Webinar; What ADHD Is, And What It Isn't

Hello, everyone. Welcome. I'll give everyone a few minutes, a few seconds to join. We're so excited you're with us this morning. I keep seeing people come in. So with that, we'll get started. A few are still trickling in. Hope everyone's having a great fall morning. It's morning on East Coast, and if you're joining us from the West Coast, hello to you as well. I know it's early. Thank you for getting up. Well, with that, I think we can get started. So I just want to thank everyone for joining us today for our Q&A with Dr. Jordan Wright on what ADHD is and what it isn't. We're excited to have all of you here with us this morning. And first, I want to tell you a little bit about Parallel and who we are. Parallel is a virtual education platform designed to empower students with learning differences and behavioral issues. We offer a number of different services, and they're highly personalized to each individual student. So I like to break us up, what we do, into 3 different umbrellas. The first being our comprehensive psychological evaluations. Some of you may know them as neuropsychs or psychoeducational assessments, and we do all of that. The second umbrella is educational tutoring. So we have skill-based multisensory tutoring and executive function coaching that fall under that umbrella. So if your child has dyslexia, ADHD, any learning difference, they could really benefit from, you know, from this educational tutoring or executive function coaching. And then in our third umbrella, we have therapy. So we have behavioral therapy and counseling, cognitive behavioral therapy, and then we have speech and language therapy as well. So those are the services we offer, and that's what Parallel does. And our mission is to give students access to world-class care anywhere. Every child deserves to see their differences as strengths, and so we're here to empower them and make them feel confident. So with that being said, I would love to introduce Dr. Jordan. Dr. Jordan Wright is one of the leading clinical psychologists in the country, and he's been researching the validity of teleassessments for over a decade and specializes in working with children and adolescents. Jordan is the author of The Essentials of Psychological Teleassessment, the most widely respected books on teleassessment. His research is consistently cited and consulted among colleagues. Jordan runs a low-income clinic and continues to advocate for access to mental health services for those who typically struggle to afford and access them. Since the beginning, Jordan has been one of a clinical advisor to Parallel, and we're so lucky to have Jordan in the Parallel family as most recently named our Chief Clinical Officer. So with that, I'll turn it over to Jordan.

