Dr. Jessica McCarthy 0:06
Kristen, welcome to the I have ADHD podcast, where it’s all about education, encouragement and coaching for adults. With ADHD, I’m your host, Kristen Carter and I have ADHD, let’s chat about the frustrations, humor and challenges of adulting, relationships, working and achieving with this neurodevelopmental disorder, I’ll help you understand your unique brain, unlock your potential and move from point A to point B. Hey, what’s up? This is Kristen Carter, and you’ve tuned into the I have ADHD podcast. I am medicated, caffeinated, regulated and ready to roll. Oh, my goodness, today is going to be the best I have with me. Dr Jessica McCarthy, she is a licensed clinical psychologist and a neuropsychologist specializing in neuropsychological and psycho educational assessments and cognitive behavioral therapy for children through adults. Jessica focuses on neurodivergent populations, including ADHD, autism and learning differences, and she conducts medically driven assessments for conditions like TBI, stroke and dementia. Listen, this is going to be an incredible episode, because we are going to talk through the process of assessment from start to finish. If you are someone who is curious about the assessment process and you’re wondering what the heck is involved, this episode is 100% for you. Dr McCarthy is going to give us behind the scenes insights, and she’s going to tell us exactly what the assessment process is like. And if you’ve already been diagnosed, and you’re like, I’m not sure if this episode is for me, we are going to have the best time,

if anything, even if you’ve already been diagnosed, like, you get to hang out with two Jersey girls for the next hour, hour and a

half, this is exactly better than that. I’m saying two Jersey girls with ADHD sitting across the table from each other, talking about yes, ADHD the assessment process and what it is, just like even maybe we can throw in living as a mom with ADHD in the world, like being put together, hair curled, makeup on jersey.

I can’t,

yes, that’s jersey.

Thank you for having me. We’re gonna, we’re gonna have such a good time today. I’m

so glad you’re here, and I’m so glad that I get to share with my listeners this behind the scenes process of the assessment, because I’ve done a couple episodes here and there about what the assessment process is like, but I’ve never had a clinician come in and walk us through it. So my first question for you is, what do you feel like makes the biggest difference between a crappy assessment experience for an ADHD er and a good experience for an ADHD er.

I think that the first thing is making sure you are working with somebody who knows what they are doing, which sounds crazy, but there’s a difference between somebody clicking every single box on their Psychology Today page and throwing in it like they work with people with ADHD and attention and executive dysfunction, all of like the hot words on like Tiktok and whatnot, and somebody who is up to date with the research, who knows what they are looking for, who understands the patterns of that we see in the data with ADHD, and just has experience with with the population. I think that’s that’s one part of it, and then the other part of it is, you know, the assessment process, like you said, Kristen can be incredibly daunting and incredibly overwhelming, because people think tests. They think like, oh my gosh, it’s

like a small test, like, but yeah.

So you know, when we have people come in office for for the evaluations, like, I have taken such great care to make the office such a warm, beautiful and inviting space, so we’re not dealing with any additional anxiety or worries or stress on top of what might already feel like an inherently stressful process for

people now, how does someone with ADHD who’s already overwhelmed, who’s already feeling a little bit maybe defeated in their real life? How does someone like that figure out if the clinician has the experience that they want them to have. So how do we know how to, like, deduce on Psychology Today, like, are they just clicking a box, or do they actually have experience? They are just clicking

a box. So I always tell people to, you know, go to a person’s website. If they don’t have any information there about like, their background, their experience, what they’ve done then, then don’t go and see them. Number one, number two, even how we’ve built into our processes for how people can get in touch with us. So you can send us a message on Instagram, you can send us a message through our email. You can text. You can call like I know me, for example, I hate talking. On the phone, I will do everything in my power to avoid talking to somebody. So if I can send you a message, I’m going to do that. You will get our office manager, Jackie, who is incredible, and she is patient, and she will walk you through. You will get an email from our system. You will get an email from Jackie, explaining everything. You will get text. We give you all of the reminders in place that make it not only easy to access us, but difficult to forget your appointments and what you need for each appointment. So what I

hear you saying is that there are clinicians out there who make the process ADHD friendly,

yes, and if they don’t, then don’t go to them, because this whole process is inherently stressful and you’re paying money for because a lot of people don’t take insurance, because it’s

a whole other episode, but yeah, yet

you need to be it’s not just about cultivating the experience, but it is in this instance, like you want to know that you are seen, heard, understood, so we can do our job of Getting the cleanest data possible, because if I’m not then, then what am I? What am I measuring here? Am I actually measuring someone’s, you know, pre existing anxiety and stress, or am I measuring these, these confounding variables of all the stressors, because someone couldn’t get a parking spot, someone didn’t remember to bring a snack, like I keep a ton of snacks and protein shakes in the office. People didn’t bring a sweatshirt. We, we, we just make it easy to get the questions answered. They’re emailed to you so you can check your email if you forget, like, just so many stop gaps in place that it’s difficult, like I said, for patients to forget an appointment or to feel overwhelmed by the experience.

I like what you said about like, getting the cleanest data, because you’re absolutely right, even just getting out of the house, and we talked about that, you know, like getting out of the house this morning, like, we both have kids, and we both have, we both had a commute to get here. Like that, in itself, is enough to get you agitated, overwhelmed and feeling really chaotic. And then if you’re a clinician who’s doing an assessment, and the person is already in this agitated, chaotic state. It’s hard to gather whether or not you’re getting, like, the

cleanest data, and we can see that it’s like people are coming in hot, like I like to say, then we take the time to cool them down, yeah, because what’s the point? Otherwise, you know, we tell people from the start. You know, the children and adults are like that. We assess like this is not necessarily a one and done appointment. They’re broken down into multiple appointments, and we will break them down into as many appointments as possible to get the good data, especially when we work with the younger kids. So like parents of kids that might have ADHD, this might be for you. We will block off maybe an hour and a half to two hours. But if all a child can tolerate, or even an adult for that matter, is 45 minutes, guess what we’re done? Yeah, we’ll see you next appointment, because and we take breaks in between, and we’re not trying to fit a square peg into a round hole, because then I can’t make what conclusions Am I making? We just wasted time and wasted money, two things that I in particular not interested in. Yes, I don’t have time to give and I’m gonna do it. I’m gonna do it right the first time. Okay,

so what would you say are the most important steps when someone is looking for someone to assess them? So an ADHD are out there undiagnosed. Can you give us, like, one or two things, like, Hey, here’s what to look for, like, here’s what to put in your Google search. Or, like, how do we do that? I’m

trying to think of like, the keywords for our Google search. So like, ADHD assessment near me, ADHD expert. And when you get to their website, they should have a section, as I’m in the middle of redoing mine on ADHD, they should be able to explain it to you. You shouldn’t leave that website feeling like I have. I’m more confused on when I started. I don’t know what to do, and I don’t know what my next steps are. And if you fill out the office, and if that’s a stressful experience, then I wouldn’t go there, because if they’re not putting policies and procedures in place to get it right from the first phone call, yeah, then what is it going to be like throughout like, just, let’s just make this as this. I

just want to encourage anyone who’s like, I don’t know if I have the executive function to like, continue to call offices like it is worth it. It’s worth it to find a clinician who is going to really have compassion and understanding, and if they’re making it difficult, they don’t actually have compassion and understanding. They don’t,

