ADHD and Rejection Sensitive Dysphoria

good evening everybody welcome to our webinar this evening we're just letting everyone in so um there'll be a few people joining so just give us a few moments while people join and we have got over 150 people signed up um tonight so it could be a full house and we can fit a maximum of 100 people online at one time we've currently got 40 and they're rapidly climbing so thank you so much for your joining um this evening it's so lovely to have you here i'm going to get started off by explaining who i am and then i'm going to introduce you to these two lovely people um so my name is victoria bagnall and i am the co-founder and managing director of connections in mind and we're an organization that specializes in raising awareness about executive functions and how we can all develop stronger executive functions now executive functions are the brain processes that we find in the prefrontal cortex of our brain so this is a bit of our brain behind our foreheads and they help us to regulate our emotions to help us manage time to organize our belongings um and really just to get on with life um so they're essential parts of our brain makeup which help us to contribute towards society and life generally and i'm gonna hand over now to phil to start us off and introduce um yourselves hello everybody uh my name's phil anderton um together with lisa um we are the founders of an organization called adhd 360. um we could easily write that off i think as an expression of where providers of adhd healthcare um probably a bit too easy to do that in so much is that for the last 20 years lisa and i have worked together off and on trying to improve people's lives for people who have adhd and that journey has brought us through to eventually having our own health care business lisa as a career nurse uh and myself coming through the criminal justice route of being a senior police officer and then working in the nhs working in the pharmaceutical industry and then realizing there's a better way of doing this so bringing that to fruition with 360. and i've probably stolen most of lisa's thunder there so i'll hand over to her while she's got a black piece of paper and a blank mind on how to introduce herself hi i'm lisa mangle and i'm the other half of adhd 360. so my background is that i've come through the nhs and worked in adhd for 20 years as phil's just said um and we've been um working in our own business for the last two and a bit years now two and a half years where we um assess diagnose and treat from the age of four i think my youngest patient is and my eldest patient is 76 i'm very proud of that um we change lives actually on a daily basis just by understanding diagnosing treating and supporting people who've struggled for many years um and i love my job it's not a job it's a hobby really introduction's done we're back to you now victoria brilliant thank you so much for those introductions so you're joining us this evening because the hot topic came up on our facebook group um before christmas and we started discussing um rejection sensitive dysphoria which is something that comes a lot of symptoms that comes alongside adhd and a lot of other neurodevelopmental disorders as well um but really is recognized as being um a symptom of of adhd um and so i reached out to you guys and i was like help my adhd experts can you give us some insights on this and would you like to do a webinar um so you've been off busy kind of collating all of your knowledge and some case studies for us this evening i see um so i'm going to hand over to you guys to take us through what you've prepared um and then we'll have a bit of a discussion at the end and we'll have some time for questions from the audience as well so if you do have a question um as they come up please do put them in the q a box and you'll find that at bottom of your screen um to the right hand side um of where we're speaking so you should see that so if you if you have a question that comes up um please just do write it in there and then we'll get to your questions at the end of the presentation in a few moments great stuff so i will start sharing my screen if i can um when i hand over to you phil to get started a really um interesting challenge that you set before as victoria with um rsd um [Music] it's it's almost it feels when lisa and i were briefing you when you originally asked us to do this it feels like one of the new sexy things to be emerging out of neurodiversity and and challenges of neurodiversity and and yet when we look at it we've been dealing with um rsd throughout our years of dealing with adhd it's the label that's perhaps becoming a little bit um more modern if you will than than what it's describing in it it does represent future thinking i think of how we how we manage and how we label if you will um the nuances of of neurodiversity being euro diverse we've said for a long time and we've said on many of these webinars that we've done together um adhd isn't about being hyperactive inattentive and impulsive adhd is about as you talk about a lot victoria with us it's about the executive functioning and then what are the deficits of that executive functioning manifesting impairment in somebody's life and i i would hope that within my lifetime the label adhd disappears and we have a more meaningful label that actually starts to describe the challenges and the outcomes that people have um with this with this prefrontal cortex limitation if you will and the the biggest barrier i think to changing the label is that our really sexy logo which is over here on the left hand side will have to be changed and i'm not sure what to change it to do but less less flippantly um i think discussing things like rejection and sensitivity um and challenges is the way forward for adhd and starting to label things appropriately in terms of impairment is exciting we battle long and hard on a very regular basis with trying to convince some elements of society that adhd is not about naughty boys and it's it doesn't have to have a naughty boy syndrome to be classified under the dsm the manual that we use for assessment and i think this is a really exciting opportunity um to discuss one of those emerging more appropriate label opportunities for the impairment of adhd and i think for me we could draw the line under the session there and just sort of say look the reality is that rejected and sensitive to rejection and sensitive to criticism is an impairment of adhd let's stop discussing it let's just move on because that's a fact that's there that's a reality and we won't because you've asked us to give an hour so we'll we'll we'll have a look at it in a little bit more depth but that's our reality i believe is that it is there so if i could have my chris whitty impression thank you very much and have my next slide please um both chris whitty and i both got a um what what i'm going to do is lead lead the the the webinar through a series of slides if i may um and bring lisa in a key moments to to provide that kind of medical background and that medical what's going on at the coalface perspective um and what we see on a