The Psychologist Who's Assessed Over 700 Children for ADHD: "Here's what we NOW know about ADHD"

0:00We see ADHD and autism as a language of difference, not of a disorder. The D should be for difference. The difference in your brain means you have to approach things differently. There are many people who have ADHD. If we were to do genetic testing, you probably wouldn't find something. There is no gene that causes ADHD. There are a handful of genes that have been identified that say, if they are faulty or don't necessarily work in the same way as they should be working, you have an increased susceptibility of then developing ADHD.

0:29Dr Daniel Weisberg:genes load the gun and environment pulls the trigger when it comes to developing adhd is it possible to develop adhd without being born with that loaded gun it's a really good question when families come to see me um loyal listeners and viewers i can't thank you enough for tuning in to adhd chatter where we ask world-leading adhd experts the hard questions to give you access to the most cutting-edge information on the topic if you've ever felt broken or different i hope this helps in your search for information, answers, and community. And do you know what would really help me in return? By clicking the follow or subscribe button wherever you're listening.

1:09Dr Daniel Weisberg:It might not seem like much, but at ADHD Chatter, it means a huge deal. And with this, I can book more incredible guests and keep the self-discovery fire alive for all of us, including myself. Just one click of a button goes a lot further than you think. We'll promise to listen to your feedback and book the guests you want on topics that matter to you. And remember, you're not broken, just different, and you have always been enough. Dan, thank you so much for joining us. Thanks for having me. I feel like this episode is going to be really therapeutic for me as someone who felt very different when they were younger as a child growing up, feeling very misunderstood.

1:50Dr Daniel Weisberg:I think When I started this podcast, I said I wanted to, I wish I could have gone back in time to put my arms around the younger version of myself to reassure him that he's not broken, just different, and that he has always been enough. But of course, I'm not able to do that. But the thing I can do is speak to people like yourself in the hopes that a younger version of me does hear something that triggers their journey of understanding earlier than I did. So on behalf of the younger version of me, thank you so much for being here today. Oh, it's a pleasure. That's a really nice reflection. I think a lot of adults feel exactly the same.

2:28And if we can help at all, that's our job.

2:31Dr Daniel Weisberg:Just to kick things off, Dan, what is your mission in the world of ADHD? That's a really good question. So I'm a consultant clinical psychologist. and the job of a psychologist is to understand, to find out what's going on and why it's happening. Because particularly in ADHD, there is a distinct lack of understanding and a lack of knowing what's going on. It's misunderstood, it's misrepresented, people see what's on the surface, not necessarily what's underneath. The example that I often use is that of an iceberg. So if you imagine like an iceberg, what you see on top of the water is the visible bit of an iceberg and that's the bit that is obvious and what we see um and that's what we talk about and that's what's there but the psychologist wants to understand what's going on beneath the water and with an iceberg there's a huge amount going on underneath that's the stuff that isn't directly obvious that's what's hidden away and my job is to try to understand that and if we can do that and share that with parents and teachers and educators and professionals the amount of support that we can offer is great.

3:44Dr Daniel Weisberg:Just following on from that iceberg analogy, which I totally relate to, what traits and personality features or aspects of someone do you think would be above the water? The things above the water are the things that we directly see, which funnily enough is more the case in boys. Not always, but often is the case. It's the stuff that is externalised. So that's the visible parts of behaviour, things that you do things that you say the way that you move so your activity levels your impulsivity so the things that that come out of your mouth or the things that you do um the interactions that you have anything that is visible is what is above the water that that's the stuff that because we can see it people think that's that's where the problem is and that's where the attention goes i want to be thinking what's underneath the stuff that's hidden that's the stuff that looks at family background and behind the scenes reading between the lines and the stuff that is harder to interpret what about shame would that be something that's below the water the feeling of it would absolutely be below the water the emotion of it might then show itself but yeah absolutely it is feelings and emotions and where those emotions come from You don't just one day feel shame.

5:01It's built up over time, and it can appear in a very obvious way. But it's the background stuff. How do we get to that point, the hidden stuff that is driving it that's really important?

