Ep. 44 – Ted Leavitt – ADHD: Now Playing In A Person Near You
- Distinguishing between problem behaviors and mental health problems and why this distinction matters.
- Why children lie and how we respond in a way that welcomes the truth.
- How our response to symptoms of ADHD can create symptoms because of ADHD.
This episode is from our 2019 conversation with Family Therapist Ted Leavitt. Ted describes his adult diagnosis of ADHD as a discovery that changed everything, including his personal perspectives and professional practices. Ted now focuses on removing distinctions between behavior problems and mental health problems, recognizing that children do well if they can, and when they can’t, there is more to explore than them just being ‘naughty, lazy or rude’.
Ted LeavittTed Leavitt is an author, an addiction counselor, a youth and family therapist and a specialist in ADHD: attention deficit and hyperactivity disorder. His work is built upon years of study, practice and personal experience.
Diagnosed with ADHD in his thirties, Ted came to see himself and his clients through new eyes. In his work with both clients and medical professionals, he highlights the challenge of distinguishing between problem behaviors and mental health problems.
Transcript: Ep. 44 – ADHD: Now Playing In A Person Near You
Rachel Cram – Ted thank you so much for being in the studio today.
Ted Leavitt – Glad to be here.
Rachel Cram – I am so interested for this conversation, partly because I think I will learn a lot as well. In preparation for this interview I listened to your TEDx talk, which is fabulous.
Ted Leavitt – Thank you.
Rachel Cram – And I actually have a lot of ADHD that runs through my family as well so I’m here as a learner.
Ted Leavitt – Welcome.
Rachel Cram – Welcome to the club.
Ted Leavitt – Welcome to the club. Yeah.
Rachel Cram – It’s a beautiful club.
Ted Leavitt – Yes it is.
Rachel Cram – I’m going to start today with a question that we typically open with in our interviews. Aristotle stated, “Give me a child at 7 and I will show you the adult.” So Ted, is there a story or an experience from your childhood that has shaped the man that you are today?
Ted Leavitt – Yeah, I mean there’s so many stories right. I’m a storyteller and so I remember all sorts of things. But it’s interesting that the quote talks about the age of seven because the story that rises to the top for me, I was probably seven or eight. I think I was in Grade 2 and there was this little girl that moved into our school and she was just odd. I mean as a 7 year old you can’t articulate but she would just sit a lot of the time staring, either staring at you, through you, at nothing. She sort of had her mouth hanging open. She had a runny nose a lot of the time. And I was drawn to her. She looked like she needed a friend. So I said to my mom, “I’m going to try and be a friend to this girl.” So I tried really hard. I talked to her. I tried to include her and ask her questions and I got nothing.
And I remember one time seeing her in town with her dad and I just got this weird vibe. And I just I had this feeling something not good was happening there. And then they moved and I never saw her or heard from her again.
And I always felt kind of haunted by that, especially as I got older and learned about the world and things that happen in the world. And I thought, “Man, that poor little girl was all by herself and nobody was helping her.” And I don’t know if she ever did get help. I don’t know if she had some developmental difficulties. I’m sure there was some trauma going on there. So that’s kind of me. I was always the person to notice that person in the room.
I would say that’s probably the one that stands out the most for me.
Rachel Cram – Thanks for describing that. It’s amazing how early compassion, or empathy, manifests itself and that it led you to this career. Now you started off as an addiction counselor, is that correct? That was your first career in the area of counseling. Were there any big takeaways? I know you shifted, and we’ll get into that. Were there any experiences or understandings that you gained through that particular form of counseling?
Ted Leavitt – Oh yeah. Like so many, so many. It was such a good place to learn on the job. One that served me really well over the years has been to not take lying personally.
Rachel Cram – Lying from the client?
Ted Leavitt – Lying from the client or your child or whoever. So I was working as the intake worker. I ran the group for the guys in their first two weeks and this guy came to me one evening and he said, “Oh my grandma’s dying. She’s in the hospital. She was my caregiver growing up. I would just feel terrible if she died without me having a chance to say goodbye to her. So I need to discharge from the program early and go in to see her.”
