Understanding Neurodiversity: Thriving with ADHD and Autism

[00:00:00]We're still stuck in this medical model idea of neurode divergence which is person needs to be fixed. We need to diagnose them. We need to treat them. We need to cure them and the world is right again.

[00:00:11]>> Mhm.

[00:00:12]>> What we we should be looking at is much more around creating that inclusive culture where everyone is seen, where everyone is heard, their differences respected and and they're able to to kind of leverage their strengths. We do know that some people only show symptoms of ADHD after trauma or because of trauma >> and we do know that these people have the genetics so have the kind of base but the environment works towards making them express the genes but what do we do with that knowledge and almost tragic because there's like a whole generation of people who are still living it and they're being diagnosed at a later stage but what happens to them.

[00:00:57]>> When I got my cognitive assessment through, it made me cry. I I almost couldn't accept it. It was like, "This cannot be true, you know, because of the story I told myself.

[00:01:16]Welcome to Connect for Health, the live webinar and podcast brought to you by Signa Healthcare, Middle East and Africa with a little bit of help from mental.

[00:01:25]I'm Scott Armstrong. I'm the founder of Mental, a platform that tries to tackle the stigma of mental health and help the community thrive. And as always, I'm joined by my fabulous co-host, Mesa Alkafari, the head of government affairs and strategic communications at Sigma Healthcare Middle East and Africa. Now, today's topic is one that is very, very relevant to so many people, and I can see you're already getting very, very engaged because the questions are coming in already. understanding neurodeiversity, thriving with ADHD and autism. Um, it's a topic that's been in the news a lot. Um, a lot of people are also getting diagnosed with latestage ADHD. I'm one of them. This is a safe space. Uh, I have ADHD. One of our guests as well has ADHD. We've got two amazing guests. But if you want to get involved, please ask the questions because we've got two amazing experts.

[00:02:17]So, please ask your questions. whether or not you think you have ADHD, your child may have, or you want to know how to support a partner, friend, or a colleague at work. Um, as always, um, we will also ask you poll questions. If you're watching on the catch up on YouTube or on the podcast channels, you can't get involved. But if you want to be with us next time live in the room, reach out to Sigma Healthcare for details of membership. So, let's get into this. Uh, my two guests today.

[00:02:44]Firstly, we've got and if you watch the mental space podcast, you'll know Sarah.

[00:02:49]We've got Sarah Christensen who is an organizational psychologist and the chief executive officer of Christensen Consultancy. And Sarah works at the kind of intersection of human behavior and workplace performance at organizational culture. And our second guest is Dr. Valentina Fire who is a specialist psychiatrist and psychotherapist at Bio Psychosocial Clinic with more than 20 years experience and specialist expertise in neurode divergence including ADHD, autism and giftedness.

[00:03:20]That's the intros out the way. Welcome both to you to connect to health. Great for you to be here. Great to be here.

[00:03:25]>> So let's start with an overview. And if I may, I'll start with you Dr. Valentina and I will call you Valentina from here on in.

[00:03:32]>> Thank you. um when we're talking and obviously we hear a lot about neurodeiversity but just just give us an uh you know an overview of what neurodeiversity is you know talk us through ADHD autism and and other varieties of other uh conditions that are captured within that umbrella.

[00:03:51]>> Thank you for the question. Um so neurodeiversity is the collective term that indicates that brains can work in very different ways.

[00:04:04]>> Okay.

[00:04:04]>> So the neurodeiversity refers on a population level. The term neurodiversity refers on a population level to the fact that different >> people might have brains that work in a different way which >> seems um a given right now because we're talking so much about the topic but it's actually quite a recent >> um understanding >> because we tended to think that all brains are probably the brain of I don't know 25 years old 6 foot 70 kilos guy which is what typically medicine has been looking at.

[00:04:37]>> Okay. The neuro term neurodiversity suggests there are so many differences between the the different ways different people operate, think and process emotions and knowledge as well.

[00:04:50]>> Neurode divergence instead is a work in progress.

[00:04:56]It's a definition that is being built now with the understanding that amongst neurodyiversity there are individuals who tend to position themselves somewhere in a spectrum. For what concerns the way they process their thoughts, the way they feel their emotions, um the way they relate to others and lastly their behaviors which is the only thing we see objectively. we see an ADHD child because he acts in a certain way >> or someone is um suspected of being autistic because maybe interact in a slightly different way socially. So neurode divergence is not a coded term still in medicine.

[00:05:43]We're working on it. It's like probably what we would call a proposition. We're trying to understand whomever can fall into the term neurode divergence. And at the moment we have a variety >> of experiences. We have people with who have ADHD people who position themselves somewhere in the spectrum. Um so they are autistic to different degrees. But we have also people with a variety of learning difficulties. Disculia, disgraphia, dyslexia and they also belong to this population which is called >> people with neurode divergence >> and also people who have very specific symptoms that are properly neurological like Tourett >> Tourett syndrome and they also fall into the same domain. So what are what we're looking at now is truly and it's it's amazing I guess to be part of the process to try and understand how um neurode divergence can encompass so many different presentations the facto they are very very different >> and very varied >> um and still be a thing if you let me say it so what we do when we assess and diagnose someone is that we purely tend to stick to the behavior of the individual because we it's what comes out.

[00:07:08]>> That's why there are so many misconceptions for instance amongst uh ADHD everybody has a little bit of ADHD. Well, actually, no. Not everybody has a little bit of ADHD. A lot of people are inattentive.

[00:07:23]That is true. But ADHD is very well coded. It's very well defined. But when we assess someone, we have to look in depth because what shows through behavior >> typically is neurobiologically coded. There is a genetic, there is an epigenetic.

[00:07:44]We do know that some people only show symptoms of ADHD after trauma >> or because of trauma >> and we do know that these people have the genetics so have the kind of base but >> the environment works towards making them express the genes. So I guess what I'm trying to convey here is the complexity of a developing field that it's still in our hands somehow to explore and I'm talking you know I'm mentioning to Sarah because that that is a struggle >> that we have when we try to explain what neurode divergence is >> to companies or to big organizations.

