Unraveling the Complexities of ADHD in Women: Insights from Dr. Brady Bradshaw

In this insightful episode, we sit down with the brilliant Dr. Brady Bradshaw, a dual board-certified psychiatrist specializing in working with neurodiverse patients, including those with ADHD and autism spectrum disorder. Dr. Bradshaw shares her personal journey of being diagnosed with ADHD in her 30s and how it has shaped her understanding of the unique challenges faced by her patients. She delves into the often-overlooked emotional dysregulation aspect of ADHD and explains how the disorder manifests differently in women, leading to frequent underdiagnosis.

Join us as we explore the complex interplay between hormones and ADHD symptoms, the importance of a collaborative approach between healthcare professionals, and the effectiveness of medication in managing ADHD. Dr. Bradshaw also shares valuable insights on the role of therapy and coaching in addressing the emotional and executive functioning challenges associated with the disorder. Whether you have ADHD, suspect you might have it, or have a loved one with the condition, this episode is a must-listen!

Episode Highlights:
[2:11] - Dr. Bradshaw shares what drew her to specialize in working with neurodiverse patients.
[5:04] - The impact of being diagnosed with ADHD in her 30s and how it changed her life.
[8:31] - Explaining what happens in the brain of someone with ADHD.
[12:04] - The role of dopamine in ADHD and its relationship to reward-seeking behaviors.
[14:52] - Addressing the misconception that ADHD is overdiagnosed, especially in boys.
[17:17] - Recognizing the challenges of identifying ADHD in girls and the importance of a thorough evaluation.
[19:53] - The complex relationship between ADHD and anxiety, particularly in girls and women.
[22:23] - Rejection sensitive dysphoria (RSD) and its impact on individuals with ADHD.
[27:58] - Identifying potential markers of undiagnosed ADHD in women in their 40s and 50s.
[32:17] - The standard treatment approach for ADHD and the importance of collaboration between healthcare professionals.
[35:53] - The often-overlooked emotional dysregulation aspect of ADHD and its significance.
[38:53] - Addressing concerns about the tolerability and safety of stimulant medications for ADHD.
[42:07] - Understanding ADHD as an ego-syntonic disorder and the challenges it poses for self-recognition and treatment-seeking.
[46:50] - Dr. Bradshaw's favorite behavioral hacks for managing ADHD symptoms.

Resources:
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Transcript

Dr. Brady Bradshaw: 0:00

The point I think that is also helpful to understand about ADHD and all of the things that we've talked about. ADHD is an ego syntonic disorder, that means that it feels normal to me. It's it does not bother me. Anxiety, depression, these are what we call ego dystonic disorders. So anxiety when I'm having a panic, panic attack that feels bad, I'm gonna go get help for that. I don't like the way that feels. Or when I'm depressed, and I can't do my job that feels horrible. I want to go get help for that. It's an ego dystonic disorder. ADHD is an ego syntonic disorder. This is my operating system. This is the way that I go through the world. I don't have a problem ala yo. Yo, people get hung up on time. Like, that's your deal. Welcome

Colette Fehr: 0:59

to insights from the couch. If you have ADHD, or someone in your family has ADHD, or even maybe you're worried that you might have ADHD, and you don't really know where to begin, or if it fits for you, you are going to love today's episode, because we have this amazingly talented specialists with us here today, Dr. Brady Bradshaw, who is dual board certified in adult psychiatry, and adolescent and child psychiatry, and specializes in working with patients in both diagnosing and treating patients with neuro divergence, including autism spectrum disorder and ADHD. So first of all, Dr. Bradshaw Welcome, and thank you so much for being here with us.

Dr. Brady Bradshaw: 1:44

Thank you for having me. Yes, thank

Laura Bowman: 1:46

you. Yeah, this

Colette Fehr: 1:48

is going to be so great for our audience. And we're going to really dive into in particular, some of what women need to know, because ADHD may show up a little differently in women. And it seems at least anecdotally, that it's often under diagnosed. So before we dive in, maybe we could start out just by asking you what drew you to this specialty.

Dr. Brady Bradshaw: 2:12

This is a topic that's so dear to me. And I can talk for a long time about it. Because it is so interesting to me. I always loved working with ADHD kids during my training, like they were just the kids that I enjoyed so much, they had so much energy, they were so impulsive. And I just, I think looking back, I just resonated with how they presented and how they felt. And I just felt a really deep empathy for them that I could understand their struggles. I actually have been diagnosed with ADHD in adulthood in my 30s. And I think that my story is similar to many women who get diagnosed with adult ADHD, I was looking for my son at the symptoms, and I'm a child psychiatrist, I diagnose ADHD all the time. And I still didn't see it in myself. But I was looking for my son, which is what I hear from a lot of my adult female patients, that they start researching for one of their children that they think might have some symptoms, or a teacher might bring it to their attention. And then they start realizing, to like, I mean, I have that struggle to I have that problem too. Or I you know, I struggle with time management or transitioning attention, some of those like key symptoms, and then that brings them in to get diagnosed. And that's what happened to me, I was looking for symptoms that I was seeing in my son started listening to different experts about ADHD. And it just really resonated. And so I scheduled my I didn't want to, you know, treat myself so I read or diagnose myself. So I scheduled my own appointment and got evaluated and diagnosed.

