PODCAST. Rethinking Adult ADHD with Dr. Russell Ramsay.

Originally aired: September 27, 2023.

In our latest ADHD Wise Squirrels podcast episode, we had the privilege of sitting down with Dr. Russell Ramsay, a leading expert in ADHD, to unravel the complexities. Dr. Ramsay has written five books about adult ADHD, including Rethinking Adult ADHD and The Adult ADHD Tool Kit. He is a Ph.D., ABPP, a retired professor from the University of Pennsylvania. He co-founded the Adult ADHD Treatment and Research Program and was a professor of clinical psychology.

Dr. Ramsay is board-certified in Behavioral and Cognitive Psychology, a diplomate of the Academy of Cognitive and Behavioral Therapies, and an expert in adult ADHD. His work has been translated into multiple languages and is recommended by ABCT. He received teaching and research excellence awards and is in the CHADD Hall of Fame. Dr. Ramsay's contributions to adult ADHD assessment and psychosocial treatment continue in his solo virtual psychology practice, where he provides cognitive-behavioral therapy for adults with ADHD and trains future behavioral health clinicians.

Topics discussed include.

• Definition and prevalence of ADHD

• Hallmark symptoms of ADHD

• Types of ADHD presentations

• Genetic and environmental factors contributing to ADHD

• Importance of professional diagnosis and collaborative assessments

• Range of treatment options, including medications and behavioral therapy

• Practical daily life strategies for managing ADHD

• Challenges of late ADHD diagnosis in adults

• Building a supportive community for individuals with ADHD

• Embracing neurodiversity as a unique way of experiencing the world

Understanding the World of ADHD

ADHD is more than just a buzzword; it's a legitimate condition affecting children and adults. Dr. Ramsay provides an insightful overview of ADHD, diving deep into its definition, prevalence, and the latest diagnostic approaches. You'll learn that ADHD is more common than you might think, impacting a significant percentage of our population.

Exploring ADHD Symptoms and Types

What does ADHD actually look like? Dr. Ramsay breaks down the hallmark symptoms, from inattention to hyperactivity and impulsivity. He also discusses the different types of ADHD presentations, shedding light on the complexities that individuals with ADHD face daily. This informative interview offers clarity for all Wise Squirrels.

The Science Behind ADHD: Causes and Risk Factors

Ever wondered what causes ADHD? Dr. Ramsay explores the genetic and environmental factors that contribute to its development. You'll better understand why some people are more susceptible to ADHD and how certain triggers can influence its expression.

Diagnosis and Assessment: The Crucial First Steps

Getting a proper diagnosis is essential for effective management. Dr. Ramsay emphasizes the importance of professional evaluations and collaborative assessments. We include a free ADHD test as a great starting point.

Unlocking the Toolbox: Treatment Options

ADHD treatment is not one-size-fits-all. Dr. Ramsay discusses the range of treatment options available, including medications, behavioral therapy, and alternative approaches. By listening to this interview, you'll gain insights into the tools available to manage ADHD effectively.

Daily Life Strategies for Thriving with ADHD

Living with ADHD comes with unique challenges, but it's entirely manageable. Dr. Ramsay shares practical strategies for daily life, from time management to building self-esteem and resilience. These insights are invaluable for individuals with ADHD and their loved ones.

ADHD in Adults: Late Diagnosis and Beyond

Did you know that many adults with ADHD go undiagnosed for years? Dr. Ramsay explores the complexities of late diagnosis and its impact on work, relationships, and daily life. If you suspect you might have adult ADHD, this interview will resonate with you.

Building a Supportive Community

Living with ADHD can be isolating, but you're not alone. Dr. Ramsay discusses the importance of finding a supportive community and connecting with others who understand your journey. You'll also discover recommended books, websites, and organizations that offer valuable resources.

Embracing Neurodiversity

As the interview concludes, Dr. Ramsay leaves us with key takeaways and a powerful message of embracing neurodiversity. ADHD is not a limitation; it's a unique way of experiencing the world. By understanding and supporting individuals with ADHD, we can foster a more inclusive and empathetic society.

Are you ready to dive deep into the world of ADHD? Don't miss this enlightening interview with Dr. Russell Ramsay. Listen now to gain knowledge and insights that can transform your perspective on ADHD.

• Transcript

  0:00

  I've been excited, obviously to have you on the show. And you know, you've done. You've written what, five, five books? Is that right? Yeah, five books. I count we it's the first and second edition of the cognitive behavioral therapy for adult ADHD. So I count that as two because it was really a big overhaul. So, yeah, so it's going to be number six coming out in May. Yeah. Congratulations, by the way. That's a huge under like a huge undertaking. Just, yeah, the whole, just the, I've written a book myself, and it was, it was pre diagnosis with ADHD. So naturally, it was not the not the easiest thing

  0:38

  I ever did. But yeah, let's talk about let's talk about your background a little bit first, like what got you obviously, you're a licensed psychologist. So tell me a little bit about your background and what got you interested in sort of that ADHD space? You know, what I started at Penn as a postdoctoral fellow at the Center for cognitive therapy back in 1995. And ADHD was not on my radar screen. It wasn't until I was approached by Dr. Tony Rothstein, the co founder and for longtime co director of the program, approached me about the possibility he said he could handle the medication side, but it would seem like some sort of psychosocial treatment would be useful. And

