Revolutionary Mind Body Strategies to address ADHD, Addiction & Trauma

Foreign like to welcome everybody to Today's presentation on ADHD, addiction and mental health interventions. I'm your host, Dr. Donnelly Snipes. Today we're going to explore interventions in each piece of life that is physical, interpersonal, emotional, cognitive and environmental that can benefit ADHD and comorbid conditions. We will also identify some common treatment issues and interventions for people with addiction, ADHD and trauma. And. And you'll see why I threw trauma in there in a minute. People with ADHD and addictions both have difficulty with impulse control. I don't think this is a concept that anybody's going to argue with. Both conditions involve atypical reward processing. So it's not just a thinking issue. It is a neurological issue. I shouldn't have done back here. I should have done up here. A neurological issue in the prefrontal cortex. Remember, your prefrontal cortex is where you do a lot of information processing, planning, and your executive functioning, so which also involves some of your impulse control. Interestingly, ADHD and addiction both involve alterations in dopamine and norepinephrine signaling in the frontal cortex, which impacts the regulation of attention, behavior and emotion. We know people with addictions, for example, may seek out the addiction in order to sort of increase the dopamine levels and increase the norepinephrine levels in their body. When people engage in addictive behaviors and their system is flooded with dopamine, the or a toxin. But either way, for a behavioral, it's just dopamine. The system registers that as a threat and kicks off the HPA axis, which increases the amount of norepinephrine. We also know in ADHD the levels of norepinephrine tend to be lower, which is one of the reasons that some of the stimulant medications are effective for people with ADHD because they need that increased stimulation. ADHD is often a lifelong condition and predisposes people to the development of mood and addictive disorders. Now let's think about why that is for a moment. ADHD typically starts in early childhood. It may not get diagnosed until later, early to middle childhood or adulthood for some people. When you are living in a body that is neuro atypical, you're wired differently. It's not bad, it's not good. It's just different. You're wired differently and you're trying to fit into a neurotypical environment, it can feel very rejecting, it can feel very overwhelming because that's not how how you're wired. So people with ADHD often experience a lot of criticism and rejection early on. I know of one parent that. Whose child has adhd, and they are very young, they've been diagnosed, and one of the symptoms of ADHD, or if you will, is difficulty with fine motor control. And my son had the same issue. So I can empathize. But this child is really struggling in school with penmanship because the teacher is not willing to recognize that the child is doing the best they can and they have this neurological difference. They're not going to be able to write as clearly or as pretty as some of the rest of the world. And that really makes me angry. But I digress. My point being from children, from peers, from parents, people. Children with ADHD often experience a lot of difficulty integrating into a neurotypical world with blurting, with penmanship, with not being able to sit still. You can think about kids that you've seen in the grocery store or you've seen in church or even in the movies who, who probably have adhd. And you can imagine if their caregivers don't understand why they're acting the way they're acting and don't have tools to help them integrate and manage themselves within a neurotypical environment, because not all environments are going to change to fit the child, that the child would experience a lot of anxiety and. And rejection. So anyhow, that being said, from an early, early age, children with ADHD develop rejection sensitivity and may feel unsafe and powerless in their own body. They're trying to do the very right thing, but they just can't. Those impulse. That impulse control is not there. And remember, we're talking about kids. Kids by their very nature have much poorer impulse control than adults. I remember my son telling me that, you know, he. It just took every ounce of energy he had to try to hold it together and sit still in class when he would finish his assignments. And the teacher's suggestion was for him to put his head on the table. Well, that's not something that's effective. He wanted to read a book. The teacher said, no, you put your head on the table. And when he would get home from school, he would all of a sudden just be wide open because he had pulled in and reigned himself in and used all his energy holding it together all day long. And he was just ready to explode. And he usually did. We want to understand that. We want to understand that children recognize when they are not like the other children. Children recognize and it hurts. Peer rejection hurts. Whether you're 2 or 22. Mood disorders are associated with worse ADHD symptoms and the risk Of a develop of developing addictive disorders. Sometimes people with ADHD may turn to addictions in order to try to self medicate, especially if they're not diagnosed. They may turn toward stimulants, for example, to try to self medicate. And even your other addictions, cocaine and, and some of those others, cocaine's the one that comes to mind because again, it's a stimulant. Are going to increase do dopamine and a little bit norepinephrine. So it may help the person feel like they can integrate a little bit better, at least for a moment. Either way, if somebody with ADHD may not self medicate the ADHD with the addiction, but they may start developing social anxiety, clinical depression, cptsd, a variety of issues, and then they may turn to substances or addictive behaviors to try to self medicate that. We