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What is ADHD? Q&A (Episode 13)

As part of the DPSS training week in March 2021, Aimee-Elizabeth Parsons and Trevor Friesen did a session entitled “What is ADHD?”. That session was based on Episode 3, which you can watch here. In this episode, Aimee and Trevor tackle some of the questions that they were asked during and after their session.

Some of the topics Aimee and Trevor discuss are:

  • Medication: how they work, benefits, side effects, and more
  • Strategies to help with “explosive” emotions
  • Melatonin and other strategies to help with sleep
  • How to talk to your child about their diagnosis

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TRANSCRIPT: What is ADHD? Q&A (Episode 13)

Trevor Friesen

Welcome, everyone. My name is Trevor Friesen. I’m a Behavior Analyst with the DPSS team.

Aimee-Elizabeth Parsons

And good morning. So my name is Aimee-Elizabeth Parsons. I’m a PPRO on the DPSS team. I am a caregiver and advocate for individuals with ADHD. And I was also a teacher and a school principal.


Trevor Friesen

So on March 19th of 2021, Aimee and I spoke to many of you about attention deficit hyperactivity disorder or ADHD for short. During the disability programs, specialized services, online info sessions. In the last hour of that session, we received and answered several questions related to ADHD.

Aimee-Elizabeth Parsons

So because there were so many of you participating in that chat, we were not able to get to every question and some of the questions might need further explanation. So we’re recording this conversation today in hopes that by listening to it or watching this video, you’ll be left with a little bit more information.

Trevor Friesen

If at the end of this, you are unable to find the answers that you’re looking for by watching this video or by listening to this recording, you will be able to find more information by following any of the links that we’ll include in the description box of this recording.

Aimee-Elizabeth Parsons

Okay, so let’s get started. One of the major themes that came out of our question and answer period for our ADHD discussion was the use of medication. So let’s start there.

Trevor Friesen

That’s right. And some of these questions were things like, how do I know if my child needs it? How long does it take for medication to work? And some of the questions were about the possible side effects. Things like lowered appetite and trouble sleeping.

Aimee-Elizabeth Parsons

So it’s important to start the conversation by reminding our listeners that medication is only one part of an intervention plan and should always be combined with other strategies like social skill development. So that would mean turn taking, friend making, managing emotions and building strategies to help in the area of executive functions. Those are things that are difficult for individuals with ADHD.We also know that exercise and sleep need to be a part of any plan.

Trevor Friesen

That’s right. So for anyone who’s maybe a little bit late and has stumbled onto this discussion and maybe this is the first time that you’ve joined us today, we are talking about attention deficit hyperactivity disorder, or ADHD.

Aimee-Elizabeth Parsons

As mentioned in our podcast. Simply put, ADHD is a disorder where the chemical messengers in the brain called neurotransmitters may not work properly. So two of the neurotransmitters involved with ADHD are dopamine and norepinephrine.

Trevor Friesen

That’s a real mouthful. That’s right. Dopamine norepinephrine. That’s right. So some of these medications have an effect on those messengers in the brain. Can you tell me a little bit more about that?

Aimee-Elizabeth Parsons

Sure. So scientific research suggests that stimulants like Vyvanse work by changing the levels of dopamine in the brain. And there’s another category of medication which is called non stimulants. And one example of that is a medication called Strattera. And that medication works with norepinephrine.

Trevor Friesen
R

ight. Okay. So basically and this is just my basic knowledge. Dopamine is like a feel good messenger in the brain and norepinephrine is the messenger that’s related to attention and focus. And so when these levels of these messengers in the brain are low, that might be when you start to see some of the symptoms of ADHD, which begs an answer to the next question, Amy. If those levels of dopamine and norepinephrine are low, what time of day should you take your medication? This was a question that we got as well.

Aimee-Elizabeth Parsons

Yeah. So again, we have to look at the category of medication that your doctor has chosen with you. So stimulant medication typically starts to work within an hour and it wears off within a set timeframe. So some of those medications might last for 4 hours. Some of them six and some of them are eight. Then the other category, so non stimulant, that’s a medication that needs to build up over time in the body.

So actually over several weeks. So it tends to work best if you take it at the same time every day. So to answer the question, most often individuals take their medication at a time when it is most needed to help them manage their challenges with ADHD. So for school-aged children taking a stimulant medication, it would be best to take it one hour before the journey to school begins.