[00:08:28]>> Yeah. because it's so varied and and you can't you I can't I can see that >> five minutes into the conversation people are lost and like so you're saying what exactly is the exactly I have a lot of questions >> and so do our audience I I can see that you're already asking lots and lots of questions we will get to them um because there's so many questions out there and I think you know we talk about misconceptions and all that kind of thing I mean let's focus on ADHD and then autism but just talk me through actually, you know, I know and also having been diagnosed, I know there are sort of slightly different strands or flavors of ADHD, but just talk us through what ADHD is >> from a clinical perspective.

[00:09:13]>> Yeah, from a clinical perspective, we do define ADHD through the main concept of the attention deficit >> which is the core of ADHD. So um we know that from a diagnostic point of view we can have ADHD with or without hyperactivity >> but it's much more um complex than this and I'll um so if the attention deficit is probably the core of ADHD the hyperactivity is somehow always in the back lines and can be an hyperactive brain. The definition of ADHD historically is based on a seven years old who climbs, you know, the walls and is impossible to keep sitted and uh blurts out answers and is very uh provocative at times >> and again a boy and a girl.

[00:10:10]>> Yeah. And now we know that there are so many differences in the presentation between children, boys and girls. So gender gender determined differences.

[00:10:20]The majority of women as a matter of fact are diagnosed later in life.

[00:10:24]>> Yes.

[00:10:24]>> Either adolescence. But I am seeing a population of pmenopausal women who come and say, "I don't know what it is wrong with me. I fixed the hormones. I'm on HRT. I'm training. I'm weightlifting.

[00:10:36]I'm taking 140 grams of protein every day and I'm still brain fogged. And I don't know what is happening to me." And what is happening is that the coping mechanisms that they have been implemented for a lifetime are falling apart. Yeah, >> because we hormones have an impact as well >> on cognition >> and that is why at times >> and with ages we see those increases those peaks in diagnosis around uh puberty for children and then around menopause sometimes in postpartum as well.

[00:11:09]>> Interesting.

[00:11:10]>> Very interesting. Yeah.

[00:11:11]>> Very very interesting. Yeah.

[00:11:13]>> I can I kind of missed the point.

[00:11:16]No, because again I'm and obviously I'm I'm aware because I've been diagnosed last year but you know you know if we talk about inattentive attentive combined you know there are these different different sort of flavors what they are but also you talk about how it shows up you know the differences between men and women and ADHD for example and we'll come on to autism in a moment but >> how you know how does that actually show up then because as you say the stereot stereot type is that hyperactive trouble-causing seven-year-old boy at school.

[00:11:51]>> If I have to sum it up, you know, the the neurobiology is quite clear at the moment. So, we do know that technically from a neurobiological point of view, we have a lack either our production or of the ability of the brain to use dopamine, which is a very powerful neurotransmitter in the right prefrontal cortex. So it's a very specific part of the brain >> and what the prefrontal cortex does is that it execute plans.

[00:12:18]>> So the struggle of someone with ADHD is not about cognition per se, they're super capable. I mean I think on average the the average person with ADHD has probably 100 notes and lists on their phone. Super good at making lists.

[00:12:36]They're super good at making plans. They know. They wake up in the morning and they know exactly what will make them feel better.

[00:12:43]>> I should get up now, exercise, have a very healthy breakfast, and then shower and possibly go for a walk with my dogs and make my my wife happy, by the way.

[00:12:54]And then straight to work. And this is all before 9. 6 hours later, they're hooked on the phone >> and the Sunday is gone.

[00:13:02]>> Yes. Yeah. Yeah. Yeah. So what the preffrontal cortex does is that helps actualizing >> what the brain knows is the best way forward. I think this is the best definition that I can which is applicable >> to our children.

[00:13:18]>> Mhm.

[00:13:18]>> Because our children as well they perfectly know >> what I should be doing how they should be doing it. The point is how do you get from that frozen status where you are >> in this knowledge and this knowledge is so complete that the different 10 different tabs open in your brain and know exactly what >> hundreds as well. How do you treat?

[00:13:46]>> How do you go from there? Okay.

[00:13:49]>> How do you go from there to pushing out your duvet?

[00:13:53]>> Yeah.

[00:13:54]>> And head into the bathroom. That's it.

[00:13:56]>> It's that execution.

[00:13:59]>> Yeah.

[00:14:00]>> And it's so deeply frustrating and painful.

[00:14:04]>> That's the thing >> because I think if you didn't know >> Yeah.

[00:14:08]>> Well, maybe whatever. I had such a great time. I spent six hours in bed scrolling my Instagram. That's something that someone could say or someone who knows >> the damage and feels the pain >> that's so dabilizing as well.

[00:14:24]>> Sarah, I can see you obviously taking cycle. Yeah.

[00:14:27]>> Um >> I don't think you'll mind me sharing that you have a lived experience with ADHD as well. Um when were you when were you diagnosed and what's your experience been? You know, how did it show up for you? Well, it's been more along the case of uh I was doing an assessment on a client and I was like so there I was with my screening questions going through everything and she was providing the responses back and as she was doing that she was also talking about how she was compensating for these things and what she was describing and how she was going through it. And I was sitting there I was writing my notes and I was like I do that.

[00:15:03]>> Yeah, >> I do that too and I do that and I do.

[00:15:05]And it was this light bulb moment of like, oh, okay. So, I think I've just discovered something about myself today.

[00:15:12]Um, and I think from that side of things, it was this aha moment of like, oh, now it all makes sense. The challenges with school, with relationships, with doing things. I'm like, now it makes sense. Um, and I think for me a lot of that was >> it was kind of just a weight lifted off.

[00:15:33]And I think you can you felt the same as well. the weight lifted off cuz it was like, okay, so it was validation. I'm not stupid. I I I just do things differently. My brain is different and that's okay. And I think that was such an enlightening moment um to be able to have that um to be able to have that experience like okay, right? So, and then understand what it is I do, how I do it, and learn more about the experience, what that looks like, what the more efficient strategies that I can put in place to to kind of be able to engage in the world >> um as effectively as possible. So, yeah, it was yeah, interesting way of learning that you have these things.