5:16Dr Daniel Weisberg:If someone's coming to you and they want to go explore their life, whether it's themselves or their kids, and they want to understand what is below the water, what would you say is a sign of a good psychologist, someone who really understands how to look below the water yeah um by not doing what comes naturally which is a really weird place to be so the natural response is to respond to exactly what you see in front of us so if if if your child is behaving in a certain way they're they're a bit active they're a bit impulsive they are responding in ways that you as a parent might not necessarily approve of we go straight to that don't do that stop doing this don't shout oh you're terrible you know and it's that's the reason i do it as a parent all the time i say don't do it that's not the way it's going to help but that's that's what we see and that's what we respond to it's about taking that step back how do you put a pause on things how do you take a step back and see what's happening and why it's happening so the the the line that i often say to many families is every behavior everything that you see above that water is an expression of something so it's a communication of some type.

6:23I'm tired, I'm bored, I'm in pain, I don't like it, whatever it might be. But we're talking about children who don't necessarily have the words of, I'm tired, I'm in pain, I'm bored. So it comes out through behavior. So we have to stop that initial intuitive response, which is clamp down on the behavior, take a step back and understand it so that we're then in a much better place to focus underneath the waterline.

6:48Dr Daniel Weisberg:if someone's at that age where they have not developed language yet and they don't know how to express emotions how does that person feel things like shame things like rsd not in the way that we as adults would feel so in terms of so emotions are a really powerful one um shame regret disappointment all of those sort of strong feelings we as adults can sit here and try to talk it through. Like we can sit in a nice calm place, explore those feelings, think about it and talk about it and put words to it. You are never going to sit down with an eight-year-old and think about the feeling of shame and how you came about that and the impact on other people.

7:32You might comment on it, but you're never going to get more than a quick conversation before your child is then off wanting to do more interesting things, Minecraft or whatever it might be. So you are, you have to find more creative ways of exploring it but it's going to come out from that child through their behavior through their actions through the things that they do or the things that they interact with or the way they respond in certain ways now and they'll express that at home they'll express it at school they'll express it out and about we have to try and understand why that behavior is happening and we can do that as parents we can take a step back and sit and try and think about it, it's much harder in a structured environment like school.

8:14If you are feeling shame of some sort, you've got no way of expressing it or you find it hard to express it, how on earth are you going to be able to express that healthily through difficulty? So it's going to come out through your behavior, the way you interact with your peers, the way that you interact with schoolwork.

8:31Dr Daniel Weisberg:It's tricky. I remember, I think I remember my first feeling of, it was either rsd or it was justice sensitivity i was about six years old boiling hot day at school the mud was really dry and everyone was having fun digging in the mud and i thought what could i do to make this task easier make digging in the mud easier so my parents were having some work done on their house at the time i found this these box of nails i brought this box of nails into school okay um and i suggested to all the other kids like let's we can use the nails to help us dig in the dry mud to make it easier. Someone cut themselves.

9:09Dr Daniel Weisberg:There was blood everywhere. And the teacher said, who brought these nails in? And I said, I brought the nails in. And they called my parents in and I had a meeting with them. I remember the teacher called me stupid. And objectively, as an adult now, I can look back on that and see how dangerous that was, me bringing nails into a school. But at the time, I remember after the meeting and my parents went home, I went off to a quiet area in the playground into a corner on my own and I remember the rage like I remember feeling this rage inside me um and I isolated myself and I just sat with the anger and that's a core memory that I have do you think that feeling is a response to the injustice of the situation i.e my intentions being misrepresented by that teacher or do you think it was a a an rsd trigger or both or i mean that is that is the perfect demonstration of the iceberg of what we're talking about that what is seen on the surface is awful child brings in dangerous nails and is a danger to society um but that's that's what it looks like um but that's in no way was there any form of malicious intent from your side in fact all you wanted to do was help and you found a quite creative way of helping okay not the most effective way of helping but you you certainly didn't think anything other than this is going to be great for lots of people um and you got in a huge amount of trouble for that and if you imagine that then happening day after day after day and then slowly the perspective of other people around start to expect that behavior of you so you start to become thought of here's the kid who's going to cause problems again oh my gosh look what's happened if there's a problem school i guess who's going to be involved that sort of narrative you're absolutely going to feel that that those those emotions be it the rejection be it the shame be any form of emotion without necessarily the way of expressing it surrounded by people who don't understand it um that's that can be extremely traumatizing for children and if you say it's a core memory i have absolutely no doubt that it probably was because this the injustice of that whole set of circumstances is terrible it broke my heart recently when i put out a poll to the viewers and the listeners of this show um what word would you describe your your lived experience and sadly the most common answer was broken um which was devastating and it made me think because that's certainly how i felt for for many years what traits of adhd do you think are not accepted by the modern world and therefore if someone goes through their life with that trait would potentially lead to a feeling of being broken that's really sad isn't it really sad it's and it i feel it's it's even more so because that's entirely avoidable um and we shouldn't have to feel like that.