Trevor Friesen

Okay, so I just want to make sure that it’s really clear. So it sounds like in those cases where the person will take their medication well before they actually want to feel the effects, that’s the idea. Although I imagine that each individual case might be slightly different. So that would still be an important question to ask your health team.

Aimee-Elizabeth Parsons

Correct.

Trevor Friesen

Good stuff. I’m on it. Okay. So speaking about effects, let’s get back to that question about side effects. So what about the side effects? The possible side effects, the side effects that are most often talked about is a loss of appetite, which means not being hungry. Also things like tummy aches and difficulty sleeping and feeling like a zombie or having a loss of personality. These were some of the concerns that people expressed during our question and answer period as well. What would you tell them about that?

Aimee-Elizabeth Parsons

So to start with, the answer to that question, actually, even to talk about medication in general, medication is really a journey. It’s because your health team and you really need to find the right type of medication and the correct dose. And that rarely happens the first time you take a medication. So it really is working together to find what is right for you.

And some of the side effects, an individual may need to learn to work around. So if I look at loss of appetite, for example, this can be worked on by starting the day with a big healthy breakfast. And then during the day there’s that loss of appetite because we’re on medication and then we supplement in the evening with a good dinner if the appetite back and if not with snacks before bed.

Aimee-Elizabeth Parsons

And this can help to make up for not eating as much at lunch when it comes to tummy aches though, and people saying that they feel like a zombie or their child or themselves, their personality has been affected. That’s really important to talk to your health care team because that’s a sign that perhaps you’re not on the right medication or not on the correct dose.

This does not mean, however, that medication, all medication doesn’t work, it just means you have to go back on that journey with your team and figure out what is right for you. So, Trevor, I talked a lot about medication, but one of our questions was, how can you help someone if they’re not taking medication?

Trevor Friesen

Right. Okay. So for somebody who maybe is not on that journey yet or is not going to be towards medication, how can we help them out now? So if you remember from our presentation, we talked about the right medication for somebody being a little bit like putting on a pair of glasses, the right medication does not necessarily make ADHD symptoms less challenging, but it may make it easier for the person to use the supports and the strategies that they have in place to work around those challenges.

So me, for example, I wear contact lenses so that I can see if I don’t have them in my vision is pretty blurry and I find it difficult to do the things that I already know how to do pretty well. So, for example, it’s difficult for me to drive a car if I’m not wearing my contact lenses. It’s even difficult for me to walk around a dim room.

I might be walking into furniture and I don’t even feel comfortable going for a run outside on a bright day. If I’m not wearing my contact lenses to make my vision better. So that’s the idea of the medication is kind of like a pair of glasses. Without them, you can do the things, but it’s a bit tougher with the right medication, with the right glasses, it might make it a little bit easier to do those things that you already know how to do.

So if you’re not comfortable with the idea of medication, some of the other strategies that might be helpful are things like regular exercise and using things to help remind the person who has important daily tasks things like alarms on your phone or text messages right before an appointment, or sticky notes or notepads. And this is just my personal experience with using some of these kinds of strategies.

I myself don’t have ADHD, so my experience with them is not going to be comparable. But what I have found useful when using things like regular exercise to focus is making sure that the exercise happens right before the thing that I need to focus on. So if I’m trying to focus on something in the evening, that exercise isn’t going to happen in the morning. I’m going to make sure that that exercise happens right before that thing that I’m trying to focus on. So, for example, if I want to sit down and work for one hour on my homework at 6:00 p.m. at night, I might go have a real heavy workout for one hour right before a workout at 5:00, I’ll shower at 5:50 and I’m going to sit down and start my homework at 6:00.

Another thing that I like to do, and again, this is just for myself, is I like to leave reminders where it’s impossible for me to miss them. So, for example, I might need to remember to take a very specific folder to the office with me. And so the night before I’m going to put the folder on top of my shoes at the door. That way, when it’s time to leave the next morning, I have to physically touch the folder in order to put my shoes on, and it’s less likely that I’m going to leave it behind. Again, these are just my own strategies and remember the things that might be effective for each person with ADHD, they could be different. Everybody’s different.

Aimee-Elizabeth Parsons

So Trevor, what’s really interesting about what you said is it comes into two categories that I wanted to address. So the first one, all those strategies you’re using, we can use the term external brain. So putting strategies into place so that it helps our ADHD brain with some of these challenges. So again, external brain is getting some help when our brain doesn’t want to help us. So that’s great to share with our audience. And second is, when you talked about exercise, well, physical activity stimulates the release of dopamine. So remember when we talked about before that there’s a medication that is taken to help with that dopamine production. Well right there naturally with exercise, that is a strategy that can help. So great ideas to share.