Thank you so much, and thank you everybody for joining. Thank you, Blakely, for the kind introduction. This is going to be a quick crash course around what ADHD is and what it isn't. We're going to focus on both of those things because There is debate in the field, and certainly there are misconceptions in the larger world around what ADHD is and what it isn't. So I'm going to try and take us through that. There is a Q&A button. Please feel free to put your questions in, and Blakely, I know, is going to be monitoring those. And at the end, we'll have some time to answer a few questions after I do the presentation. So the first question is, what is ADHD? Seems like a fairly straightforward question. Unfortunately, it's not so straightforward. Right? So yeah, my kid is all over the place. My kid's mind is scattered. My kid's behaviors are scattered. They're, you know, my kid is just sort of, you know, maybe messy or whatever. Is this ADHD? Well, the answer unfortunately is a little complicated. Maybe. It might be. It's one of those, it depends. The worst answer possible, right? It depends. This is certainly potentially an indicator of ADHD, but we need to think carefully about what ADHD actually is, how it's defined, how it presents to decide if this is actually ADHD in this particular case. So when we think about what ADHD is, the first point is that it is a disorder of the brain. And I've put disorder in quotes. I want to put it in air quotes. I don't know how to do that in a slide because it is listed as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5-TR, which is what I'm going to be talking about, as well as the ICD-10. These are our giant diagnostic manuals that do characterize ADHD as a disorder. We're going to talk about, you know, rethinking that a little bit. But in general, it is a disorder of the brain. And you see on the picture, it's actually a disorder of what we think of as the prefrontal cortex. I'm pointing to it as if you can see my brain, but it's the front of that red section in the picture there. So it is a disorder of the brain, and it's an alternate way that the brain develops. The brain just develops differently. It's a hallmark of diversity. Our brains develop differently. And ADHD is one way that it develops. Now, this is a little bit unfortunately contentious. The DSM-5-TR defines ADHD as a neurodevelopmental disorder. So it admits this is a neurodevelopmental disorder. It's developmental. It is a disorder of the brain and how it is developing. are not neurodevelopmental at all. They're all behavioral. And this is problematic. This is an artifact of the, you know, psychiatrists predominantly write the DSM-5-TR. The DSM in general is written by mostly psychiatrists, and they don't do neuropsychological testing. So they need more behavioral correlates. They need things they can see and ask you about in order to diagnose it. But The DSM does admit it is a neurodevelopmental disorder. So it is some sort of brain mechanism happening. It is a mental health— again, disorder is in quotes and air quotes. It is a mental health disorder inasmuch as it causes problems, right? It can be super frustrating for kids, for adults. I will freely admit I was diagnosed with ADHD, but not until college. And it can cause problems. It can cause problems with your everyday life, with your education, with your social functioning, with all sorts of areas. ADHD can be a problem. And that is what we define as a mental health disorder or a sort of psychiatric disability or psychological disorder or any of those is when it causes some sort of functional impairment in your life. It is also a developmental disorder. I said it was a neurodevelopmental disorder. This is important because ADHD, the definition of it says it has to be present before the age of 12. There is no such thing as late onset ADHD. You can't have adult ADHD without having had it developmentally, having it at an earlier period. If you do suddenly start having problems with inattentiveness or impulse control problems or hyperactivity, it's probably more related to something medical like a tumor or some sort of other medical illness or substance abuse or a head trauma. There's something that caused a shift in the brain. That being said, the developmental nature of the disorder does not mean it had to be obvious. Early on in development. And we see this a lot in especially what we call 2E or twice exceptional children who really compensate for a lot of the symptoms of ADHD early on and seem to do okay in school. They excel in school because they're super duper smart. You know, a really, really high IQ. That is one of the exceptionalities. And then one of the other exceptionalities could be ADHD. And it sort of serves to compensate and mask and hide the ADHD early on. So it doesn't have to be obvious in childhood, but it does have to be present. There has to be some evidence that it was present early on in development as a neurodevelopmental disorder. When we think about the reason I put disorder in air quotes when I think about ADHD is there is a big movement called the neurodiversity movement that includes ADHD that's starting to really think about ADHD as a natural variation of human diversity. It is just a different way a brain can develop that comes with strengths, that comes with weaknesses. We know from research that ADHD brains tend to grow into more entrepreneurial individuals, sometimes more creative individuals, out-of-the-box thinkers. Like there are some benefits to an ADHD brain. However, there are way more drawbacks in the way that we've structured our world, right? We've arbitrarily decided that there is a