(upbeat music) - And welcome back to "Family Health Matters."

I'm Shelley Irwin.

With me today, Dr. Julie Smithee, licensed psychologist at Pine Rest Christian Mental Health Services, Dr. Tamara Rosier from the ADHD Center of West Michigan, and Margaret, we'll call you Maggie, Meister, therapist at Telebehavioral Health US.

We'll take that apart.

I'll stay with you, Maggie.

Tell us about how you're involved with this subject.

- Yes, so I am a limited licensed counselor at Telebehavioral Health US.

I see children, ages six all the way up to adults with ADHD and various other diagnoses as well, but primarily ADHD.

It's outpatient therapy, it's individual, but we also tie in parents in the setting as well for therapy.

- Are you working strictly via screen, or are we one-on-one as well?

- [Maggie] So it is virtual therapy only.

So telehealth, and parents will join in on camera as well.

Sometimes they will start with just the child, and then parents will jump right in with the ending of the session, last 15 minutes, with any concerns, and we'll kind of go over what we talked about in the session as well.

- [Shelley] Thank you.

Dr. Smithee, share your expertise.

- I work, I'm a licensed psychologist.

I work at Pine Rest in doing primarily assessment and diagnosis of ADHD.

So we see ages young through adulthood and work to identify and diagnose ADHD in individuals that are interested in pursuing that.

- Yes.

Are you busy?

- Very busy.

- Yes, lending us to the need for this conversation.

- Dr. Tamara Rosier, we'll add author to your list.

Tell us about you.

- Well, I founded the ADHD Center of West Michigan, and I founded it because I was an ADHD coach and I got lonely because there was so much to do.

So when people get diagnosed, they're like, now what?

I'm diagnosed, or is medication my only option?

So there's so many options.

So at the center we have parent coaches, we have academic coaches, we have highly trained therapists who work with ADHD.

And I'm trying, I'm forgetting someone, and my staff is gonna yell at me, going, "Why didn't you mention us?"

But I have a highly trained staff, and what we like to do is come around the entire family and give support.

- Tell them the host said you had limited time.

That'll take you off the list.

(group laughs) - I had limited time, guys.

Sorry.

- No, no, no.

Dr., we'll call you Dr. Tamara, coach versus therapist.

- Therapist.

Yes.

- Before we get into the details, we'll go with you, Dr. Smithee, what's the difference?

- Yeah, there's a big difference.

Licensure is one of them.

ADHD coaches are trained in ADHD.

We don't treat ADHD.

We walk beside our clients, and usually it's almost like we're saying, "Hey, I've been up this ADHD mountain before, and I think you could use some help."

And "I can't climb the mountain for you, but I'll walk with you, and I'll be your Sherpa as we climb it together."

And so that's kind of the picture of ADHD coaching.

So we build skills, we build capacity.

When you have ADHD, we'll get into it later, but there's motivational issues, there's task issues that are very difficult for those with ADHD.

- Thank you.

Yes, we will discuss that.

And we'll go back to you, Dr. Smithee, on the general definitions.

Tell us more.

- Unfortunately, I think this can be confusing for people because we've changed the name of this disorder a few times.

We used to call it Attention Deficit Disorder, ADHD, with or without hyperactivity.

Our current nomenclature is attention deficit hyperactivity disorder.

So that's where we get the ADHD.

But we have varying presentations.

And there's two categories of symptoms that we're looking for in ADHD, difficulties with attention and focus, and then hyperactivity and impulsivity.

And these are things we all deal with from time to time.

So we're looking to see does the individual have more difficulties than we would expect for someone of their age in either or both of those categories.

And that presentation tells us which category of symptoms they have.

So if it's predominantly inattentive presentation, an individual would have more difficulties with the inattention symptoms than hyperactivity and impulsivity.

There's a predominantly hyperactive impulsive presentation, where someone is presenting primarily with hyperactivity and impulsivity.

And then we have what we call the combined presentation, where an individual is struggling with symptoms in both of those categories.

- My question for all of you, how early are those symptoms presented?

You work with children.

- Yes, children.

So I would say anywhere from like eight to nine years old, as some of the cases I've seen for both combined typed and inattentiveness.

So, it could be either one.

- Back to more of the diagnosis.

One of your books, "Your Brain's not Broken."

Is this a mental disorder?

- It is not.

Thanks for asking that.

