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Sept. 30, 2021

#83 ”Taking Charge of Adult ADHD” - 2nd edition | Guest Russell Barkley

#83 ”Taking Charge of Adult ADHD” - 2nd edition | Guest Russell Barkley

In this episode, I am delighted to be reviewing the book, "Taking Charge of Adult ADHD", - 2nd edition with author Russell Barkley, PhD.   
This is a must-have book for all adults with ADHD! and a must-listen conversation 
We talked about:
- Latest resea...


In this episode, I am delighted to be reviewing the book, "Taking Charge of Adult ADHD", - 2nd edition with author Russell Barkley, PhD.   

This is a must-have book for all adults with ADHD! and a must-listen conversation 

We talked about:

- Latest research in ADHD

- Medication and ADHD - what's on the horizon

- Emotional dysregulation 

- How to move past the diagnosis and take charge of your ADHD and sooo much more. 

Be sure to order the 2nd edition of Taking Charge of Adult of ADHD 

 

Additional resources - http://www.russellbarkley.org/factsheets.html

The ADHD Report - http://www.russellbarkley.org/newsletter.html

 

About Dr. Barkley 

Russell A. Barkley, Ph.D., is a Clinical Professor of Psychiatry at Virginia Commonwealth University School of Medicine (2016-present).  He is also a retired Professor of Psychiatry and Neurology from the University of Massachusetts Medical Center (1985-2002) and subsequently worked as a Professor of Psychiatry and Health Sciences at the Medical University of South Carolina (2003-2016).  In semi-retirement, he continues to lecture widely and develop continuing education courses for professionals on ADHD and related disorders, as well as consult on research projects, edit The ADHD Report, and write books, reviews, and research articles. He is board-certified in Clinical Psychology (ABPP), Clinical Child and Adolescent Psychology, and Clinical Neuropsychology (ABCN, ABPP).  Dr. Barkley is a clinical scientist, educator, and practitioner who has published 27 books, rating scales, and clinical manuals numbering more than 43 editions, and creator of 7 award-winning professional videos.  He has also published more than 300 scientific articles and book chapters related to the nature, assessment, and treatment of ADHD and related disorders.  He is the founder and Editor of the clinical newsletter, The ADHD Report, now in its 29th year of publication.  Dr. Barkley has presented more than 800 invited lectures in more than 30 countries and appeared on nationally televised shows such as 60 Minutes, the Today Show, Good Morning America, CBS Sunday Morning, CNN, and many others.  He has received numerous awards from professional societies and ADHD organizations for his lifetime achievements, contributions to research and clinical practice, and the dissemination of science.  His website is www.russellbarkley.org.

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Transcript

Partial transcript 

Cathy Rashidian  0:00  
In this episode, I have a special guest for you. As I often do, I like to go out into the field and bring in experts on my show. And I'm talking top notch experts. And today I have another expert for you in the field of ADHD. I like to introduce you and he needs no introduction by any means. Dr. Russell Barkley. He is a Clinical Professor of Psychiatry at Virginia Commonwealth University School of Medicine. In his semi retirement, he continues to lecture widely and develop continuing education courses for professionals on ADHD, and related disorders, as well as consult on research projects, edit the ADHD report, and write books, reviews and research articles. Dr. Barkley is a clinical scientist, educator and practitioner who has published 27 books, rating scales and clinical manuals numbering more than 43 editions. Dr. Barkley has presented more than 800 invited lectures in more than 30 countries and appeared on nationally televised shows such as 60 minutes, the today show, Good morning, America, CBS Sunday morning, CNN, and many others. You can find more information about him on his website, Russell barkley.org, which is a wealth of knowledge in itself that website. So my friends, without further ado, in this conversation with Dr. Barkley, I am going to be reviewing the second edition of his book titled, taking charge of adult ADHD proven strategies to succeed at work, at home and in relationships. Be sure to listen to the entire episode, I have pulled out some of the best nuggets of his book, and I'm really having a conversation, a candid conversation about some of the topics that are discussed in his book, we talk about medication, recent studies, and much much more. So without further ado, this is my conversation and an honor to be speaking with Dr. Russell Barkley. Welcome to proudly ADHD at work and in business. I'm your host Coach Cathy Rashidian. And I help professionals like you understand the science behind your unique brain so you can unlock that inner genius, ready to transform your ADHD into your best asset. Keep listening. Welcome to another episode with Coach Kathy today I have the honor and pleasure of having Dr. Russell Barkley drumroll please. And I want to give you a little bit of a context into this Thank you doctor when I got my diagnosis. Thank you when I got my diagnosis in my early 40s I remember I reached out to a friend and I said I got diagnosed with ADHD and she's like Welcome to the club. I'm like oh I didn't know there was a club okay I'm in it now and then she I said Where do I even begin there's so much information and one of the names she mentioned was Russell Barkley she said you Google him you study him you study all his material. So for the first while Yeah, I was on YouTube a lot with watching all of your lectures and then I purchased the book and I'm like okay, the book is too big. Then I purchased the audio book so it's been it's I feel like I know you even though it is the first time I'm meeting you, doctor,