12:16But that I think is because the system in inverted commas is not set up for neurodivergent children. The system works for most people. And when I say the system, I'm talking about everyday life here, the way the mainstream schools are set up. And of course, there are exceptions. I'm not denying that for one moment. But the majority of schools are set up for the majority of pupils, which for the majority works. But for those children who struggle with that they just cannot access it and if you can't access it you then struggle against it yet being told that you're struggling against it because you are the problem you are naughty your behavior above the iceberg like what we see is not acceptable you are responsible for this therefore it's your fault and you're given this message of you are the problem that's going to break anybody um that an awful thing to have to experience so we want to try to we're working hard with schools to try to change that i think that is changing it absolutely is but there is a long

13:22Dr Daniel Weisberg:way to go with it i feel like if you are a child with adhd and you are exposed to feeling different and feeling misunderstood it's almost like you're gonna potentially be an adult that is so desperate of other people's approval and if you sense that approval is taken away it could almost snap you back to the perhaps traumatic experience of experiences of your childhood and with that turbulent character how that looks in romantic relationships do you think i think it that's a very there's a very strong relationship that is there so you're touching on something that starts not just in experiences in being a child even earlier than that.

14:07So there's a very significant theory. It's not a theory, it's reality, it's still known as a theory. It's called attachment theory, which essentially says your experiences from a very, very young age, so your earliest possible years, even before you are born, form your model of the world. And this is essentially your expectation of how the world is. So your experiences as a very young child tell you how people interact with you. It tells you what you can expect from relationships. It tells you how you expect the world to be. And it teaches you rules of the world. And what then happens is as you continue to grow up, that expectation, that model starts to solidify in your brain.

14:50So that then becomes your reality. And then you go through the rest of your life based on that reality of what you're experiencing. So if in your earliest years, you are given love and kindness and compassion and care and healthy relationships, when something goes wrong, you've got parents or support people to help you, that teaches you that sometimes things go wrong, but it's going to be okay. And that's what we call a secure attachment. But sometimes there are young children who develop insecure attachments, which is when you don't have that same relationship, which can sometimes mean if you're upset, you might get inconsistent care.

15:36So you might get a cuddle, but sometimes you might be ignored. Sometimes you might be shouted at. And worse, sometimes you might be abused. And that teaches you that that way of the world then becomes your normal. So then as you go through the rest of your life, that becomes your expectation. So if you have been brought up with an insecure attachment, yet find out that the world doesn't really work like that, you are forever fighting against it. And that idea is critical in ADHD, because it might not necessarily be about that earliest possible experiences, but it's your experiences that you have at school that form your understanding of how the world is.

16:14And so if you are taught that you are going to be shouted at or scapegoated or blamed, then that's what's going to become of your expectation of the rest of the world as you grow up. It doesn't have to be, but that's often a pattern that we find. And so you then go into adulthood and develop intimate relationships. Sometimes that then causes a real conflict because especially if you have someone who's not necessarily as understanding of you as you might need, all of your early experiences then come to dominate that relationship. Again, not always, but that's the general pattern that we often see.

16:51meeting someone who gets you and understands you and is on your wavelength and can support you when you need and be there when things are going great but understand when you're having a tricky time means that you can have an exceptionally happy life there's no reason why you shouldn't have that