and especially for adults, by the time people reach out to us, yeah, they are already at a level 10 because they probably just spent, I don’t know, the last few decades struggling, yes, then the last thing they need is getting someone on the phone that’s cranky or there’s not clarity on the website with what I’m doing and what my next steps are, and when the adults call it. It’s, it’s everything is time sensitive, but like I said, there’s, it’s usually because something has hardcore crash and burned. So it’s like an acute problem, a very well it’s acute and chronic, to the extent that when we when we meet with the patient, the problem, when we’re doing the clinical interview, the problem has been existing for quite some time, but they either ignored it, or they were able to compensate, or they thought it was something else. But by the time we get the phone call, somebody just, you know, failed their semester in college, somebody didn’t pass the bar exam because they didn’t have the accommodations that they had in place. And again, like that, we always had, like the ADHD, or there’s a November in New Jersey, the bar exam deadline to submit accommodations for the, I think it’s the number February exam is November 30. Yeah, without fail, November 1 hits. We get like, three or four phone calls of people being like, I need an evaluation now, because it’s, it’s overwhelming to do. And, you know, we try to, we try to get as many people in and make and just make

it as quick as possible. Yeah, it’s so great. Okay, so what are the first steps? Somebody calls your office. They come in for an assessment. What are the steps involved in the process? So yes,

the first step is like I said, you’ll you’ll speak to our office manager, Jackie, and I cannot sing her praises enough. She’s like my partial frontal lobe. She will go over everything, what, what this entails, what this does not entail, what the cost is, and how we break it down, and we break it kind of into three different chunks. The first chunk is the intake, and that’s when we meet with patient, and sometimes the patients and their families for an hour and an hour and a half, we do a very in depth clinical interview. Now, depending on the person sitting in this chair, some people will say, like, you can do a really, really good clinical interview and be able to diagnose ADHD without doing any other testing. A lot of times, psychiatrists will do that because ADHD is a neurodevelopmental disorder. So if somebody as an adult is saying, like, oh my gosh, like, I can’t pay attention. I can’t remember this, but they don’t have the history going back to childhood to back that up, then it’s not necessarily ADHD. There might be some executive dysfunction, but not to the level where we would make a diagnosis, or there could be something else going on, like anxiety or depression. So that first intake process really gets us to understand what’s going on us as a psychologist, we have some working diagnoses. We have some things that we also want to assess and look at. If there’s any learning issues, like, we catch dyslexia in adults, believe it or not, like, if someone’s struggling with taking a standardized test and they have ADG and anxiety, well, guess what? You also have maybe mild dyslexia that impacts your ability to read a longer passage and make sense of it under a time demand. And we also can assess for any comorbidities, so co occurring conditions, anxiety, depression, substance, if there’s some personality issues, trauma, things like that, then the next, however many, usually it’s be two to three, sometimes more of those sessions of the actual testing that’s in person, paper and pencil testing. There’s some manipulatives, there’s some computerized tasks. That’s the bread and butter of it. And then usually about two to three weeks later, we do the feedback, where we go over our findings, we go over our recommendations, and for us, it’s a very collaborative process, because we’ve, you know, we’ve looked at their medical records and records if we’ve needed to, we’ve looked at academic records. We’ve had patients fill out self report forms. We’ve had teachers fill out self report forms, if it’s, you know, a child, or even we’ve had college parent like, be like, you know, can you talk to my professor about this? You know, whatever? Yeah, we look at everything together, and we also make the question of asking, like, what do you need? Now, we’re not in the business of giving out Sure, diagnoses or recommendations, but I want to be very clear. Like, what the question is, not just the diagnostically, but like, what do you need? This? This, this report I’m giving you has legs. Where do you need this to run to? How can this report and any recommendations or accommodations improve your quality of life? Because if it’s not doing that, yeah, then I didn’t do my job. My team didn’t do our job. So feedback is collaborative to make sure what we are putting in place, the patients understand and the families understand, especially if it’s for a medication, consult, if it’s a therapy consult, if we’re making like school based recommendations or college based recommendations, because those are two different processes for children who are K through 12 and for adults in college, and how to even start that process to get accommodations, or if you need to submit it to, you know, the College Board, or, you know, the state licensing, if it’s just for how to make things work in the workplace, if it’s ADA accommodations in the workplace, like we take the time, yeah, and then we finalize the report, and then the magic’s done. Well, at least the reports, the assessor process is done. And then we’ll a lot of times, you know, our patients stay with us because we do provide services as well, or if they need, if they need therapy, you know, we tend to keep a lot of our patients in house, so they’re with us for a while. Okay, so

I’ve, I’ve a couple of questions about all of that. So my first question is, do you. Also feel that every clinical assessment should involve both an interview and some sort of like written paper test or what you were describing with, like manipulatives and different types of things. Yes, 1,000% can you explain that a little bit? Yes.

So there’s a difference between getting a diagnosis and understanding your diagnosis. So I can put 10 people in the studio, and they’re all going to have an ADHD diagnosis, but where their executive dysfunction or their emotion dysregulation occurs is going to look different. Someone might have a hard time with task initiation. Some might, might. Someone might have a hard time like with working memory or processing speed. Somebody might have a hard time with organizations staying on task. Someone’s emotion dysregulation might be just incredibly severe because of all these things. Some people may have a hard time with, you know, transitioning. I have a hard time with transitioning, and I’m 42 and I do this for a living. So a diagnosis doesn’t tell me that, but an assessment does. So a lot of times people wait, I have to, I know, absorb. I could just go, but on that you have to stop. Wow,

oh, okay. A diagnosis does not tell you the specific areas in which the ADHD or struggles, but the assessment will tell you the specific areas in which this particular ADHD or struggles,

fascinating, and people call and I tell people pills don’t build skills. So if it’s an adult, they’re like, I need meds. Great. Why? Why do you need meds? So we turn the temperature down on your brain. Then what do you know how to manage your time? Do you know how to manage your schedule? Yeah. How do you struggle? Like, okay, but a diagnosis won’t do that even like as a great psychiatrist, other members that we work with on our team that actually will do a little bit more of an in depth interview, they’re not trained to do what a psychologist or a neuropsychologist can do, as far as administering the tests that can help us answer those questions, and usually for adults, the batteries are less detailed than what they are. For kids, we don’t necessarily have to do all of the academic testing because, for the most part, we’re not making academic accommodations unless we think that there’s dyslexia or something that is directly impacting College, law school, med school, something like that. The testing does team seem to be, or tends to be, a little bit more pared down, a little bit quicker to get through, and it helps us to say, hey, you have ADHD, and here’s what it looks like for you. And then it’s, it’s kind of like we’re giving the next clinician, whether it’s us or they’re going, here, here’s, here’s the roadmap. Yeah, like, I don’t, I don’t understand. And we and we get it sometimes like and look, when we do executive function, I call it, we call it executive function skills training for us, it’s a combination of the coaching and this emotion regulation piece. We can kind of sort of figure it out if people haven’t or don’t want to do a full blown battery, because there is cost involved in that. Some people can come in and say, Yo, here are the problems I’m having, and we can do that however, especially for people who might have comorbid major depression, anxiety, trauma, and they didn’t talk about that with their psychiatrist or their primary care, because they just came in and said, I have ADHD. We take the time to ask that so I can give someone you know, recommendations for ADHD, but go see my my girl. I refer to people that I know, go see my girlfriend who does really, really good trauma work, because this is like pouring gasoline on the ADHD fire that’s already occurring. Sometimes you just, you can’t understand that, or see really, how somebody might decompose during a task like they would during an interview. Wow. And that the more time we get to spend with people doing doing different things, I’m not I don’t care how people do it. I don’t care about the outcome. I care about how people do it. I care about the process. And that is the magic of the assessment process. We get to see it, we get to touch it, we get to feel it, and then we get to fix it. Wow. It’s awesome.