regular basis um and lisa before i trot on into these slides um one of the things we've been discussing is is how people manage rejection and perhaps it's worth just having a couple of minutes of what we see in the clinic in the broadest terms and i can think of a lady in lincoln that we've got as a patient and i can think about a man in norwich that we were dealing with and both of whom immediately when we started talking about this sprang to mind you want to talk about them for a second just to bring this to life yeah we've got we have we have several patients who you know are very sensitive and so their reaction um to many experiences is to lash out and leave extreme voicemails and um text messages and emails and obviously you know phil and i are made to not take those things personally because we know that those reactions in adulthood come from many many years ago um but you know it's very difficult for the patient to begin to understand where those emotions are coming from um but they can be extreme really extreme you know we've had patients who we've had to get the police out to and ambulances for and you know it's quite um upsetting when when you have a patient who is so distressed by something that to me seems small but to them is absolutely overwhelming and and life-stopping almost um and it and it's it can be difficult to to to deal with those situations but i think one thing that phil's really good at and he's good at um well he's calm for a start so i think that's a good place to start um and he's reassuring and he begins to explore the reasons for people's extreme behaviors um and where that may have come from um in the beginning but it it's been extreme at times hasn't it phil yeah it's as a clinical team we've had the 11 o'clock till midnight threatening calls because the patient hasn't been able to get their medication on time and and what have you and i think those kind of experiences of what we'll explore as part of going through and these these six steps to understanding as we've labeled them and bringing our clinical work both in terms of what we see in our patients and what our patients give us sometimes um to bring that level of reality and victoria i'm kind of looking to you to sort of just check that that's the right trajectory for you um and i'll keep bringing you back in to make sure you're still there um and just to make sure that's the right trajectory for you for the for the next 50 minutes or so is that okay yeah give me a nod yeah okay um so if if we're on a six-step journey as it were let's have a look at the relevant adhd bits and the first bit that came to my mind before we started diving into the science and things it was actually that um 19 years ago i think it was steve brown and i as police officers working in america in the uk on adhd and criminal justice we ran a survey of 250 families 250 in the uk 250 in in the us and one of the questions we asked them and i keep returning to this in many many presentations because it resonated then and it still does now is when did you notice a change in your child and and what were those changes and and it was quite amazing that with two completely different nations what parents were writing about was the change in the self-esteem of their child who has adhd from the age of six and and that that to me struck a massive chord it hit me like a sledgehammer in the face really i wasn't expecting that and i wasn't expecting it to be duplicated on either side of the pond with such clarity and when we looked at it and probed into it by the age of six kids at school are already not included with their peers if they're neuro diverse and segregated at school by their teachers kept in rather than having a break because they're behind with their work therefore not getting to exercise play have fun enjoy the moment with with the kids at school with and embarrassing their friends and therefore being embarrassed and not understanding why by both their conduct and their behavior and and how when when then delving deeper into that how that starts a negative trend in the internal emotions of that individual and the internal emotions of that child um and it transpires that these are classic adhd outcomes which are manifested and have their roots from the age of six and you know the flat earth society would tell us that kids can't show symptoms of adhd at the age of six well they damn well can and what's more important is they've got the emotional suffering of being impaired starting to affect them um at this tender age and you know as lisa will testify those children who are under six that we've treated um where um protocol would say you shouldn't treat um it's mainly because of things like this when we look back on it it's not because of hyperactivity or inattention it's actually because of dysregulation of emotions coming from these feelings that we're talking about and we've turned many a four or five-year-old's life around kept them in school where they when they were never going to be they were being excluded from nursery um and and it has its roots and we should not be frightened to talk about it in the in the build of internal negative emotions in the child and lisa if i bring you in for a second just to talk about and and it is really off guard it's it's off piste it's it's it's not the thing that you'd find an nhs clinician talking about but that's about treating the four-year-old who who's at this place where their self-esteem was bottomed already and how we turn that round perhaps we're just exploring a couple of those quickly yeah definitely um so i think the the age six for treatment is a little bit of a contentious area um and just to talk a little bit about science the reason that age six for treatment is mainly because the clinical trials were done on six to 17 year olds um and the reason for that is that they were questionnaires for the children involved in the clinical trials so before the age of six the children were deemed too young to understand the question so hence the medicines are licensed of six but that doesn't mean the dangerous before the age of six and when you've got a child who's struggling to go to school and not learning not because they're not intelligent but because they can't focus and can't sit still um and they're having outbursts at home sometimes masking at school but having outbursts at home that's a difficult place for a four-year-old to be and so i'm quite happy providing i think the child warrants treatment and the symptoms are impairing enough that they're getting in the way enough that starting treatment with the right support and the right monitoring is perfectly acceptable and in my my understanding is that the building blocks of learning occur in infant school so that is from the ages of four to seven so if you've got a child who is struggling significantly at the age of four they're not going to learn anything and if they're not diagnosed and treated until the seven then the building blocks of learning have gone and that opportunity to catch up takes a while um and i just want to mention phil something from today's clinic actually that but it is a slightly different