Transcript: Episode 26 | ADHD: Now Playing In A Person Near You | Pt. 2

Ted Leavitt – You know what? I’m going to play the violin! And you watch a thousand videos on teaching yourself violin. You do all this research on buying violins. You pick up the violin and you can’t make a note. And you’re like, “Oh, forget it. But you know what? Mandolin! That’s what I need. I need a mandolin! Maybe it’s closer to a guitar. So you switch.

So it’s hard to say that you’re not interested or you’re not motivated, but there just isn’t a payoff for that interest and motivation. And so things kind of fade out quickly. Now lack of focus, that can play a role too because a lot of times something like playing the violin or learning to draw requires persistence and follow through before you get the payoff. And if you don’t have the ability to stick with it you don’t get the payoff. Even if there was a payoff at the end of the end of the rainbow you don’t get to the end of the rainbow, so you never get to really experience it.

Which leads to a lot of learned helplessness, like,“What’s the point in trying to do something because it’s probably just going to disappoint you anyway.”

Rachel Cram – OK so are you making the shift now? That list you just gave are symptoms of ADHD. And when you’re talking about ‘learned helplessness,’ this becomes a symptom because of ADHD. So can you talk more about that?

Ted Leavitt – So, ‘learned helplessness’ was first studied with a rat. They put him in a container of water. He swims around the outside looking for an exit but there is no exit. So it eventually just stops swimming and floats to conserve energy. It’s survival behavior.

So after a few trials of that you take the rat and you put him in a container that does have an exit and they don’t even look for the exit. They just float right away because their brain has learned, “In these situations you can’t get out. So don’t try. Conserve your energy.” And so then, what was an adaptive response, becomes a maladaptive response. Now it’s not helping you. And so in humans what that looks like is, ‘I try to succeed and I don’t. I try. I don’t. I try. And you know why try? Why would I try?

Rachel Cram – You start floating.

Ted Leavitt – Right. You just start floating. On a purely survival level part of your brain, it is an adaptive strategy. Why would I waste precious energy pursuing something that can never be attained? when I can conserve that energy for other things that are attainable. The problem is it’s built on a false premise which is that failure is inevitable, when really it’s just possible. And in some cases it might be likely. But it’s not inevitable. So the brain then over generalizes, which is what everyone’s brain does, that’s what they’re built for, jumping to conclusions and overgeneralizing to simplify the decision making process.

But for the people on the outside looking in, they’re like, “Why wouldn’t you even try it? It doesn’t make any sense. You like swimming. Why wouldn’t you want to go to swimming lessons or be on the swim team?”

Because that person’s brain is saying, “Well, everyone thinks I’m good at it but when I got in there I know I wouldn’t do well, and then I’d be embarrassed. So why would I go? I’m just signing up for embarrassment classes? I don’t want to do that.”

But because the outside person doesn’t share that perspective, it doesn’t seem to make any sense why they’re quitting. It’s a phrase I don’t like but, ‘self sabotage’. Right. People shooting themselves in the foot.

Rachel Cram – Can you give an example of that? That self sabotage?

Ted Leavitt – Ok. One SCA that I work with, she said, “There’s this little guy and he never does any work. And then one day we actually coaxed him into doing this math worksheet, and he got them all right. And we’re like, ‘Wow! See! You can do it!’ And he immediately ripped it up and threw it at me. Why would he do that?”

And I said, “Well, probably because he doesn’t want you to expect that from him. He doesn’t want you to think, ‘Oh, this is what’s going to happen now.’ So he’s got to lower your expectations again, not because he’s lazy and I want to do work, but because he doesn’t believe it himself.”

So when you achieve success, your brain doesn’t really let you enjoy it because it’s terrified of what’s coming next. Because I don’t do well. So, if I’ve done well then that must mean something bad is coming around the corner. Which of course it always is because that’s part of being alive right.

Rachel Cram – Yeah. That’s difficult and sad though, being stuck in a limited and perhaps inaccurate belief system about yourself.

Ted Leavitt – Yeah. As a counsellor, I deal a lot more I would almost say with the symptoms because of ADHD which are things like low self-esteem, depression, addictive behavior, aggressive behavior, self-harm. Some pretty disturbing statistics.

