When The Call Hits Home | Episode 6 : When ADHD and First Responders Collide - Navigating the Complexities Together

Jennifer [00:00:07]:
Hi. I'm Jennifer Woosley Sailor. I'm a licensed professional clinical counselor and the kid of a cop, and this is the podcast when the call hits home.

Ashlee [00:00:16]:
Hey, everyone. It's Ashley Gethner. I'm a licensed clinical social worker, and I'm also a child of a police officer.

Jennifer [00:00:22]:
Well, welcome back to When the Call Hits Home, and we have our guest, Andrew, with us today. Thank you so much for being here, Andrew. We're excited to have you. Can you just start telling us a little bit about yourself and your background?

Andrew [00:00:36]:
Thank you so much for having me. I'm so excited to be here. So, yeah, again, my name is Andrew. I am a licensed clinical social worker. So about me, I was diagnosed with ADHD when I was 6 years old, and I kinda just turned it into my whole thing. So I went to school for social work. I got my master's degree in social work, and I found the love for helping other people with ADHD who struggled in a similar way that I did. So I've been providing services for people with ADHD.

Andrew [00:01:02]:
I like to say I've read more books than any one person should in a short amount of time about ADHD, and I just love talking about it.

Ashlee [00:01:11]:
Well, we're so excited to have you. And one of the main reasons why we wanted to have you on here is because Jennifer and I obviously both work very, very closely with first responders and with the first responder community. And with this podcast, we're also hoping to kind of touch on the parenting aspect too in children's responders, which ADHD can come with all of that. Right? And so we wanted to ask you a little bit if you could just explain the diagnosis of ADHD for us.

Andrew [00:01:37]:
Yeah. So ADHD is a horrible name for what ADHD actually is. Let's let's just let's just lead with that.

Jennifer [00:01:46]:
I love that.

Ashlee [00:01:47]:
That's where

Jennifer [00:01:47]:
we're starting.

Andrew [00:01:48]:
Yeah. Yeah. It I mean, it is, though, because, like, ADHD is so much more than a deficit of attention. If anything, it's an excess of attention just in areas that we can't control. So we think of ADHD, we think of executive functioning. Prioritizing, impulsivity, emotional regulation, time management, and time awareness. Right? All of our executive functions. ADHD impacts all of those different areas.

Andrew [00:02:16]:
So it can present with 3 different subtypes. There's a hyperactive impulsive, the inattentive, and the combined. So there's different ways that this diagnosis can present. It's a childhood disorder. You have to have it from the time of childhood. You don't just get it.

Jennifer [00:02:34]:
Okay.

Andrew [00:02:34]:
And so yeah. I mean, in a nutshell, that's how I explain ADHD. It's an executive functioning disorder, not as much just attention deficit. Executive functioning.

Jennifer [00:02:45]:
Can you just define, executive functioning just a little

Andrew [00:02:48]:
bit? Yeah.

Jennifer [00:02:49]:
About that. Like, what falls under that umbrella?

Andrew [00:02:52]:
Yeah. So think of everything here. Right? Right behind our forehead is our prefrontal cortex. So our prefrontal cortex is what allows human beings to be human. Right? It's that advanced level thinking. It's things like, like I was saying, planning and prioritizing, emotional regulation, impulse control, so on and so forth. Right? Those higher level functions that humans have that no other species has. Right? Mhmm.

Andrew [00:03:23]:
So and if we wanna get even more technical, there's about 5 brain structures that we've known to be associated with ADHD. So we're talking the prefrontal cortex, the cerebellum, the basal ganglia, the corpus callosum, and I'm gonna blank on the 5th one, but there's a 5th one. But we know that the dopaminergic receptors, the dopamine receptors, aren't properly working. We believe that this is associated with roughly 42 different genes that could be tied to ADHD. And so because of that, you're gonna have different presentations. It's a spectrum of symptoms. It's not just one linear presentation. It's a spectrum of symptoms, and all different things can impact it.

Andrew [00:04:09]:
It. It can be great. It can be really great in careers like first responding, right, where you have to have heightened alertness and attention and be doing multiple things at a single time.

Jennifer [00:04:21]:
Right.

Andrew [00:04:22]:
Right? But you're just sitting around idling your thumbs. You're gonna get in trouble. So it's it's kinda like a double edged sword.

Jennifer [00:04:31]:
I'm sure. Absolutely. Well, I appreciate you kinda answered this a little bit, but, you know, what led into you specializing in ADHD? You know, you shared your own experience, which I appreciate you being so open about that. But could you talk a little bit about that experience and maybe what you feel comfortable with, obviously, about maybe being diagnosed and what that meant for you? Mhmm.

Andrew [00:04:53]:
Oh, yeah. I'm not shy. Okay. So I'm if if any any of your listeners follow me on social media, you know I'm very, I like to use myself as an example, not only on social media, but as a therapist. Because when I work with people, I'm transparent. Right? I struggle with it too. So I was diagnosed when I was 6 years old. In the nineties, it was pretty easy for someone like me to get diagnosed with ADHD.

Andrew [00:05:15]:
Right? But I was also a textbook case, according to what my parents told me. I I I was off the charts ADHD. So I struggled a lot. Socially, I struggled. Impulsively, I struggled. There were a lot of things that I struggled with just growing up knowing I had ADHD. I would get really emotional. Like, I remember when I was in 6th grade, kind of a tangent, but bear with me.

Ashlee [00:05:40]:
Good.

Andrew [00:05:40]:
I I really wanted to get in the LEGO club. I didn't get in the LEGO club. I left that classroom crying in the middle of class, and the teacher had to talk me down. Right? Like, I experienced emotions in a bigger way, but it was also the nineties. Shiny Object was how we understood ADHD back then. We didn't really understand it, so I faced a lot of that internalized stigma. I still do. A lot of people with ADHD feel like, I had a client say to me, and I felt this, that I felt broken.

