SPEAKER_00 0:30

This is Dr. Estee Hess.

SPEAKER_01 0:32

And I'm Dr. Ann Kirsh.

SPEAKER_00 0:34

And we are podcast on and off the spectrum. Tonight we're doing something a little bit different. Ann and I happen to be uh not in our usual places where we are doing the podcast together. We actually decided to go ahead and use our own technology because we needed to be in two separate places. But tonight we are still going to be talking about a very, very important uh topic that uh I think is valuable to a lot of our viewership. And that's the fact, Anne, that you and I read this wonderful article out of the most recent Parenting Magazine, and it was about how ADHD is easily misdiagnosed. And we were talking about different cases that you and I have had over the years, and there are several reasons that kids get misdiagnosed with attention deficit, hyperactive disorder, both well, there's there's actually three types of attention deficit disorder. They include inattentive, hyperactive, or what we call combined type, okay, where kids have both a bit of interactivity, excuse me, in inattention as well as hyperactivity. But part of the problem is that a lot of clinical teams do not recognize the reasons necessarily behind behaviors that present as a hyperactive child. And there is a large percentage of children who have been misdiagnosed and been consequently put on a regimen of medication as early as four or five years of age. That should never have happened. So I wanted to open this discussion tonight between you and myself and talk about our clinical experiences and what we have offered families who've come to us and helped them get somewhat redirected.

SPEAKER_01 2:32

Excellent. This is a really big topic. It began in the 70s when all of a sudden medicines started coming out. It was Ritalin at that time, and this was a magic pill, and it literally would last one day, as these medicines tend to do, and it's out of the system. Um didn't always listen in the classroom, had trouble with homework, just normal kids. All of a sudden, teachers were saying, and they were the ones that were driving this at that time, were saying, I think your child might be hyperactive and needs to have uh medication. And I got so many phone calls at that time about is this true? You never said anything about this, as are my kids hyperactive? And I said, calm down, slow down, let's meet as together with the parents. Their kids were not hyperactive. There's another category which you alluded to, which we called ADD, which is attention deficit disorder without the hyperactivity. And that means kids have trouble focusing on their schoolwork. It's difficult for them to focus in class in the classroom. My oldest child went to school in third grade with his best friend, his to be best friend. And this child was super smart, and he could not sit still. They said to him, this was in an interesting school that not did not promote medications, they said to him, we think it's all right for him. He paced back and forth. To pace in the back of the room, they explained to the kids that this was something that he needed to do in order to relax. And every kid understood. And so this boy paced, stopped, start, he didn't cause any problems, he got A's on everything because he could hear while he was moving. So it's this kinesthetic part of ADHD, where if you're moving, a lot of kids feel this way, then you can hear what's going on around you better. You can listen in the classroom better. But of course, teachers, you know, it blew their mind. They didn't want to do that. They thought it would be too disruptive in most classrooms, whether they're public or private. So I was thinking about a child that I had um that I was able to be with when she when he was three, and um was in a playgroup in a in a um in a mommy and me class that had a play group with interns, and this kid was in every other child's face and face. He would go right up to their faces and stare at them. They would back up, they would run away. This became a chasing game. This other little little boy he would chase after them, and they would say, no, no, no, go away. And he didn't hear the no, no, no. He heard the, he saw the action. His mother said to me, we met, I said, we've got to meet, and and she was lovely, and and we met, and I and she said, I think he needs ADHD medication. This was now in the 90s. And I said, No, it was in the late 80s, and I said, I don't think so. I said, let's try a few things first. I said, what I'm seeing is that in order for your son to engage the other children, he has to get up really close to them. What that says to me is that he wants to participate, he wants to be friends and have friends, but I don't think he can see well. And she was astonished. And she said to me, What do you mean? You think he needs glasses? And this horrified her because she had to wear glasses when she was very young, and I didn't know that she wore contacts. So I said, you know, glasses don't look the way now, the way they did when you were a kid, and a kid who, you know, they probably put the worst glasses on. It was not a wealthy family. I said, please do one thing for me. Just take your child to a pediatric um um person who knows how to how to diagnose children in, and she did. And I said, and while you're there at this person, it first she went to an ENT. I said, have his hearing tested because we might as well check both. She came back and she said, he needs gosses. And I said, she said, how did you know? And I said, I knew because I watch, and that's what I was telling you. What we as clinicians learn to do is watch what our little kids that we're working with, and not so little kids, we learn to watch them, watch their behavior. Behavior has meaning. So the upshot is he came to the group with glasses on, the kids spent about two and a half minutes asking about the glasses, and then that was it. And he never got in another kid's space. He never was what we would call hyperactive behavior back to normal.