Trevor Friesen

Right. Okay. So our next question, we had a really tough question. Okay. But I like it because it makes for a good conversation. So someone in the question and answer period had asked about learners with ADHD who have explosive or big emotional reactions. So for example, when they get mad, they might get really mad. Or maybe when they get sad, they get really sad.
Or when they get scared, they might shut down completely or maybe even completely remove themselves from that situation. So the question was, for someone who’s having these big reactions, what are some things that we can do to help? Now, I like this question, but it is a really tough one. It’s a tough question because the answer for each person is not always the same.

And as you can guess, emotions and feelings are not always easy to explain whether you have ADHD or not. So in trying to answer this question, we are forced to become detectives on top of all of our other responsibilities as parents, as students, as teachers, as professionals and as caregivers. So, Aimee, I think you’ll agree that usually our first approach is that we’re going to try and start with prevention. So prevention means what can I do to help make this big emotion smaller? Before it even happens? So remember when I said, we’re going to put on our detective hats, we’re going to try and figure out what can I do to help make this big emotion smaller before it even happens? So in order to try to start building a plan, we need to figure out why the individual is reacting the way that they are.

Is it anxiety? They might be thinking to themselves, I don’t know what’s next. That makes me feel anxious. Is it impulsivity? So are they reacting to someone or something that’s around them? Is it embarrassment because the person doesn’t understand what to do? They don’t have the skill or the understanding of what they’re supposed to be doing. So start by asking these questions first and if it’s appropriate, you might actually be able to ask the person themselves during a quiet moment, not during the big emotion, but at a different time. You might be able to actually ask the person. You may begin to find some of the.

Aimee-Elizabeth Parsons

I was just saying that that’s great that we’re asking questions because I remember in the classroom I could see what I thought was the same emotion. Perhaps I would see the same thing. A desk go flying. But you’re right. Sometimes it went flying because I was nervous or not me. Sometimes it went flying because I was angry. So really I’m seeing with my eyes a behavior, but that could be for so many different reasons. So I really like that we’re asking questions we’re being a detective, great. What do we do next?

Trevor Friesen

Yeah. And that’s a really good point. And remember when I said, I really like this question, but it is it is a tough one because it is complicated. Emotions are complicated, just like you said. But the reasons behind each big emotion, it could be different from time to time, too, right? So with your detective hat on and you’re asking these kinds of questions, you might be able to figure it out, but you kind of always have to keep your detective hat on because it could change from one situation to the next.

No, that’s a good addition. So I think where I left off there I was just saying it might be appropriate to ask the person who has those big emotions, but just don’t do it during one of the big emotions. Maybe wait for a quiet time later to figure that out.

The next step to kind of putting the puzzles together with our detective hat on is thinking about the last time that this person experienced a really big emotion. So where were you? Where was the person? What was happening right before? What was going to happen later? What was said by you or by someone else? What was happening in the room right at the moment before the big emotion? Was it loud? Was it bright? Were there lots of people? Is there anything about that situation that you could change that you think might make that explosive, that big emotion, a little bit less explosive? So, for example, something like a quiet room, right? A quiet room for taking a test, maybe a learner has some challenges surrounding test taking. So they might be allowed to go to a quiet room to take their test and have a little bit more time. That might be the change that you can make that’s going to support that person’s challenge that they’re going through at that moment. But the detective work is not done yet. Finally, sometimes additional supports will need to be put into place.

Even if you figure out all of those answers, there’s still going to be work to do. So, for example, things like routines and visual schedules or visual support. On top of that, even sometimes new skills might need to be taught or old skills might need to be practiced more often. So, for example, communication, as Aimee said before, turn taking, anger management. And then sometimes all of these things need to happen all together. So again, this is where putting on your detective hat is so important because it won’t always be simple to figure out which supports are needed for each different person. Sometimes the right move might be to call in another detective who can help to put the puzzle piece together. So it might be a school resource, it might be community partners like a special needs educator, or it might be DPSS through a clinical advisor in your community. So it sounds, it’s big, right? And it’s because it is it’s complicated. But if I had to sum it up kind of in a in a short phrase or sentence, it would be something like this; by making the world more predictable for learners with ADHD, it’s less likely that they’re going to be faced with those situations that make them express that fear, that anger, and that embarrassment in such a big way. The predictability and support it probably won’t make those emotions disappear, but it may help for them to be expressed in a bit safer way. Not quite as big if you follow.