see a very high correlation between ADHD and addictions. And especially in early recovery, there is often a lot of ADHD like behavior because the person's brain is sort of coming down off that flood of dopamine and norepinephrine, so their entire nervous system is trying to re regulate. There is a higher than average correlation of ADHD to trauma, addiction, autoimmune issues, and mood disorders. And I want you to recognize, and I put the autoimmune issues out there for a re for a reason. Obviously, we've talked before about how when somebody's autonomic nervous system, their stress response stays on for too long, if you will, the body recalibrates. And when their cortisol stays high for too long because they are fearing rejection because they're having trouble integrating into a neurotypical society, whatever it is, the receptors become resistant to that cortisol. So cortisol loses its ability to suppress inflammation. We start seeing unfettered, you know, inflammation happening in people who experience chronic stress. And we start to see immune system dysfunction overall in people who experience chronic stress. And so I would hypothesize that the stress of neuroatypicality in a neurotypical world may contribute to distress that may trigger autoimmune issues. It's important to recognize and be familiar with what autoimmune issues are out there. And I'm not going to list them all here. That's a whole different video. And to screen your patients for them, because certain autoimmune issues like Crohn's disease and celiac disease may be very commonplace. You know, like I said, they are very common with adhd. And those may be issues we need to address or help them address in order to not feel stressed, not have physical stress of pain, and not have mental stress of, you know, everything else. A disregulated or miscalibrated, however you want to say it, stress response system is associated with all of the following symptoms. Emotional disregulation. We have a stress response that is generally either hyperactive or relatively unresponsive. So it's hyperactive or flat, that autonomic nervous system. Remember, it's the balance between a sympathetic, the fight and flight, and the parasympathetic. The rest digest and repair. But. And that sympath. Parasympathetic nervous system. The rest and digest involves that vagus nerve. And remember that when the stress response stays activated too long, it gets really strong and the vagus nerve starts to get very weak. Now, that's not exactly. We're not talking about muscles here, but use that analogy. Chronic pain is very common in people with a miscalibrated stress response, as are autoimmune disorders. These are also very common in people with adhd. Attention difficulties are very common. When you're stressed out, you're paying attention to all the threats. You're hypervigilant. You feel unsafe and powerless. You feel like that little bunny rabbit in the middle of the forest. And that's exhausting. That. That's exhausting. And people tend to have more difficulty filtering stimuli when they're stressed out. People with ADHD have a lot of difficulty filtering stimuli, partly because of their neurological wiring, if you will. And it definitely makes it more difficult for them to filter out distractions. I had a colleague of mine in graduate school who had adhd, and she gave a presentation one time, and she walked up in front of the class and she started talking. And then all of a sudden, somebody out in the hallway started playing their music relatively loud, you know, way louder than you should outside a classroom. And a lot of us were like, well, that's rude. We're distracted by it, thinking what was going on. And then she started having somebody else tap the desk. And a lot of us were distracted by that. And so the music's going, there's the desk tapping. And then somebody starts flickering the lights on and off. And we're all sitting there going, what the world is going on? This is just overwhelming. And she said, welcome to my world. She said, it's difficult for people with ADHD often to filter out that passing siren, to filter out that annoying cockatiel in the other room, to filter out different sights, smells, sounds. It's just all there and the body's taking it in instead of selectively going. Don't need to pay attention to all this stuff right now. People with a hyperactive stress response have difficulty sustaining focus. Well, guess what? If you're hyper vigilant vigilant, it's going to be hard to focus especially on something that is not pertaining to fighting or fleeing. They have difficulty with planning and problem solving when you're in stress response. When you're in fight or flee, you're not activating that prefrontal cortex. We know the prefrontal cortex is differently wired in people with adhd so they have more difficulty organizing and planning anyway. But then when the stress response is kicked in, it's even more difficult because fight or flee means you're there's a threat to your survival. Do what you need to do. Don't think about the options. They develop rejection sensitivity. They experience it enough, they become hypersensitive or hypervigilant to the non verbals, to the signs, to the places where they've been rejected and that negatively impacts their self esteem. And we see this in people with CPTSD with or without adhd. We see this in people with adhd. And because addiction is such a strong, such a potent stressor on the body, people with addiction develop a miscalibrated stress response system and exhibit a lot of these symptoms. Interventions aimed at healing the autonomic nervous system so there's better balance, better control and handoff between the stress response and the relaxation response and strengthening vagal tone. That relaxation response have been shown to be extremely effective. What can we do physically get adequate quality sleep 7 to 9 hours. This is important for people with ADHD. Addiction trauma One of the when