topic but builds into this slide i actually assessed a six-year-old boy today and when we talk about um self-esteem plummeting from the age of six this this boy was clearly bright real bright button lovely lad full of he was just like tigger i mean he was all over the place but when he went on to tell me that he sat on the stupid table my heart just broke because this boy knew that he was placed on the same table as other children who really struggled with the learning and it was so obvious that this boy was intelligent the language that he used the stuff that he spoke about his hobbies his interests and yet he told me he was on the stupid table and then he came out with a comment about and it literally is that third bullet point he said that i embarrassed my friends and that's why they don't want to play with me and he talked about being lonely in the playground and then he talked about getting angry at home and you know he masks at school but gets angry and frustrated and he loses it at home and he loses it really quickly so that's the building blocks of of why a child's self-esteem starts to plummet when they're understanding at the age of six is so powerful but yet their words that they use about themselves are so negative um so i thought i'd just bring that in from a from an experience just today in clinic i think that's incredibly relevant and pertinent um and and was a question just popped up there about um how do we get this message across um that that we shouldn't wait to to commence assessments and treatments where children have got these these issues in such tender years um i i find that we have to two communication issues there and i'll i'll jump back to the slide and i will stay on piste victoria i promise you but i'll answer this question um one is that um parents often see it but are reluctant to treat with medicine that's one of the bigger barriers that we have and that's a right that's a parent's right to choose that but i i would ask that all parents do that from an educated perspective not from a google and social media perspective um and consult with the experts and and the second the second barrier um is that a lot of school teachers don't see adhd and don't see the emotional dysregulation and these trends in self-esteem because they're looking for the naughty boys and um i think one of the biggest struggles we have is overcoming prejudice in the in the education system on what adhd is and what it looks like and how it manifests um so i think it's constantly about education to answer that question it's about education here's my drink less thank you very much um marvelous timing um everybody meet my wife samantha and um she'll kill me for that and um it is about education and training and and but it also we we've got to actually use opportunities like this 100 people um to spread that message spread that word and have some faith and trust in the professionals um because i think that's that's hugely important back back to the um back to the script victoria you can smile again um if you think hang on angle not too quickly let's go back a bit no one does this to chris whitney do they um crikey and if we think about that plummeting self-esteem that withdraw um the the the um that self-esteem plummets from the age of six and then couple that with the performance deficits that naturally come with adhd i've been impulsive impulsivity which isn't just about throwing a pencil without thinking about it is emotional impulsivity and not being able to regulate things because there's no pause button um it's not it's not and it shouldn't be surprised that people with adhd cannot handle rejection or criticism as as well as neurotypical people and i think this will be the next debate whereas 15 20 years ago we were debating whether or not it's in girls and boys or whether it went to adulthood i think we need to start the debate on impairment and this should not be a surprise that impairment is huge and it's emotional for the individual as well as the outburst so if i could have my next slide now um you know and it's important that we don't just deal with children we look at adults as well challenges with their executive functioning the prefrontal cortex that that um victoria talks about so well and how that is the conductor of the orchestra being the rest of the brain and um if the if the instruments in the rest of the brain are pla played out of tune and out of time we might have incredibly skilled musicians but it sounds like a complete farce of music and that's when the front prefrontal cortex doesn't work properly that's what's going on in the adhd brain and these are constant daily challenges russ barkley everybody knows i've got a man crush on russ um he says it's not a deficit of knowledge it's a definite deficit of performance and and we were with him two weeks ago and he was reinforcing that point to us yet again um it's a deficit in performance so we've got somebody who's had a very emotional upbringing through life not not parental necessarily but their whole emotional forward-thinking way of life is being crushed around them they are struggling to get their conductor to work properly with the orchestra of their brain and by the time adult comes along to the ill-informed they're presenting as if they were depressed and i don't know what the number is but the extremely high percentage of our adults who we treat and change their lives who've been in and out of the gp surgery for the last god knows how many years presenting with depression but not responding well to the drugs foot depression and it's a constant it's a known absolute known constant in clinic and the these poor people have a total fear of failure um and because remember that procrastination session that we did last year where the fear of failure was one of the main reasons that people will not start to do things and move forward um and this group really have that fear of failure and and that how that plays into ef doesn't it yeah absolutely and and you know there's all this work on you know your growth mindset and things like that but what we find is that a lot of people um with executive function challenges have a really fixed mindset because and they're so they're so scared of failure they're like i can't i can't try because if i try i might fail and that would be even worse and so it can be very paralyzing in fact in terms of making progress and developing as individuals paralyzing what a great word to someone where that plan and then being like that on a daily basis um if i if i'm allowed to swear and i think i've used this expression before um i don't think people in this um in this presentation are depressed i think they're situationally pissed off because for that where they've got to in life they've got a fear of failure self-esteem is low they don't want to start new things no no they're not included the same everything's harder and everything becomes a challenge and i don't want anybody telling me i'm stupid anymore i don't want to be told i've not got this right anymore um it's a constant nagging saw that they cannot cure that this is going on every day and they are situationally pissed