Colette Fehr: 3:51

Well, thanks for sharing your experience with us. That's really helpful to know. And I know, I've heard a lot of clients say something similar.

Dr. Brady Bradshaw: 3:59

Yeah, I think it's really relevant psychiatrists, we don't tend to disclose a lot about our personal lives and histories. But I've heard this said and I agree with it. I do think that having a therapist or a provider who has ADHD really helps to understand patients who have ADHD in their experience. So I do think it gives me a special understanding for for what people are experiencing, or some version of it.

Colette Fehr: 4:27

Are you open with that with patients?

Dr. Brady Bradshaw: 4:29

I'm just curious, some of them I am some of them. I am, you know, again, I think they're the traditional psychiatrist stances. It's really your time. It's not about me, and so I don't really share if they asked me point blank, I'm honest about it. And some of them you know, some really bright ones are like, clearly this is also a struggle with my shirt or I'm running five minutes late, you know those things. That's

Colette Fehr: 4:55

great, though to be relatable. How did that change? Your Life? And did it have a huge impact to get diagnosed in your 30s? Honestly,

Dr. Brady Bradshaw: 5:05

it was like this huge opening for me internally, because so much of the symptoms of ADHD have a moral judgment associated with them. So, you know, it's common for people with ADHD as an example to be time blind, so they might run late, or they might misjudge how much time it would take to get them places. Our society says, Well, if it really mattered to you, you wouldn't be on time. Or if I was really important to you, you wouldn't be there on time. And that truly isn't the case. For people with ADHD, they know it's important to be on time, that person does matter to them. It's really such a biological organic struggle, that takes a lot of effort. And some people can sort of white knuckle effort, modify and make behavioral changes. But it still is a challenge and takes more work to accommodate than someone who doesn't have ADHD. So for me, it was like, looking back at my life and be like, Wow, all of those things weren't really quite the reason and didn't really mean that I was just told that's what they meant. But it actually was something else that I was struggling with that no one was recognizing. So it opened up a lot, I think I had a lot more grace for myself and empathy for myself. As a child, psychiatrist, I'm really all about modeling for my children and allowed me to start modeling for my kids. Shoot, I missed that appointment. Ah, I hate when that happens. I must have been thinking about something else that was really brilliant. And I couldn't make it to that point. Starting to model for them, the grace of that, because they're going to have that experience too. And so I don't want to beat myself up in front of them for things that they're going to struggle for, we struggle with most likely down the road. So

Laura Bowman: 7:00

that is so interesting. I have I mean, just to disclose, I have three members of my family that have ADHD, one of them being my husband. And I do see that, like, you're always up against a lifetime of that kind of shame that gets accrued around a lot of this stuff, especially from school, and little boys and school performance. So a lot of that, like defended stuff comes up of like, you know, but you're right, having some, some grace for yourself, can be really hard. Dr.

Dr. Brady Bradshaw: 7:31

Becky, who wrote good inside talks about how she calls them deeply feeling kids, which is another way I think of saying neuro divergence, but how they're and we can talk through some of this, the emotional dysregulation that can come with ADHD, that their emotions sit so close to their shame that when they are dysregulated, or they are having big feelings, that's very quick to go to shame. I love

Laura Bowman: 7:58

her. By the way, I just listened to her on the Huberman podcast, and it was excellent for anybody listening, I highly recommend anything by her, maybe you could give us a little distillation

Colette Fehr: 8:08

of what is actually happening in the brain, because I have had so many spouses who just don't really think that there's something really happening that can't be overcome. And I think you're making an excellent point. If I mattered to you, if I were a priority, that's what I hear all day in couples therapy. So can you explain just a little of what's going on in the brain that makes this so

