Episode #81 

How CBT Can Help ADHD - Part 1

ADHD (Attention Deficit Hyperactivity Disorder) is a term that is used often.

What is ADHD?

What causes or doesn’t cause it?

What are the different types of ADHD?

What does ADHD feel like?

Join me, Dr Julie Osborn, in part one of this two-part series about ADHD and how you can use the principles of CBT to help ADHD.

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Full Episode Transcript

Hi, my name is Dr. Julie Osborn. I'm a Doctor of Psychology and a licensed clinical social worker specializing in Cognitive Behavioral Therapy. I'm here to help you bring the power of CBT into your own life. So in this podcast I'm going to answer your questions and share with you some practical ways to apply CBT principles so you can achieve a greater level of happiness and satisfaction in your life and your relationships.

In this podcast, I'm going to talk about Attention Deficit Hyperactivity Disorder.

This is going to be part one of two episodes. Today I'm going to kind of just talk and educate you about what ADHD is. It's a term that's used a lot, and I don't think people really know specifically. I think people get under diagnosed, over diagnosed with it. And then part two, my youngest daughter, Molly agreed to let me interview her because she does have ADHD and she's done a lot of research on her own and understands it well and has worked on herself and is open to sharing with us about what works and what doesn't.

So I'm really happy about that. That'll be part two. So first, let me start the podcast with sharing. A wonderful email I got from one of you guys. Listening to my podcast starts off by saying, Dr.

Osborne, foremost, I want to thank you for your podcast. They've helped immeasurably to think inwardly and help me change behaviors and connections to my thoughts and feelings. I love my wife and have found that our communication is not very good and as a result of it is why we have our conflicts.

We're seeking help through marriage, family therapist. But for supplement to our visits, I got mine over mood and listen to your podcast. I find that your podcast are directive and informative, while I find sometimes the therapy visits aren't as so. So using the book has made a difference for me.

I love the changes I have made by following the mind over mood book and want need to continue those changes in our marriage. Best regards. So thank you very much, podcast listener, for sending me the email just for Privacy. I don't always share everybody's names, but I just wanted to share the feedback that I got. And I really appreciate all the emails you guys send me, and I encourage you to keep sending them always with questions, suggestions for podcasts, whatever you want to share.

And I always really love hearing that the podcasts are making a difference in people's lives and they're really getting a lot out of them. So I appreciate that very much. So let's start talking about attention Deficit Hyperactivity Disorder. I may be a little background on it first, and then we'll talk about what it is. So most people with ADHD don't know they even have it.

And the disorder was not even recognized until the 1980s, and it wasn't until the 1990s that the recognition of adult ADHD was even established or focused on. So it is a condition that can have a significant impact on the way a person functions in the world. And unfortunately, ADHD is poorly named, meaning that it's not so much a disorder as it is a difference in the way some people process information and focus their attention, and they call it a deficit really fails to recognize the many strengths that people with ADHD have as well. So ADHD, however, is perhaps a better name than the old word for it, which was actually minimal brain dysfunction, which is horrible and does not describe it well at all. So let's be happy they changed it.

So researchers used to think that what they called, quote, hyperactivity, was a condition found in childhood that was outgrown during adolescence. So we now know that about one third of children with these symptoms outgrow them during adolescence, and the other two thirds continue to show symptoms all the way into adulthood. Adults with ADHD is a topic of much current scientific research, and many adults are able to put a name on what for them has been a lifetime of feeling misunderstood. The professional community recognizes now two variants of this condition. So one is the hyperactive type and one is the Intersective type.

I've met a lot of adults that said they were taking their kids to get assessed if they have ADHD. And as they were sitting in the room and listening to what does that actually mean? And the symptoms, they're like, oh, my God, that's what I have. But my generation wasn't even a thing. It wasn't a disorder.

So there's just a lot more information. That's why a lot of adults are getting diagnosed now, because there's a name for it, and they realize what's going on. And although not much is known today about the causes of ADHD, researchers do agree that it is a neural chemical disorder, and it likely has a genetic component. So that is, it tends to run in families. And actually, in fact, many adults with these symptoms don't know that it has a label until, again, one of their blood relatives is diagnosed with the disorder.

I'm like, oh, okay. And occurs in women and men, boys and girls, adults and children. It cuts across socioeconomic strata, income levels, education levels, and definitely levels of intelligence. It is not the same as a learning disability, dyslexia, or a language disability. And it's certainly not associated with low intelligence.

