EP 73: ADHD Symptoms & Solutions

Please excuse any errors in this autogenerated transcript

Dr Olivia KesselHost00:06

Welcome to the Send Parenting Podcast. I'm your neurodiverse host, dr Olivia Kessel, and, more importantly, I'm mother to my wonderfully neurodivergent daughter, alexandra, who really inspired this podcast. As a veteran in navigating the world of neurodiversity in a UK education system, I've uncovered a wealth of misinformation, alongside many answers and solutions that were never taught to me in medical school or in any of the parenting handbooks. Each week on this podcast, I will be bringing the experts to your ears to empower you on your parenting crusade. In this episode, we'll continue on our ADHD journey. Hopefully, last week's episode has cleared up any ADHD myths or misconceptions. Today, though, we're really going to explore the importance of recognizing the signs that your child might have ADHD, the science behind their struggles and the solutions that can be put into action.

01:06

Today, and really the reason why I want to share this with you, is because of my own personal journey with my daughter Alexia. We got her assessed and diagnosed last year when she was 11 years old, and I honestly, even as a medical doctor, had not put together the troubles I was having at home and the crisis moments we were having at home as ADHD. In my mind it was a hyperactive little boy, in fact. I remember my brother who definitely had ADHD, spent his year eight or not year eight he was eight years old with his desk outside the classroom because he was so disruptive. So that's kind of what my perception was of a child with ADHD. And actually the reality is girls present very differently and they can be construed as less evident or less disruptive signs. So for a girl, they might be daydreaming, they might be staring off into space signs. So for a girl they might be daydreaming, they might be staring off into space. They might be prone to having bouts of emotional dysregulation, so crying or getting upset or easily frustrated. They can be inattentive, they can seem to be younger than their age and so all of those things are kind of softer kind of pictures. But actually with boys as well, I mean that hyperactive little boy like my brother was only 25% of kids actually present with hyperactivity and as they grow older they actually grow out of their hyperactivity. So adults usually only display about 5% of them having hyperactivity.

02:37

So our misconception that ADHD I mean even the name attention deficit, hyperactivity disorder kind of misleads you and that's why I really wanted to share on the podcast today signs that maybe we're not that aware of and signs that we need to recognize. Because, as I will explain in the next couple of minutes, it's really important for us to recognize that our child has ADHD and struggling so that we can get the right supports and treatments in place, so that they can get the right supports and treatments in place so that they can go on to thrive in their lives. And I know, you know, after getting the diagnosis of my daughter, I have, you know, done a deep dive into the research in terms of ADHD and one of the things that really shocked me was, if ADHD goes untreated and unsupported, it really has a long-term impact on our children as adults. They have more failed marriages, they don't hold down jobs, they have more substance abuse disorders with both alcohol and amphetamines from self-medicating, they have more incarcerations, more prison times and they actually have a decrease in their life expectancy. And when I say decrease in life expectancy, it's about 13 years of their life is reduced by having ADHD that's unsupported and undiagnosed. And if you add in death due to suicide or death due to accident, which are also raised in terms of ADHD, then it's 21 years. So a reduction in life expectancy of 21 years. And if we look at some of the big causations of decrease in life expectancy like smoking, obesity, cancer, cardiovascular disease. The top five combined are still less than the decrease in life expectancy for a child that's going into adulthood with unsupported ADHD. So key here is really to recognize when our children might have ADHD and then getting them assessed to find out whether or not they do or not. But there's lots of stuff we can do now, even before diagnosis.

04:41

But I know for myself and I'm a medical doctor I struggled to connect the dots first of all that what our challenges were and my daughter and I. I was at breaking point as a parent. I have to be honest. I didn't know how to parent her, I didn't know how to reach her. She was becoming more and more violent. She was kicking, she was biting, she was just lashing out and I couldn't understand why she couldn't do the things I was asking her to do, why she seemed so much younger than other 11-year-olds, why we were struggling so hard with her sleep, with her outbursts, with everything. Everything was so, so difficult.

