SIO350: A Very ADHD Episode on ADHD

Transcript

This transcript was generated automatically and may contain errors — the audio is the record.

0:00:15 Thomas: Hello and welcome to Serious Inquiries Only. This is episode 350. got a great episode for you. Stormy Decisis, finally! I teased Stormy a while ago, but you may recognize the name, of course, Stormy Decisis, Amazing Questioner, but they are also known as, or well, really just only known as Dr. Alan Smirbeck, and Alan takes us through a deep, okay, it's a very ADHD episode on ADHD. ADHD and that's who I am. And I hopefully that's something you folks tolerate or maybe enjoy, but I thought it was fitting. It was a very, we jumped around, but a very educational deep dive on ADHD. And, uh, I talk a lot about recently my efforts to be diagnosed and what I've gone through, but it, you know, there's a little bit of, you're not boring my story kind of stuff, but there's also a ton great info in here and a lot. I thought it was so fun. So excited long last. I am joined by Stormy Decisis. Or should I call you Dr. Decisis? You, How let me know how you, what you go by.

0:01:19 Stormy: Czar. Czar is fine.

0:01:20 Thomas: Czar Decisis, no, I can't, look, it's heartbreaking to me to call you anything other than Stormy Decisis, but I'm sure you would rather have people know who you actually are, right? Right. I mean, so feel free to introduce yourself how you would prefer to be called.

0:01:20 Stormy: Uh my name is uh Alan Smirbeck. I'm a psychology professor at Rochester Institute of Technology and uh I have no special skills.

0:01:45 Thomas: That's not true. Of course, Dr. Decisis, which is now what I'll call you forever. Wait, do have a special skill, which is you were this is going to offend some people, but you were OK, don't tell anybody I said of this. You were hands down the best question asker in all of the other podcasts history. But that's a tight race. That is to say nothing disparaging about any other questioners who are also incredibly great. In fact, they were so great that that only makes your greatness look better. There was a tight trace. I would say you edged them out. So that's why you will always be stormy to me. But I guess I'll say, OK, nice to meet you, Alan. Thanks for going on the show. And I'm so so excited to speak with you today.

0:02:00 Stormy: Yes!

0:02:24 Stormy: Well I just want to thank you for saying that I edged them out and not edged to them because a lot of news things keep saying like in the polls someone's edging someone else and I'm like, I mean, maybe, but that's doesn't mean what you think it means.

0:02:38 Thomas: We're you see the tweet? It was by that guy from Some More News who was, I got to say, really, really funny. Chris Pine, I believe, who's in the new D&D movie. And the headline was like, Chris Pine is Ed. It must be like Edgin or something, but he's like E -D -G -I -N. You know, it's like Chris Pine as Edgin the Bard in the New D &E movie. And he tweeted, Chris he's doing what?

0:02:38 Stormy: Oh,

0:03:04 Thomas: It's so good. But it's great to have you again. I'm super excited about today's topic and I wanted to give a little introduction because it kind of, it's actually a little bit of a crossover in it's based based on an episode of Dear Old Dads that came out in March, and it was about me getting a diagnosis or, well, I don't know.

I don't have it yet, but going through the evaluation for ADHD, and I know not everyone listens to every podcast, so I' l kind of briefly state what that was about, but you should listen to the episode because it's actually really funny. It's an incredibly funny episode, but suffice to say, I, I've been paying out of pocket for ADHD stuff because of, I, and it sounds like other places in the West Coast.

I don't really know what the limits are, but I have a thing called Kaiser and lots of people don't know what I'm talking about when I talk about Kaiser being my health provider. It's insurance, it's everything, it's doctors, it's a whole, it's a whole everything. It's every level of medical care basically. And it's really good on a lot of stuff, like most stuff. It's very good coverage, except mental health. It'' S like notoriously not great with mental health.

And And because I knew that and because I had talked to a therapist in Kaiser and he had kind of warned me about how shitty it can be with ADHD and other stuff, I just went one route of one of those online bullshit ADHD things because to reset even further, sorry, I'm virtually positive if I have ADHD based on my entire life of not ever being able to focus on anything.

And only recently I decided I wanted to like actually pursue some sort of treatment for it. You know, I'm 36 now and I've always thought I had it, but I never thought I could do anything about it, you know, and I knew that the treatment often was like, you, you know, these drugs, these stimulants. And I've always been nervous about that kind of thing. And I don't, you know, I'm somewhat prone to anxiety. So I've, I'm always worried about that.

Like, are they going to trigger my anxiety kind of things? So it took a while. And then eventually I decided like, no, I got to just try, I actually don't even remember why I decided to try it. But eventually I decided try to get treatment. So I did one of those online things and it was as bullshit as it sounds.

They asked me a few questions and then I had, you now, was able to to get Adderall, but eventually, because the Adderalls shortage is so bad, I can only, there's nothing like I can't get anything. And like, so the pharmacies stopped filling the prescriptions for those online bullshits, you know, cause of, uh, cause of other reasons too. Like it's related to the pandemic. They had a temporary permission to like e-prescribe stimulants, but then that's going away.

So then I had to change and find another doctor. I found a doctor locally, but again, because there's no Adderall, I can only do this super expensive one is like the only one I can get because it's, it's Vyvanse and it's not, there's not generic

0:03:04 Stormy: My oh, Yeah,

0:05:47 Thomas: Yet.

0:05:47 Stormy: Vyvanse of Adderall that they have sort of attached an extra molecule onto it, and if that molecule is attached it won't work, it gets detached as it goes through your digestive system and through your liver and all of that, and basically the thing is you can't crush it and snort it.

0:05:48 Thomas: Yeah.

0:06:10 Thomas: Oh, is that like the only innovation of it?

0:06:13 Stormy: So it's designed, it was designed to be given like to an adolescent that you're worried they're gonna abuse it, but

0:06:19 Thomas: Hmm. Interesting. What about, okay, now don't, don't take a drug advice, but I, what about just the XR in general? Like if you have Adderall extended release, can you snort that or is that the same deal, right?

0:06:33 Stormy: Extended release, so if you snorted it you would get some effect of the drug, but because it's extended release you would not get the same rush, I believe. Now I am not a pharmacologist, so nobody snort drugs on my behalf, I mean, I'm not going to stop. So

0:06:53 Thomas: Because What if I want to snort drugs on your behalf, just as a friend though, like is that okay? So I have gotten the impression that, um, for example, the local doctor I I found only prescribes XR, and I was thinking it was for that reason, like even Adderall xrand I was thinking, oh, maybe it's because they they don't want people snorting it or selling it or whatever.

0:07:15 Stormy: Like antidepressants, it takes a long time for them to have an effect. The stimulant drugs, the regular plain old Adderall has its onset in under an hour, and it peaks very quickly and then drops off. So usually you're going to need multiple doses per day, which is already hard if you've got ADHD. And the onset and offset, that going up and coming down, a lot of people can really feel that. You find yourself getting jittery and then tired. And so most people prefer the extended release.

0:07:40 Thomas: Oh, yeah. Good point.

0:07:53 Thomas: Yeah, for sure. Like Oh, okay.

0:07:58 Stormy: Will last you, depending on the exact formulation, 8 to 12 hours. So you have a much smoother onset and offset. Set.

0:08:04 Thomas: Gotcha. Well, okay. Interesting note about that. But you're saying the Vyvanse is what's interesting about that is Vyvanse is super expensive to me. And the only benefit I'm getting for that added cost is someone else can't crush it up and snort it.

0:08:22 Stormy: Mean, yeah, that's pretty much the difference is that it's designed to protect against abuse.