Aimee-Elizabeth Parsons

Yeah. And I like that we’re using the word big emotion because there’s nothing wrong with anger. There’s nothing wrong with sadness. There’s nothing wrong with these emotions. What we’re talking about is the fact that they’re expressed in a big way. They’re expressed in a way that might have effects on other people, on their self. So you had finished up with safer way.

So safety and as a previous classroom teacher and as an administrator, safety is super important. While we’re being that detective, those big emotions might still be happening. And sometimes we’re unsuccessful in preventing big emotions from happening. And once it’s in motion, it’s happening. So it’s not time to be necessarily detective. And you had said not asking and we really need to make sure that you as the adult and caregiver are safe, that those around seeing the emotion or experiencing it are safe. And also the person showing the big emotion is safe. Prevention will come next time. So in that moment, you’re now you’ve moved into like, how can I keep everybody safe? Once that big emotion is over, it’s time for clean up, for lack of a better word. And what I mean by that is when the time is right and the individual is back in the just right zone.

So our colleagues have talked a lot about that feeling just right. I’m ready now for talking. I’m ready for doing. That’s when it’s time to figure out and acknowledge what happened and to repair anything that’s broken. So whether that’s sometimes cleaning up the physical mess or rebuilding relationships. So that’s where that’s really important to talk about the clean up afterwards.

Trevor Friesen

Right. And something that I really want to emphasize that you just said when the time is right. So I think we agree that the time is not right during the big emotion, that’s a pretty hard and fast rule. It may be not right right after the big emotion. It might have a big explosion and the person is coming down. It might still not be the right time and it may be not even the right time that evening. It’s important to make sure that the individual is ready to listen and for change to take place. But again, that’s going to be different for each individual.

Aimee-Elizabeth Parsons

Mhm.

Trevor Friesen

Okay. So our next question that we got, we’re still on the topic of I guess it’s not necessarily medication, but in that same theme, another question we had was about a supplement actually called melatonin. So the question was, what is melatonin? And is it a medication like the ones that you talked about already?

Aimee-Elizabeth Parsons

Okay. So melatonin is a hormone found naturally in the body. So melatonin’s main job in the body is to regulate the night and day cycles or like our sleep in awake cycles. So darkness causes the body to produce more melatonin, which signals our body. Okay, it’s time for sleep and light, decreases melatonin production and signals the body to prepare for being awake. So it’s thought that by adding a supplement, by adding melatonin, we might help individuals with this sleep pattern. Melatonin is also suggested a lot in the ADHD community. So if you join a support group, a Facebook group, a parent group or a group with people who have ADHD, that’s a word that’s going to come up in the community.

But like any supplement or medication, it really should be discussed with your health care team who really knows everything you’re trying, everything you’re doing. So they really need to have the full picture. So for me personally, when I discussed using melatonin with the pediatrician for my kids, she said it was okay to use melatonin, but it should be part or one part of a bedtime routine or a sleep routine.

Trevor Friesen

Right. So just adding melatonin on its own may not have the effects that you’re looking for. It should be part of an overall bedtime routine. It’s in addition to that routine you already have in place. Okay. So then let’s talk a little bit more about that. What does it mean to have a bedtime routine? My bedtime routine might look very different from someone else’s.

Aimee-Elizabeth Parsons

Okay. So bedtime routines, you’re right, will be different from person to person. But some of the key parts that we’re looking for are to stop electronics at least one hour before bed. So, I mean, that’s a whole other topic of discussion we could have about electronics, but really, really, really important that it stops one hour before bed. And for most it would be out of the bedroom, right out of sight, out of mind. So that’s our first thing. We’re going to stop that. Then these other things, depending on your order, having a snack. So it’s important to have a snack, make sure that we’re not waking up because we’re hungry or we’re not going to bed because we’re hungry.

For some, it’s having a bath or shower, right? One, it’s for hygiene, but we need to do it. We’re signaling our body. Okay, I’m coming down. I’m good. If you’re choosing to use melatonin, that might be a good time to slot it in there. And then for others, it’s box. So depending on the age and your family, the way you run your household, you could read the books to your child, you could be reading the books to yourself or the individual with ADHD is reading to themselves.

Sometimes it’s fun just to listen to a story, right? We’re not reading, but if you have a storyteller in the family, telling stories. I know with one of my children, we sang. We sang our camping songs. We just sort of giggled and just brought ourselves down a little bit. And then having a routine for lights out. What is lights out look like? Is there a nightlight involved? Is the hall light left on? So these are all suggestions to put together to make a plan. And this will help signal your body that it’s time to slow down and it’s time to prepare for sleep.