you're sleep deprived, your body registers it as registers it as a stressor and that's going to activate the stress response. When you don't get adequate quality sleep, it throws your circadian rhythms out of balance, which also throws your cortisol levels out of balance. Remember, cortisol spikes in the morning and decreases throughout the day. Therefore, if your stress response is dysregulated, one of the things you need to start doing is removing sources of unnecessary stress. One of them is sleep deprivation. So get adequate quality sleep. For some people with ADHD and trauma, you may need to work on their sleep hygiene routine. You may need to work on sleep strategies because they may have difficulty laying down and falling asleep. Circadian rhythms to support normal cortisol levels and HPA axis functioning are also important. Circadian rhythms Involve when it's light outside, when it's dark. That helps set your circadian rhythms. But also your circadian rhythms are set by temperature and by the activities that you're doing. When I get up in the morning and, and get out of bed and brush my teeth, my brain knows, hey, it's time to start getting ready for the day. And then it knows kind of what I'm supposed to be doing. My son, you could have set a watch by him the way his circadian rhythms were when he was a child, when he was a toddler, because at, at one o' clock every afternoon, it was nap time. You know, he would just, all of a sudden it was like he would hit a wall and it was nap time. And, you know, we all get hungry about the same time every day. You'll be at your desk and you're like, oh yeah, you know, it's lunch time. I guess that's why I'm hungry. So your body's releasing those hunger hormones as part of your circadian rhythm. So when your circadian rhythm gets out of whack, your hunger hormones do too, as well as your sleep hormones and everything else. Take medication as prescribed, whatever that medication is, if it's an anti inflammatory, if it's a psychotropic, if you're not on medication, okay, then don't take medication. Eat healthfully to support dopamine, serotonin and norepinephrine production. And brain glucose. One of the things we see with people with ADHD and trauma in particular, and depending on the type of addiction, sometimes addiction. The brain is one of the biggest consumers of blood glucose. And when people are hypervigilant, when they are thinking a lot, when they are really active, cognitively or physically, they burn through a lot of blood sugar. And when their blood sugar drops, you know how you feel when your blood sugar suddenly and precipitously drops, you start feeling sluggish and irritable and that triggers that stress response, which is going to trigger more irritability. Morton. Or epinephrine, et cetera. So modulating blood glucose with a healthy diet can be helpful. And making sure that you're eating those healthy foods. I'm not saying you have to be a nutrition nut, but making sure you're getting enough protein that you're getting colorful antioxidant foods on your plate at every meal and drinking enough water is really important to helping modulate your blood sugar, which will help reduce the spikes and declines not only of your blood sugar, but also of your HPA axis. When Your blood sugar goes down, HPA axis kicks on, tells your body, hey, we need to get some blood glucose out of storage. So come on. And so the body's flooded with it, which means it's not good for people with diabetes either. But I, I do digress. Exercise to increase dopamine and serotonin. This doesn't have to be going to the gym. It can be dancing like a crazy person around your house, cleaning, you know, hard, not just kind of lightly dusting anything that moves your body. Play with the dog, do something to move it. Increases oxygenation, increases circulation, and it helps increase dopamine and serotonin. Why? Dopamine is the chemical in your brain says, let's keep doing that because it's good for us, or it feels good. And if you're doing something that is positive for your body, your body naturally says, hey, keep doing that. Find constructive outlets for excess energy. If you are one of those people who has difficulty sitting still because of your trauma, because you're hyper vigilant because of the ADHD or the addiction or all of the above, finding ways to stay busy and constructive outlets can be really helpful. Like if you're one of those people who has difficulty sitting still in long meetings, bring something that you can do. I am always grateful when I have to go to a long seminar or something because I, I think I've got some ADHD characteristics. I don't know if I would qualify for the full diagnosis, but I have a hard time sitting still and I need something to do with my hands. I will scribble, I will draw. If I can bring my crochet needles, I will crochet. But it's always helpful. When I do conferences and longer webinars in, in person, I typically give people adult coloring sheets and I put color colored pencils or crayons at the table so people can doodle. We can listen and doodle at the same time. And it actually helps some people because when they're doodling, their mind is more open, interestingly enough, and get more sunlight in order to increase vitamin D, which will help increase dopamine availability. Develop distress tolerance and downregulation skills. Now, a lot of times we talk about distress tolerance in the emotional section, but it's really a physiological activity. What you're trying to do is slow your heart rate, slow your respiration, reduce your blood pressure, and you're doing that by activating your vagus nerve. Those are physiological processes. We can do that through vagus nerve massage. We can do that through deep breathing we can do that through singing really loudly. All of those things can help downregulate, improve your nutrition. I already kind of mentioned that antioxidants help get rid of the nasty byproducts that they call oxidative that lead to oxidative stress and get them out of your body. Antioxidants are found in colorful foods, eat foods, and each different cola has different types of antioxidants. So your black and purple foods and blue have different antioxidants than your red foods, than your yellow, than your orange. Try to have three colors on your plate at every meal. And that doesn't include condiments or skittles. So omega 3s actually upregulate the body's own antioxidant defenses. Getting enough omega 3s through walnuts or. Fish oils, salmon, that can be really helpful. Hydration is important. Your body is a significant proportion water. And just 1% dehydration slows our cognitive functioning. 