Isabelle & David welcome Isabelle’s husband, Bobby, and their friends, Christina, AJ, and Gabe, to continue to listen and learn from David’s tried and tested presentation on ADHD, which he normally gives to fellow clinicians (for the 1st-5th parts of this talk, please see episode 4, All About ADHD Part I; episode 6, All About ADHD Part II; episode 9, All About ADHD Part III; episode 12, All About ADHD Part IV; episode 15, All About ADHD Part V). The audience checks in about the things they’ve remembered from previous lectures—the need for structure, wins, energy bar (making sure you use your energy during the day)—inability to integrate past memories into future experience means you have to develop metacognition, thinking about your thinking. What are we going to do about ADHD? ADHD is most often scapegoated for the world’s crap. For example, people dealing with all kinds of things, but the one diagnosis a parent will share on the playground after their kids shows all kinds of behaviors is ADHD, not the OCD, Bipolar II Disorder, etc. that their child is also experiencing. We also only attribute things to ADHD when they’re negative or could be viewed as negative—for example, after a meltdown—“It’s my ADHD” when no one ever completes a task brilliantly and says “it’s my ADHD!” Are people born having ADHD? Yes, you are born with it, you are genetically predisposed to it, if you have it someone in your family likely has it, and in places where ADHD is not present in the entire family, there is a family traumatic experience that can prime you, and even specific gene setups that can link to being more or less vulnerable to environmental factors (See Orchid Children article below). David talks about ADHD as a gift, referencing his incredible friend, Bill, who’s excited and about to make anything exciting when he talks about it. He travels the world giving speeches, writing articles, or improving his investment portfolios, the man does not relax—this is also about ADHD. It’s genetic, not a choice. What we do have a choice in is how we develop frustration tolerance, developing a sense of who you are, developing your self-esteem: that’s the variable. You have to believe you can do “it,” no matter how realistic, the belief needs to be fostered. The second most important thing is advocating for accommodations: knowing what you need and asking for it. The third most important thing is metacognition (thinking about thinking): knowing why the accommodation works, knowing you can do it because you’ve done it before—understanding why it works—for example, knowing you’re frustrated because you didn’t use your energy bar. Some people are born like an orchid, some are born like a dandelion: a dandelion can grow through a concrete slab, you can mow over them, they grow right back. David describes the orchid he is purchasing for his love and partner, Robin, and got this orchid and then he says he’s going to take care of it, and he killed it in a week. You can also put one ice cube on the orchid a week (or sprays)—and let it run with water. Students in schools are all treated like dandelions; but if you water an orchid like you water a dandelion, it’s dead. But orchids are beautiful, they last so long, they grow on some of the most inhospitable things, they add color and beauty to anything. What are the environmental watering instructions for someone with ADHD—it’s constantly having a menu and having to do things differently. Knowing why you struggle with something—a school would never take someone in a wheelchair and asks them to walk—they would create accommodations. So why take someone with ADHD and ask them to do something that they need to do differently and ask them to do it the same? ADHD is not a learning disability, it’s a sitting still, a pacing disability (when things move slowly, David turns into an insane person—like a slow-walking person…but put him in the trenches and he’s ready)—so he crosses the street, he goes out of the way to mitigate his frustration.  Using a relief pitcher metaphor from baseball, a relief pitcher doesn’t pitch the whole game, or run, or hit the ball—it’s hard to define them as a baseball player…but they’re highly coveted for what they do.  Now imagine a relief pitcher saying to their school: “I want to be a baseball player” so the school focuses on the running, hitting the ball, etc. but…it misses the thing that person does and does well. So part of the accommodation is knowing where you a relief pitcher, what you do well, and staying in your lane. For example, David and his partner set it up so that he has an allowance and passes money to her—not because he’s in shame about how he manages money, but because it helps him stay in his lane and not spend all his money on jujubes. The best accommodations are ones we make ourselves. One type of accommodation is Differential Reinforcement of the Other (DRO) which means that you make the behavior you’re trying to avoid not an option. For example, if you’re trying to not bite your nails, you wear gloves or bandaids so that you can’t bite them. So you get a win without having to deny yourself all the time. Like if you want donuts or marshmallows but you don’t buy them so they’re not available when you crave them, so you win even though you don’t have to try to ‘win.’ Another example: you’re struggling to study in study hall because you want to talk to your friends: switch rooms so you’re not with your friends. Instead of expecting yourself to regulate the distractions, which you cannot do well with ADHD, you change your environment to eliminate the distraction. It’s not wiring together the urge with the thought with the behavior, because it can set you up for lower self-esteem and self-confidence—if you keep failing at resisting something, you believe you can’t resist it. Another comparison is like a smoker trying to quit smoking—you can’t break the urge to smoke, but you can not have cigarettes on you when the urge hits. David emphasizes that one accommodation fits one person, there isn’t a one size fits all: instead it’s changing how you think about making accommodations. The group brainstorms ways to do DRO accommodation when you’re always facing something—like when you’re trying to eat healthy when eating out, but tempted by all the options. You can try to not have a menu—or having a time window when you are a sticking to a boundaried diet (10-2p)—so harm is reduced. Harm reduction is one way to think about it, versus abstinence.

Orchid Children article David mentions (renamed “The Science of Success”) (Source: The Atlantic, 2009)

Differential Reinforcement of the Other (DRO): Making the behavior you’re trying to avoid not an option. How to succeed without having to combat an urge. 

For example: not having the amazon app so you don’t buy things impulsively, not buying the marshmallows so you don’t have them at home when hit with the urge to eat them. If you struggle in study hall because you want to talk to friends, you switch study hall to a room that doesn’t have your friends in it. 

Metacognition: Thinking about thinking. Knowing why something works, like an accomodation. A crucial skill to hone to help you work with your ADHD. 

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