Speaker 1Is this you? Your daughter is described by every teacher as a pleasure to have in class. Polite, gets on with others, fine at school, but at home it's entirely a different world. The meltdowns, the homework battles, the chaos that erupts the moment she walks through the door. And somewhere along the way, you started to wonder, is this something I'm doing wrong? Or maybe you've been trying to get her ready in the morning for years, not just nagging, but actually being there every single step. Because without you, she simply can't sequence through it. And when you push, you get an explosion that leaves you both wrecked. And she's 11. 12, 13, and it isn't getting better. Maybe your daughter has been struggling with anxiety for a long time. She's seen a therapist. Maybe she's been medicated for the anxiety, but something isn't shifting. The worry is treated and it comes back. And there's a restlessness underneath it that nobody has quite been able to name. Maybe you've looked up ADHD and immediately dismissed it. Because everything you've ever seen about ADHD shows a hyperactive little boy. Who can't sit still. That isn't your daughter. So it can't be that. Or maybe, and this one might be the most uncomfortable, you've started to see yourself in what I'm describing. The pieces of your own childhood, your own struggles, your own way of operating in the world are starting to click into a picture you were never given a name for. If any of that sounds familiar, this episode is for you. Today, I'm joined by Dr. Olivia Kessel, medical doctor, podcaster, and author of Beyond the Label, Empowering Parents of ADHD Girls. Olivia has lived this from both sides. As the doctor who once dismissed the signs in her own daughter, and as the parent who slid down her front door and cried after a morning she could not get through. Her book and this conversation exist because she found the other side of that moment and wants to have it. We get into what ADHD actually looks like in girls, and why the hyperactive boy stereotype means most girls are diagnosed three to four years later than boys, if they are diagnosed at all. We talk about masking, why girls are so extraordinarily good at holding it together at school, what the cost of that is, and why the fact that your daughter is fine in the classroom is not the reassurance it seems. We cover the following. We cover the conditions that most commonly travel alongside ADHD in girls, anxiety, depression, eating disorders, and why treating those without looking for what's underneath them often doesn't work. We tackle the diagnosis question, the medication question, and the gender gap in the research that every parent should know about. And we close on something that I think will stay with you. And what you will come away with is by the end of this episode, you will know exactly. Exactly what to look for, what questions to ask, and what to do right now so that you can start supporting your daughter in the way her brain actually needs. I'm Dr. Mary Han, psychologist and parenting expert. This is the How Not to Screw Up Your Kids podcast. Pour yourself a cuppa, find a comfy seat, and let's do this. Olivia, welcome, welcome. Thank you so much for being here.
Speaker 2Thank you so much for having me. And I have to say the feeling is absolutely mutual. I am such a fan. I'm a fan of yours as well. So it's a complete love fest here. And I'm looking forward to just having a chat with you because I always love talking to you. Oh, my goodness. Well, I've got my hands.
Speaker 1I was about to say my grubby hands, but I have got my hands on Olivia's book. And I guess probably the important, and the book is called Beyond the Label, Empowering Parents of ADHD Girls. Now, this book was a particularly, a labor of love for you particularly. So can we just start with your story and what led you to write Beyond the Label?
Speaker 2You know, if I look back and think what led me to write this book, it's really, you know, I can take you back to a specific moment and how I felt in that moment. You know, my daughter and I had had a completely hideous morning, and it wasn't unusual. It was the norm. I had tried to get her up to get ready for school. She'd thrown the remote control at my head. She'd kicked. She'd screamed. We'd ended up in her bedroom with me. And, you know, this is an 11-year-old girl with me trying to literally wrangle her into her clothes. Finally, got ready to school, but, you know, I shouldn't have been trying to wrangle her into her clothes. It was just such a chaotic, horrendous, not the way I envisioned going to school mornings would be. And I had shut the front door, and she'd gotten into her taxi for school, and I slid down to the floor, and I just started crying because I couldn't do this anymore. And I didn't know what was going on, and I couldn't understand why, what was going on, you know? I'm a medical doctor. I thought I was a pretty good mom, but I was like, this is not good mom behavior. And I, you know, I blamed myself. I blamed her. I didn't, I just didn't know what to do, and I felt so alone. And that's really why, kind of the impetus for me writing this book, because I want to reach out to all those other moms who felt or are feeling exactly like I was feeling and hand out my hand and say, you're not alone. And, you know, there is a way forward. So, you know, that was my impetus. And also, I think it was kind of cathartic also to put all my thoughts together. And, you know, my daughter was diagnosed with ADHD, and the book goes into that. But I'm a doctor, so I also went into the science and the research and understanding her brain, and it was fascinating to me, you know? And that understanding and that knowledge completely changed my lens of how I looked at myself and my daughter. And I wanted to share that because it was, it honestly has been life-changing. And so it's kind of like, you know, when you have a moment, like, aha, a moment like that. And you, you know, you go from a place of absolute chaos and crap, if I'm honest, then to a place where I am now, you know, and I'm a doctor. Why wouldn't I want to help other people with that? You know, it's kind of in my DNA.
Speaker 1Yeah, totally. And I think you really touched upon with your story, even as a medical doctor, that kind of like what's going on. And I think so much of this quiet, insular shame that happens around. All of those scenarios that you're navigating as a parent with a child with ADHD, that you, as you say, that kind of like, I've got my 11-year-old here, and I'm literally wrangling her into her school uniform. And there's so much of that. And I think just helping other parents, you know, get out of that shame spiral and that they're not alone.
