In this episode, Andrew Greenfield looks at the subject of ADHD, how you gain a diagnosis and what that actually means. It's an important one for parents, so stay tuned. I'm Anthony Pearl and you're listening to The Being Comfortable Podcast. Andrew, I wanted to ask you about ADHD and ADD, two particular things that we hear a lot about. Explain to me what difference is because I know parents hear that terminology around, but I don't think they really understand it all that well and get the differences between the two. Yeah, and again, often we're talking about ADHD and A versus ADD. We talked about the DSM-5 that I talked about not the long ago, when you talk about specific learning disorder and you have to fulfill certain criteria to meet the disorder, it's the same with ADHD. Now, officially, it's called Attention Deficit Uproactivity Disorder, ADHD. That's what it's called, but with ADHD, you can have three different subtypes. There's purely the inattentive type, where you can't pay attention and focus and it's not necessarily that obvious. You can have the purely hyperactive and positive type where you have difficulty physically sitting still. You're very impulsive with your thoughts and your actions, which is obviously more obvious, looking at the child, and you can have a combined type. So more often than not when people talk about ADD, they're more often talking about without the hyperactivity, but officially, the terminology is ADHD. That can be with or without the hyperactivity, or it can be combined inattentiveness and the hyperactive impulsivity, or just the hyperactive impulsivity on its own. So it's those three separate subtypes, but there is no difference necessarily, officially between ADHD and ADD, besides, it depends what you're talking about, depends which subtypes you're talking about. And I think that's the distinction. So it's generally known as ADD, and that's it, but that's the official term is ADHD and which subtype. I'm interested in your professional opinion on this, because I hear ADHD thrown around a lot, almost in a self-diagnostic fashion, people said, "Ah, yes, that's the reason why." And how difficult is it actually to properly diagnose and how useful is it, I suppose, the second part of the question with people doing that kind of self-diagnosis? Yeah, and it's like doing an IQ test, you go on a line and you do what's called an IQ test. Well, an actual formal IQ test, for example, has to be one-on-one, it has to be, the examiner has to get certain key measures, same with ADHD, you can fulfill a checklist online, and it might come up with some sort of criteria for ADHD, but is that the official diagnostic criteria, according to the actual DSM-5, which is the holy grail of criteria, most likely not. So we've got to make sure that anyone may talk about or thinking about the diagnosis, it has to be done properly by the most, by the appropriate people, whether it's a child, a psychologist, whether it's a pediatrician, whether it's a psychiatrist, they're the ones who are trained in the actual diagnostic criteria. So I think we can all, and you have to meet six out of the nine criteria for it to be significant, there are certain age limits that you have to go by, you have to have had symptoms by a certain age with ADHD, it has to be persistent, it has to be consistent in lots of different environments. So there are strict criteria that have to be met in order to come up with an actual diagnosis. But at the moment, it is symptom-based, it is symptom-based, and it is subjective based on rating questionnaires that we get parents and teachers to fill out for, I guess, up to 18, and then once you're an adult, it becomes there as self-rating questionnaires that somebody feels out as well. And obviously, we look at the background of the history and the morph, and then it will do a psychometric assessment, they will help gather a whole lot of information. So it's a combination of all of those factors. There are a whole lot of other measures that people use, sometimes people use what's called the continuous performance task, which is a little test on a computer, and you've got to press a button every time you see a certain number or something comes up. That can be useful in some respects, there's a whole lot of other range of assessment tools that some people use. There is no one ADHD test. You can't do a blood test, you can't do a brain scan necessarily. There are certain markers of the neurobological markers that can be used, but unfortunately you're not going to routinely do a CT scan on any one particular person because it's not going to happen, it's not viable. So it's not reasonable to do that. So we have to use, it is subjective to some degree, but there are certain criteria that have to be meant. And it's a combination of factors that people should look at, not just yes or no, or not just a tick box, and that's it. So I suppose the next part of the equation is then okay, you've got an official assessment. What does it actually mean for you as a parent and indeed for the child? Yeah, so once someone has a diagnosis, through whichever measure they had, there are a few different ways of moving forward. One way is to go and see developmental pediatrician or a specialist developmental pediatrician or psychiatrist. And I guess what they do, what we don't do is they deal with the medical side of things. And they made you blood tests that look at iron levels, or they may talk about medications if that's appropriate, stimulant medications. That's what psychologists don't deal with, we don't deal with medications. So that's one possibility. Obviously, the other thing that can be done and more from the done is behavioral strategies and techniques. And now we'll be working with the parents and the child in combination of together and separately as to what they can do and what are some specific strategies that they could work on as well. And it's about which brings me to the, it brings me into that whole idea of what you were talking about it, the reason for the name of the show being uncomfortably comfortable. I suppose that's the question is, what does it mean for the child when they're diagnosed with ADHD? How much does the diagnosis help them in knowing and how do they cope with how they're feeling? Yeah, so ADHD is a deficit of a drug in the brain and it's not necessarily a child's fault. They haven't caused anything, they haven't anything. So more often than enough, that will take maybe stimulant medication, which increases the production of the drug in the brain to the normal levels. So that's one part of the medication complaint, but at the same time, they have to be able to come up with strategies to be able to help them focus and concentrate and then organize themselves. And more often than not, when