Russell Barkley  3:47  
but you probably do and you put my kids through college. Thank you. Thank you for purchasing

Cathy Rashidian  3:54  
the book. Yeah, of course and all that you've done over the years, you are truly a gift to this community. And I love having your perspective. And you know I've had dr Halliwell on the show as well and and I love the the different perspectives that each expert brings on and different views that I really believe in that when it comes to ADHD. It's not a you know, one size fits all as you talk about in your book. And so for today, what I love to talk about is the new edition of take charge of adult ADHD second edition. So it's out in the market, and I have many questions. So thank you.

Russell Barkley  4:37  
Oh, it's a pleasure. And thank you, I appreciate you even mentioning the book. But yeah, I'm glad it's out. It was one of my pandemic projects and was to bring that as up to date as we could based on 1000s of research studies have been done since the last edition and trying to roll all of that into the new edition. That is anything clinically relevant was was very important. So thank you

Cathy Rashidian  4:59  
Absolutely. So let's get into that. Let's get into the research and evidence. I want to quote on the beginning of the book, there's a sentence that says, and I want to read this out so that I do justice to it. evidence from more than 100,000 scientific articles and books on Adult ADHD, since the last edition of this book from 2020, this is from an expert that you haven't in on one of your pages, and essentially the idea that this is not just an American made up thing, because that's one of the things he says. So actually about that research, what's what's the reason for

Russell Barkley  5:38  
there's an awful lot going on in the field. So much. So I review all the articles published in the journals every week, there's at least 35 to 50 new research papers, a lot of it's replication, but there's always something that's pushing the envelope and expanding our knowledge and awareness. And it goes in, in multiple directions. I mean, obviously, there's a great deal of activity going on in genetics, molecular genetics, huge studies of hundreds of 1000s of people in genome wide studies, identifying genes linking genes up with brain networks. And, you know, what does that have to say about you know, ADHD in the brain and how these networks are functioning on top of that, of course, is the new research on newer medications for ADHD. And then, of course, in the area that has really excited me over the last two years has been changing the view of ADHD from a mental health, difficulty to a public health problem because of all of the links between ADHD, particularly in adults, and health outcomes. And as you know, from the new edition, one of the major expansions in the new edition is the subject of health and wellness and all of the risks that people need to be aware of if they're not having your ADHD managed properly. So we could spend a few minutes on that, but certainly, that to me has been a very exciting development this last year or so is looking at the connection between ADHD and obesity women with ADHD and eating disorders like bulimia, the role of estrogen and progesterone balance and female hormones and its impact on women's ADHD symptoms across the lifespan not just during our monthly cycle, but and learning more about that. And then the link between ADHD and diabetes, ADHD, and you know, early mortality from accidental injury and suicide, I mean, it just goes on and on and on these risks that are not really discussed a great deal within the mental health community if at all, and almost never discussed within primary care. And so one of the things I along with Chad and others have been trying to do this last year or so is to try to make primary care clinicians and their associations aware that they're seeing a lot of adult ADHD, they're just not recognizing it as such. And it's going to interfere with the care they try to provide people who come in with, you know, alcohol problems, smoking problems, weight control problems, marital difficulties, you know, as well, as I mentioned, diabetes and other things. So you know, the list just goes on endlessly. I mean, just to summarize how sobering it is, children with ADHD are twice as likely to die by age 10. Because of accidental injury, adults with ADHD are five times more likely than others to die by age 45 as a result of accidental injury, suicide homicide and then my own study from two years ago shows that adults with ADHD that go untreated have a shortened life expectancy of about 13 years that may not sound like much to you that is worth all the major killers combined that we worry about from smoking to alcohol to exercise to sleep, none of them by themselves even comes close to that number in terms of what it does for life expectancy and the reason that ADHD is so bad is it ADHD predisposes to all of those other things that we just talked about that can have an adverse effect on lifespan so you know when you see all of that and you pull that all together it's very sobering to think that people just pass off ADHD is trivial remit or not worth looking for in their primary care practice. When in fact it's you know, to me it's the big gorilla in the room that you need to be paying attention to so you know long story short I think the health consequences of ADHD are getting there just do finally and and hopefully we'll get primary care to begin to take it as seriously as they did depression and anxiety which they now routinely screen for and manage within primary care and feel comfortable doing so. But don't feel that way about this. So those are some of the major avenues of research that have been going on I could talk about others but those are the impressive to me.