Speaker 2And it's been wonderful since the book has been published. And, you know, I've done some speaking events like this, the amount of moms who've come to me and are just like. Thank you. Now I feel like I can talk about it. I've reached out to my school. You know what I mean? It's been so liberating for other moms. And, you know, that is my greatest joy and passion is that we can help each other and you don't have to be so alone. And also then you can start to mend that relationship with your child. And you can start to start feeling like maybe I'm not the worst mother on earth and maybe I don't have the worst child on earth. Not the easiest, but, you know.
Speaker 1There is so much sort of shame around parenting. And I think particularly when you're parenting a child who is either neurodiverse or who is just going through a particular period of time where their behavior is challenging and you're not, you know, we're just not equipped for these things. You know, that whole saying children don't come with an instruction manual. And if they're ADHD, they most definitely don't come with an instruction manual.
Speaker 2I came with an instruction manual, which was my parents. Right. And everything, you know, they were very authoritative. They were authoritarian, punishments, including smacks. You know, they were, they were the authority and, you know, you must obey. And that actually is the worst playbook you can have in your mind when trying to deal with a neurodiverse child. In fact, it's like adding fuel to the flame. So my knowledge and my expertise of parenting from my own parents did not put me in good steed for my own child. No. And then that just compounds, doesn't it?
Speaker 1Yeah. Okay. So given that you've written the book Beyond the Label. What do most people fundamentally misunderstand about ADHD? And how does that misunderstanding specifically disadvantage girls?
Speaker 2You know, and it's, it's something that I was completely guilty of myself. You know, the myth that ADHD is a hyperactive little boy. And, you know, that's 180 years ago. That's how it was originally defined. And you'll see, like, even in the diagnosis rates, there was a study done in Wales where they looked at children. And for every one girl. For every one girl that was diagnosed with ADHD, there were five boys. When they looked at the prevalence in adulthood, every one woman, 1.9 women, equated to two boys. So there is a problem with diagnosis and there's a gap with recognizing girls because our preconceived notion is a hyperactive little boy. And in fact, they used to think that it was mainly boys who got ADHD, you know? And so that's kind of the backdrop for both clinicians, teachers, and parents, I have to say. So when your child isn't presenting like that, and, you know, my, my brother, although he hasn't been formally diagnosed, you know, he couldn't sit still. He was put in the. hallway of his primary school classroom for almost a year. My father too can't sit still. They fit more of that stereotypical belief system that we have. But girls are very, very different. And I didn't recognize the signs. You know, it took me and actually my podcast and listening to other experts to kind of the penny started to, and an educational psychologist had also said, oh, maybe she has, but I had poo-pooed it much to my detriment, but you know, oh, it couldn't be. And I think, you know, I just, yeah, it took a lot for me to shift and actually learn and understand that actually girls, and if I'm honest, boys too, can present very differently. So a couple of like the things that I had no idea, you know, what was really tearing up my house at that time was this emotional dysregulation, you know, and that's multifactorial in the causes of it. And I'm sure we'll get into that later, but I had no idea that, you know, these violent outbursts, both of them, you know, they were just, you know, they were just, you know, they were just, you know, both physical and verbal were a part of her ADHD. And that was really destroying the fabric of our, you know, family. But that was actually taken out of the diagnostic criteria in 1968 because it wasn't measurable, you know? So that in itself is confusing. And then sleep was a huge issue for us. And I didn't know that either. I just thought like, I have a very unusual child who never sleeps. It would take us two hours to get to sleep in the evening. And then she'd wake up two or three days later and she'd be like, oh, I'm not sleeping. And I'd be like, and I'm talking for 11 years, you know, the toll on her and me, unbelievable. 70% of kids with ADHD have sleep issues. So the two most painful symptoms I would say in our lives were ones I didn't recognize. Oh my goodness me.
Speaker 1And of course I'm guessing because we know how the medical model typically works is it has to be really super measurable. That needs to be a tangible. Can we observe what our observations are or not? There's none of this. And does it happen in two settings? Of course. And that's an important thing actually, that I think a lot of that is missed in terms of how it is currently diagnosed is if you are observing the patterns of behavior in one environment, in other words, home, but it's not evidencing at school, then that wouldn't hit the criteria because it has to be evidenced across two different contexts. And I'm thinking that that is one of the areas where girls are disadvantaged when it comes to a diagnosis or identification.
Speaker 2You've hit the nail on the head, Dr. Miriam, because, you know, they could be masking people pleasing and also they're not picking up on the subtler signs that girls present with, you know, like sitting in class, looking out of the window, daydreaming, being very creative, you know, maybe having some social anxiety, but you know, oh, that's just girls and girls of teenage years, that's normal. And, you know, often parents and including myself, they won't hear anything from the school that anything's wrong. And then when that same child comes home, they can be a complete, you know, then the explosions happen because they've been holding it all in so tightly. And I actually say to some of my parents, you know, how are they when they go to a camp or to an afterschool club? Is there other environments where this comes out, going to visit your parents, you know, or things like that, and that can be the other environment that might not be school?
Speaker 1Yeah. So let's talk through now so that as listeners are listening to this, that they can identify. So what does, how does ADHD actually show up in girls? And what are the signs that parents are most likely to miss or explain away? And I know you've sort of touched on some of those anyway, but let's sort of spell those out really explicitly.