0:08:24 Thomas: Weird. Okay, it's working. I like it, but cost an arm and a leg. So that finally gave me the inspiration to do what I needed to do, which is try to get the actual diagnosis through my insurance, my actual insurance Kaiser, so that if I get it, then I won't have to pay seven arms and eight legs for this medication. And hence, I know it's a long, boring story to get there, but that's where the Dear Old Dads episode came from. And the evaluation involved asking me for a lot of weird stuff that maybe I'll let you take it from there. There. And people reacted thinking like, oh, is this real? How does have to answer these questions and go through all this for ADHD? That sounds weird. Lot And of people were really curious about this. So I would love to hear the expert take on what's going on here.

0:09:13 Stormy: So the number one thing to remember is that any given symptom can come from dozens of different sources. There's no symptom that definitely fits one diagnosis. So whatever Whatever ADHD symptoms you report, they can come from lots and lots of different things. So the number one thing they're trying to do is figure out which one of those things is causing your symptoms.

0:09:46 Thomas: And as I said in the episode, Kaiser in particular, I don't know if it's because they just really want to not. Well, let's step back. Can I ask you your opinion on it like everyone in the world has ADHD now. Now, is this just the, the, the internet algorithm only showing me that now, because I'm interested in the topic. So I see everybody posting about it and everybody talking about it or genuinely, is it more people than ever getting diagnosed? I'm is it just that more people have it? Is it our internet shortened phone, whatever attention attention spans. What's going on there?

0:10:16 Stormy: So my guess is that there's not a real increase in the actual amount of ADHD because it's a highly, highly genetic disorder. That doesn't seem too likely unless, you know, 20 years ago there was just a big convention of distractible people fucking. I'm, I'm... Thomas,

0:10:36 Thomas: I will not comment. Uh, yeah, I'm on the advice of council that, uh, yeah.

0:10:41 Stormy: I don't know how old you are, but I don'T, I DON'T think 20 years AGO you were just fathering a bunch of children.

0:10:48 Thomas: Look, I, again, I I'm the vice of council. No. Yeah. Um, totally. I would say what about the possibility though, that if environmental factors like say, you internet Valley companies competing for our attention in ways that really just blow our our attention span. If that made people marginally worse, maybe it took a lot of people from, oh, I have this, but I don't really, you know, need to do any, because a lot of people don't, they just manage it without drugs or without diagnosis as I was, I guess, for a long time. But maybe something could have put them over the edge in terms of feeling like, ah, geez, I really have a problem now.

0:11:22 Stormy: I, think that happened, and I think the thing that did it was the pandemic. So, ADHD is, in a lot of ways, an insensitivity to mild consequences. So, if you've got ADHD and something looks awesome but has a downside, but the downside is kind of distant and mild and in the future, you're going to be less sensitive to that than most people. So let's say you're working from home.

0:11:36 Thomas: Interesting. Gosh.

0:11:57 Thomas: Yeah.

0:11:57 Stormy: Normally, dicking around at work, there's a fairly immediate consequence. You get criticized. But if you're working from Home, it might be, well, if my project isn't done in two weeks, my boss is going to be mad. But right now, there is no consequence. I can can imagine that a lot of people who had mild to moderate problems with that kind of thing suddenly found a lot more impairment when they were working from home.

0:12:14 Thomas: Right. Right? Right. Smart. I also think we you already started to, maybe you could just tell us more about the basics of ADHD. Fitting my personality of my ADHD brain, I've started this backwards and inside out, but now we're finally getting to the beginning of the show. Hi, how are you doing, Alan? Why don't you tell us the basics of ADHD?

0:12:43 Stormy: So is a neurodevelopmental disorder, and like the other neurodevelopmental disorders, which include things like intellectual disability, learning disabilities, autism, speech-language impairment, developmental motor impairments. They are predominantly genetic. They are almost always, to some extent, about an ability. So if you have depression, it's not like there's a thing you're unable to do because you lack a skill.

0:13:20 Thomas: Interesting.

0:13:20 Stormy: You might not feel up to doing it, but you don't lack an underlying skill. The neurodevelopmental disorders, you might lack language skills or executive functioning or academic skills. There's an actual skill that's not there. Very importantly, you have to have always been behind in your whole life, not that you had it and then you lost it. That could still be a problem. It'd still be a disorder, but it can't be ADHD.

0:13:36 Thomas: Okay.

0:13:52 Thomas: So it's that rock solid. You don't have any adult onset ADHD. Uh,

0:13:57 Stormy: Because what ADHD is, is developmentally, your executive function skills are developing more slowly than typical. So for example, if you Have normal cognition, and then you have a head injury as an adult, you have serious problems, but you don't have intellectual disability, because intellectual disability you were always behind cognitively.

0:14:08 Thomas: Oh boy. Hmm. Interesting. Oh, okay. Wait. So was that just an example or is ADHD technically an intellectual disability?

0:14:30 Stormy: No, it's just all the neurodevelopmental disorders are about some kind of mental skill or ability. Most of them are. There's also Tourette's, but which Generally speaking, there's some kind skill or ability that is delayed or lower than normal and Tourette's is just unlike the other neurodevelopmental disorders because almost of them are on a continuum with typical functioning, so your typical, a little unusual, more unusual, and eventually you get to the disorder. Tourette's has a symptom that really isn't in normal functioning.

0:14:40 Thomas: Hmm. And

0:15:10 Stormy: Tics are just completely different from.

0:15:10 Thomas: So it's a bit of like a binary rather than everything else seems to be kind of a spectrum.

0:15:17 Stormy: So that's why they're kind of off in their own little thing in the neurodevelopmental disorders.

0:15:22 Thomas: Interesting. That makes a lot of sense. And it also explains a lot of, I mean, already a lot the process for diagnosing. More basics, if you don't mind. It ADHD or, because this is like a genuine thing I've been wondering about. I don't have the H part at all. I still call it ADHD because I thought that's what the whole thing was called, but someone online was like, no, you have ADD or something. I just, could you clear that up for me?

0:15:49 Stormy: Consists of one, the other, or both of two categories of symptoms. There's the hyperactive impulsive symptoms, and there's the inattentive symptoms, which I'm actually not wild about the inatentive label because inattention is only a small part of it. Disorganization is is much bigger. But you have those two categories. We used to say ADD if you had the predominantly inattentive type, and ADHD if you Had inattention plus hyperactivity impulsivity.

0:16:09 Thomas: Yeah.

0:16:23 Thomas: Oh, interesting.

0:16:24 Stormy: For one thing, that was kind of confusing for people. And for two things, it leaves out people who have hyperactivity impulsivity but not inattention, so

0:16:36 Thomas: That's a combination I've never thought about. Okay. So those people can focus on something, but they're just fidgeting like crazy while they're still focusing fine on something. That'S interesting.

0:16:45 Stormy: Now the way it's done, and I'll be the first to say that this is just insanity, is it is ADHD inattentive type. So it's attention deficit hyperactivity disorder inattentive type, which means it's attention deficit hyperactivity disorder without the hyperactivity.

0:17:05 Thomas: Interesting. Yeah. Okay. So, okay. So it, so it is now I would say ADHD and then I could further clarify inattentive type if I wanted to.

0:17:14 Stormy: Right. Most adolescents and adults with ADHD don't show frank hyperactivity. They're not bouncing off the wall. Some are, but it's less common. We may still see evidence of that impulsivity. I don't know if any of that shows up for you, but things like blurting stuff out, interrupting people, um, um, so,

0:17:32 Thomas: I don't, well, okay, all right. Let he who is without, no, yeah. Okay, interrupting. So that's interesting. I thought the interrupting came from, because I, of course I have a bit of a problem with doing that, but I always thought that came from the fact that like, if of any sort of hyper -y thingy and more because my my brain is, is so scattered that like, if I don't say it, then I'm going to lose it kind of thing. Like I'm gonna lose the thought.