Andrew [00:06:11]:
I felt like there was something wrong with me because my brain didn't work. I am sure a lot of your first responders have said similar things to you because of the trauma that they went through. In that sense, ADHD and trauma share a lot of overlap. Right? We because of the way that our brains are working, we just I felt so different. Right? So growing up, I didn't want other people to feel alone. I found psychology my junior year of high school, and it was like putting on a shoe that fits really well for the

Jennifer [00:06:39]:
first time.

Andrew [00:06:40]:
You know?

Ashlee [00:06:41]:
I do love that.

Andrew [00:06:42]:
It's so cheesy. But, like, oh my god. It it made so much sense to me. And then the more I practiced, the more I just gravitated towards ADHD. Understanding it helped me understand myself. Being vulnerable online helped me understand myself. It's that radical acceptance that I kind of had to come to terms with. So for me, that's part of my ADHD journey.

Andrew [00:07:03]:
But it's it's not easy. Like, even today, I still struggle. Like, it's not always gonna be easy. And it's understanding that that's been part of my ADHD journey. Love that question, though. Thanks for asking.

Jennifer [00:07:15]:
Oh, it's a beautiful answer, and I I can remember that moment too of being like, oh, psychology, that's perfect. I I it's a good feeling when you find your club. Right?

Andrew [00:07:24]:
Yeah. I'm sure both of you have that similar experience because, like, you you we don't. Anyone who's a therapist who's listening knows that, like, you you don't get to this because you're bored and say, therapy sounds cool.

Ashlee [00:07:36]:
Right. Exactly. Exactly. Well, and one of the things too, first off, I love that we've already talked about the brain because I feel like we're making our listeners really dive back into the episode right before this, and our little video on our social medias of the brain. And so that was such an excellent way to explain it, and I appreciate it. And, also, just your experience with it. Like you said, you are so open about it, but I think that's what helps so many people. Right? And and that's incredible.

Ashlee [00:08:05]:
I do know with ADHD, though, there is so much misinformation that goes around, and I think it's almost it's so hard. I feel like I I hear it both ways as a therapist. People are so into, like, yes, ADHD. Like, we need to focus on it. And then I'm now hearing people with this information be like, it's overdiagnosed, and it's not, you know, it's it's not as valid as we think it is. And so what is some misinformation you hear about ADHD that you would want our listeners, our first responders, and their parents, right, like, of their children who may have it as well? Like, what do you want them to know? What is some misinformation that you've heard that you you want them to know about?

Andrew [00:08:43]:
Alright. Let's take some big ones. I spend a lot of time on social media dealing with this. ADHD is overdiagnosed. I'll lead with the one that you said. So we know 75% of people with ADHD have not received proper diagnosis. Any mental health condition any mental health condition at all can be misdiagnosed, including ADHD. Right.

Andrew [00:09:04]:
There's certain things like so what I recommend as a therapist, you have to rule out certain things before you get to ADHD. One chief among them is a trauma related disorder. Symptoms of CPTSD often overlap with the emotional dysregulation and the impulse regulation that you see with ADHD. Right? It's important to make sure that when diagnosing a condition like ADHD, you have someone who's trained in it. It's like, if I went to a hematologist and said, I think I have a yeast infection. Right? Like, wouldn't wouldn't be the right doctor for it. So you you wanna make sure that you're understanding that it's not overdiagnosed. It's woefully underdiagnosed.

Andrew [00:09:48]:
And it can be misdiagnosed, but so too can anything else. Unfortunately, mental health is not an exact science. We can't we don't have a nice little model of the brain that we can just pull out and say, you know, let's look here. Yep. You're ADHD. It's unfortunately, we're not there yet. I hopefully I think we're leaning more towards that as understand more about genetics and brain anatomy. Right.

Andrew [00:10:10]:
But we're we're just not there. That is a big one, the over diagnosis. Stimulants are another one. Oh, yeah. Stimulants are oh my god. I hear I've I've gotten into it online with this one in particular. I hear a lot of people try and compare, like, Adderall to meth. It's just not right.

Andrew [00:10:31]:
It's like saying it's like saying water is hydrogen peroxide. They're chemically similar, but they aren't meth. Right? So there's a lot of parents that you'll find are scared to put their kids on this medicine. Mine weren't. I'm grateful. Stimulants are the one medicine that really gave me the most improvement in my symptoms and allowed me to get where I am. Are there risks with taking a stimulant? Sure. Are there risks with taking any medication? 100%.

Andrew [00:10:56]:
Right? Simulants have side effects, like insomnia, loss of appetite. Some people may experience anxiety. Right? You talk to a doctor, you monitor it, but you don't compare it to meth. Right? That is a big misnomer that goes about the EDG community. So much so, I think that's what's fed into the stimulant shortage that we've had. It's not overdiagnosed. We're not using it as meth. I would say another one is that we can just try harder.

Andrew [00:11:23]:
Right? You hear a lot of people say, just try harder. You can do it. There's a really great book that just came out from the Holderness family. ADHD is awesome. It really talks about the fact that we are not doing a lot of these things on purpose. On the outside, it looks like we are. With any mental health condition, especially with ADHD, it seems like you have more capacity than you actually do. We just don't.

Andrew [00:11:48]:
Capacity changes. You lean into something like if you've heard of spoon theory. Right? You only have so many spoons throughout a so if you haven't, let's explain that one really quickly. Spoon theory is the idea that we start each day with a certain amount of spoons. Doing certain activities uses up our spoons. So some people have more spoons to do for a certain act takes more spoons towards another activity than it would for someone else. Right? So it's not a matter of not trying hard. It is a matter of inability.

Andrew [00:12:19]:
It's not an excuse. It's an explanation. That doesn't mean you get off scot free. It means you make accommodations. But understanding that ADHD is an explanation, not an excuse. So to recap, it isn't overdiagnosed. It's underdiagnosed. We aren't meth heads.