So for someone who maybe lives in Florida and is not going to be coming to New Jersey for an assessment, like, by you, what can they

catch a flight? Like, that’s catch lights, not feelings, like, come on, come see us in Jersey. It’s beautiful, especially it’s time of year as we get into winter. Yeah,

America, we just need to set the record straight that New Jersey is actually the most beautiful state, awesome. I mean, Newark and flying. Don’t understand how important it is. It like Newark doesn’t really, that’s it. That’s a blip. It’s a blip on the radar. It doesn’t but

everything else is beautiful. Please come see us. Okay,

so how can an ADHD, or what language should they use with the person that’s going to be diagnosing assessing, what language can they use to get what you give? Do you know what I’m saying? So like, How can an ADHD or ask for. Are the right things from their clinician when,

when they are working with somebody who knows what they are doing, they don’t have to. It is our job as psychologists to ask the questions and to listen people think that like psychologists like I’m in the business of giving advice. I tell people all the time, I don’t want to give advice, because then two reasons. Number one, then I’m responsible if it’s the wrong advice. Number two, my job is to teach you how to solve your problems. I don’t want you to be my patient forever, and if you do wonderful, I love that. But my job is to teach you how to figure shit out, whatever that may be. Yeah. So I’ve gone into my own therapy, addressing my own stuff, being like, I literally have no idea where the fuck to start. Yeah, yeah. And that is, that is, it is not my job or responsibility to problem solve. It is the doctor, the therapist job. It is to to start and know what questions to ask. Because if someone’s like, Oh, you have a hard time paying attention if and if they don’t go beyond that. I would walk I would be like, I need my money back and walk out. Yeah, immediately. So you don’t, you can literally come as you are, come with the tears, come with like that. I mean, that’s how I show up, usually, to my my therapy sessions and like, whatnot. But like, that’s what I’m saying. It’s you don’t, yes, why? That’s when you come to see us, especially at our practice. Like, you can surrender. You really can, because or anyone that knows what they are doing, especially in this world of ADHD, you don’t have to, like, you can take the barb or barber the builder tool belt off. You don’t have to fix anything. That is literally our job to help give you the tools that you can then go heal thyself. Out in the real world you don’t have.

So it really all comes back to make sure you find someone who knows what they’re doing Correct. That’s just, that’s the the fundamental concept here is making sure that you, when you do your Google search, that all of the pieces are lining up. So so they say they’re an ADHD specialist, but then also their website indicates that as well. And then also, when you give them a call, they’re really compassionate, they’re kind. They give you reminders they don’t expect anything from you.

Check out their Instagram page. Like, I’m 42 like, I did not grow up in the world of social media. Social media is a bit of a thorn in my side. Guess what? Like, I have college and high school interns that help with that. I have an amazing publicist who I’m like, literally tell me how to do this. We take so much time in I did a series in the summer about, like, what to expect out of a neuropsych evaluation. So people can go watch that and listen to that. What’s the difference between an evaluation for school and evaluation for something else? We just had ADHD Awareness Month. I didn’t do as much posting because I had the flu and ammonia one at the same time. But, you know, we’re, we post stuff from, you know, constantly, we make content. We so they, you should be able to find their online presence. And by the way, you can also do a consult like we offer a want, like they can do like a 10 minute, 15 minute consult with us, just to if they want to vet us or make sure we know what they want. To make sure that we’re the right we’re the right fit for them. We offer that

as well. Yeah, okay, so when someone goes in for a ADHD consult with somebody that knows what they’re doing, they should expect to have an interview, and they should expect to have some sort of assessment where they’re, where they are, working with paper and pen in front of them, correct

paper, pencil, cell, manipulatives, computer, and they will have self report forms to fill out, which, in advance, probably, yes, you and that’s what we usually get people in for an intake within a week or so. We try, always try to, because that’s an hour and we can do that virtually. That’s easy. Why? Because when people call, they don’t want to wait. Yeah, we all know that. But why? Why do we have to wait in so many practices? Well, it depends, because if it’s an insurance based practice, they tend to be booking out because it’s insurance based and people, and I can appreciate you know that there is a substantial financial investment in this, even for our practice, like, I’m thinking right now, like, What month is this? This is November. We’re probably, like, getting people in and about the like, physical testing within three weeks. We get that intake done immediately, just so people can feel like, okay, the process is starting, because they will also have self report forms if they have parents or a spouse, just to get you know, perspective on how this person’s functioning is. A lot of the tools that we use are designed to do just that, get my information as a patient and get collateral information. And sometimes that takes time, and especially with the school based evaluations, sometimes the teachers get back right away. Sometimes we have to hunt them down because they’re, I don’t know, managing a classroom of 20 some odd kids, and they might be feeling so right, that process takes time. So we get people in for an intake right away, so they feel like we care. We’re starting the process. We get them in as soon as we can for testing, usually within two or three weeks, and they’re filling out the forms in the process. But I said, we don’t, we don’t take insurance, so I can get people in a little bit quicker, and I don’t. So the marketing, advertising piece for our practice is always tricky, because, like, you want to have patience, right? But like, I don’t like, a two month wait list, because, like, I just called my dermatologist for my daughter this morning, and they’re like, March. I was like, nice try. That’s not happening. I have a problem you right now. Do better. So I mean, we’re getting in on Friday. That was my train ride down here. Was handling that. So we’re getting in on Friday. But like, it’s, that’s just how I

anyone with ADHD who is like an adult who is finally reaching out for help, yeah, they’re struggling like the shit has hit the fan. Yeah,

repeatedly, probably, yeah, right, like,

exactly it’s hit. So it’s like, when they’re told, we can see you in the summer, there’s like, I need help. Now,

absolutely, although sometimes we have parents and like the kids, they’re like, they’re doing well enough. But like to address this comment when there’s a friendship behind that, that’s that is completely, completely different from this and and we understand that, and we get we get them, and we also know how hard, and I know this my I’ve been in and out of therapy since I was a teenager, how hard it is to make that first call, text, email, reach out to be like, Hey, I’m struggling. I’m having a really hard time with this. That that’s, that’s more than half, half the battle right there. And we recognize that by the time someone has reached out, that they have had to, you know, put their their brave pants on, and, like, make that call, and that they were probably shaking and nervous and probably for every time right before they clicked send, or they called us, they probably hung up or closed out the email or sent it in their drafts a few times before they actually did. Yeah, reach out, and we recognize that. And I saw it too, like I’m not in the business of good news, like I’m not Santa Claus, like I’m not necessarily bringing cheer when people call me, there’s a problem, and it’s our job to fix it, period, and give or give them the information that we can work together on them. Fixed,