[00:16:15]I wanted to just touch on a point that you mentioned Sarah and that was when you said in retrospect everything started to make sense and I feel that when there are discussions taking place around ADHD they still pretty much focus on um the earlier stages so like the impact when it comes to processing knowledge being at that education stage in one's life but >> I I I don't feel that there is enough that is said as to how being say in a relationship with an ADHD I hate using the word sufferer person when you are working as part of a team or you you there are so many things in everyday life that ADHD spills into or makes I would say takes quite a substantial part of our dayto-day. Um, but I just don't see enough of that, you know, conversations happening or it always seems to be something that's trending rather than something that is a true reality. And I how how do you feel, you know, things are moving if at all?

[00:17:32]So I think um it's a great point because I think our awareness about neurode divergence in general has progressed loads in the last sort of you know 10 15 years and there's a lot of reasons why I think our access to social media there's a lot of people talking about it that we've got very public figure individuals talking about their lived experience >> today. Yeah. And uh and even sort of from a research perspective, from an evidence base, we have so much more robust knowledge about what that is now.

[00:18:04]So I think our understanding of what it is, how it shows up, our awareness is good.

[00:18:11]>> Okay.

[00:18:13]>> But where we're not there is moving it to the next level is how do we integrate it?

[00:18:17]>> Yes. what we're in is is like what we'd kind of call it is we're still stuck in this medical model idea of neurode divergence of that um which is person needs to be fixed. We need to diagnose them. We need to treat them. We need to cure them and the world is right again.

[00:18:36]>> Rather than that what we we should be looking at is much more around creating that inclusive culture. What do we need to do in rather individual fit with how we do things around it? How do we create that more inclusive culture where everyone is seen, where everyone is heard, their difference is respected and and they're able to to kind of leverage their strengths and be able to integrate in that world. And I think >> you know a lot of the work that you know we see happening in organizations for example great at doing awareness days.

[00:19:12]We have awareness days left, right, and center. But my question is, and what next? What next? What are we doing to take this not from this this training session, this virtual session we've just done with, how does this impact on a Tuesday afternoon meeting for our team?

[00:19:28]I want to really like piggyback on that comment and it was something that I had a discussion I had with a friend of mine who was looking at a a team member and they were sitting down and they were looking at his performance appraisal and just doing his assessment and he had basically you know said that and it wasn't it wasn't something of like you know um a sympathy card he was basically saying that you know as a person who has been recently ly diagnosed with ADHD. Um he was very um vocal about some of the challenges that he was facing in the way he was able to deliver work um able to perform. And that just got me thinking about what are we doing daytoday within organizations when we're looking at these metrics when we're looking at you know these draconian ways >> of trying to um you know measure performance.

[00:20:31]It's fascinating as well though because I mean I and we'll come on to perhaps relationships as well but I I changed my LinkedIn status >> um to to say ADHD >> um obviously because we tackle stigma and that's part of our role. Uh my wife was furious about this. So well how's that going to look professionally you know no one's going to hire you. I mean thankfully I run my own business so I'll hire myself but you know but that that idea but then it also shook me. Um you know I left school with five GCSEs. I did very very badly. Um, that's not specific to anything. There was different things going on. But when I got my cognitive profile, it actually showed there was five things I was really, really good at and one thing that needed help, needed support.

[00:21:12]>> Um, and we're almost at this point where actually we should, if you were thinking from an organizational perspective, if we could walk through an interview and you know, and go right, this is my cognitive profile. This is what's happening with me. then we can optimize and go yeah you're perfect for that role yeah and we'll do this you know from a performance p perspective but that stigma is still there that we'll never get I mean deote did a big study and 1% of women in the workplace said they were prepared to vge that they were neurody divergent so it shows you there's a massive stigma there >> and if I can tap into this >> yes >> from a neurobiological point of view genes that don't matter tend to be deleted >> right >> you know evolutionarily this is very clear. So there must be a use >> to people with ADHD which we know >> this is very interesting >> get stuff done >> get stuff done >> creativity >> cool under pressure creativity ability to read a room >> to see patterns >> to see patterns >> connecting the dots is something that I'm very good at but also seeing how things go like traders for instance a lot of them have ADHD because they kind of see >> and they sit behind 16 screens and they can't see that the markets in Hong Kong and that has happened five years ago and then New York and they sell New York and it kind of saved the boat. You know what I mean?

[00:22:35]>> Yeah.

[00:22:35]>> So that's so many positive um skills >> that actually get deleted because we want that single employee to be on time and that is never going to happen. And I know it because I I mean I come from a I work clinically so sometimes I address HRs and I send letters and I send emails and they're like oh I'm so understanding. Yes, of course. And and we want to invite you to speak to us but yeah but what about this employee? Well, can't you help them being on time? And I'm like this is the exact point. This is a person rather than the culture >> fixing the the this side detail of their personality.

[00:23:16]Do you notice the amount of work that this person is taking on?

[00:23:20]>> Have you seen how much that she contributed that >> to the company?

[00:23:27]>> I'm going to because the audience I can see to see this popping up. U first I'm going to ask you to get involved in our first poll of the day.

[00:23:36]So if you can uh look to your screens, you should see uh the questions coming up. But our first poll of the day is going be interesting to see what you guys think out there. What do you think the biggest myth around ADHD and autism?

[00:23:49]I will answer this poll and then I'm going to bring in some of your questions because you've been very patient so far.

[00:23:55]But biggest myth, so that ADHD just means that people being distracted or hyperactive, that autistic people all behave or communicate the same way. That neurode divergent people cannot be high performing. That support means lowering expectation. That annoys me a lot, that one. um that people should just try harder and be more disciplined or that it only affects children. I mean from your persp you know from your two both your perspectives through work which do you think the audience is going to come down as sort of one of those >> uh big the biggest myths that people hold.

[00:24:32]>> I I think purely from a work perspective I think there's that link to high performance. It's that when we talk about neurode divergence we see difference as deficient. Yes.