Dr. Brady Bradshaw: 8:31

different? This is a really good question. And it's complicated. There is an opening and we are starting to diagnose women more and especially adults with ADHD, but we still follow the DSM criteria for diagnostics. Even though it seems that more you know, it kind of seems like more people are getting diagnosed, we're really just kind of catching up and realizing that the symptoms might look differently. But we're still using the DSM criteria to diagnose these adults and women or females with ADHD. So you're looking for six symptoms in the inattentive list, or six symptoms in the hyperactivity impulsivity list. And there needs to be because it's a neurodevelopmental disorder, there needs to be symptoms prior to the age of 12. So when I'm diagnosing an adult, I am asking about some of their early childhood experiences. Wow. And we used to think that 50% of people outgrew ADHD. We now are kind of backpedaling on that and realizing that this is a neurobiological disorder that continues into adulthood, people figure out different accommodations to manage their symptoms, but probably most people continue to have ADHD. Russell Barkley and Ned Halliwell these are like two of the big names in ADHD research. They both feel that the DSM criteria sort of do it too. service in terms of diagnosing and explaining what it's like to have ADHD. Russell Barkley talks about ADHD as a disorder of self regulation. And I actually think that that's probably the best description of ADHD, because it captures the fact that ADHD affects all aspects of life. So it's not just, I can't pay attention in school, or I'm a behavior problem in school. It's everything that gets affected by this difficulty in regulating the self. So that can apply to emotional regulation. So people with ADHD can have 10 out of 10 feelings, you know, over small things, seemingly small things, so they can get really emotionally dysregulated. They can struggle with transition of attention. So they can have a lot of attention and be totally hyper focused on something or a lack of attention. So it's trying to like trying to find that middle ground for them that is really, really challenging. The time blindness is sort of a separate issue, I think it probably has something to do with some of what we understand about ADHD, which is that their frontal lobes and their prefrontal cortex, the brakes of the brain is what Ned Halliwell calls it, are not as effective or not as strong, so they're more impulsive. And that is where time is thought about, you know, the lower parts of the brain don't track time. And we know this from trauma research, right? That if you get triggered, it's like it's happening now. Right, which was five. So so it's probably related to that, that the frontal lobes and the parts of the brain that track time, aren't as online as maybe they are for someone who doesn't have ADHD. And then dopamine is the other big player for ADHD. So do you want me to keep

Unknown: 11:56

going, I want to hear about it tell

Colette Fehr: 11:58

us about the dopamine, dopamine. Who doesn't want some of that was

Dr. Brady Bradshaw: 12:04

a dopamine so. So the theory is that there's a deficit of dopamine and people who have ADHD. So things that maybe you know, dopamine is related to the reward systems in the brain. So dopamine is like making a big purchase, you know, or having a really good meal or winning an award. It's like this rewarding feeling that we all naturally can have. And the thought is that people with ADHD, maybe need more of those feelings to get that same reward type of feeling, and that they're constantly looking for dopamine, because they're running at a deficit. So they might look at food for reward, they might look at alcohol, they might look at shopping. So that can relate to some of those compulsive behaviors, your for that reward gratification, my

Laura Bowman: 12:58

experience with some of the people in my family is like working memory seems to be very like, can be impaired. I'm just I watched my husband move through the house and put things down and have no sense of how to like unwind that. And so then, you know, he has no idea that he was in the laundry room five minutes ago, and then the bedroom so he'll toss the whole house, you know, you can just tell there's no working memory there. Or very, it's muted.

Dr. Brady Bradshaw: 13:26

We see that in neuropsychological testing. So when people have neuropsychological testing done, which is like IQ testing, basically, from a psychologist, one of the things that they're measuring is short term memory or working memory. So that's the memory that you hold on to for a little bit to get something done. So maybe it's you know, like reading the first two steps of a recipe and going to the kitchen and getting the ingredients and the tools that you need to then like move on with the recipe, people with ADHD, their working memory or short term memory is really poor in general, and so unless it's something that they really care about, or like have a lot of feelings and are passionate about, it's like in one ear out the other, you know, it's really, really hard for them to hold that information. And we see that on the neuropsychological testing that those are usually their lowest scores for Neuro psych testing.

Laura Bowman: 14:23

Fascinating. So the other piece that I'm I hear a lot about is like that little boys are overly diagnosed in childhood like that this has become like a catch all bucket for any little boy that can't sit still. And that little girls, we just we're missing a lot of that so is could you talk about how it shows up differently in, you know, as young kids between these two genders.

Dr. Brady Bradshaw: 14:52

The overdiagnosis point I want to say I think ADHD is both over and under diagnosed. Most experts agree With that, the protective factors for ADHD are a high IQ. Also, if you have any anxiety, will neurosis will, like inhibit your impulses. So that's good. So if you're afraid, you're definitely afraid of getting in trouble, that might help you control some of your behavior. It's not easy, but you might be able to. And then if you're a girl, all three of those are protective factors for ADHD, they have better prognosis, we talk about boys are more likely to have external icing symptoms, and girls are more likely to have internalizing symptoms. So boy, boys are more likely to get picked up because we can see that they're struggling with attention, because they're talking to their friend getting out of their seat, you know, playing with some other kid instead of doing the worksheet, whatever you know, so it's much easier to see the behavior that is reflecting what their internal experience is, versus girls. Things that are you're often said about them as their day dreamy. They're in their own world. So they are quietly distracted and not necessarily causing behavior problems, they're more likely to be an attentive, sometimes they will get in trouble for talking too much. So I can I ask my female patients who are adults, I did you ever get in trouble for talking in class and you know, a lot of them? Yes, they also might do smaller behaviors like twirling hair, tapping foot, things that are less disruptive in the classroom. And for whatever reason, we are just sort of bias against diagnosing females. So even the girl who's inattentive and daydreaming, she might get labeled as anxiety, versus ADHD. So there's just bias in our culture to label as a as anxiety, and not ADHD. I think the first study about ADHD in girls was like 2000, or something like that. So there's a big lag, this is true for autism as