  1:18

  a, we hit it off. And it's been a great collaboration over the years. We both left Penn since then. But it's probably some of the best work we ever did. And that's how I got into adult ADHD. I like to say I'm dispositional II lazy and there was very little literature to review at the time. So I got in on the cheap. But But hopefully, yeah, over time, developed, like some assessment protocols, we and others colleagues around the world, independently, we're focused on cognitive behavioral therapy for adult ADHD, which is now viewed as an evidence supported treatment, psychosocial treatment for adult ADHD. That's yeah, it's amazing. What were some of the insights into that programs achievements that you were doing at Penn, you know, during your tenure there? Well, like I said, I think we and other programs are doing the same thing coming because the diagnosis is difficult. Even doing it for a long time. Many of the ADHD symptoms are nonspecific. The example I use is like in a general medical practice, like a fever, you go to your doctor with a fever, it could be the flu, it could be an infection, it could be malaria. And just like inattention

  2:31

  is pretty ubiquitous, and depression, anxiety and other things. So,

  2:36

  you know, focusing on how do you sit with people and figure out whether it's ADHD are not in addition to the fellow travelers like depression and anxiety that can go along with ADHD. But, you know, hopefully, if there's any lasting thing, it's the modification of cognitive behavioral therapy for adult ADHD. Like I said, we have many

  2:59

  colleagues who are also friends around the world who are working on the same thing. And when we get together and talk about it, and present together, we agree, we're pretty much all circling around the same thing. But I think we would all agree the name of the game, there's no trade secrets, it's more about the implementation. So I think that's something like helping adults with ADHD. And I think that was also

  3:20

  the executive functioning model, the self regulation model of ADHD helps with the assessment, as well as the tree as well as the treatment and people like Tom, Tom Brown, Ross Barkley and others. were leaders in identifying that and popularizing that, but it's, but it's also backed up by research as well. Yeah, it's been an interesting time for me discovering, you know, learning obviously, about ADHD for myself, but also, you know, like, watching a lot of presentations and learning about, you know, experts in the field like yourself, I think of, you know, you mentioned Dr. Barkley. I, I know, there was like, there was a an event where, I guess was that the probably the chat at a conference where I'm kind of paraphrasing here, but my understanding was that Russell Barkley and Dr. Ned Halliwell were kind of on stage and, and, you know, Ned is sort of this kind of teddy bear. I mean, with all due respect to both of that, and then Dr. Barkley is more like a curmudgeon, like kind of straight from the, you know, shooting from the hips kind of guy. And, and but they both kind of came to this consensus. You know, I think the question was, is ADHD a good thing or a bad thing? And I think they, they came to the consensus that like, if it's treated properly, it can be a good thing. And if it's not treated at all or not treated well, then it can be a bad thing. What are your What are your thoughts on that take? I mean, that's, that sums it up. I mean, when you think about it, and some of this comes from the work of art

  5:00

  Cleon Brown and others, but

  5:03

  the executive functions helped early humans work and play well, together with other early humans. And it had a survival benefit to doing that working together, we're better together, if you will, the executive functions that allow us to adapt to our surroundings. And so how I phrased it one of the frustrations expressed by many adults with ADHD is the consistent inconsistency. I know I can do it. I've done it before. But I'm not 100% Sure, I'm going to be able to make myself do it when I have to do it. And that can be maddening. If you know, you can be a really good writer sometimes, and you have another writing assignment. But you can't draw on that past experience, to be able to get started now and have confidence that you'll be able to finish this essay or this report. So I think adults with ADHD might be particularly sensitive to contexts, there can be situations where somebody's a rockstar, adequate support, checking in hands on stuff or things with clear objectives, whatever is the strong suit, but then you, you shake it up a little bit or twist it around a little bit, and then it's a dump to a dumpster fire of difficulties. So I think, yeah, it's, you know, it's it sounds like the clinical, the clinician cop out answer it depends. But I think with ADHD, especially, especially adults with ADHD, very sensitive to surroundings, and can do quite well with supports, and, you know, following following interests and passions, but there can be some other half two things that can really, you know, undermine them. And you mentioned that it's a little bit of both. Yeah, you mentioned one thing there that stood out to me about kind of helping people get started, you know, they know what they need to do. But they're not getting started. Are there are there tips or, you know, any any ideas there on, on how to nudge somebody to get started to get the thing? Or get it done or get it started? At least? Yeah, I mean, I'm asking for my wife, by the way. Yeah, sure. What's the old psychiatrists stroke? I have a friend, right air quotes. Yes. Yeah, exactly. No, you know what?