17:07Dr Daniel Weisberg:but we have to consider it in your relationships as you grow up you said sometimes your attachment style can be determined pre-birth does that mean there's a genetic component yes there does so a lot of work has been done into this um and now there is no gene that causes adhd so it's not like there's one specific gene if you have that or you don't have that you're going to have adhd but there are there are a handful of genes that have been identified that say if they are faulty or don't necessarily work in the same way as they should be working you have an increased susceptibility of then developing adhd and there is there's one gene it's now i'm a psychologist not a medic so i'm hoping not to butcher this explanation of it but i do know of one gene called the the dat one gene the d-a-t one gene it's a dopamine transporter gene which i mean i had to google what that actually means but essentially in your in your brain when two neurons connect to each other there is a gap between them called the synapse and in there builds up dopamine and this dat1 gene is responsible for clearing that dopamine through that gap i mean our brains do amazing things this is all happening without us even knowing but if you have a faulty gene it means it can build up in that gap which can then potentially lead to increased displays of what we see in in adhd um now what we do know is that there is a very strong link between that gene and mothers who drink during pregnancy so that gene is expressed more in in moms who drink during pregnancy and so what we see there is there is a genetic component but there is absolutely an environmental cause that can almost trigger or or show off that gene in more detail that's and that's our understanding of how adhd works there might be sort of a genetic basis to it but there has to come an environmental factor alongside it to help to develop that expression of it and that's why i believe the the support that we put into place for adhd is not just that of a medication to change the biology but it's the environmental side and to develop the that side because it's there's a lot of nurture to it as well not just the nature side of things we had a guest on following on from that who said that genes load the gun and environment pulls the trigger when it comes to developing adhd um do you agree with that and if is it possible to develop adhd without being born with that loaded gun um you see i knew i'd butcher it because that is a much clearer explanation of exactly how it works yeah absolutely what a brilliant visual description and that that's absolutely right now but that doesn't necessarily mean that has to be the way there are there are many people who have adhd if we were to do genetic testing you probably wouldn't find something and you might do i i don't know but i'm i don't think that has to be the only way because it's the it's the world around you and the expression of it that is exceptionally important you're talking to a psychologist here i'm interested in how the world works and how we respond to each other not necessarily the biology of it although it is an important factor do you see a a common attachment style with those who have adhd now that is a really good question um i so i work predominantly with children um so i that might not have expressed itself just yet so working with children you do a lot of work with parents and supporting parents to then support their children or supporting teachers to support their pupils and we don't necessarily get to that detail and i would expect that that would form a significant part of support for adults absolutely and i believe it probably should do and if if we want to go down that route it's like pandora's box do we really want to open this do we really want to explore this but sometimes if you struggle to hold down relationships or or manage employment or just find the world too difficult to manage, maybe actually exploring it could be really helpful.

21:23And going back to your earliest years, I think is a significant part of that exploration. And this is why therapy, psychological therapy, is difficult. It's exposing. You know, we're going back to things that we probably don't even think are things, but are important to consider, definitely.

21:40Dr Daniel Weisberg:I think with relationships for me, RSD, rejection-sensitive dysphoria, has been such a catalyst for chaos and destruction in the past. And ultimately, I think why relationships and friendships have buckled and failed. And knowing the people who listen to this podcast, I know how prevalent RSD is with them too. Do you have any theories as to what RSD is? What causes it? Where it comes from? i would like to i don't think we can solely attribute this to adhd i think that is a predominant driver of it absolutely but i think we do need to look at wider pictures under the surface stuff again so that starts with that earliest possible attachment i think that is a really important part of it again i i really want to emphasize the point that we're talking generally here so some of the things that we say don't necessarily apply to some people but we know that if we take a step back and scale this across the whole adhd world it's a general pattern that we see so the way that we are brought up the experiences that we have at home your example of the experience with nails and being in the playground all forms part of you um i sort of imagine it a bit like a like a bucket or like a vessel in a way that you have buckets the one i use with children it's much nicer words than a vessel um but it's essentially the things that you have with you and that you carry around with you but you don't even know you're carrying it with you and it's things that have happened in your life and again sometimes there are things in there that you don't even know are things and your experiences build up and up and up and sometimes there then becomes an event, something big that then allows all that previous stuff to then express itself.