05:24

She would wake me up at least three or four times a night. It would take us two hours sometimes to get to sleep and then she'd wake up at 4.45, five o'clock in the morning, so we were both tired, which didn't help either one of us in terms of being able to calm down and relate to one another during the day, and I was at my wits end. I didn't know what to do next. I didn't know who to reach out to for help and actually, through this podcast and listening to other experts, I started to question myself could she possibly have ADHD? And it still didn't make it simple for me. I still was like should I spend the money it's a lot of money because Cam's got such a long waiting list and it's going to cost me 1,800 pounds to get her assessed at a private clinic? How do I pick the right private clinic assessment actually process? Because I was like this is a waste of money, this isn't going to have a solution, this isn't what she has, and so I mean I doubted myself all the way to when, finally, the clinical psychiatrist actually spoke to me and she confirmed that my daughter did have a combined type of ADHD.

06:39

And up until that very moment, I had convinced myself that no, I was wrong and that I was barking up the wrong tree, since having got her diagnosed it has and then diving really into the science behind what's going on in her brain, because it's a neurodevelopment, is a commonest neurodevelopmental condition in children, and neurodevelopmental. What does that mean? Well, it means our brain and how it develops, and it's different, and I'm going to go through how it's different in the next couple of minutes, hopefully not bore you too much of the science, but I think it's really key because it definitely for me as a parent, changed how I looked at my child, changed how I parented my child and changed how our dynamics were together. So, hopefully, which was life-changing, I have to say and then also getting her onto the right medical treatment and getting her what she needs to succeed in life was really super important as well. And I'll end the podcast today with kind of the four key wheels that you need on a car for success with your ADHD child, which are medication, sleep, nutrition and exercise and accommodation in the classroom and as a parent. So those are the key things and, honestly, our life has changed so much for the better. It's not perfect. We still have challenging days, it's not, you know, she still has ADHD, but we are doing so much better and I now understand her.

08:06

So the first thing that I didn't realize was a sign of ADHD was acting, not acting her age. So, interestingly, if you look at and you know this is fascinating now that we can actually, you know, use MRI imaging, can look at a child's brain and understand where its development is, whereas before we couldn't. So ADHD was very invisible, we couldn't actually see it. It wasn't like if you lost a limb and you can see that they don't have a limb. No, we couldn't see it.

08:36

But now we can and we can look inside the brain and what we see is that it's characterized by a delay in cortical maturation and that's the development of the brain, and it's particularly predominant delay in cortical maturation and that's the development of the brain and it's particularly predominant in the prefrontal cortex, which is this area behind your forehead here. And it's typically 30% delayed from other children's development at that same time, at that same age. And what that means is is that your child and this is where all of your executive functioning skills are, and we'll discuss that in a little bit but that means that your child is going to seem younger, is going to not be able to do the things that someone else their age can do, and it means that we, as as their parents, need to kind of change our expectations and what we think they should be able to do. And this was really key for me, because if we look at it and how, how then can you eat? You know, how can you calculate what their actual age is? So if there's a 30% delay, what you can do an easy, cheap way to do this is just take your child's age now and multiply it by 0.7. So you've got their chronological age. You times that by 0.7, and you will get their executive functioning age if they have ADHD. So what this means is if you're a nine-year-old, they actually have an executive functioning age of a six-year-old. If you have a 12-year-old, their executive functioning age is that of an eight-year-old, and at 15 years old, their executive function age is that of a 10-year-old. And you can see, as they get older, that gap kind of gets bigger because the number gets bigger, the 30% number gets bigger. So when we're looking at our child and we're expecting them to do things, we need to modify our expectations and we need to ensure that we're taking into account their executive functioning age, because that is the development of the skills they need to be able to complete goals, to do tasks, to be independent, and that is delayed, and you know it's also important when we have the safety of our children.