- I say that because that verbiage is still out there.

- Right.

And so my first book was written to all those people that I'll never meet, the clients who are just sad because having ADHD, there's an emotional dysregulation component to it.

And so I want people to know their brain's not broken.

It's a neurological difference.

In other words, I have ADHD, my brain is wired differently.

It processes information differently.

It interacts with my environment differently.

- Is this a genetic issue?

- Highly genetic.

- Tell us about this.

- So when parents have it, they will have a high likelihood that there's a child running around in their family who has it.

And I think Maggie alluded to it, sometimes we will assess children for ADHD, and then the parent will sit there and go, "Oh, that sounds familiar."

And then one will try to rat out the other, going, "Ask him.

Ask him."

So, it's highly hereditary.

- Yes.

And let's stay on that topic.

I'll go back to you, Maggie.

If an adult is worried that there could be some diagnostic need, should one follow up?

- Yes.

Oh, of course.

So we would definitely want to make sure that we get a referral to a neuropsychiatrist to make sure that they are thoroughly evaluated.

We wanna make sure we're not missing any other diagnoses.

We wanna rule out other diagnoses that could be underlying issues that we may not be seeing or presenting yet.

- [Shelley] Yes, Julie, expand on that.

- Unfortunately, those two symptom categories, the inattention, concentration difficulties, and the hyperactivity impulsivity aren't exclusive to ADHD.

We see difficulties with impulse control in a variety of mood disorders, behavioral problems, concentration difficulties are not uncommon in people that have depression or anxiety.

So we want to make sure that we've ruled out any other cause for those disorders.

But we also know, especially in adults, there's very often co-occurring disorders.

ADHD, unfortunately, doesn't usually travel by itself very often.

There's another, usually depression or anxiety, that we want to make sure we're identifying and treating as well.

- Could I add something here?

- You can.

- Back in the 1980s, and I think you guys will agree, this was known as the naughty boy disease.

- The naughty boy disease?

- Yes.

- And I'm being a little bit tongue in cheek here, but it was those boys who couldn't sit up straight in their chair, who ate the glue, and if you grew up in that time, you're like, "Ooh, I don't want ADHD."

Because there was an idea that you had to be dumb to have ADHD.

And I really wanna make a point of it has nothing to do with IQ.

One of my niches as a coach is I work with high-IQ people with ADHD, and it is really hard to have this beautiful Ferrari brain, it's stuck in just a junker of a car.

And that's what I do as a coach to help them.

- Nice.

- Right.

- Let's move a bit into treatment.

First of all, cure versus control.

- Yeah, it's not- - Is that a fair question?

- Yeah, so it's something we have to continue to live with with the rest of our lives, right?

But it's something we can cope with.

We can have coping skills.

We give our clients the tool belt to use of coping skills.

So we wanna work on that impulsivity and decreasing those urges.

We wanna work on how do we prioritize what's needed to do first, the organization skills.

Those are things that we wanna work on with our clients and making sure that we give them the tools they need.

The hard part about ADHD and the parent issues that they're having is one thing works one week, but it may not work the next week.

So we're constantly interchanging things with them.

- What happens after your diagnosis?

- We're exploring different treatment options.

I see part of my job as part of the diagnostic process is to educate parents about the fact that we're diagnosing you with ADHD doesn't necessarily require you to be on medication.

And I think that's a fear of a lot of parents that they don't even wanna go through the process of diagnosis because they've decided they don't want to put their child on medication.

But my job isn't to do that.

My job is to get a good accurate diagnosis and explain that there's a variety of treatments.

It doesn't, medication is one treatment option, and it can be effective.

But we like to say we need to build those executive functioning skills, planning, organization, time management, emotional control.

- Yes.

What do you add to this?

- I don't quite agree with the executive function building.

I have ADHD.

And so I'm gonna nerd out for a quick second, but I'll come right back to you.

And you guys already know this.

If your viewers kind of tap on the front of their head, that's where your prefrontal cortex is.

And part of the problem, part of the problem of having ADHD is you don't have reliable access to your prefrontal cortex.

That's kind of a problem because that's where your executive functions lie.

Planning, organizing, I don't know, thinking ahead, reading emails to plan on how to get here on time, all those things.

- You did a good job with that.

- Thank you.

I needed that point.

- Yes.

- By the way, we respond well to positive feedback.