0:17:58 Stormy: It would be an inattentive thing if you, um, zoned out and then spoke when you just, like, "Oh, I had a thought," like completely ignoring me, whereas if you're like, "I gotta say it now," then that's more of an impulsive thing. But the reality is there's a lot of overlap, which is why it's all one disorder, disorder. Even people who have just the inattentive or just the hyperactive impulsive type usually have some symptoms of the other group. It

0:18:14 Thomas: Interesting.

0:18:28 Thomas: Okay. Yeah. So I actually, as a kid, I very much don't think I had the hyperactivity thing. It's weird. I've always been, I, I just don't think I have this. So it seemed like you were saying, you know, maybe as an adult, you wouldn't notice that as much, even if you had it. Is that kind of what you're saying? But I think I maybe maybe just never had that.

0:18:46 Stormy: May be less external, you might not actually see somebody squirming and not staying in their seat. You may see someone who can't wait in line, who interrupts people, and who's impulsive in a lot of ways, like, um, kind of dumb decisions that they know better, they just push on through. Yep.

0:18:48 Thomas: Okay.

0:19:07 Thomas: That's so fascinating. And obviously all this is going to interact with already who we are as people and what other factors, because I've always been a careful, like I don't make reckless decisions in my life like ever. Like I'm very calculated in many ways. And yet one time I try to get a diagnosis or I'd think about getting a diagnosis, there's part of me that sees everybody getting it and thinking, well, then I must be a fraud. We must all not have it. And I'm just making it up. And so I questioned myself because I questioned myself about everything. Then when I was talking to the therapist and he was bringing up some of the stuff and I was like, yeah, I have that. Yeah, I'd have that. The one where he, where it just totally blew my mind was he's like, like, yeah, do you have problems driving? Like you're impatient driving. I was like, yeah, that's a, that'S a thing. It's like, shit. That's a part of it. Oh crap. I have, I cannot do it.

0:19:55 Stormy: Is strongly associated with increased risk of traffic accidents, so much so that right now the medication recommendations for pregnant people, people with ADHD, because we don't test most drugs on pregnant people, so we don't know for sure what all the risks are. But they suggest you balance any risk to the fetus if this is a wanted pregnancy with the risk of the pregnant person dying in a car accident.

0:20:11 Thomas: Right. Oh, wow. Wow. That'S, that's incredible. I didn't know that.

0:20:27 Stormy: While driving and inattention while driving are both dangerous.

0:20:32 Thomas: This is maybe a great example of how it also is mediated through your personality, because I have never gotten in a car accident that was my fault ever. And also am completely to what I'm doing. So it's like a weird thing where it's just impatience. I'm really good at controlling myself in certain ways. So what I do is I'm just extremely impatient and angry about it while I'm driving, but I don't do anything about it other than like, you know, I will obviously, I imagine I drive a little fast, but like, I'm not going to like ride someone's ass and get mad at them or bump into them or do do anything.

So that's kind of a funny example of, I'm just constantly mentally stressed about it while I'm driving, but I'm doing everything I can to make sure. And especially with kids, of course, like I'm making absolutely sure that I'm not endangering my kids with this, but it's such a struggle. Like when he said that, I was like, oh my God. Yeah.

I just, for whatever reason, I if I'm going on the goddamn road and someone is going under the speed limit in front of me, I just cannot fucking deal with it. It's the weirdest thing. Like I, Lydia can just drive. She'll just be like, oh, okay. It's speed limits 40. I'll go 35. Cause this guy's in front of me going through. I'm like, no, that's not an acceptable outcome of life. I cannot do that. And I don't know what the fuck

0:20:47 Stormy: So,

0:21:43 Thomas: It is. Why does, why is that?

0:21:43 Stormy: I mean, being a psychic, a do not know. But that's a really good example of the issue in diagnosis, which is what you're describing there. There could be an impulsivity element. There couldbe an irritability element. There couldb all kinds of things. So any one problem is very difficult to pin down. I mean For impulsivity, I've worked with people who literally grab a pen out of my hand.

0:22:00 Thomas: Sure. Yeah. Wow.

0:22:14 Stormy: I'm writing, and they're like, I need to write, and just grab the pen. Then they feel bad about it. They're like oh, I shouldn't have done that, but right in the moment, they want a pen, and right out of a hand.

0:22:19 Thomas: Right. Yeah, yeah. Well, it sucks in, in a more serious note.

0:22:30 Thomas: Like, you I do, you my foot in my mouth a little bit because of this, and it sucks because like I feel shitty about it. It's the worst combination of thing where I really don't want to ever say anything that upsets people, and yet I involuntarily can. Sometimes it's frustrating, it's really upsetting.

0:22:49 Stormy: And that can be a source of impairment. And ADHD is the social element. You know, there's evidence that kids with ADHD, when they show up on the playground, pretty quickly other kids don't like them very much. Some of that might be other kids being a little wary just of someone who's a little unusual. But that can also be because kids with ADHD might be disruptive, might not play the game the way they're supposed to, might push other kids out of the way, might blurt out things, you know, you're playing hide and seek and you yell, "She's over there," and you're like, "No, she was hiding, you shouldn't have said that," um.

0:23:29 Thomas: Interesting, obviously thinking a lot about this, can't help but think about it as it applies to me. Me, what's funny is right away I was like, "Oh yeah, I did have a hard time getting along as a kid," and then everything you described was not something I... I so I'm wondering if that was just coincidence, because for me, another one of the diagnosis things that they asked was, do you have a heart time, you know, taking turns, like waiting your turn? I was fucking never, no, I absolutely, because like I have such a strong fairness impulse as a person that I could never cut in front of somebody. Like Like knowingly. You absentmindedly or something, but never like knowingly, I need to go because it's, I need to go. And you, even though you're waiting, I'm cutting you off. I would never do that in a billion years. It's kind of interesting, again, how these things are mediated through our personalities.

0:24:13 Stormy: I mean, so that's an impulsivity sign, is just I'm, I'm thinking about what I want, and it's not that I, I don't care about your well-being, it's that you're really not on my radar, it's I need this right now, and oops, you were in the way. I

0:24:26 Thomas: Right. But I'm intensely focused on that. Don't sit around and lose track of things because I'm thinking about nothing, I lose track of things because I'm intensely thinking about other things, you yeah.

0:24:43 Stormy: Inattention is actually a bad word for it. So like really depressed people can't pay attention to anything. They're literally just staring there thinking of nothing and they are not doing anything.

0:24:50 Thomas: Right, right, right. And I've had that before. Yeah. I know the difference in those feelings, but

0:24:59 Stormy: ADHD, what you're doing is you're unable to keep your attention where you need it. So the hyper -focus is almost always on something that is rewarding. It's on something enjoyable.

0:25:06 Thomas: Yes. Right. To, to your brain, like relative to your own own brain, right?

0:25:17 Stormy: Don't but hyper -focused on your taxes unless you really like taxes.

0:25:20 Thomas: Or do I, or do I actually,

0:25:24 Stormy: Maybe you do. Yeah,

0:25:25 Thomas: I, so what's funny is I do, because I am a spreadsheet -y person, not literally my taxes, because taxes are actually kind of boring, but I, I will hyper -focus on certain things involving numbers that are, that people would describe just as boring.

0:25:37 Stormy: If you enjoy them. So

0:25:38 Thomas: Yeah, no, so that's the point. I wasn't at all disagreeing. I was trying to, that's actually the point I was gonna get at was when it comes to the the taking turns thing, for example, one of the things that I believe I hyper focus on but I tend to hyper focus on first off everybody around me. And, you Know, I, I to the point where I could never like cut someone off knowingly because it would make me so upset. Like I focus on everybody around me when I'M physically around people. And I also focus on, um, a lot. I don't know why, but I pretty I'm intensely focused on fairness. And again, I just want to say that doesn't mean that I'm like always right about these things. Like I might just be wrong and like do something wrong because I'm fallible, but like, I'm always focused on these things, you sure.