3% dehydration slows our reflexes and our cognitive functioning to the point that it's like somebody who is legally intoxicated, which I found that to be very, very interesting. But you can test that for yourself if you want to and make sure you have enough proteins. Your neurotransmitters need proteins, tryptophan and, and others in order to make the, in order to be created. So make sure you're getting good quality proteins. You don't have to go out of your way and eat weird things. If you're getting enough whole protein, then you're getting what your body needs. Chia seeds and quinoa are plant foods that offer complete proteins as well as obviously your, your animal based foods. Get a physical and blood work. Your T3 and T4 levels, your gonadal hormones, vitamin D levels and, and vitamin B12 levels all can contribute to stress, which can exacerbate the adhd, the addiction and the trauma. Get vision and hearing screenings. This is important if you haven't been diagnosed with adhd. Some children and even adults who fight tooth and nail and say I don't need glasses, I know I was one of those, may have difficulty focusing and concentrating because they can't see or they can't hear what is being said. That leads to confusion and potentially misunderstandings and stress and again activation of that stress response. So get screened, it's not hard and it can reduce your overall stress. If you're engaged in addictive behaviors, obviously seek treatment. Addictions by their very, by their very nature are stressful. Vagus nerve Stimulation. You know, this is a favorite topic of mine. Direct vagus nerve stimulation via transcutaneous auricular, which is the nerve vagus stimulation and transcutaneous vagus stimulation, which is other than right at the right at the ear, targets the vagus nerve in the autonomic nervous system. Reduces stress responses which are known triggers for impulsivity in ADHD and known triggers for relapse in addiction. So get to be friends with your vagus nerve. Figure out how to strengthen that puppy because it is important at helping you with ride the wave, at helping you decompress, downregulate whatever words you want to use. By increasing vagal tone, your vagus nerves ability to actually kick into gear. Vagus nerve stimulation improves emotional stability and reduces cravings. That's really important. If we get stressed out and we start having cravings or we start feeling urges to be impulsive, then and, and we're able to down regulate our nervous system, we go into rest and digest and we become less impulsive and our HPA axis is less active and there's less emotional turmoil. We're actually turning down the volume of those intense emotions. Research on vagus nerve stimulation for ADHD shows improvement in emotional control and attentional focus through its effects on the HPA axis and neurochemical balance. If you prevent your body from staying hyperactive in that stress response for too long and causing the HPA axis to start to get dysregulated, then you're going to have an easier time regulating your emotions. Difficulty with emotional control really starts with once, once that HPA axis is disregulated and people go from flat where they just, you know, they're exhausted, they just don't care whatever, to furious or frantic. If we can prevent those surges and pace the emotions, if you will, then people will start to heal their nervous system. In addiction, the vagus nerve stimulation has shown promise in stabilizing dopamine related reward circuits, reducing the likelihood of relapse by minimizing stress driven cravings and mood fluctuations. Relapse is basically an impulsive behavior. And by developing more control over your emotional responses, by not feeling like your emotions are going to overwhelm you, by feeling like, hey, I'm safe, I am empowered to downregulate my own emotions, then people with addictions often don't feel the need to resort to using because they're able to accomplish the same thing by activating that vagus nerve instead of triggering the dopamine circuits otherwise. In adhd, vagus nerve stimulation improves tolerance to Frustration. Well, guess what? People with adhd, they start doing something, they start getting frustrated. That triggers impulsivity. When they start getting frustrated, if they activate that vagus nerve, they're going to downregulate. That impulsivity goes down, the frustration goes down. They can get into their wise mind and think more clearly. So vagus nerve stimulation improves tolerance to frustration, which often leads to emotional outbursts. While in addiction, vagus nerve stimulation mitigates the emotional triggers. Vagus nerve stimulation combined with biofeedback fosters an understanding of individuals or individuals understanding of their own stress responses. When I work on vagus nerve strengthening exercises, I typically have my heart rate monitor on. I wear one of those polar straps and I will do interval work. I will work really, really hard and get my heart rate up. Then it's kind of a game to see how quickly I can get my heart rate to come, come back down to baseline. And I do a set of 10 or 15 intervals during my workout. And that's how, that's how I strengthen my vagus nerve. That's not how everybody wants to do it, but ultimately I'm