10:41

So, you know, would most people think it's okay to leave their 12 year old alone at home? Yes, my daughter, who's now 12, she's actually eight years old. She struggles for me to leave her at home alone because she is not at that age of a 12 year old, she's at that age of an eight year old. Similarly, you know a 15 year old who wants to go and babysit by themselves, who has an executive functioning age of a 10 year old who wants to go and babysit by themselves, who has an executive functioning age of a 10 year old. Would you feel comfortable, as that mother of that baby, leaving your child alone with a 10 year old, even though their chronological age is 15 years old? So it's really, it's a paradigm shift, I think, in your head in terms of are they able to manage? In your head in terms of are they able to manage the things or the expectations we have of them at their current age?

11:33

And I think it's important to just go over what I mean by executive functioning skills because that can be a little bit confusing, but basically the knowledge part of our brain is in the back and then our executive function skills are in the front of our brain and they're involved in things like self-awareness, being able to have self-restraint, how our self-directed sensing and self-speech is, how we self-direct our emotions and how we regulate our emotions and how we get motivated and how we then plan and problem solve. And we build these executive functioning skills in a step-like fashion, as one is developing, then the next one develops and the next one develops. So we start developing them about the age of two to three and we continue to develop our executive functioning skills until we're about 28, 30 years of age. So a long development, and after about 28, 30, our executive functioning skills are pretty much solid. The only time that you see some disruption is during menopause, with hormones can play havoc with executive functioning skills, and then when we get really old, like over 70s, 80s, you can see some, some dysregularities in executive functioning skills. So, as I've already mentioned, a child with ADHD has a neurodevelopmental delay of that prefrontal cortex, the area behind the forehead, and so they have a day in these executive functions and so they are 30% delayed from their peers, which means they find each of these things more challenging, and they're actually at a younger age point Now. So when they get to 28 or 30, their executive functioning age is still at around 24, 25. And that's where they'll stop. So they will never reach the maturity of their neurotypical peers, but they'll still be able to function and do really well in life.

13:26

Interestingly, though, when you give a child treatment, pharmacological treatment for ADHD, they can actually close that gap in terms of executive functioning age while the child is on medication. So they then don't have the 30% gap, but that's only when the medication is active in them. So kids that are given, in particular, methamphetamidate stimulant medication used for ADHD, when they are on the medication, 55% of children respond, and there is no gap at all between them and their peers. So their executive functioning skills. In 35% of children they have an improvement in their executive functioning skills, but they still need additional accommodation. That's where my daughter falls into that 35%, and then there's 10% that don't have a response at all 5%, and then there's 10% that don't have a response at all.

14:27

And it's really, though, important to know that the medication isn't always active in your child, and so it's important to realize that when they're not on treatment that they're going to struggle more with those expectative functioning skills that I mentioned previously. So I think you know this is one of the easiest solutions that you can implement right now. It's really to change that belief that your child is being difficult. They just don't want to do it. You know they should act their age. And I'm sorry I was guilty of all of those things because I just couldn't understand why she couldn't do these things, because I just couldn't understand why she couldn't do these things. And now, looking at her through the lens of executive functioning, I can actually understand where she's coming from and I can ensure that she has the right supports in terms of what she needs to bridge that gap.

15:21

And I think it's important, you know, for teachers out there as well to realize it, because you know the amount of time you would ask a child to sit still, the amount of good behavior you would expect of them, how much homework you would give them, how long you expect them to sit down and do their homework vary greatly if you're shaving off three years, four years from their actual chronological age and by doing that you set them up to succeed instead of them constantly feeling like they're failing because they actually don't have that. Their brains are not actually developed to the point where they can do the things we're expecting of them. So I would challenge all the listeners out there If you changed your lens, if you put on your executive functioning glasses and you looked at your child through those lens, everything starts to make a lot of sense. It really does. I'm quite amazed how it changed the dynamics with me and my daughter.