Kids that are not treated for their ADHD are 700 percent more likely to have a substance abuse problem later in life. People with ADHD are eight and a half times more likely to self-harm in some form. So the way I view it is, it’s the individual’s way to cope with the alienation that comes from the symptoms of ADHD. That’s why I call them symptoms because of ADHD. It’s how I’ve learned to cope with the pain that comes from being the way that I am. And that pain actually comes from the people around me not knowing what to do with me. Not understanding me. And so the more people are educated about what’s actually going on here, we reduce the need for that coping stuff. We’re intervening way further upstream and not just trying to keep him from going over the waterfall.

I’ve seen statistics that say probably 70 percent of people with ADHD have a comorbid anxiety disorder.

Rachel Cram – Have a what?

Ted Leavitt – Comorbid – meaning occurring at the same time. 70 percent. That’s a lot. And yet it’s predictable. I mean if you’ve dropped the ball 100 times, it makes sense that you would anticipate dropping the ball.

Rachel Cram – You expect to fail?

Ted Leavitt – Yeah, your brain is just conditioned to expect the worst. Right. And that of course starts to take its toll on your self-esteem, and you start to feel like a loser and hopeless, and here comes depression, and I hate these feelings. Oh somebody passes me a joint. Oh they went away! I’m going to keep doing that. And these things start to feed on each other.

Musical Interlude

Rachel Cram – I think right now culturally, giving positive feedback is something that we do to encourage others. We say, “I believe in you. I can see you can do this. I can see your potential.” And I think what I’m hearing you saying is, when you have ADHD that’s not actually helpful, when someone comes along and says, “You’ve got so much potential. Like that rat. Start swimming.” Is that what you’re saying?

Ted Leavitt – Yeah.

Rachel Cram – Because what does that do to you?

Ted Leavitt – It just feels like pressure that I will inevitably not meet your expectations. Again, this is where that frame of reference pops up, because now when I do well on an assignment, I think, “Oh, it’s because he likes me.” Not because I did well on the assignment. Because the brain has a quick way of putting things back to our baseline state of beliefs.

Rachel Cram – You talk about mindful encouragement. The necessity from mindful encouragement when you’re working with someone with ADHD, or living with somebody with ADHD

Ted Leavitt – So, the ‘mindful encouragement’ really is about leading with validation. Saying, “I know this might be hard for you to accept,” or, “I know that you might have a hard time recognizing why I might think this about you.” So, we encourage the ADHD person in our reactions to their reactions. Not so much in coaching them on what to do and to try hard, but when they fail, absorbing that failure.

Rachel Cram – Can you give an example? You’re talking about a difference between validation and positivity. I’m wondering, can you give us an example, even from your married life? Because those are fuzzy lines to me.

Ted Leavitt – Yeah, I guess how a validation and positivity would look different would be like saying “Well, you know I have to give this talk and I’m going to do terrible at it.”

Instead of saying, “No, what are you talking about? You’re going to be great!”

It’s like, “Well you might do terrible at it. I mean, you do have some of those experiences in your life that have taught you that you’re going to be terrible at it. But you also have experiences where you’ve done fantastic.”

Because this idea that I’m going to inevitably fail is not built on imagination. It’s built on actual experiences of failure or setbacks. So to ignore that and say, “No no. It’s fine, it’s fine.”

Now they know you’re not telling the truth because these are demonstrable tangible things that I have messed up on. To say, “No, no. You’re fine.” No, I have messed up, so I would come at it like that.

So sometimes a kid will say to the parent, “I feel like I’m such a burden. I make your life so much harder.” And the parents are, “No! You’re not a burden!”

I’m like, “Well they kind of are. But they are a burden gladly born, right? We’re willing to carry heavy things because it’s worth it. And it doesn’t make me care about you any less.”

Rather than denying the reality that it is harder to parent you than your non ADHD sibling because I don’t have to e-mail their teachers twice a week to find out how much homework you’re missing. I don’t have to argue with them about every little thing.

So, to deny what is obvious becomes not a genuine relationship. So if someone says, “I’m afraid I’m going to forget.”

You say, “OK. Well what can we do to help you not forget?” So that’s the difference between validation and this blind positivity, “You’re gonna do great!” You have it in you to do great but we might need to get a plan built around you to help you do great. And if you don’t do great, who cares. It doesn’t mean anything about who you are as a person, it’s just another experience that we chalk up.

My son likes this band AJR. They have a song called 100 bad days, and the chorus is, “100 bad days makes 100 good stories and 100 good stories makes me interesting at parties,” which is kind of how I frame it with my kids.