  7:25

  One of the things I found helpful, there's a particular type of procrastination called progressivity, I did not invent a word. It's been out there. If you can trust Urban Dictionary, it's been around since 2010. But it's how the example I use,

  7:40

  you're working on taxes or doing something else that you just really hate doing. All of a sudden, you're magically motivated to mow the lawn, clean up the kitchen, do something else that you might have been procrastinating on for the past week. But compared with the more difficult tasks, now you can get it done. And I took a look at some of those tests and reverse engineered it pretty much and said, What is it about those tasks that at that moment, make them preferable and are there any tips in there. So the tasks tend to be more hands on or manual that you can touch it, it's physical. So if we do that with something we're avoiding now something like doing taxes or writing an essay or report, those are still very cognitive tasks. But if we can make the getting started, like going to a workstation, like sitting down at a desk, logging on, opening up the spreadsheet, or the document on the computer, walking into the kitchen and opening the dishwasher door, we could stop there and still procrastinate. But that that's like one small tip that comes from that the other things are pre commitment, having a specified day and time that your gut you intend to do the task that's realistic.

  8:58

  Cuz that specificity seems to be helpful. And also some sort of task bounding, I'm going to work on this for 15 minutes, 30 minutes, or I'm going to write at least 100 words, whatever you however you frame it, so you view it as doable. And that answer might be different for you than it is for me. But getting it to the point where you go Well yeah, I can at least do this. And the very fact or the very process, I should say of going through these steps and thinking them through maybe writing them out.

  9:28

  It's it's also we could call it cognitive exposure, it makes us still think about the task rather than escaping it and escaping into action by doing something else. And all these things.

  9:40

  They're like swing votes, increasing the likelihood that you're going to get started on the task. The relapse rate for procrastination is 100%. We will do it and not all being off task. Times are necessarily procrastination. Sometimes it might be to what I don't

  10:00

  feel like doing this because I'm really tired, I need a break. I've been doing a lot of work already today. There's a step I knew I need to do before I start writing the report of gathering data, something. So those are not procrastination, there are things that still have to be done. But going back to the end, and also when we're, when you're planning to do something, spending a moment or two for what I call the valuation of it, why do I want to do this in the first place? What's in it for me? What about this? Why be underestimating in myself? Hey, I'm, I'm a good writer when I get down to do it. But it can also be something like I just don't want to have to think about this after today. And that's, that's motivation too. But a couple of these steps, these can sort of they're like swing votes in Congress, where it nudges it where we might be a little more likely to get started a little earlier than we would otherwise for God's sake vote. Right. Yeah. So obviously, both both politically speaking, but also, as a new american myself, I just became an American citizen.

  11:03

  A few weeks ago. Yeah. Thank you from Canada, originally. Oh, yes. My home and my father, my father's side of the family. Well, originally Scotland, but they were Canadian. And both went to the University of Toronto. Oh, nice. Nice. Yeah. We just did a tour of UT with my son. Are you ft, I should say. And yeah, so he may be getting back to both my kids are being raised here in Nashville. But both were born in Toronto. So yeah, who knows? Well, we'll see what happens there. What part of Scotland

  11:34

  it was a small place called Nairn, er. But I've also heard it pronounced his Northern, okay, a ir N, at least to my knowledge, and that's where they're from. But yeah, I lived in Edinburgh for about a year and took by, we took the family, the kids and my wife, we all went back. My wife and I both lived in Edinburgh together. So we we brought the kids last year and gave them the grand tour of Scotland and went up to the Highlands and Islands sky. And yeah, it's gorgeous. It's gorgeous. I had a good chance to go to Glasgow a couple times, once the World Federation Congress of ADHD was there back in 2015. Nice. And then the family went there. And yeah, we visited Edinburgh, Glasgow and the highlands is lovely. Yeah, it's, it's a beautiful, beautiful part of the world.

  12:20

  That's interesting that so you mentioned being in Scotland for that conference. I've had some conversations with some, you know, doctors and coaches and things about culture and how it plays out as it pertains to ADHD. Now, obviously, ADHD is blind to our upbringings, and our backgrounds and such, but, you know, some cultures are less quick to diagnose people and maybe even any, anything for that matter. Certainly, with any kind of like psychotherapy, or you know, things like that. Is that something you've come across? And you know, with different different cultures, different people, backgrounds, faiths, all that stuff? Yeah, I mean, you could go with a culture of within a family where one parent sees the benefit of medications, and somebody else is skeptical about it,

  13:14

  you know, cross culturally, some of the different rates, I mean, they'll they'll generally cluster around similar prevalence rates for ADHD, but you'll have some, like, I remember one study where, like, I think there were much lower rates of ADHD in Italy.

  13:34

  There, there can also be, you know, various differences in terms of, you know, how do you define a diagnosis? How do you define a symptom or a behavioral problem that needs help? Who do you go out to different communities? You know, black Americans can be very skeptical of some of the medical professions and rightfully so based on some past history. Yeah. And, and also, different groups have different avenues of seeking help some, some groups that might be more faith based first, it could be the family doctor. And, you know, others might rely on the family and not want to go outside the family. So there are a lot of individual differences. But I think as you alluded to, even with all these group differences, the numbers don't lie. Wherever there's a human brain, there's going to be you know, the, the possibility of

  14:29

  a prevalence of ADHD and we can say the same about depression or anxiety even though there might be differences in how different groups define these and define seeking help. Yeah, it's interesting, I'm kind of thinking along the lines of like the, the Blue Zones, you know, study or studies about like longevity, like healthy longevity, and and, you know, kind of narrowing down what these different groups have in common as far as diet and you know, lifestyle, social circles, things like that.