16:16

Now, the other sign that my daughter and this was probably the biggest crisis point for me was her emotional dysregulation. If I asked her to do something, if we're transitioning from one activity to another, usually one she enjoyed to one she didn't enjoy, or getting ready for school, she would really have a complete and utter emotional breakdown, a tantrum I guess you would call it. She hates me saying tantrum, but that's basically what it is. And you know it's not just a tantrum of you know, like kicking and screaming on the floor, but she would lash out, kick, bite. Yeah, just, I couldn't. I just I couldn't believe it, you know, in a way that I have never experienced before, you know, and I wondered if it was how I parented her. My dad suggested perhaps it's because I didn't, you know, do enough discipline, didn't set up enough structure, but none of that really seemed to add up to me. What was going on here. Why was she struggling so hard with her emotions? And you don't automatically think of that as something to do with ADHD you don't, and I wanted to research why that was.

17:25

And actually, if you look historically through all of the documents that was written about ADHD, for 170 years, the criteria for diagnosis has included a description of emotional dysregulation that these children are full of passion, that they're easy to anger, they have very difficult times self-regulating, and they easily get frustrated and can become hostile. So, wow, where did that go? I mean, you know what happened to that? Well, in DSM-2 in America, the Diagnostic Statistical Manual for Disease, they left emotions out of the diagnostic criteria. They had it associated with, but they took it out of the diagnostic criteria, and the reality, though, is this part of ADHD, this emotional dysregulation, is a big part of the conflict that can happen at home, and a big part of what can happen at school in terms of peer rejection and challenges that they have socially at school and behaviorally in the classroom. In fact, the single breast predictor of peer rejection is emotional dysregulation or impulsiveness and actually 50 to 70% of children with ADHD will experience some form of peer rejection by the time they're seven or eight years old.

18:42

Children on the playground they do not forgive anger and hostility and emotional outbursts easily. They just don't emotional outbursts easily. They just don't. So, being able to recognize this in our children and to understand why that is so, I had previously gone through those executive functioning skills and step number five in our development of our executive functioning skills is emotional regulation or self-regulation of our emotions. And, as I've shared with you, our kids with ADHD, they have a neurodevelopmental delay in the prefrontal cortex, that area behind the brain, a forehead, not the brain, the area of the brain behind the forehead and therefore 30% younger for peers. So they're quicker to get angry, to have tantra tantrums and they can express hostility and get easily annoyed.

19:34

And in fact, 11% of kids with ADHD will go on to be diagnosed with oppositional defiance disorder. They only need one more criteria to actually tick that box. They have four of them are within their ADHD diagnosis and that kind of inability to self-regulate and have one emotion really flood their brain, literally blocking their ability to listen or reason. They can't hear you at that point, they are dysregulated. So what can we do?

20:06

And this has really changed my life in how I interact with my daughter at these points and also teaching her how to recognize her emotions and when she's going to dysregulate, and giving her tools and techniques that she can use, has been incredibly powerful. But when you're in that crisis moment, coming from a place of understanding and empathy, so understanding what she's struggling with, she's not just trying to be struggling with, she's not just trying to be defiant, she's not just trying to not do something I've asked, she's really struggling here. So that's, first, the key thing that has switched or shifted in terms of my gears in my brain and that's allowed me to be more empathetic. If I'm honest, understanding that her executive function age means that I need to modify my expectations has also decreased the amounts of bouts of emotional dysregulation because she's able to do what I've asked of her. And this is really important because, you know we would get into a tango. It almost got comfortable. We were going to. You know it was going to escalate. We were both going to escalate and it just, you know, neither one of us were happy. It was crisis at home all the time.

21:28

Instead, realizing that it is so key that I remain calm and that I remain peaceful is easier said than done, and I think you need to find a way to release your pressure cooker so that you can be there for your child, kind of like the analogy with put your mask on first. Self-care is really key here, and I know I've had people on the podcast who have said to me well, easier said than done, well, it's crucial. I mean, for me it's exercise, and I will wake up earlier to exercise because that keeps me on an even keel. And you know, when I don't, even my daughter will say to me mommy, please can you go run or do some exercise. And you know it's made a huge difference. It also makes a huge difference to your child too if you can get them involved in some physical activity to release, kind of those pressures.