I’m like, “Hey, it’s gonna be a good story one day,” to the point where they’re now excited to come home from school like, “Oh man, you wouldn’t believe this ADHD thing I did today!” Or, “I forgot this, and then I blurted this thing out,” and it’s not like a source of shame for them.

So that’s the biggest symptom because of ADHD is the shame. The feeling of, “I’m less than other people. I don’t have the capacity, the abilities that other people do. I’m less likable than other people.”

And so all of the things that arise from that; depression, anxiety, self-harm, addiction, risky behavior, all of those are coming generally from the need for approval, for belonging, or soothing the pain of not belonging. Soothing the pain of alienation in one way or another. Whether it’s being the class clown to get attention or it’s using heroin because it provides endorphins to my brain which I should be getting from loving relationships. Since those don’t seem to be an option for me, then maybe I’ll just use these other ones. The synthetic form of relationship.

Musical Interlude

Rachel Cram – I’ve heard you talk about the important distinction between capability and capacity and I’m wondering, does that tie into what you’re talking about right there?

Rachel Cram – Yeah, absolutely. The analogy I use a lot is; let’s say you walk into a gym and you see this person hit a half court basketball shot. Is it safe to assume that they can always hit that shot? No. I mean that’s a ridiculous shot. Usually luck. And if they did hit it, they probably shot 50 misses before they hit it.

Now that they’ve hit it, is it safe to say, “Ah, so I know you can do it. I know that you have it in you.”

So do they have the capability to hit that shot? Apparently. They just did it. But do they have the capacity to always hit that shot? On demand? When you want them to? Or even when they want to? No. A whole bunch of things have to come together at the same time for that capability to be turned into capacity.

And so I kind of look at ADHD almost like an allergy, in that the allergy doesn’t show up until it’s exposed to the allergen. So if I’m in an art class and it’s, “Draw what you want. Paint it however you want.” No problem. No disorder. But as soon as I have to draw it the way they want me to and I have to be done at a certain time, this is the allergen. It’s the structure and expectation. And now I start to struggle.

And that’s where I have the capability to be creative, but within certain parameters I have less capacity to express my capability. And that can be true not just in creative ways, but do I have the capability to read and understand text? Of course. But in certain environments I don’t have the capacity to actually do it. Like in a library where people are walking around and the door’s opening and closing. I don’t have the capacity to close that stuff out and just focus on the book.

So that’s a big difference. Whether it’s adults or kids, we might pull it off one time and then people say, “See! You can do it. I knew you could do it. I knew you had it in you.” But it’s framed as if, “You’ve been holding out on me.” That’s a big difference.

Rachel Cram – Yeah. And you can see how that is so confusing for teachers or for caregivers because again, it’s under that perception of choice. You’re making a decision to do something or not.

Ted Leavitt – Right.

Rachel Cram – I think the whole conversation around to medicate or not to medicate is a really challenging one for parents once they know their child does have ADHD and their behaviours are not merely choice. Where do you land on that?

Ted Leavitt – Well, as I said, I was not a medication person until I saw it work a miracle in this guy’s life. And in my experience with my adult clients, I would say I have never had an adult client who is diagnosed as an adult, start medication and come back to me and say anything other than, “This is amazing! I cannot believe how well my brain works. I can’t believe that I’m now doing stuff that I always wanted to do but could never quite do.”

It’s a bit different with kids, partly because the part of their brain that recognizes how am I doing isn’t really well developed yet. Until you ask a kid, “How does it feel?”

“I don’t feel anything.”

But outwardly it’s very different. They’re doing their homework, or they’re fighting less with their brothers and sisters, or they’re not bouncing around driving everyone crazy. But they don’t have the ability to be subjective about it.

A lot of people are afraid of medication but really what they’re afraid of is misinformation.

And so, it kind of sounds bad to say it until you understand what’s behind it, that the easiest way to diagnose someone with ADHD is to give them ADHD medication and see what happens.

Rachel Cram – Because it happens quickly doesn’t it? Like, if it’s going to do anything for you, it’s going to do it in about 20 minutes.

Ted Leavitt – Yeah. If you don’t have ADHD, and you don’t have a dopamine deficit, and you take that medication, you’re high on speed. And so all of the stuff that looked like ADHD will probably get worse if you give that person medication. The good thing is, it gets worse for six hours and then the medication’s out of their system and now we know. It looks a lot like ADHD but it’s not, otherwise it would have responded differently to the medication. Whereas, for myself, within half an hour of taking the medication it’s like someone’s turned on the defog on my windshield. Now I can see where I’m going.