  15:01

  So I suppose there, yeah, there isn't really, I mean, ADHD is ADHD, it's just like our operating system, is it not?

  15:10

  Well, that's a way to think about it in a way, like if we think about it as an executive functioning problem. Now, even using executive functions, you know, if we broaden out, we think about it as a self regulation problem. And there are other facets of self regulation outside of or overlapping with, or like Jeff, new corn, Dr. Jeff Nucor, and I love the phrase, he uses interdigitating.

  15:34

  But there are around like, how efficiently do we do what we set out to do?

  15:39

  So on that front, that is a, a guiding system for most people, most humans. And I also think that this is why the problems of ADHD feel familiar to a lot of people who don't have ADHD, and hence the myth. Doesn't everybody have ADHD? Or a little bit? And no, not really. Now it does fall on a continuum as a matter of degree. It's not like a hard, there's a hard marker between you got it or you don't? What what I forget who said it?

  16:17

  But he said, it's hard to tell when day turns into night, but it most decidedly happens.

  16:24

  And that's how it is with ADHD? Where do you draw the diagnostic line? But it's usually clinically we're looking at functional status, is this getting in the way of your life? And if it's like sub threshold or mild but still causing problems? Well, then it's, it's worthy of treatment. But going back to this is where it I think it is a core feature, or like the executive functions to self regulation is a part of our factory settings, if you will. So it that's, like I said, I think that's why some people might have a hard time understanding it, or thinking that everybody has it when in fact, no, not really, are their estimates. I mean, there I know, there are estimates. And the last I saw I think was like 20% of people with ADHD don't know they have ADHD, or they're like, more up to date or more accurate numbers that we can go with. I know like, it's 5% of Americans are up to 5%, which is 8,000,020% of adults don't know they have it. Is that. Does that resonate with you? Or yeah, I think you know, what, actually, I might have heard, it may be flipped a little bit where there might be

  17:40

  a somewhat higher rate of on unidentified and ADHD and adults are untreated. Yeah. Even though I think there's been some corrections since the pandemic and things like that, and greater emphasis on mental health and increased access during the pandemic, which hopefully, with remote treatment will persist. well beyond it.

  18:05

  But I think generally, we're still talking about,

  18:09

  you know, some of the numbers, probably the adult numbers are going up a little bit, but you're still within that, like three to seven range. But also because we spend more time in adulthood. So in some ways, there's going to be more we spend more time in adulthood than in childhood. So you know, there's probably going to be some more, more later identified, you know, individuals there. Yeah, I think I think there's still an under representation in terms of people who could benefit from specialized treatment. Oh, yeah. Now that I know, I have ADHD so often, like, I'm, like, I've said this on the show before, but like, I'm at the grocery store, checking out, I'm like, I, this clerk totally has ADHD.

  18:50

  Like, I see it everywhere, not to say that I'm like,

  18:54

  or even trying to diagnose somebody, but you know, I'm like, seeing things that kind of resonate with me that way that I think, like, I wonder, I wonder if this person and I did read to that there was an uptick in diagnosis, especially during the pandemic, because, you know, and you touched on that a little bit like, more people were working from home. And so if you're, if one of your kids or your kids have ADHD, and you're working from home, and you're with them all the time, you start seeing a wait a minute, you start seeing some of these traits in yourself, or that just the change of scenery, or your office space completely throws you off from from working from home, or more people are spending more time on social media and, you know, watching tick tock videos, God forbid, and you know, learning about it that way. So it's yeah, it's interesting. Well, you know what, and when we think about self regulation, we sometimes overemphasize the self even though that's part of it, but things like the structure of getting up and going to the office, that that

  20:00

  Create some self regulation, when you're at the office, you're physically protected. I mean, we always got our phones with us, but from some of the distractions at home or getting up and going to school or going to campus, and then having access to the campus library, just getting ourselves to certain places, if you've ever woken up with to have an alarm, that you set that self regulation or set something by the door, so you didn't take forget to take it with you. That's self regulation. On the topic of self regulation, I think about well, you know, obviously with addiction that that it My understanding is that's a big problem for folks with ADHD. Can you explain that a little bit, I know, it's part to do with the lack of dopamine, right?

  20:43

  That can be part of it, there can be many causes, there is the self medication hypothesis, that it is an effort at self soothing.

  20:53

  And with different medication, I'm sorry, different substances having different effects.

  20:58

  It can be perhaps, you know, talking about sensitivity to context, maybe being around others who are using and upwards of abusing substances where it becomes part of that subculture, if you will.