22:15

And then another really important thing is I found, with my daughter, the moments when we would have these massive outbursts were when we were transitioning from an activity that she enjoyed to an activity that she didn't enjoy. So, for example, like she loves playing Minecraft and she was building a world and I would ask her to come for dinner and she would not want to come and then the volcano would erupt. Instead, now I come in and connect with her. I take her, I transition her from that highly dopamine, interesting activity of Minecraft and I sit down with her and I say what are you building? Show me what you've done. Oh, okay. And then she tells me about you know the sheeps and the diamonds she's found and you know everything else, and you know we start to connect. So I'm pulling her away from what she's really interested in and talking to her and then, once we've made that connection, I'm like that you know, you know it's time to go for dinner now. Let's put this away and I look forward to seeing what you build on it tomorrow when you get the chance. And that makes the transition easier, that gently easing into it versus a demand to come and immediately and come to dinner. So you know, really finding out what transitions work for you is key and for your child. But that connection with your child to enable them to move and transition from one activity to the other.

23:31

It's also important to prioritize the demands you make on, and I know I looked at how many demands I'd make on my daughter and then, thinking of her executive functioning age, would I make that many demands on her? You know, like pick up your towel, clean up your room, put your clothes in the laundry, hang up your coat, put your shoes away the list goes on and instead really focused on the ones that I found are important for her things that she needs to be able to do in life, and just focus on those. And that's really helped too, because we're not now living in a zone where I'm constantly asking her to do stuff and she's constantly not being able to do that, so the tension and the crisis levels have decreased. So, again, I'd really encourage you to think at home what demands do you make on your child at home and for teachers out there, what demands are made at school and make sure that they're appropriate for their executive functioning age, and how could you do things differently with that lens of executive functioning age? And then, also key in this is to figure out how you take care of yourself and how you can keep yourself calm and in a peaceful space so that you can model your behavior, which is really helpful. I mean, I even had my daughter say to me wow, you're so calm. That really helped. I'm like wow, because I got it so wrong before.

24:50

Another thing that is really difficult for kids with ADHD. You know this one attention deficit it's an inability to follow their instructions and to pay attention or to focus on something that they don't find interesting. It's one of the criteria for diagnosing ADHD you need to have six symptoms that you have in two different settings for six months or longer that have had a real impact on their lives. So, having a short attention span and being easily distracted, making careless mistakes at home and at school, forgetting things, being unable to stick to tasks that they think are boring, that take a lot of time. They just can't seem to focus or get interested in it. They really struggle to carry out a list of instructions more than one instruction. You know that's definitely been a challenge with me and she's like mommy, don't give me more than one instruction. I can't remember it. They like to change between activities and tasks. My daughter might be playing Minecraft, then we'll watch TV, then I'll play with the dog. Complete difficult organizing things like getting clothes ready in the morning, knowing how to get yourself ready for school, misplacing possessions I don't know how many water bottles I mean. I have two sets of calculators one for home, one for school we still manage to lose, don't know how. I think it was during term, holiday, when they bring everything home and difficulty sustaining mental effort.

26:18

So what's going on in our kids' brains that's causing them to be inattentive? Well, self-directed motivation is our sixth step in exact functioning skills to develop and, as we've already said many times on this podcast, that's 30% delayed in children with ADHD, so their motivation to do stuff is not great. There's also a genetic alternation in the dopamine transporter between, which means there's less dopamine available, which means there's less ability to activate reward areas in the brain, because dopamine really drives our reward and pleasure areas, and low dopamine means they need a greater stimulus or greater motivation and reward in a situation than, say, another child. But understanding that science really gives us a good clue in terms of what solutions we can do right now with our children that have this lack of attention, lack of motive and find delayed rewards are very difficult. So first of all, again, it's key that we make sure that where we are asking them to pay attention is appropriate for their executive fund age.