[00:24:43]>> And that's the big thing. It's this idea that when you've got some form of neurode divergence, you're you're broken. You're you're less than and that you're never going to be able to perform because you're always going to be struggling. It's not actually the key is. So, I think there's a big piece around that around that performance. Um, and I'm sure we'll we'll talk more about that. So, I'd say that's >> Let's see what the results are. We're going to try and bring in the results now. See what you've actually voted for.

[00:25:07]Um, and the biggest one we have is that ADHD. Yeah. Or was close as well. It's it's an arm wrestle between it only affects children.

[00:25:17]>> Mhm.

[00:25:18]>> And that it just means being distracted or hyperactive.

[00:25:22]>> So they're the two biggest limiting.

[00:25:24]Very limiting.

[00:25:25]>> Very limiting definitions. Yes, of course.

[00:25:27]>> So how should or should we be defining it though as well? Is is our is is our focus on this almost like too narrow?

[00:25:34]>> Yes. I mean I I that I I have no so um lived in experience but also looked at people around me over the years >> and I'm looking at how we mentioned awareness has really come through to the surface but again it's still it's still kind of but what do we do with that knowledge and almost tragic because there's like a whole generation of people who are still living it and they're being diagnosed at a later stage, >> but >> what happens to them? I mean, is it like that's it now? You know, like it's >> we can talk through those. I mean, being diagn you you have to kind of and thankfully I went through it pretty quickly, but it's that almost like anger and frustration of what could have been, >> you know.

[00:26:30]>> Yes, exactly.

[00:26:31]>> Yeah. I don't know if that resonates with you Sarah as well, but you've done pretty well anyway. So, crack on. What else can you do?

[00:26:39]>> Yeah. Well, and that is something we do.

[00:26:40]Well, I am gonna I'm gonna put some questions in because we've got them all stacking up. Uh Rajri, I hope I've pronounced your name right. I am very passionate about this topic. So, please excuse my long list of questions or you going to do my job for me. Um, how can someone get tested and get a diagnosis?

[00:26:56]Uh, disclosure of a neurode divergent condition can be a difficult decision.

[00:27:01]How can organizations create a safe space for employees to feel comfortable to disclose their conditions? We'll come on to that. And are there any cultural or workplace considerations for organizations in the UEE to be mindful of before developing neurodiversity strategies? And four, you've really gone for it. Uh any lowcost high impact in adjust adjustments that employers can put in place to support neurody divergent people. I think the first thing we need to say is also we've got the new UEE mental health law which makes it illegal for employers to discriminate against employees with mental health uh conditions. So that's that's a first starting place. Let's take Raj's first question though which is about how can someone get tested and a diagnosis? Um what's that process?

[00:27:52]Because for some people that they're still not quite sure.

[00:27:55]>> Well, first of all, it would be great if insuranceances will pay for that. Well, that's that's a push.

[00:28:01]>> Well, actually, >> I mean, um I know that there are like um certain insurance. I I'm I'm immirati. I I am covered by >> and um uh insurance does >> and I believe um so does Sigma on certain policies. So reach out and sometimes I think as well we've talked about health literacy in the past and and sometimes we don't actually know what is or isn't covered within our health insurance and I know my health insurance which isn't um it wasn't covered and that can be a barrier as well because it can be quite expensive.

[00:28:36]>> Yes. Especially if you want to have a complete assessment >> because otherwise >> you know a psychiatrist can diagnose a patient through a very quick 15 20 minutes testing but that would be very very limited a very limited understanding of how that person works what their strengths are >> what the neurobiology behind the behavior is what the >> um emotional support kind of emotional support that person might need. So I recommend always to go through a process which is a complete neuroscychological assessment which which takes several hours is expensive >> and but gives you a clearer picture for the carer and for the individual of what they have been going through what different elements have played because cognition is also a byproduct of emotions. It's a byproduct of trauma of a history.

[00:29:36]>> So all of that has to be explored. What we add very peculiarly at BPS is that we do also personality assessment.

[00:29:45]>> So we kind of see how the neurobiology, how the neurode divergence has affected development and has translated into the personality >> that's interesting >> of the individual. And when it's children, instead we look more at what their emotional needs might be because that's also part of the process of assessing children that we want to support parents.

[00:30:09]>> One of the things um that truly bother me, sorry because I'm going back to them.

[00:30:15]>> Yeah.

[00:30:15]>> To the myths around ADHD.

[00:30:18]>> Yes.

[00:30:18]>> Is when people say um that it's a matter of uh you know those children are not well raised when I was younger issues.

[00:30:27]It's a parenting issues is putting the blame on parents and putting the blame on society or school uh or whatever structure.

[00:30:36]>> Um because one of the things that we notice um is that when we assess someone typically now we end up taking on the family.

[00:30:45]>> Mhm.

[00:30:47]>> So the individual that because that's a genetic because that's a predisposition let's call it this way >> for neurode divergence. Mhm.

[00:30:55]>> We often assess the kid and then we look at the mom or the like why don't you come in for an >> assessment buy one get one free I speak to so many friends who yeah they their children >> even that the strategies you implement right you should you're supposed to co-regulate with your autistic child but if you are disregulated how are you supposed to co-regulate before you >> you know make an intervention on your child and if you are impulsive and you end up in shouting you know, fights with your child. How can you really do that?

[00:31:28]>> So true. Yeah.

[00:31:30]>> Yeah. And it's an interesting I mean, you know, access to diagnosis. And again, Julie's asked the question as well. How do you approach getting a diagnosis and what help is likely with a diagnosis because there are also different treatment plans and we're still talking about ADHD. I will bring in a question in a moment about autism as well, but just stay with ADHD for a moment. you know what are the different sort of u I mean I remember my diagnosis was yeah and it was the best money I've ever spent >> genuinely but it is a bar that is a barrier to kind of overcome but the things it tests for but then the help you can get on the other side of it so perhaps >> for example just imagine that I've just had a diagnosis from you what's the support that you're then going to be suggesting that I could access >> there are many different avenues you know I'm a psychiat So everybody thinks I just you know >> give drugs but this is part of the >> part of the process. You know sometimes we really want to trial to make a few trials of different medications and we usually start with a medication that is known as a non- stimulant or a light stimulant and then we progress depending on the response. But I would say that probably the main task that whomever as is the first kind of point of interaction with a patient because can be a coach can be a support group can be a friend >> um who's like you know what I think you have ADHD >> can be someone who self diagnoses on a website we have people I have people coming in and saying okay so clothe this and sad this and then I've taken the 16 free of charge online >> which are all waited to try and sell any product >> whatever you know and but they come and they've done the the the bit of work you know they're genuinely being in the process of understanding and this is understanding as well but whomever is the first point of contact >> you need to be aware >> that there's a cognitive >> different way of functioning but there's an emotional roller coaster >> that person who's just been diagnosed is going at the same time through anger, >> relief.