  21:17

  There can be simply the genetic predisposition towards addiction or some combination thereof, that can lead to that increased risk factor. Now, I know some recent studies have shown that because there's some concerns about

  21:37

  the medications, often the stimulants use for medications, but there are some recent recently published studies, one was one was tracking high schoolers into young adulthood who are taking their on prescribed stimulant regimens for ADHD. And another I think, was a cross section of adults with ADHD. And both studies using different methodologies found that taking prescribed stimulant medications does not increase the risk for addictions beyond the population risk, you're at no greater risk than anybody else in the population. And also, it would seem like if we're effectively treating ADHD, that that should reduce the risk for it, maybe not eliminate it. That's, that's the thing as being a clinician, you'll always see the outliers, but it should greatly. It would seem like greatly reduce that risk, and also be a benefit for people in recovery or trying to reduce their substance use. Yeah, so I quit drinking three years ago, and I quit smoking cigarettes like 20 some odd years ago. And, but certainly, when I was younger, I would smoke like a chimney. I've finished a pack in the you know, and I would drink like a fish often. Also, knowing my own limitations. For example, my father was a pretty heavy drinker, but would drink like Scotch whiskey. And so I knew better to tend to avoid such alcohol. So I would drink beer. And as far as like drugs were concerned, like, I did know people who got into some pretty serious drugs. And I always avoided those drugs, because I knew I had a tendency tendency to kind of be excessive with things. And so it's interesting, reflecting on this, and, you know,

  23:26

  part of it too, and I guess the question here, is, maybe in the studies you've done, or in the patients you've had,

  23:35

  when somebody is diagnosed with ADHD later in life, and this is something I'm experiencing, I'm often wondering, I'm not reflecting on the past too much, because I know that can get to bad places. And and that's not my intention. But I do think a lot like for example, I'm a very funny person, usually, I promise.

  23:55

  And, you know, I've, I'm quite, you know, the life of the party quite humorous, and things like that. But I think sometimes, like maybe I was being really funny as a kid, certainly the class clown because I couldn't sit still or because you know, for and so it starts to make me wonder, like, how much of my personality is because of ADHD or non undiagnosed, ADHD versus like, it's just Dave.

  24:25

  Well, you know, what, like, how do we? This is a question Tony Roston and I would bounce back and forth.

  24:32

  How do you differentiate like ADHD and executive functions from personality because we're talking about some of the more persistent parts of oneself

  24:43

  and interacting and dealing with a variety of individuals and contexts. And bringing that back to, you know, if we think about humor, it's being able to see things in a different way.

  24:56

  And, and also, if things are boring and

  25:00

  you can make them funny and get a laugh out of it, that's a way to pay attention and sort of self stimulate oneself

  25:06

  and make something, you know, being able to sustain attention by looking for or thinking about a wisecrack or, you know, stay engaged in some way. So it is an effort after attention in a way now, can it get you in trouble? Sure. And are there times it's really, you know, you could say somebody, anybody can say the wrong thing at the wrong time to the wrong person. Absolutely. But yeah, that's, that's one of those things to consider. And, and ways that,

  25:34

  for lack of better phrase, somebody could take their like, for like a better phrase, ADHD personality, or these predispositions and also find a way to hone it and make it work for them. Yeah, because I go through periods. You know, I work for myself, I'm an entrepreneur and my own business, and I do a lot of public speaking for my for my business, things like that. But now that I've been diagnosed, like asked me what executive functions were last year, I had never even heard of them. And now, I'm not I can't say I'm obsessing about this, but I did launch this podcast and why squirrels website, I, now I tend to find that I am.

  26:19

  Sometimes I feel like if I hadn't, if I didn't know about my diagnosis, I'd be in better shape. And that's probably I'm sure that's wrong. But I don't know, it's just part of the struggle, I guess, of being diagnosed kind of late in life.

  26:34

  Yeah, and I know that ADHD is one of those diagnoses, and and it, it can lead, in some ways to it being minimized.

  26:49

  That it's viewed as, for lack of a better phrase, quaint, or a nuisance, or, Hey, it's my ADHD, it's sort of, it's almost like a brand name, like Kleenex or Xerox is used, and it sort of loses its loses its meaning or its credibility, for lack of a better phrase.

  27:10

  And so, you know, the, we want to be careful with labels. But you know, ADHD is one of those if, if it's being thought of, as there there is a, I don't think style is the right word, or maybe a temperament that goes along with it.

  27:30

  Now, again, there's a lot of diversity within people that share the diagnosis of ADHD. But if it's viewed more as like cognitively, predispositions that have some challenges that come with it, but also

  27:45

  some predispositions that in the right setting with the right people with the right encouragement, can support people and doing wonderful things. And like you launching a podcast based on your curiosity about it once you got the diagnosis. I mean, it's that's that's part of the clinical craft, if you will, coming from it, as I do as a psychologist is helping people find their way to that. And like Alina used

  28:16

  several times. There's the idea of rehabilitation. How do you get yourself back to a previous level of functioning, like if you have a knee injury or something like that? There's also within I think that literature what's called habilitation, to take the ar e often just habilitation, which is making the best out of what you got. And I've not yet found this word. So this one I'll take credit for inventing, but somebody who proved me wrong, and I'm happy to give credit where credit's due, but sometimes at its best,

  28:50

  you know, me being a therapist, you know, how therapy but combined with medications or whatever works, we're looking at abilities, patients, what are some of the abilities that previously undiagnosed ADHD might have covered up or interfered with. And these difficulties can also take the form of self doubt, self criticisms, and avoidance, assuming one can't do something, and maybe re explore some of these new opportunity or old opportunities, pick them up again. Now that there's the understanding of ADHD and how one's brain works, so that sort of habilitation of hey, let me try this again. Or this thing that I thought I couldn't do, let me give it an honest try and at least find out by trying and sometimes being able to do things and assume roles that people thought they couldn't. Yeah, I sometimes think for my own business that like if I found a co founder who was like, quote, unquote, neurotypical like we'd be like, you know, a force to be reckoned with.

