All About ADHD - Part IX

Isabelle & David welcome Isabelle’s husband, Bobby, and their friends, Christina, AJ, and Gabe, to continue to listen and learn from David’s tried and tested presentation on ADHD, which he normally gives to fellow clinicians (for the 1st-8th parts of this talk, please see episode 4, All About ADHD Part I; episode 6, All About ADHD Part II; episode 9, All About ADHD Part III; episode 12, All About ADHD Part IV; episode 15, All About ADHD Part V; episode 18, All About ADHD Part VI; episode 21, All About ADHD PART VII; episode 24, All About ADHD Part VIII). David describes how with ADHD, the context matters. As part of a respite care program, he once took out this amazing kid out who loved to scream--not angrily, he just enjoyed the sensations of screaming. The behavior would get to his parents and they felt they couldn’t take him out to eat, etc. because the screaming would bother people. David took him to a football game. Is there ever a point in a football game where it’s not okay to scream? The same behavior is contextually appropriate. Gabe thinks about violence or hunting, which he is wondering about connecting to ADHD and appropriate/inappropriate behaviors—David does not see a connection between violence and ADHD. Instead he talks about danger and stimulation. He picks up an agate coaster (rock) and says if someone with ADHD was handed this, they might start tossing it around. But tell that person that this is a one of a kind, very valuable thing, and they’re not going to toss it, the added risk has raised the stimulation so you don’t have to toss it anymore to be stimulated. It’s about safely increasing the danger or risk of something, pushing the limits. Another example is the water cooler. David describes working with kids where they press the button to fill up their cups with water to the very top, to see how high they can make it, and then have the added risk of trying to carry the cup without spilling it. In those moments, they are actually attending so well to the water, really focused on it. Bobby wonders if his “That’s So Raven” (see below) moments, where he has flashes of what might come to pass, like the danger in taking one route or another. Isabelle hypothesizes that it's a way to introduce danger to a scenario that doesn’t hold any. David describes that it’s a way to safely visualize danger so you can organize your thinking, but not actually have to experience it. Everyone has a different level of tolerance to danger, and it’s not about “hugging the danger,” it’s more about introducing structure. Like at a garden party, telling a kid to make sure this guest has enough water and whatever you do, don’t step on this other person’s shoes, and suddenly, it’s not a dead person command (something a dead person can do, AKA, not what you give someone with ADHD), it’s actually structure. Isabelle wonders at how this seems to help with their toddler (setting up some ground rules to think about ahead of time before visiting a place) and at how she might do that for herself, setting up rules for a meeting, let’s say, where she knows she’s going to doubt what she said so she’s going to say something silly and get it over with first thing. Bobby likens it to an accusational audit, which is a negotiation strategy, where you make all the accusations you’re scared of hearing up front, you get them out of the way.  Bobby gives an example of asking for a raise and starting off by saying “I know I might seem ungrateful or like I don’t understand how tight the budget is…” This connects to David’s DARE technique for asking for accommodations. D=Describe the dilemma.  “I really want to ask for a raise because I think I deserve one but I don’t know how to do it.” A=Ask for accommodation. “I would really like a raise.” R=Reinforcement, no matter what they say.  “Thank you for saying no, I appreciate your honesty and being up front with me.” E=Empathize, or remember that the other person is a human and negotiate closer to what your want is. “I hear you, when’s a good time to come back to this conversation?” AJ seconds that this is a technique similar to what is taught in his sales-based organization, and David describes that he stole it from DBT (dialectical behavior therapy, see below) and it’s acronym DEARMAN, because it simplifies it for someone with ADHD (too many things to remember). Gabe asks about the romantic nature of danger, how he pushes limits, like when he was younger, see how far he could ski down a black diamond ski run without turning, which led to him being injured. David wonders about this: is there any way that him telling Gabe no wouldn’t stopped Gabe from doing this? (no). Would Gabe have just gone back another day to do it? (yes). The potential consequences on that day might’ve been worse? (yes). David says there is no way Gabe would’ve learned those limits without trying it himself. So how to set that up to do it as safely as possible, without trying to prevent what the person is going to do anyway. David describes how collaboration is one of the biggest ADHD accommodations and you don’t need another person with ADHD to do it. People with ADHD have a lower self-esteem and have a greater callous to take injury, but neurotypical folx don’t get injured as much (their self-esteem), so the person with ADHD in a group will often fall on the grenade or blame themselves. It also means you might be more organized or task oriented than usual because you don’t want the other person to fail. This is similar to body doubling. When you sit down and join somebody, think about the structure you’ve just put into free time (for example, we’re all studying! Parents sitting down to read alongside their child who is working on homework). It helps when working in groups to find people with complementary, not competing, strengths. Isabelle describes how becoming a parent served as this kind of body double and heightened danger accommodation—first of all, parenthood undid all her previous accommodations, but now she finds that during naptimes, when her kid can wake up at any moment (danger of being interrupted!) She gets so much more done because she feels that risk and pressure and she feels like she owes it to her kid to get it done.What happens when the naps doesn’t happen? David describes that he would consider the rule that the kid doesn’t have to sleep, but can’t leave the room. And earmuffs for the sound. He also shares that the next level of an accommodation is the metacognition around it, the awareness of saving those tasks for naptime. David goes on to explain that he works with clients who struggle to get to work on time, but are on time when they have to drop off their kids at school (when someone is dependent on you, you don’t want to screw it up for them). The key is to not become dependent on the other person. If there is a dependence on another built into the accommodation, it will foster aggression. The more you need something, the more dependent you are on it, and it gets taken away, the more incensed you become. The difference is like being dependent on the sun or your partner, you’re going to lose it if someone threatens them. So instead of having a partner always make the lunches because they help you get the kids to school on time, you ask “can you make the lunches?” Every day—it’s not a dependency or an expectation, it’s an assist, but you are still accountable for the thing you’re trying to do, not angry that the other person ‘screwed it up’ for you. Ask more. But as folx with ADHD, we’re often trained to ask less because we’re told NO so many times.