0:26:17 Stormy: I think that's a little different than what we usually mean by hyper focus. That sounds more like those are your values. Hyper Focus is usually the sort of thing where you are just in a flow state and you're just like, well, this is great. And you're just kind of ignoring everything else and you are really focused in on a specific topic.

0:26:23 Thomas: Yeah. Okay. Sure.

0:26:36 Thomas: Right. Right, enough. Yeah, but the only point I wanted to make was I, some of these things that are traditional symptoms or signs, I think can be a little bit counteracted by maybe your values. You know, like the fact that like my, values go against some some of these things. It doesn't mean I wouldn't have these symptoms if my values are different though, right?

0:26:53 Stormy: Be, I want to be very clear that I am not diagnosing you, but I will say, no, I am diagnosing exactly one listener. What I want you to do is go pick a card, and if it is the of diamonds, you have Tourette's syndrome.

0:26:57 Thomas: Of course. Yep. Yep, or anybody listening or... Snort some drugs. Nice.

0:27:12 Stormy: Just throwing it out there.

0:27:13 Thomas: Let us know who the big winner is. Email in. Email the show.

0:27:16 Stormy: Yeah. So anxiety is commonly found in people with ADHD. Now, one of the reasons for that is that people with ADHD have a longer history than most people of their actions leading to unpleasant consequences. Consequences. So if when you talk to people, more often than not, they're mad at you, you're going to start having a lot of social anxiety. So some people with ADHD really worry a ton about what other people think of them because fairly often when they interact with other people, it doesn't go well. So that might lead to someone really monitoring everyone everyone carefully because they're anxious, because they are worried that things are going to go badly because their experience is that it hasn't gone very well.

0:27:34 Thomas: Oh, yeah.

0:28:10 Thomas: Right. And of course, if we were diagnosing me, there's also a lot of the... I think my understanding is a common response to the kind of toxic person in my dad might be this, some of these same issues. Um, but suffice to say, different uh, uh, for different folks, but that driving one really just, Oh boy, that that, was was an eyeopening one. Cause I was like, yeah. And, and it was another reason why I wanted to make sure to get it treated if I could, because like you said, with the pregnant women thing, like I, I have kids now. I would love to be be able to manage that better if I can, just in case.

0:28:41 Stormy: Is a genuine danger. I know people with ADHD who do not regularly take medication, but they take a short -acting dose before driving ensure their and their passenger safety. I used to work with, or rather I studied under a researcher who was in the process of developing a driver education program for teens with ADHD that involved a lot of hours in a simulator and a lot of extra teaching to protect them from car accidents, which are one of the most common causes of death and serious injury in adolescents.

0:28:50 Thomas: Wow. Yeah. Yeah, I also worry about like, well, we don't have to go to keep going down that road. But not so worried now, because like, I's just an extremely, when I'm driving, I'm very focused and I'm a very competent person in general. So like, you know, the people who are like, oh, I can't back up or parallel park. I'm like, no, I can do all that. I can whip all that out. I'm just in general with things like that. I'm vey good at them. But what about when I get older and like my abilities aren't, you kno, maybe I'm not as good at that stuff. And then all of a sudden I have that same like rushing intensity and driving, but I'm a little bit slower mentally. Maybe I'll get in accidents. I don't know.

0:29:56 Stormy: So think it was very unkind of you to call out Eli on this podcast when he's not here to defend himself. Self.

0:30:02 Thomas: Yeah, your words, not my, no. He would call himself out on this. He's a terrible driver.

0:30:06 Stormy: But no, that is absolutely true. So there's a normal developmental curve of things like focus, reaction time, even just your senses that all go down as you age. And so if your focus capacity is a little bit lower, as it starts to sink, you're going to hit that danger zone sooner. I don't know that anyone has actually studied this, but I would not be at all surprised if people with ADHD start failing driver's tests, if they do like a retest as you're aging, that they start failing at a younger age. That wouldn't surprise me at all. The whole reason for the simulator program is that driving can be an over -learned skill, something that you have done so many times that you can do it pretty well with minimal attention, the same way you brush your teeth or things like that.

0:30:52 Thomas: Interesting.

0:31:06 Thomas: Right. Totally. Not how it is for everybody. That is how it is. Isn't that how it Is?

0:31:14 Stormy: That is how it is for most people. Once get to a certain point. So hopefully what happens with someone with ADHD is is honestly, they're never going to be quite as good as everyone else at really paying attention to everything, really shifting their attention, really controlling impulsivity. But if they build up enough automaticity that, for example, every time you hit your turn signal, you look at your mirror and you keep doing that over and over, that can be a compensatory behavior and you can can still manage to be a safe driver.

0:31:16 Thomas: Okay. Gotcha.

0:31:45 Thomas: Interesting Well, I think this came from obviously me asking you the basics of what ADHD is. But the ADHD and lateness? Is it, is it purely, oh, I was distracted or I, cause I feel like for me, there's something else going on there.

0:32:04 Stormy: Executive function is more than just distraction. So the distraction is, you know, I need to leave by 7:30. At 7:15, I look up my email, and then an hour has passed, and I've not noticed the time. But disorganization might be, I needs to leave at 7 .30, and I didn't plan my morning. So I woke up at 7 .15, which doesn't leave me enough time.

0:32:07 Thomas: Okay. Okay. Right. Hmm. Hmm.

0:32:32 Stormy: Or I didn't plan things out where, you forgot that there's other people in the household who need to take a shower. And I just assumed the shower would be available when I needed it.

0:32:41 Thomas: So, okay, here's What I have. And it's neither of those things. And so weird. And I'm curious, maybe this isn't ADHD. I don't know. Whatever reason, don't I know if it's always been the case or just because I've become so busy, but it's, it's been the case for as long as I can remember. For some reason, I can't be early to stuff. Like if I'm early, it's like, well, then I'm just wasting time. Like I'm, I'm just sitting there. What am I doing? I'm early. What was the the point of that, I need to be doing something at all times, you know, otherwise I feel mentally like I, I just, I'm, I don't like, like I'm stressed, like if I, if someone's Like, oh, get to this thing,

0:33:14 Stormy: So can I ask, is that an intolerance of boredom? Boredom is the worst thing ever? Or is that time pressure, I have a ton of things to do and I can't, if I'm waiting, then I could be doing stuff that needs to get done, so

0:33:30 Thomas: It feels like both, um, but I have to say, if I'm trying to be, again, brutally honest with myself, and for some reason the the podcast audience, It do it with things that are not important as well, you know, like, yes, I, yes, I have a bunch of important stuff to do, I also do it, it with stuff that's completely unimportant, where I'm like, well, you know, if I, like, let's say I'm having a leisure day for once, or having at least leisure activity for once, I'll be like, well, I could leave to get there five minutes early, or I could just squeeze in five more minutes of, I don't know, a video game or something.

And I have the most impossible time not just always trying to squeeze in five more moments of whatever it is, the thing that I want to do, versus, you just being there early and being like, yeah, I'll sit here for five minutes so that I'm not early.

Now, what I've recently tried really hard to do, and this is something I'm like, I'm legitimately personally working on, and it's, it's, I'm, I just say to everybody I schedule anything with, including you, Stormy, I'm trying, I're really working on it. And I'll tell you what's going to be the funniest thing, you know, who is influencing me for the better here, is actually Eli Bosnick, because Eli, contrary to what people might think, is the most punctual, organized of anybody.