Cathy Rashidian  9:55  
And I and as you were saying all of that I was getting goosebumps and I was like oh yeah Yeah, I see my clients too you know, when people seek out coaching it's I always want to say what what do we do coaching for and if there's deeper fundamental stuff, it's not about coaching it's about proper treatment and then we get you in the right path so and like eating disorder and the the female stuff and the hormones and all of that stuff. And actually, for me, what part of the reason for my diagnosis was having a child at the age of 40. And that really my heart was that everybody was just like, sat me over there.

Russell Barkley  10:33  
Yeah, yeah, no, it kept me in there with there's a great article that Ellen Lippmann and her colleagues just published in my newsletter in August, which reviews the the small, but growing body of evidence on the impact of hormonal changes on women's ADHD and the fact that women with ADHD have more pre menstrual attention symptoms, have more postpartum depression have more perimenopausal symptoms than do typical women. And in addition to that, we know that women seem to have a two phase onset girls can have an onset of ADHD in childhood, like the boys do. But a good percentage of them don't, they sort of go under the radar as subclinical until they get to puberty, and then that provokes them to move from the subclinical into the clinical range. So we have this second wave of onset for women, which seems to help explain why ADHD is three times more common in boys. But by the time we get to adulthood, it's not even one and a half times more common in males, it's almost a dead split. So something is happening to women during their development, where they catch up to men in the prevalence of ADHD, but not initially. And I think the the hormones and puberty and other things are one piece of that puzzle.

Cathy Rashidian  11:48  
Fascinating. Doug, you said something, and I, of course, I'm gonna forget. But the gist of it was the the, how life impacting this could be if it's not managed. And I'm just going to kind of go out of order of our questions for a second, there's this theme that I see on social media these days. And I am also as a coach, I always say, strength based coaching, let's focus on that. But there's the superpower side of it, if you will, that if you tap into it properly, if you know what to do with it, you can make the most of it. And then there's this other heavy side of it. So I don't want to glorify that it's this, you know, superpower thing we have. I'm curious about your opinion on that, because it does some days, it's very debilitating to have that,