  29:48

  But that's like one of those things like finding partnerships and I without geeking out more than I have, there's, there's some like research collaborators who they go, hey, this person is really great at the theory

  30:00

  I'm great at the methodology. It's sort of like the old Reese's Peanut Butter Cup commercials where you'd see somebody walking down the street, eating a chocolate bar or somebody walking down the street for some reason with an open jar of peanut butter and they'd run into each other. And they'd say, You got peanut butter on my chocolate? You got chocolate on my peanut butter, but but the tagline for the peanut butter cups was two great tastes that taste great together. Yes, yes. And how many times says that happened to me with the peanut butter every day? Everybody's running into me with open arms? Yes. I think they were only running because there's bees all around them trying to Right, right. Yeah, that's right.

  30:35

  Tell me a little bit instead of looking at their phones or looking at their edible whatever, eating walking down the street.

  30:42

  Exactly. Hey, by the way, speaking of edibles, CBT What are your thoughts on on on that? That new confusion? Hey, why don't you Why do you get a lot of hits, like just misspell and say, Dr. Ramsey, he's talking about CBD for ADHD? Yeah. People get really excited when they must hear that. You know what? Today, I'll make it simple. I'm not aware of any compelling evidence that it's helpful.

  31:08

  Some people use it, like smoking marijuana or using edibles or something trying to reduce anxiety or, you know, be able to fall asleep quiet their mind and I'm not going to tell anybody it's not working, but

  31:23

  that it may not be directly treating ADHD, it might be some of the side effects. Yeah. And there's there is some evidence in some very specific cases of particular types of anxiety, or other medical conditions where various forms of cannabis. And I know there's many differences that are beyond me, without checking notes. But in terms of helping ADHD, there's no at least existing credible evidence, there might be studies ongoing, I think it should be studied. But if nothing else, it may actually interfere or make ADHD worse, and particularly for teenagers. Yeah, but but fees and like the question we don't know about psychedelics and but you know, there hopefully, there's going to be some randomized studies about you have safety and tolerability and seeing what works and how if it does work, yeah, cuz I almost think with like anxiety.

  32:26

  And, you know, in my totally novice mind here, but I'm almost thinking like, If one was to, if they were to turn to like, say weed, to help them with anxiety, but they have ADHD than that, not to say that weed is addictive, but you know, different habits can be addicting, at least, and you don't want to be turning to pot leader want to be like Seth Rogen, or unless, I mean, he's very successful, maybe about a year. Sure, sure. But you know, you don't want to be just like a pothead. Basically, it becomes a it becomes a behavioral habit it becomes associated with, if I do this, then I can fall asleep. Yes, I'll share I'm a coffee drinker. And it becomes associated with when, when I have work to do, I'll start fix going to fix a cup of coffee, even if I catch myself because it's part of the behavioral script. And this is another one of these things that we can use, you know, part of that making the task manual to get started, it could be, I'm gonna get to where I do work. Now, it might be the library or when I'm writing working on a writing task, I'll go to a coffee shop near me. So it can become part of this routine, just like hopefully flossing becomes part of our brushing routine. But you know, the other thing and this is, I'm not sure if there's evidence to support this, but anecdotally, like the day after smoking marijuana, I've heard you know, enough people say to me that they suffer from a motivational syndrome. Now, these might be idiosyncratic I like on the other hand, I don't want to oversell something. But yeah, this is where clinical practice, you look at the individual, just like not everybody responds to prescribe stimulants who has ADHD, even though we know the general research is that they're quite beneficial. But there's going to be the people within those samples who don't respond and need other sorts of treatments and supports now and you'll have to excuse me for not reading your book rethinking adult ADHD. But tell me a little bit about the well, it's only you and like 10 million other people, so it's really small.

  34:27

  There's even more who haven't read my books, I don't feel.

  34:30

  But yeah, tell me a little bit about some of the the key kind of takeaways from the book about rethinking this. Well, you know, the main takeaway, the main reason I did it, it was answering, it was published in 2022. actually came out like December 2019, but 2022 I mean, 2020 copyright, and it was really a more than a decade long. In the coming answer to a question I was asked in a conference in 2002, which was what

  35:00

  What is the cognitive theme of adult ADHD? So within cognitive behavioral therapy, different diagnoses are different conditions, if you will, they might share some of the same distorted thought categories like all or nothing thinking or negative fortune telling. But there's going to be different themes like for depression, common theme is loss, loss of opportunity, loss of esteem. with anxiety, it was typically the assessment of risk, and maybe the overestimation of risk. And even more recently, and more relevant to adult ADHD. And this is part of the forthcoming book, the issue of intolerance of uncertainty.