Poor parenting, early trauma, labeling, or other psychological factors do not cause ADHD. There may be, however, significant psychological problems that develop from growing up with the disorder. So things that happen in your life don't cause it, but because of the symptoms with it can feed into psychological disorders. So that's a problem, I should say. I'm sorry.

And that's why I wanted to really clarify that for you. So definitely more genetic. Maybe if you have it, look at your parents, grandparents, cousins, siblings. We tend to always find it in other family members. When we start asking the right questions and seeing how other people have felt through their childhood, maybe, or if they were labeled as hyperactive and always felt like they didn't do well in school or always thought they were stupid or they couldn't keep up with everybody else.

So you just want to ask the right questions. And that's why I want to really go to a professional and get a really good assessment. So you really know, like, okay, yeah, something really is going on. Or maybe it's something else because I've also talked to some people that depression or anxiety kind of mimic some of the symptoms, and it was misdiagnosed. So that's important.

So let me talk a little bit about the ADHD experience, as I call it. So think of ADHD as the inability to turn off stimulus. So most of us are able to block out information from our environment, and they keep us from becoming overwhelmed. So to give you an example, if we're trying to concentrate on a book, we tend to block out sounds from music or TV in the background. If we're trying to listen to a teacher's lecture, we don't pay attention to what we see outside through the window.

We tend to focus on one line of thought at a time to keep ourselves from becoming confused and chaotic. The person with ADHD, on the other hand, cannot turn off the external stimuli as well as most people. Although they certainly do blackout, most their lives become a struggle to filter out and manage the oversupply of information they have to deal with. What are they trying to do is to protect the sensitive inner selves. If the amount of information from your environment becomes overwhelming, you become overstimulated.

So, quote, Hyperactivity is simply the response of the nervous system to an onslaught of stimulation, right? So I'm going to repeat that hyperactivity is simply the response of the nervous system to an onslaught of stimulation. So we're going to talk about three different symptoms of ADHD that really define it. The first one is distractability. So this is usually associated with the intent of type of attention deficiency.

Rather than focusing on one thing, the mind wanders to different arenas. So Daydream is one of the defining characteristics of ADHD. In conversation, a person might jump from topic to topic. In class, a student listening to a lecture suddenly finds herself looking out the window and then having fantasies about her upcoming summer vacation. Some other symptoms associated with distractability also include in attentiveness to detail a tendency to misplace belongings, difficulty in completing tasks once they're started, avoiding a task that require concentration, poor ability to plan, forgetfulness, and disorganization.

So these are just not everybody has everything, but these are some things to think about if you're relating to what I'm saying or if you know somebody or maybe your kid.

Another symptom is impulsivity. So this is found in both types of attention deficit, the hyperactive and the inattentive type. So most of us have the ability to insert a thought between the stimulus and our response to the stimulus. So, for example, we're able to inhibit our responses by thinking things through. Right?

There's my CBT, we're thinking things through. Although people with ADHD are able to inhibit their impulses most of the time, at times they feel overwhelmed with stimulation and they simply take action without thinking about the consequences. So this is why people with ADHD are quickly aroused to anger. They just react sometimes. I have found and we'll talk more in episode two that I'll be talking with my daughter about something and we just get to an argument super quick and I'm kind of confused how we got to that place so quickly.

Right. But when someone's feeling overwhelmed with stimulation, they just react. And anger is what comes out when they have the ADHD. Some other traits with impulsivity include poor personal boundaries, so they might be really intrusive or intruding. When somebody is speaking, blurting out a response before speaker is finished and difficulty in waiting for one to turn right.

So that's that impulsivity part. But the anger part is really important to remember because most people I have talked to have not been aware. They're just like, I don't understand why the person gets angry so fast, why they start yelling. I just asked them a question. And in general, I haven't found a lot of literature that focuses on that.

And when I learned that as a parent, I was like, oh, okay, that makes sense because I'm just like, what the heck, right? So being educated in knowing what's going on is really important. So just know that that's part of the ADHD if that's something you experience, another characteristic is the hyperactivity or having excessive energy. And it's found frequently in ADHD. So it occurs when the nervous system is unable to cope with an oversupply of stimulation that cannot be controlled or filtered out.

So rather than channeling their energy into daydreaming, the person stays connected to the energy, increases body activity, some other hyperactivity indicators, or someone who's vegetarian, maybe playing with their fingers, their feet are constantly moving or toe tapping, being restless, difficulty engaging in quiet activities, and a pressured need to talk. So that's part of where all the energy is coming from. So a couple of other characteristics of ADHD I want to mention also is because there's so many of them and they're found with an attention deficit. So let me say that most of us experience at least some of these in our day to day lives. So it's Advisable not to conclude that you have ADHD if some of these items describe your behavior.