best way for kids to learn. We are expecting kids to sit in a class, to listen to lectures, to listen to read things from the board, to listen to things like this and pay attention to me while I'm boring you. And take notes and remember things and study things. Like, we've decided this is the best way for kids to learn, for every kid to learn. But in actuality, this is a pretty big mismatch with how the ADHD brain works, right? This is not playing to the strengths of kids with ADHD. The ADHD brain doesn't necessarily like to sit and listen to a long lecture, watch notes on a board or a PowerPoint presentation, take notes. try and ingest all of that information and then regurgitate it on a paper or a test or something like that. That's not the way that the ADHD brain thrives, but it's the way that overwhelmingly our educational systems are structured. Our work systems are structured very similarly, right? So if you're thinking of like a clerical job, this may not play to the strengths of the ADHD brain, whereas some other jobs absolutely do. Unfortunately, our educational system is pretty homogeneous across the entire population, right? We, when we get to the work world, we get to specialize and decide where we're going and play to our strengths in certain ways. In the education world, we don't tend to. So the ADHD neurodiversity view of it is not as just locating it as a disorder within an individual, but it's Understanding that this is a natural variation on human diversity that is not well matched with the way that we as a society have arbitrarily structured education, structured the world around us. And so that causes problems, right? If there's a mismatch between how my brain works and what is expected of my brain every single day for 8 hours a day, it's going to cause some problems. And that's where we see the disorder. In the DSM, there are 3 kinds of ADHD. There are 3 subtypes of ADHD. We'll talk about a couple more that have been identified and started to be sussed out in the literature as well. But in general, there's the inattentive kind of ADHD. This is the head in the clouds, easily distracted, right? You, shiny keys distract you and you're kind of all over the place and you make careless errors on things and you're just not attending well enough to the requirements of your situation, to the requirements of school, to the requirements of your job. That is the predominantly inattentive type of ADHD. There is a predominantly hyperactive and impulsive type of ADHD. This is the more sort of stereotypically ADHD, especially boys tend to be more on the hyperactive impulsive side. They can't sit still. They're out of their seat. They're all over the place. They're fidgety. They're tapping their legs, tapping their foot. They've got the pen that they're clicking constantly, which thankfully you can't see in the Zoom screen right now that I am kind of doing that. This is the predominantly hyperactive and impulsive subtype of ADHD. The inattentive type used to be called ADD, attention deficit disorder, and it used to be different. Now it's all under the umbrella of ADHD. The inattentive, predominantly inattentive type, the predominantly hyperactive and impulsive type, and then the combined type that is both inattentive and has symptoms of hyperactivity or impulsivity. And this is again exactly what it sounds like. You're You're both inattentive. You're both making those small errors and easily distracted and all over the place, as well as having the hyperactive, the motor within you that is constantly going and causing you to talk fast and interrupt and these sorts of things. Not wait your turn in class, not raise your hand and wait your turn to be called on, right? These hyperactive-impulsive and combined types will just start blurting out answers and yelling in the class or clowning around or other stuff. In the literature, there's been another sort of what we consider a subtype of ADHD at the moment. It may be its own disorder at some point. And this is something called sluggish cognitive tempo. Sluggish cognitive tempo just has to do with a slowness and carefulness in the way that you think, the way that you interact with the world, the way that you take in information. Is just a bit slower. This looks like ADHD, and the reason it's considered when we diagnose it, we diagnose it as ADHD, is because if I'm sitting in a class and I'm taking in the information from a lesson very slowly, I may still be assimilating that information, taking it in, thinking about it while you've moved on to another topic. I'm not going to be paying attention to that other topic if I'm still thinking about The last topic that you were talking about. So that sluggish cognitive tempo, the end result is what looks like inattentiveness. Like, oh, you heard the first thing I said, but not anything that came after it. Not necessarily because you were distracted by external stimuli, which is very common in the inattentive subtype of ADHD, but because you were Internally distracted by still thinking about the last thing that was said. So these are the 3 kinds of ADHD. We'll talk about another sort of weird subtype of ADHD that will come on in a little bit, and we'll talk about that as well. Now, ADHD is so much more than just inattention and hyperactivity or impulsivity, though. The literature, again, the diagnostic criteria are a little confusing because it's got stuff that's not just inattention and not just hyperactivity, but it doesn't always include everything that has been shown in the research to be related to ADHD. But different things that are very often a part of ADHD are things like disorganization.

