms,
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  Speaker 1: have three basic psychological needs, and they are known as
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  Speaker 1: relatedness or connection, competence or an ability to master or
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  Speaker 1: at least progress in something, and autonomy a sense of control. Okay, So,
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  Speaker 1: research specifically examining ADHD through an SDT lens shows that
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  Speaker 1: kids who have ADHD symptoms are often experiencing high levels
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  Speaker 1: of what we would call need frustrating or need thwarting environments,
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  Speaker 1: and that parents or teachers in those environments might be
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  Speaker 1: using more controlling approaches in response to challenging behavior, or
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  Speaker 1: maybe the kids just don't feel like they're competent. They're
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  Speaker 1: not capable, and so they rebel They become inattentive because
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  Speaker 1: they're struggling and they want a self sabotage because that's
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  Speaker 1: better than looking dumb. Or maybe they're gifted and so
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  Speaker 1: they're just bought out of their brains, or perhaps the
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  Speaker 1: relationships that they're experiencing around them just don't feel safe.
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  Speaker 1: In other words, your son's behaviors, things like daydreaming and
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  Speaker 1: risk taking and difficulty with daily tasks might be his
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  Speaker 1: brain or his nervous system attempting to meet basic psychological
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  Speaker 1: needs of feeling in control, feeling capable and competent, and
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  Speaker 1: feeling like I'm connected to others in environments that may
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  Speaker 1: not be supporting them optimally. Now, I don't know what's
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  Speaker 1: going on in your home and in your family. I
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  Speaker 1: don't know what relationships are like there. It might not
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  Speaker 1: be a relationship thing. It could be a competence thing,
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  Speaker 1: it could be a giftedness thing. There's any number of
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  Speaker 1: things there. But the first thing that I always do
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  Speaker 1: when I hear parents asking these kind of questions is
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  Speaker 1: I ask you to do a really thorough examination of
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  Speaker 1: your environment. And also the school environment and other environments
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  Speaker 1: where he may struggle in those areas. The Parenting Revolution
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  Speaker 1: is a really deep and careful look at what we
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  Speaker 1: can do to navigate the environment more effectively. So that
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  Speaker 1: kind of addresses the let's put it back on the
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  Speaker 1: parents side of things. Let's understand the environment, see what
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  Speaker 1: it means for the kids. After the break, I want
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  Speaker 1: to talk about development and also neuroinflammatory issues and finally
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  Speaker 1: give you a framework for where you could move forward with. Okay,
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  Speaker 1: let's talk about ADHD and inflammation in the brain. Emerging research,
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  Speaker 1: and this is something that a lot of people are
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  Speaker 1: just not aware of at all. Emerging research shows that
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  Speaker 1: there's some pretty strong links between neuroinflammation and ADHD, including
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  Speaker 1: elevated pro inflammatory ciderkinds in children with ADHD symptoms, and
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  Speaker 1: some evidence as well that early life stress and maternal
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  Speaker 1: immune activation during pregnancy can increase ADHD risk through inflammatory mechanisms.
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  Speaker 1: That's a mouthful. I had to write it down to
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  Speaker 1: make sure that I could read it to you and
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  Speaker 1: get it exactly right. I got this from a guy
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  Speaker 1: by the name of doctor Bryce Joinson. He's based on
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  Speaker 1: the Gold Coast and all of his work is on
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  Speaker 1: neuroinflammatory issues related to ADHD and autism. So what doctor
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  Speaker 1: Joinson says consistently is that children with ADHD, according to
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  Speaker 1: plenty of studies, have increased oxidative stress, and that neuroinflammation
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  Speaker 1: activates different things in the brain which disrupt normal neurotransmitter function.
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  Speaker 1: So we've got animal studies that demonstrate this kind of
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  Speaker 1: neurotransmission challenge as well, and now we're starting to see
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  Speaker 1: it in adults. It means that there's more nourepinephrium, it
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  Speaker 1: means that there's less dope mean, and it means that
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  Speaker 1: if we can reduce brain inflammation, and this is something
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  Speaker 1: that's still fairly new in the science, we've got to
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  Speaker 1: work out exactly how to do that, but it usually
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  Speaker 1: has to do with lots of time outside, really good diet,
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  Speaker 1: lots of movement and exercise. If we can get that
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  Speaker 1: stuff right, what we're going to find is that kids
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  Speaker 1: are going to have less neural inflammation and we can
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  Speaker 1: literally reduce ADHD symptoms by reducing that neurological inflammation. Fascinating, honestly,
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  Speaker 1: beyond my level of expertise. I've got to stop it
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  Speaker 1: there because I'm just going on the stuff that people
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  Speaker 1: who know way more than I do at pointing me towards.