able to engage in those vagus nerve stimulation activities and then I watch my heart rate go down and as I see it go down, I'm like, hoorah. So you know, the little games we play with ourselves when we're exercising. But it really is helpful. Group based vagus nerve stimulation training has shown effectiveness in increasing self awareness and in social situations, like what's going on in the social situation that may be triggering, fostering supportive interactions. Okay, I recognize something's going on here that's triggering me. Let me reach out for social support. And all of this can reinforce positive behaviors and reduce impulsive responses. VNS has also been shown to enhance cognitive, cognitive flexibility and executive functioning by increasing norepinephrine and GABA levels, which are crucial for focus and impulse control. Well, let's go back, think about our neurotransmitters again. What is gaba? GABA is our main calming neurochemical. GABA is the one that says slow down, you got this. Let's just think about what we need to do. Norepinephrine? Yeah, it's a little bit of stimulant, but it's also one of our main focus chemicals. So when norepinephrine goes up, focus can go up. Especially if GABA is going up. When norepinephrine goes up with glutamate, that's I'm focusing on getting the heck out of here. I'M focusing on stress. When norepinephrine goes up with gaba it's I feel safe. Now let me focus on the task at hand. Interpersonally significant others. Here's a couple of tips. If you have somebody with adhd, addiction or trauma issues, focus on the person's strengths, not their mistakes. And why am I putting all these together? Because when you look at the symptoms of CPTSD and adhd they overlap a lot and it's really important to get a good diagnosis. You can have ADHD and trauma concurrently or you can have ADHD or trauma and the treatment is very different. You're not going to give somebody with, with trauma stimulant medications that would be effective for somebody with adhd. So it's important to really get a good clinical history of what's going on. However, people with addiction tend to have low self esteem, poor impulse control, you know the stuff we talked about. People with ADHD and trauma also stressed out, hyper vigilant. They're probably going to be more sensitive to criticism recognizing or dare I say assuming that they have rejection sensitivity. Focus on their strengths, not their mistakes. It doesn't mean don't acknowledge their mistakes. It means focus on their strengths and with their mistakes. Help them do better. Make sure that they know that they are loved for who they are and that they have all these strengths. And yeah, this area over here, they may not be great in, but they're good at all these other things. Help the person learn from their mistakes. If they're in, if they make a mistake and they feel like they're being criticized, anything you say to them after that is going to go one in, in one ear and out the other because they're in fight orf flight. They're that rejection sensitivity has been triggered when the person is down regulated. You know, help them down regulate if you need to. When they're downregulated, then help them learn from their mistakes. Let's look at how this occurred. What happened that led up to this impulsive behavior and what can we do next time? One of the things I learned as a parent was right after school was not the time to take my son grocery shopping because he had built up all that stress. He had held it in for so long and he was ready to just explode. And taking him to the grocery store right after school was destined to, to provoke impulsivity and all kinds of other acting out behaviors because he just, he couldn't take it anymore. Part of, part of it is helping the child learn from the mistakes and if we're talking about a child, sometimes parents need to learn too that that's just too much for him to handle. So we would go to the park first before we would go to the store. In terms of adults, significant can others, teachers, supervisors, make sure that you're providing or helping the person create to do lists. People with ADHD often have difficulty organizing and planning. So if you sit down and you help them figure out how to plan it out, that can be super helpful. And that's a reasonable accommodation. You can even give them a step by step to do list. That's a reasonable accommodation. Helping them recognize also when things need to be done. Because people with ADHD often have time blindness, they have difficulty recognizing how long something's going to take. And it's important to help them figure out how to manage their time. Now, this sounds like a lot for a teacher or a supervisor to do. Hopefully the person has learned along the way through school and through working with their parents. But a lot of times that doesn't happen. Helping them recognize. Okay, I really do. I don't like setting time frames, but I really do need to do that in order to make sure that I get everything done. Improve mindfulness. Help the person improve mindfulness of their needs and their ability to communicate them. I know what I need in order to focus right now. I know what I need. Here my son again, I can use him as, as an example. I am one. Y' all know I'm very structured and I like my lists, I like my schedules, I like things. And that's just too structured for him. Despite the adhd, he does better with to do lists that he has to get done in a particular day or something. If you get it too structured, he feels overwhel. And it took a while before he felt comfortable communicating that to me and saying, ma, you're just. You're overwhelming me with all these, with all this minutia. You know, I need bigger strokes and a little bit of time and fine, you know, being able to communicate what you need to others is also important. Being able to communicate to your boss, I hear you want me to get this project done. I need you to help me break it down