off and the way to treat them is not to use depression drugs it's to actually cure the cause uh or fix the cures and look at the the possibility of this presenting being being adhd and lisa you talk a lot about the fuse and that the high junk bar that people have and and perhaps it's worth just having a couple of minutes on that and you often talk about it in children but it's relevant for everyone yeah and give us that anecdote so i i talk to my children and adults about a losing line so i basically draw a line on a graph and then i draw a line just below the limit line and and i describe this is where you are all the time and it only takes one little blip and you cross over that lose it line and then you just explode and it appears that you're going from not to a hundred like that but you're not actually starting at naught you're starting at 99 and the minute you go over that lose it line it's gone and actually i was thinking about another patient that i've seen today um who is a byproduct of over this buildup of frustration from the age of six and he's now 22 and he is so short fused he he just loses it all the time his relationships fail because of it his relationship his relationship with his sibling is non-existent his relationship with his parents is very tricky he's a really bright kid and i got so frustrated doing his assessment because he was an absolute classic adhd in an era where adhd has been around you know i've been working in adhd longer than he's been born and he's still being missed and he's been missed because he's clever and he's not failing to a school's perspective but he's failing to his own level and this poor kid is losing it constantly and when i spoke to him and and talked the right language he was just elated that somebody had understood where he was at but but on and down side he was using substances and i mean hardcore substances he scored six out of ten on our substance michoud scale which is unusual um and i wasn't expecting a kid at university i was expecting someone in a darker place than he was but um but he was losing it all the time he was so close to that losing line all the time being in trouble with the police and everything so you know but treatment can can help with that and identifying his issues a long time ago would have made um life so much easier for him um sad sad but good that you've got here indeed so if step one is the relevant adhd understanding and step two is accepting that it goes forward into adulthood from those foundation stones and step three really is understanding that was your cue there victoria step three yeah come on people um it is that fear of failure that we're discussing um a fear of failure that in your 22 year old has been with him for 16 years day in day out every hour every day um and as responsibility in life grows that frustration continues to grow um back to the depressed thing why do things if i'm going to fail and we talked about it in the procrastination piece but also talking about it in the emotional piece and how that pushes you closer and closer to the loser line on a constant basis the mountain of constant criticism for failure for getting things wrong and and i don't believe it takes a rocket scientist to work out when you've had enough of this and you're so situationally pissed off that you just don't want it anymore you can't take it anymore and why would you have to um praise and good results are often lacking and they're also really difficult to start accepting because you don't believe it you don't believe your own press you don't believe what's saying to you and a lot of these patients that we have when you actually say do you know what you've done a really good thing today what's that you put yourself up for treatment you put yourself up for assessment and and i've had patients cry at that point because they actually start to believe that they've done something right even if it's only to admit to themselves that they're impaired and they may need help it's a huge huge moment um and they all get they without fail they all get to the stage where they can't see the wood for the trees they can't see beyond this failure um problem this criticism problem and and you know people that we've worked with very very closely who've either tried to take their own life who've or have had suicidal thoughts because they just can't cope with it anymore and it's it's beyond belief and as lisa says 20 odd years of dealing with adhd in in in our work yet we've still seen people presenting like this to us who've been missed through the school system through the education you know the suicidal ideation statement that you've just made because when we assess p patients that's one of the things that we delve into with children and with adults as part of our risk assessment and it makes me sad how just how many patients when i say have you ever felt suicidal have you had suicidal thoughts about 75 of my patients say yes and when you delve into the reasons why this is a lot of the reasons why you know this failure this you know um you know and even this 22 year old today and it's about asking the right questions and getting the right answers because this kid's not being picked up because he's not failed as far as education is concerned and when i delved into his history his academic history he did well in his gcses and that's because he was clever and he could just walk it he didn't need to revise he didn't really need to pay attention in less than he just needed to turn up and do an exam when it got to his a levels he got three b's which looks great but you know what you are capable of a stars when he did his first degree he got a 2-1 but he were capable of the first and that's all he could tell me not that i'd passed all these exams but what i hadn't done and that constant failure in his eyes just really really took its toll really took its toll and it's about really delving into someone's story and someone's history to make sure that you get getting the right information out um it's really important not just oh well he passed everything so he must be okay no it's not that simple it's really not that simple um yeah um and what we find in a lot of patients thanks lisa is that the coping mechanisms that have developed through childhood into adulthood um it could be become one of two things and we could almost categorize in in a binary way it's either fight or flight the flight is the procrastinator that doesn't want to do anything the fighter has only got one coping mechanism to cope with anything that's not going their way and that is to batter their way out verbally or physically or both um and i'll i'll talk about one of those uh in a wee well could we just on to the next slide please thanks um these triggered emotions uh was session with russ barkley a couple of weeks ago he talked long and hard about um triggers and and there's a question popped up here um is there a distinction between rsd and and odd and the most certainly is and and um the the difference will come out as we go through the next couple of slides built build into that trigger points are hugely important for feelings of rejection um and