Andrew [00:12:36]:
It's not not for funsies. We're not Not

Ashlee [00:12:39]:
not Not for funsies, he says. No. I love it.

Andrew [00:12:42]:
I I say that all the time. Like, if we were doing this with funsies, we wouldn't miss prescription doses all the time. It's not for funsies. True. We aren't doing this on purpose. We cannot help it, and it we feel more shame than anyone else in the world can ever put on us. So those are kind of my my big three misunderstandings of ADHD.

Jennifer [00:13:02]:
I appreciate you sharing those, and that makes a lot of sense for sure. And then I just wanna talk, you know, we are here about, you know, first responders as a community that we serve. And I'm just wondering if, like, you could talk a little bit about how a high stress job can be impacted by ADHD or even the relationship possibly with ADHD in a high stress job or a a job like first responding?

Andrew [00:13:27]:
Yeah. So I learned a lot about how AD so crisis. Right? People with ADHD can really snap into focus in a crisis. We wonder why that is. Right? All that adrenaline flowing through your body, it boosts your focus. It boosts your dopamine. It helps you stay channeled and focused. For someone with, like, the most focused, the most neurotypical I have ever felt are in 2 crises in my life.

Andrew [00:13:52]:
One of which was when my father passed away. Right? I never felt more laser focused than I was in handling that crisis. So people with ADHD can often really zone in during a crisis. So they end up being more successful in jobs where you're required to have that response. So first responders do often tend to have ADHD at a much higher rate than you see in the average population. I may be misquoting this number, so bear with me. General population, you see it roughly 4%. In first responders, you see closer to 10 to 14% of cases having ADHD.

Andrew [00:14:29]:
So it's more frequent. And with that, you also experience burnout. I worked with someone who's also has a neurodiversity, was a was a nurse in the ICU during COVID. Mhmm. The trauma lingered longer. It took her longer to process that trauma. So while we do great in those environments, that trauma will linger longer. People with ADHD are 4 times more likely to develop PTSD than someone who's neurotypical.

Andrew [00:14:59]:
Wow.

Ashlee [00:14:59]:
Yeah.

Andrew [00:15:00]:
Four times more likely. So while it is very conducive to the way that people with ADHD work, you're also more likely to develop a trauma related disorder. So if anyone goes into, like, into first responding with ADHD, it is so important to practice things like self care, understanding your symptoms, understanding things like burnout, understanding things like compassion fatigue. Right? Those are the things that are important for people with ADHD when getting into this line of work. But it can be really helpful, and they can really thrive in this environment. You're not carrying tasks on tasks on tasks with you. You're just dealing with it, and you're done. So in my opinion, works great with a big red asterisk on it.

Ashlee [00:15:46]:
Yeah. And I, I also one of the things that I do hear a lot about why first responders get into the job is because they like, like, that unknown. And it it that's what my brain just went there is, like, every day is something new.

Andrew [00:16:01]:
Yeah. That's what

Ashlee [00:16:01]:
I said. Everything there's something new that is brought out and different kind of challenges that they do have to face. And so that connected in my brain just now while you were saying that. I was like, well, that that would make sense. That and the fact that if they're 4 times more great like, greater to develop PTSD, but then we have 10 to 14% of our first responders who may have ADHD. Right? Like, oof. There's just so much overlap, which is extremely powerful here. Sorry, Jennifer.

Ashlee [00:16:27]:
I saw you had something to

Jennifer [00:16:29]:
No. No. No. You're fine. I was thinking that too in terms of the career and what probably appeals more to that, you know, neurodiverse mind and not being still. I think, you know, Andrew, you said, like, oh, sitting still is not necessarily gonna be a place we're gonna be really successful. So that makes a lot of sense. And then I just was wondering, like, in terms of possibly unpacking a little bit of the piece of maybe it makes it harder to process, like, seeing something, and I don't know know the connection there.

Andrew [00:17:02]:
Yeah. So we know the amygdala is responsible for emotional regulation, that fear center in the brain. We know that fear circuitry is haywire in both people with ADHD and people with PTSD. Right? So if our brains aren't processing emotions in the same way people with ADHD experience and so too do people with PTSD, emotional flooding. Right? You are slammed with emotions. For people with ADHD, you feel it, and then it's out of sight, out of mind. So you're not processing it. You're just like, I did this.

Andrew [00:17:35]:
I'm done. That's how I process my grief with my father. Right? I thought I could steamroll it. I was so wrong. Like and so I I didn't consider the fact that, well, there's also trauma with taking care of him. Right? There was trauma of watching them get sick. There was those kind of traumas that I just didn't process right away, and I couldn't. And my brain couldn't make sense of that.

Andrew [00:17:58]:
So for people who are witnessing these things day in and day out, there's more, an attunement to just getting that out of your head through any means possible. We know peep I've got so many stats in my head. We know that 50% of people with a substance use disorder also have ADHD. Mhmm. There could be such a link between people using substances to cope with that constant trauma, that emotional dysregulation. Yep. We don't sit in big emotions very well. So it's more likely that we're gonna do anything.

Andrew [00:18:30]:
We're talking numbing. We're talking dissociating. We're gonna do anything possible to not stay in that feeling of discomfort. I felt that. I'm good. I'm moving on. Right? And so that's kind of where I see that becoming a barrier for people. It's I shove it aside, but it doesn't shove I I can't actually shove it aside.

Andrew [00:18:52]:
It comes back.

Jennifer [00:18:53]:
I appreciate you breaking that down. That makes so much sense. And I appreciate too the piece about substance use and coping.

Ashlee [00:19:01]:
My brain and this is a little bit kind of I'm kind of shifting a little bit here, so bring me back on track if this isn't something we want to discuss at this moment. But, like, my brain can't help but wonder too when we are talking about them being successful as well in these, like, high stress jobs. Right? We and you already talked a little bit about the advantages. Could you explain a little bit how people could who are first responders could cope on the job with ADHD? Different ways they can cope and ground themselves maybe?