I said, “Okay, that sounds like a legit reason to do it.” So we bought him a bus ticket and took him down to the bus stop and dropped him off.
When I got back to the treatment center a couple of clients pulled me aside and said, “No, his grandma’s not dying. He wants to use drugs.” and I always hated being lied to. Which is ironic given how much I lied to other people as a kid.
So I was like, “What!” I was ready to get in the van and drive back down there to take the ticket back. How dare you take advantage of my sympathy. And then I realized, he didn’t pick that story because he thought I was stupid enough to believe it. Which was always a trigger for me. People thinking that I was dumb. I just realized, OK people lie because that’s what they know how to do. Their brain has told them that is your best strategy in this scenario. So let’s do it. And I learned to not take it personally. And sometimes when they knew that I knew that they were lying but didn’t really care that they were lying, they would feel safe enough to open up a bit more. They would then tell me the truth. Because often when you say to kids, “Oh, if you do the thing that you shouldn’t do, that’s one thing, but if you lie about it that’s when I’m gonna be mad.” But if I’m not even mad then, it becomes very safe to tell you the truth.
Rachel Cram – Well I think what you’re describing is the complexity of people and, I think related to this, in your work you’ve been looking into the difference between problem behaviors and mental health problems. I’m wondering as you reflect on stories like this, what are you discovering about that difference, or lack of difference?
Ted Leavitt – Well that is a source of frustration for me I would say; sitting in meetings with people who in my opinion ought to know better, who just cannot stop themselves from delineating mental health problems from behavior problems.
Rachel Cram – Are you talking about therapists or are you talking about clients here?
Ted Leavitt – Therapists
Rachel Cram – OK
Ted Leavitt – Therapists, psychiatrists, mental health professionals, people whose job it is to know the difference saying, “We don’t have enough beds in the child and adolescent psych unit because we have all these behavior kids coming in.”
And me saying, “Well, behavior problems are mental health problems.”
And then they say “Yeah, I know, but when they’re not.”
I said, “But they are, always.”
Rachel Cram – Well and this comes back to teachers and schools too right. There’s a lot of conversations right now about all the behavior problems that are in the schools and I think this reflects directly on that conversation as well. And your attitude towards that very much affects how you relate to that individual.
Ted Leavitt – Absolutely. Yeah. So a lot of the presentations that I do, I start with this slide that says EEFB.
Rachel Cram – EEFB? That’s an acronym?
Ted Leavitt – Yeah. So, there’s an event that happens. We have an explanation for the event. Which gives rise to a feeling about the event. Which gives rise to a behavioral response to the event.
Rachel Cram – Event. Explanation. Feeling. Behavior.
Ted Leavitt – So you have a child who’s saying, “No!” when it’s time to work on math. “No it’s stupid!”
If your explanation is that this is a power struggle; then my feeling, I feel like this person is trying to take power from me. Which gives rise to either a fight or flight response.
If my explanation of this behavior is that this child feels overwhelmed, insecure, afraid, I would hope that my feeling would be more compassionate and my behavioral response would reflect that.
Rachel Cram – Which are mental health concerns, right?
Ted Leavitt – Right. So I think part of the hang up is, “What does mental illness mean? Right. And people think of the person mumbling to themselves walking down the street or suicidal depression, but it’s a spectrum just like physical health. There’s nobody who’s in perfect physical condition and why can’t the same be true with our mental health. We all slide up and down that spectrum day to day, based on things that happen. And it comes back to, kids do well if they can.
So if a person is having a behavior problem, I always say, “Nobody in their right mind does that. Nobody wants to do badly. Nobody wants to get in trouble.”
And I’m kind of a stickler for words. One of them will say, “Well, he likes to argue about everything.” Or, “He wants to make other people annoyed.”
Really? Does he want to, or is he feeling compelled to do that due to some unresolved thing that’s going on in his life?
And that’s what neuroscience research has shown over and over, is that our default setting is reflex. And that makes people uncomfortable I think, because then how can I blame other people for stuff? So now my power is given up if I recognize that we’re all reflexive creatures.