Russell Barkley  12:35  
well, you know, this, this is a fine line that I walk. And I certainly have been accused of over pathologizing the disorder. But on the other hand, you know, that's why we do clinical research, we don't do it to discover how great you are. Because nobody cares about that in the research community. Instead, we want to know what makes this a disorder disorders are disorders because they lead to harm to individuals, the excessive level of symptoms, the persistence of symptoms, reach such a degree that it poses risk to the individual, it creates suffering. And so we go out and we try to study that. And along the way, we may discover a few odds and ends that are kind of, you know, quirky features, I won't call them gifts, but unusual characteristics. But you know, the long share of our findings, you'll come down on this being a legitimate disorder that deserves to be recognized and to have entitlements and accommodations and medications. And you're not going to get that if you run down the halls of Congress screaming what a gift you have. Because at that point, people are gonna say, then you don't need anything. You know, when Why should we accommodate you? Why should you be, you know, entitled to medications and support and social security disability, and Id, EA and 504, and all these things that we have fought so hard to get for people with ADHD. And you can ruin that. If you take this other this sort of neuro diversity approach to the extreme and say, we don't at treatment, we're just different thinkers. And you have to respect our diversity. Well Speak for yourself, my friend, but let me tell you, there's a lot of people out there who suffer and die like my twin brother from this particular condition. So but on the other hand, where it's properly managed, and you find an appropriate niche, and you have a supportive family environment, and you capitalize on your talents and aptitudes by accessing community resources, as I described in the book, the four keys of success are those well then you can easily prosper particularly in non traditional fields like entrepreneur or you know, videographer or you know, a TV producer or actor stand up comedian or, you know, performing artists like you know, I could just list off people like you know, Adam Levine and Justin Timberlake, or we could get into athletics like Simone Biles and Bubba Watson and you You know, others like that, or we could move over, you know, into stand up comedy and talk about people like Howie Mandel and others or move into the entrepreneurs, like the owner of JetBlue, or Richard Branson. And I mean, just google ADHD success stories and you see how people can thrive when they get diagnosed and manage, and they have a supportive environment that allows them to pursue non traditional aptitudes. So to me, there's a lot of qualifications in this ADHD superpower stuff. I got it by itself. without treatment without diagnosis. This is no superpower. And this is a life threatening, yeah, get it under control. And to me, there's, there's no end to the stuff that you could do when you have this properly managed. And I think that's the method I like to see, particularly among people who bring unusual challenge you, you're not a gifted musician, cuz you're ADHD, you're not a gift to comedian for them. those gifts come from other genetic and family and environmental sources, but that you can capitalize on those because of your energy, and your propensity for hyper focusing under some circumstances. And the fact that you can be, to some extent, in unusual settings, more creative than other people. That's not across the board. people with ADHD are not more creative than others. But that's under certain circumstances they are and so learning what those are. And the gift that you can bring to that is, is the kind of thing I think, walks the walks the fine line balances, the non traditional aptitudes I bring along with my ADHD, plus the management and the diagnosis, and the owning it I love Adam Levine's video on YouTube, you got to own this before we can do anything about it, and you can't own it. If you keep buying into the superpower gift neurodiverse idea that there's nothing wrong with me. It's the rest of humanity.

Cathy Rashidian  16:57  
Yes, thank you for saying that. Oh, keep going on that.

Russell Barkley  17:01  
Yeah, well, I hear it in the autism community. I've a grandchild on the spectrum. And it just galls me to no end to hear these really high functioning gifted people who are barely qualify as high functioning autism if they do at all, you know, saying that this is just a neuro diverse approach to, to the mind and to reality, and we don't need a label, we don't need treatment, we just need to be respected at the table for the diversity. Well, great if you've got a IQ of 130, and you're a little shy, you don't look at people in the eye. You know, maybe maybe that's true. But if you're talking about traditional autism of the moderate to severe form, you're not talking about that at all these people are in great need of diagnosis, evaluation assistance, because 90% of them will never work or leave home. So and we need to do something about that. So as I tell my neuro diverse colleagues, you don't speak for everybody, Speak for yourself. Doctor, I want to take you on a rant. Oh,

Cathy Rashidian  18:03  
I love your rant, because I am where I am there now. A few years ago it was I mean the name of this podcast is proudly ADHD because when I came came you know public with it, I'm like, you know, I'm proud of it. It is what it is because I've done some amazing things in my life, didn't know that I was ADHD. But as as I got to know more and being in the field and coach clients, there are some of my clients that are truly suffering, and they don't see it as a gift because there's some work that needs to be done. So for me, it's an it's not an awesome them. It's not a neurotypical versus neurodivergent. And, like, we're all human beings trying to make the most

Unknown Speaker  18:45  
out neuro diverse.

Cathy Rashidian  18:46  
Exactly. So the division sometimes it bugs me a little bit too in that language. So everything you just said, I humbly agree and I thank you for giving that perspective to it. I am exactly where you are now with that. So on that note though, let's go deeper a little bit into your book and into you have a chapter there's a section you talk about the three types of diagnosis the predominantly hyperactive or present representation rather predominantly, hyperactive, inattentive, combined. And then you threw in this new one that I see here is the sluggish, sluggish cognitive temple. Right? Yes. Telling me.

Russell Barkley  19:29  
Okay. Well, let me tell you a little bit about this. Back in the day when we call this add with or without hyperactivity, we did a lot of research. This would be back in the late 80s through the 90s comparing these groups and it turned out that they weren't worth comparing because they both pretty much had the same disorder. It just depended on when in life you saw them what time you know, of the week or month it was and people were moving across these types. And so we said there are no types. Let's get rid of that. It's ADHD is one thing.