Andrew [00:19:32]:
Oh, yeah. I love it. So dealing with intense emotions in the moment is gonna be hard. Right? You're gonna if if you see I'm a fidgeter, that is a great way to deal with some of that excess energy. Right? I, as a therapist, I lean into a couple different modalities, and I'll explain what tools people can use in order to do that. I lean into for people with ADHD, dialectical behavioral therapy, and acceptance and commitment therapy. Radical acceptance of our thoughts being thoughts because think of it like this. An ADHD brain works really, really quickly.

Andrew [00:20:05]:
That's a great gift. That's a great curse. Right?

Ashlee [00:20:09]:
So if you're

Andrew [00:20:10]:
on the job and your mind's going a 1000000 miles a minute, you need to slow down those thoughts. There's a great exercise from acceptance and commitment therapy called dropping the anchor or ACE. That exercise involves acknowledging your thoughts. Right? So maybe you can't maybe you open up your phone, you write out some notes on your phone. Just put those thoughts out of your head. This is specifically when your thoughts are kinda spinning out of control and you can't do anything with them. Acknowledge the thought, feeling an emotion, then you center yourself to your body. You can do this a few different ways.

Andrew [00:20:43]:
Press your hands together, push your back against a chair, plant your feet on the floor. I like to visualize a ball of energy coming from the ceiling and working its way through my body. So now my thoughts are off my my thoughts, and now I'm focusing on my body. Then acknowledge, center, engage with your environment. So just 5 senses, some way to engage with your environment that connects you to your physical sense. So this is a way to get those thoughts out of your head. Right? Because I would imagine for a lot of people, you really can get in your head and that can distract you from the moment. Right? That's a common ADHD struggle.

Andrew [00:21:22]:
Also, a great acronym from DBT is tip. Temperature. So, like, cold water, splash your face with some water. A lot of ADHDers, myself included, yeah, we experience, like, the temperature dysregulation. I get really hot when I'm angry. I had to do it today. I you go splash your face with some cold water, shove your head in a freezer, put an ice pack on your neck. Right?

Jennifer [00:21:43]:
Yeah.

Andrew [00:21:44]:
Do something to regulate your body temperature. Temperature, tense exercise, fidget, move, get your body moving, work that cortisol out. Out. Paced breathing, I mean, I don't need to lecture anyone about paced breathing. Impaired muscle relaxation, just tensing and releasing. Sometimes in a in a conflict, you might notice that you're stiffening up. Intentional tension, intentional releasing. So the goal during a conflict of all of these things I'm saying is emotional triage.

Andrew [00:22:12]:
The latter half of that is processing that emotion. I really think it's important for people with ADHD to build in breaks for themselves, especially on the job when you can't. Right? That's not always an option, but make that time and space for yourself a priority as is positive reinforcement. Right? You're going through some intense emotions. Give yourself space to feel it and then process it. Right? Yeah. Because I think it's so important to give yourself space to process those things that you're going through. Also, talk to people.

Andrew [00:22:43]:
Right? It's so easy to feel isolated and alone. Connect with other people. Share your experiences. Don't let yourself get isolated in your head. Super true.

Jennifer [00:22:53]:
Things are wonderful, Phibbs.

Andrew [00:22:55]:
I love that. Thanks.

Ashlee [00:22:56]:
Absolutely. And we do know that ADHD can be genetic.

Andrew [00:23:00]:
You sure can. 70%. Right.

Ashlee [00:23:04]:
So that's a I mean, that's a pretty big number, and we're trying to make sure that we also include children into this podcast. I think that's something Jennifer and I have been really good at making our point across because we wanna make sure we're kinda hitting different facets of the family. And so, I mean, do you wanna talk a little bit about some helpful ways to parent or to even maybe address the concern of a child might having ADHD or some characteristics of it.

Andrew [00:23:28]:
Yeah. Okay. So we know that kids with ADHD tend to be roughly 2 to 3 years developmentally behind. Except in gross motor, everything else is a little behind. Right? You'll have a climber who may just be emotionally and mentally a few years behind. So classic parenting probably won't work. So as kids get older, they benefit from things like a token economy. So what does that mean? Right? You set up mini reward.

Andrew [00:23:55]:
So is that a sticker chart? Is that a toy chest that you pull from? Right? Reinforcing behaviors, small rewards along the way. Here's a great example. So say you have a kid you wanna do math homework. Right? You can do 2 things. You can say, here's a bag of M and M's when you finish your homework. I promise you that kid won't that doesn't matter. That's too far out. Put an M and M on each homework assignment.

Andrew [00:24:19]:
That gives them more incentive to do it. Finish the problem, eat the m and m. Right? Immediate reinforcement. That's part of it. Also, really reinforcing good emotional expression and intelligence. Right? Whenever I work with kids with ADHD, it's learning how to recognize your emotions. Mindfulness. Teach your kiddos mindfulness at a young age.

Andrew [00:24:41]:
The more body awareness they can have of their symptoms, the more they can recognize those early warning signs of dysregulation. Also, you're gonna have to be an advocate. Parents with ADHD have a lot of legwork to do as far as getting those kids accommodations. You are entitled to accommodations in school, but you gotta be grateful for the teachers that are putting in that legwork. Right? As much as you have to deal with your kiddo at home, they gotta deal with them at school. And I if you're a first responder, you don't have a lot of bandwidth for that. So lean into your community, rely on the resources you have, and connect with those resources that you have.

Jennifer [00:25:20]:
To take that just one step, like, I guess, before the start, and you have concerns about your child's, you know, symptoms maybe or, like, characteristics that are showing up, what would be some first steps to kinda help to diagnose? Or

Andrew [00:25:38]:
Yeah. Yeah. So, I mean, number 1, talk to the teachers. Right? Like, you know what? Like, talk to the teachers. Notice the people who see your child in all aspects of the life. Right? Because what you're seeing at home may be similar or different. Then we go to a like, this is what I tell anyone, kiddo or adult. Look up symptoms online.