Colette Fehr: 17:06

well. So if I'm a mom, and I have a little girl who may have ADHD, is it just gonna be really hard to figure that out? Potentially,

Dr. Brady Bradshaw: 17:18

yes. I think it's really important when I have a parent who's concerned, or an adult patient who's concerned, when it comes to ADHD or autism, I always want to hear as much as possible about what their experiences, because there's your experience, and then there's the compensating behavior, right? And so I'm less interested in like, how you look to other people I'm more interested in like, what is it like for you to be able to look that way to other people, okay, because

Colette Fehr: 17:53

some people may be able to pull it together and compensate better than others, but their internal experience may be fraught,

Dr. Brady Bradshaw: 18:01

absolutely so to effort. So if you were that mother, I would say to advocate for your child and get a good evaluation. I mean, when I'm evaluating a child, it's like a two hour evaluation, at least, and I might then see them again for another hour to really get the information that I need. It can be really challenging. I wanted to also mention, I'm glad that you brought this up. People think that testing is required for an ADHD diagnosis. And it's not, wow, it's a clinical diagnosis. So that means it's based on the history that the patient is giving you. Okay, we do get collateral often for ADHD. So I might try to talk to a teacher, see what we're, you know, what's happening in school or peers or, you know, other other areas of their life. Because, again, the DSM criteria is we're trying to see it in more than one setting, it should be pervasive. But it really is based on the clinical evaluation. So this idea that you can test for ADHD is actually wrong. There is, you know, psychologists will do testing, which is IQ testing, or learning disorder testing, which is helpful. And the patient may have short term memory deficits that might show up on testing. But a very intelligent, anxious girl can white knuckle it through testing and not necessarily show up as ADHD in the testing. You know, that's the whole point.

Laura Bowman: 19:28

I'm so glad you mentioned anxiety because I, for one always get a little lost in like the Venn diagram between like ADHD and anxiety. And is that something you see a lot of and I'm wondering, are like, especially in girls, that those things kind of dance together? Or is there a way you like, kind of tweeze that apart? There is

Dr. Brady Bradshaw: 19:53

a lot of comorbidity, I think it's like 40 to 50% of females with ADHD have comorbid anxiety. So you can have both. Where I try to tease it out, at least, you know, in teenagers and adult females, is the anxiety that I hear about in my ADHD patients is in forgetting or missing appointments or forgetting or missing things that need to be done, or the to do list is so long, and I don't know, if I'm going to be able to get it all done, or I have all of these things running around in my head that I need to do. And I just don't know, if I'm gonna be able to do it all. And I might forget, you know, my son's lunch or, you know, so it's the anxiety is really specific to the struggles with executive functioning. And we can talk about executive functioning, but the anxiety that goes with the ADHD woman that's more ADHD rooted, I find tends to be associated with their struggles with executive functioning, versus, like a generalized anxiety disorder, where I'm worried that, you know, my kid might get bullied at school. And then I'm also like, worried that, you know, a hurricane might come to my house or, you know, it's like these fears that get that people ruminate on and kind of keep them up at night. That feels to me diagnostically different than someone who's worried that their to do list is too long, and they're not going to be able to get it all done.

Colette Fehr: 21:34

So the anxiety often with ADHD is related to anxiety about the ADHD and the ability to perform those executive functioning duties. Stress related to that, that makes a lot of sense. Yeah,

Laura Bowman: 21:48

where my brain goes next, because I hear a lot about this term, like rejection sensitive dysphoria that goes along with like ADHD, which is like the emotional processing of like, where negative emotions seem to come in at you in a stronger way. Do you see this as well? And is this like a neurodivergent thing, an ADHD thing? Does it cross over into autism? I'm just curious on that point,