[00:33:42]>> Yeah.

[00:33:43]>> Resentment.

[00:33:44]>> Yes.

[00:33:45]>> Disappointment.

[00:33:46]>> Yeah.

[00:33:47]>> And in a word, grief.

[00:33:49]>> Yes. I was just about to say that.

[00:33:50]>> Grieving the life they could have had.

[00:33:53]>> Literally just about to say that >> they grieve in the relationships that they >> like. It's almost >> think they ruined. I when I got my cognitive assessment through.

[00:34:01]>> Yeah.

[00:34:02]>> It made me cry.

[00:34:03]>> Yeah.

[00:34:04]And I I I almost couldn't accept it, you know. It was like this cannot be true, you know, because of what the story I'd told myself >> um all my life. Sarah, I want to bring bring you in as well because when we talk about different kinds of treatments and I think that's one of perhaps one of the other stereotypes that was certainly around in the media in the US and the UK was well it's just drugging children now you know because I do take medication and it's been a gamecher for me but you don't um but you're di you still you know you medic almost like medicate through exercise and >> so >> yeah so I think everyone I think the biggest thing that we need to understand is that everyone's going to present in a very different way. We've got these universal titles that we're giving people, but again, we keep talking back to this idea about the cognitive um components and the cognitive profiles that we have.

[00:34:57]>> And I always kind of explain it like, do you know the audio mixing boards you get? Like we've got some Yeah.

[00:35:02]>> Yes.

[00:35:03]>> So, think about your brain like that.

[00:35:05]And each one of the dials and switches and the sliders are a different form of cognitive trait. So, we've got one for working memory. We've got for one for organizing. We've got one for sensory processing.

[00:35:18]>> And each one of those dials can move up and down. And for the majority of the population, those dials are somewhere in the middle for everybody. That's nice.

[00:35:26]And that's how we operate. That's what neurodyiverse in general just looks like. We're all got the same plate to start with.

[00:35:32]>> But when it comes to people who are neurode divergent, some of those sliders and dials are turned really high up. we see really high creativity or exceptional problem solving or sometimes they're actually really low and you know difficulty with working memory or sustaining attention. Um and it's kind of like this idea that because you're different and that you're somehow deficient and that there's more weaknesses within within people who are neurode divergent that there there's something wrong with them. And that's not actually the case. We're just different. Yeah. Um, and I think we can't just take one brush and kind of put that through everyone. Um, so when it comes to the workplace stuff, like when I'm doing workplace assessments, >> I will kind of take the overall broad view of, okay, what have you kind of come in? What does your report said?

[00:36:23]>> All right.

[00:36:24]>> How does this affect you on a day-to-day basis? What are the challenges, unique challenges that you experience >> on a day-to-day basis? Okay. Is it time management? Is it sequencing? Is it working memory? Is it whatever?

[00:36:38]Understand that. Then you have to go and you have to understand from a work perspective, well, what does your job require you to do?

[00:36:44]>> What do you needed to do on a day-to-day basis to be able to perform and where is the mismatch from that? And we want to then try and layer that over the top to to create a set of reasonable adjustments that's going to be applicable to you. So your set of reasonable adjustments is going to be different to mine, is going to be different to yours, however. And that's what's important about creating that inclusive culture.

[00:37:08]>> Rather than going, "Okay, we need to fix Scott to put him into our culture, let's fix our culture so that every single one of us >> can leverage our strengths that we bring. We're removing those barriers that stop each one of us really giving off our full potential and we're getting the supports, the individual supports that we need to be able to thrive and do our absolute best."

[00:37:31]>> Yeah.

[00:37:31]>> Can I bring in another question as well?

[00:37:33]Uh, and I'm just going to stay with ADHD just a little bit longer, but we've had a couple of parents also um messaging in. Um, Shatha, thanks for your question. As parents, what should trigger us to pay attention to ADHD in our childh? And another parent has also asked, I remember the question from earlier. Um, yeah, Bouvenes, uh, for a child with ADHD and emotional dysfunction, is it is medicine safe or go for therapy first? and also how to handle child with ADHD meltdowns. So there's a lot there, but let's just start with uh not limited to children >> as as parents, you know, what should we be looking at? And because this we were talking before we came on camera as well, there's almost two different lenses. I have ADHD, so I need to be very very careful about not putting >> my perspective onto my daughter even though it's genetic. You know, just seeing my condition in her everywhere, you know, in everything that she does >> versus also what should parents be looking out for >> in their children.

[00:38:36]>> Well, I would say in the UAE there's a lot of attention in schools.

[00:38:41]>> Yeah. So I would say what not to not to do. So don't assume that because your kid is very uh successful in school, they're not struggling.

[00:38:53]>> Yeah.

[00:38:54]>> Yes.

[00:38:55]>> Because we read the school reports >> which may or may not be written with AI.

[00:39:00]>> Yeah. No, but we've had a few we've had I've had a few encounters. one of our guests as well. You have highly functional ADHD people, but they had really struggled >> to get to that point of recognition and conformity.

[00:39:17]>> Yeah.

[00:39:17]>> Because especially girls.

[00:39:19]>> Yes. Especially young girls because they tend to conform more.

[00:39:23]>> Yeah.

[00:39:24]>> They compensate more. Yeah.

[00:39:25]>> Yeah.

[00:39:25]>> But to conform as well, you know, they're more aware of the social rules.