Andrew [00:25:59]:
We have the resources. We have the knowledge available. See if those symptoms line up with ADHD. Whether or not they can be explained by something else is in what we're looking for right now. Start with that. Okay. Take them to a therapist who knows ADHD. They can help you at least start breaking down, is it ADHD, or is it something else? Okay.

Andrew [00:26:19]:
Then you can get a formal diagnosis. So formal diagnosis typically looks like you get referred. I usually say call your insurance company so you're in network. Or talk to your primary care your child's pediatrician, and they can refer you. Mhmm. Because it's gonna be hard getting in network affordable coverage for people who listen in the United States. I can't speak to international policies. I can only speak to what I know in my in my area of practice.

Andrew [00:26:45]:
Right? So that assessment process will they'll ask for collateral information from you, from your teachers, from everyone else in your child's life to really affirm these symptoms, and it's both written and observational. Again, I was diagnosed at 6 in the nineties. I have no idea what that process looked like for me, but it it is a pretty in-depth process. And if it doesn't go the way you anticipate the first time, always entitled for a second opinion. But recognize that that process can be lengthy, stressful, and difficult. But once you do get that diagnosis, that affords you leverage under the section 504 of the disability act from 1970 something or other. But you're afforded rights and accommodations as well as under IEPs. Right? So you have options once you get that formal diagnosis.

Jennifer [00:27:44]:
Well and then with that too, is there any and especially since you're such an expert in this area, is there any certain things or characteristics that sometimes go under the radar that are ADHD, especially in kiddos?

Andrew [00:27:59]:
I'd say in girls and people assigned female at birth is what I noticed the most. Yes.

Jennifer [00:28:03]:
I was wondering if we would talk about that. Mhmm.

Andrew [00:28:06]:
Yeah. Yeah. Okay. So you see, girls don't have that that hyperactivity component in the same way. So I don't trust the data. I'm a little skeptical. Right? You you hear a lot of data that says girls and people assigned female at birth are on like, have less hyperactivity, more inattentive. I believe and I've seen that it's more internalized.

Andrew [00:28:28]:
Right? So someone who's more prosocial, it shows up as prosocial behaviors or, like, you're really chatty. You're really you see a lot of that people pleasing. It's more the inattentiveness symptoms, like that daydreamer, that distract ability, those are kind of the big symptoms that I see that often fly under the radar. Or people who are intelligent. Right? I the amount of people who've told me I was told I'm too smart to have ADHD discuss me, but you hear yeah. You hear that a lot. Right?

Ashlee [00:29:02]:
Yeah.

Andrew [00:29:02]:
There's and I thankfully wasn't told that even though I would fall under that. But, again, I have white male privilege. I own and acknowledge that as a, like, as a white guy in the nineties, I was easily diagnosed. Not everyone had that privilege. And so you're seeing more and more people with that late diagnosis, but I think we're getting better at recognizing it now. Right? You see, like and I know we're talking kids, but those are the people that go on to be those bulldogs in life. Right? Those people that just steamroll their way through life, don't really care about what other people think, but, internally, they're they're really struggling. Hormonal changes really play a role in this.

Andrew [00:29:43]:
Right? So as people go through puberty, as estrogen rises and falls, you see that play a role in ADHD symptoms. Right? So, specifically, when estrogen is lower, progesterone is higher, ADHD symptoms get worse. So you see more you see more instances of PMDD, Premenstrual Dysphoric Disorder, and, PCOS, polycystic ovarian syndrome, in people with ADHD. Right? So another another indicator, if a mom has PCOS, she's more likely to have a kiddo with ADHD. I think the the number is about 40%. Oh. Right? Yeah. No.

Andrew [00:30:22]:
I do. Yeah. Right? You'll learn something new. So the it's you'll see it, and then, also, you see it in in people of color. It's more it's more treated as, like, conduct disorder or oppositional defiant disorder, which is a gross diagnosis, in my opinion. But right? So there's different ways that it may manifest in different populations that just gets overlooked.

Jennifer [00:30:48]:
I appreciate that.

Andrew [00:30:49]:
Yeah. Sure.

Ashlee [00:30:51]:
Extremely thorough. So I that was excellent excellent ex explanation of that. And with I mean, with all of that said, right, that's a lot to digest. It's a lot for someone to learn and understand. How would you say that ADHD well, the ADHD brain, how can that impact a family or a relationship?

Andrew [00:31:09]:
Oh, yeah. Ask my wife. Like, yeah. So, like, in a family or in a relationship, right, there's we think of it like this. Ari Tuckman wrote a book, ADHD after dark. He said it best. It just makes problems that are already present in relationships a little worse. Right? Like, they're all things that can happen in a normal relationship.

Andrew [00:31:35]:
You forget to do chores. You for you need to be more micromanaged. Right? So there's more stress and tension in that dynamic. Also, you've probably I I know you've talked about the whole concept of, like, walking on eggshells. The emotional dysregulation people with ADHD experience, if left unchecked, can very much make a family feel similar in that dynamic. Right? I know for me, my emotions can sometimes get out of my control. Happens enough to where I don't like it. Right? I do my best even as a therapist who understands ADHD to remove myself, but I'm not perfect.

Andrew [00:32:08]:
And it's understanding that how do we how do we dialogue about those things. Right? Normalize the conversation of, I am not always gonna have a control over my emotions. I'm gonna do my best, but I'm not perfect. Those things will come out. Right? So emotional instability is a big thing I see, But impulsivity is gonna play a role. Right? We know that people with ADHD are more likely to do things impulsively, substance use, infidelity, financial decisions, all of those things can impact the family and the relationship in a way that isn't pretty. So I always recommend good, good, good communication. Like, you think you're communicating well, then just do it better.