into manageable tasks. Okay, that works too. Discuss the have the person with ADHD discuss with their significant others what their symptoms are and what the significant others can do to help. For example, with children or with patients that I had in residential, when we'd be in group, I would. If somebody would start to blurt, I'd hold a finger to My, to my mouth, not looking at them, going, because that's rude. But I would just, you know, kind of non descript and not looking at anybody in particular. And that served as a cue for some people because of the time blindness. It can be helpful to call somebody 30 minutes ahead of time to remind them that you're going to be there to pick them up. For example, that is a reasonable request that somebody with ADHD may make. Educate people about your adhd. They can't help, they can't intervene, they can't understand if they don't know. Separate other people's irritation with the ADHD behaviors from rejection of you. And this can be said about addiction and trauma behaviors too. Behaviors are behaviors. They are responses. It doesn't mean even if you make a bad response, it doesn't mean that you're a bad person. It was just a poor choice. Accept responsibility for inappropriate actions and develop strategies to reduce those behaviors. You can go to askjan.org that's the job accommodation network. So askjan.org to learn different reasonable accommodations that can be requested. It's not an exhaustive list, but those accommodations can be requested in the workplace and in the school for people who have adhd, addiction, trauma, or a variety of other physical or mental disabilities. Identify situations in which the person with ADHD is most likely to behave impulsively. Some things are more overwhelming, more stimulating, more triggering than others. Being aware of those ahead of time doesn't mean you can avoid them, means you can prepare for them. Encouraging the person to explore these situations that I behave impulsively, do they typically increase my stress? I venture to say probably so. If so, what is that distress you're feeling related to? And for a lot of people, it may be related to the trauma of prior rejection, prior embarrassment, prior criticism. And when they go into those situations, they're like, oh, every time I've gone into a meeting like this before, you know it's been bad. So I'm anticipating the worst. I'm getting stressed out ahead of time. Sometimes people with ADHD feel unsafe and powerless in their own bodies because of the disorder. Same thing is true with trauma and addiction. They feel this compulsion, this impulsivity that feels overwhelming sometimes and they don't know where it's coming from or how to control it. And that's part of treatment, is helping people identify their triggers and develop strategies, strategies to manage those triggers. Encourage the person, once they identify the situation and what distress it's related to, encourage them to identify down regulation strategies they can use such as breathing exercises, grounding exercises, movement, sometimes just walking a little bit, Going out and walking around the building once can help. Or splashing cold water on your face. And then encourage them to think about how they can prepare ahead of time for stressful situations so they're less likely to blurt or get agitated. Encourage people with adhd, addiction and trauma to improve their communication skills. Being able to communicate assertively and calmly instead of blurting or being aggressive to reduce blurting. Some suggestions before you answer somebody. Inhale slowly, exhale slowly, put on a thoughtful expression and say to yourself, well, let me think about that. And caregivers can really prompt this. So the, the child may go, you know, and this was always, I don't know what about grabbing your chin as a thoughtful experience. But expression. But this is what we always did. Encouraging them to stop, stop and think. You don't have to immediately respond to a stimulus. As I mentioned, putting a finger over your mouth. And this can work for the person with adhd. They can go, hmm, let me think about that. Or you can just jump right in if you have difficulty taking that breath and paraphrase whatever the person has said. Oh, so you want to know about, or you're asking my opinion about. And that can be something caregivers can prompt too. It gives you a chance, gives the person with ADHD a chance to get space between the statement or their request and their response. Emotionally, people with anxiety and ADHD has significantly poorer responses to stimulants than those without anxiety. Well, gee, you think you have somebody with ADHD and anxiety or ADHD and cptsd and you give them something that increases their stress response, which is what a stimulant does in general. It's typically not going to be as helpful as you had hoped. Now, let me say a lot of people with ADHD respond differently to stimulants than people who are neurotypical and they don't have the same stimulation, exhilaration response that other people do. It helps them focus a little bit more. But if there's concurrent anxiety, it's been shown that the, the stimulant interventions tend to be less effective with that population. There is a, an antidepressant that can work for people. If the stimulants are not recommended for people with dysregulation and low frustration tolerance, encourage them to enhance their distress tolerance skills. One mnemonic that you may try using is bats. Encourage them to breathe. Find activities they can do to help them downregulate or tolerate their restlessness, talk it out or sensations. Finding sensations like splashing cold water on your face, that can help kind of jar you out of that stress response and so you can get into your wise mind. Increase positive activities, positive activity activities. Prime those dopamine receptors and that's really what we want to do here. So what can they do to help naturally sort of prime