And then we moved into the presentations in 2013 with the DSM five. And the only reason we called it presentations were just to say that on this day in my clinic, you show this profile. Now I could see you in a year, and you could have the reverse profile, nothing static stable about it. It's all one disorder that varies in severity of its dimensions, depending upon stage of life, and your development. So people can go across all three presentations as a function of just growing up. So people need to understand there aren't three kinds of ADHD every time I see that in my news feed at some popular trade media website. It's like, Oh, here we go. Again, there's one ad a, but it can vary. So for instance, women tend to have more of the inattention and less of the hyperactivity, men tend to have more of the disruptive, impulsive, hyperactive and to some extent, aggression. But that's relative, I mean, that's as a group, you can find women who are as hyperactive is the man and vice versa. But But the point is, it changes. So we have one disorder in the human population that's controlled largely by genetics, and that's what we're facing. Now. Somewhere in that research, we discovered a subset of people who were not impulsive, not hyperactive, had no whiff of self regulation problems at all ever in life. But who were highly inattentive. And when we studied those people in detail, as we've been doing now, for the last 20 years, we discovered that the nature of their inattention was markedly different than the problems we see in ADHD. So for instance, in SCT, the sluggish cognitive tempo which by the way, we dislike the term, we are going to change it this fall, I'm on a workgroup of the world's leading researchers, that's writing a complete review of the literature of what we know. And as part of that we will rename the disorder because it's very demeaning. It's pejorative and implies that this sluggish cognitive sluggish cognitive tempo is not a happy camper. I know not a good and I don't like it. I haven't liked it for decades, I've been writing against it. I like the idea that we're splitting off a new attention disorder. That's very exciting, but we need to rename it and we've narrowed it down to a couple of names. We'll be voting on that in the next week or so or two weeks, and then we'll finish the review. And it'll be out by the end. In the meantime, you can read a review of through 2017 on my website, under the fact sheets directory, if you want to know more about SCT. So what is SCT? It's a problem of staring, daydreaming, being disconnected from your environment. So you're the sort of absent minded head in the air space cadet, who's easily confused because you're not monitoring the world around you the external world, you're more decoupled from it, and you're, you're in your own head too much. So there's a lot of mind wandering, mind, blanking, daydreaming that's going on in there that is preventing you from interacting appropriately with the environment around you. And when the environment tries to bring you back, that's where we see the mental confusion. So it's like a kid who stares in as well. There goes Steve, Steve, and see what shakes his head. What. Yeah, and Steve has now missed everything that's going on for the last 20 minutes. Because of all of this maladaptive mind wandering, daydreaming, blanking, and whatever that's going on in there, we still don't know the nature of all of what's happening in that mental arena. What we do know is that the individual has decoupled and disengaged from the environment. And that is not what people with ADHD do. If anything, people with ADHD are overly coupled to the now to the events around them, and are not properly coupled or being guided by mental representations about goals, plans, promises time, the future. That's all what's going on in the executive brain and our working memory. And those representations aren't guiding you at having ADHD is a lot like being an old man like I am, where you're losing your working memory. And I literally can get up and go into the next room to do something, cross the threshold and forgot what I went into that room to do. So you know, there's a huge working memory deficit and ADHD that we do not see at all in SCT. So I like to think of it this way and it oversimplifies it. People with se with ADHD are overly coupled to the environment. And the now whatever is happening around them is capturing them to the exclusion of plans, goals, lists, commitments, agreements. And so ADHD is really a problem with future directed attention and persistence. That CT is more of a problem with decoupling from this environment, not monitoring it very well and becoming overly engaged with mental content. And that's where we get the mind wandering and the daydreaming going on now you can have both, as my national survey showed eight years ago, half of people with ADHD have SCT and half don't and but when they go together It is doubly impairing in the individuals life, because now they're vacillating between. That's right. I mean, they're going between the two extremes of these attention deficit. So they're not mutually exclusive. Even though half of people with one don't have the other half of them do, but it's a very impairing disorder in its own right, it markedly increases the risk for depression and anxiety. It carries no risk for drug abuse, addiction, criminal behavior, antisocial behavior, all the risk taking tracks with ADHD. Whereas what we see with this is more rumination, depression, internal preoccupation, disengagement from the world around you. So yeah, both our attention disorders but have a markedly different quality.

Cathy Rashidian  25:47  
Just not like we could talk about this one for a whole hour. But Oh, yes, we could. Treatment perspective. What what what have you seen to be helpful for for these folks?