[00:39:29]I remember this young girl moving slightly towards um autism. She had a double diagnosis. It was a UA ADHD.

[00:39:37]Yeah.

[00:39:37]>> Yeah. Um and she was um and a mom who was a patient of mine um called me and said she was in tears and she said, "I think she's psychotic."

[00:39:48]>> And I was like, "Whoa, whoa, whoa, whoa, whoa. What are you saying?"

[00:39:50]>> No, no, no. I've been observing her.

[00:39:52]She's been talking to herself and she's she speaks like she's speaking to someone. She might have hallucinations.

[00:39:58]I was like, "Okay, okay, cool down.

[00:39:59]Let's have a look at her." And this girl was rehearsing her interactions with their peers.

[00:40:07]>> So she was literally spending hours a night talking to not imaginary but actually real friends and rehearsing the way she would have approached them over lunch >> which of course made her extremely weird in her interactions. It was part of her isolation you know. So what we should be looking at is trying to be curious.

[00:40:34]>> If I have to give a recommendation to parents, myself as a parent is be curious.

[00:40:39]>> Educate yourself. Do you suspect there might be something going on?

[00:40:42]>> Yeah.

[00:40:43]>> Just >> choose your way of educating yourself.

[00:40:46]It can be audio books, it can be books, it can be talking to an expert. Go yourself. Ask people.

[00:40:52]>> Rewatch this episode >> again and again and again. episode again from the beginning follows cut I know you know what I mean it's like gain an understanding for yourself be curious be open-minded try as much as possible >> not to be in denial it's very difficult very difficult for parents >> for parents especially >> to look at our children us clinicians we don't see our children >> better they want us to see what they want us to see >> they're very good at hiding as well >> yeah right so people pleasing And >> it's a dynamic, but not a lot of children with ADHD, children in general, >> I would say.

[00:41:30]>> Yes.

[00:41:30]>> But it's also a thing that I've seen a lot as well is that I've got this label now. My child has got this label.

[00:41:37]>> Alas, and it's like I can almost allow that behavior, they've got ADHD. And it's kind of stepping back from your responsibilities of providing the right support. And I think that's a big thing is that parents who do they don't know what behaviors or how to challenge those behaviors and put that structure in place to allow their children to be able to thrive. And by just giving it as an excuse going well they've got you ADHD is not a good enough answer. Education ask for support. There's loads of people that are there to provide support to to help you understand what to do when a child melts down. And to be completely honest, medications are not >> necessarily the answer. Absolutely. They work in a minority of patients and sometimes we need doses that are too high or not compatible with >> you know the previous state of the individual. If they have a hypertension they might not be taken not be able to take a medication. And I have always mentioned how I was in the UAE during COVID and we went in 24 hours from working in person to working completely remotely. So we went into Zoom sessions and assessment etc. And I could see a certain population of my patients who were brilliant, young, very motivated, uh, super active people, uh, super determined, you know, like typically consultants flying in and out Saudi, Bahrain, all around the region, etc. >> Being locked in in their studio apartments and deteriorating very quickly. And I met a lot of ADHD assessments during COVID. Not because these people didn't have ADHD before COVID, but because they was so transformed by >> the lockdown that they could not go. And then I started looking into their habits and I was like, I remember asking some of them, can you show me around with the camera? And I could see piles of deliveries, the exclusivity, >> chaos, >> chaos everywhere. And these were people that I used to see, you know, like on a Friday 3:30 we would come straight from the airport and they were just about to go potty and they sometimes I would would get changed in the bathroom in the clinic because they were pottying very hard and working very hard and they went into >> I can't raise on my bed.

[00:44:04]>> I can't get anything done.

[00:44:07]>> Yeah. And what was missing the 5 a.m. uh F45 I'm sorry I'm going to training you know was missing the super higheed dopamine adrenaline >> in place all the things that they had to put in place unconsciously for themselves not knowing they were self-medicating.

[00:44:26]>> Yes they were >> well my career is you know we've talked about this in the past but it's like we we we almost tend to build lives >> um to kind of compensate without knowing it. I mean, I was in journalism, lots of deadlines, multiple tasks, you know, plate spinning pressure. So, there is that adrenaline, there is that dopamine going in. I'm going to ask the second poll and then I think cuz I just can see this. I'm going to grab this iPad and I'm going to start rolling through your questions because this is for you. So, second poll of the day if we can launch that. And that's is because I think we'll try and focus on your questions for the last 15 minutes. Um, and because I've got ADHD, I always overestimate how much time I have to do any task. Um, what change would make the biggest practical difference in your workplace, school or home environment? Uh, clearer instructions and expectations, more flexibility in how tasks are done. Uh, fewer interruptions and better focus time, more understanding from managers, teachers or family. That's something we should come on to. uh better access to assessment or professional support or more confidence talking about neurode diversity. Um any of those stand out for you or all of them? Sadly, we always say this, there isn't an all of the above, but which of those do you think would actually work for you the best? Clearer instructions, expectations. I mean, it's interesting. More understanding from managers, teachers, and families. And this is something this is something that we've you know we were talking about off camera as well like and if you've been diagnosed like my wife still hasn't really accepted that Scott has ADHD you know it's like you find >> I wouldn't say that more flexibility will work by the way flexibility leaves you very on your own and then you will end up procrastinating till the last minute. So >> there are things that can work and things that cannot work. that kind of you know whether it be partner or colleagues it's like well you've been fine so why are you no longer fine why what you know and it's like how do you have that conversation with partners or colleagues that >> and I think it's yeah a lot of that is around masking and I think for people with ADHD have been masking so masking is the idea of you are hiding aspects of yourself in order to fit into the broader context but actually when it comes to things like ADHD you're not necessarily masking aspects of yourself you're masking aspects of how you perform form. So, you've got these compensatory strategies that you've put into place for years and years and years. Like, I have to read emails two, three times to make sure I've got spelling mistakes all cleared through before I send them out. I've got to practice conversations before I I do them. I overprepare for presentations because I need to sequence everything in the right way. I need to put plans and and routines in place around my household in order to do it. But no one sees the invisible energy that it takes to put those things into place.