Speaker 2So, you know, a child that is not able to do things that you think they should do at their age, you know, and if you say to them like, oh, go and do, you know, you know, make your bag, get dressed, brush your teeth, pack your bag. And that just is, is an absolute impossibility. You know, they can't pack their, you know, they, they, my daughter used to say to me, but this is before we had any idea. She'd be like, mommy, you know, I cannot follow more than one instruction. That's, that's, that's a good hint there. And you know, when you, when you look at your friend's children and they're able to do things that you think, oh yeah, that's right. You know, they're making their lunch, they're getting their school ready. They're doing their homework independently. And your child just is not meeting those kind of milestones. And it's, you know, you're like, what's wrong with my child? I think that's an indicator when you see that kind of delay, because it is a neurodevelopmental condition and there is that delay of about 30%. So your child is actually functioning at about three years younger. That's just a real guesstimate way of looking at it. So what they're, how they're behaving is appropriate for that age. Let's say an eight year old, not at an 11, 12 year old's age. And then we often also explain why, because often girls are diagnosed three to four years later than And I thought, I think part of that is due to the fact that they're not picked up, but also part of it is due to the fact that that's around the 11, 12, when the hormones start activating, estrogen actually modulates dopamine pathways. And so kind of when those fluctuations in estrogen happen, it's almost like you turn up the volume on ADHD. But then as the parent, you're like, oh, is this just hormones? Is the reason why she's kicking me and breaking it and smashing the door because of her hormones? And you say, and honestly, I said this myself, and I actually said it to the clinical psychiatrist. I said, is this just puberty? And if so, I don't remember it being like this, or is it something else? And I was almost like, and if it's not ADHD, what is it? And you have to help me because I don't know how to handle this. And oftentimes you will, you know, another indication is that, you know, at school, it seems absolutely fine. And at home, it's not. And so then understanding the pressures and often you'll hear like homework is just, I mean, I hear, and I felt myself PTSD from trying to do homework with your child because they can't concentrate, they can't sit down, it turns, you know, turns into a nightmare. The sleep is another one we've mentioned that is also really prevalent, I think. So those, those are a couple, I think. Gosh, yeah. And
Speaker 1can I just go back to the piece that you said about hormones? Because, and I've done, recorded a recent episode with Jesse Hewitson recently about the, in first time diagnosis at PERI and postmenopause in women. So can you, I want you just to unpick it for a real lay person. So you talked about estrogen modulating dopamine. So we want to make it accessible in terms of the actual, the neuroscience and the neurochemical aspect to ADHD so that parents can understand how this may play out in their daughters through puberty and the recognition there. But also I think a little bit, in terms of mothers identifying that they may well themselves be also neurodivergent.
Speaker 2Absolutely. And you know, a lot of moms do get diagnosed in the menopause time period as well for that reason. So let me, let me unwind it a bit. So when we're looking at ADHD, what's going on there? So I've mentioned it's a neurodevelopmental condition and we have areas in the prefrontal cortex, which is the area behind our forehead, which are, I don't want to say underdeveloped, but they are slower to develop. So, and, and, and there is that 30% delay and those kinds of functions are dictated and activated by dopamine. Um, so we have different pathways, dopamine's released, they act on cells, they cause them to be activated and that kind of activates and grows that prefrontal cortex. That's in its most simplistic forms and because of ADHD and it's a genetic disorder, there are differences in the gene kind of transporter mechanisms and how that dopamine is released. So basically, in a nutshell, we don't have as much dopamine in the system and we don't have as much being re-uptaked and we don't have as much activating those cells. So although we think of ADHD as like a hyperactive energetic type of thing, actually we're slower in the areas of the prefrontal cortex because in a way we don't have the petrol that we need to activate that area, if that explains it. And now let's throw in estrogen. Okay. So when we, when we think of our pre-puberty and in-puberty and also pre-menopausal and menopausal, our estrogen levels are fluctuating and those actually help to modulate dopamine pathways as well. And so you can see here, we already have a little bit of a shaky system, um, with our petrol and now we start turning up the volume with the estrogen and it's fluctuating around. Our dopamine kind of petrol tank gets even more disrupted. So the volume then of the problems that we start to experience with using our prefrontal cortex gets even more pronounced. So where we might've been coping before coping in school, being able to people please and whatever. And it was at a level that was manageable. And when I say manageable, I mean, that kid is working a lot harder than any other kid. And that mom is working a lot harder and has been working a lot harder than, than other people, a lot more energy. And that's why you see that people are able to cope. You know, I mean, and, and that's what you really have to think. These are strong individuals who are very resilient because of the coping mechanisms they put in place, but that estrogen just tips them over the edge and the petrol tank is empty. And that's where we see, okay, now we need to reach out for help. We can't manage anymore.
Speaker 1Yeah. Oh my gosh. That is just such a brilliant explanation. And the one thing that I would add just in terms of maybe, I don't know if it's sort of our understanding, or misunderstanding of dopamine, am I right in saying, Olivia, that when we talk about dopamine, we often think of this thing about getting a dopamine rush. But actually, what we also need to remember is that dopamine is essential in motivation, learning and drive. And so if you've got less dopamine in the critical area that you need to plan and execute things, then it means that you just have simply having to work so much harder than anyone else.