- Yes.

- But anyway.

- And I don't wanna go away, but those are your challenges.

- Those are my challenges.

And so something I do, if I'm medicated, yes, work on the executive functions because now I have access to my prefrontal cortex.

If not, we have to really rely on the person hacking their brain.

So the limbic system is quite overused when you have ADHD.

That's the seat of emotions, which means when Maggie referred to, sometimes it doesn't work.

That's because sometimes the client's like, "Yeah, that doesn't, I don't like that anymore."

And so as a coach, I try to tap into emotions, helping them use positive emotions, but helping them use a planner doesn't always work.

- Right.

- Unless you're appropriately medicated.

And I guess I'm asking parents, like, stop asking your kid to use a planner if they're not medicated, but they can do other things, right?

We can hack it in another way.

- [Shelley] Yes.

And ultimately, you work with your provider, and you make your decision.

- Right.

Yes.

- Mm-hmm.

- Well, and for people that, for whatever reason, can't take medication because of other medical issues or other medications, we want them to understand that there are still things.

Maybe it's putting the correct supports in place at school, at home.

- That's a great point.

- I think that's important too.

- Right.

You can have an IEP at school, which is individual plan for them.

There's a 504 plan, right?

These are things that you put in place for testing.

You know, you're getting the written and the verbal instructions for the student.

They are allowed breaks, they are allowed to have fidget toys.

These are things that they are allowed to have access to.

- That's because ADHD is very sensitive to environment.

If I were left on an island to survive, guys, I'd rock it.

Like, I'd be so good at it.

I'd use coconuts to communicate with people.

Like, I could do it because my brain's wired like that.

My brain's not really wired to interact with modern society very well because it's very focused on the prefrontal cortex.

And so we have a lot of times ADHD people can be gifted.

It's just their environment isn't matched well with them.

- Yep.

But this world lives in this time.

- And yes, I have to show up in a modern world, right?

- Yes.

- [Shelley] And you're doing it well.

Book number two, "You, Me, and our ADHD Family."

So you put it out there.

- Yeah.

This was a personal project.

This is for anyone who finds themself in an ADHD family.

The first chapter is called "Welcome to the Goat Rodeo."

And I confess, I don't really know what a goat rodeo is, but I imagine that's, you know, what my family would look like is a goat rodeo.

And so the book really helps family members learn how to communicate better and ultimately love each other better.

- Nice.

Back to you Maggie.

You mentioned the child and the school involvement.

What about being stereotyped as the kid with the ADHD?

Where are we with this?

- Yeah, this is hard, right?

Like she said, right?

This is the one that is like bad behaviors.

This is why some kids go undiagnosed, right, before nowadays because females presented differently, right?

So boys were a little more louder.

They were the climbers.

They were ones that were disrupting, right?

Females were maybe the high achievers.

Females were quiet, they could sit still, right?

But they were inattentive, they were daydreamers, they were not following directions maybe.

So being outcasted and like put into a different room never helped these kids, right?

So we needed to be able to socialize because that is an issue, right?

Relationships is a challenge for people with ADHD as well.

- Yes.

Well, speaking of of kids, here at WGVU, of course, the PBS provider, "Carl the Collector," PBS Kids' newest series about a warm-hearted raccoon will be its first, of course, led by a character on the autism spectrum.

We'll talk about that and perhaps the animated TV show.

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It's a series that's geared toward kids age four to eight, featuring a cast of diverse characters alongside a production team of neurodiverse and neurotypical writers, advisors, and voice talents.

Let's check out a peak, a sneak peek right now.

- [Speaker] PBS Kids welcomes "Carl the Collector."

- Hello rock collection.

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- My bouncy ball collection.

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- We made you this friendship bracelet.

- For me?

- [Speaker] So add "Carl the Collector" to your collection.

- What's more important than a collecting mission?

- Let's go.

(upbeat music) - "Carl the Collector" premieres on WGVU HD and our PBS Kids 24/7 channel on Thursday.

You'll never get any sleep.

November 14th, thanks to our presenting sponsor, the Hope Network Center for Autism.

Glad to offer you a 24/7 role.

I'm gonna, because this is autism, we're mentioning neurodiversity, spectrum disorder, who wants to answer the question of are we part of ADHD?

Julie?

- And we'll nod to you.

- Yes, yes, yes.