Now that’s our default setting. Through mindful practice you can learn to recognize your reflexes and override them. So we’re not doomed to stay that way.
Rachel Cram – But that takes a lot of conscious choice and practice.
Ted Leavitt – It does right. And often it takes a lot of painful experiences to wake us up to the reality that maybe we’re not quite as in control as we thought we were.
Musical interlude #1
Rachel Cram – Now, before we keep going forward, I’m wondering if we can back up a little bit. You mentioned the trigger for you of people thinking you were dumb. And your book Teddy Hit Me, which is a great title by the way,
Ted Leavitt – Thank you.
Rachel Cram – covers reasons for this, and the confirmed discovery of your own mental health challenges when you were in your thirties. I’m wondering if we can look at that because I think often when you are a therapist or when you’re working with people, the more that you can personally relate the more effective you can be.
Ted Leavitt – 100 percent.
Rachel Cram – Can you tell me about that experience? What happened for you that brought that to your attention in your 30s? What was the journey?
Ted Leavitt – So in terms of the diagnosis?
Rachel Cram – Yeah, what made you be diagnosed at 30? And what did that do for you as an adult? How did that change, how did that shift things for you? Or did it?
Ted Leavitt – Oh yeah, it changed my life entirely.
Rachel Cram – How so? You were at a work conference on mental health I believe?
Ted Leavitt – Yes. So, it was with Dr. Gabor Mate who wrote Scattered Minds and he had just written a book called In the Realm of Hungry Ghosts about addiction.
And so it was all about attachment trauma and brain development and the need for comfort. And I was like, “Oh my goodness, this explains everything!”
So I loved everything that he was saying. So of course I bought all of his books. And one of them was Scattered Minds, a book about ADD, is what he called it when it was written. And I thought, “Oh, I think a lot of my clients probably deal with this. Maybe it’s a good way to get to know them.”
And so I started reading it and from the first pages I was like, “What the heck! This is my life!” Like there were lines in there that are things I’ve said many many times to other people.
Rachel Cram – What would be an example of that?
Ted Leavitt – So my wife one time, I was kind of like storming around the house, and she said, “You need to figure out what is stressing you out.”
I said, “I know what is stressing me out. I’m stressing me out but I can’t get away from me is the problem.”
And that’s one of the things he talks about. Being terrified of being left alone with your own mind. And he talks about reading a book in the bank lineup because he can’t stand being alone with his own thoughts. It’s almost a visceral experience. What you could describe as impatience would not fully capture the lived experience of standing in a lineup that you can’t make go faster but you have to be in.
Rachel Cram – So you have to have a distraction.
Ted Leavitt – Yeah. You have an itch that cannot be scratched.
Rachel Cram – And did you think everybody felt like that? Or had you not really thought about it in detail?
Ted Leavitt – I hadn’t ever really thought about it. I mean nobody had ever attached any kind of a label to me except depression, and that was just like a one time comment when I was about 18/19 years old. When they said it, I was like, “Oh, that would actually explain a lot.” And they weren’t wrong, but the underlying source still wasn’t there.
Rachel Cram – So you’re reading this book and you’re thinking, “Oh my goodness, this relates to me.”
Ted Leavitt – Yeah. So I’m like, “This is me!”
So back then I was very antimedication. I was like, “Oh you don’t need medication. Just learn to think differently, and plan, and all that kind of stuff. But that didn’t make any difference for me.
A big part of the treatment for ADHD is knowing what that is. Like, “Oh that’s why I do all that stuff, or don’t do all that stuff.” So that was a huge boom right off the top. Just understanding that.
Rachel Cram – What is the ‘that’? Like, when you say you understand that’s why I don’t do this, that’s why I don’t do that. What did that book tell you was the reason for that?
Ted Leavitt – Not enough dopamine in the prefrontal cortex of my brain. It actually had nothing to do with my character or my desire or will or any of that stuff that I had always been attached to. Laziness. Those kinds of things, which later became very apparent when I started to take the medication.