SPEAKER_00 9:15

All right. Well, you point out a couple of things because in our previous podcast, Anne, you've talked about the fact that um you were first, you first entered the world of children as a teacher. Teachers we know are not formally and officially allowed to diagnose, but they can alert. All right, so they can alert to a clinical team like ourselves, and we can then go ahead and do appropriate diagon diagnosing. That includes developmental psychologists, um, uh pediatricians, actually, better yet, developmental pediatricians, uh, and people who have uh child psychiatrists, people who have a familiarity with this particular level of child challenge. But you said something so profound. There was another reason, and by spending time and observing, you could see a child's behavior and see was there a pattern to it. So, likewise, I had a child in my own practice where he presented with these hyperactive, um, even aggressive types of behaviors. And mom would look at this little guy and say, he's such a sweet little guy. And part of my assessment is I spend time, besides, I actually spend time with parents more over six hours before I go ahead and make a formal diagnosis when I am rolling out attention deficit or any other uh childhood issue. And part of my observation is to go into the home and to really talk extensively with the parents to get their own developmental history as well as everything about the child from conception on out to present day. So I found out that aside from anything else, this child snored. I mean, to the point where mom would say he makes the walls round. Well, he snored because under guidance and further examination, this little guy had terribly enlarged tonsils and adenous. And so he was not sleeping properly. He had very poor sleep hygiene. And once parents saw and corrected this upper respiratory issue by going in and have having the tonsils and adenoids removed, and then further going to a dentist where a dental pallet spreader was able to be inserted and helped spread the palate because his mouth actually was a little too small for his little face. Then what ended up happening is he slept well. Once he slept well, again, the same exactly the same kind of results in terms of your case. This little boy suddenly became a model child. He could sit next to his teacher for hours on end. He loved stories, he didn't have to go into another child's space, he was able to relax.

SPEAKER_01 12:16

He was able to breathe. He hadn't been breathing properly.

SPEAKER_00 12:20

He was able to breathe. There are many, many reasons that children's behaviors are what they are. Sometimes, sometimes you truly do see developmental delays and they get diagnosed. And I go back to my assessment. For example, when I have parents who first give me their developmental history, I actually saw a child earlier today. We have both a mom and a dad who have the genetics of attention deficit disorder. Mom will present with difficulty with executive functioning, dad has difficulty. He's one of those guys who paces. He has some hyperactivity. Now, both are very successful because they've chosen fields where they could move their bodies.

SPEAKER_01 13:08

This is the boy I was talking about, very successful in his field, and he moves.

SPEAKER_00 13:15

He moves. All right, so respecting the fact that that's the way that they learn. But when you have parents who, one or both, who have attention deficit, there is a genetic susceptibility, a proclivity for this to happen. So then again, I would turn to our uh psychiatric team, developmental psychologist, developmental pediatrician, a child psychiatrist to evaluate and to go ahead and medicate. Because I do believe that really any MD could go ahead and offer medication. But I really choose when I when a parent asks my my for my suggestions, my preference is to go ahead and work with child psychiatrist who does this all the time. Pediatricians tend to be wonderful, but unless they've been trained specifically in the area of attentional issues, hyperactive issues, they have a very wide scope of interactions that then and and challenges with children that they have to attend to. They can go ahead and give medications, but I rather would leave it to somebody who specializes in in both the evaluations and certainly in the distribution of medications. But I'll tell you something interesting. I often tell my families, no child lives alone. And I think when you're talking about attention deficit disorder, it's really, really important to look at the whole family, not only just what I was talking about in terms of understanding the genetics of parents, but let's look at the family dynamics. You and I just talked about this case. I met with a wonderful family. This was a woman who herself admitted that she just did not know how to feed her family. It wasn't that she didn't love her kids, it wasn't that she wanted to not give them the best of foods, but she said she just was lost in the kitchen. She was herself raised by by a single parent who did not know really the ins and outs of the kitchen. So she never learned these basic skills. It really wasn't that interesting until she realized she had to feed her kids. And so these kids didn't get basic proteins, they got a lot of carbs. No, they they got, you know, they they came home and they, you know, devoured all the chips and and and sugars in the house. And by the way, when we we know we give sugars to kids, all kinds of behaviors will spike. And uh, so part of my work with this family, I said, let's let's remove any kind of question about attention deficit. I don't know yet, but I know what we got to do is we gotta feed your family correctly. So my first work with this child was actually to say, my friend, we're gonna put you to the to the side momentarily, and we're gonna go ahead and spend time with mommy because she wants to learn how to cook. Dad kind of had didn't have too much interest. Fair, okay. That was a relationship and an agreement between them. So mom and I worked out menus. We went to the to the grocery store together. We looked at different ingredients. We saw what was nutritious, what was protein-filled, what was alternatives to protein that still provided the family with all different kinds of nutrients that suddenly began to show it in behaviors. The children began to relax, the children began to be fed differently, they began to present in class and with their peers differently.