[00:47:19]>> All people see is that outcome. They're performing so they must be fine.

[00:47:22]>> Yeah.

[00:47:23]>> Um and the difficulty comes then is when you end up hitting that burnout when you kind of go can't do this anymore. I am just done. Um and that's when I think you talked about people come later in life um for diagnosis. And I do wonder is that is is that because they're they're not having the compensatory strategies to be able to do what they need to do or is it because they've been compensating so much in life for so long they're so burnt out >> that they need tell me what's wrong with me. Oh actually it's a diagnosis that helps me now to understand what's going on and I can go from there. So my experience was literally it was like I can't do this anymore, you know, and you've been pushing it down and pushing it down and just whether it's age, you know, over 50, but you just find it harder and harder and harder >> to keep pushing the things down and to keep doing the things you've always done. And thankfully being relatively educated in this space, it was like something's wrong here and we need to actually lean into this. I'm going to plow through as many Oh, top answer by the way was better access to assessment or professional support, which I think is really, really important. Okay, so um we're going to roll through as many questions as we can. Uh Annette has asked, "Could a person with difficulty filtering their thoughts before speaking be related to ADHD? And what strategies can help, especially with work beers?"

[00:48:51]Uh yeah, I found that's got me in trouble a few times.

[00:48:57]said the money has been fired from two or three places.

[00:49:00]>> It's a cognitive trait. Um it doesn't necessarily mean that you have got ADHD.

[00:49:06]Um uh well yes it yes but it's it's well go ahead.

[00:49:12]>> No no no no.

[00:49:13]>> Yeah it's about finding that I think what do you do with it? Um if it's getting you into trouble the biggest issue if it's getting you in trouble what are you going to be doing about it?

[00:49:22]And that thing is is is having that cognitive awareness, that emotional intelligence to go, "Oh, I'm about to have something come out here." And okay, let me just take a pause for a moment if you can. I appreciate that. Particularly when it comes to ADHD, you don't have that filter time. No, >> you don't. And that's the difference with filter on the topic. Yeah.

[00:49:43]>> The sense of justice and justice. I was literally about to go there.

[00:49:47]>> You know, it's it's incredible. It's impossible. You know, you you can't stop someone who's feeling like the very core of their very core values have been has been attacked.

[00:50:00]>> And and it's about saving humanity. And if you don't say that this is wrong, >> you know, hell, >> you're going to crumble.

[00:50:07]>> You're not talking about my behavior or my performance. You are talking about me.

[00:50:12]>> Yeah.

[00:50:12]>> And it or humanity as well. You know, some people are extremely empathetic.

[00:50:18]>> Empathetic. And so it's not just about me. Some people intervene. I I had a patient who's being fired >> because his boss didn't kept being rude to one of the assistants who was bringing coffee in and he said you could say yes please and or thank you at least once.

[00:50:35]>> And the guy said say it again. You fired. Well you can say yes please.

[00:50:40]Thank you at least once. It was fire.

[00:50:41]Yeah, >> someone once explained to me as well like cuz I know and I've I've learned that you know feedback and criticism >> and you know my wife Christina she can be quite direct with her uh >> her assessments. I'm not saying she's wrong but she can be quite direct but that it was someone explained it to me it's like it's like being stung by a bee >> you know one person it'll be mildly irritating and then for the other person they'll go into anaphylactic shock so it's same thing but experienced in a very very different way. I find that fascinating because I used to think, okay, it's working on your triggers >> and why is it that you feel so reactive and so, >> you know, vexed and have to respond?

[00:51:24]>> Yes.

[00:51:24]>> I didn't think that.

[00:51:25]>> Well, I was mentioning earlier, right?

[00:51:27]These genes must have a reason >> to stay. I mean, what would we do without people who stand by others or by themselves? people who are ready and able to fight and they don't look at the consequences. They're not they don't have second thoughts >> and sometimes they're very brave and very courageous and you know they're capable of advocating for what is right and what is true. That is so true >> and it's of course we should try to support these individuals not being fight right left and center and kind of keeping a little bit of continuity in their personal life as well. But the reality is that there's a core which I admire deeply in people with ADHD which is all about justice and fairness and kindness. I want to bring in Allison's question um because it kind of connects to what you were just saying there particularly around I hate the word accommodation as well that really drives me nuts but um if I can say that uh but Allison's asked it's a great theory particularly in the workplace where diversity can be really valuable but in practice even in the schooling system and there's there's still an expectation that children should behave in a certain way and conform entirely how to support neurodeiverse children who are struggling with the expectations of the school system and I suppose that does extend into the expectations in a workplace as well.

[00:52:53]>> Absolutely.

[00:52:53]>> Yeah.

[00:52:55]>> Thoughts >> because often those individuals grow into having to fit into the workplace and there have been children who struggle to fit into the >> whatever assignment uh deadline and so on. I would say that the answer is rarely the accommodations because technically if you give a kid with ADHD accommodations, they're just going to move the deadline down the line.

[00:53:20]>> Yes, >> that's it.

[00:53:22]>> So, you giving an extra couple of days means it's going to start working two days later most likely. But I understand that sometimes that helps especially if there's a little bit of supervision from the parents. So there's a little bit of conflict between because my patients ask me for accommodations all the time and I give them all the accommodations they need and it can be for ADHD or for autism can be sensory issues can be whatever it's needed >> but the reality is that then they end up procrastinating their deadline.

[00:53:51]>> Um >> so for Allison who's got a neurodeiverse child um who's struggling with the expectations of the school system >> we need to educate the school. We need to educate.

[00:54:02]>> We need to educate ourselves. We need to be able as parents, as professionals to go and be reliable, trustworthy, accurate, evidence-based >> and explain and reexplain and explain again and try and find new ways to make them understand >> what truly entails neurody will work with you on this as well.

[00:54:23]>> Yeah. And it come back to the point, it's not about fixing the child, it's about fixing the system. We've talked about this before the opposite. Yeah.

[00:54:31]What's the opposite to inclusion? The opposite to inclusion isn't exclusion.