yeah, for the record, you have ADHD. I

do. It was very late diagnosed because of masking and the the wonder that is anxiety that I tend to present with on a regular basis. But yeah, it was a therapist, as you and I were talking before the show, like I was that I was that girl, that bitch in school who had, like, the the high IQ and the in the straight A’s and the really good grades, you know, I slipped a little bit in, like, calculus and the sciences. And my guidance counselor, I was telling you, you know, told me like, Oh, you’re just not good in those areas. Well, no, guess what? Those just had multi set problems there. There were intricacies in there that just my brain struggled with. And like, I wanted to be like the next Al Roker on the Today Show. I wanted to take his job when he retired, but, or chase tornados. But that didn’t happen because I struggled in STEM and maybe that was, you know, like life saving, because I probably would have gotten, like, killed, chasing, chasing the dopamine rush. That would be a tornado, right? So I was a psychologist, but I got to college, I did my undergraduate at Lehigh, here in Pennsylvania, and I went from being like student council president, field hockey captain, great grades, to a 1.67 GPA after my first semester, because I had no idea how to study, yep. I had no idea how to organize my time. I had no idea how to initiate, like, start tasks. And the biggest thing that I tell parents, especially when kids are transitioning to college, the bumpers are about to come off, like bumpers from Bowling, like we, I don’t want to say we toddle kids, but wow. The structure that is in place for kids these days does not set them up for success in college. And then they go and they’re on their own. It’s like, sweet, here’s your schedule. Go about. And I just stopped going to class because I’m like, well, I’ll just figure. I always figured it out. But then I got an F in intro to psych, an F in intro to psych. I love it, I apparently have to go and then study for the exams. I just thought I could wing it. And then I and then I didn’t like I had friends in our in the lecture hall, like they applauded when I showed up occasional. And that was that, and kind say that was, should have been

a problem. I just think that’s so inspiring, though, to the ADHD or who is struggling, who’s paralyzed, who is watching daytime TV and scrolling on their phone and feeling like I’m never gonna amount to anything. I failed. X, Y, Z, I can’t do it. And it’s like no. When you have the right support, you can go from failing intro to psych and having a 1.6 GPA to being an extremely well educated and successful neuropsychologist,

and there were, but I still struggle with it and how I manage my time, especially now being, you know, a parent with two kids, and I’m a single parent. I actually got divorced during COVID, so it it makes it that much more difficult, and I have to have that. Many more systems, which sometimes I pay attention to, and sometimes I choose violence and I don’t, but it wasn’t even so good. It wasn’t even until I was in my doctorate that somebody even mentioned ADHD to me, the therapist I was seeing at the time I was in grad school. And it was either my, you know, towards, like, the middle, end of my first or second year, I don’t remember. And I was, you know, we were, I was working in the clinic at our school, and I had a really hard time finishing the event, like the writing the reports, the extended reports, which require a ton of working memory and organizing, and how am I putting the information together? And I was behind getting a report done, and my supervisor was like, You need to get this shit done. Yeah, and I’m like, so anxious, and I got it done, because now, now there’s a threat of me getting yelled at. The dopamine kicked in. I stayed up to two o’clock and I finished it. But the director of our program was like, You need to get your butt into therapy. And that was the because the anxiety, that was the obvious part. But my therapist at the time, it was at the end of one session we had just done like, a mindfulness exercise, and she looked at me, and she was like, Is it possible that you have ADHD? I’ll never forget this. And I was like, No, oh my gosh. Like, hell no, I’m not that kid who’s like, the troublemaker, like, what we think of when we think of ADHD, like the hyperactive kid, like, that’s not me, bitch. Get the fuck out of here. Like, and that. Like, like, I was insulted that, that she even considered me that, and then I like, over the years, I’ve thought about and I realized how much I mask and what the hype, how the hyper focus of ADHD works for me and when it works, and the the anxiety and the pressure that I always felt to like, to keep up appearances when, like, I’m like a duck underneath the water, like, I’m frantically, frantically going, and to the point where, like, just last year I started medication, took me to last year because I’m, like, I got I’m a behaviorist. Like, I want to put systems in place. Like, this is going to be great. And I was like, all right. Jess, like, Do you think maybe you actually need more, like, what the research that you read and what you talk about with families in terms of, like, what’s the gold star treatment, which is medication and therapy? Do you think maybe you want to practice what you preach here and do that? So I did, and it’s been, it’s changed a lot for me in a good way. How’s it, it has, what’s

that been like?

I mean, it’s, it’s literally, like, some like, breathing into it, like, it’s like, someone turns the temperature down on your brain. And I’m like, Oh, I can actually, like, go to my computer and, like, start a task, as opposed to walking by it and not starting a task. Like, the task initiation and transitioning from tasks to tasks is so huge, the emotion dysregulation that occurs that I always thought was, like, just the anxiety, or just my personality, or me being like unhinged, which, like, you know, maybe a little bit, but like, not to dim my sparkle or anything. But like, some of that was very directly related to like patterns that I saw in my own, in my own day to day of when I tried to get stuff done, lifestyle choices trying to do stuff, when I was exhausted, forget about it. It was literally like I couldn’t, not even because I couldn’t do it, or I had just pushed through it’s I could not do it, yep. And the meds, the meds help with that. But I will also say the behavioral piece and the lifestyle choices, and we talk about this with our patients, is huge. And I tell everyone that I work with my therapy sessions, and even when I’m doing an assessment, we put a I call it a systems check. What are you eating, what are you drinking? How are you moving your body? Are you sleeping? And like, how are you talking to yourself? How are you being kind? Because I don’t give a crap. How much medication is in your system if you’re not hitting at least three out of five of those things consistently, there is no amount of medication that is going to help with that. So I’ve been much more mindful in prioritizing how I take care of myself, so that in conjunction with meds, or if I don’t take my meds, because, like, I lift weights for fun, I love lifting heavy weights. But guess what you need to do? You need to eat. Yes, guess what doesn’t happen when I take my meds? I don’t always eat. So I’m I’m mindful about when and how I take my meds. I’m mindful of how I eat. So I can say, stay strong and sustain myself to do all the things that that I need to and want to do for fun and for necessity too. That was a lot I love

keep going. I’m loving it. I’m at a health kick right now, and my kids are so annoyed at me. I’ve changed the type of rice and pasta and bread that we eat at home. I’ve even eliminated all breakfast cereals from the house. No more Captain Crunch or cinnamon toast crunch to be found in the Carter home. It’s a true ADHD hyper focus for me right now. But one thing that I’ve stuck with, and I don’t think I’ll ever stop taking, is ag one i Kristin Carter, an adult with ADHD, have been able to be consistent with taking ag one every single day for a long time. So. It’s the first thing I do when I wake up the morning, before coffee, before anything. It literally takes me about 60 to 90 seconds to just scoop it into some cold water, shake it up and drink it. It really is so easy. And I’m traveling with my family to Indiana for the holidays. Will be staying in a hotel, eating out for a lot of our meals, and generally partaking in lots of non healthy activities, which is fine, because balance. You know what I’m saying, and I know that I can stay consistent with ag one thanks to their travel packs. I’m just going to pop six travel packs into my shaker, slip that baby into my travel bag, and done. It’s so simple I don’t even have to think about it. So I encourage you this new year, if you want to do one thing to improve your health as an adult with ADHD, try aging one for yourself. It’s the perfect time to start a new healthy habit, and that’s why I’ve been partnering with aging one for so long. And listen to this. AG, one is offering new subscribers a free $76 gift. When you sign up, you’ll get a welcome kit, a bottle of d3, k2, and five free travel packs, just like I’m going to be using over the holidays. You’ll get all of that in your first box. So make sure to check out drink a G one.com/i have ADHD to get this offer that’s drink, AG, one.com/i have ADHD to start your new year on a healthier note. I know that clinicians need to gather information about an individual’s past. So what type of information are we looking for? So when someone goes into an ADHD diagnosis, they need to have maybe some notes jotted down about, like, things that they remember from their past. Or, like, how does that work?