Of anybody that I'd record with, he will be there 10 minutes early, ready to go. And I've recently tried to just meditate on like, I need to be more like that. Like I need two, I'm never gonna be 10 minutes, I'm just fucking, there's no way, but within reason, I could at least start being goddamn on time every time. I'm really doing my hardest to like try to prioritize that feeling, you know,

0:35:03 Stormy: I, you know, I, I, is a really late and early, there's a lot that goes into that besides just ADHD, like you can have just sort of a puritanical work ethic of, of sitting around is inherently lazy and bad, um, you can have, uh, of stress and just be like, I can't believe I'm just sitting here when, you know, clearly my snake needs a walk and my kids need to be fed to my snake, and, um, there's a lot going on there, and both of those things happen more, I don't know about the puritanical work ethic sometimes, but the the stress because there's a ton of things to do, happens more to people with ADHD because they're always behind on all the things they need to do. They have less of a sense of, they don't have a nice organized mental list of, okay, well, I have this, this, and this. They have a sense of, okay, I've got stuff to do, but I don't exactly know what it is or when I'm going to do it, but I know I haven't done it yet and I really should.

0:36:02 Stormy: And that's a lot more stress than I have A, B, and C. So any of those things could play a role in I said, disorganization is not just an attention. I have a relative with quite severe ADHD who never shows up on time, But they could be anywhere from an hour early to an hour late because they never plan well enough to think about, like, how long is it going to take me to drive there? They just kind of assume it's always going to takes 30 minutes, you know, and then they show up half an hour earlier.

0:35:45 Thomas: Right. Yep. Yep, yeah.

0:36:25 Thomas: Interesting.

0:36:35 Thomas: That's funny. That is funny. So, that is not

0:36:39 Stormy: So

0:36:39 Thomas: Me whatsoever. My thing is I fucking know exactly how long everything is going to take me and I use that knowledge to make sure I never waste any time. I am always there. Like literally, literally, I try to be at things the minute they are like I want. And because that's fucking impossible, I'm often means I'm like a minute or two late. But like I wanted, I just want to be at the time, you know, and I actually have a really good sense of how long stuff takes because of that. I feel like it's a skill I've just maybe worked on for this thing. So actually, OK, we can move on. But I am curious, do you think that's still, in your opinion, not, you're not diagnosing me, but does that still sound like an ADHD thing, or is that a different, does it sound like a different personality thing, ah

0:37:18 Stormy: Is actually relevant to the diagnosis question is there are things that are intrinsic to the diagnosis. And then there's what we call comorbid symptoms. Those are things that are more common in people with ADHD than in the general population, but they're not actually a part of ADHD. So being to press your buttons like you say you are when driving, that's definitely more common in people with ADHD, but it's not an actual diagnostic criterion.

0:37:29 Thomas: Hmm interesting okay

0:37:51 Stormy: And then going back to what you were saying about it seeming like everybody's diagnosing themselves with it, I think it's really good that people are thinking about their own mental and behavioral health, but I do sometimes worry because I see these like lists of, "you might be ADHD if" kind of things that mainly seem to be focused on those comorbid symptoms, not on ADHD itself. So they're saying like, well, if you're irritable, if you have a lot of social anxiety, like, are more common in people with ADHD, but they're also more common and people who have social anxiety disorder.

0:37:51 Thomas: Right there is so much bad pot like it just seems to me as not the expert but there's the the TikTok age of mental health diagnosing just seems like I don't know maybe it's good like you say maybe it's good that people are becoming aware of stuff but it just feels so ridiculous to me oftentimes there'll be stuff that's like, totally normal, and they'll be like, normalize, like, for example, that meme, I always see that's like, look, normalize bringing up a related thing in a conversation that you've gone through, because that's a way that, you know, neurodivergent people, and it's like no, that's fucking, everybody does that, literally everybody in a conversation brings up a thing that's related to the thing you're saying in conversation, it would be fucking weird if you didn't, but there's a meme that's, like that means you're neurodivergent, because what other people, what non-neurodivergent people do is they don't even say anything in conversation. They just listen.

0:39:20 Stormy: Seen that. I can't really go with that. But I would say that the neurodevelopmental disorders are primarily on a continuum with normal. So there's a range for inattentive ADHD. There's a range from extremely focused and organized to about average to a little scattered to very scattered to diagnosable ADHD. And so people who are on the, I'm a little shattered, are going to recognize themselves in some of these signs and symptoms, but that doesn't mean they necessarily have it enough to merit a diagnosis.

0:39:55 Thomas: Yeah. Right.

0:40:02 Stormy: The other thing is that, remember, every symptom can have a lot of different causes. So like I said, there's no such thing as adult onset ADHD. I have, I teach at a college and my students will sometimes come up to me and they'll say, you know, I think I have ADHD. And in some cases they're like, so, you Know, I've had all these problems ever since I was a kid and I've got all this, but some of them will be like, you Now, I never really had a problem until this year. And I say, look, I'm not your clinician.

0:40:28 Thomas: Oh

0:40:38 Stormy: I'm that a lot of things that can make it hard to concentrate and stay organized and maintain focus on your studies and things like that, that do have an adult onset, anxiety, depression, sleep problems, substance use. Any of those have an adult onset regularly, whereas if it was ADHD, it would have been present in childhood. So a lot of these like TikTok things will say like, hey, if you can't focus on your schoolwork, you have ADHD. Not focusing on your schoolwork could mean anything, you could just have a shitty teacher, you could have fallen so far behind that it's like they're speaking another language. Could not be sleeping, you You could be a teenager and just have more interest in your friends than in academics. Could have a substance use disorder or anxiety or depression. You could having incipient schizophrenia. Of options. And I really like throwing that last one in there to scare the crap out of people. Don't worry. It's not very likely. You, you asked on Dear Old Dads why they kept asking you if you had depression. And it's not because you can't have both.

0:41:27 Thomas: God. Yeah, yeah.

0:41:54 Thomas: No, I, well, I want to clarify. Yeah I didn't, I didn't ask that. I actually, I actually get it, but, but a lot of people were confused and thought that it was like inappropriate that, you know, that they would even ask that and it does seem like it's the more more, they're trying to suss out those more temporary causes rather than like you say, a childhood, you know, permanent kind of thing.

0:42:00 Stormy: Yeah, exactly.

0:42:14 Stormy: So it's not that you can't have both, lots of people do, because is frustrating, and that frustration can make you depressed, but if you have depression, you will have attention and concentration problems, so they want to make sure that's not what's causing it. Yeah.

0:42:17 Thomas: Yeah.

0:42:35 Thomas: Yeah, and it, and it was, again, for people who didn't listen, I got kind of the hint from my, I know he's not my therapist, but the therapist I had been talking to, who I liked, I gotten the kind of a tip off that like, yeah, if you have any, any depression symptoms They're not going to evaluate you for ADHD. They're just going to focus on that. And so I was just like, well, you know, I mean, it's not false that my depression has gotten a lot better. So I maybe emphasized that a little bit more than I might have otherwise, because the depressions, you pretty permanent too. So I don't, if they're going to, if they're gonna make me try to get rid of that first before they treat anything else, well, then I'm never going to get anything else treated.

0:43:16 Stormy: So it's not reasonable to say, "Say, we can't treat it, ADHD, until you have no depression," especially if your ADHD is to some extent causing your depression. If were me, I would say if you have depression and you have inattention, then I want to, first of all, look at the timeline. How long have you had the inattension and how long have the depression? What order did things happen in? And then I'd want to suss out the symptoms in more detail. There's, like I said, depressed people often find they don't focus on anything.

0:43:50 Stormy: You know, you're reading a book and you realize 15 minutes have passed and you just haven't done anything .You're not daydreaming. You're doing nothing. Whereas people with ADHD are, you know, that inattention will often look more like you start reading and and then you start daydreaming, and then you look back at the page, and then you do this, and then you do that. So they have, it has a different character.