Russell Barkley  25:58  
Yes, well, for SCT, we don't have a lot of treatment, I could count the studies. On one hand, it's still we've got one study of children showing that maybe struttura is better. And a second study that shows that SCT predicts a poor response to methylphenidate and children. In other words, it has almost the opposite effect. On the other hand, there's a study just published three weeks ago by Len Adler out of New York showing that, at least for adults who have ADHD, that's the qualifier, they have ADHD. But if they have SCT, on top of it, then stimulants like vyvanse, and others do seem to help them manage both attention problems. So to me, it depends on whether they're co morbid or not, if you just have SCT, probably the stimulants aren't going to be very good for you. And norepinephrine or another drug, even a serotonergic drug might be better. On the other hand, if you do have ADHD with SCT, maybe you'll get a little bit more usefulness of the stimulants than somebody with SCT alone. But barring that, we don't know what else works for these people. I happen to think that cognitive therapy might be even better for them than it is for ADHD. I happen to think that mindfulness training might be better for them, even though it does help people with ADHD, you know, it does help you to regulate your mind, which is part of the problem with SCT. But frankly, we don't know. It's that new a disorder. At this point in time

Unknown Speaker  27:21  
I find with coaching, I even changed my style of coaching, I become even more hands on with them more frequent touch bases to just kind of get them down. What are we doing today? Which is not the traditional coaching that you know, we're trying Oh, we have to modify? Yeah, yeah. Yeah. Amazing. So I think

Unknown Speaker  27:38  
people need to understand there's two attention disorders, and this is the other ones. Unfortunately, the DSM five only has one attention disorder, and everybody gets dropped into that one. And these people get misdiagnosed as ADHD often inattentive presentation, or they get called add by the clinician, but there is no such thing as add we got rid of that term in the 1980s. So you know, it's, it's, it's a horrendous situation for the people with SCT. Because we don't have an official diagnosis, you're not gonna get paid. If you use that diagnosis. If you're a clinician, we don't know how to manage it. At this point, we're really still doing a deep dive into the weeds of what the heck is this? What's going on on the mind? And what might work for these people.

Unknown Speaker  28:21  
Back to our conversation to about these folks will not call it a superpower because they're stuck like they're they're no HUDs and it to them, they get more frustrated. It's like, What are you talking about strength based and superpower suffering here? Yeah. So I absolutely get that. And it's important to talk about that so that we're not, you know, glamorizing this thing. Where there are folks like this, I want to go into another chapter and talk about, I'm going to bring up a couple of things. And you tell me which way you want to go there. Okay. There's poor emotional, emotional self regulation. Yeah. Yeah, yeah. So what inspired you to change that title?

Unknown Speaker  29:05  
In the Well, the problem

Unknown Speaker  29:07  
areas you had there?

Unknown Speaker  29:09  
Right? Well, the, what we wanted to do was to focus on with ADHD. There, there's a two pronged problem with emotions in ADHD that makes it different from a mood disorder, like bipolar or depression. Number one, people with ADHD show emotions very impulsively. That's just part of the disinhibition that comes with the disorder. The emotions they're showing are not weird or in any way pathological. They're just showing them too quickly. They can't seem to restrain themselves so that when something happened that provokes them, it would evoke the typical person to but the typical person would have quashed it would not have shown it would have then engaged in self calming, self soothing, moderated, let's make it more socially acceptable, you know, just because your body You know, disrespected you is no reason to grab his tie. You know, that's the kind of thing I'm talking about where the emotion is up out and expressed without regard to your welfare and your ability to socially moderate this through self control. So the two pronged problem then is emotions are coming too impulsively and too quickly. And even though they're rational, and they're understandable, they're raw, they're immature, they're poorly regulated. The second problem is, once the strong emotion has been elicited, people with ADHD find it harder to get control over it. That's a self regulation problem. And that's step two. And so they've got both problems going on, emotions are coming very quickly. And if they're extreme, I find it hard to manage it hard to control it as well as my colleagues do. And so learning how to deal with that or taking medication to try to manage that becomes very important. But all of that said, That's not a mood disorder. That's not an anxiety disorder. That's not bipolar. That's not borderline. And it certainly isn't this new rejection sensitivity disorder that some clinician invented, which does not exist in the official taxonomy, and for which there is almost no evidence of because you're basically taking this self regulation problem we already know about and have a lot of research on, and you simply relabeled it as rejection sensitivity. And well, that does a disservice because these emotions go beyond just being rejected. People have trouble with emotions, even when there's nobody in the room. If they engage in a frustrating event, that that's anger inducing to them. I remember interviewing a weightlifter who locked his keys in the car, and within 20 minutes had torn the door off the car. Yeah, no, there was nobody around, there's no rejection sensitivity going on. What you have is this impatience, low frustration, tolerance, quickness to anger and reactive aggression. And that goes with the, with the ADHD part of it. So whereas a mood disorder on the other hand, the the moods are not provoked, they're long lasting hours, days, weeks, they're across situational. They're not rational people around, you don't know why you're manic, or why you've been depressed for the last two weeks. And they're often extreme. And that's not the case with ADHD. So, you know, I teach clinicians that's your checklist for whether it's ADHD, or whether I need to go shopping for a mood disorder to account for what's going on. But if it's more the impulsiveness of the emotions, and the difficulties getting control over them, that's ADHD Doc,