where we've got where we've got a struggle regulating emotion that is built around the trigger point what i'm about to say now is just so straightforward and easy to think about remove the trigger point and and if we can start to learn what those trigger points are we can start to actually uh remove that emotional um dysregulation opportunity remove the opportunity um and and if someone's gonna fight and and have aggression um and bring some really unpopular deep-seated um flurry of activity that's negative to the front remove the trigger flight it is harder to work with in a lot of ways it's it's seemingly unseen still water is running deep people who withdraw themselves but those triggers are still there and we have to look for and work with those those trigger points and and barclay if we go to the next slide um he was very very clear the other week with us and i do hang on his work because he just brings everything together in such a good way um can i just have the next slide victoria please um and and he talks the adhd emotions and therefore the rsd that's linked to adhd emotions are time limited they're not moods they're time limited around the trigger and they are very setting specific they are quite rational when we actually understand what's gone before and think about the previous slides and think about those trigger points think about the um the the the stuff we talked about about the lose it line there's a rationale to this and there's often a provocation and whether that provocation is deliberately provocative or not it doesn't matter there's a rational argument to what's going on we might not agree with the feelings of the person who is feeling rejected and their reaction to this but there is a rationale whereas to go back to the oppositional uh discussion of mood disorders those emotions are long durations they are proper moods they are not trigger-based they're not situational um they're cross-situational not setting specific very excessive or extreme and capricious and irrational and hard to put a rationale to and and that's the fundamental difference in what we're trying to learn and understand here is that if we have a trigger point and if we have a situation that can be removed then we can actually start to reduce if not eliminate the opportunities for rejection and emotional dysregulation that comes from rejection um by by dealing with things differently um and and it's just quite classically a bit of analysis and and a bit of skills in in the person dealing with uh the person who's feeling these things i go back to i go back to my policing days where steve brown and i very quickly learned that when coaching and training police officers around the northern hemisphere as we did and trying to get them imagine yourself sitting with 40 odd american police officers all who are huge they're all armed and you're running a training session for them where you think if i don't get this right i'm going to be in the right question too i've got to get this i've got to nail this session i'm trying to trying to convince them that if you're presented with somebody who is who is reacting in this fight way because of their emotions and what could be their adhd and it's for us to change our behavior not expect that person to change theirs and and then making that the rationale for life it's for us to change not to expect them to change and and when lisa very kindly said i i i can be calm and a calming influence i don't think i am particularly calm in anything in fact i can lose it just i've got to lose it live the same as everyone else but i think what i've learned over 20 years is i'm never going to get somebody who's poorly whose poorliness is causing them to not be able to regulate their emotions i'm not going to get them to change i've got to actually be the person that changes my approach and try and change the setting try and reduce the trigger and and that's the key to working this through and we had a patient today one of my anecdotes from the clinical setting today if i can who who were drunk because um their gp wasn't issuing their medicine in in the timely manner that this patient wanted them to and and and this this mum of a child literally chewed the left ear off one of my team in the office because the gp wasn't prescribing and starting prescribing uh undershared care in the time that she wanted this to happen and and poor ashley our supervisor in the back office really got the brunt of this um so we managed it as a complaint ten minutes after she she'd had this conversation i rang the mob and just sort of said okay we've had this conversation you've got your views what is it that you're trying to get to where is it we need to help you get to and it was very clear that the trigger had been the gp and the way the gp had dealt with it not anything that we've done and she had a blast off had her fight and now by not being the gp not trying to represent the gp and just coming at her from a completely different angle and accepting the rationale of her feelings that they were genuine that she was disappointed she'd been let down and then trying to work away with her to find a better answer that um that emotional outburst was calmed almost immediately and that's not about my skill set it's about the fact that if we can remove any connection to the trigger we can change that scenario for that individual and it happens jump in there as well actually just to say that what we've found in our work is that empathy is the most powerful tool in in this particular situation and that is about like recognizing the emotion and and and feeling that emotion with the person and validating that that's okay to feel that emotion and that can really help people move through these difficult emotions that they're feeling and because they feel okay it's fine i can i can feel that they can move through it and then we can get to having a rational conversation but empathy is such a strong antidote to these emotional outbursts um in terms of helping that person to regulate sorry i'll let you carry on i know it really better because what that what that counselling skill victoria that coaching counselling skill is is removing the trigger that empathy is actually a subtle way of removing that trigger and you know and then we prove that it's an adhd based thing because it's not extensive of a long duration it's not without rationale there is a rationale and mum i would suggest that mum has undiagnosed untreated adhd mum has had that rejection from somebody and her up uh only coping mechanism that she has in her arsenal is to fight and shout and shout and fight and fight and shout and um you know it was quite a classic case to see um and and very easy to actually then deal with if we to use your word victoria if we empathize and if we don't expect them to change but we change the scenario and remove the trigger and and if we go forward to the next slide if this is making any sense there's a pathway coming here in in terms of where we go next this model of of um what we can and can't control in terms of emotional impulsivity and dysregulation he it tells us that we'd have three or four hours on