Right?

Just being disorganized, not being able to find stuff, losing things is very common in ADHD. Losing things, leaving things behind, not being able to find them. I think about— I have a daughter. I think about my daughter who does not have ADHD. She's a very neurotypical girl in middle school, but certainly needs to do a better job of putting things where they belong so that she can find them more easily. But in ADHD, the volume on this gets turned up. Right? You just tend to lose things, leave homework behind at home and not put it in your notebook to bring to school. Careless errors, careless mistakes. Sometimes this looks like rushing through things. In our educational system, especially when we think of like math education, we very much value showing our work. And of course, teachers want us to show our work so that they know that we're doing it the right way. They know that if we do make a mistake, where in the process we've made that mistake. Sometimes ADHD brains just sort of jump to the end and have a much tougher time showing their work. And then we don't know where those careless mistakes happened, where in the process they happened. Seeming not to listen, right? So this is not just getting easily distracted by extraneous stimuli, but in the moment, if you're talking to a kid with ADHD, they may seem like they're not listening. In the moment, right? Maybe their mind is going really fast. It's going a mile a minute with other stuff that's happening in their brain. Maybe they're actively searching out stimuli in their environment to maintain their attention. This is one thing that I write a lot of books. I write a lot of journal articles. I do a lot of research. And when I'm writing, I need music playing and a TV on, right? It drives my family nuts. But I need that stimulation so that my brain doesn't keep searching for other stimulation. That stimulation, that background noise of music and TV occupies part of my brain so that I can actually focus on what I'm doing. Not following through. So either not meeting our long-range plans or being unable to sort of do longer-term projects that are not broken down into easily digestible chunks. or just not meeting their requirements is very common. And then not sustaining, not having this sort of perseverance when it comes to reading, when it comes to sitting with, you know, more complicated math problems, when it comes to really sustaining what the focus, the attention, the grit is talked about a lot these days, like having that grit to really push through difficulties. ADHD brains sometimes have real difficulties sustaining in the moment. All of these things fall under the umbrella of what we call executive functioning. Again, I'm going to point to my prefrontal cortex because this is what's implicated most often in executive functioning, and it tends to be defined as sort of our brain's control of our brain, right? Sort of weird. Like, we don't really have like What we would think in psychology as a homunculus, a little, like a little person pulling the strings in our brain. But the prefrontal cortex is about, can our brain control what our brain focuses on? Can our brain control our working memory, which is the ability to take in information and work with it, manipulate that information in the moment? Can it help me organize? This is all the prefrontal cortex and its executive functioning. And in fact, although it's not in the DSM-5-TR, in the ICD-10, there is another disorder that is very highly related, which is called frontal lobe and executive function deficit, which is a mouthful. And this is basically ADHD without the inattentiveness and without the hyperactivity. Sounds weird, right? Attention deficit without attention deficit, hyperactivity disorder without hyperactivity either. But it— we do see sometimes kids who don't have necessarily a problem with focus, don't have a problem with hyperactivity and impulsivity, but they have a real problem with executive functions, other executive functions like organization, planning, working memory, these long-range things, initiating, following through on things. And this in the ICD-10 is called this frontal lobe and executive function deficit. In the DSM, we tend to diagnose this as an other specified neurodevelopmental disorder or other specified ADHD disorder, however we want to define it. But it's basically a deficit in these executive functions without the inattentiveness and hyperactivity. But a lot of ADHD that includes inattention and hyperactivity does include a lot of these problems with executive functioning as well. So that's a bit about what ADHD is. Let's think about for just a few minutes what ADHD isn't. And this is where we get to some myths about ADHD. We get to some misconceptions even within the mental health field about what ADHD is and is not. So it's not just poor attention. There are a lot of things that cause poor attention. There are a lot of things, there are a lot of moments in my life, I'm a bad example, but there are a lot of moments in other people's lives where they just don't pay attention very well. And that may or may not be ADHD. And we'll talk about that in a little bit. It's not getting distracted by your phone. Everyone gets distracted by their phone. Everyone is obsessed with their phones. Everyone gets distracted by their phones. It's just way more fun than a lot of stuff. My daughter has just gone to middle school, so we just got her a phone. And she's not allowed the phone during school, thankfully, but she's obsessed with it, right? It's brand new. It's way more fun. It blinks a lot. It's got games. It's got videos. It's just way more fun. So, it's not just getting distracted by your phone. It's not just poor attention. And it's not being 100% unable to focus. The truth of it is that everyone can focus on things they really want to focus on, right? When it comes to video games, people can focus