Speaker 2Absolutely. So that's such a good point to highlight here because it's our normal, we need it for our normal functioning of those things. Then when people call about, oh, that's a dopamine high-rich activity, that's slightly different. I'll use the example of food. We need food to eat and live, right? But then when we see a piece of cake, that's like a dopamine rush. Oh, we really want that. But we need food all the time, whether it's just the bread and butter that we need all the time to live. And then we have the things that really excite us from a food point. We can think of dopamine in that same way. We need dopamine for our normal functions of our prefrontal cortex and other areas, but we can also have a dopamine rush if it's something that's highly attractive to us and delicious to eat.
Speaker 1Brilliant, because I think that that's an important piece. And we'll come back to that, I'm sure, when we talk about the question of medication or no medication, because I think when we think we've got it, we've got to have this fundamental understanding that dopamine is not just this rush thing, but actually is fundamental. It's fundamental to young people and adults' ability to kind of execute on things. So we've sort of touched on it, but can you talk me through what masking is, why girls do it, and what the cost is, and why this sort of, this she's fine at school can actually be a red flag rather than a
Speaker 2reassurance? Absolutely. And you know, I think it comes back sadly to our roles really as females and males. Because it is ingrained within us as women to be pleasers, to make everything okay. And, you know, I've learned it from my mother. I inadvertently teach it to my daughter. You know, it's part of who we are. It's part of who society expects us to be. You know, it's our role. You know, it is in years of DNA. It's been imprinted into our epigenetics. So, and it's a wonderful thing. You know, that's why we're nurturing to our children. That's why we nurture our elderly parents. It's part of who we are as a female, which is a beautiful, wonderful thing. But there also needs to be boundaries. And this is where it can also backfire because our go-to is, okay, well, what do I need to change within myself to be able to adapt to this environment? How can I make myself likable here? It's important that this, that I'm, I'm like, that I can please. And so our little girls in school, they're trying very hard and they're using up a lot of energy to be that way, you know, and to feel that way. And then when they get home, the wheels come off and that's where parents see this real difference between what's happening at school and what's happening at home. And, you know, some schools will say, oh, well, it's your parenting style. You know, you're not, you're not putting up sound, you know, hard enough boundaries. You're too gentle as a parent. You're, you know, they're, they're walking over you. That's why it's happening. And they're putting the blame on the parents when actually that's not what's happening. It's the pressure at school that's erupting in a place where they feel safe at home. And I'm not saying all schools do that. And I think schools are changing now. I had a mom who contacted me about their ADHD autistic son actually, and she reached out to the school and they've been really good about then understanding what the pressures are that, that is happening there. It's our, it's in our nature and our DNA. And it is a red flag, as you say, to kind of understand that. Yeah. Brilliant. Oh, super,
Speaker 1super helpful. So now let's think about, obviously we've talked about sort of the ADHD, but what are the most common conditions that accompany ADHD in girls? And why does treating those without the addressing the ADHD often not work?
Speaker 2Yeah. And this is really sad. And this is especially sad when you talk to women who are getting diagnosed in their forties and fifties, because they've often spent a lifetime in and out of doctor's offices being prescribed for conditions and it not working. So anxiety, depression, eating disorders, and a whole slew of mental health issues. And basically clinicians are trying to treat the sign, the depression, the anxiety without understanding what's going on underneath it. Very similar thing happened with women in menopause actually. So we also would be, you know, given antidepressants, anti-anxiety medications, when really what we needed was hormone therapy because we were in menopause, you know? But the long-term effects of that are, is that that person is feeling depressed, is feeling anxious, and they're not being treated for the underlying issue. So they're never getting actually relief from it. So then it also goes back to, there must be something wrong with me. Why can't I get over this anxiety? Why can't I get over this depression? Why is life so hard for me? Because it is hard until you put the right it is super hard. And if you look at the research in terms of what are the long-term effects of not treating ADHD and not supporting it, people have a decrease in their mortality of up to 13 years. So you die 13 years before your peers. And in some terrible cases, it's up to 21 years. And you have things like failed marriages, failed jobs, you know, suicides, drug addiction, alcohol addiction. And I don't think people realize, and I didn't realize like what the consequences are of not understanding that you have ADHD and not supporting it. On the flip side, not to sound all doom and gloom, if you are supported and if you are managed properly, those things don't happen and you can go on to flourish and have an amazing life. It's about those coping strategies and it's about understanding yourself and understanding how your brain works. Yeah.
Speaker 1So would you say that as a parent of a daughter, for example, where your daughter is presenting, or you're at least picking up and acknowledging that there's anxiety and low mood, maybe in depression, to just probe a little deeper before you sort of make a definitive decision that it is anxiety rather than asking, actually being curious that could the anxiety be rooted as part of a neurodivergent diagnosis and whether that's the first place to go rather than necessarily the anxiety bit?
Speaker 2I think that's absolutely key. And even in things like anorexia as well, where you see huge failure rates with anorexia, you know, and it could be an underlying neurodiverse condition. And I'd even say like when you're exploring this, even to open that net even bigger than just ADHD, and they did with my daughter as well, could it be autism as well? Because they can often go hand in hand and ADHD can sometimes mask the autism. So they did, the clinical psychiatrist that I went to had a specialism in girls with ADHD and autism and kind of screened for the autism as well. She didn't have it, but I think it's good to have that. Broader picture so that we don't go down a rabbit hole and then treat the end symptom versus the underlying issue. Yeah, absolutely.