That's why I was saying it's important to go to a professional, really get good diagnosis and testing. But they can be part of ADHD, which would include problems managing your time so you don't give yourself enough time for a task, a tendency to take on too many tasks at the same time, difficulty in concentrating when reading or watching a movie, problems managing finances and balancing a checkbook. Difficulty controlling your temper. A history of underachievement and not meeting one's goals. A history of periodic depression starting in adolescence, depending on other people to take care of life's details.

Frequent moving and changing jobs. Difficulty with long term relationships. Low tolerance for frustration. A tendency to stay up late and rise late. Losing track of the conversation when someone else is talking.

Chronic procrastination, frequently searching for high stimulation. Experiences hyper focusing at times to compensate for difficulty maintaining attention. A sense of insecurity. Problems with negative selfesteem. A tendency to worry.

Mood swings, especially when not engaged in activity. A tendency towards substance abuse, especially caffeine, cocaine, or amphetamines. So if you have any of these symptoms and are having difficulty in everyday living because of them, you may want to consider an assessment again by a trained professional. Treatment for ADHD is generally effective and can have a highly positive effect on the quality of your life. So you're not going to necessarily have ADHD because you relate to some of this.

But if there's a lot you really want to consider that and it can't hurt to get tested, right? To say yes or no. So I understand from hearing all this so far, it might seem that having ADHD is a negative experience. But this doesn't have to be the case because actually, in fact, there's many creative people and well known historical figures probably had a detention deficit. So to give you an example, it's been speculated actually, that Albert Einstein, one of the greatest minds of the 20th century or the greatest mind, suffered from ADHD.

He certainly had difficulty in his early school years, as do many people with ADHD. But he also had many of the positive qualities found in people with this disorder. So, for example, people with ADHD tend to be creative, energetic, talkative, socially aware, insightful, spontaneous, and enthusiastic. And once someone can learn how to contain the symptoms that cause the problems, the positive qualities can surface. And in fact, the proper treatment for people with ADHD, they can live productive, normal lives.

So it's not all negative. I know I'm focusing on it to understand what is it. But all of these things are really true about the positive things. And when you can embrace that, you have ADHD and work with it instead of fighting against it, you can change things in your life. So I want to talk about some considerations in dealing with ADHD, because people who suffer from it, though no fault of their own right, often cause difficulty for other people.

So their minds might wander during a conversation, or they might blurt out remarks that are inappropriate to the situation, or they never show up on time for appointments. So during childhood, they might create difficulties for both parents and teachers, especially when their activity level is high school. Children with ADHD may Daydream frequently in class. You may have trouble following a logical line of thought, right? So they put off working on assignments and then they turn them in late or not at all.

And it's easy to understand why people with attention deficits invite anger from other people. Other people often label the sufferer mercilessly and do everything in their power to curse more appropriate behavior. So the ADHD sufferer is frequently treated in a thoughtless and often brutal manner by others. And people with ADHD are sensitive. They're highly aware and bombarded daily with stimulation that they need to manage.

Their goal is to protect their fragile inner lives. And life becomes a struggle to maintain a balance between the integrity of the inner world and the onslaught of stimulus from the external. So the struggle is intensified when they have to deal with negative feedback from other people. People with attention deficit often have to deal with self image issues and depression. They constantly hear feedback telling them that they are intrusive, out of control, or low achievers.

They end up feeling lonely and isolated. As they internalize the negative messages they hear from others, they begin to feel it that way about themselves. And because of the negative way the world tends to treat them. People with attention deficits develop psychological problems. So even though ADHD probably has biological issues, as I mentioned earlier, the psychological problems can just make everything worse.

Unfortunately, a trained professional is able to work productively with clients on these issues in a safe and understanding setting. So once the person with attention problems makes the decision to find treatment a more normal, easier life lies ahead. So there's definitely hope. I heard someone phrase it one time with me, which I really agree with, is that if you have a kid with ADHD, you're always in corrective mode, right? So you're always correcting them.

And when you correct somebody, the message they get is you're not good enough, you're not smart enough, you can ever do it right? And then that's where a lot of shame comes for the person with the ADHD. They also have a lot of anxiety, right? Because am I going to do it right? Am I going to remember?

Can I show up on time? Is my teacher asked me and I won't have the answer. Lot of anxiety comes from having the ADHD thinking, nobody's going to understand me, having thoughts like, they don't think I care, they don't think I'm taking the time, they don't think I'm trying. And I always remember. I'll never forget.