Andrew [00:32:52]:
You wanna set clear expectations. Like so a good example. Let's say you have a partner. You want them to do the dishes. They do the dishes, but they're they're still, like, a puddle of water on the floor. So now the instruction is do the dishes, wipe the counter off. You start by, like, making specific detailed lists. It takes a lot of front level work, but in the long run, it eventually becomes something that your ADHD partner will take on for themselves.

Andrew [00:33:20]:
So good communication, clear expectations, constant dialogue, constant check ins. Those are usually the things that I think help people who have an ADHD person in their family.

Jennifer [00:33:32]:
Oh, I think that that's wonderful, especially that communication piece. I mean, that's impactful for any family, but especially thinking about that if maybe there's some wiring in the brain that's a little different for one person or the other.

Andrew [00:33:44]:
Yeah.

Jennifer [00:33:44]:
And then just to piggyback on that too in terms of if you're a parent and kind of the impact of the family or what are some kinda thoughts about that in terms of parenting and, like, how do they dynamic?

Andrew [00:34:00]:
How does ADHD impact parenting, you're saying?

Jennifer [00:34:03]:
I guess I'm more asking if you're a parent of a child with ADHD.

Andrew [00:34:08]:
Okay. So you're gonna be stressed out. I mean, for for lack of a you're doing a lot of extra work to make space for your kiddo. Parents with ADHD often report much higher levels of stress. And, I mean, given the audience we're working with, you're probably already stressed out. Right?

Jennifer [00:34:27]:
Yeah.

Andrew [00:34:27]:
So really building on your natural support systems. And if you don't have them making them, you are not an island. No person is an island. I have worked with enough first responders to know that that is often the mentality. I'm gonna knuckle down and deal with it myself. Yep. Rely on your community. Rely on your resources.

Andrew [00:34:47]:
Rely on the people around you. Acknowledge your stress too. You are it's the whole put your oxygen mask on before other people. If you're not taking space for yourself, do that. Your partner with ADHD is very sensitive to your needs. Your person with ADHD in your life is very sensitive to your needs because they don't wanna get rejected. We don't like rejection. It it really physically hurts us.

Andrew [00:35:13]:
So we will do everything to help you, including making space for you. So if you're supporting someone with ADHD, do things to manage your stress. I strongly encourage daily self care, but if that's not an option, make it weekly. Self care is as simple as drinking enough water. Self care is taking some time to go exercise. Self care is just going and petting your dog. Like, do something to nurture yourself. If you don't, that stress builds up, and you are no good to your ADHD kiddo.

Andrew [00:35:44]:
You're no good to the people in your life. Self care is so key. And for for anyone too, especially for first responders. Right? Like, you gotta take care of yourself.

Jennifer [00:35:54]:
Mhmm. Absolutely. I appreciate that. You know, I have a little, like, a a story, and I went to school so long ago. But I had a professor who had a child that was diagnosed with ADHD, and he just talked about really working through, like, my kid's not a liar. That's kinda how he started it. But he would say, hey, Katie. Did you put your shoes away? Yeah.

Jennifer [00:36:19]:
And he'd go see the shoes weren't put away, and he would get frustrated, and and you lied to me. And his ability to walk that back a little bit of, like, she answered a question she didn't hear.

Andrew [00:36:30]:
Mhmm.

Jennifer [00:36:30]:
And then walking that back to this isn't about, you know, you not telling me the truth and and and his ability to kinda, again, walk that back to say, look. I need your attention. How do I get that attention to make sure you heard the question you

Ashlee [00:36:50]:
know, and

Jennifer [00:36:53]:
you know, and calling anybody a liar is a pretty harsh label. And, you know, just sometimes recognize maybe there's something else going on in the brain here rather than your kids just wanting to be dishonest with you.

Andrew [00:37:07]:
Yeah. Well, let's let's point this one out. Right? By the time a kiddo is the age of 12, they'll hear 20,000 more negative rejections than someone without ADHD. Oh. We internalize that so much. So a lot of it is understanding, like, how much of a priority is this thing? What is my what is what am I letting go? Learning to let go of some ex some of your expectations is going to be inevitable. I mean, as a parent, I know that your kids aren't gonna be the way that you always think they're gonna be. Right? You have an idea of how your kid's gonna act and behave.

Andrew [00:37:44]:
Not always the case.

Ashlee [00:37:45]:
Right. Right?

Andrew [00:37:46]:
You you have a little little to no control over some of those behaviors. Learning to let go of some of that control will give you a lot more emotional flexibility in those responses. And having that emotional flexibility is what allows you to give them that support. Right? Kiddo with ADHD, 100% will respond better to positive reinforcement, but they're also very attuned to that. And what I'm describing takes a lot of work. Right? Those things are not easy. I recognize that. That is why I so emphasize stress management and self care for the caregivers of people with ADHD.

Andrew [00:38:24]:
That work pays off in spades. But if you do that for yourself, those arguments, those instances of are you are you lying to me come far and fewer between. Hey. I noticed that you left your shoes here. So let's clarify. Did you hear the question that I asked?

Jennifer [00:38:40]:
We're good.

Andrew [00:38:40]:
Right? No?

Jennifer [00:38:41]:
I

Andrew [00:38:41]:
didn't. Okay. How can we make sure that happens differently? Or what does active listening look like for us? When I ask a question, what do I need from you? Is it eyes on me? Is it, like so communicating what good communication, again, what good communication really looks like.

Ashlee [00:38:58]:
I think it was so important that you just talked about that piece of control and having to learn how with our children to let that go because we've emphasized that. I mean, I know we've talked about that in several of our episodes now, right, of, like, our first responders that is sometimes a struggle, and then you get into a constant struggle with your children. Right? And I I think Jennifer made such a great point too of that story of maybe it's not always that they're lying. There could be something more going on. Right? And and lying to a first responder, I know at least in my world as a child of 1, that was a no go. Right?

Jennifer [00:39:32]:
Bad. No go.