unknown 17:01

Okay.

SPEAKER_00 17:01

And we did something really important. The kids came home from school and they were starving. And so they would go in and like like little locusts, they would hungry rab and go after, as I mentioned, all the chips. So we had mom start preparing dinner at four o'clock in the afternoon when the kids arrived. And she started to feed them. And they ate until they're filled, and suddenly they had the brain power and the capacity to do homework, and then they got their ability to do play and do games and so forth. So we changed the whole dynamic of the family first to really assess what was going on behind the behaviors.

SPEAKER_01 17:46

That's because behavior has meaning and you paid attention to the behavior. Exactly. And it's my motto, as long as I have been in practice is behavior has meaning, because we have to learn whether we are teachers or we are um therapists, if we're interacting with children in a way that can change how they behave, then it's our duty, if we make it that choice to interact with them as parents, as teachers, then I believe it's our duty to pay attention to who they are. Pay attention. You did such a brilliant thing by helping her fat mom switch to four o'clock. Most people, I would guess, would never think of that because dinners at 5 30. That's how I grew up. Dinners at 5 30, be in the house at 5 30. But that was a long time ago. Now, when kids need to eat, if they have food available, I always, with my children, would have in the refrigerator chopped up a bowl, clear bowl, with chopped up fruits, all kinds of fruits. It looks like gems to children. They love that. And bowls on the table and spoons, and they could help themselves. I did the same thing with vegetables in bite-sized pieces. And they could, when they came home, I put it out on the table. I didn't say anything. I just put it all out. Cut up cheese, and you know what they did? They sat down and did your version of dinner. And that meant because they were eating till they're full, which is so important that you don't cut off children when they're eating healthy food. Let them eat until they're full. Healthy, normal children will not overeat. They will eat until they're not hungry. I always I also say to parents, have you ever watched a cat eat? They go and they come and they go and they come. You never have to worry. That's how children are. They eat fruit until they don't want fruit anymore. And then they go off and they're busy with other things. The other thing I think that that I thought of, and I would like you to talk about this, is how important it is to have exercise, be outside, uh with the family, in your own backyard, playing with the sibling, with friends, I mean, however, you see that. Do you see that as something that is necessary here?

SPEAKER_00 20:43

Well, children have to move, right? And so when I, you know, it's funny because it's again this big wide spectrum. If I see children who are moving too much, I guess that's the alarming behavior stuff, if I see children not moving enough, and one of the very frightening reasons that you are also seeing an elevation of behaviors that are being misdiagnosed as attention deficit is the addiction to technology. There it is. There's too much screen time. So aside from anything else, kids aren't going outside, kids aren't moving their bodies. Kids are just can't wait to get home and and eat with a bag of chips and sit in front of the screen. And and it's uh a terrible, terrible combination, both in terms of the potential for this poor nutrition and that impact on brain development, and the amount of of uh of hours that the brain is is having to deal with all different kinds of artificial light and and unusual and uh over stimulating mental activity that mimics, by the way, that mimics the same kind of neurotransmitter. Called dopamine that stimulates and and is missing oftentimes in kids with attention deficit, truly, but is created artificially from this kind of excessive up from two to seven hours a day. And I'm probably being I'm I'm probably grossly underestimating the average child today, certainly in this in the United States, and the effect on the brain and the craving, the craving for further dopamine hits that creates an artificial base for attention deficits. And aside from anything else, we are growing up with a generation that has learned to basically hide behind a wall and a also a group of children who don't have good social skills, aren't moving their bodies, and they are unfortunately addicts to technology.