I always remember years ago I was seeing a young adolescent who had ADHD very hyper and acted out a lot. And both his parents were professionals in the medical field. They were going to send him to military camp and they were just so frustrated. And they came into session one time and I said to the patient at adolescent and I'm like, do you feel good about yourself? How do you feel about you?

And he just started bawling and the parents just looked at each other and they looked at me and they were so in corrective mode and disciplining that they didn't see it all, that this kid had no self esteem because everybody was always telling him how he screwed up. So I've learned through my years as a therapist that I tell parents that the most important thing is your child's self esteem so that they can work on these other issues. And that's the thing that really gets knocked down when a kid has ADHD, because again, they're always being corrected. They stand out. They might be picked down by even the teacher, even if she or he doesn't realize they're doing this.

But there's so much embarrassment and they feel stupid. A lot of kids will just say, I'm stupid, I'm stupid, I'm stupid because they can't just sit down and they watch their friends take a test or write a paper, do the homework. They just kind of flow with it or fly through it, and they're just kind of sitting there looking at it. So the most important thing you got to understand, if you're raising or working with someone that has ADHD, that their self esteem, they are very sensitive because they know they struggle and that you really need to work on building up your kid's self esteem and their self worth and separating their symptoms from who they are. As a person, that's really important that I want you to definitely take away with today.

And also remember, am I always in corrective mode with my kids? Do this, do that, that type of thing. So it's hard if you haven't had that before, you weren't. Maybe it comes from your spouse's side. So in your family, you didn't deal with anyone with this and you're like, what's going on?

So it's hard to understand. You got to get educated. You got to understand, not just think like, oh, if I just tell them to do this repeatedly, they're going to get it, because if they could, then they won't have the ADHD. So let's talk a little more about treatment options for ADHD so I can give you some direction. So as I was saying, most people with attention deficit don't suspect that this is their problem or that it even has a name.

They've been exposed to a great deal of pain in their lives, and they finally see a professional therapist for a number of related problems, such as work difficulties, relationship difficulties, depression, anxiety, substance abuse.

The substance abuse I just want to discuss for a second is that you might say, well, why substance abuse an issue is because when someone takes Stimulants, it works like the ADHD HD medicine, not exact, but where people's brains kind of slow down and feel calm, it works the opposite, right? If I take a Stimulant, I'm going to be feeling it as being stimulated and hyper and all that kind of stuff. So with ADHD takes it. It works. It's like, oh, I can focus now, right?

I'm a little calmer. I can manage all the stimuli that's going on in my world. So I tell parents that are really afraid of the medicine to go get educated and talk to psychiatrists who specialize in this. So many people are afraid of the medicine. But I say if your kid ever finds out or gets their hands on some stimulants out there and realizes like, God, I feel a whole lot better, that's what they're going to go use.

And that's a whole nother problem compared to medication, which can be monitored and managed with the patient and the doctor. So that's something to be concerned about. Now, medicine is not always the answer. There are a lot of behavioral techniques you can do as well. But I've also met some kids that medicine changed their lives.

They were failing school and they would end up being like straight A or B students, no joke. So it can't hurt to go try and get educated and see what is best out there and what's going to work best for your kid. So usually treatment for ADHD usually consists of some of the following things I'm going to share with you. So first, again, you want to find a trained professional who seems knowledgeable and you want to feel comfortable with this person.

You will first review your history with your therapist. So this will include your family history, your physical history, like medical issues, your development, your history in school, at home and jobs, your history, relationships. So whether it's you're going in for yourself or with your kids, you're going to give all this information. And then the therapist will help rule out other possible causes such as anxiety, depression or substance abuse, which we've mentioned already. You'll likely be giving a psychological assessment, although not necessarily in all cases.

Sometimes a lengthy interview will be enough. Once the diagnosis is made, your first goal will be to educate yourself about ADHD. You need to read books, articles, resources, other podcasts out there, I'm sure, on ADHD as well. And that's what I was saying, like embracing the ADHD and really getting educated so you can make some it's not just, oh, I just need my medicine. It's like, now what can I do to do things differently?

And with the help of a therapist, you can work on restructuring your life both internally and externally. So internally you can start to think about yourself differently. And you can examine your self image issues, as I was mentioning before, which might be really poor. And externally, you can work on ways to improve, how to organize and insert control into your life. So if you're someone that misplaces things a lot, you know, have a bowl by the front door where you come in and you always put your keys there.

So you're now running around looking for your keys, right? Or if you're in school still always this is where I live and I do my homework. I take it over by the front door. I put in my backpack. It's right there at the front door.