23:38So you might be going around perfectly well, holding your bucket, skipping around, thinking everything's absolutely fine. And then suddenly there is a trigger of something and all that earlier stuff just comes pouring out. And that might show itself through RSD. It might show itself through difficult relationships. And that's where we sometimes see sabotaging things, people almost ruining things for themselves again not not purposefully not maliciously but get to a place where they find it really hard to deal with whatever that set of circumstances is because of all that stuff that's happened previously so you don't just one day wake up and sabotage a relationship it's it's a developmental thing that starts in childhood so interesting for me it's

24:21Dr Daniel Weisberg:certainly like a self-preservation thing when you realize how painful criticism and rejection is you'll make the first move to reject someone else before they can reject you in relationships, for example. Or in social situations, it'll turn you into a massive people pleaser. You'll be really scared of confrontation because the pain of any pushback or any retaliation is essentially a reminder of being disapproved and putting everyone else's needs before your own. when I got my diagnosis two years ago I think you know I looked back and I could see it so clearly and the shame actually lifted when I was able to look back throughout my past and add add color and context to 34 years of people pleasing and rejection avoidance.

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26:42Dr Daniel Weisberg:go ahead and use your notebooks for something useful like propping up a wobbly table leg or mopping up a spilt coffee. Back to the episode. How important do you think it is for someone to receive a diagnosis? What knock-on effects positively can that have to someone's mental health? I think you've just explained it exceptionally eloquently. So it can provide a meaning. It can provide an understanding as to why things have been difficult or things have been hard or why you have certain character traits. When you were talking, you reminded me of an example with a family recently. we were talking about sharing um and sharing is something that is very commonly misunderstood from a parenting point of view so let's say there's two kids playing at i don't know in a soft play and um just happily getting on with their own thing and one child has this super cool funky toy and the other child wants it what often we see is the parent of the child with the toy says oh you know share with jimmy or whatever it is um now that isn't sharing that's giving your things away to someone else because someone else wants it that's not a healthy message to be teaching to children now we all do it that's the natural thing we want to generally help out and make sure no children feel upset but that's not a good message that we're giving to our children and that's essentially teaching you people pleasing like you just want other people to be happy so give them things and they'll be happy but whilst it teaches the child with the toy to be a people pleaser it also teaches the child who gets the things to expect from other people so they become expecting things this is not a healthy dynamic what we need to be teaching is um when you finish with your toy then you can share it with jimmy um and that's a harder message to to deal with but psychologically the right one now why on earth am i mentioning sharing because it doesn't necessarily have to be part of adhd it can be part of what we experience when we're younger and now the adhd factors make that situation more difficult most certainly they do but that's this is why taking a step back and trying to understand those behaviors from a psychological point of view can be exceptionally powerful because if you've experienced that as a child the messages that you're being taught about the world are then very different already that's before we're even thinking from an adhd side of things it's important to consider that element of it one of the biggest injustices dan in this whole adhd conversation is how let down women and girls have been um in the whole landscape and 85 percent of listeners and viewers of this podcast are women um a whole generation of women were missed and are almost playing catch up now in their understanding of self but why do you think so many women and girls were missed for so long i'm delighted that you've mentioned this this is a it's sort of seen an explosion of interest recently because and there is a really clear pattern of that being absolutely the case women and girls have been missed there's a lot of ongoing research into it to try to answer it but i i wonder if there are three general explanations for it the first one is is a um the expression of adhd and what that looks like and we know there is a difference between boys and girls for that the second is the um historical perspective of of what's happened um that's the um looking back over time and how how we've done research to ADHD.

30:22And then the third is that societal expectations, what we expect from boys and girls. And I think there's a mixture of all of these. But if we take the first one, for example, the expression, that goes back to what we were talking about with our iceberg. So what you see above the surface, that generally, again, not always, but generally is different for boys and girls. Boys, traditionally, traditionally is not the right word, typically might express things through their behavior. So you see lots of the outwardly expression, fidgeting, movement, shouting out moving around that sort of thing so it's very externalized whereas girls tend to have the opposite effect where it's internalized which is things like disorganization um finding it hard to concentrate and that's very inward now as a result what tends to happen teachers or parents see children um showing that they see that above the the surface of the water line again And so it's then much quicker to concentrate on the boys with the challenges, not necessarily the girls.

31:22So it's easy for girls to be missed with that. Then you've got the societal expectations of it. And from a societal point of view, we are changing. We absolutely are. So I'm talking very generally here. But from a societal point of view, there are very different expressions of how boys and girls perform and what general roles might necessarily be. and i think we have lived in a society where girls are expected to sit and concentrate and do something with sitting and quietly and whereas boys are more outgoing again i'm talking very generally and that is that is absolutely changing but the expectation of what we see is is absolutely part of it and finally you've got the historical side and historically assessment understanding ADHD has been done on loud, busy boys.