  35:40

  That goes along with anxiety. And I make the case in the forthcoming book that ADHD is an uncertainty generator, I know I can do it, but I'm not sure if I will when I have to. So if you're running through it, it was part of taking a look at the cognitions, emphasizing the cognitions with ADHD and the role they play in procrastination and other things. But I guess the main takeaway that I wanted to achieve with it was I concluded that and this is anecdotal. This has not been studied, even though some colleagues have said they might look at it. But

  36:13

  my contention is based on some clinical experience, and that the main cognitive theme and adult ADHD is self mistrust. I know I can do it, but I don't trust myself that I will be able to do it when I have to do it. Similar to what I said before I've done it before. I know I can do it, it's not lack of capacity for doing it. But I don't know if I'll be able to get myself to do it, when I set out to do it or have to do it. And that consistent inconsistency, that consistent uncertainty, that is stressful and frustrating.

  36:49

  And that part of at least, the cognitive work is building up increased self confidence and trust, in addition to other things. But if we're talking about the central themes, now, it's not done in isolation, it comes from actually facing and doing things, the implementation of coping skills, increasingly being able to get engaged and get started with what we want to do and make progress and reach a point of completion. And, you know, throughout this is very important to the personalization, it's not one size fits all, what works for you might not work for me might not work for somebody else. But elsewhere, I've used the analogy and they're like recipes that people then adjust in season to their own tastes. So there might be some general principles in there. But what works and what is tastes good for one person will not for the other person, but it's it's a good starting point, in terms of helping people getting to where they want to go. Yeah, and I can certainly attest to the to the feelings of self mistrust. I haven't thought about it worded that way. But yeah, you kind of nailed it there.

  37:56

  Yeah, no, that's, that's great. What are some misconceptions that people find?

  38:01

  You know, when it comes to ADHD?

  38:05

  I still there, I think, still think there's some myths that everybody has it, which is a bit of a dismissal of it? Yeah.

  38:15

  I think one of the ones we still hear is, if you can, ascending up some condition, if you got through high school, you can't have ADHD, if you got through college, you can't have ADHD. If you've been working at this job for more than five years, you can't have ADHD are too smart to have ADHD or to accomplish to have ADHD. And there there is solid literature. Now.

  38:39

  ADHD is not

  38:43

  a measure of intelligence. Now, some facets here and there of executive functioning difficulties can affect some sub tests on intelligence scales, like working memory tasks, or speed of processing tasks, but they are different. But some studies have looked at high IQ individuals who often also report significant executive functioning problems, some of the work of Tom Brown and

  39:10

  some, Kevin Anshul have identified like ADHD and high functioning high achieving individuals. So again, wherever there's a human brain, there can be you know, these sorts of executive functioning difficulties. I think one of the other myths I've referred to is that

  39:31

  the stimulants are scary. Now there are medications and tape but taken as prescribed. They're among the more effective and I'm a psychologist, I can't prescribe but based on the research that are among the safest we have, like I mentioned the recent studies saying that being on a decently

  39:51

  persistent and monitored dose of stimulant medications for ADHD does not increase the risk of addiction there.

  40:00

  You know, greater risk for addiction than anybody walking around in the general population. So there's, you know, there's still a lot of those things out there.

  40:09

  And, you know, even going back to, to something I'd mentioned before, and we were talking about the increased numbers of the diagnosis that can lead people thinking about, Oh, my gosh, it's everywhere everyone has it, we're probably really talking about a correction. Based on the studies, I think we both mentioned before, of that there are probably majority of people, you know, based on the prevalence rates, probably many more people walking around with one identified ADHD

  40:41

  that have not yet been identified and not yet received specialized treatment. And that's, that's another thing. There are competent treatment pro treatment assessment protocols out there, that can be used, especially for establishing the initial diagnosis of ADHD published by Margaret Sibley, whose work I really admire.

  41:05

  And you know, getting a a competent evaluation with a trained professional familiar with ADHD, you have one of the I had a conversation with someone a while back a doctor, and he expressed the annoyance or frustration in in sort of the process of being medicated. So I personally am medicated. And

  41:32

  I'm on, I guess, my sixth month, I think. And I started on one medication, did it for a couple of months, change the dose,

  41:43

  had some weird side effects, so switch to medic, a different medication, and then have just this month actually reduced the dose, because of some some side effects, nothing scary or terrible. But you know, I don't want to scare people. Because I do think it is important to do this. But his his concerns or frustration was in what he explained was that. So at some point, you would be diagnosed with something, you know, like a low dose, and after a week, you'd see your doctor talk about it, and then maybe increase that dose by a little. And then the next week, follow up with your doctor. And you know, kind of rinse and repeat. And because of insurance companies and the way this all plays out, now, you basically get diagnosed or you you get medic, prescribe something for 30 days. And then you know, you might get a consult with your doctor, or you might just have to follow up and say like this, don't like this, and then change. So what are your thoughts on like the best? Again, you're not I realize you're not prescribing, but in your studies and experiences? Is there validity to this? Like she I mean, would it be better to to have more frequent updates, and maybe more frequent changes, and the dose

  43:00

  depends on the medication because there are some non stimulant medications that might take longer to become active and the notice changes, but I'm working with a lot of psychiatrists.

  43:14

  Now, this is a guideline, so don't take it literally. Yeah. But you know, one of the ideas is because many people if they're responders,

  43:25

  you know, adults with ADHD prescribed a stimulant.

  43:29

  They'll notice things the first couple days the first week. And then the thought is, okay, we're seeing is working. Let's increase the dose a little bit, sort of what you outlined there. Yeah. And this would be the going, I wouldn't even call it a guideline, it's sort of like what like one of these rules of thumb, you increase, we are within the safety limits, but you increase until you hit side effects. And then you take you taper back a step.