So what pushed me to actually be officially diagnosed was a client who had been through the treatment center many many times. He was in my colleague’s group at the time and just a classic case of ADHD. Legs bouncing all the time; talking all the time. He knew all the answers to all the questions. He could write out the plan with his eyes closed. But he could not follow through on any of it and he could not stay clean for more than a month. He would come in for three months in the program. Leave. Relapsed almost right away. Come back. Do it again.
And so his last time through, the counselor and I were pretty good friends and we’re talking a lot about my ADHD realizations, and he’s like, “Huh, I wonder if that’s what’s going on with him?” And so we were actually able to get him to a psychiatrist who prescribed Dexedrine for him, ADHD medication, and, totally different guy. He graduated and stayed clean and stayed clean. And you know, last I heard he had been seven years, and this is a guy who couldn’t get 30 days.
Rachel Cram – So what that medication was giving him was the dopamine hit to his brain that he needed.
Ted Leavitt – Yeah. That he kept finding in crystal meth.
Rachel Cram – Ted do you have a general statistic of the population of how many people are affected by ADHD? I know that’s a very broad term right now. It’s a big spectrum term. But do you have numbers? Do you have stats that address…?
Ted Leavitt – It’s incredible how widely varied prevalence estimates are for ADHD. I’ve never seen one that rates it at higher than 10 percent, but prevalence estimates are always difficult because it’s based on people seeking help.
So I tend to think that maybe all of those prevalence estimates are underestimates.
Rachel Cram – I asked that because in schools right now we’re hearing so much about the behavior problems, as we talked about before. And I think something resonates within us to know, to feel, it’s not always a choice. That it is perhaps a mental health problem. But then when you look at your child for example, or your husband in your wife’s case, you think, “I don’t want to attribute a mental health problem to this person because that doesn’t fit the stereotype of what I think.”
But there’s so much self-esteem, there’s so much potential, there’s so much capability that’s lost with not being aware of the necessity of a dopamine hit to our brain. Can you walk us through your growing up? What was school like for you?
Ted Leavitt – So, it’s kind of like an athlete who’s naturally athletic. They can get by on their talent but when they get with other people who are also athletic who work hard, then they kind of end up on the bench. So that was me in elementary school. I could kind of wing it. I was very creative. I didn’t get in a ton of trouble. My report cards were always, you know, “Ted could do a lot better if he would apply himself. He could be a great student if he would only be more organized.”
A lot of last minute projects with my dad helping me finish. A lot of frustration, you know, foot in the mouth, saying the worst thing you could say, “Oh man! Why did I say that?” Those kinds of moments. But I had lots of friends and I was pretty well liked. And then when I was going to grade eight there was a big uptick in what’s required of a student in terms of self-directedness, self organization, self-regulation essentially.
Rachel Cram – So high school requires that?
Ted Leavitt – Yeah. In elementary school, not so much.
And so I’d really dropped off, and was doing really badly in school. But nobody really thought anything of it because they could see that I was the smart kid. So I must just be lazy or not working hard. Or I was really depressed. And so that persisted till the end of grade 12. Essentially this underachievement.
Rachel Cram – So what sort of things would your report card say? What were your teachers saying about you?
Ted Leavitt – It was a lot of the same stuff. “Not organized. Not handing stuff in. Not paying attention. Not applying himself,” the classic one that ninety nine percent of ADHD people have on their report cards. “If they applied themselves or were less social…” that kind of stuff.
Rachel Cram – And what were you thinking about yourself at that stage? Do you remember that?
Ted Leavitt – Yeah, I just thought I was an idiot; an inevitable disappointment I guess. A lot of people say, “I’m hardest on myself,” or “I’m disappointing myself.” I never felt like that because I didn’t have expectations for myself.
Musical interlude #2
Rachel Cram – That’s such a sad outlook on yourself. You talk about there being symptoms of ADHD and symptoms because of ADHD. Is that kind of self image a symptom?
Ted Leavitt – Yeah
Rachel Cram – Can you give the distinctions for each? What are symptoms of ADHD?