Speaker 1And I would say that my daughter was diagnosed at 19 when she was at university, she'd been having some sort of therapy and she'd, and the therapist had sort of said, I wonder if you might be neurodivergent. And she'd sort of identified with it a little bit anyway. And I didn't, there were clear signs when she was younger, but just hadn't sort of reached a point. Where that label seemed to be something as a logical next step. And for her, the psychiatrist made it clear her primary diagnosis was ASD, autism spectrum disorder, and then ADHD and her hyperactivity is in her thoughts. But interestingly, the statistics in terms of whether when you've got autism as the primary diagnosis, which it is for her, you have a 40% chance in terms of girls where the primary is ASD, there's a 40% chance that then you will also have ADHD.
Speaker 2And it's, you know, that's super interesting. And it's also, I think it's popped into my mind as well, like being dyslexic. So being dyslexic, you have a 50% chance of also having ADHD. I'm dyslexic. My daughter is dyslexic, but it also, it wasn't in my toolkit to kind of think about that. And I wish that clinicians and actually a lot of diagnostic centers, cause not all of them are the same. It sounds like your daughter and my daughter had a really good clinician looking at them, but really getting that kind of, broader sense that neurodiversity overlaps and underlies with each other and really making sure you're understanding it in its entirety is how you can really help and support your child and yourself if it's you.
Speaker 1Definitely. And can we kind of just touch, because I think there's probably quite a big, strong narrative, I think coming out that I'm sensing about this sort of notion, possibly the lay person, possibly someone who is maybe not currently parenting a child of children's where you're sort of dealing with those sort of daily challenges that, you know, for goodness sake, everyone's being diagnosed as neurodivergent. Can you speak to that particularly? Because I know that there'll be some parents listening where this is really resonating, but there may be a light, a slight nagging thought at the back of their mind. Well, a number of nagging thoughts. One might be the narrative that just, you know, everybody's being diagnosed and what might people think. But I think possibly also a narrative of maybe a little bit of shame and embarrassment, because I think for some people, the thought of their child being diagnosed, in their mind, they're holding this view that it still could be quite life limiting in terms of opportunities because of other people. people's prejudices. Absolutely.
Speaker 2And, you know, I'm going to use an example that I've used before in that, you know, when my mom was young, she went to the Royal Ballet and there was a lot of gay boys in the Royal Ballet in the ballet school. But when she had my brother and he was 13 and she was wondering if he might be gay, it wasn't really acceptable. It was still a bit taboo. And she said to me, you know what, Anthony, if you're gay, I'm okay with it. It's a very difficult life and it'll be tough for you, but I'll support you. Okay. Fast forward to now, there's lots of gay people everywhere. They're not just in ballet schools, are they? And it isn't a terrible life. They have wonderful lives. They have families. They are part of our society. I think neurodiversity is going along that same trajectory. You know, they've been hiding in plain sight and no one knew who they were. It's not that we're all of a sudden, it's just that we're recognizing and we're supporting and we're more accepting of. And I would predict as we move forward, it's going to be just like, and I know there's still struggles with being a gay person and I'm not negating that at all because it's still on that journey as well. But I think neurodiversity is kind of going along that journey. And so I really don't think that we have an over-diagnosis situation. We've had kind of the blindfolds taken off of our eyes. And actually, you know, to those parents who are worried about the stigma, you know, I've been there as well. But with the way the world is changing, our issues in the world, the way AI is changing, the way we're seeing things, the way we're seeing things, the way we're coming out, our neurodiverse brains, I think are going to be a real positive moving forward. It's going to be a skill set that people are going to be looking for. People that don't think like other people, you know? So I think, you know, be strong and your child is who your child is and your child is who you've always loved. And so even if they get a diagnosis, it's still the same child, you know? It's not going to change your feelings towards that child. And if you're worried about what other people think, you know, you've got to be strong. And if you're worried about what other people think, you've got to let that go. I mean, that's the one thing I love about being 50. I don't care at all anymore what anyone thinks.
Speaker 1And so much of it is about reframing, because I think there's been, and I don't know quite how they've done this, and I could have got this completely wrong, but there's been now some suggestion that Albert Einstein was neurodivergent. And I wouldn't be surprised. He couldn't attend school, could he? So this notion of, you know, we need people who think differently when it comes to shifting and breaking away from the status quo. And I think that's a really good point. You have to have a brain that operates differently to a neurotypical brain, surely.
Speaker 2Well, they talk about it, like when we were hunter-gatherers, right? And let's say we had this lovely area where we could hunt great food and we had lots of berries to pick. And then all of a sudden, you know, that started to run out. Well, you need the people who think, well, if it's running out here, why don't I go over there or do this over here or create this over here? You need those people that think differently.
Speaker 1Yeah. So hopefully that will help in terms of that sort of reframe. So if a parent's suspects their daughter has ADHD but doesn't yet have a diagnosis or they may never get one, what are the most important things that they can do at home and at school right now?