0:43:50 Thomas: Oh yeah. Yep. Yep, I live in daydreams. It's crazy. Like as a kid, oh my god, I just lived in day dream. I was never in the world. It was the hardest thing to read or to do class. God, it was impossible. Possible. So yeah, that's more me. I'll do, I'll do pages and pages that I've turned. I've turned the page like three times and then I'll be like, I've not read any of this. What am I doing? Like my, my eyes, I guess, are still following the words or something, but like I have not processed anything I've read. It's crazy.

0:44:16 Stormy: Yep.

0:44:39 Stormy: So, and that's actually a good example of something where, I don't know you and your symptoms, but that's something that it's really hard for most people to estimate what's normal. So it's normal to zone out while you're reading somewhat, and You don't really know how often other people are doing it. Like, this is a totally different example, but people who think they have a porn addiction, they don't know, they'll be Like, well, I I

0:44:56 Thomas: Yeah.

0:45:09 Thomas: Alan, I looked at porn yesterday once and I think I think, I think think I'm addicted.

0:45:14 Stormy: They, they'll say, like, well, I think I, I look at porn way more than other people, and I'll say, well, how, how do you know how much other people aren't looking at it, you know, that's a a pretty private behavior. Well, how much you pay attention while you read is a private behavior, so that's why, you know, when people say, well, I think I'm way more distractible than most people, not lying. They're not trying to exaggerate or anything, but they might be inaccurate because how do they know how much most people get distracted?

0:45:22 Thomas: Yeah.

0:45:49 Thomas: Can get, and we should get back to, to your track of what you want to explain. Although I think we've touched on a lot of it, which is that, you know, that adult, there's no adult onset. I did want to ask in terms of the adult onset thing, I do feel like it's worse now. And one thing I was thinking of is, does it make sense that it would get worse when you just have more obligations and crap to think about? You know?

Like when you're a kid, it's like, oh, you got homework and that, you know, I would get stressed because I couldn't start my homework because I had the fucking, you know, executive dysfunction there. I think I just can never start it. Once But I got started, it was easy. I could just do it. But that's like the problem you have is like, ah, my homework. But as an adult, you've got a billion other things that are just at all times haunting my brain.

And I'm worrying about like, so it genuinely feels like it's gotten worse. That make sense that it could feel like it's gotten worse, but it doesn't mean that it's an adult onset per se.

0:46:41 Stormy: So there's a lot of of different things that can happen. So one possibility is that when you're a kid, you have so many supports in place. And based on Dear Old Dads, it doesn't sound like this was the case for you. If, you know, there are kids who have so many sports in place that they're able to function pretty well, but then you're an adult and you don't have, say, a parent going over your or homework with you every day, and you can't handle it. There's changes in the immediacy of consequences. Kids tend to get their consequences pretty quickly. So if you're a kid and you say something rude, another kid will probably just say, that's mean, right off the bat.

0:46:52 Thomas: Right oh yeah mm -hmm

0:47:26 Stormy: Whereas if you say something rude as an adult, the consequence might be you find out four weeks later that that that person's kind of mad at you. The of consequences shifts and the amount of stuff you're expected to do shifts. So, you as a kid, you might have been expected to be simultaneously thinking about when do I need to brush my teeth before I get to bed and completing your homework. As an adult, you have to think about brushing your teeth, doing housework, taking care of your kids, interacting with your spouse, preparing for work, and so that's a lot more balls in the air to drop, uh,

0:47:27 Thomas: Yeah yeah absolutely Um, have a million other things I could say, but I want to check in and get back on, uh, on on what your schedule might might've been for the episode.

0:48:17 Stormy: Just one other thing that I think comes up a lot is with medication. So first of all, um, the most comfortable thing to bring up, but they do actually, it is legitimate that they're kind of checking for, um, what we call malingering, which is intentionally faking symptoms for material gain. So that's when somebody wants to get some Adderall so they can abuse it or sell it, because it's an addictive drug, you know, just like people might go to the doctor and fake a back injury because they want oxycodone. Do really have to worry about that.

0:48:39 Thomas: Sure. Yeah, for sure. Yeah. No.

0:48:54 Stormy: But most of the time when I'm talking to people who think they have ADHD, one, they might have it, but the much more common thing is all these other things we've talked about, like, they might be kind of over-interpreting a mild thing because they don't know what the average is. They think like, well, I get distracted, but maybe you actually get distracted the normal amount, or they have anxiety or depression that's distracting them, um,

0:49:20 Thomas: Can me if this is a legitimate or illegitimate example, but one that just reminded me when you talk about people, not gauging people properly. I also, and I imagine this is something we could talk about at some point, um, identify as quite an introvert personally. And I remember remember in college, I was talking to this girl, uh, was in my opinion, very clearly an extrovert. Like the fact that I was talk to her meant she was an extroverted actually just by definition.

And she she was super affable. She was great. She wasn't nice. She was talkative. She's everything. And but somehow we got on the introvert extrobert thing. And she was like oh yeah, I'm an introvert. And I was I was like, what? Like, and she's like, oh yeah. Cause I know that like, yeah, I'm, you know, I's all about talking to people, but then after I've done that, I, I need to recharge.

I was, like, okay, but like, I think you're just overestimating how much it like, yeah, you might get tired from hanging out with people that doesn't mean, doesn't mean what do you think it means? But, of my jokes I've had for a long time is I think one of the hallmarks of extroverted people would be trying to identify with introverts by saying they're also an introvert. Oh yeah, I'm an introverted too. I'm exactly like you. Let's keep talking about it and be extroverted together about

0:50:24 Stormy: I Mean, I think that the degree to which social situations drain you is precisely the kind of thing that you're very unlikely to know what normal is. Like, how would you know that? You know, one of my favorite questions to ask my students when I'm explaining this is literally like, so do you think you skip washing your hands after going to the bathroom more or less than most people?

0:50:52 Stormy: And everybody has an answer. They won't say it out loud, but they have an answer. And then I'll be like, well, how the hell do you know? Do you just hang around the bathroom and like count the flushes and count the sounds from the sink? And then they realize, like, no, you don't have that information.

0:50:36 Thomas: It. Yeah, yeah, yeah. Right.

0:51:08 Stormy: So I think the degree to which, um, feel awkward or have to put effort. You know, ADHD is associated with social skills problems. And there are some people who would be like, well, I think I have ADHD because it's really hard for me to socialize. And maybe you do. I don't know yet. But do you know how hard it is for people to socialise in general? So how do you Know whether your level of difficulty is higher or lower? Now, there's sometimes when it's really clear you know If if you're 25 and you can't let someone get two words out without blurting things out and you're just jumping you in there with um you

0:51:52 Thomas: With stupid stories about introverts and extroverts from college.

0:51:54 Stormy: Know, insane.

0:51:55 Thomas: Yeah, holy

0:51:55 Stormy: No, see, that would be relevant. Insane commentary would be, um, I was talking to the parents of an adolescent who just suddenly out of nowhere said, "I wasn't looking at porn on my computer," like, in the middle of dinner because clearly that had been on his mind and it just came right out. So, you know, there's times when you're like, yeah, that's impulsivity right there. That's poor social judgment. But then there's other people who are like, well, I'm able able to compensate. And again, there's a lot of possibilities there. One possibility is that actually you're doing a similar level to compensation as most people. Another possibility is that you've developed a ton of skills that most people don't have. And so that's why you need a trained clinician to actually dig into

0:52:12 Thomas: Crap. Wow. Yeah, yeah, oh,

0:52:49 Stormy: That, because it can be difficult to figure it out. I, I had two other kind of things about diagnosis, and one was the fact that it's highly heritable, so parents often also have it, so I'll see, you know, clinicians sending home this paperwork for the parent and the parents never going to do that. Shit.