It was probably a couple of weeks after I started taking medication, I called my wife from work and I said, “I don’t think this is working anymore.”

And she said, “Why not?”

I said, “I’m just so bored today. Like, I just want to lock my office door and watch YouTube all day, but I can’t even do that because I can’t even finish one video.”

And she’s like, “Yeah, you actually didn’t take it today.”

I’m like, “What? Yeah I did!”

She said, “No. I found it on the counter next to your cereal bowl.”

I’m like, “Oh, so it does work.” And then I thought, “How did I live like this for 33 years?”

Rachel Cram – Well, and that is part of the question isn’t it.

Musical Interlude

Rachel Cram – So when a parent comes to you and says, “So my child’s been diagnosed with ADHD. I’m afraid of medicating them.” What would be your response?

Rachel Cram – Well I find the best response in those situations is to ask a lot of questions. “So, what is it that you’re afraid of?” “Where did you get your information from?”

Rachel Cram – So they say, “I’m afraid of putting chemicals into my child’s body. I’m afraid of altering the personality of who they really are. I’m afraid of them feeling labeled that they have to be medicated.”

Ted Leavitt – Ok. So, let’s start with the label. I don’t want them to have a label. Well they already have a label and it’s just going to get worse. Right now it’s, rowdy kid or, loud kid but eventually it’s going to become idiot, bad kid. So you can’t escape a label. We may as well have it be accurate.

In terms of what if it totally changes his personality. OK. Well then stop taking it. It’s that simple. You have to balance side effects with main effects. I don’t really experience any side effects from my medication. It doesn’t suppress my appetite. It doesn’t keep me up at night. But other people do. And so sometimes they have to decide, ‘Is the improvement in productivity worth the other stuff.’ And sometimes the answer’s no.

I had a little guy. He would come in and we would play games in my office. And he needed to win, and he would bend the rules so that he could. And if I wouldn’t let him he got so angry and he’d ball his fists up and crossed his arms. And so one day he came in and he wasn’t like that at all. He was just kind of like rolling with the punches and everything was fine. But I could not have a conversation with him at all. He was about eight. He was just in La La Land. And I said to him, “Did you take your medication this morning?”

“No, my dad forgot.” And I thought, “OK, this medication is locking him in so that he can put his shoes on, get out the door, function in school. But it’s also making him so rigid and fierce that it’s become a clinical issue.”

And so I said to Dad, “Well, why don’t we just do an experiment and not take the medication for a week and see what happens.”

You can do that with the ADHD medication because it’s in and out in a day. It’s not like an antidepressant. So you’re not going to go through withdrawal or anything like that. So after a week of that they said, “Oh, he’s just so much more pleasant. You just have to tell him 15 times to go get his shoes on.” Well, which would you rather deal with? The 15 reminders or the temperature tantrums?

So they decided to not medicate, whereas others will make will make a different choice

Rachel Cram – And there’s different kinds of medications and different potencies?

Ted Leavitt – Right. The rule is start low, go slow. So whatever medication you start with, start with the minimum dose for maybe a week or two then bump it up if you need to. If you don’t, if that lowest dose was enough, you stay there. If it’s totally zombie your child, as in the early days of Ritalin, if that’s happening it’s either the wrong medication or the wrong dose. So don’t throw out the baby with the bathwater.

And in terms of putting chemicals into our children’s bodies, for people who want to go the natural route, that means a totally unregulated field. Just because it is natural on the label doesn’t mean that it is

Rachel Cram – The organics?

Ted Leavitt – Yeah, all of that kind of stuff. In medicine, if a treatment is not effective or if it’s not safe, it does not last in medicine. And we’ve been treating ADHD with stimulants since the 30s, so it has stood the test of time. And when people say, “Well, we don’t know what the long term effects are.” We actually do know what the long term effects are because they’ve been doing longitudinal studies on kids taking medication into adulthood for decades now and there aren’t really any serious if any long term adverse effects.

But the long term effects are positive in terms of self-esteem and opportunity. And so what I say to parents who are hesitant, I say, “Well you should be hesitant of course, instead of just rushing into it. But after you’ve tried everything you’re comfortable with, you might have to try something you’re not comfortable with and see if that helps.”

Rachel Cram – I think part of the wrestling with this falls back into what we were talking about; the difference between behavior problems and mental health problems.