- I think there's, at this time, our diagnostic manual has two separate diagnostic categories, one for autism spectrum disorder, one for attention deficit hyperactivity disorder.

However, the research suggests that they co-occur very frequently together.

And I think it was the conference that you and I were at recently where there's some people kind of exploring the idea.

Is this on the same, are these disorders kind of underlying, genetically very similar, but with different presentations?

And I think we're just beginning to explore that.

- My guess is in 10 years, ADHD won't be called ADHD, which is unfortunate.

I'll have to rename the center.

But it will be called something else because our understanding is growing.

We can see the brain, we can see through FMRIs and other images of the brain.

- FMRIs?

- FMRI.

Yep.

- MRI, gotcha.

- Yep.

We can see what's happening in the brain.

So we can see ADHD, which means this whole world has opened up.

We understand so much more.

So now we're asking questions of, "Huh.

This seems familiar."

A lot of us with ADHD also have dyscalculia.

I always have to take a running start at that word.

- DYS?

- Yes.

It's like dyslexia with numbers.

Dyslexia, dysgraphia, and all the other dyses.

The problem in the prefrontal cortex seems to also affect those dyses.

- Yes.

In person versus what you do, obviously a new world we live in.

- Yeah.

New world, right?

And so we were doing this before Covid hit, right?

So, company had found a new link that people are actually more comfortable at home.

I have found that my clients actually open up to me a lot more on the comfort of their own couch.

You know, we will say, our saying is, "Same therapy, different couch."

And they actually will open up more, kids are excited to come to therapy because they don't have to leave home.

They don't have to get in the car after school.

They don't have to spend an hour in an office, right?

They get to turn their computer on, sit on the couch with their toys, talk to me while they play.

And sometimes we get to interact by drawing together, playing toys together.

So it's really made a huge difference with the comfort level of therapy, I feel like.

- And you get to see their pets and their different things.

(group chattering indistinctly) - Yes.

- Yeah It's definitely opened it up a whole new world to therapy.

- [Shelley] Nice.

Julie, on that note, your diagnosis, and then do you start, or it may be a question for all of you.

When does the caregiver, when does the family be brought into the conversation?

Perhaps the parent doesn't have ADHD, and this is totally new.

- They're our primary source of information when kids are coming in and when adults are coming in.

What we know is that this is a neurodevelopmental disorder.

So there has to be, one of the diagnostic criteria is there has to be evidence that some of these symptoms started in early childhood.

So even though someone may be in their thirties when they're coming in for an assessment, we're going to be asking about childhood to see were you having some of these difficulties early on?

Because that's really, I think, a core piece of what the disorder is.

- Yeah.

And Dr. Rosier, I wanna go back to you on your personal life.

I mean, is it, are you in the, I mean, your kids are probably older, or not too old.

- They are.

Yeah.

- Are you managing?

- [Dr. Rosier] Oh, quite well.

So, I wrote the book, my second book about ADHD families, because we're finding, even though it's not in the DSM, emotional dysregulation is a hallmark of ADHD.

- Hmm.

Expand on that.

- Yes.

It means we have big feelings, and those are often our motivating force or demotivating force.

Now let's say, what was I trying to do today?

Oh, I got signed out of my email, and I'm like, "For crying out loud, I'm signed outta my email.

What's my password?"

I'm like, ba ba ba.

And my brain immediately latches onto frustration.

And if I'm not careful, ooh, that can spill on my family.

Right?

And so I wrote this book because so many families are really dealing, I mean, sure, the goat rodeo is about lost keys and all that stuff, but a lot of it is emotions spilling on each other, and the chaos that happens because of it.

And it's not just children who have meltdowns.

- No.

- It's grown people who I work with who are very smart, who are lawyers and doctors and a couple surgeons who still latch on emotionally.

- Yes.

- So our family, yeah, it's been tough, but we've grown through it.

And last, as I told you earlier, last weekend was a wedding.

My husband and I just sat there.

We were just so moved because you could feel the love between the bride and the groom, but also just among our family.

Like we're a good family.

We're not a perfect family.

- Yes.

- But we figured some things out.

- Maggie, your therapy, is it three times a week for six weeks?

Is there an end game?

Is there homework involved?

- Yeah, like I said, we meet the client where they are, right?

So it's what parents need, it's what kids need.

It's what the adult client needs.