Speaker 2And there is so much that you can do. And I talk about this in the book because, you know, when you read each of the chapters, there are strategies. It's first to really understand how an ADHD brain works and what kind of scaffolding they need to help them be successful. So simple example with my daughter getting ready in the morning, you know, she can't do instructions. So, you know, I would take post-it notes and write each instruction on the post-it note and stick it up on the wall. And she loved to rip it down and crumple it up. There's something so satisfying and putting it in the bin. So yes, every morning I rewrote those post-it notes. But you know what? It enabled her to scaffold her prefrontal cortex. And then after we've done it for, I don't know, a year, she doesn't need the post-it notes anymore. It's become a behavior. She doesn't need her prefrontal cortex anymore. She knows how to do it. And we do that for everything. We put lists for what needs to go in the bag. You know, there's lists for everything. And when I went away, I just got a new job and I went away traveling and my dad was looking after him. My dad's not exactly, you know, look after you like a parent would look after you. So when I came home, she'd slept in my bedroom and I saw these post-it notes and she'd stuck all the post-it notes as a strategy of what she needed to do and what she was responsible for. So I was like, wow, you've taken a tool that I've taught you, which you've used it because this is a scary new thing where you are using your prefrontal cortex. You're kind of the mom. Now you need to get organized. You need to get the dogs ready. You know, your grandpa isn't going to do that. And you figured out how to do it based on what I taught you when you were 11, you know? So I think there's so many things you can do and also looking at your child with a different lens. So my expectations of Alexandra at 11 were wildly out of whack with what she was capable of with her brain and changing that and saying, okay, what is she capable of at eight? And that goes into school. So I think that's a really good thing. I think that's a really good thing to do in school too. So what is she capable of in terms of homework? What does she need from how that homework is given? You know, like a project six weeks down the way, that's not going to work for an ADHD brain. You know, she needs deliverables every week and it needs to be broken down into chunks. So talking to the school about it, getting them to help you with it and getting them to make it a right challenge for them so that homework is rewarding, finding those motivations. And there's just so many things. I mean, I could go on and on and that's why I wrote a book about it. But I mean, there are so. You are not helpless before a diagnosis to think of solutions that you can use right now.
Speaker 1Yeah. And there's me. Obviously, you can't hear it. You can't see it. But I am pointing to the book. Loads of really, really helpful strategies there. And that connection with school is a really important part of that. You know, this is what we're dealing with at home. These are the challenges. How can we work together, whether we're going to move on to the diagnosis or no diagnosis?
Speaker 2But there's one other thing I just thought of, Dr. Marianne, that's super important as well. And, you know, I didn't realize this either because I, you know, picture the typical morning, put your shoes on. They don't do it. Come on. I've asked you to put your shoes on. Please put your shoes on. And then it escalates. Could you just put your shoes on? You know, and probably because I have undiagnosed ADHD as well, my emotional regulation can go in an instant as well. Right. So there was a huge part actually that has nothing to do with your child, which has to do with self-work. Honestly, and that's a big part of it because my nervous system regulates her nervous system. And I have to be calmer than Gandhi on a mountaintop. And it's not it wasn't easy for me to do that and to learn the skills to be able to do that, especially when you're being attacked. So I think there is a big part of as the parent self-work.
Speaker 1And that speaks in lots of ways to the, you know, you might be listening to this and thinking, my goodness me, do I need to put post-it notes every single day to remind my child to do things? But my argument is always whenever we are doing a strategy or employing strategies that seem to be incredibly time consuming, is that we have to remind ourselves how much time do we spend emotionally, physically and mentally having those battles and that constant reminder and backwards and forwards and increased agitation, getting them to do all the things that we need them to do that by yes, there's effort in terms of writing post-it notes, but we've given them something tangible that they can do that will minimize the amount of time that we actually spend. Reminding them 3000 times a day what they need to do.
Speaker 2And I have to be completely honest, it did get a bit tiring doing the post-it notes. So I did modify my system. And I hung a string on her thing with clip it things. And then we had flashcards. So we'd stick the flashcards up, and then she pulled them down and we'd reuse them every day.
Speaker 1I love your honesty. But I think it does speak to this idea that actually we can modify, but that the work that we do, even though it feels a lot, because it's initially it is a lot. Because you're dealing with the behavior as it currently is, whilst trying to put in systems that are going to be more transformative. So you are almost doubling or trebling your workload. But you're doing that with a very clear knowledge that your workload and the emotional toll and that mental toll is going to reduce significantly for both of you very quickly. So let's deal with the sort of the sort of the logical next one as to diagnosis versus non diagnosis. What are the benefits and the limitations around that? Because some people will be very, you know, like, I need to do this, I need to understand, I need to get a diagnosis, and then others will be reticent. So there are pros and cons both ways.
Speaker 2Absolutely. And you know, it's, it is a very personal decision. I think there's, unlike with autism, you know, ADHD has a really good medical treatment option. And unfortunately, without a diagnosis, that is not an option for you. Also, there is the option of the sleep, which I said is a huge issue of melatonin, which is not available outside of prescription in the UK. That is not some some will maybe give it if they don't have a diagnosis, but it's harder to get. So so there's that element first off the bat. But then there's also the element. I mean, it depends on whether or not you need that to be able to understand your child. And for me, that was the case. But I'm a scientist, I'm a doctor, and I needed to know what was going on so that I could constructively support her and understand her brain. Because what if it wasn't ADHD? What if it was autism? What if it was, I don't know, personality disorder? You know, what if it was something else, just like we talked about earlier about, you know, treating the anxiety, treating the depression, but that's not really what was going on. But that's, you know, also lends into my medical kind of brain. But then, you know, just to be completely hypocritical, you know, I've talked to a GP about myself. And she's, you know, listened to me and said, Well, yes, I actually think maybe, you know, you do have ADHD, and you could go down the right to choose pathways, she gave me the links. Have I ever looked at them? No. Okay. So I haven't gone for a label for myself, but I have for my child because it was really important for me to get her the support and get my understanding to support her. So that was kind of my rationale. Yeah. And it is all incredibly personal.