27:28

So you would have a different requirement in terms of attention for an eight-year-old than you. You need to decide with your child what is the time limit for attention. So, for example, with my daughter with homework, we've agreed that she will do 10 minutes of homework and then we get a five-minute break and I use an external clock that she can see and watch it ticking off of when that 10 minutes is going to be up and also when that five minutes is going to be up and when she's done that 10 minutes of being attentive and doing her homework, something that's fun, like maybe put a song on Alexa, dance around, go into the trampoline, do something to kind of shake off some of that energy or reset the neurological system so that she can come back and then sit down and do minutes. And then creating a reward system because, as we've mentioned in their brain motivation, the low level of dopamine it's a struggle for them to actually self-motivate themselves and a reward of like getting a good job by your teacher or turning that paper in it's too far in the future. It's not intrinsically going to motivate them. So, having a reward system for doing their homework and for younger children that can be a star chart, it could be activities. For older children it could be pocket money. You find the reward that works for your child. That will motivate them and make it really quick that they get that reward, because it's all about instant gratification and then they get bored too. So make sure you change them up, because they'll become immune to it if you don't. Basically, so there's some really easy things that you can do at home to help your child with their inattention.

29:09

Now the next big bucket, which is one of the diagnostic criteria too, is impulsivity, hyperactivity. So again, just like with the inattention, it's defined by six or more and I will read the list to you over six months, in two settings, for example, at home or at school, or socially. So they have difficulty sitting in their seat when they need to sit. Still, they love to blurt out answers in the classrooms and at home They'll complete other people's sentences. I know my daughter always wants to be talking and not listen to what other people are saying, often will interrupt people or intrude in terms of what they're doing, really struggle to stay quiet during activities that require them to be quiet. They might be fidgeting around, tapping their hands or feet. My daughter is constantly got to be touching something. If we're at the dinner table, the napkin gets shredded into a thousand pieces. The eggshell gets broken up into a thousand pieces. She has difficulty sitting still, waiting their turn, talking excessively, feeling restless. So those are all of the signs of impulsivity, hyperactivity.

30:19

So what's the science behind what's going on in our children's brains? Why do they find it so challenging? Well, in their brains there's a structure called the thalamus and it's an egg-like structure in the center of your brain and it kind of works like a gate sending signals to allow or to stop behaviors. In ADHD the thalamic volume and cortical surface area is reduced, causing a disruption in that gatekeeping or sending of signals to be processed by the frontal cortex, signals to be processed by the frontal cortex. So by having a delay or having that be reduced, they lack the ability really to process their emotional expression and their problem solving. So they will struggle with impulsivity and will be more likely to ignore warnings that might shut that thalamic gate and allow them to control their behavior. So they are going to be more prone to doing risky things because they're not going to think of the consequence and understanding, first of all that you know, back to executive functioning age again, how long should they be required to sit still or be quiet and we need to adjust it.

31:30

And you need to be really specific in terms of expectations and consequences. Telling your kid just to be good is too. They need to have outlets for that energy and they need to have frequent breaks when they are asked to have to be really attentive. So, using things like in the classroom, you can get them to get up and maybe pass out something in the classroom. At home, at the dinner table, for example, I might say, oh, can you go get the ketchup from the fridge please, alexandra, and then she can come back and sit down again. And also being able to actually focus their motor energy on something like having a fidget toy. Or my daughter has a fabulous math teacher and she has a ball under the desk that you put your foot while you're doing your math problems and it actually it enables them to pay more attention. So you know, those are all ways that we can help our children.

32:25

Alongside managing our expectations of how long we're expecting them to pay attention, that can lead to them being successful. And as they grow you'll change that amount of time and you'll see, and what's right for your child might be different for another child. So it's figuring out. Where's that sweet spot in terms of getting them to do some really good work and then giving them that break and then getting them to come and do that work again? And all of these things, you know, culminate, all of these signs that we've been talking about today, the, you know emotional age, the emotional dysregulation, the inattention, the hyperactivity, impulsivity all of those become an issue when we're asking children to do homework, because really they have to tap into all of that to be successful at their homework.