Unknown Speaker  32:34  
where have you been? Oh, my God, this is so good. The

Unknown Speaker  32:39  
problem is, you know, Kathy, if I could just interrupt for a moment is none of what I just said, is in the DSM, or in most of the trade books on ADHD, or is known by, by many clinicians. And so, you know, the clinician here is all about this drama going on in your life. And he goes, Well, that's not ADHD, there's something else going on here. So you get a diagnosis of borderline personality, or, you know, maybe you're kind of a mild hypomanic or bipolar or, you know, the clinicians grasping to try to label that emotional difficulty when it doesn't need any label at all. It just comes with the disorder of ADHD.

Unknown Speaker  33:19  
Thank you. I know there's my case in point because I wanted to do an episode on RSD and how I don't buy into it and now you've heard it from Dr. Barkley himself. So thank you very much. I think he did it better than me. Thank well

Unknown Speaker  33:35  
if it's truly rejection sensitivity, that disorder that captures that which we already have is borderline personality disorder. So there's no need to reinvent the wheel. But the emotional reactions people with ADHD beyond rejection include non social circumstances I mean, road rage for instance, is commonplace in ADHD adults particularly males and so they'll be out driving and if somebody does something they don't like or doesn't do something they want them to do they can become very aggressive with a motor vehicle and consequently contribute to to crash risk. You know, that's not rejection sensitivity disorder, that's road rage, but it fits with the impulsive emotions and low frustration tolerance that is so characteristic of adults with the condition

Unknown Speaker  34:28  
agreed more we're almost close to the end and I don't want it to end but a couple of things. Before I get into medication I do want to like you know, we're unpacking this amazing book it's like a user's manual for ADHD because honestly folks you got to read the book. Like I said, I've studied it through and through and now the second I did doctor goes in depth in all of these and and he really the way he segmented the book in the different section is also really beneficial because it helps my brain kind of compartmentalize information. There's a section around self acceptance, self awareness, all of that good jazz. You know, it's one thing that we can go by these labels and be like, Oh, it's hard to deal with this. But then it's I like how you're like park it all. Now what you want to do, but it's it is. That's right. But also awareness into this new edition,