on video games. Or when it comes to like a really interesting movie, people can focus, even people with really, really significant ADHD preferred activities can maintain our focus. Non-preferred activities, those boring activities— I don't want to call all of school boring, but a lot of moments throughout the day in school may not be what the ADHD brain wants to focus on. So these non-preferred tasks, we may see a lack of focus, but we also may see Great focus on video games or something, or texting friends or whatever. And in some cases, it can be in fact a hyperfocus, right? The ADHD brain sometimes hyperfocuses so much that you miss everything else going on around you. That's pretty inattentive, right? I tested somebody who was so focused on the tests that I was giving, and they were boring tests. The tests that he was focusing on were so boring, but he was so focused that he missed everything else going on in his environment. An earthquake could have happened and he probably wouldn't have noticed. And that is part of an ADHD process as well, this sort of tunnel hyperfocus and a screening out of everything else that may be important in that moment. It's not laziness. It's not stupidity. It's not fake. ADHD is very real. It does affect lots of kids, lots of adults. Unfortunately, it can look like laziness. It can look like you're not living up to your potential. It can look like you don't care about school, about your job. It can look like these things, but it's not these things. It is not laziness. It is not stupidity, certainly. And it's not just present in kids. Like I said, it is developmental, so it's got to be present before the age of 12, but it's not only present in kids. It can persist throughout the lifetime. When it comes down to it, especially in childhood, a lot of stuff can look like ADHD. And in fact, there are Diagnostic criteria. There are actual symptoms of different things that look like a problem concentrating, a problem focusing. Very common is depression. Depression in childhood and adolescence often looks very different than depression in adulthood. Depression in adulthood, we think of sadness, of melancholy, of not being able to get out of bed. That can look like that in children and adolescents. But it can also be very irritable. Depression in children often looks like acting out behaviors, oppositional behaviors, inattentiveness, problems concentrating. But it's really a depressive process that is driving the inattention and the acting out behaviors, not an ADHD prefrontal process. Similarly, anxiety. Perfectionism, anxiety. Think about if you're anxious in the moment, if you're like, oh, I need to do well, I need to do well, I need to do well. What's going on? What's going on? That occupies so much of your mental energy. It occupies so much of what your brain can focus on in that moment that you don't have the resources to focus as much on other stuff. Perfectionism does this too. It slows us down. Perfectionism is sort of a component of anxiety often. And it makes us really perseverate, really ruminate, think over and over and over about what's going on in the moment. We don't think ahead. We aren't paying attention to what's going on around us because we're so like mired and steeped in that perfectionistic tendency. Trauma. This is one I have a colleague that I am very grateful to, and she and I talk a lot about how what tends to look like ADHD can actually be missed trauma. And this trauma changes the way our brain develops. It changes the way we interact with the world, sometimes in very adaptive ways. So if I've undergone a trauma, my brain may react to that by being very, very vigilant, by always being on guard in the world around me. And that's going to interfere with my attention. That's absolutely going to interfere with what I can pay attention to, how long I can concentrate. Trauma is probably underrecognized and underdiagnosed more than anything else. And this can be capital T trauma, what the DSM and psychiatrists have decided is a risk to your own life or witnessing a risk to some other life. These are things like being physically abused and attacked, rape, these sorts of things. It can also be what we call lowercase t trauma, these things that add up. Living in a racist world, living in an oppressive world, as a minoritized individual and then always having to be on alert. My daughter often talks about a lot of her friends needing to interact with the world differently than she does. She is a white girl. And so we live near a police precinct and she feels very comfortable walking by it in a way that some of her friends who are Black and brown do not feel comfortable. And so they might be more vigilant in those moments and may not attend to the world around them nearly as well as she would in that moment. That trauma is occupying their brain in that moment. It could be contextual, right? A kid whose parents are fighting all the time, a kid whose parents are getting divorced, is certainly going to be in a situation, in a mental space, in an emotional space that is preoccupying. and does not allow them to pay attention, and it may lead to more anxiety or some depressive symptoms in the moment. It may not reach the level of diagnosable depression, but it can absolutely preoccupy them and cause them to act out behaviorally or be inattentive or be in their own world during school. So there are a host of contextual things that can mimic ADHD in the moment that are not a prefrontal neurodevelopmental problem. This is the worst part. Completely normal child behavior. Children don't pay attention well. The best children in the world, right? Don't pay attention well. My daughter is a great student. She's developed— her brain is developed completely Typically, she's neurotypical. She doesn't have ADHD or autism or any of these other neurodevelopmental differences or learning differences. She doesn't have dyslexia, but