Trevor Friesen

So I know I said before that maybe my bedtime routine might be very different from someone else’s. But Aimee, like this was pretty much my bedtime routine when I was a kid. These key points here, the snack, I’d have an apple, we’d have a hot bath or a hot shower and then a book, a story, and then lights out.

And that was the routine every night when I was a kid. But as I said before, your bedtime routine might not look exactly like this, right? But your bedtime routine should be the same every time. That’s what a routine is. So whatever your bedtime routine ends up being, try to make a routine that’s realistic for your family and for your reality, and then do your best to follow it every night. It will probably take time before you notice any changes. So don’t give up after one or two. Give it a good length of time where you’re trying to put this routine in place.

Aimee-Elizabeth Parsons

And it’s really important at first to either have it written up and agreed upon if you or a child can read, or if it’s for yourself, you’re writing yourself a list that we talked about in our podcast, or to have a visual schedule for those who might need it expressed in a different way. And again, if you want hints on how to do those things, it’ll be in our show notes and on our website to help you through that process. But it would be really important, as Trevor said, to try it, to follow it the best you can, follow it regularly, have it either written out or have it in pictures ready to follow.

Trevor Friesen

Perfect. Yeah. Okay. So the last question, we’ve come to the last one for today and it’s a good one. They’re all good, but this one’s a good one. I think to end on. So the final question that we’re going to dig into today, it was how should you tell a child that they have ADHD? I’ll tell you front and center, I don’t have the answer. This is another tough one for me personally. On one hand, I might like to know that there is a reason why certain things are more challenging for me and it’s not my fault. But again, everybody’s different. So, Aimee what would you say to that question?

Aimee-Elizabeth Parsons

You’re right. Everybody is different. And it is a personal choice, but it is really, really, really important to remove stigma and shame. We love the person. We love everything about them. And if that happens to have ADHD in there, that’s what’s there. And that’s the package that we love. So it’s really, really important to remove stigma and shame. The recommendation out there is really to be honest and use age appropriate words when explaining a diagnosis. So I know in our house how we explained it at seven years old is not what the kids have come to know at 15 years old. Their understanding of it has grown. And one of the reasons it’s grown, I think, is whenever possible, have your children or the person, the individual with ADHD to participate in the discussions, to learn about what’s going on.

And now that I’m saying that if you’re an adult with ADHD, it would be important that your partner, your girlfriend, your boyfriend, other family members, someone you trust is also part of that conversation and grows and learns with you. There’s also really good books out there available to explain ADHD. I have a few here. One of the ones that’s often presented again, it will be in our show notes is My Brain Needs Glasses.

So that’s where we get the story from about the glasses. And this is a really good explanation written by a doctor to explain ADHD. There’s also a lot of storybooks involving characters with ADHD. Again, mine are French, because that’s just what one of my children were reading. But in these books, there’s a character, a young boy, who goes through different challenges and they’re funny, they’re great, and it talks about the challenges and how we overcome them.

So like making friends, impulsivity. So that’s really fun for them to read stories of people that they can sort of connect with. And one of the other strategies that was shared with me right at the beginning when I was going through this process, was finding people that our children admire, whether it’s someone in the family who has ADHD, how they’ve come in their life, what they’re doing as a profession, as a passion.

There’s many sports heroes, if your child or you personally are into sports, that have ADHD and learning about their story or famous actors. So really it’s about, yes, it’s hard to receive a diagnosis, but that’s again, we talk about it often in our team and in our podcast. That’s one part just one part of who you are. Just like we have colored eyes, just like we have straight hair or curly hair, just like we have different strengths and weaknesses. It’s a part. And so really we need to look at the positives, the strengths and keep having open discussions. So I guess that would be how I would answer that question.

Trevor Friesen

Thank you. That’s great.

Aimee-Elizabeth Parsons

Thank you very much for joining us. To learn more about ADHD, Meegwitch. I really appreciate you listening today. And we also want to thank our DPSS team for continued work on having difficult conversations and sharing knowledge out there. And you, the listener, for joining us today. Thank you.

Trevor Friesen

Thank you very much for joining us. In our discussion on ADHD, Meegwitch. Thank you for listening. Our thanks to the team and Michael Lautman for their help creating this recording and to you, the listeners and to everyone who asked questions. Thank you.

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