SPEAKER_01 23:09

I you know, I I was hoping you would go in that direction because it's so it's all connected, and what we want people who are watching our podcasts to understand is that all behavior that we see and we exhibit as human beings is connected. It's all connected, and our job, and it's a hard job, whether it's parenting, whether it's being a teacher, a therapist, whether it's just being a person moving through through the world, our job is to pay attention to what we see going on around us and figure out why it's happening. If someone bumps into you, if you're in New York, I'm not gonna say LA because people aren't walking on the streets here. If you're in New York and you're walking down the street along with a thousand other people at any given time, somebody is going to bump into you. The most interesting thing that I noticed and was stunned by was that people said, sorry, or they smiled. It was a given that you were going to be bumped into. Nobody took offense. I looked around to watch people get mad. Here, people would get mad and yell at you. There it was understood that the dynamic was so many people and such a small sidewalk will bump into one another on occasion. And it wasn't to be taken personally. If you grow up being outside, if you grow up like I did, I was out, I didn't care about watching TV. It, you know, it wasn't back in the day, it wasn't that interesting to me, except for the Mickey Mouse Club. Other things to do were the things to do outside. When the clocks changed like they're gonna do this next weekend, and we got lighter hours later, I was in heaven because it meant that I could go outside and play with my friends after dinner.

SPEAKER_00 25:27

Absolutely.

SPEAKER_01 25:29

So what what is the end goal here? What are what is effective treatment for what parents primarily who are watching, what can they do?

SPEAKER_00 25:43

Well, I think, and we've been really you know talking about various ways that behaviors can be misunderstood and and so and labeled mislabeled as attention deficit disorder. And what we've talked about today are several different categories of alternative considerations. Do they see well enough? Is there an overuse of technology? Do they have the correct uh proteins in their diet? And each of these necessitate going ahead, and as you say, we have to observe our children, we have to listen to teachers who have sometimes you know right on the ground floor knowledge of our kettos during their most awake hours of their day. And then if we do have concerns, to make sure that your children are assessed properly, because there are definitive developmental delays that do need to have professional involvement, but you need to speak again to a clinical team, a developmental psychologist, a developmental pediatrician, a child psychiatrist, so that you get the correct diagnosis, the correct direction, and if necessary, if necessary, to consider medication. And you earlier said also that schools are changing. Every once in a while, you mentioned a school, I think in the 70s and again in the 90s, that allowed a child to move their bodies. They were a little bit um more of a rarity then than they are today. I think schools are much more aware that children need to learn sometimes in alternative manners, and that it doesn't mean if you even if your child does have a diagnosis of attention deficit, that it can't be directed, and a child can't be successful despite the diagnosis. We just want to make sure that that it's correct.

SPEAKER_01 28:00

It's so important.

SPEAKER_00 28:01

I think so too. So this has been a fun, different experience for I I miss you on my side of the screen.

SPEAKER_01 28:08

I know, me too. But this is really this works beautifully, and it's what we normally do with a third person.

SPEAKER_00 28:15

And we and we will again. In fact, we're going to have actually in the very near future uh uh a wonderful guest. Uh his name is uh Taylor Cole, who didn't allow the diagnosis of attention deficit disorder to interfere with him becoming an exceptionally creative and uh successful person. We're gonna hear his story in the next upcoming weeks. But in the meantime, this is Dr. S. D. Hess.

SPEAKER_01 28:44

And again, I am Dr. Ann Kirsch.

SPEAKER_00 28:46

And this is on and off the spectrum. We want to thank you for joining us this evening. We also want to encourage you to listen to our podcast, subscribe, follow. But if you think that you have something to add and you'd like to be a guest, please reach out when we uh are selling sending out our uh notifications for the upcoming launch, which is now every Thursday. Please add your name, contact us, and we will certainly contact you back to see if you could join us on On and Off the Spectrum. Until then, we wish you a good night.

SPEAKER_01 29:22

Thank you so much, everyone.

unknown 29:24

Bye bye.