I’ve heard the analogy that, if your child has diabetes of course you’re going to give them insulin without a second thought. Because you know that is a medical diagnosis. And I think that still in this area of ADHD, we still can think of it as a behavior problem and not see it as a health problem that requires medication.

I know for myself as a parent, that approach was helpful for me, to see this is the difference between my child’s success and life.

Ted Leavitt – Right. So, my approach as a counselor is very psycho educational. It’s informed by philosophy and theories and things like that. But the reality is, 99 percent of people don’t know what dopamine does in their brain. They don’t know what a prefrontal cortex is or a reticular activating system, or any of these kinds of things that are not functioning normally in the ADHD brain. So I find that the more education they have about the mechanics of paying attention, it becomes easier for people to go, “Oh! OK!”

So, in conversations with clients and family and friends, I’ve turned around some of the most ardent anti-medication people just with education, because they don’t understand how it works. Just like I didn’t understand how it worked until I saw it work, and then learned about it.

So, what you’re talking about, it’s easy to see diabetes/insulin, you don’t choose to not have insulin. Well, you don’t choose to not have dopamine either. But people don’t know about dopamine. And if you think about it most people probably don’t know much about insulin either other than diabetics have to take it.

So again, that’s coming back to when someone has concerns, I’m always going to be asking them questions first before I start answering questions because I have to assess, “What do they know?” And most of them have very very little awareness. And that goes with the teachers and other people that are involved with them. So always coming back to educating. This is what it is. This is what it isn’t. So that you know why that intervention that you keep trying isn’t working. It’s not because they don’t want it to work, it’s because you’re pressing the wrong button.

If you’ve got a loud ticking noise under the hood in your car, putting more air in the tires is probably not going to be helpful. But that doesn’t mean it’s a stupid car. So education about the science that’s underlying it is the absolute key and the starting point with medication.

Musical Interlude

Rachel Cram – So Ted as we start to wrap up this interview, can I put this to you as a closing question? If we are wondering if our child or even if we ourselves might have ADHD, where do you start practically, and where do you start emotionally?

Ted Leavitt – Yeah, probably the ‘emotionally’ comes first. Because if you have a lot of unpleasant emotions, I wouldn’t say negative, but unpleasant emotions about it, it puts a stopper in what are the next practical steps. Because the practical steps are actually fairly simple. You go to your doctor, if they’re uncomfortable assessing or diagnosing you get a referral to a pediatrician. I’d highly recommend that you find a pediatrician who actually specializes in it.

If you’re an adult and your family doctor is not comfortable dealing with it, or isn’t familiar with it, you need to do your homework and find a psychiatrist, psychologist or other family doctor who is comfortable but who also knows what they’re looking at.

Psychologists can diagnose but they can’t prescribe medication. So if you’re wanting to go the medication route don’t bother with the psychologists because it’s just an extra step.

Rachel Cram – That’s a good point.

Ted Leavitt – Yeah. And if you see a long wait list. “Oh man it’s going to be a year!” Get on the waitlist, because that might be your only option. You really do have to be a self advocate and self educate

Rachel Cram – Which is hard when you’ve got ADHD.

Ted Leavitt – Which is hard. Although you can hyper focus and just become like an expert.

So the practical side of what to do is actually not that complex. The emotional side, we come back to that EEFB that we talked about at the beginning. So what does this mean to me? So your child has ADHD. Okay. What is your explanation for that?

Does that mean that you did something wrong? That you wrecked them? That your child’s defective? That you’re defective? That their future is over already?

What are the explanations that I have? Because that’s giving rise to my feelings about it, which will give rise to my behavioral response.

So my emotional reaction to the diagnosis, or the label, or the medication tells me what I think of the label and what it means. Now I have to explore, ‘Where did I come by that meaning? Was it given to me by other people? Is it accurate? Because if it’s not, then maybe I need to shift my belief or definition, which will lead to a different feeling.

A lot of times parents that I work with will feel guilt. Particularly if the kid’s older. A teenager. They’re just like, “Oh man! How did I not see this? They feel bad. They look at it as, ‘They did this to their child.’

It’s like, “Well, it doesn’t matter whether you did or not, we can do something about it. So let’s start now. You didn’t know then what you know now, so now is when your accountability begins essentially. So I hope that answers your question.

Rachel Cram – I think it’s a great answer. And I thank you so much for sharing your own story, because I think hearing it in that first person point of view is so meaningful. So thank you so much for your time today Ted.

Ted Leavitt – You’re welcome. Thank you for having me.