they are disorganized or they can't focus, they feel a bit uncomfortable. And that's part of, even ADHD is associated with being a bit, you have to learn to be a little bit come to be uncomfortable, because that's just part of our personality, that's just part of who we are. So even with ADHD, that's really important to learn to be okay. It's not a criticism, it's not a negative. And a lot of the times we actually talk about ADHD as being a superpower. Being a little bit impulsive is not a bad thing, it just means that as long as you're taking healthy risks and not stupid risks, that can be a positive. Often more people, people with ADHD are often more creative, and they're more likely to be able to take, to be able to think outside the box. So it can be a superpower and I think it's important to be able to teach kids to be able to look at it as if it can be a superpower. It can be a positive. We don't want it to be used as an excuse as to why you can't do things because it's important to get kids to be able to take control over what they can control. And yes, if you have difficulty in a certain area with maybe organizational skills or focus and concentration, there are things that you can do to be able to help you help with that. And once we're an adult, we can get somebody else to organize ourselves, to organize our diary or we can hire someone to do that. So we don't always have to be the best at doing all that. It's important to be able to learn to live with who you are and what you've got, but you can improve on certain areas as well and that's part of why we do that original psychometric assessment to find out if there is an area that needs improving and there are things that can be done to be able to improve on key areas. I love what you said about treating it as a superpower because these sorts of things, whatever it is, of who you are as a personality should be taken advantage of and I know in a business sense, and most business people out there will be very familiar with the whole series of different personality type tests that can be done these days and how you should be mixing this person and I think being self aware of where you are from a child onwards can be something you can really use to heighten your career, to heighten what you can do and what you love doing. Yeah, absolutely. We've got to be out there. Everyone's got different strengths and weaknesses and different learning styles and we don't have to be any particular one star and it's important to be able to embrace what you do have. I said, you can have different deficits and certain areas and we can work on that and that's great, but we've got to embrace what it is that we can do as well and use that as best as we can. Yeah, and I think that's an important point as well, it is about setting those expectations and I think that is that part of the strategy that you would work together with a parent and with the child on how do I actually make sure that we're taking advantage of what the superpower is but also not being limited by that. Yeah, absolutely. I think we've got to be sensible in terms of that and we may have limitations in terms of what we can do and we need to acknowledge that and say, well, if we can't sit down and focus, we've got a very difficulty focusing on periods of time, well, let's not focus for long periods of time and maybe sit down, work for 20 minutes, get up, have a break for five minutes, work for another 20 minutes, so there are certain organisational strategies that we can use if that's the way that we learn. Some people might be able to sit down for half an hour and that's great. So we've got to be able to try and brainstorm with parents and that child and figure out the way that they learn the best based on all the information that we have and a lot of that information may come from a psychometric assessment, it may come from a specific diagnosis, it may just come by saying a child prefers to work a certain way and that's okay as well. So we've got to any time I'm looking at any profile, cognitive profile or psychometric assessment, I've got to take all of that information to account, not just focus on one bit and another bit and even it is, yes, you can improve the areas that need to be able to be improved and there's a whole lot of different strategies that can be used but at the same time, I often say within a school environment, they're not necessarily going to wait until you improve that area of weakness because that might take a few months, it might take the process that takes time. So what they need to be able to do is also focus on, well, be realistic and say, well, that's the way that it is and not necessarily get a child to rely on their poor working memory, for example, or on their processing speed and learn to accept that and have strategies to help them around that. And I think eventually when, I was going to say, eventually when they're in year 12 or year 11, year 12, you can have special provisions in some cases where you can have extra time or you can have a reader or a writer, depending on what your strengths and weaknesses are. It's not that easy to get these days, but we're trying to basically get every child to perform to the best of their ability and make it as fair and reasonable as possible. I think what you've summed up there as well as how important it is going back to the beginning of this little discussion is that getting a proper diagnosis and developing those strategies is super critical. It's not something to be afraid of. It is something that there's a process and there's a real advantage in following that. Yeah, absolutely. And it often ADHD, for example, there's often there are comorbid factors. So there are often other factors that go along with something, someone has ADHD. They might have ADHD and they have a learning difficulty. They might have a language difficulty. They might have issues with anxiety. So often it's not just the one factor. It can be complicated where a child has difficulties and a whole range of different areas. And then we have to try and make sure that we're accommodating for all of those factors as well. So it can be quite complex and it's not just a yes, no answer that we're coming up with. But at the same time, in coming up with a specific diagnosis, there are certain criteria that have to be followed and there's a process that has to be followed as well. And that's really important to make sure that it's done appropriately, properly by the appropriate professional as well. Thanks for your company and please see the show notes for how to get in contact with Andrew Greenfield. And don't forget to subscribe for future episodes. And remember it's important to learn how to be comfortably uncomfortable some of the time. 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