33:14

But there's one other bit that I just wanted to mention as well is time management is also key for that as well. Kids with ADHD really struggle to understand time and to use it well. It's very challenging for them, and so externally, or being able to take that management of time outside of their brains to somewhere where they can visually see it, is really helpful. And then all of the other things that we talked about in terms of making sure it's age appropriate, making sure that the time we're asking them to do their homework is right, and making sure that we break down information that we're giving into bite size. And you can start to do that first for your child. I use Post-it notes and we break down the activity to its chunks that she can then do and then, as they get better and they start to understand it, then they can work with you and they can choose which chunks and then how they're going to do it. So it's a gradual process of understanding how their brains work, not giving them too many instructions, taking the frequent breaks and those rewards.

34:22

So the solutions we've talked about today breaks and those rewards so the solutions we've talked about today and recognizing the signs are really you can use it before you know your child has ADHD, when you might just suspect. These are things that you can use in your back pocket to see if it has an impact and decreases the challenges and makes for a happier life at home and at school. But after you get a diagnosis, what are the four key things that you need to have a successful life? And the research has shown that using a pharmacological intervention like medication and accommodation with therapies and support, you can really change the outcomes, or the quality of life outcomes, the educational outcomes, the lifetime outcomes of a child with ADHD as they grow to an adult. So this was another key part for me. I thought like getting the ADHD diagnosis was a nice to have. Oh, it would you know. Maybe it would help me with solutions to help her. But actually finding out she had ADHD and making sure she has the right support is going to impact who she becomes as an adult.

35:28

Now I talked last week about medication, so I'm not going to speak too much about it, but it really is a key factor and a key aspect of supporting your child with ADHD. It's one of the four key things. So medication, sleep and exercise, nutrition, and then accommodation at home and school. And if we think about it I've talked about this already the role of stimulant medication in decreasing that gap in terms of executive functioning age is so key and actually kids that go on to grow out quote unquote of their ADHD tend to have been ones that have been medicated as a child, and actually the medication can permanently improve brain development and growth. Also, interestingly, for those 11% of children that develop oppositional defiant disorder which, although my daughter hasn't been diagnosed with it, I'd say she could be it also improves that and makes it easier for them to manage their emotions of anger, frustration and hostility. It also helps them with their perception and management of time when they're on the medication and it's the most effective and more effective than an asthma inhaler.

36:45

And, honestly, the side effects, which can include loss of appetite, delay in sleep, headaches and sweating or dry mouth, they're usually not severe enough to stop the medication, and I know I wasn't told about this when I started the medication with my daughter. I decided to do it over summer, where we could just, you know, concentrate on onboarding it, because each child is different. How they metabolize the drug is going to be different, what dosage they have, and you kind of build up to a good dose and then you stick on it. Well, the first week that she was on those medication, it was terrible. Her symptoms got a lot worse, in my opinion, and I almost stopped taking the medications. When I talked to the clinical psychiatrist about it afterwards, he said to me oh well, that's quite normal. And I'm like well, if it's quite normal, why didn't you tell me about it? Because obviously you know it would have helped me to keep going, which is what I did do, because I had promised myself we would try it for a month.

37:36

There's also non-stimulant medications as well, and you know your clinical psychiatrist will work with you with what is the right drug for your child and then, as your child grows, they experience hormones, other things. You have to alter the dose you might have to what drug you choose. So it's not an exact science, but it's a science that actually has incredible impact in terms of their development and growth and can function with their ADHD. And there's a saying that you know if you wire it, if you fire it, you wire it. So by being able to do things that they were unable to do without Medicaid, they are wiring and firing and I have to say my daughter now is able to get ready in the morning, get her backpack ready, she can sit down and do homework much longer than she could before.

38:22

Independent. She's able to do things in a way that she wasn't able to before. And she had a great way of describing it to me. She said, mommy, she went to a painting class, actually during the summer that we started the medications, and she came home and she said you know, mommy, normally when I go to the painting class I really have a hard time paying attention to the teacher, because their dog is running around, I hear the fountain, the birds are in the trees and she's like. I really found it hard, but this time I didn't. This time I was able to pay attention and look what I've created. I was like wow. And she, you know, the proof is in the pudding she remembers when to take her medication I often forget when she's home for the lunchtime dose and she remembers.