Ashlee [00:39:32]:
That was a real bad no go. So, like, I do think it's important for these first responders who are parents to hear some of this and hopefully take that step back to recognize that maybe it could be something else or or maybe they already know their child does have that, but they just need that that reality of, like, I'm not approaching this in a way that I could be. You know? So Yeah.

Andrew [00:39:53]:
And, like, recognize that traits in one scenario do not always apply to another scenario. Right? Right. My wife's a great lawyer. She's really good at analyzing a situation That does not always apply to every situation. Right?

Ashlee [00:40:07]:
Yeah.

Andrew [00:40:08]:
Being a first responder, it is great to be direct, blunt, and take no BS. You bring that home to a kid with ADHD, you're gonna make them defiant. I promise you that kid will rebel. Yeah. No no argument.

Jennifer [00:40:23]:
You know, Andrea, I think in that too, really hearing being much more proactive in your approach instead of you know, reactive. Like, again, implementing things that sounds like to be really important to kinda help with the day to day.

Ashlee [00:40:38]:
And I think too, great point, Jennifer, right there. Right? Like, what if both have it? What if that first responder or that parent or the spouse has it and the child? Right.

Jennifer [00:40:47]:
Like, genetics might be saying that might be a part of it. Right.

Andrew [00:40:51]:
Probably do. 1 or both like, your if you have a kid with ADHD, my my first question is, do you think your parent has it? Like, maybe. I know my mom has a raging ADHD. I know where I got mine from. Like, no question.

Ashlee [00:41:07]:
Yeah. Yeah. It's fair. But I I just think that collaborative piece is so important, and I love that we've talked about it.

Andrew [00:41:13]:
And that's my thought. Right? That's why I'm so open. Should I have children who have it, I want them to understand that it's okay. It's doctor Hallowell describes it beautifully. It's like having a Ferrari engine for a brain with bicycle brakes. Just need to improve those brake systems.

Ashlee [00:41:31]:
Love this.

Jennifer [00:41:32]:
That is a wonderful metaphor for sure.

Andrew [00:41:35]:
My favorite. My favorite.

Jennifer [00:41:38]:
Well, knowing that, you know, sharing that your mom had that diagnosis and, I don't know, having the ability to reflect now as an adult, did you see that in terms of parenting?

Andrew [00:41:50]:
Is in high so when I was a kid, no. I like, if I looked at it, I couldn't tell you. In hindsight as an adult, a 100%. Yeah. One of the first stories I've heard is she got too overwhelmed to change my first diaper and had to tag out. Classic overstimulation. It was probably a sensory overload. Right? Right.

Andrew [00:42:10]:
I was described as a colicky baby. Was I colicky, or was my mom having trouble regulating her emotion? Having been having gone through that phase, I don't know. There's certain things that I just don't have the insight and I don't have the ability to go back and look at, but my my hunch is that she didn't deal with her ADHD. She dealt with mine. That's her journey. I'm not there to judge for it. You know? But, like, I think for a woman who grew up in a time where ADHD wasn't even considered, she's you know, she was a baby boomer. So Right.

Andrew [00:42:42]:
She went from a generation that didn't even see ADHD, let alone see it in women. So she was just this artsy fartsy daydreamer who didn't get to deal with her ADHD. Then here I come, a raging case of ADHD, and she's turning into an advocate. I wouldn't be where I am without my mom. She's given me all the tools and resources. She was that bulldog for me, but never for herself. Her unmanaged ADHD gave me tools to manage my own. So, yeah, like, it's a both and.

Andrew [00:43:11]:
So, like, the cautionary tale that that tells you is, like, deal with your ADHD and use that as an example to help your kiddo deal with theirs. You're gonna understand what they're going through better than anyone in that world in the world will. I understand where my mom struggles because I understand where I struggle.

Jennifer [00:43:28]:
Yeah.

Andrew [00:43:28]:
And the way she struggles are very similar to the way that I struggle. You learn a lot from your parents to help your kiddo. You learn the kiddo learns right. It works together. Yeah.

Jennifer [00:43:38]:
You know, I I will say I mean, I definitely do not give parenting advice by any means. But I will say I do think that it is very important if there's something that you want in your child to explore that for yourself. You know? And and if you are able to teach yourself that skill, our kids learn through seeing us much more than any other lecture or video we're gonna show them. It's always gonna through be through that experience. So Oh, yeah. I really appreciate you sharing that.

Andrew [00:44:08]:
Yeah. Our kids value us so much. We are we are their everything at that young age. Right?

Jennifer [00:44:14]:
Yeah.

Andrew [00:44:15]:
Embrace that. Really embrace that.

Jennifer [00:44:17]:
Yeah. You know, again, you being the expert, and, again, I'm so lucky that you've given us your time. But what are some kind of tips and tricks, some kind of little easy grab bag things that you have for ADHD? And and maybe they're not easy, and I I don't wanna minimize it too much, but you're just such a expert. Like, what would be some things that you would definitely want people to know?

Andrew [00:44:38]:
Oh, you flatter me. I, you know, I never thought I would hit that expert point, but it's kinda it's kinda cool feeling in that role. I'm gonna just soak that in for

Ashlee [00:44:47]:
Yes. Please do.

Andrew [00:44:49]:
But, like, I think for some quick tips, I like a method called the Pomodoro method. So the Pomodoro yeah. Yeah. You've heard of that one. So the Pomodoro method, there's a bunch of different ways to do it. So to break it down to its nuts and bolts, it's anywhere from 20 to it's a let's call it what it is. 20, 30 minutes of productive time with a 5 to 10 minute break. You go through, like, 3 to 4 sets of that with a prolonged break.

Andrew [00:45:15]:
There's so many different ways you can do that, find what works for you, but this is what we also call chunking. So let's let's take the dishes for example. Right? You do a little bit of the dishes. You take a break with a dopamine boosting activity. So this is where something called the dopamine menu can come into play. So the dopamine menu is where you list out what things provide you dopamine based on how much effort or time they take. So a starter is something that, you know, doesn't take very long. It's under 10 minutes.