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  Speaker 1: But I think it's fascinating. Here are a couple of
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  Speaker 1: other things that are important here. First off, the developmental perspective.
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  Speaker 1: Your sign at the age of eight is at this
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  Speaker 1: really crucial developmental transition his executive function skills. So we're
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  Speaker 1: talking about attention regulation, we're talking about impulse control, working memory.
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  Speaker 1: These things are still really in a developmental phase. He's
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  Speaker 1: going to get better and better at e motion regulation,
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  Speaker 1: but he's going through through a maturation phase here that's
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  Speaker 1: going to accelerate over the next little while, And honestly,
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  Speaker 1: you're going to see continued improvement with a couple of
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  Speaker 1: steps back now and then. Where your son is right
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  Speaker 1: now compared to his peers could be not at all
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  Speaker 1: about ADHD. It could just be normal developmental timing variations.
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  Speaker 1: Where he is right now compared to his peers could
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  Speaker 1: be it could be just a mismatch between environmental demands
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  Speaker 1: and his current developmental capacity. Like just because most kids
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  Speaker 1: can do it, doesn't mean that all kids can. Perhaps
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  Speaker 1: there's a nervous system stress response because of some unmet, frustrated,
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  Speaker 1: thwarted psychological needs. We've talked about that and maybe maybe
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  Speaker 1: rather medication, he needs support. Now the reality is maybe
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  Speaker 1: he needs medication. I don't know. I'm not there, but
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  Speaker 1: the fact that you've been so proactive with nature based
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  Speaker 1: education and reduced academic pressure, that tells me that you
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  Speaker 1: know this intuitively. So his where I want to challenge
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  Speaker 1: what your stress focused expert has said. Research show that
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  Speaker 1: kids with ADHD symptoms who develop a stress is enhancing mindset,
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  Speaker 1: That is, they see challenges as opportunities for learning rather
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  Speaker 1: than as threats. They just show more resilience, they show
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  Speaker 1: more regulation. So I don't want to see you reducing stress.
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  Speaker 1: Is what I want to see instead, is I want
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  Speaker 1: to see you build his capacity to handle appropriate challenges.
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  Speaker 1: When I'm looking at the latter of san I'm just thinking,
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  Speaker 1: this kid needs to do more hard things. I know
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  Speaker 1: that that sounds horrible and cruel, and it sounds like
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  Speaker 1: we're setting you up for a really, really hard future.
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  Speaker 1: But growth mindset interventions, specifically design for kids with ADHD symptoms,
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  Speaker 1: show that when kids understand that their brain is neuroplastic,
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  Speaker 1: and then it gets stronger by doing hard things. When
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  Speaker 1: they believe that they can develop their abilities through effort.
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  Speaker 1: They show improved the tension regulation, they show reduced behavioral problems.
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  Speaker 1: They just seem to be more resilient. So what would
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  Speaker 1: I do. Here's my recommendation at this point he's eight.
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  Speaker 1: I'd say, unless they're severe impairment, you've got time, so
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  Speaker 1: delay formal diagnosis for now, for now this year, to
• 13:00
  Speaker 1: try to optimize environment and build his capacity and build
• 13:03
  Speaker 1: that growth mindset. Second thing, I'd say, address that inflammation pathway.
• 13:08
  Speaker 1: Make sure he's getting enough sleep. It's absolutely crucial for
• 13:11
  Speaker 1: neuroinflammation regulation. Look at anti inflammatory nutrition. Amiga three is
• 13:16
  Speaker 1: a big here. Minimize process foods, if it comes out
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  Speaker 1: of a packet, try to get it out of his life.
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  Speaker 1: Don't be religious about it, don't be fanatical about it,
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  Speaker 1: but be as good on this as you can be.
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  Speaker 1: Regular movement in nature, your instincts about that, outdoor education
• 13:31
  Speaker 1: a spot on here. I love that you're doing that,
• 13:33
  Speaker 1: and just stress management for the whole family. Next, do
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  Speaker 1: that basic psychological need audit. Have a look at how
• 13:41
  Speaker 1: much choice he has in his life and in his
• 13:43
  Speaker 1: daily routines. And it's not just choice. Autonomy is not
• 13:45
  Speaker 1: about independence. It's about understanding the why. So when he
• 13:48
  Speaker 1: does need to comply, just make sure that he knows
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  Speaker 1: why he needs. To help him to find his strengths
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  Speaker 1: and build from there. Help him to I mean, I
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  Speaker 1: think risk taking is very much about courage and adventure
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  Speaker 1: seeking and try to build confidence I really do and relatedness.