this model in itself um and and i want to stay on the yellow end if we can and focus on the yellow end because core adhd based emotional impulses impulsivity and dysregulation can be controlled with medication and treatment so the yellow end is where we we would look to treat medically and as we progress further down where we get to the need for cognitive change and modifying responses that's where cbt and other coaching and other support kicks in in the emotional journey now if we can lessen the uh the situational um stuff a combination of when this is where medicine will work but it's also where removing the trigger changing the situation also happens if we've got a child that is constantly being triggered by something going on in their classroom whether it be another pupil or something going on with that teacher or that environment we are not going to be able to change the child's reaction to this we have to change the trigger and that level of awareness of trigger change is where we start to get success and it goes back to as a cop just remembering that it's for the cop to change not for the person with adhd it's to understand the environment that needs to change if that's the trigger if we really really really aren't getting on with billy and that's the trigger to emotional dysregulation why the hell do we make that child sit next to billy every day why not flipping movement to somewhere else this the the power dynamic of what we've been giving in is what's a nonsense what we're doing is actually trying to turn something into success and change that power dynamic successfully and so if we if we just jump to the next slide uh victoria please um a mindful of the clock trump it on we have to remove the situation the trigger or change the dynamic to remove reduce the amount of promotion where you sit who you sit next to who you talk to what alternative tasks to bring with you something for self-calming take your mind off things and then as you get further down the journey start to teach the coping mechanisms of being able to project your mind into a different space think positive thoughts think differently um and so on and if there's any message that is about rejection and sensitivity for people with adhd it's got to be don't expect them to grow out of it find the triggers remove the triggers treat the treat the adhd and we will start to have success with with rsd if we try and treat it any other way we'll get absolutely nowhere and the next slide and takes us to you know what we can do to help we should massively accept the crossover of adhd and rsd and that goes back to that very first slide about impairment is not about being impulsive it's not about inattention and there's three bloody words that everyone talks about for being adhd it's about impairment it's about looking at what is impairing as a consequence of the conductor not performing well for the orchestra and make sure there is an accurate diagnosis um and lisa's role he is unashamedly as as a clinician specializing this and i would say probably more than any other clinician in the nation because in most clinics you get um a specialist in five or six different elements of neuroscience which i find difficult to qualify as being a specialist because we've gone into a broad brush stroke of of um illness [Music] by definition is across a multitude of disciplines and lisa's got this beautiful opportunity to be an expert in one thing and that is adhd assessment diagnosis and treatment and and and that unlocks a whole new um sense of opportunity for the patient as long as they're in the right clinic that they get actually seen by the right person to do the right thing and there's no doubt about it that we have a very particular view at 360 that we are specialists in one thing that one thing only we're not going to take on the world now things like rsd are massively in our our gambit because it's an impairment of adhd which we are specialists in and um you know we should we should be appreciating the level of impairment um beyond what the dsm gives us as its criteria and we should look at treatment options you know which drugs can have a calming effect at least i'll bring you in in a minute to talk about medication and you know we've spent a lot of time with scientists looking at different medications for adhd that can actually have a negative effect on people with an rsd and kind of impairment and output and using the right medication and then later on in the in the journey choosing the right coaching executive functioning work and building up strength and resilience through coping mechanisms and going back to that six-year-old and the question we should intervene as soon as possible can i break in at that point lisa to talk about the kind of the medical approach that we consider here yeah so for someone who has um you know these kind of difficulties having a the right treatment is is key so i think for me i would choose a medication that is more calming on the body less stimulating in terms of less raising of pulse and blood pressure so this is the reason why in chinese is a really good medication so originally in chinese was used for hypertension so high blood pressure so it's side effect profile is actually that lowers your blood pressure and lowers your pulse so it's got a very calming side effect profile it also helps with sleep so again that helps with mood and emotion and it also covers 24 hours a day so you know when you've got an issue like this that is impactful across the day not just for for the daytime when stimulants are going to work inching if is is a 24 hour a day product so you have to look at the kind of medication that you're going to use and the side effect profile and what it does physiologically to the body then lowering the blood pressure and pulse which then lowers the fight flight process is is a good product to use so that's the you know the kind of medication that i would be looking towards and it is licensed in children but it doesn't mean that i can't use it in adults so i do have quite a few adults on incentive with really good response rates and so it's about getting the right medication for the right patient with the right um symptoms and that's what we do really well i think at 360. there's no one-size-fits-all it's about getting it right for for each patient um there's an interesting question here lisa about um if we specialize in adhd what do we do with um the likes of anxiety and ocd and and the answer to the question which you you partly led into there is it as and when and they most likely are anxiety and and compulsion behavior um being a byproduct of all these things we're talking about of the impairments of adhd it becomes something that we treat not by working with the anxiety per se but by working with the cause of the anxiety because of the compulsion uh and and we've got some we've got we've got some amazing uh case studies which one day lisa we need to put our foot on the ball and write up in terms of the physical health manifestations of anxiety um for instance high blood pressure hypertension and how um specialists would not treat adhd because of high blood pressure and