those dopamine receptors? Address trauma or other issues contributing to anxiety or depression. Identify cognitive themes, particularly rejection, failure, getting in trouble or being unsafe in some other way. Identify those themes that they have that may be contributing to their anxiety and hypervigilance and difficulty focusing and address emotional reasoning. I feel scared. Therefore there must be a threat. Address that by encouraging them to look at the facts for and against the belief and anticipatory anxiety that fear about what could happen. Really play the tape through and looking at the facts in this context at this time, what is the probability that your fear is actually going to come true? Cognitively help people with adhd, addiction and trauma, enhanced self esteem and efficacy. That's their belief that they can do things. Encourage them to ask themselves what am I good at? And help them learn how to set and achieve smart goals. If you set goals and you fail to achieve them, that just dings that self esteem even more. So help them figure out, learn how to set and achieve specific, measurable, achievable, relevant and time limit time limited goals. Learn about the person's learning style. Some people are auditory, they learn by hearing. Some people are visual. Learn by reading. Some people are kinesthetic. They learn by doing and help them use that knowledge that to work with the information. I have an entire video on learning style and adult learning theory that goes into how to do that. And some people are active learners. They think and talk at the same time. Those tend to be your extroverts. And some people are reflective learners. They hear it, they take it in, they soak it up, they move it around and then they have this aha moment. It's not that they're ignoring you or not paying attention. They need the data. Then they need processing time before they provide a response. If you've got somebody who is more of a reflective learner, that's fine. Give them a minute after you ask a question, give them a minute to think about it. They're not going to be the first one going oh, call on me. But that's okay. Encourage people to get screened for dyslexia. There's a lot of overlap. There's a lot of concurrence between ADHD and dyslexia. And people with dyslexia get frustrated in school. They have difficulty learning up to their abilities, if you will, because they're having a hard time reading or adding. I mean, there's all kinds of dyslexia, but dyslexia can be mistaken for ADHD because a lot of people with dyslexia will get frustrated and just kind of zone out. Prioritize. Encourage the person to prioritize what's most important for them to move toward what they define as a rich and meaningful life. Encourage people to chunk it. Adhd. Have difficulty concentrating for long periods unless it's something they really, really like. Addiction, trauma, same thing. So, okay, you're already stressed out for whatever reason. Whatever you've got to do, break it down into manageable chunks that you can get accomplished. Whatever that chunk is for you, 15 minutes, 30 minutes, an hour, chunk it. And if you're doing something you're not interested in, try to relate it to something you are interested in. Maybe you have to get this proposal done for your boss and you're really just not interested in it. However, you know, you really like having that paycheck, and you're going to use that paycheck to go on vacation, you know, in two weeks or in a month or something. So you see that I've got to do this in order to achieve the goal that I want. Create solutions lists and keep them with you. You know, if you've got ADHD or trauma to provide options in response to distress or impulsivity. So when you start feeling distressed or impulsive, that's not the time to think, well, gee, what should I do? You're already in that fight or flight. You're already in that stress response. So keeping a list with you on your mobile device, in your purse, in your backpack, I don't care. 10 things I can do when I'm feeling this way. 10 things I can Think About When I'm Feeling this Way. Plan ahead and use impulse control strategies. Adults with ADHD or addiction often have difficulty drawing on past experiences to guide their actions. They go from flat or not impulsive to furious, frantic, impulsive, just, you know, off the chain. It's very dichotomous. They may not be good at recognizing the subtle aspects of problems and the various tools that might solve them. When they start getting stressed, they have more difficulty filtering out the stimuli. And they're in fight or flight because they're stressed. So it's hard to analyze what's going on because you're in fight or flight. We need to help them down regulate so they can analyze and start to see the subtle aspects. One tool that can be helpful is to encourage them to picture a television. Imagine the last time they were in a situation like this, whatever the situation is, and play that prior situation on their imaginary TV like a movie and think to themselves what did I learn from this experience and what were some of the details of that experience that I'm watching on my tv? The rerun that made it similar and different to the current situation? Verbalize thoughts and reasoning when there's an urge to act out, sometimes that can be helpful even if nobody's around. I'm having the urge to and this is why and it encourages you to start trying to pull your energy over to that prefrontal cortex. Train your brain with apps like Luminosity or Elevate or something else that improve focus, memory and thought organization through practice and repetition. Many people with ADHD forget the purpose of their tasks so they're uninspired to finish them and keep prompts around to keep things moving forward. As soon as I get finished with this, this is the reward that's waiting for me. Imagine the positive consequences of doing something can be a potent motivator for most people with ADHD