0:53:04 Thomas: Oh, my god, okay, yeah, let's take a second on that, and this is something that even the every Kaiser person I talked to involved with this process was aware of this, they were like, okay, so if you're gonna get a diagnosis, first thing I did was I talked to the guy that I liked, you know, I was like, all right, he's the guy who would kind of tip me off to, oh, just maybe do the online thing. Because honestly, it's really hard to get this Kaiser diagnosis.

And so I did. So he's, he was like my inside guy, and I felt, you know, that I could trust him. And so he was giving me some of this info, and I was like, alright, I'm ready to do the evaluation. I'm, you know, feel like I need to do it. And he's like, okay. And so he explained the process to me, and he was like, it was basically impossible for anyone with ADHD to do this. Cause it's like it's it's a series of traps, like it just is. Okay, first thing you do, you have a conversation with one person, oh, I can do that, yeah, a little little evaluation, and then you're done.

No, you're not even close to done, then you need to wait, like I don't know, six weeks or something, or that they give you another form to fill out. And as I joked about on dads, I barely made it, I was so like, it was again, I had to use coping strategies, I, um, that like, okay, if I'm ever going to to get a handle on this fucking thing and not have to spend an arm and a leg on, you know, designer medication that apparently the only benefit is other people can't snort it.

0:53:07 Stormy: Yeah, I You can't snort it either, just to be clear, uh,

0:54:25 Thomas: Gonna need to actually do this on time. Like I just was really intent on it. So I put it, you know, in it, not only in my calendar, which wouldn't necessarily help because what if I am distracted and don't look at my calendar? But I also put like sticky notes and everything to just tell me the date, like this is the date I need to do it.

And, uh, to, to be fair to me, this was also like during when Remy was born, like it was really hard to do. And they gave me 30 days and they said, if you don't do it in 30 days, we're just going to close the thing. Like you're done. Like there's no, it was so unnecessarily, in my opinion, like punitive for the very behavior that's hard to fix when you have ADHD, you know? So that kind of sucked, but I did it. And guess what?

I did on the very exact day that it was like, I just barely got it done. It was, you know, it was hard. I had to talk to my mom and do all the stuff that I described in the episode. And then after that, you have to do some more forms. And fortunately, after the second evaluation that only happened subsequent to that episode being recorded, lady told me, she was like, hey, you Have to do two more surveys. Just do them right now.

Like she was almost, and I appreciate it because I need it. She was like right when we get off the phone, just do, I'm going to send you them. Just do, do them, right

0:55:35 Thomas: Away. Way, just do it. And I was like, all right, I'll do them right away. Cause if I don't, I will never do it like if I just do when I'm thinking about it, I will completely forget and not do it because filling out a survey isn't like an important thing to my brain, you know, unless I somehow artificially make it so. And I think they're aware of how much the process is very difficult specifically for people with it, with the thing they are diagnosing, which seems a little, that seems a rough to me. Like, what do you think about that? It feels like something you should try to be more accommodating of.

0:55:35 Stormy: -huh, so, It's interesting because remember I said that ADHD in a lot of ways is an insensitivity to mild consequences or distant consequences, which means that if there's no consequences, or the only consequence is sort of ephemeral, then they tend not to respond. So if you don't put a due date, the chances of people with ADHD ever getting it done, if it's not a very fun thing, but

0:56:27 Thomas: Okay. Okay, that's a very, very interesting point. Wow, Stormy, you've blown my mind. Maybe they're geniuses.

0:56:41 Stormy: At the same time, you do have to be, uh, flexible to the fact that, yeah, some people are going to lose the form and then they find it, but then they put it aside and you have to be flexible with that. But yeah, if you don't have a due date, it might never get done.

0:56:50 Thomas: Yeah. No, that is a good point. If they had said, yeah, just fill this out, I would probably have done it when I thought about it. No. Let's be real. What I would have done was say, oh, maybe I would've thought of it another other time at some point, who knows? Could have been 10 days. Could have been a hundred days. Who knows? I would've been like, oh yeah, I should do that. It could have been like when I'm checking my finances after having spent a billion dollars on impossible to afford medication. And then I would have looked at it, and it would have said, yeah, you need your report cards from when you were a kid, and you got to talk to your mom. Fucking never done it. Like I literally would have never fucking followed through. So you've blown my mind. Is why you're the expert. That actually might legitimately be what they're thinking there, because it did get me to figure out how to like talk to my mom and get her to do this form with me. And I don't know that I ever would have done that.

0:57:47 Stormy: Yeah, it really, and, you know, it's interesting talking to parents if they have the same disorder as the kid, that can sometimes make it hard for them to see certain things. I gave an example on the Patreon comment of I was evaluating a boy for autism, and I knew this kid. He had no facial expressions. Like, the only thing he had was this little giggle that could mean anything. He never looked happy or sad, even when he pretty clearly was. Was. And so I'm interviewing this dad, and we're going through this thing, and the dad's telling me pretty emotional stuff, you know, that his son never hugs him, and his son's never had a friend, and the Dad has no facial expression whatsoever. And we get to the part where I ask him about his son's facial expressions, and The Dad's like, hey, he's normal.

0:58:16 Thomas: Yeah.

0:58:43 Stormy: And I was like, looks normal to you, doesn't he? He was like yeah, he does. I'm like, yeah, I can see that. And, so you can definitely have parents with ADHD who are just like, I mean, my kid is just as disorganized as normal. And I'll be like, well, your kid is as dis Organized as you.

0:58:42 Thomas: Yeah, that's yeah. Yeah yeah Right. That's so true. Side I, note, um, I, would love to talk about autism at some point. I find it very interesting. Uh, be, be curious to learn more about that and why that manifests in, in that way sometimes really fascinating.

0:59:04 Stormy: Yeah, there's a lot of stuff there. And some of the most effective treatment for ADHD is behavior therapy, where we're going to basically make those distant consequences more immediate. So if, you know, not doing your homework means you fail a test in a week, that's too far in the future. We might take a kid and say, like, each time you do your homework, you're going to get a high five or a quarter or an extra bedtime story or a star. And for some kids, that'S still too far into the future, so it'll be if you work work for 10 minutes, you're going to get a high five. If you work for 20 minutes, you get a hi -five and an extra bedtime story. But the thing is, that only works if the parent can concentrate on it.

0:59:18 Thomas: Yeah.

1:00:00 Thomas: This is good to know. Oh God. Yeah, that's true.

1:00:08 Stormy: And worked with a woman who had adult onset attention problems because she had multiple sclerosis, and she had lost a lot of cognitive abilities, and her son had severe ADHD, and she really was not capable of doing these things where we're like, okay, you're going to remind him in five minutes, and he couldn't do anything in five minutes.

1:00:24 Thomas: Right, right. Oh yeah.

1:00:32 Stormy: That wasn't going to happen.

1:00:34 Thomas: That's good to know because, as you say, it being highly heritable or whatever, like I'm on, I'm always on the lookout with my kids. That might be an interesting thing. And, you know, I want to ask you this, cause I said this on Dads and again, a bit of an emotional thing for me, because I had the hardest time as a kid, the hardest time, as I alluded to earlier, with homework, like, I just couldn't.

But what's frustrating to me is a lot of the questions, a lot of the like evaluation seemed to be focused around like not being good at school or not being, you know, like not be in a way that I was like, well, no, I if I started the homework, I was fantastic at, I'm really good at school.

Like, I so I felt frustrated that it was like, no, it's just that I can't start it, like I just, I get stuck and I, what I was realizing at the time was I had so much stress as a kid over this. Like, I know it's, it's gotta be a source of a lot of kind of, you know, I don't know.

Well, I guess I can't say for sure, but it feels like it would be a resource of a lot of, um, lot my problems, maybe, uh, psychologically with just how much stress I always put myself under over the, over the stuff. Like, I, I just would have to stress myself out to no end in order to try to function something like a human, because I couldn't, because the very thing you just said, like, like I couldn't, the consequences weren't anything until the last minute.