They don’t. I mean, look, some sometimes people do, because if, if they, if they haven’t been doing well, and if they’ve been keeping a meticulous record, which nine times out of 10, because of the issue, they’re not, yeah, but that’s also why, like, I said before, like, when we do the intake, like, this is a process that takes a couple of weeks. So like, we might ask you stuff, and they’re like, Oh, wow. Let me go, like, pull a grade, or pull a transcript, or let me double check that, and then they can get the information. So again, they don’t have to come in prepared. What we ask about, like, we’re we dig into the archives, like, we’re asking about school, we’re asking about grades, and we’re not just asking about the outcomes, but like, how did you do in school? So you might have had A’s. Like, was your locker messy, right? Did you turn those assignments in on time? When were you finishing them? Because I know, for me, in middle school, I had straight A’s, but I was that kid who would literally be sitting at my locker in between a class or before, like, finishing the assignment, and it was wrinkled, and my backpack was it didn’t start off that way. Everything was perfectly neat. My locker looked like a dumpster fire. Like I’m concerned about that. I’m concerned about, you know, when you sat down to take a test or navigate something, what happened in that moment? Did you actually start Did you did you know how to move through it? When you got homework? When did you do it?

How did you do it?

Were you able to start on your own? Did you need a parent to help you? And as you move through school and the assignments got longer, when did you start those assignments? What were you doing the 12 hours before that assignment was due? Like, that’s what I don’t want to talk about it, yeah, that’s what I want to know. Like, I have, I have, you know, we have kids in the practice, kids, young adults in the practice, who are in college, who are AP, AP students with, like, great grades, but, like, there’s a lot of work on time management and starting a task and, you know, really connecting to the to the why and the value around, you know, making healthy choices and not, you know, trying to really rewire the those neural pathways. Of, like, we don’t have to wait for the dopamine to kick in and the stress, because sometimes, like, then you get sick, like, those 24 hours or something is doomed, are not always magical. You know, time and way for things to get done, and then you end up being late, yeah. And then we, you know, I’m trying to avoid problems before they start. But then I ask people, okay, well, what happens when you’ve turned in something late? How do you respond to that? Do you get anxious? Do you depress? Does? Does the psychological piece at that point and then impact your ability to continue, so to continue to finish those assignments? So those are the lot of the things that we ask, and if it’s not starting back in, like, those, those elementary, middle school years, you know, like, what was your room like when you were younger? Like, you know, because my older daughter, like, she’s on point, like my younger daughter, like, not so much. That doesn’t mean she has ADHD, but like, people are able to talk about, you know, their differences with how they’ve just navigated information and how they how do you manage stress? What happens when you get upset? You know how what happens if you’re in the middle of doing something and you have to transition to something else? Are you able just to pick up right away? How do you manage time? Do you need, can you can you get something done in a short amount of time, or do you need a larger trunk? And what happens if you don’t if it’s not perfectly structured? Can you. Transition, yeah, things like, things like that. All

of that is so good. And then do you or do most clinicians want families to chime in? Or do they want, you know, spouses or like, I’m thinking about many of the clients that I see, if you were to ask them specific questions about their childhood. They don’t have a lot of memories. Not everyone, not

everyone does. I mean, some people do, sometimes they do. Sometimes we can get, like, just like the general gist of how things were. We do try to get collateral information from other informants, family members, spouses, when we can. But sometimes we can’t, because they might not exist, or people don’t want them in it. They’re being, like, very secretive about going for a diagnosis. So so we do the best that we can, and a lot of times people might not remember, but when we start asking, like, the very specific questions outside of, like, how did you do? Or how is this or, like, tell me about your locker or things like that. People like, oh, yeah, you know, tell me about like, were you always rushing to class? What was your like? I said, What were your backpack like? That’s that they can tell me about that

really, real quickly. I don’t have a lot of memories of my childhood, but I do have flashes of like underneath my bed, yeah, right. Like, like, what that looked like. Or I have this memory like sitting in class and looking around at everyone else diligently working, and me being like, I don’t, I don’t. What like? What are you even doing? Like? What is everyone doing right now? Yeah, so those flashes, I think are so important, right? And

that can tell the story, that can tell enough of the story and give us enough information to start to put the pieces together. And that’s what the lab is to tell your story and fill in the blanks, maybe where you might not recall, but we can combine what you know from your past with what the data from testing are telling us, and then kind of put together, you know, who you are, what your strengths are, too. Like, I mean, we haven’t talked about strengths like when, when I’m putting together, you know, recommendations or accommodations, or how I can help someone figure out how to do this thing, like, what, like, what’s working? Yep, you know, like, I don’t care just about like, what’s not working, like, what is working. If someone had asked me that, they would have realized that what works for me is when I get up at 330 in the morning to do work. Now I know so for like, a lot of ADHD, or they end up staying up late. I am not hardwired that way. You want to know why? Because my mom doesn’t stay up late. My mom has never stayed up late. I can remember when I was younger, like waking up in the morning at like, four o’clock, which seemed like the middle of the night to go to the bathroom, like she’s already up in the kitchen, like doing stuff I didn’t pick up on that until, like, the end of college and the start of grad school that, hey, just because everyone else might work better at night, guess when you work better when you are least distracted, when you are rested and there’s nothing bothering you. So there are times when I will get up at like 330 or four o’clock in the morning, and my best work will be done between four and seven o’clock when my kids get up. I wish someone had asked me that. Yeah, nobody did. So I always ask about that. Like, do you know when your good time is? Because that’s a strength that I can then work in to say, Hey, if you have a longer assignment, or, like, if you’re working on a 20 page paper, or you have a big project to do for work, and if your boss can be, you know, flex, if you have some flex time, maybe get up early. Yeah. What a novel concept. Go to bed, stop, stop trying, just stop. Because the amount of time that’s going to take you to, like, read five pages in the morning, it’s going to take you, like, a quarter of that time. So just shut the damn book, shut your laptop, go to bed, Night, night, get a good night’s sleep, and get up in the morning and be more efficient and be more responsive and less distracted.

I love it. Okay, so what are some of the ways that clinicians assess executive functions?