or addiction. So for example, put a medication reminder app on your phone to remind you each morning to visualize your day. I'm going to do all these things and this is why I'm visualizing the positive consequences of getting things done. I get to work on time, my boss going to be happy. Hey score. Imagine how great it will feel when you get to your goal and add visual reminders of your goals around you. Increase motivation in all the pacer dimensions. Physical how's it going to help me feel better physically? Sleep better interpersonally? How's it going to improve my relationships and my self esteem emotionally? How's it going to make me happier? Cognitively, how's it going to help me think more clearly and environmentally? What can I do in my environment to make this happen? But for people with who need an increase in motivation because their dopamine is low, increasing these things can be really helpful environmentally. Adding pictures of your goals or auditory cues can be helpful environmentally. Train yourself to be more organized. Use alarms and push notifications. Write things down on your mobile device and set an alarm to check the notes each morning. Scan in any documents you may need later so you're not sifting through a pile on your desk going I know it was here somewhere. Envision the steps of your day each morning. So you're kind of priming your brain. But don't get over organized. Too much organization and you'll get lost in the weeds. So how much organization do you individually need? Minimize distractions in your environment. When you need focus, have private space. Use noise canceling headphones. For some people that I've worked with who have adhd, they swear that they cannot focus unless there is background noise. So so figuring out what it is that helps you focus is very individual but very important. Ensure you feel safe in your environment and keep a distress toolkit with you to help deal with boredom and restlessness for teachers and caregivers. Facilitate success in car rides at restaurants, church, grocery store, or when visiting people by bringing that rescue kit to address fidgety behaviors and facilitate success in school or work activities by working with the person to develop checklists, helping them train themselves to pack and check the night before for whatever they need. Enter syllabi or to do list into an online calendar and helping people plan. For example, the science fair is on November 12th. All right, so let's work backwards. When do you need to start working on your project in order to be finished by November 12? And put those incremental dates on the calendar I mentioned earlier. The Job Accommodation Network Essential Tool an effective treatment plan starts with determining if you are dealing with trauma related symptoms, masquerade masquerading as ADHD or actual ADHD trauma symptoms won't respond well to stimulant medications. However, many people with ADHD who have ADHD develop trauma related symptoms as a result of the experiences they have prior to or even after their diagnosis. So it's very possible to have CPTSD and ADHD concurrently. Treating someone with ADHD must recognize not only the impact of the ADHD increasing stress, but also schema beliefs related to rejection and criticism and how that how those schema trigger the stress response. In similar situations, people with ADHD and or trauma will sometimes self medicate with addictive behaviors. ADHD trauma and addiction symptoms all respond well to strategies aimed at strengthening vagal tone and helping them feel empowered to manage their emotions and downregulate. ADD and ADHD can negatively impact relationships, work and addiction recovery if not addressed. People with ADHD and the people around them need to understand it's not a problem with willpower or intentional maliciousness, but a condition caused by differences in the physical and chemical workings of the brain. As with any other disability, people with ADHD need to learn their abilities and be empowered to make necessary modifications to address their symptoms in a neurotypical environment so they can move toward a rich and meaningful life. It's more important to identify and address symptoms than worry about fitting particular diagnoses. All right, everybody, thank you for being with me today. What questions do you have? Electrolyte drops in your wallet can be really helpful. Great suggestion, Dr. Darlene. I'm sorry to hear that. Roller girl. Roller girl, are you still here? Oh, yes, you are. Excellent. Roller girl. Can you email support supportlce.com or supportocsnipes.com that's probably easier. I have something I wanted to ask you, but I didn't have a way to get in touch with you. Hello, Alyssa. Hello, Damon. You are quite welcome. Do I offer mentorship? Sure. I'm always happy to mentor new people in the field. Now, clinical supervision is different because states have all their own, you know, weird, wacky, wild rules. But I do do mentorship, and yes, I do. So you can also email supportoc snipes.com. Costas. Oh, hello, Shyman. It is so good to see you. I hope you've been here the past few weeks, but you tend to kind of fly under the radar sometimes. But it's always good to see you and I'm glad you are. Well, Costas, if you're still here, one of the things you may be experiencing is the stress over not seeing the improvement that you're hoping for might actually be setting you back. I would encourage you to embrace the mindful awareness of where you are in the moment and objectively identify the symptoms of pause you are experiencing, discuss them with your doctor, and set goals for what you're hoping they will look like in a month, three months, six months. You. All righty, everybody. Have a wonderful, wonderful rest of your week and I'll see you next Wednesday when we are going to start our sort of miniseries on working with the older population, people with disabilities in skilled nursing care, and people with dementia. It.