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  Speaker 1: I want to make sure that he feels really connected
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  Speaker 1: and understood, accepted, accepted, not just managed at home, at school,
• 14:08
  Speaker 1: in all of his environments. Fourth thing, implement growth mindset practices.
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  Speaker 1: Teach him about neuroplasticity, that his brain literally grows new
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  Speaker 1: connections when he practices things. Use yet, most powerful, most
• 14:20
  Speaker 1: resilient word in the English language. Use yet. I can't
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  Speaker 1: focus on this yet and really focus on helping him
• 14:26
  Speaker 1: to develop there. And I think reframe symptoms of information.
• 14:31
  Speaker 1: So his daydreaming might just be an indicator of a
• 14:36
  Speaker 1: rich inner life. He might just be a really creative kid,
• 14:39
  Speaker 1: and he might also be bought at school. His risk
• 14:41
  Speaker 1: taking I think shows adventurer and courage and a need
• 14:45
  Speaker 1: for appropriate challenge because he wants to be competent. His
• 14:49
  Speaker 1: struggles with routine tasks they don't necessarily indicate adhd. It
• 14:53
  Speaker 1: might just mean that he doesn't get the point. And
• 14:56
  Speaker 1: if he doesn't buy the why, then he's not going
• 14:58
  Speaker 1: to act with volition, choice, autonomy. When you ask him
• 15:01
  Speaker 1: to do stuff that's in the routine. He's got to
• 15:02
  Speaker 1: know why. All right, let's wrap this up in terms
• 15:06
  Speaker 1: of assessment. If you do pursue assessment, it's going to
• 15:09
  Speaker 1: cost a lot, it's going to take a lot of time.
• 15:10
  Speaker 1: But do it comprehensively. Don't just go through a symptom
• 15:13
  Speaker 1: checklist with your local GP. I think that that's unhelpful
• 15:16
  Speaker 1: in the majority of cases. Studies show that only about
• 15:20
  Speaker 1: half clinicians follow diagnostic guidelines requiring symptom evidence from multiple
• 15:26
  Speaker 1: sources and settings, but ninety three percent of them are
• 15:30
  Speaker 1: immediately willing to prescribe medication. And I just want you
• 15:34
  Speaker 1: to find someone who understands development and trauma and giftedness
• 15:38
  Speaker 1: and family systems, not just ADHD checklists. I want someone
• 15:43
  Speaker 1: who's going to ask about the whole child, not just
• 15:45
  Speaker 1: the symptoms. Fundamentally, here's the bottom line a question like this,
• 15:50
  Speaker 1: anyone who's wondering you're not responsible for quote unquote fixing
• 15:53
  Speaker 1: something that might not actually be broken. I think that
• 15:57
  Speaker 1: your son is probably exactly who he's supposed to be.
• 15:59
  Speaker 1: He just needs an environment that supports his unique nervous
• 16:02
  Speaker 1: system and his developmental timeline and understands how his psychology works.
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  Speaker 1: We're not trying to eliminate all challenges. We're actually trying
• 16:09
  Speaker 1: to do some capacity building so that you can meet
• 16:12
  Speaker 1: those challenges with confidence and with confidence. My experience with
• 16:17
  Speaker 1: my own six kids is that sometimes our most difficult
• 16:20
  Speaker 1: children are showing us that it's our system that needs
• 16:22
  Speaker 1: an adjustment, and not that they need fixing or therapy
• 16:26
  Speaker 1: or anything like that. I like what you're doing. As
• 16:28
  Speaker 1: a general rule, keep trusting your instincts. I reckon you're
• 16:30
  Speaker 1: going down the right path, and the fact that you're
• 16:32
  Speaker 1: asking these really nuanced and careful questions means that you're
• 16:35
  Speaker 1: probably already doing the most important thing, which is that
• 16:37
  Speaker 1: you're seeing your child as a whole person and not
• 16:39
  Speaker 1: a collection of symptoms. Development's not a race, difference, doesn't
• 16:44
  Speaker 1: mean disordered. I really hope that there's been a helpful
• 16:47
  Speaker 1: conversation for you, Emily, so glad that you ask the
• 16:50
  Speaker 1: question if you'd like more information or if you'd like
• 16:53
  Speaker 1: to ask more tricky questions. Jump online to Happy Families
• 16:56
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• 16:58
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• 17:02
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  Speaker 1: Justin Rouland from Bridge Media. And if you'd like more
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• 17:09
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