weren't seeing that the anxiety that was caused by this stuff that we're talking about tonight was causing the high blood pressure and if you actually take away the cause then um you you okay how can i concentrate with your cats what was supposed to do and if if you can reduce the cause of the anxiety then the anxiety will diminish but you're also doing better with the adhd and keeping it away i just add to that because you mentioned it earlier phil about depression and anxiety so 75 of my adult patients come to my clinic with a diagnosis of depression anxiety or both and of those 75 once i've treated their adhd properly 90 of those symptoms resolve so it is about finding out what else the patient has is it a true depression anxiety that needs treatment in its own right or actually is treating their adhd gonna really impact positively on the depression and anxiety um and the other thing to say is something that you talk about quite a bit um is that if they've got coexisting autism are certain medications helpful um or do they often bring out things like aggression um so again uh medications like in chinese are brilliant for patients who have adhd and autism because you you providing a medication that allows the children to be the same 24 hours a day so there's no ups and downs of how they feel and that sits well with someone who has a coexisting autism so we don't just look at adhd although we are adhd specialists we are always looking at those coexisting conditions and thinking right what are the best medications in these instances and you know fighting us fighting as clinicians to get it right for the patient and we don't stop until we've got the treatment as optimal as possible but that's a really good really good question there was another question i saw as well about um might be on the um one about beta blockers here um is that the one no there was one about um if you don't get it right then do you do medication and so my answer to that was why wait until a child's failed before you even consider medication i don't see medication as a last resort i see it as you know parents have often tried everything before they come to us so the behavioral strategies have often already been done i don't want a child to fail and be sad and miserable and school refusing and you know no friendships and being close to that losing line before we even consider medication um i i see medication as being part of helping a child with their basic adhd symptoms and there was also another question right at the beginning that i am going to address because it's a bit of a bug bear of mine around medication turning children into zombies so it's a very daily mail headline but my perception on this statement is that i'll give you an example i had a parent phone me up telling me that they thought their child had been turned into a zombie by my treatment and i said go on then tell just explain to me what you're talking about and she said well on saturday morning they just sat and read a book for two hours okay well this child was so hyperactive when i assessed him oh my gosh he was literally just bouncing off the walls so when i'd removed that hyperactivity and impulsivity what was left was a child who wanted to read who had never read a book for two hours in his life and was just loving and devouring a book and so yes that child was very different you know he wasn't that bouncy bouncy child that the mum had been used to and loved but he was quite happy reading a book and so i actually think this is my thoughts and and shout me down if you want to but i think those kids who are perceived as being turned into zombies are actually an introvert in an adhd body and so when you then strip away that impulsive hyperactive inattentive child symptoms you are left with their default which is actually a child who likes to recharge their batteries on their own in their own room so it's something that i've been thinking about for a long time as to why why this perception about this turning children into zombies um and it's something that i am going to monitor every day until i get to the bottom of it but medication shouldn't turn a child into a zombie and if it does they're on the wrong medication and that needs looking at um but i just thought i need sorry it's a bit of a bug bear of mine because it's um a miss misconcept i think we had a mom sprang us up lisa's remember back in the early days and said you've destroyed my child they're no longer what they were and and okay wow um what is it that's changed that's caused this uh and and one said he's six and he's now holding my hand as we walk down the road yeah next to the traffic you're frightening him to death he's got no confidence anymore well what was he doing before but he was running across the road darting between the buses jumping up and down walls and everything hang on i think what's happened is chance to become a normal six-year-old um let's turn this back to emotional dysregulation and and rejection if we can can we can i just say um we are we are time now i think we're going to run over which is fine but if anyone does need to leave you can you can just leave um if you need to need to go but we'll be staying on i think for at least another few minutes um to finish off the webinar won't be long victoria sorry no if we could jump on two slides that's the one and so if we look at rounding this up if you will about rejection and sensitivity um it is a way that people express some of the common characteristics of of adhd and and we we should um we should see that and acknowledge that that this is this is an impairment that is bloody obvious when you look at the history the foundations of what's going on from the age of six at least it can and probably does stem from childhood it's not something that just happens in adulthood and it can be treated and managed with treatment and therapy there's no doubt about that we can all help by changing the trigger point and helping someone move further away from the losing line and looking for those triggers and constantly trying to change them and if we can't if we can't acknowledge that at least change our own behavior with somebody that is who's at that flash point um and we should really aim to protect the feelings of those around us who have aided who have adhd um and and children young adults and adults indeed um and and empathize to use victoria's perspective and and your great words there about empathy and um you know there's a thing in them there's a thing near the nhs force upon us um which actually has some merit which is quite unusual for some of the things they force upon us and it it's the duty of candle when dealing with people who've got a complaint and what they ask you to do with the juju candle which is legislatively controlled now is to actually acknowledge that person has some feelings which are making them complain whether we agree with the complaint or not the feelings for that individual are there and they're real and tangible and the first thing to do is actually acknowledge that they're there and be sorry that those feelings are there now how can i help you work through that and it struck me