I feel like every question I’m like, clinical interview is a great is again, clinical interview about that, however, and again, this is where there’s a little bit of a divide in the field. As far as are self reports enough? Are they garbage? And also what, you know, again, the paper and pencil testing. We do all of that because there are specific measures that we can give that directly assess the, you know, different components of executive function. The problem, but the issue with some of those is that they’re very face valid. So the questions are getting at exactly what we want to. Like, there’s no trickery in the questions. So it’s like, you know, like, I have a difficult time managing multi step problems. Oh my god. Like, I’m gonna, you know, if it’s a scale from one to five, like, everything’s like, 555, so sometimes it’s like, Are you Are they that severe? Or is that? Just like, I really want to make sure that this person knows that I’m struggling. So there’s sometimes there’s questions of validity in there, but that’s also why we have parents fill it out and it’s real, or a spouse, and it’s really interesting, like when you see the profile of executive function from like, a person who’s not. Like that person and also may just have a different perspective versus the person who I am assessing. Sometimes they align, sometimes they don’t, but either way, that’s really good information, because maybe the parent or the partner isn’t aware, yeah, like, maybe there’s masking, or they’re just they’re not paying attention to certain pieces, or they’re just focusing on, like, oh, that person’s like, emotionally dysregulated, so I’m just gonna focus on that, but they’re not telling the chapters of the story previously. Of like, that person’s dysregulated because their working memory is shit, yeah, and they can’t manage, you know, the stressors that come with, you know, at the end of the day, when there’s all these tasks to do, and then that person kind of breaks down the paper and pencil testing, where I think a lot of the executive function magic happens. Like, again, there are tests that directly measure what we’re looking at. We’re looking at processing, speed, fluid reasoning, higher concept, abstract thinking, reasoning, visual and verbal tasks. Like we have tasks to do that. But again, for me, it’s also the process, so I might be giving and again, I have to, like, choose my words here from a test security standpoint, but if I’m giving a task in which someone might have to draw something or copy something, I’m not I want to see how they organize it. Because guess what? Organization is an executive function task, so and that taps a visual domain. Or if they’re doing that, but they’re talking it out, or oh, they say, Oh, this looks like this item. This looks like this. So now I know that, like they’re encoding information more verbally, perhaps than visually. I can’t capture that on an interview. And if they’re drawing a complex picture, if they’re trying to put it together and it’s and their approach is garbage, well then I know they’re having a hard time with visual organization. That’s actually going to have me then go back and look at visual perception, because is this an organization issue? Like, if they’re looking at a complex picture, and if they can’t figure out a way to, like, put it together that’s nice and neat, they’re just kind of piecemealing it. Or is there actually a problem with how they perceive visual information? Like, can they actually see it? And that’s above and that’s above and beyond. Like an eye doctor thing, it’s, how is the brain making sense of that information? So, like, we can go back and actually really pinpoint where, where the problem is, which is what that test is designed to do, but also the the executive function of the task, organization, time management, all of our tech, even if it’s a memory task, it’s like, or maybe if it’s not a memory task, but like any task that we would do that’s timed outside of, like a basic processing speed task, where that’s obvious if there’s a time limit, or even if there’s not a time limit, and it’s just we have to take time to note if it’s if this person is taking longer than what, what we call the normal, healthy control that the tests are designed on. Well, then that might tell me that there’s an issue with time management, and I have to figure out where and why that issue exists, and look sometimes it is related to the executive dysfunction that comes with ADHD. But executive dysfunction can also be seen in anxiety, depression, trauma, so it’s the tools that we have can be are pretty straightforward. But it’s, again, it’s we’re almost like, I hate. I don’t want to be like, We’re artists, because that I have zero artistic ability. And it would be like, insulting to an artist for me to be like, but it’s this is, this is where the another word I hate, the synergist. Synergistic is not even fucking word effect of like, the parts are bigger than the sum of the whole. So I need to be able to see that, that I can be like, Well, you had a really hard time, like, putting that together. Like, totally tell, tell me about what was going or actually wouldn’t say a hard time. I might during an assessment, be like, oh, like, tell me what was happening here. Like, I won’t give the feedback. I’m like, You did good or did bad. I’m just like, your effort is great. But like, oh, like, walk me through that. What happened here? And I feel like, oh, this was, like, really overwhelming. And, like, I didn’t even know where to start and be blah blah, boo. Then that gives me insight, not just to their ability, like some of the visual skills, but also, you know, an executive function skill, for example, I memory test, I could go on and on, but like, we see that in memory tasks, yeah, again, test security, but if we’re giving you information that I need you to then give back to me. How are you and how are you encoding it? How are you remembering it? Because some of those tasks break. Some of those tasks, there’s there’s secret to it. Can Can you figure out how to hold on to that information in a way that is more efficient than not? Because that’s not a memory issue, per se. That’s a learning issue and an encoding issue, which is more related to attention and executive

function. It’s fascinating for you to describe what you’re looking for during the process, because I think that snapshot in a test setting is so indicative of our life, where it’s like, I may have completed the task, but what was the process like? I may have cleaned my room, but what was the process like? You know, like I may have done the thing, but at what cost? What did it cost me? What was the process like? So it’s so interesting how you’re describing that. In a clinical setting, but it’s a perfect snapshot for our life. Like, yes, I finished grad school, but like, at what cost was I burnt out? Was I pulling all nighters? Was it the same? Did I have to work the same amount as my peers, or twice as hard, you know? And so I just, I love that you’re describing that in a clinical setting. I

mean, if anyone feels bad, like I have a chair in my bedroom that has laundry on it, because I struggle with putting stuff away and organizing and like the the little tasks of of clicking and the multi stepcast, forget about it. Like I my calendar is my Work calendar is very good, because again, Jackie, I love you. Um, helps with that. But like my and I’m, like, I said, I’m divorced, so like custody, and I don’t have a straightforward custody schedule, so every other week it changes, but then every season, my kids sports change, and CCD and this, and whatever bullshit is on the calendar, I don’t even know. I get to the point where, like my I know my calendar is not updated. I rely on my quasi garbage working memory to think about it, because the idea still of sitting down and putting that stuff on a calendar sometimes is really difficult, unless I am using my strategies that I teach people of mindfulness and pause and put it in and because what’s the cost of not doing this and taking the time to do it? Or if I can’t do it right now, I will send myself a reminder. Or if it’s something that’s like, work related, and I can forward to, you know, Jackie, and please put this on my calendar so I don’t screw up. And by the way, I screwed up an appointment even coming here today, I and she was fine. I’m going to see her tomorrow. And but, and like, you know, it had, and a lot of those lay the whole race and compassion around this, because even though, like, there are a lot of fancy and quite expensive paperwork on my wall that says I know what I’m doing, I’m also human too, and I am susceptible to the same issues and struggles, and people think I have it together. And like I said, one crappy day from what feels like sometimes everything falling apart. And yes, and I would also tell people that you probably have it more together than you think, and if you don’t like maybe that’s okay, and we can help bridge that gap and help to figure it out. Because, like, my goodness, nobody, nobody has it fully together. Yeah, we think everyone is doing it better than us, and if they are in one area, awesome. I celebrate in my group of mom friends, there is one mom who is so on top of our calendars and scheduling and scheduling mom dates and dinner, we’re going out to dinner tonight, and I’m just like, how blessed am I? Yeah, to have you because I don’t know shit about what’s going on, or who’s got to be where, or like, no. So, thank you. So, thank you. That’s not my strength. Like, I’m going to send you like, the the dupe for this leotard I got on Amazon for today. Like, that’s my job. I do skincare, and I do hair and I do the nighttime pickup because I’m at work, but y’all do everything else. So I think part of it too is like, you don’t have to be able to do everything. Well, what are your strengths? How are you gonna and how can you contribute to society in your own life in a

good way? You make such a good point like bringing in community. Aspect of all of this is like, when you don’t have a community, you feel like you’re the one that has to be good at everything. When you do have a community, you can celebrate other people’s strengths and lean on other people for the areas that you’re weak, and then allow others to lean on you in the areas that they’re

weak. Yes. And I think for ADHD years, it’s a very slippery slope, because you have to ask for help, yeah. And sometimes that’s really hard. My probably, you know one of my again, and my mom friends in town, she yells at me on a regular basis, yells with love like Jessica, ask for help, please.