Andrew [00:45:46]:
So this is like, go for a walk, drink some water, have some coffee. Simple. A, aside is something you can do in the background to make a task more enjoyable. This is fidgeting. This is a scented candle. This is, listening to music or your favorite podcast. Something to do in the background while you're doing your task. Then there's a mane.

Andrew [00:46:10]:
This is something that takes a little bit longer. So this is a hobby, a focus, a hyperfixation. This is what makes a break a productive break that restores you to go on to continue that task. Then you have your desserts. They're great, but, like, don't overdo them. Right? Those things that maybe cost money, they maybe this is like doom scrolling on social media. This is something that you shouldn't overdo. Right? So you make that menu based on those different domains.

Andrew [00:46:41]:
So when you're doing this chunking or this Pomodoro method, it helps break it down. One last tip I'll give, because I I can give so many, is the Eisenhower matrix. It's a decision making matrix where you separate. Because with ADHD, everything feels relevant. Everything feels like a 5 alarm fire that I need to respond to right away. So helping yourself break down tasks into understanding what's urgent and important, urgent, not important, not important, urgent, not important, not urgent. That takes a little trial and error. It takes a little finagling, but, like, understanding that from that way.

Andrew [00:47:17]:
So there's there's so many different tips. Oh, I got an extra one. A bonus one is a website called goblin dot tools.

Jennifer [00:47:24]:
Oh, okay.

Andrew [00:47:25]:
It it uses AI to break down tasks.

Ashlee [00:47:27]:
Oh, AI.

Andrew [00:47:29]:
Oh, yeah. All my ADHD clients love AI. So it you use it to break down tasks, and it gives time estimate. You can adjust the amount of peppers based on how much steps you want it to be broken down to. But recognize it's AI. It's not perfect. Time estimates are not perfect, but but it gives you an idea of how to break down tasks if you struggle to break them down. But breaking down tasks is really important for ADHD, so I personally love it.

Ashlee [00:47:56]:
Love that. Thank you so much for all of that. Those are

Andrew [00:47:58]:
all really good tips. You bet.

Ashlee [00:48:00]:
Jennifer, did you have any other questions that you wanted to ask?

Jennifer [00:48:03]:
You know, I think that you shared previously, and I think Ashley has been going on and on about how amazing you are before we recorded. Is there anything else that would be important in terms of the PTSD aspect and the ADHD? And

Ashlee [00:48:20]:
A good point because we did you did mention a little bit of the the CPTSD.

Andrew [00:48:24]:
Mhmm. Yeah.

Ashlee [00:48:25]:
So maybe having to break that down a little bit so everyone kind of understands it.

Andrew [00:48:28]:
Yeah. So complex post traumatic stress disorder. You all probably know a lot more about this than me. I'm a trauma ish therapist. Like, I so my modalities that I use are is I have a IFS. That's the only trauma modality that I'm really trained in. I'm working on EMDR.

Ashlee [00:48:46]:
Oh, yeah.

Andrew [00:48:46]:
Yeah. So CPTSD is like it just basically, what it is, you're constantly exposed to trauma. You are in a consistent exposure to trauma, so you've developed a prolonged trauma response. Rather than one singular event, it's multiple events over time. So we think of things like first responders, or we think of things like child abuse, child molestation, those kind of prolonged trauma states. That's number 1. So number 2, in the in relation to ADHD, I always say treat the trauma first. Treat and adapt and accommodate to ADHD, but treat the trauma first.

Andrew [00:49:24]:
If we can eliminate trauma and those symptoms still are present, then you discuss things like medication. But I always say, if you can treat the trauma, you will for sure see an improvement in a lot of those executive functioning regulation symptoms. Right? So emotional regulation comes with CPTSD. Relationship instability comes with CPTSD. A lot of different executive dysfunction you see with CPTSD. So if you can improve those symptoms with good trauma informed management, you're going to improve symptoms of ADHD inevitably, but treat always be treating trauma.

Jennifer [00:50:05]:
Lovely. I appreciate that.

Andrew [00:50:06]:
Sure.

Ashlee [00:50:07]:
K. Well, I I have I mean, I could probably keep you for 20 more episodes or hours, whatever whatever that may be for real. This your your knowledge is seriously unmatched, and it's it really truly is an honor to have you on here, to be a therapist alongside you, to learn from you, and I I'm super grateful. So thank you. Thank you so much for being on this this podcast. I guess, the show. You know, there I am, making us big. Big time.

Ashlee [00:50:34]:
We're big time here. Right?

Andrew [00:50:36]:
Table.

Ashlee [00:50:37]:
One thing that I do wanna ask is if you want to share a little bit just in case our when the call hits home family is looking for more information or they wanna check you out, Andrew, where would they go to do that?

Andrew [00:50:50]:
Yeah. So I am on Instagram, TikTok, and threads all under the name neurospicy counseling. I practice in the state of Missouri, and I am taking new clients as well. Yeah. That's where you find me.

Ashlee [00:51:03]:
That's awesome. Okay. For sure. And we'll make sure to share that too so that our listeners can can have access to that and and continue to learn because I think there's a lot more we can learn on this topic, especially.

Jennifer [00:51:15]:
Oh, absolutely.

Andrew [00:51:17]:
Yeah. And I just wanna express my gratitude. I love what you both are doing. It has been such such a pleasure and a privilege getting to chat with the 2 of you. You are such experts in what you do, and I am so grateful for what you're doing. It's important work, and I'm so grateful for it.

Ashlee [00:51:35]:
We are certainly trying, aren't we, Jennifer?

Jennifer [00:51:37]:
We are doing that. We are doing that. Andrew, thank you so much. It's been a pleasure, an absolute pleasure.

Ashlee [00:51:44]:
And just don't forget that when the call hits home, Jennifer and I are here for you.