Colette Fehr: 22:16

and maybe we can explain a little bit about what that means. Yeah, rejection

Laura Bowman: 22:21

sensitive dysphoria, RSD

Dr. Brady Bradshaw: 22:23

or rejection, rejection sensitivity, dysphoria. It's not a DSM criteria. It is something that we see associated with ADHD specifically, I don't believe it's as associated with ASD though, people. There's a huge overlap between ASD and ADHD. Right. So I think it's like 70%. I might that might be high, but maybe 60 or 70% of ASD, also have ADHD. So there's a huge overlap. And I think that sometimes it's confusing like on tic tac, you see, someone's like, talking about their ASD, they sometimes we'll mix in there like ADHD symptoms, because there is such a huge overlap. But RSD another acronym, I think the numbers are something like 90% of people with ADHD will resonate or endorse symptoms of rejection sensitivity, dysphoria, how that looks or how my patients will describe that is any perceived negative feedback from a peer from a parent from a coach. It is like soul crushing, they even will describe it as like physically uncomfortable, and like distressful. So I think it's important to understand that because if you're thinking about attachment, and how important that is relationally if you have someone who feels completely shut down by a negative comment from someone else, that's significant, you know, and so probably the best case scenario is if the person with ADHD recognizes that they have that tendency to then sort of or that insight to talk to themselves about it. Like, I know that Jenny's my friend, even if she said one negative thing to me, right, maybe talk your way through it. Exactly. Maybe she was having a bad day. I know that this doesn't destroy our friendship. I can, you know, and try to sort of rationalize, but I think the challenge with people with ADHD because they can get so emotionally dysregulated it can feel like, like I said, just soul crushing like Jenny hates me. I know. She hates me, she hates me,

Colette Fehr: 24:45

as I'm listening to you. And I think this is probably a very common thing that people experience potentially even who don't have ADHD as well. But so is it is it just that At, it's so painful to feel that rejected experience, let's say, it's not even such a huge statement. But it's something small like, you know, I didn't really like the way you made dinner. I don't know, that's a bad example. But you know what I'm saying something that's not fundamental to the person, that that person might experience a feeling of rejection more deeply and intensely than somebody else. But is it also that their thoughts then become very absolute and black and white? And they extrapolate meaning? That's pretty rigid? Is it both of those components? Typically,

Dr. Brady Bradshaw: 25:38

it is, and it's such a, you know, Ned Halliwell talks about ADHD is like a disorder of opposites. Because people with ADHD, say things impulsively, that hurt people's feelings. So it's like this paradox. It's like, but you do that. So like, how do you not know that, like, other people might say things that don't mean that you know, so it is, it's felt so intensely, and that's the part of the of the dysregulation, so it really is felt so strongly that they're in, you know, if you take a DBT perspective, they're in their emotion, mind, they aren't that rational part of them is not online. So it's all emotion, it is black and white, this feels so horrible. This person never liked me. They hated me all along, and it was just a matter of time before it came out, can almost sound a little paranoid, you know, yeah. And where I see it for kids is, the teacher will yell at another student. And they are like, shut down. It is Wow. Just like they can't even tolerate being in the class just about I mean, it can be like, very, very intense. So

Colette Fehr: 26:45

from feedback, that's not even necessarily directed towards them, just even seeing that experience happen to someone near you. And knowing that that could happen to me, if I did or said the wrong thing shuts them down, or

Dr. Brady Bradshaw: 26:58

over empathizing with the student, like, Oh, my God, like if that that must feel so horrible, like, yeah, you know, they can almost Dr. Becky talks about these kids as being really porous. And I believe that's true. They're super sensors. So it's like, they can be in the other person's shoes like entirely, you know, they can over empathize with people. Yeah.

Colette Fehr: 27:20

See, I really relate to that, personally, just really being I feel like a conduit to what other people are feeling and maybe even too easily being able to put myself in someone else's shoes. So this brings me to another question, which is, you know, if you're a woman, let's say in your 40s, or 50s, and you've never been diagnosed with ADHD, but you wonder about it from time to time, what might you be experiencing? That could be good markers or clues that it might be worth it to go talk with a psychiatrist and get an evaluation? With

Dr. Brady Bradshaw: 27:58

women? I think it's complicated by hormones. Of course, this is for everything, right? So there's a factor at play that's exacerbating symptoms. So there's like these watersheds of like when women may get diagnosed with ADHD, and it's usually after big hormonal shifts. So puberty is a time when girls start to get diagnosed middle school age, childbirth, after childbirth, and then Peri menopausal or postmenopausal. So I see it as like these big step downs, almost, where you start to see symptoms coming through a woman in her 40s or 50s, may be starting to be starting to have some perimenopausal symptoms. So short term memory is like I think a flag, you know, they'll come in saying I think, I think I might have early dementia. I can't remember anything. I hear that often. That's a big one. Sleep disruptions also can be sort of like a flag, you know, going to the hormonal piece for a second because I think it really is pertinent to women and ADHD. We know that estrogen basically is protective for ADHD. So I even see variations in women in their cycle and their symptoms. Wow. So as their estrogen goes down during their cycle, their ADHD symptoms go

Colette Fehr: 29:24

up. So interesting. Yeah. And

Dr. Brady Bradshaw: 29:28

they can get to the point like right around their period where they're like barely functioning. And if they're taking medication, we haven't changed the medication, the medication is the same and they just feel like it's not working anymore. So it's pretty dramatic. And then progesterone is the hormone that's really connected to good sleep. And so that's like another flag I think for women in their 40s and 50s. That sort of can sometimes bring them in to see me is their sleep starts to get really disrupted from the progesterone changes and shifts. Those are things sleep Keep short term memory that maybe you might want to think about getting evaluated and either you know for hormone replacement, if that's applicable and healthy for you, or you know, for ADHD that maybe wasn't recognized until now.