And I still want to vomit hear that. I need

to hear that because the guilt and I have I have screwed up. There have been substantial consequences for me not asking for help, nothing. I haven’t been able to get myself out of but like, my god, like we can do a whole different podcast, yeah, but like, the consequences not of not letting people know that, like you’re in trouble or you’re struggling, because people think that your life is a certain way and think that you’ve got it together, and now you’re dealing with the anxiety and the stress and the pressure of living A life that you think is that while literally, it could be falling apart in in in maybe sometimes even some pretty unsafe and dangerous ways, you know, like it breaks down to that and letting people know you know that they’re not alone. And how can we problem solve? How can we find community, whether it’s a support group, whether it’s you already have supports and things in place? How can you connect on a social level, like, forget about the ADHD supports, like, what’s good in your life right now? Like, where are you having fun? For crying out loud, because of that, let’s get some of the good stuff going and the purposeful and the meaningful connections that might alleviate some of the heaviness that can come with a. Just living with a disorder like ADHD.

So good. Okay, you, you mentioned the divide in the clinical space, and I want to nudge that. I want to poke at that a little

bit. I’m trying to remember what I what are the Well, here I have a great question for you, which

is, what are the what pet peeves do you have when it comes to the way that some clinicians choose to assess? Like, how? What things are you like? I wish I could change that, and I don’t want to get you in trouble. I want to get you in trouble. Oh, my God, you know what things do you look at

people need to stay the fuck in their lane if they don’t know what they’re doing, refer out.

Refer us to just close in prayer and be done there. I

mean, that’s so good. And that just, I mean, that’s across the board. Yeah, I agree. That is one of my pet peeves, is when and look like I run a business, like, I need to make I need to make money. I need to know hens me and I’m a single parent too. So like, I feel that pressure even that much more. But like, I’m also not interested in making money. I don’t know someone on my team doesn’t know what the hell we are doing. Now there is a reasonable sometimes, like, Okay, I know enough about this that I can get supervision and consultation, because maybe there’s nobody else in my area that can do it. Like, I’m trained in rehabilitation medicine as well, so sometimes I get really interesting referrals from patients who might have had, like, an amputation or this or that, but like, it’s a younger kid, and I personally like working with, like, late middle school might be the youngest I go, but like, I curse in session. So like, if you’re not down with that, I’m not your patient, but I’m really but I’m really, or I’m not your doctor, but really, high school up. But like, if there’s nobody else to do it, I will take it and I will get consultation, because I can do the medication, the medical management around this medical rehab piece, but I don’t work with kids all the time, but I can get that consultation. But if a referral comes in and it’s like, oh, this person, it’s they have ADHD and possibly autism. If you have not taken trainings in autism, gotten supervision in it, refer out no amount of money is worth. Number one, a patient’s care, and number two is your fucking reputation. I didn’t go to school to to have that be tanked, but you would be surprised how many people don’t stay in their lane. That is a huge pet peeve of mine, just because, and people think also because you have a doctorate that you know everything, everything about everything I don’t, and I’m very clear about that, right? I’ll never forget, I had someone in my offices when I was a baby. Clinician recently licensed. Someone asked me about the criteria about borderline personality disorder, and I was like, Oh, I don’t know them off the top of my head, like, I literally pulled out my DSM session. We’re going over them. And this is a very like, high powered executive. And he looked at me, and I’m like, oh shit. Like, I just gave away the fact that I don’t know. And he said, Thank you for admitting that you didn’t know the answer and not trying to BS me and make something up. So, and that always sticks with me, if you don’t know it then, then don’t do it and refer out huge, huge, huge pet peeve of mine, because it discredits what we do. There are enough people out there to think that, like, what we do is a soft science relative to physicians or psychiatrists, but they need us, yeah, because we give the flavor to the diagnosis that they can’t.

So this really speaks to, you know, being very mindful in your Google searches and looking at websites, because it is very easy to say, I work with people with ADHD when you’ve never had training or specific like you haven’t had ADHD experience and you don’t really know that much about it, and so figuring out whether or not your clinician has expertise is very important. Yes,

and like I said, they’re if they’re not offering you a consultation, if their website’s not easy, if they’re if there are just certain processes that aren’t necessarily built in from that first contact with your practice, like there’s the first hint, or if their Psychology Today profile literally has, like, everything clicked that

is so annoying, because when I go and I look for clinicians, either for myself or for my kids, and they’re like, I specialize in this, this, like, autism, borderline boo, it’s just like, you know you How is that possible?

I mean, I have this conversation with a colleague of mine who is a perinatal mental health professional. Her practice is near mine. I have patients in my practice who are pregnant, who have young kids and they might, and there’s, there’s, I’m seeing them for something unrelated to that, but like, oh, they also like, are, you know, incubating babies and birthing babies and doing all of that, but like, if it’s a perinatal mental health issue, if it’s please, please, please, call my colleague Kara, like you’re not dealing with that. OCD is another one, and I worked in an OCD clinic. I won’t treat hardcore OCD. I do have some OCD patients in my practice because I know how to do it. But if it’s something that’s. Really, really, really severe. I will rule it. I will send out for that. Yeah, same with eating disorders. I have patients in my practice who I treat some of the emotion dysregulation around that. But if there’s an acute issue, I’m not the one. You don’t you don’t want me. Yeah, you don’t want me because I don’t know what I’m doing. Yeah, not supposed to, because you’re not an expert, and not supposed to. Supposed to be

so red flag when a clinician says that they are an expert in everything or or has a list of like, 10 things I’m gonna I can do this and this and this and this look. And there’s

also a difference between, like, being sensitive and having a safe space. I’m thinking for patients who are like, who are LGBTQIA plus, yeah, I have patients, you know, who identify with that in my practice. Yeah, I am not an expert with that. Sure. One of my friends, Matt, who went to high school with and he’s, he is such a doll. He lives in LA he works that population. Guess who I call if I have an issue, I call him or we just don’t take those patients on in the first place, unless it’s something, again, related to something else, right? And that’s a supporting expertise that you that I exactly that I need to be sensitive to as a well trained clinician. Or, like, I don’t. I have not. I’m like, I gotta double check my profile. It’s like, I there is a it’s a tricky way, though, to communicate, like, How is this a safe space for this? But I’m not an expert in that, and that is one of the issues with some of those, like websites that are like, find us, find a therapist. Click, click, click. So I will say that, you know, there might be some people who are just trying to say, like, I’m sensitive and I’m aware of these things because the cultural competencies in not just therapy, it’s in assessment too. You know, like, what are the norms around certain populations? COVID is a huge one. We’re looking at issues of ADHD and reading issues, especially like in kids who missed two years to some extent of education. So like, we need to take that into into account. But I’m not an expert in that. If someone is saying that they’re an expert in everything, go elsewhere. Run.

My last question for you is, what do you think about imaging to look at ADHD,

we’re getting there. We’re getting there. Say more.