when we were doing some duty condo training a couple of weeks ago with the team that actually that's one of the mechanisms to deal with emotional dysregulation and people who are feeling rejected and i think we can all learn from that constant ability to empathize and say say to ourselves i have no idea what this complaint or these feelings are about but i can see that they're real for the person i'm dealing with and how how that changes your own lens on your approach is huge and you know i was i was going to finish with a case study and i i brought it in earlier because it fitted in and but i had to explain to three gps who rang me last week they were ringing to complain that our treatment wasn't suitable for an adhd adult that was one of their patients because that patient had lost their rag and shouted at them when they refused shed care and i took i had to take three gps right through the whole rsd scenario the fear of rejection a lifetime of rejection and you've sat there and calmly said you're not going to prescribe on the nhs because you you think that the patient going privately should be able to pay for their medicine privately forever and you expect someone who's been put down since the age of six to tolerate that and cope with it you've got to change your approach and change that trigger because if you don't change the trigger something's going to go wrong constantly between you and this patient and the problem isn't the patient the problem is that you have just been the trigger for an emotional dysregulative outburst and that sits with you and having to coach three gps on this was outstanding when they'd run wrong to tell us that we weren't treating the patient properly um and they were doing this kind of nonsense with a human being and and as i say on the last line and and as a consequence i convinced them to share care and write prescriptions for that patient as well which i took as a particular success um victoria gonna hand back to you that was my last slide i think that that hopefully just rounds it all off that it stems from childhood looking for the triggers this is real this is about emotion it's about the front part of the brain and not working as a conductor and we should be able to work with this better than we do absolutely phil and as always we you know we sing from the same song sheet with with all of this work and you know it's it's just so much we see so much of this work and so much of this in the work that we do this this rsd and it comes out in so many different ways um but the best thing that we can do as professionals and people who care about the subjects who are online today um here because they want to to learn about it is to spread the word um that this is a thing um and to get people to understand that executive functions um and challenges we have our executive functions are totally human and natural and so everyone has them to a different extent and there's not a single person that we've ever met even the 500 plus teachers we've trained um who have a perfect executive function profile so we all struggle with these things to some extent um but i think from my perspective today um hearing what you've said has really kind of cemented you know my personal experience growing up as well and that feeling of fear of failure and fear of feedback as well as a professional having to try and be perfect all the time is is really difficult so when we were recording that video the other day phil and i had that butterfly flying around i was like no it's cool it's cool you know that's fine because perfection is not achievable and if we go through life showing this polished versions of ourselves it doesn't help people who really struggle with these things to understand that it's actually quite normal quite human to find these things difficult and perfection isn't achievable and it's not human and to be perfect all the time so thank you so much victoria that there's a lady stephanie fade who's asked a question and i can't find the question and i don't want to actually [Music] uh okay [Music] let's have a look at the the other questions there's a couple of questions um that i saw coming in about is this recorded yes it is recorded you'll be getting an email tomorrow with kind of highlights um and also the recording in there and please feel free to share that with anyone you think might find it interesting um yes oh stephanie um uh so yes so stephanie um was your question um do you have it's not in the answered bit of the q a and do you have experience of working with children who have traumatic early years experiences that one yeah i replied and just said yes and the treatment would be patient specific so i have got some patients who have experienced trauma i've got some patients who are late um late to be adopted and actually i've got one patient who's a sibling of three children um and i've started her medication and it's been life-changing for her and she's on medication for adhd and anxiety um and she's doing it incredibly well so so yes um we do treat patients who've had traumatic and actually it's one of my frustrations when i used to work in pediatrics that if a patient was under cams and there was any trauma they wouldn't really consider the adhd but sometimes especially in adopted children they can have experienced trauma because the parent had adhd that was untreated and their and the genetic component of adhd was passed on you you can't just say they don't have adhd because they've experienced trauma you have to take it holistically and look at the whole patient um and sometimes adhd allows you to then treat the trauma um we find it's also kind of a chicken and egg scenario as well um i remember going to um a british psychological society presentation on trauma and thinking oh i'm going to find out you know how we can work with children who have had traumatic upbringings but actually if you've been living with adhd in your life you've been experiencing chronic trauma since the day yeah um so it is a bit one of those as well um i know as someone growing up with um neurodiverse conditions probably add as well and that it's been traumatic um and i'm suffering from that still as an adult [Music] great all right well we've run run over time but that's because we're so passionate about everything we have to say here um if anyone does have any specific questions that weren't answered today and please do feel free to email us at info connections in mind dot co dot uk with your questions and we'll pass them on um to lisa if we can't answer them ourselves um the recording will be coming out to you tomorrow morning and so that you'll get that and please do share it with everyone who find it interesting um and if you need support um from um ourselves please just do get in contact with us um you can google adhd360 they come up the top of you google that and connections in mind similarly if you google connections in mind we come up top there so just google us and reach out to us and we're here to support that's what we do you

Channel: ADHD 360

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Length: 69min 23sec (4163 seconds)

Published: Wed Mar 03 2021