I do not need to think in the morning things like that you need to do. You can also do some psychotherapy to gain an understanding of what made you who you are today and what you can do to take a different orientation towards your life. Right. So if I don't feel good about myself, if I'm depressed, I'm anxious. But now I know I have the ADHD, I can see how I was affected and people maybe didn't know and treated me in really negative ways.

And you can also maybe even join a support group with other people who share some similar problems. You also might or might not be referred to a psychiatrist regarding medications I mentioned earlier. So a lot of people with ADHD do benefit from safe doses of stimulation medication, while others benefit from antidepressant or anti anxiety medication. So I know a lot of people will go to their general practitioner and they may start them on some medicine, which is fine. But I always recommend with psychological issues or the ADHD, go see a specialist, go find a child psychiatrist.

It's a really sensitive medicine and I know parents have a lot of concerns. So you really want to feel good that who you're seeing really understands children, adolescents regarding is this best to start medicine? Are there other things we can do? And there's a lot of stuff you can do that's holistic also. Right.

So I learned I've read some books that intense workouts and high protein diets can really help. So my daughter was a big time soccer player, which really helped her. And we were mindful of her diet. And to this day, if she really works out early in the morning, it helps her day. And she doesn't even need to take as much medication.

She is shared. So she's finding ways to manage it and nothing's going to be perfect. None of us are perfect. Right. We all have issues in our lives.

But this week and say, okay, if I got ADHD, these are the things I need to do. These are my resources. And I do want to mention because I forgot to mention this earlier, one difference between males and females is a lot of females are under diagnosed because they don't have the hyperactivity. They have more of the inattentive. So they just go under the wire.

So we'll talk more. When I got my daughter with me, but we were cleaning house during COVID and she was going through a lot of her report cards and now she could laugh about it, but she was like every poor card. It would be helpful if Molly paid more attention. Be helpful if Molly paid more attention. Now one teacher and she went to a really good school.

I liked all the teachers ever said to me, maybe she got ADHD if you had her checked. Nobody ever, ever, until I finally took her to see somebody, to get her diagnosed and to start the medication. But looking back, it was like, oh, yeah, of course she did. And look at me, you guys, right. I'm a professional.

But you know what? When it's that close to home, you can still miss things. And I wish I didn't miss it. I wish I had gotten her help earlier, but we did get her the help she needed eventually. But because of it wasn't that hyperness.

It was just things that seemed like, oh, come on, why did you forget? Why did you forget this or that? So that's the one thing it's called ADHD, right? Attention deficit hyperactivity disorder. But the hyperactivity might just be the brain just going, right?

The distraction. That might be the hyperactivity, not the physical, not the physical activity that is so apparent and disrupts classrooms. And that's when teachers might say something. So just be mindful of that. Don't assess whether they're hyper or not.

What are the other issues they're having? I know I had a long laundry list. So hopefully that helps you identify. Maybe this is something with yourself or somebody in your life and you can share and maybe get some help and really have some relief. Because for a lot of people, it's something that they have to manage the rest of their lives.

And it is manageable as long as you work at it. So with the cognitive behavioral therapy, I've seen a lot of clients with ADHD and we focus a lot on the behavioral part. Right. And then what are the thoughts is when we're addressing the depression or anxiety that comes with overlapping the ADHD because they've had so much negative feedback to their lives and they don't feel good about themselves, or maybe they haven't been able to accomplish what they want because they didn't know how to even fix things, and now they don't see themselves as successful. So obviously, we need to get in there and figure out what are their hot thoughts and be able to challenge them.

And to help set goals. I help people set goals and create action plans and address what are some possible problems that might happen with their goals and get ready to address those working with your doctor. If they're on medicine, maybe you need to change the dose. Just don't think, well, my doctor gave me this. I have to stick with it.

There's lots of different medicines out there. You can focus on your diet, exercise. There's lots of wonderful things you can do. And allowing that wonderful part of people of ADHD come out with the creativity and the spontaneity and the curiosity and all the wonderful things that come with it as well. So I hope this was helpful.

I'm excited to do my next podcast with my daughter Molly, and I think that'll be really insightful. This is just kind of the first one to give you the facts and the criteria and just to start getting an understanding. So as always I appreciate you taking the time to be with me again. I hope it was helpful for you.

So that's it for today. If you have any questions for me or any suggestions, any way I can be helpful, you can always email me at mycbtpodcast@gmail.com

My website is MyCognitiveBehavioralTherapy.com. Within my podcast, where there's the transcription, you can always find the books that I mentioned: the Mind Over Mood, Feeling Good, Feeling Great. You'll see a tab if you want to purchase those just makes a little easier and you get more in depth in learning the tools.

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