I don’t we knew one of us was going to hit the mic, so that was with me,

the imaging piece, you know. And I think you had also, like, talked about this too, like, in terms of what we we use. Did you mean that in the context of, like, do we use that in terms of how it’s informing the assessment practices, or like tools that we might use during treatment, or, I

mean, more of it in the assessment process, and so like process brain imaging to assess for ADHD,

you know, we don’t, and it’s interesting you say that, because that’s one of those things, like, Should we be having people do that beforehand? And we’re, we’re learning a lot about what the brain is and what it isn’t and what each imaging tool can do. I feel like that would be like a whole other podcast. We don’t require it as a, as a as a part of the assessment process, if there has been someone who, like, might have had a concussion, or there’s other things going on. Sometimes we have that, but I, I, I don’t think that we necessarily need it, per se, in order to be able to answer the questions that we because sometimes it’s like, okay, well, that might be another, another hurdle. You have to go to a neurologist. You’ve got to get the prescription, you need to get the test. We need to get the results when the at least my my standpoint, is that the the assessment process is sufficient to be able to get to what we need. But like, now you’ve got me thinking again. Talk about, like, not being, like, a full expert on, like, the neuro imaging behind ADHD, although my one colleague, Dr pojoli, she might, she honestly would be better person. Now I’m going to get home, or train on the way back to the person and be like, Girl, like, let’s double check this. Like, are we not? Do we need to, like, require this as a part of you know,

and how is that in development doing in science right, to be able to see the brain and to be able to compare and contrast, like, what a healthy brain, or a typical brain,

normal, healthy control, yeah. I mean, again, and that we’re looking at, like an fMRI, like we’re,

I mean, how hard would we have to make it for for an 80 year? That’s

right. The problem, it’s not an x ray, you know, X ray MRI is going to look at the the structure of the brain, yeah. But we need to look at, you know, the again, like what an fMRI, or even like a PET scan might look at, and in terms of the, you know, how certain neurotransmitters of the brain and parts of the brain are, quote, unquote, lighting up during certain tasks. I don’t, and not everyone’s insurance might approve that. Like, there are whole other things that’s that’s a feeling

we’re headed in that direction. Or, like, do you get a sense that that is something that clinicians are like, thinking about and wanting to I mean, like, I said, I’m literally going

to be on the train being like, is this something you need to put into my practice? Is a great question. Um. Um, I think, and a well informed clinician and business owner needs to not only be aware of, like, what is going on in the imaging world. I mean, like, I can speak to this, especially with Alzheimer’s, like, you can’t certain disorders, like, we can’t look at the imaging and be like, Oh, that’s that. Like for Alzheimer’s, we can’t confirm that until death, because we cannot biology, the brain and an MRI is going to show us how certain parts of the brain, like the hippocampus is one, are decomposing, but it’s not telling us why. It’s going to rule out a tumor. It’s going to rule out a stroke, but one of the things that we do ask about during the intake process is again, how long have symptoms been going on? Are they chronic? Are they acute? There have been times that I’ve told people, you need to go for imaging right now, because if there’s been a sudden onset of symptoms that’s impacting functioning, then I want to make sure that there’s nothing going on neurologically that would be potentially informing and explaining why I’m seeing what I’m doing. So it’s a fine line between, I think, although, like, I said, I’m gonna go home and, like, looking this up, like, do I need it out? Because I don’t. Well, I mean, again, a, I think a good clinician is always under like, saying, like, oh, okay, well, do I need to be doing that? And like, staying on top of things. So if I attempted to answer that question, I was bullshitting you. And be like, my DMs are gonna blow up, being like, you know what the fuck I’m talking about, but I’m like, You’re right. If you were asking me about that as a patient, like, how do you feel about that? Might be like, You know what? Like, we don’t do that because of our methods are in place that we can, you know? We can get to the question and imaging it’s not necessary, and it could potentially be a barrier to care, because there’s cost in all this time, and that’s going to waste time, and I want to get this answer. But you know what? Like you might be on to something we’re talking about that in my next staff meeting with my team, to think about if and if we needed to, how to go about that. So kind of that the fascination of staying in your lane. Like, yeah, if I had the perfect answer to that and I could rattle it off, I would have given it to you, but, yeah, but I know. I just think it’s so, so fascinating how much science is advancing, and how we are learning so much more about ADHD, especially in adults, and the assessment process, the treatment process, yeah, stuff. I know that I just Dr Barclays come out with this. He just, I saw some videos with his and some of his research on, like, how we’re looking at the use of nicotine and how that can help me, because we know that there’s addiction with ADHD in that, right? But can we break down the nicotine molecules to help with treatments? And, like, right now, we can’t, because when we separate out the molecules, the part that’s the addictive part, fucking helps with ADHD. Like, give us a break, for crying out loud, like it’s hard enough.

This is why, though, so many people with ADHD are addicted to nicotine, because it actually does helps. It does.

I have patients. I’m like, Oh, how’s like, our my favorite, sometimes I’ll have all patients, they’ll be like, I think my feet fell out of my pocket, and it’s like, in the couch. I’m like, maybe we can stop doing that. Like, you know, so again, yeah, but, but, you know, the work that we do, it’s not just, you know, I joke with my patients. I have a dark humor. They know that. But instead of being like, you know, there are conversations about, maybe we can stop. How do we stop? Can we think about curtailing some of these habits that might be helping with the ADHD, but sure, shit aren’t helping your body totally. But we also have a lot of conversations about, how can we get you working out, what’s your, what’s your, when was last time you ate and are you eating protein? Are you? Are you eating the right things?

Yeah, do you?

Do you drink enough water? Like, I would rather focus on some of the stuff that is might be less resistant to moving and that I might be able to make them being like, you need to put down the cigarette, like, unless it’s at the point where, like, it’s an acute problem, right? Like, the

foundation and the basic needs. Like, I feel like, for adults with ADHD, we just need to freaking meet our basic needs. Like, have you eaten anything from that? And

I need to meet people where they’re at if they’re not ready to give up certain things again, unless it’s, like, acutely impacting their functioning. Then let me meet you where you’re at, and we might get that through, that we’re gonna get there together tools

to know that. Thank you so much for being here. This has been so fun. Tell us where we can find you. Tell the people all the things, because after they listen, they’re gonna be like, Who is this woman? I need to go find her.

So we our website is elements psych.com the name of our practice is elements psychological services. We’re in northern New Jersey and Montvale New Jersey, right around the corner from the Wegmans. So we’re local, if you know that. And we’re actually gonna be opening a second location in Morris County, so a little bit more central, hopefully in 2025 because like we love it. We love a challenge. You can find us. You can google us. That’ll bring us. Bring you to our website. We have an Instagram page which is elements underscore Psych. And then I have my own professional page, which is dr, doctor, dot, Jessica, dot McCarthy. Love all together. You can find us there. We will

link all of that in the show notes. Yes, thanks

for being for me. Feel like I represent my practice and everyone. So have us me fall down here. Good.

Kristen Carder 1:10:09
Hey, ADHD er, I see you. I know exactly what it’s like to feel lost, confused, frustrated and like no one out there really understands the way that your brain works. That’s why I created focused. Focus is my monthly coaching program where I lead you through a step by step process of understanding yourself, feeling better and creating the life that you know you’re meant for. You’ll study, be coached, grow and make amazing changes alongside of other educated professional adults with ADHD from all over the world. Visit Ihaveadhd.com/focused to learn more.