Colette Fehr: 30:14

Is it then that some of the symptoms that can go just with perimenopause or menopause can also overlap and be missed markers of ADHD?

Dr. Brady Bradshaw: 30:26

Yeah, it's a lot of overlap. And I think there's a lot more research coming out regarding perimenopause and menopause, that we're getting more information. Right. So I feel like we're also on like the leading edge of that, like there still needs to be a lot more to be able to really understand the overlap of those two things ADHD and perimenopause. So

Colette Fehr: 30:50

interesting. I mean, I'm 50 and I just started taking progesterone. My endocrinologist suggested it, I have Hashi moto thyroid disorder, which is also very common in women my age, and I developed in my early 40s, or at least became aware of it in my early 40s, the Hashi Moto, and my endocrinologist just suggested that I start doing this hormone replacement. And, you know, it's so interesting. I don't think people realize until we get to this phase of life that perimenopause itself can last for you know, 10 plus years. Those symptoms Yeah, yeah. And

Laura Bowman: 31:25

I and also like, an increased risk in anxiety disorders for all these inflection points and hormonal shifts, right. I mean, I know rates of OCD can really spike at these hormonal shifts. It's something that we don't talk about depression as well. Right?

Dr. Brady Bradshaw: 31:41

Anxiety and depression. Absolutely. And we know this in psychiatry, we know that there's a connection between hormones and psychiatric disorders are psychiatric diagnoses, I think where psychiatry still has so much work to do is what do we do about it? So

Laura Bowman: 31:58

what do we do about it? Like, I mean, what is what is the standard treatment for the average person? I mean, obviously, this is also bio individual in case by case basis, but But what is the standard kind of care for people who come in and get an ADHD diagnosis? The

Dr. Brady Bradshaw: 32:17

ideal case, in my opinion, is when I have a primary care doctor and OB GYN and Endocrinol endocrinologist who's like, okay, let's work together, me and you, you the psychiatrist, me, the PCP, and let's figure out a plan, I'll start working on the hormones, you start working on this, you know, the mental health or psychiatric symptoms, and let's work together to kind of see like, you know, the least amount of medication in this case that we're talking about, that we might need to try to manage the symptoms. So when they go hand in hand, that's really the ideal case scenario. You know, the studies that they've done in the mental health field field, where they try to treat women with only hormones for these different diagnoses are not successful. So they don't show that they're very helpful. I think that that's probably related to just struggles in general with the diagnostics in psychiatry, because we use the DSM. And it's just based on symptoms. And maybe women who have a hormonal or a hormonally driven depression aren't the same as women who have depression unrelated to hormones, but they get grouped in the same study, you know, so I think it's ideal when you can work, as you know, as a physician, that's ideal. And I can work as a team with someone that's in their specialty, and I'm in mind and we can work together. What can happen sometimes is the other specialty will pop back and forth, and that doesn't feel good to a patient. When you know, when the primary says this is a psych issue, go see the psychiatrist. Right.

Colette Fehr: 33:56

That is right. So what about medication is Is it true that most people with ADHD will do better taking medication?

Dr. Brady Bradshaw: 34:07

Medication is considered to be the primary intervention for ADHD. And I always tell my patients, especially in child psychiatry, you know, any other diagnosis I'm making, I'm sending you to therapy, you know, anxiety, depression, PTSD, you know, therapy is first line for children and adolescents. But ADHD is really it's a neurobiological disorder. It really has to do with the neurotransmitters in your brain not working the same way that people who don't have ADHD have their brains writing. So medication can be very helpful. stimulants are the traditional, you know, first line treatment and those medications increase dopamine, so they help to kind of bridge To the gap, that is the deficit of dopamine in the brain. The efficacy rates for stimulant medications for ADHD are between 80 and 90%. Wow. So it's staggering. Yeah, compared to like an antidepressant that's like, you know, barely above placebo sometimes, you know, it's like 40% effect, right? So it's one of the most rewarding things to treat because you take the medicine and you immediately can see a benefit. So there is a role for potentially coaching, ADHD coaching, I think that can be very helpful to start to learn where your executive functioning deficits are, and what are some strategies that work for you. And I think there's a big role for therapy, especially in women, with the emotional dysregulation that can come with ADHD that can be very helped with therapy in a way that I think is more helpful than medication.