Ted Leavitt – So things like, getting bored really easily, even by things that were once interesting. Starting really strong and kind of fading away. More big picture and not so much detail oriented. So, I’m just sort of paraphrasing the checklist right.
Rachel Cram – Maybe we can put a link to that checklist, or the list itself on our website.
Ted Leavitt – Yeah.
Rachel Cram – So, what are other symptoms of ADHD?
Ted Leavitt – Fidgetiness. A difficult time staying seated; although with adults, for the most part we’ve learned to stay in our seat. So I’ll ask them, “How often do you feel like getting up?”
OK, so we check that box. A very specific kind of memory difficulty in what’s called ‘working memory,’ which is remembering what you’re supposed to be doing. So if you’re doing a task and you’re pulled away from it, can you go back to where you left and pick up where you left off? You know, “I need you to do A B and C.” They can maybe remember ‘A’ but the rest of it kind of gets blurry.
Difficulty learning from mistakes. So a lot of repeated mistakes. Why do we keep having this conversation? kind of stuff. Emotional. Up and down mood swings. We also tend to hyper focus on things that naturally produce dopamine in our brain. We do have a chronically low level of dopamine, which is a reward chemical. But our brain also doesn’t regulate it very well and so when something comes along that produces dopamine you get locked into it and sort of laser tractor beam focus.
Rachel Cram – What would be examples of that?
Ted Leavitt – So as a musician I had a little studio in my house and I would say to my wife, “Oh, it’s 11:00 at night. I’m just going to go down to my studio really quickly and just work on this chorus. There’s just one thing I just have to record really quickly.”
And then she’d come down at 4 o’clock in the morning and say, “You have to be up in three hours. Do you think maybe you should come to bed?”
“Oh! What time is it?” It’s like no time had gone by. I felt refreshed as anything. You just get so engrossed in it that there is no world around you, whether it’s reading books or playing video games or kids building lego. And that’s one of the things actually that interferes with diagnosis sometimes, is that they’ll say, “Well you can play video games. You can focus on playing video games or..”
Rachel Cram – Because that’s giving the dopamine hit.
Ted Leavitt – Right. But that’s where we come back to this idea of choice, right. They think, “Well you can pay attention when you want to.” It’s not about wanting to. It’s about whatever the activity is eliciting that from me, not me deciding to give it to the activity. And so those are the main symptoms; the signs,
Rachel Cram – Like the external signs? The symptoms that are more obvious to other people?
Ted Leavitt – Yeah, which is like the bouncing leg and the interrupting all the time and difficulty waiting for your turn. And then there’s symptoms which are more internal. So, a lot of racing thoughts and obsessive thinking. When I was diagnosed the psychiatrist said a lot of my symptoms were subjective. And at first I thought he meant, a matter of opinion, but then he meant only I experienced them because they’re not obvious to the outside world. Which would explain a lot of why it took so long.
Rachel Cram – So these are symptoms of ADHD. Before we look at symptoms because of ADHD, can I just ask you, you talked about getting bored, even with activities that were really interesting to you. When you’re bored, is that because you have actually lost interest or is it because you can’t maintain the interest?
Ted Leavitt – I guess for me those are two different feelings. So Dopamine’s role, one of its many roles in your body, is a reward chemical. And so, if you have a chronically low level of it then things that are rewarding for other people, let’s say nine out of ten for you, are five out of 10. And so I use the phrase, it doesn’t hit the spot. So there are lots of things that I am interested in and I want to try and learn about. But when I do them, it’s underwhelming. But I am genuinely interested in them. So that’s probably what you called boredom right. Is that things just don’t do it for me.
Rachel Cram – So you don’t continue to pursue.
Ted Leavitt – Right. There’s no payoff for it.
Rachel Cram – So it appears probably like you’re starting a lot of things but not completing them.
Ted Leavitt – Right. And when you start, you’re all in. Like,“You know what? I’m going to play the violin!” And you watch a thousand videos on teaching yourself violin. You do all this research on buying violins. You pick up the violin and you can’t make a note. And you’re like, “Ahh, forget it. But you know what? Mandolin! That’s what I need. I need a mandolin. It’s closer to a guitar.” So you switch.