39:02

So it's been incredibly key in terms of her success and in terms of managing her ADHD, and that is one wheel on the car that we need to help our children who have ADHD. The second wheel is making sure they have sleep, and I think this is intrinsically linked with exercise as well, which is also key. Sleep, and I think this is intrinsically linked with exercise as well, which is also key. So exercise research has shown that 20 minutes of aerobic exercise, such as biking or running, can decrease challenging ADHD symptoms and improve executive funding skills, but it also helps you in terms of sleep. I find that exercise is super important in my life and, you know, incorporating that into my daughter's life is really key as well.

39:47

But sleep is a real issue and this was another less known sign I would say that you know pointed towards ADHD of my daughter. I mean, we didn't have a good night's sleep until she's been diagnosed and has gone on to melatonin. I didn't realize, though, that 70% of children have sleep issues with ADHD and it's multifactorial, it's behavioral as well as due to other causes like their diurnal and circadian rhythms. They can have alterations, they can even have alterations in production, but getting poor sleep really makes the ADHD symptoms worse. So finding out sleep solutions is really behavioral solutions. So you know, decreasing the times of tension and emotional dysregulation before bed, dealing with the anxiety Anxiety can be a huge causative factor in terms of not being able to go to sleep, and I found actually doing tapping on my there's an episode in podcasts on how to do has incredibly reduced the anxiety that she feels. And I found actually doing tapping on my there's an episode in podcast on how to do has incredibly reduced the anxiety that she feels.

40:48

And then, addressing the circadian and diurnal rhythm alterations and melatonin dysfunction using melatonin, I think really, if I'm honest, among all the things that I do for her sleep including a regular routine early in the evening so we have plenty of time to go to bed Melatonin has made a huge difference and it's prescribed. So she has fast acting melatonin to help her get to sleep and then long lasting melatonin to keep her asleep, and she. Honestly, she doesn't wake up. We get to bed within 20 minutes, she's asleep maybe less sometimes, and she stays asleep. And it's changed my life. I can go out now, I can have a babysitter with her, she can get a good night's sleep. She still wakes up at the crack of dawn with the roosters, but you know it's hugely important. So we've discussed two wheels We've got medication wheel and then we've got the exercise and sleep. The third wheel is nutrition, and this is super important.

41:41

I mentioned earlier about dopamine deficiency and ADHD and alterations within the dopamine transported gene, which means less dopamine. So you want to give your child's body all of the precursors to make dopamine so that they can make it easily, and that is foods that are rich in protein, which have tyrosine, which are the precursor. You can also use supplements. Now you can use external supplements or you can get them in their diet. So zinc really helps with dopamine regulation and attention. Iron and magnesium is needed to make dopamine, and omega-3 has shown to reduce ADHD symptoms.

42:20

We did a great podcast with Lucinda Miller and I'd recommend listening to that too, but I have found that a healthy, protein-rich diet and how you the sugary, curvy breakfasts that you know are so common today. Give them some protein. You know, I even serve chicken for breakfast chicken, smoked salmon, eggs, things like that are really going to set them up to have a successful day. And then throughout the day, and then the final wheel in the car for it to run properly is foundations and we've talked about that in each of the solutions we talked about today. So you need to really ensure that your expectations meet your child's executive functioning age, both at school and at home, and then you need to scaffold support at the point of performance to bridge that biological deficit and allow our ADHD children to thrive.

43:12

So four key points here breakdown requests in manageable chunks, one instruction at a time. Decrease or negate time intervals and make sure that you reward at the point of purpose to motive and putting those structures in place. Huge difference and they're not expensive. They can be done easily. So I hope you've enjoyed today's podcast. If you have any questions about what I have talked about today, please reach out to me on the SEND Parenting website that's S-E-N-D parentingcom. You can reach out to me on the SEND Parenting website. That's S-E-N-D parentingcom. You can reach out to me there. It would be lovely to get your email addresses too, so that I can follow up with you, and I wanted to wish you and your family a calm week ahead. Thank you, you.