[00:54:35]It's fitting in >> and we don't want that. We want to leverage those strengths. And so each individual needs to understand that and their their own kind of system and what it is supports individualized supports that's going to help them to be able to thrive in that. And I think that's >> I remember distinctively a phone call with an HR that I was trying to explain that my patient was struggling to wake up but she was often working much longer than anyone else's in the office and she was bringing work home and she could not get out because she could not biologically get out of the hyperfocus.

[00:55:08]So she was she would continue working throughout the night but then she would be >> seven or eight or nine minutes late.

[00:55:14]>> Yes. Yeah.

[00:55:15]>> In the mornings and this HR telling me >> so I can't ask I cannot ask. He finally connected and said so I cannot ask her to be on time. And I was exactly and she was >> but so what's reasonable? And I was like shall we say half an hour?

[00:55:31]>> Yeah.

[00:55:32]>> And they were like well if what you say is true there should be no limit.

[00:55:39]>> Ultimately there should >> ultimately there should be none of that control.

[00:55:43]>> Yeah. Yeah. Yeah, >> I'm going to and we're going to try and ask you to because we've got about 5 minutes left, so bullet point answers, which is a bit short, but at least we can try and Yeah, that we wish is difficult for any of us. Uh, Kira's asked, "Do you have any advice or tips on how to keep up work performance at work, especially after being a high performer >> in the first six to eight months or so when you're watching sort of in great despair as your work performance goes to the dogs context, ADHD?" So, it is that kind of you know, when you're beginning to struggle, when the wheels are beginning to come off, um any tips to keep your performance up at work? And I guess that comes back to the relationship perhaps you have with work.

[00:56:22]>> It does. So, there's a couple of things.

[00:56:24]Number one, know where what you need.

[00:56:26]And that's the big thing that comes through education, working with your psychiatrist, your psychologist, yourself to know what is it that you do.

[00:56:33]Do you need time in the morning? Do you need quiet to do? Understand that. You then also need to have an organization who has that psychological safety. Am I able to ask for these things? Because it's great that I know what I need, but if I'm not afraid, if I'm too afraid to ask for these things, then I'm never going to get anywhere.

[00:56:53]>> So, we need to have those inclusive cultures where we have that ability to ask questions, to raise concerns, to speak for what we need and to advocate for what we need and for that workplace to be able to put those things into place. So understand yourself first and then be able to ask is is ideally the right thing. But I do appreciate that not all organizations have that level of psychological safety to to bring that into play.

[00:57:18]>> I'm just going to answer Gulara's um not question but I I see you and I hear you.

[00:57:23]Uh, she said, "Could you guys please stop saying yeah and ahuh and it's really annoying and distracting."

[00:57:29]Which which which actually, you know, if you do have ADHD or if you have autism, that kind of, you know, those pings and that kind of thing in the background can actually be very very distracting. So, well, no, I said it was a safe space.

[00:57:41]So, yeah, point taken, he said, saying yeah, again, sorry about that.

[00:57:45]>> Geraldine, how does ADHD affect relationships and how do we navigate these challenges? I would I think this is an entirely different podcast almost.

[00:57:54]>> It's impulsivity. Yeah. For instance, impulsive decisions or blurting out answers or and also there's a very specific feature to some of our some of some of patients with ADHD are extremely sensitive and reactive. there's a there's something you know in their emotional need um which is >> fear of rejection that >> fear of rejection it's called you know reduction hyper sensitivity it's called in many different ways yeah >> but again when you've got that kind of inbuilt sense of injustice you know >> how can you not be reactive >> I'm justified in my argument >> yeah absolutely uh more questions more questions >> and also the non sorry partners not understanding partners being in denial of feeling especially with late diagnosis feeling cheated because they married someone and they thought they got everything together and instead >> they haven't >> you know so >> been there still there Rose has asked how to know whether a child is ADHD is hyperactivity the only parameter which we've kind of covered but let's just quickly talk about that again >> no hyperactivity is more of a coping mechanism because through hyperactivity exactly like you when you exercise in the morning or myself when I exercise in the morning what we gain is a little bit more of dopamine. Some children only can pay attention if they are moving around and it's not their way of not being attentive. It's actually their way of getting into a decent level of connection. Mhm.

[00:59:27]>> I remember my son used to be on be able to be on a phone call with his dad who was abroad >> just if he was let free to run over literally chairs and and run around the table and he would then he would be able to have a conversation. If I'd ask him, can you please sit down?

[00:59:44]>> Yeah.

[00:59:44]>> It'd be lost.

[00:59:46]>> Right. So the hyperactivity cannot be the only the only feature. It's probably the one that is more annoying. Let's be honest, especially in young children.

[00:59:56]and visible.

[00:59:57]>> Okay. Sadly, and there are still some questions here as well, which just very very quickly if people want to reach out to both of you, uh, tell them where they can find you on social media if they want to ask some more questions.

[01:00:08]>> Um, I would say the Instagram page of my clinic, it's BPS clinic. That's the best way because someone always answer. Don't reach out to me directly on my Instagram. And my Instagram is very simple. It's Dr. Valentina Fire, but I can't >> truly cast, but someone will will probably pass the answers to me.

[01:00:27]>> Yeah, probably best place to get me is on LinkedIn, Sarah Christensen. So, or Christian Consultancy both on LinkedIn and support people either individually or at work.

[01:00:36]>> Brilliant. Um, this episode will be obviously very shortly uh on the podcast channels. Please subscribe and rate the episodes. We love that. That really helps us get discovered. And you will also see it on YouTube very shortly as well. So you can kind of play it back and go over and share with friends or colleagues who whoever you feel might benefit from it. When the podcast ends, when the webinar ends, you will be asked feedback. Um please uh we welcome it. It helps us shape future conversations >> and I think I will try and put some sort of fact sheet together as well to go with the episode notes on this one because you've been so engaged. So thank you for being so engaged. Thank you for asking your questions. I hope you found this uh as insightful and as useful as I found it. Once again, thank you for joining us on Connect for Health. Sorry, we've overrun slightly and we'll see you again next month.