32:12That's who the research group is. And so that's what we've come to expect of ADHD. And if you combine all three, you are in a position of thinking, that's what ADHD looks like. The child who moves around and jumps and shouts and can't sit still. And that's not necessarily the presentation of girls. So I think combining them is why girls can be missed.

32:35Dr Daniel Weisberg:Yeah, I mean, it's heartbreaking, isn't it? I think, again, like you said, these things aren't exclusive to women, but it certainly seems to be a higher concentration within late diagnosed women, some of these lived experiences, that internalized hyperactivity, which you amazingly just described, and how those internalized, highly caffeinated squirrels that don't stop sometimes you know some days those can get so manic and each squirrel pulling the person in a different direction each one with a different idea and the overwhelm that that can create sometimes and when you are physically paralyzed in a state of overwhelm and in that moment you can't do anything other than lie on the sofa and scroll social media because that's the only thing that's distracting you from that horrendous inner critic telling yourself that you're useless.

33:31Dr Daniel Weisberg:And it's heartbreaking because if someone is that person, the optics of that lying on the sofa, unable to move, exposes them to even further criticisms from colleagues, partners, friends. Why are you so lazy? Why can't you just start the task? And it perpetuates that inner critic or in relationships, that rejection. RSD we spoke about earlier, why are you so sensitive the comments that their behavior opens them up to sort of sets them off and perpetuates the inner critic that tells them that they are different with with late diagnosed women do you see a common thread of emotion when women in their 30s 40s 50s 60s and onwards finally get a diagnosis?

34:20So remember, I predominantly work with children, but if we think about that genetic component, children with ADHD are very likely to have parents who have a neurodivergence of some sort. And we meet many children who are going through the assessment for ADHD and their parents have said that either they have been diagnosed with ADHD as a child or have recently found out that they are ADHD themselves or going through their own assessment. And when we talk about that, which isn't necessarily a big part of our assessment process, but if we have the opportunity to talk about it, the overwhelming emotion is relief.

34:59Relief and an explanation and a sense of, finally, I have an explanation for why it was so difficult. Because I was always told that I should be better and I wanted to be better and I tried to be better, but couldn't. And that's where our language comes from, which is the language of can't, not the language of won't. So we absolutely focus on things that you want to do but struggle to do it rather than a defiance, like a behavioral, purposeful problem. And that shift. And finally, parents are feeling relief. And we see it absolutely in moms. Absolutely, that is crystal clear to me.

35:40Dr Daniel Weisberg:Do you see, when a child gets diagnosed, do you see like a narrative or a story arc that starts with the parents maybe thinking there's nothing wrong with my child because I do that too and then the child gets diagnosed and it sort of sets off that domino effect and the parents realize oh maybe I also have ADHD yeah so it works the other way around as well so parents who have been told to go for an ADHD assessment for some reason and they go through the process maybe a bit skeptical not really sure if this is the right thing and then as we start talking you see this almost light bulb moment of parents going i do that oh my gosh that we're describing me and this is what and again not always but that pattern is there and then it often finds that parents want to go and do their own assessments as well one of the one of the interesting parts of of doing adhd assessments is just to start the process we have to battle through a narrative that's there a societal narrative so adhd is still massively misunderstood it is still i believe seen as a parenting problem um so because the majority of people who don't have adhd see children who do have adhd and say they need a good slap around the face i mean we don't say that anymore i might be what we're thinking i remember going to a restaurant once and this is before i had kids and i'm sat there um watching and there's family with kids with ipads and i'm sat there going there is no way that when my children will be at a restaurant we will ever have now ipad sit on your ipad don't talk stay there but like what we expect of children is that of good behavior and compliance and when children don't do that it is often because we often are quick to assume that it's because they are not being brought up appropriately it's a parenting problem and that's not fair that's not fair there i would argue from experience that every parent is really trying yet there are parents out there who are trying the things that they've been told to try and it's not working and that's when it becomes a problem like i'm doing everything we should be doing but i'm still finding there are difficulties and that's when assessments can come from and that's when there can be that realization the parents might also find they've got differences themselves.