That's the only time that consequences were enough to where my brain could do anything. And I'd have battles with my parents and I'd feel like shit because they'd make me feel like there's something wrong with me and I'm worthless because I can't start my homework. And so what I want to ask you, this isn't just me doing a confessional, I actually want to asked you, it's important for my parenting strategy.

What I brought up in the episode was, if ever feel like my kids have any of this, know, you if I had just had someone to help me start my fucking homework, like I'm, I'm like, I'm not even joking. Just, just sit me down and say, and I'm talking as a kid, like if I had a parent who was like, all right, what do you need to do? Okay. Let's look at this. Okay. It looks like you've got alphabetized your, you know? Your spelling list here.

Why, here's the list. Why don't you, uh, why don't you get, what's the first word? If I had somebody just fucking helped me start, would I, have been day and night. Like it would've been so much easier. It would have changed my life. I really believe that. It just was so hard to start things like that. And I'm wondering, do you think that instinct is correct?

Or do you think, I mean, I know you said earlier that may be the kind of thing where it works as a kid, but then you weren't set up later as an adult to function. So is there any downside to taking that approach with kids, do you think?

1:03:09 Stormy: I have great news for you. There is absolutely no downside to helping small children get organized. If Your kid has trouble starting their homework, there is no downside to helping them, you know, say like, okay, well, what are you going to do first? Help them make a plan. And that actually Helps People, it actually helps people develop those skills. You Start to internalize the, there, there can Be an overdoing it point where you're a helicopter Parent And Stuff But

1:03:28 Thomas: But they won't have grit. Oh, Yeah, that's what I'm worried about. Yeah. Where you just like get too reliant on on them.

1:03:44 Stormy: If you say to your kid, like, okay, you, you know, what do you need to do? And then say, like, okay, so you need to do your reading and your spelling and your math. What do you think you're going to do first? Do you want to have a snack before or after your spelling? What you're doing is you're modeling how to make a plan. And that's going to help your kid learn to make a plan as they get older and more skilled, no matter what's causing any difficulties, whether it's ADHD or just normal kid stuff or whatever. Modeling, making a plan is a great thing to do. Going to give you my single happiest piece of parenting advice.

1:04:28 Thomas: Oh, hmm.

1:04:29 Stormy: There is a world of difference between bad parenting and adequate parenting. There Is the the tiniest difference between adequate parenting and great parenting, so When it comes to outcomes, if you're really harmful to children, that has a big effect, but the difference between the parent who's like, well, at, you know, 3 p.m. we have our rhyming practice and then we do our our music, and then versus the parents who's like, yeah, man, we just, you know, we just built stuff with Legos.

1:04:36 Thomas: Oh OK. I like that.

1:05:08 Stormy: There's only the teensiest of differences and outcomes. Yeah.

1:05:11 Thomas: That's good to know. I think I'll have to bring that up on next dad's meeting.

1:05:14 Stormy: It it takes a lot of the pressure off, or put another way, if you're the kind of parent who worries about what kind of curriculum your child's preschool has, your kid's going to be fine. Bad

1:05:26 Thomas: Yeah. And I'm glad you phrased it that way because in seriousness, and this is more of, again, a Dear Old Dads kind of topic, but I like the fact that there's an attitude out there of like, ah, it doesn't matter. Parenting doesn't matter because you know what? It's your zip code. Doesn't matter at all. And I'm like, I don't know. I feel like my, I feel Like my dad affected me. I feel Like there are ways that I was affected.

1:05:47 Thomas: Exactly. And that's why I love that you phrased it that way. Like, yeah, maybe we can't control everything and just parent our ways to being our way to having amazing kids no matter what, in the face of every kind of adversity. But yeah, there does seem to be a big difference. I'm glad you said that. A difference between just being shit and being adequate. That's really good advice.

1:05:46 Stormy: Parenting Matters No There's a huge difference between bad and okay, and then the difference between okay and great, really small, all. So it's fine to be a little more relaxed about that. Did have one other thing, and that is what people call the paradox of stimulant medication. They'll say, hey, if you give it to a hyperactive kid, it makes them calm down.

1:06:14 Thomas: Yep. All Oh, right. Yeah.

1:06:29 Stormy: But if you gave it to somebody else, it made them more alert. So what's going on there? It's not a paradox. Stimulant medication does the same thing for everyone, whether you have ADHD or not. It increases goal -directed behavior. So if you're hyperactive and bouncing all around, meeting a goal means sitting down. If you're zoning out and dicking around and not doing shit, meeting a goal mean doing more. A lot of people think, well, if I take Adderall and I'm more focused, that means I have ADHD. No, that means you have neurons in your brain. Everybody is more focused on Adderall. Now, there's debates and arguments about whether that means it should be more widely available. That is a whole separate question. But just responding to stimulant medication doesn't say anything one way or the other about ADHD. Hd Yeah.

1:06:54 Thomas: Yeah, yeah, yeah.

1:07:33 Thomas: To know because seem like it would be easy for someone to think, well, I took an Adderall and I felt great, so it must mean I have ADHD, but not necessarily true.

1:07:41 Stormy: I mean, just try cocaine and see what's up with that. I, I get, so my students, a whole bunch of them abuse Adderall to study, and I'm like, guys, there are better reasons to do drugs. You have other options. Why, why, um, I have tenure, so, so I'm allowed to say things like that. Hat

1:07:58 Thomas: Yeah. This was awesome. I really appreciate this. And I will say too, again, apologies for my brain being the cause of disorganization in this episode, but I got a lot from it and I will Say, I bet people have a lot of questions. So I would encourage, you know, patrons and if people want to email in as as well. Bet you we'll have questions about this and maybe, Alan, we could address those on some other date because there's so much we didn't get to. And this is such an interesting topic for so many people, I know, for me as well, and so maybe we can tackle some questions later on about this. So, if there's anything that we didn'T get to that you'd like to hear Alan's opinion expert take on, feel free to drop us a line. Right. I know that I ask people to promote their their, social media, their whatever, their blog, their podcast, but you've had a really cool idea for something to do kind of in place of that. And so why don't you tell us a cool thing people can do again?

1:08:38 Stormy: Sure. I'd love it. Uh, You want to do some real volunteer work that matters, but you don't want to leave your house because outside has snakes and people and snake people. Now, the city of Philadelphia is looking for volunteers to serve as online adult education tutors for literacy, basic math, GED prep, and English for speakers of other languages. You don't have to be an expert. You don't need to be a teacher. Will provide 10 to 12 hours of training and ongoing support, court and you just meet with the person you're tutoring online on a schedule that works for both of you. So if you're interested, go to bit .ly slash OCF volunteer. That's B -I -T dot L -Y slash O -C -F volunteer, and they'll show you how to sign up.

1:09:13 Thomas: Oh, wow.

1:09:47 Stormy: Talk

1:09:47 Thomas: That is really cool. So much. And of course, I'll link that in the description. So thanks again, Dr. Alan Smerbeck, not Smer -beck as I decided. Excited. Thanks for joining us. And thanks for joining me rather, and looking forward to speaking more.

1:10:03 Stormy: To you soon. To you soon wasn't a great sign off button on here's

1:10:46 Thomas: Dr. Alan Smer... Oh, Oh, have I been pronouncing your last name correctly?

1:10:50 Stormy: It's exactly like it's spelled. Smirbeck, no.

1:10:53 Thomas: Okay, but you said smir. I would have said smare for some reason. That's what I've been working on. Smirbeck.

1:10:59 Stormy: It's Smir, it rhymes with

1:11:01 Thomas: Okay, there you go. So I'm just not, it's exactly the way a person should pronounce it is what you're saying. And I just, Dr.

1:11:01 Stormy: Cur or burr.