Unknown Speaker  35:20  
I brought it in for two reasons. First of all, there's kind of two separate tracks there, that I talked about in the book. The first one is the self awareness, self monitoring people with ADHD. But one of the jobs of your frontal lobe and your executive brain is to monitor what you're doing while you're doing it, track your progress. See how well you're progressing toward the goals, you're holding in mind what some developmental people call metacognition, I'm aware that I'm aware of what I'm doing. And that's very important, because if you just stay on task, it helps you to track your progress, it helps you to get back on task, when you've gotten off task due to distraction or some variation around you. Because you're holding in mind what you're doing, you're taking what you're doing, you know, you're not doing it, you'll get yourself back on course, again, that's part of your executive brain, people with ADHD struggle with, they don't monitor themselves as well. So they're not as aware that they're off task as early as other people would be, or that their behavior is excessive for the situation, or that they've interrupted other people for the fifth time, or that they can't seem to get to the point in a cocktail conversation. And you know, the person they're talking to is glazing over, almost becoming SCT. so to speak, in that. So yeah, that, to me is the self monitoring problem. And it can lead people with ADHD to not realizing that they're getting into as much difficulty as they are with their behavior. And it leads them to sometimes conclude that there's not a problem, or that it's not as bad as my partner, or spouse, or boss, or neighbor says it really is when in fact, they're right. And you're just not as aware of these issues and difficulties. And the reason I brought that into the book is it's very hard to treat somebody who doesn't think they have a problem or that the problem is as great as the people around them or trying to convince them that it is because you won't engage the system. If you don't feel that there's a difficulty there. So you know, there's a lot that goes along with that self awareness deficit that people need to, I think spend some time on and we teach people as you as you do as a coach, various ways to try to compensate for that. So make yourself accountable to others for the goal, let them be monitoring you make yourself accountable to your coach or a colleague or a mentor or somebody or a partner with the goals that you've set for yourself use little vibrating watches or the motivator device that pings you on a random basis. And that ping is a cue. Are you on task? Are you aware of what you're doing? Have you drifted? Has your mind gone elsewhere? So use some technology around you to try to do that meet people periodically and just ask them so how do you think I'm doing you know the old Mayor Kotch member when Ed Koch ran for mayor of New York City You're too young to recall that but his campaign slogan was how am I doing? How am I doing, you need to be inviting the loved ones in your life to giving you more frequent feedback and be open to it. So there are various strategies you can use to get around that and then of course the medication greatly expands one's self awareness and self tracking. Then there is the second prong of that issue in the new book, which is the idea of Alright, I'm aware I have these issues. I need to do something about it. The next step is the one we already said own it. Don't dismiss it don't minimize it. Don't avoid it don't reject it. Don't deny it own it because once you've owned it the next thing is so what we all have our deficits difficulties lack of aptitude and just own it because now once I've owned it it's part of me it's part of who I am. Let's get on with art What can I do about it? How can I be the best person I can be knowing that this is part of who I am and there's nothing wrong with that it's like me acknowledging that I'm colorblind and bald and developing a left facial weakness as I get into my 70s now and you know I have a virtually zero mechanical spatial ability you don't want to see me hanging wallpaper or repair something you know, so Wow, that's me right? So let's let's just get on with this. So I talked about that in the book that the the need for ownership to be step one after diagnosis.

Unknown Speaker  39:41  
So good so so so so good, I'm Thank you. It's really important to bring that up. I always say that I have this thing about you know, you become aware of it, you accept it, and then you start making conscious choices. And those conscious choices are about like, you know, Okay, I see what's happening here, really be in that choice. What do you want to do? No blaming no awesome there. It's just what is in within your control to do. So I love that right. Before we wrap up, I have two questions and let me know if we should just move to the wrap up question. I want to talk about a little bit of medication or Sure. Okay, in the new there's you talk about what's on the horizon. There's a paragraph and you have this thing for children. Do we want to talk about that? Or is it different medication conversation?

Transcribed by https://otter.ai

Russell A. Barkley

Author, Researcher, Professor of Psychiatry, Clinical Scientist

Russell A. Barkley, Ph.D., is a Clinical Professor of Psychiatry at Virginia Commonwealth University School of Medicine (2016-present). He is also a retired Professor of Psychiatry and Neurology from the University of Massachusetts Medical Center (1985-2002) and subsequently worked as a Professor of Psychiatry and Health Sciences at the Medical University of South Carolina (2003-2016). In semi-retirement, he continues to lecture widely and develop continuing education courses for professionals on ADHD and related disorders, as well as consult on research projects, edit The ADHD Report, and write books, reviews, and research articles. He is board certified in Clinical Psychology (ABPP), Clinical Child and Adolescent Psychology, and Clinical Neuropsychology (ABCN, ABPP). Dr. Barkley is a clinical scientist, educator, and practitioner who has published 27 books, rating scales, and clinical manuals numbering more than 43 editions, and creator of 7 award winning professional videos. He has also published more than 300 scientific articles and book chapters related to the nature, assessment, and treatment of ADHD and related disorders. He is the founder and Editor of the clinical newsletter, The ADHD Report, now in its 29th year of publication. Dr. Barkley has presented more than 800 invited lectures in more than 30 countries and appeared on nationally televised shows such as 60 Minutes, the Today Show, Good Morning America, CBS Sunday Morning, CNN, and many others. He has received numerous awards from professional societies and ADHD organizations for his lifetime achievements, contributions to research and clinical practice, and the dissemination of science.