Once a week is what we try to do, at least for six weeks when I'm meeting someone new.

I wanna develop that rapport.

I want to establish good boundaries and understanding what they need and setting that goals and those treatment plans.

And then from there we gauge like, how are you doing?

How are things going?

Like what do you need, you know?

And then we can space it out if they're doing well, right?

Sometimes we go down to like every other week.

Then we can space it out if they're still continuing to do well, once a month.

And you know, eventually the goal is that they get back with us as needed, right?

So with medication and therapy, I feel like it's the best combo.

- My clients are like, "All right Tamara, I know what you're gonna say.

I haven't been getting enough sleep."

- Yeah.

- Yeah.

- It will make our symptoms worse.

There's something magical, and magical means research-based, that we don't completely understand about ADHD people being in nature.

- In nature?

- In nature.

Yes.

- Green eyes.

- Outside.

- Let's get out in nature.

- Get outside.

And sometimes I will say, "Let's pick up your computer.

Go outside."

So just a quick side note, those of us with ADHD, the easy things in life are harder for us, and the hard things in life, well, those are interesting.

I'll just do those.

And so it's the easy things we tend not to do well, and that's one of the paradoxes of having ADHD.

- Yes.

- Like sleeping, eating, and drinking enough water.

- I think, I mean, I always put in my recommendations, regular consistent sleep and then consistent exercise.

Because we know those are all related.

Like the better you sleep, the better you can focus.

The more you exercise, the better you sleep, the better you focus.

- Again, information for all of us.

Margaret, we'll call you Maggie Meister, on behalf of your Telebehavioral Health, leave us with some good words, and how do we find out more information about you?

- Yeah, find out more information.

You can reach our website at telebehavioralhealth.us.

You can request an appointment at a request appointment form, and then you can check a box for Maggie Meister for anyone who needs ADHD therapy.

- [Shelley] Yes.

What do you leave us with?

- It's never changing, right?

It's ever changing.

All the time.

So we're always constantly researching this field.

We're trying to break the stigma, each and every one of us.

Right, so just seek help if you need it.

And first, if you even need to start with your primary care, a teacher, you know, parent even reaching out, anything will help.

- Great.

Dr. Smithee, on behalf of Pine Rest, you as a licensed psychologist.

- Yeah, you can get more information at pinerest.org under the Psychological Consultation Center.

That's where I work.

We do our testing and assessment work there.

I think what I wanna encourage people is if they are wondering whether they may have a diagnosis, please have that conversation with your primary care physician or call us and get the evaluation because education, educating yourself, knowing yourself better.

You know, as you've given all these tips of what you've figured out to help you, you know, I think this is just good information for everyone to really reach their potential.

- [Shelley] Before I ask for your contact information, back to the chapter, the goat, now you were talking the goat with the four legs versus the greatest of all time.

- Right.

- Yeah.

- Yeah.

- This is old school goat rodeo.

- That's right.

- This is like jumping on a goat.

- Yes.

Okay.

- And holding on.

- Okay.

Don't do this at home.

- Yeah.

I don't know why anyone would.

- That's okay.

- Yeah.

- What do you leave us with?

- Well, a lot of people with ADHD, when they come to me, they're worried that they're actually lazy, that they have a character issue.

- Yes.

- Or they're just not that smart, - Which are all myths.

- Yeah.

And I work with people, a lot of times, they're just so broken down by the world's expectations on them and not ever meeting those expectations.

And having ADHD is tough.

And I want you to know there's a lot of hope out there.

Your brain just works differently.

Figure out that difference, and let's figure out like how to interact with your environment differently.

You don't have to pretend you're normal.

That's exhausting for all of us.

So I just, I wanted to leave a lot of hope.

And families, if you're a parent, and you're crying right now because you're like, "I'm pretty sure my family's affected by ADHD," there's a lot of hope.

And get your whole family involved.

Don't just try to fix the ADHD person or persons.

- And they all know that they're in your book.

- Yeah.

- Yeah.

- That's important.

How do we find out more about your services?

- Yes.

I founded the ADHD Center of West Michigan, and we can be found at www.miadhd.com.

We work telehealth, we also work in person.

- Thank you, ladies.

- Thank you.

- Thank you.

- For your expertise, and continue the good work you do here in West Michigan.

- Thanks.

- Thank you for watching.

Have a good day.

(upbeat music)