Laura Bowman: 35:53

I love that we're talking about the emotional dysregulation piece, because I just know that most people do not associate adhd with emotional dysregulation. You know, it's it's always a crisis of attention and focus. But that is such a huge piece of it. It really

Dr. Brady Bradshaw: 36:10

is. I mean, I'm into Hearing you say that you're I know, you're right. And it breaks my heart because it's so it's almost to me even more. So, you know, from a psychological perspective, that's even more important to me to help your child with their emotion regulation, than if they get a C or A B in school. You know, like, that is such a big, important piece of this.

Colette Fehr: 36:32

Oh, yeah, I know, I see that with my family member who has ADHD and another child who doesn't being not always so sensitive to that, you know, What's with her and she can't get it together emotionally. And, you know, that breaks my heart because it's not as easy for somebody to regulate. If they're struggling with those other factors, does medication also

Laura Bowman: 36:57

begin to stabilize that piece as well, that you can make a lot of progress with the combination of like medication and therapy around the emotion emotional regulation piece? Or is it because you've like stabilized focus and executive functioning, that that piece has an opportunity to come online a little bit?

Dr. Brady Bradshaw: 37:16

I think it's both. I think it's both and I think it depends on who we're talking about, you know, if you're talking about a child that's melting at the end of the day, so having like huge explosive outbursts, tantruming, super dysregulated emotionally at the end of a school day, I like to think about if they're unmedicated and they have ADHD, during the day in the classroom all day, they are working so hard to try to control their impulses, and troll their behavior, focus on something that's not interesting to them do the work, write it nicely, you know, a lot of them have struggles with fine motor, like the amount of effort that's being put into their long eight hour day where they're sitting all day, is they especially if they have hyperactivity, that's so hard. And then they're having these huge, emotional outbursts at the end of the day. It's like, of course, they are forced they are. Yeah, so if you've medicate that child and help them with their ADHD symptoms during the day, then yes, I think there could be less of those meltdowns at the end of the day. I think the same is true for adults, but maybe it looks a little bit different. You know, if my day isn't requiring 110% of me, I'm going to have more left at the end of the day to give to my kids to give to my husband, whatever, you know that I can be more patient and less dysregulated less reactive. If it didn't take all of me just to get through my day.

Laura Bowman: 38:49

Are there certain people that just can't tolerate stimulant medications?

Dr. Brady Bradshaw: 38:54

We think it's about maybe five to 10%. But I also see that if medication is rushed, or if it's you know, titrated too high too quickly, or you know, or started on like a 12 hour Med and you've never taken a medication that is often going to lead to side effects. So when we start with too high of doses or like this, you know, big guns stimulant like, and you've never taken medication before that can be the problem. I think if you know child psychiatrists, we always start like really low, and with something really short acting, just to test the water and see. So I think probably they're some of the people that you hear saying, I just can't tolerate it. I'm curious, like, what have you tried? What did you know? What did you take? And is there a way to make it smaller to see if you could get some benefit from it? Right?

Colette Fehr: 39:47

And what would you say to a patient ready who might be worried about the safety of taking these medications and some people are so afraid, oh, I don't want that and, and it can be so helpful. So how do you tip Please answer that for someone. Well,

Dr. Brady Bradshaw: 40:02

the data on that is very, very clear, because these medications have been around for a really long time, the data shows that they're very safe in general, and really have minimal side effects. You know, again, unfortunately, for whatever reason, our culture is so sensitive to side effects. And I wonder if maybe it's because it's in our children. And so we're all like, very sensitive to, you know, our children and not wanting our children to be over medicated and their personalities change over these fears I hear about that is usually if a child is over medicated, or an adult is over medicated. So starting really low, starting really slow is helpful, the most common side effect or is a decrease in appetite, and then our ways to work around that. But in general, these medications are really, really safe. And I also reassure adults, patients are taking it and parents, we can stop it at any time, and you ready right back here. You're not marrying it, it's just a trial. You stop it, and you're done. You're right back to where you started. There's no permanent change that's being done by the medication.

Colette Fehr: 41:19

I love that. So it's safe, and it's effective. And I just know, as a therapist, I have seen people for a long time, who have this mental meaning structure around medication, you know, fear based, or just an idea of what it means to take medication, and they fight it and they fight it and they fight it. And then eventually, finally, they give it a shot. And I hear almost across the board. Oh my God, I wish I had done this sooner.

Laura Bowman: 41:50

Yeah, when I'm not similar,

Dr. Brady Bradshaw: 41:51

I'm always really sensitive to that, you know, and definitely explore with the patient, like, what is the fear and, and respect, you know, if you don't want to take it, that is okay, this is totally your choice, you know, right,

Colette Fehr: 42:06

it's your life.