Speaker 1And I think possibly what I would touch on is that quite often when it's not impacting your life and you could counter argue that maybe, Olivia, you've learned very well to mask and other things. But fundamentally, I think that there is often that shift because with our children and particularly where we meet those crisis moments with you sliding down that door in tears, where you just think, I just can't keep operating like this. And that actually for my child, a diagnosis is the best route forward to get them what they need so I can truly understand. And for others, they haven't hit that point.
Speaker 2Yeah. And I think that's a really important point. I mean, honestly, because I was in such doubt whether she had ADHD or not, literally to the point the words came out of the clinical psychiatrist's mouth, you know, before when I got on the phone to get the results or the Zoom call, I started the call with, if she doesn't have this, you need to still help me. I mean, so that's for me, the diagnosis was a starting point for help. And she's like, no, Olivia, she does have ADHD. And I was like, okay. But then, you know, that also wasn't an end. And I think, you know, there's also this misconception that once you get the label, oh, okay, you know, everything's solved. No, they, they, again, they don't hand you a handbook with the diagnosis either. They sent me a whole bunch of PDF files, which is the dyslexic was like, you know, and also boring. Hello. I didn't want to look at them. So it, it was the beginning of the journey. It's not the end of the journey. And then you really need to educate yourself. And I needed to have that definitive, yes, that's what it is before I could motivate myself to be like, all right, now I'm going to hyper-focus and deep, deep dive into this. And that's what the book is kind of about. And I think that's a really important part of the book. Because you don't have to read the whole thing. You can read chapters. If that's, if this is what's really bothering you right now, you can read that. You don't have to read it in its entirely, although I would recommend it, but it's getting that help that I wish I had that, you know, you can navigate this better. Yeah. Hence the title
Speaker 1Beyond the Label.
Speaker 2It's not the label,
Speaker 1it's just the starting point. Yeah. So let's say now we've got a diagnosis and what to or not to medicate. And is there a gender gap in the medication research, which parents should know about, or in the same ways we've talked, we've talked about the fact that ADHD was very much the sort of the hyperactive boy, so that parents who may be choosing not to medicate for fears may well be reading research papers or evidence that has been very skewed to boys.
Speaker 2Yeah, I think it's a, you know, it's, it's, it's a hand grenade, the whole medication, and it's, it's really interesting to me, you know, as a doctor, I'm very comfortable with prescribing medications, but even when, as a parent, when I thought about medicating my daughter, I did stop and think like, is this the right thing? Why am I questioning this so much? You know, like if she had diabetes type one, I wouldn't question giving her an insulin. There wouldn't be a question in my mind. If she had asthma, there wouldn't be a question in my mind to give her inhaler. I feed her Calpol, you know, whenever she needs it pretty much, you know, and it's interesting that when we talk about medication for the brain, it becomes a totally different conversation. So that's the first interesting point. And I, I was also falling in that trap. So I have complete compassion, not trap, but I have compassion for those feelings. And so when those feelings arose with me, I started to dig into the research as I love to do. And, you know, ADHD medications have been well-researched for over 60 years in children. Very few medications that are actually, you know, have been researched in actual children, including Calpol, which has only been extrapolated from adult research. So this is a very well-researched drug and it has incredible efficacy. It's more efficacious than asthma inhalers. So by that, I mean, it really impacts the condition and it actually has quite a low side effect profile. So it has a high tolerability and some of the side effects that, you know, like not wanting to eat and other, you know, having difficulty with sleep and things like that, as you progress on the medication, those become less. I'm not, I'm not negating them. For some people, they are real issues, but there's also, different ADHD medications that you can use. More broadly, they're broken down into stimulants and non-stimulants. And what's interesting about it, and I think what I didn't understand about it is what is the impact on your child when they take these medications? So remember I talked earlier about the prefrontal cortex and that 30% gap. Well, in about 70% of kids, when they take methylphenidate, which is a stimulant, the first drug that your child would be put on, it negates that gap. It's 50 to 70% of kids. It negates that gap a hundred percent. So that means their prefrontal cortex, I used the petrol example earlier, it's cooking with gas at that point when it's got the medication. Okay. It's working. And that's only when the medication, the medication comes and goes, you know, there's long acting and there's some people who take two bills a day. So there is variability there, but it enables the brain to do something it wasn't able to do before. In other children, it doesn't negate the gap completely, but it might negate it 70 to 80%. That's like my daughter. She still needs some supports and scaffolding as well. And it's only about 5 to 10% of children that the medication doesn't work at all. Now that said, kids that have autism and ADHD, they might respond differently to ADHD medications. And sometimes they have to go on to a second line non-stimulant. So it's really important to work with a clinical psychiatrist to understand, you know, what your child's needs are to have that onboarding, to have that check-ins, you know, and you're going to, we've changed medication, we've changed dosing. So it's very personalized. But the impact, of what my daughter was able to do with medication and not on medication was just night and day. I mean, she was like, she was able to do things that she wasn't able to do before. She'd sit and do her homework by herself. I mean, I, I mean, honest to God, I would never think that would happen. And she, if I told her I'm taking away your medication tomorrow, she would, she would get really angry at me because it makes such a difference to her. So I think we need to, I would advise parents, you know, read my chapter in my book as a starting point. Listen to some of the podcasts I've done with experts, listen to other podcasts, listen to, really educate yourself and then make an informed decision. And then, you know, if you're going to try it, pick a time where they're not at school. You know, I did it over the summer holidays. Understand that it can get worse before it gets better as their brain adjusts and the dopamine kind of builds up because it, you know, it goes a little bit haywire in there a bit. And I almost quit actually in the first week because things got bad and the psychiatrist didn't tell me that things could get bad. And I wish he had because, knowing that, then I would power through it. And then it all settled in and the brain readjusted. It got the dopamine flowing. Her prefrontal cortex was cooking with gas and she was, you know, able to do things. And that, you know, it made her feel so proud, you know? And she's even said to me, she's like, with some of her kids at school that aren't medicated, she's like, mommy, would you mind having a chat with your mom about how like this has impacted me? You know? And she likes to come on the podcast and talk about it. So I think that's all I can say is, you know, educate yourself. Learn about it. And then, you know, don't be so scared of it, you know, or next time you give Calpol, maybe you should put the same scrutiny on that. Yeah. And I think that's
Speaker 1the common myth, isn't it? Is that we, we assume that the Calpol that we're giving to, giving our children has been well-researched, but actually, as you say, the research is on adults and it's been extrapolated backwards in terms of dosage and then application for children. Whereas the medication for ADHD has been researched with children and on children for decades.