  43:55

  And that way, you can optimize the dose because a certain listeners say, you know, not not talking about a specific medication, but let's just say 10 milligrams works really well. But, you know, maybe 15, or 20 works better. And we're not, it's not sort of like, Oh, if we can get you up to 20, you can work for 20 hours a day and focus, no, we're talking about functioning, including things like driving safety, being able to read to your children, and focus on things like that. So there is there is something for that tweaking, or if something's not working, being able to change quicker rather than having to wait 30 days. Now, very often, you know, even within the 30 day

  44:42

  limits, if you will,

  44:44

  there there might be ways that a psychiatrist works with somebody to sort of make changes within there, you know, all all legal and within, you know all the appropriate professional standards, but to work to work within some

  45:00

  those insurance limitations to still deliver good care. Yeah, that's helpful. Thank you. I know, being mindful of the time here and I know you have a hard stop, do you have any quick tips for like better knowing yourself or understanding yourself, and then respecting yourself. And then connecting yourself finding community, finding people to connect with. So know yourself, respect yourself, connect yourself any thoughts or tips around those three categories, you know, what I would say, monitor your thoughts and feelings, and even the unpleasant ones or negative ones, look for the element of what might be positive about them. Now, maybe they're, they're experienced, at too severe level like guilt and shame. But even if we dial guilt back to say, maybe 3% of that is, alright, this is me taking responsibility for myself. So even though this feeling is unpleasant, now, I shouldn't be experiencing 90% guilt because I came showed up at my dentist office on the wrong date. But part of this is alright, that reaction is me taking responsibility for myself. So that's a positive, but I want to dial back the guilt. And okay. And this could be a related principle for knowing yourself or dealing with

  46:19

  the knowledge of yourself is then keep the slip ups make them behavioral, not personal. Okay, I wrote the wrong month in my planner, or I in my Google Calendar. The other part of knowing yourself is how do you make sense of things? What are your reactions? How do you think about what happened? How does that make you think about yourself? Yeah, you probably know, one of the early if not one of the earliest popular books on adult ADHD was entitled, you mean, I'm not lazy, stupid or crazy? Because that tended to be the attributions of and still, to this day, the attributions of adults with ADHD. So question those, they may be coming from a good place, you know, I'm, I want to get started earlier on these things. So knowing how you're hard on yourself, and also a nice flip on that is, and it's one of my favorite is perspective taking. If somebody I knew with ADHD, this happened to them, and they had this thought, would I agree with them? But how would I talk them? How would I talk them back from that? Still, I mean, you can still be honest about slip ups. But that what I mentioned about keeping it behavioral, because if it's behavioral, then we can correct it, and change behaviors rather than saying, I'm lazy, stupid or crazy. It's hard to change character flaws. So I'm not sure if that maps on everything but But with that, you know, what it is, you know, finding people who are willing to be understanding whether you share adhd with them or not, but willing to be understanding

  47:50

  that, you know, there's a reciprocity back and forth. And you mentioned the International Conference for ADHD, that's always a good venue. And there's many local chapters of Chad and Adha, where they're offering opportunities for that sort of community. And you might look to join up there some of those. Yeah, that's great. And I'll include links to everything we're talking about here in the show notes for folks to check out. With just a few minutes left. Is there anything I didn't ask you about? Or anything you'd like to share that that? Yeah, I didn't, I didn't bring up with you.

  48:27

  Know, I mean, we covered that and what you mentioned at the end about knowing yourself and connecting with others. No, I thought that that allowed me to bring up some of this stuff. You know about the how you think about yourself, your relationship with your feelings. I mean, managing ADHD requires facing some discomfort, short term discomfort, but getting through it by engaging in what's important for you what you value. And then once you get to the other side, it's like Tom Hanks in the movie, Castaway paddling over the waves, but finally getting over them. Now again, that the example breaks down there because then he was alone in the middle of the ocean.

  49:04

  But but you know, sometimes if we should just shorten it up and saying, yeah, it's getting over that big intimidating wave, but when we're over it over that you get smoother waters, which we know. But but that's the the implementation issue with ADHD. So that's why if you know, valuing, keeping in mind, why you value what you're doing, even if it's just to get it done. And you get over that wave. And it's just increase the likelihood of getting to the other side and building confidence through experience. And tell me a little bit about how folks can you know, learn more about what you do. I know you switched to virtual virtual sessions, right? Like, I'm no longer at the University of Pennsylvania. I retired from the University of Pennsylvania, but I'm not retiring and I'm not stopping by any stretch of the imagination. But I have a solo completely virtual tele psychology practice, but if you're if you want to check things out, and I have all recordings of podcasts on there and other things

  50:00

  On the website is www CB T number for adhd.com. And the email there my pen email still works if you track me down that way, but it's my last name. Ramsay ra MSAY. Make sure you get the a in there at CBT for adhd.com Yeah, this has been fantastic. So I really do appreciate you sharing your your insights and smarts and encouragement. Yeah, this has been great. Great. Well, Dave, thanks for inviting me. You're a great interviewer. Thank you