Dr. Brady Bradshaw: 42:08

I'm just here to provide you the information, you're in charge of making the decision, you know, but the point I think that is also helpful to understand about ADHD, and all of the things that we've talked about, ADHD is an ego syntonic disorder. So that means that it feels normal to me, it's, it does not bother me. Anxiety, depression, these are what we call ego dystonic disorders. So anxiety, when I'm having a panic, panic attack that feels bad, I'm gonna go get help for that. I don't like the way that feels. Or when I'm depressed, and I can't do my job that feels horrible. I want to go get help for that. It's an ego dystonic disorder. ADHD is an ego syntonic disorder. This is my operating system. This is the way that I go through the world. I don't have a problem ala yo. Right? You people get hung up on time. Like that's your deal. You know, another way that I like to say that to teenagers, especially, it's like, you're a Mac and a Windows world, your operating system is your operating system, it still gets things done. It's a different way. But the problem is that we're in a Windows world. So there is a structure in our world that is set up for people who don't have ADHD, and we're trying to convert all the time, we're trying to get you over here to this Windows way of forking. So I think that that can feel really validating for people with ADHD, that it's your operating system. So it's okay, but where you're having some issues, maybe we can help you with that, like paying bills late or blowing up your relationship or wherever it's showing up those ripples that are giving you problems we can help with. But it I think that's one of the challenges for women to get diagnosed because they can be like,

Laura Bowman: 44:07

I don't have a problem. Everyone

Dr. Brady Bradshaw: 44:09

around them to like you definitely.

Colette Fehr: 44:12

Right. I'm just a great Mac. And you know, the analogy because I'm like, wait, we're not living in an Apple world. I'm living in an Apple world, Microsoft. Right. But that's really how it feels right? If that's your thing, and that's your operating system, and that's your world. It doesn't feel like this thing is happening to me. And I have to get rid of it. And I have to fix it and figure it out. Like extreme anxiety or depression. It just feels like this is who I am and how I moved through the world. Mm hmm.

Laura Bowman: 44:42

And to that point, most people get brought in by like a spouse or is it Are they getting tapped on the shoulder to be like, come on deal with yourself? As opposed to Yeah, yeah,

Dr. Brady Bradshaw: 44:55

it's usually it's usually a spouse that I'll get you know the patient To me, you know, my wife thinks or my husband things, or it can be painful consequences, like, yeah, you're getting still a job loss, or losing their patience with their children getting dysregulated with their child or feeling like, you know, secondary effects feeling like a failure, I never remember when it's like mom's day at school, I like had it on my calendar wrong. So it's like, those mistakes that start to feel bad, that will bring people to treatment. So

Colette Fehr: 45:33

and then I think it's great going back to what you said at the beginning, really having grace for yourself with those things, understanding that there are differences in the way your brain is working, that are contributing, you're not to blame, not being hard on yourself, but maybe being open to evaluating and seeing if this is playing a factor. You don't need a test. You don't have to take medication if you don't want to. But it's possible and very probable that there are a lot of people listening right now, who may have ADHD and just never have known that. And they're just moving through life thinking, you know, this is my operating system. And it's possible that with a diagnosis, there's so much more resource and help available to you that can really enhance the quality of your life.

Dr. Brady Bradshaw: 46:21

There's so many like behavioral hacks that can be helpful that, like you said, even if you don't take medication you can learn about there's so many resources now out there on YouTube, tick tock all these platforms that might really work for you. One of the funniest and best things I've heard about behavioral Hacks is some of the tricks work for some of the people some of the time, you know,

Colette Fehr: 46:46

yeah, do you have a favorite trick, like a favorite behavioral hack, you could share?

Dr. Brady Bradshaw: 46:51

I have a couple. I mean, one for me is not trusting my brain to remember something like I think like, I'm gonna remember that this is really important. I'm totally gonna remember that. And then I don't. So I don't trust myself to remember things. So I write everything down. I have all kinds of apps. I have sticky notes all over my house. I've got whiteboards everywhere. And it's like, just get it out. Another like saying is that the ADHD brain is an idea generator, not an idea container. So getting all of that out of my brain and writing it down. So I don't forget, is really one of the things that's been most helpful to me. I

Laura Bowman: 47:27

love that. Yeah. And I mean, we could have you on for hours, because I am so curious about like, even the uptick in like, neuro divergence across the board. Because I know rates of like ASD have gone way, way up. And I, some of that's our sensitivity and diagnosis, but some of it's just the prevalence is going up. So I'd love to talk more about that. And another point, but this is in the same realm. So I'm so glad we talked about it today.

Colette Fehr: 47:58

Thank you so much. This is so helpful. I learned so much. And you know, where you're at, we're therapists, we're in mental health. So it just shows you how much there is to learn. Right? If there's so much that we don't even know and we're both in families dealing with ADHD. I just think everybody will benefit from this information and more to really get more and more educated about understanding. You know, this is a real thing. And it doesn't have to ruin your life. It's just about understanding it. Thank you so much, Dr. Bradshaw.

Dr. Brady Bradshaw: 48:33

My pleasure.