she doesn't pay attention as well as I do. And I'm a grown-up with ADHD. She sometimes jumps off the walls. She's sometimes hyperactive. She sometimes has too much sugar or gets overexcited. About things. Sometimes normal behavior, and this, the volume on this can be turned up in the little jungle that is their peer group, right? If you look at a classroom full of friends, it's a bunch of little animals. Normal behavior can sometimes look like ADHD, just jumping around, being energetic, not paying full attention. This can be completely normal and normative and adaptive even. This can be a good thing. We don't want to say, you know, every time a kid is playing around, it's ADHD. This can be very, very normal and adaptive and fine behavior. So when we get back to what ADHD is, we now know that a lot of things can look like ADHD. A lot of things can mimic ADHD symptoms but are not in fact ADHD. This causes us a problem when we go back to decide what ADHD is, because if we just look at a list of symptoms, if we look at a list of behaviors, it's like, oh, you're not paying attention well. Oh, you're, you know, bouncing off the walls. You're making careless errors. You know, you technically check off all those boxes diagnostically, and we could technically call you ADHD. But when we think about the fact that all these other things can cause those same symptoms, It means it's extremely complicated to diagnose accurately. It is really, really tough to diagnose ADHD with accuracy. There are going to be some mental health professionals who do an in-depth interview and maybe give a couple of screening measures or surveys, and that is okay. That is a way to look at it. But when we think about the, probably the best way to diagnose ADHD is to do a really comprehensive assessment because we need to start ruling out the depression. We need to start ruling out the anxiety, the trauma, every possible contextual potential contextual contributor. We need to really think about, is this actually a problem with the brain? Now I'm biased. I'm an assessment psychologist. I do neuropsychological assessment and that kind of stuff. And when we think about ADHD as a neurodevelopmental disorder, it makes me want to do neuropsychological assessment. It makes me want to look at the cognitive abilities of the brain. So we think about when we're diagnosing it, we think about not just your typical behavior, your typical behavior in school, Around your peers who you may love, you may hate, you may have mixed feelings about, a teacher you may have strong feelings about or not like, coming from a home where you maybe are potentially going through stressors within your family, right? That's your everyday functioning. And we need to know about your everyday functioning. ADHD is going to show up in your everyday functioning. But we also need to know what can your brain do Under ideal circumstances, when we remove your peers and their distractions, right? Them throwing spitballs at you or finishing an exam before you, right? If you're sitting in a room taking a test with everybody else and they finish sooner, that can ramp up the anxiety and make you freak out and you make more careless errors or that kind of stuff. So when we remove the peers, when we remove the classroom environment, When we give you one-on-one attention in the testing environment, when we think about an environment that's free from distractions, relatively free from distractions, then we're talking about what can your brain do? What resources can you muster in the moment? And what can your prefrontal cortex do in the moment? This is called maximal performance testing or optimal performance testing. We're trying to get your best performance, not your typical performance in your everyday life. And these things may differ, right? So if you or your kid is struggling with attention in class, but under these ideal circumstances they have zero problems, their prefrontal cortex is fine, we may want to start looking for other potential contributors. To their inattentiveness, to their hyperactivity, to their oppositional behavior, whatever those typical symptoms are. We may want to start thinking, okay, this may not be a neurodevelopmental problem, a prefrontal cortex problem. We may want to start thinking, are there other potential contributors? And to get those other potential contributors, we have to do a lot more than just think about what symptoms are present. Right? We have to do a lot more digging into context, into emotional functioning. We have to do a lot more digging into all of these things that can kind of mimic ADHD. And what makes it even more complicated is that they can also be there with ADHD, right? Kids with ADHD struggle in school, which can be very, very anxiety-producing or depressing. Or it can lower self-esteem, which then of course worsens attention, and it can be this cycle. It just gets really, really complicated. So this more comprehensive approach to diagnosing ADHD is really important because of all of the different contributing factors and problems that can look like and be comorbid with or co-occur. with ADHD and worsen ADHD symptoms. ADHD symptoms can worsen emotional symptoms. They can worsen relationships with your teachers, with your parents or caregivers, right? It gets really, really complicated. So we need to be— we as mental health professionals, we as psychologists need to be meticulous in going through the information and understanding what might be contributing. And if this is truly a neurodevelopmental prefrontal difference, or if it might be something else going on. I'm going to stop there and say thank you and see if we have any questions that I can engage with. I want to thank you for taking time to watch this. I want to thank Parallel for hosting this, and we are going to go to some questions and answers, and I'm going to stop sharing so that you can see me really big.