Speaker 2Yeah, exactly. So, and I think I, hopefully that makes it less scary. And, you know, social media does no favors, you know, there's some, some huge celebrities, Will.i.am, who I love on Voices, you know, saying, oh, we're medicating our children for, to have them behave in school. No, we're medicating our children to enable their brains to be able to meet the demands at their age level at school.
Speaker 1Yeah. And I think when you have an understanding and you've been so brilliant in this episode in terms of the explanation and things about what's going on in the world, I think that's a really good thing. I think that's a really good thing. The brain is when we understand what ADHD is and we get away from this myth about this dopamine, you know, and really understand how dopamine impacts learning motivation, then we have a much better idea about how the medication then works rather than it just simply being this, you know, we're drugging young children is actually we're putting in petrol into the engine that our children need. And you know, it's super interesting.
Speaker 2There's new research coming out. We're looking at children who've been on ADHD medication since they were, you know, a child and growing up. And actually the areas in the brain that are slightly smaller to the neurodevelopmental nature of ADHD, those areas have grown to normal sizes and they've actually gone off the ADHD medication because they've had structural changes. Now it's still new cutting edge research, but it's fascinating to actually understand that. And I think that's a really good thing. Yeah. And that's, that would absolutely sit
Speaker 1with this notion of neuroplasticity because if you are allowing the brain to operate as it should, you're flexing the muscle repeatedly enough that you're creating that strength and those neural pathways that you then don't need the medication to scaffold it because it's built itself. Yeah, exactly. Oh my gosh. Okay. Final or to her parent who has internalised the narrative that she's just not good enough, when actually she has been working three times as hard as everyone else just to keep up. And we've talked about this in some ways, but I just feel that that would be a really great sort of closing bit of guidance for you.
Speaker 2I think what you need to say is, wow, you have been, you know, you have been managing so much and you are actually, all of these things that you've been having to navigate has given you things that nobody can ever take away from you. Strength, resilience, even when things are so hard, you keep going. Those are the skills you need for life and no one can take that away from you. And a lot of girls and boys actually who have been called that in school by people, I'll use the example of Jo Malone. Okay. She was dyslexic. Her teacher said, you'll be nothing. You're a loser. You know, you're, you're not trying hard enough. You're not going to be anything. Okay. Need I say anything more? Look at her. The teacher actually called her up, but you know what? It's all of those skills that she was using to survive, which led her to be able to be like, I can do whatever I want in life. And actually the skills that you're learning, it might feel hard now, but these are what put you ahead of everyone else. That's why there's so many entrepreneurs with ADHD and other neurodiversities, because you know what? When the shit hits the fan, they know what to do. They don't just lay down. They got to get up and they fight. So, you know, Oh, Oh my God. I love that.
Speaker 1Oh, now we will be sharing the link to, purchase the book. Highly recommend it. And also to Olivia's send podcast, because I think there is so much there. If you've listened to this and it sparked something within you and you want to know more than Olivia, 100% is the person to listen to, to reach out to, to follow and to join her community as well. Because, you know, you just, honestly, you've been so incredible at explaining something that I think is super scary, super loaded with shame and stereotype and made it accessible to everybody to be able to understand and taken that whole shame away. And in lots of ways for me, I found it incredibly inspiring. So thank you, Olivia, so much.
Speaker 2Thank you so much. And, and, you know, with that community as well, I'd just like to give a little plug to that too, because it's moms who are going through this right now. It is a paid for community, but it has, you know, moms who get it, who have all been sitting on the floor crying and they all help each other. And it's a beautiful, beautiful community. And I think it's a beautiful community. of moms who just get you. And that is so important because sometimes other moms in the playground don't get you, but don't worry, you're not alone. So, and I just want to say a big thanks to you, Dr. Marion, for all the support and help you've given me. It's just been a pleasure talking to you today. I love talking to you. Oh, I think I'm sure we'll do it again.
Speaker 1So thank you so much. Thank you for being here. Thank you for being here.
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