So, Dr. Jordan, I, I don't know if you can see this, but would love to. We had some questions from our listeners, and one was, I've been treating ADHD with— what is the crossover between executive dysfunction and ADHD? And they said, I've been treating ADD with medication, but I'm wondering how I could treat it with executive function coaching. I have some disorganization and activation issues that results in me not finishing things.

Absolutely. Now, one doesn't tend to replace the other. The evidence shows that medication can be really, really effective with ADHD. And when I think of medication for ADHD, I think of it as sort of a band-aid or a crutch, right? So it is— it can help you in the moment. It's like an aspirin. It kind of can help fix things a little bit in the moment, but it's not going to teach you any skills to do better. It's not going to teach you how to organize your life better. It's not going to get at the underlying executive functioning skills deficits. So I then think of executive function coaching or CBT for ADHD, which is very similar to executive function coaching. And this is now building the muscle. So on one side, we have a crutch that is helping us get through the day right now. And on the other side, we're building our executive functioning muscles in the long run so we no longer need the crutch. Crutch anymore. We can actually do that, but it does take longer. So we've got the quick fix to let us like survive in life right now. And then the executive function coaching or CBT for ADHD or executive functioning is really working on those executive functioning muscles.

I love that visualization. That's great. We have another question that said that you had mentioned some individuals with ADHD having some background noise and stimuli can be beneficial during study and work times, like having the TV on in the background. How would you approach this if a family is looking for accommodations in school and testing environments who specifically want access to this background noise when, you know, it may not be appropriate, feasible, or reasonable?

Yeah, so there— of course we can't, you know, during every exam in a classroom with every student, turn on the TV and play whatever happens to be on the TV. That is probably a nonstarter. However, we could absolutely, if we found in an evaluation that sort of the background noise is actually beneficial, it is a reasonable accommodation to say, okay, we need a kid to be able to have earphones with maybe white noise in them. And if that's going to be too distracting to the rest of the class, like, why does this kid get headphones, or if they're embarrassed, like maybe they need to be in a room by themselves and in a separate room, which is a very common accommodation for ADHD when taking exams, especially high-stakes exams like the SAT or ACT or these sorts of things. So they can be in a separate room. They can have these sort of white noise or noise-canceling headphones with music playing. Of course, you know, the school will have to check and make sure they're not— they'd have to be really clever to feed themselves the answers somehow to the exam or cheat in that way. And we would have to be careful in an educational environment, but the idea is that is a reasonable accommodation. If they need that background noise stimulation, we can absolutely request headphones during exams and assessments.

That's awesome. And just to clarify, you know, if someone came to Parallel for a psychoeducational evaluation, they would If that was needed, the psychologist would note that in the accommodations?

Absolutely. We try our best to make the reports as— I was going to say, I'll say user-friendly as possible for teachers, for families. I was going to say ammunition. We want to be as specific as possible in what we think kids really, really need to help them thrive. So we will list, okay, you need to You know, make these accommodations to better fit in, but also your context needs to make some accommodations so that you can thrive in that environment. And we will try and make that as clear as possible in every assessment.

Thank you for that answer. And the next question is, how do you know whether you need CBT, cognitive behavioral therapy, versus executive function Yeah.

So cognitive behavioral therapy obviously has developed and grown up and become very sexy and is great in terms of a lot of issues. It's great for anxiety, great for depression, great for— there is a modular approach to treatment of children called MATCH-ADTC, which uses a cognitive behavioral therapy approach to specific symptoms. Executive function coaching utilizes so many of the exact same techniques. So executive function coaching, which has grown up as a separate literature, some executive function coaching is not evidence-based and it's just sort of, you know, and then it ends up being a good crutch, like maybe someone just keeping you accountable or helping you break down things. But more evidence-based executive function coaching is going to be based on CBT principles. So you may want to ask about that. Ask the, the whatever coach you're working with, whatever company you're working with, like what, what is your model of executive function coaching? Does it integrate some CBT? Because that's actually what's going to lead to kind of behavior change and thought change, which is what we need in, in ADHD.

Perfect. Thank you. And we have several questions in here. I know we're getting close to time, so I think we have time for one more. There's several questions about What tools— are there any apps out there that you know of that improve productivity or for students with ADHD?

Oof. There are thousands of apps out there. There are— there's not one that I think is like, oh, this is amazing, and the evidence base behind it is so great. So many of these apps are new that they haven't been researched. Certainly organizational apps are always helpful, like a planner, and whether it's an app or a physical planner. These things are great, and executive function coaches can help you figure out how to use a planner better and hold you accountable for different things. But I don't have an app that I can recommend that has a strong evidence base behind it for really improving executive function skills yet. I hope that they are doing these research studies. I hope that people are out there doing it. I know that some people, some academics, some of my colleagues are absolutely doing some research in these areas. But in general, I apologize. I don't have one I can, I can point you to yet.

Well, maybe one day you'll find that at Parallel. And I think we're, we're right at time. And I just want to let everyone on this call, on this webinar today, first of all, thank you guys for joining us. And if you have more questions, if you're thinking, you know, this may be me, my student, you know, what can Parallel do to help? What I would do is encourage you to go to our website, www.parallellearning.org. Or call us directly, 914-377-5655, and you can talk to one of our care specialists, you know, for a free consultation to kind of walk you through what's going on, listen to you, and then kind of guide you in the right direction. And we would— we're here to help. We would love to, you know, set your child up for success, or you if you're an adult. We work with adults as well. Thank you so much, Dr. Jordan. And, um, with that, I think— thank you guys.

Thank you very much.