So, it’s hard to say you’re not interested or you’re not motivated but there just isn’t a payoff for that interest and motivation and so things kind of fade out quickly. Now lack of focus, that can play a role too because a lot of times something like playing the violin or learning to draw requires persistence and follow through before you get the payoff. And if you don’t have the ability to stick with it, you don’t get the payoff. Even if there was a payoff at the end of the end of the rainbow, you don’t get to the end of the rainbow, so you never get to really experience it. Which leads to a lot of learned helplessness. Like, what’s the point in trying to do something because it’s probably just going to disappoint you anyway.
Rachel Cram – OK so that list you just gave are symptoms of ADHD. And when you’re talking about ‘learned helplessness,’ this becomes a symptom because of ADHD. So can you talk more about that?
Ted Leavitt – So, ‘learned helplessness’ was first studied with a rat. They put him in a container of water. He swims around the outside looking for an exit but there is no exit. So it eventually just stops swimming and floats to conserve energy. It’s survival behavior.
So after a few trials of that you take the rat and you put him in a container that does have an exit and they don’t even look for the exit. They just float right away because their brain has learned, “In these situations you can’t get out. So don’t try. Conserve your energy.” And so then, what was an adaptive response, becomes a maladaptive response. Now it’s not helping you. And so in humans what that looks like is, ‘I try to succeed and I don’t. I try. I don’t. I try. And you know why try? Why would I try?
Rachel Cram – You start floating.
Ted Leavitt – Right. You just start floating. On a purely survival level part of your brain, it is an adaptive strategy. Why would I waste precious energy pursuing something that can never be attained when I can conserve that energy for other things that are attainable? The problem is it’s built on a false premise which is that failure is inevitable, when really it’s just possible. And in some cases it might be likely. But it’s not inevitable. So the brain then over generalizes, which is what everyone’s brain does, that’s what they’re built for, jumping to conclusions and overgeneralizing to simplify the decision making process.
But for the people on the outside looking in, they’re like, “Why wouldn’t you even try it? It doesn’t make any sense. You like swimming. Why wouldn’t you want to go to swimming lessons or be on the swim team?”
Because that person’s brain is saying, “Well, everyone thinks I’m good at it but when I got in there I know I wouldn’t do well, and then I’d be embarrassed. So why would I go? I’m just signing up for embarrassment classes? I don’t want to do that.”
But because the outside person doesn’t share that perspective, it doesn’t seem to make any sense why they’re quitting. It’s a phrase I don’t like but, ‘self sabotage’. Right. People shooting themselves in the foot.
Rachel Cram – Can you give an example of that? That self sabotage?
Ted Leavitt – Ok. One SCA that I work with, she said, “There’s this little guy and he never does any work. And then one day we actually coaxed him into doing this math worksheet, and he got them all right. And we’re like, ‘Wow! See! You can do it!’ And he immediately ripped it up and threw it at me. Why would he do that?”
And I said, “Well, probably because he doesn’t want you to expect that from him. He doesn’t want you to think, ‘Oh, this is what’s going to happen now.’ So he’s got to lower your expectations again, not because he’s lazy and I want to do work, but because he doesn’t believe it himself.
So when you achieve success, your brain doesn’t really let you enjoy it because it’s terrified of what’s coming next. Because I don’t do well. So, if I’ve done well then that must mean something bad is coming around the corner. Which of course it always is because that’s part of being alive right.
Rachel Cram – Yeah. That’s difficult and sad though, being stuck in a limited and perhaps inaccurate belief system about yourself.
Ted Leavitt – Yeah. As a counsellor, I deal a lot more I would almost say with the symptoms because of ADHD which are things like low self-esteem, depression, addictive behavior, aggressive behavior, self-harm. Some pretty disturbing statistics.
Kids that are not treated for their ADHD are 700 percent more likely to have a substance abuse problem later in life. People with ADHD are eight and a half times more likely to self-harm in some form. So the way I view it is, it’s the individual’s way to cope with the alienation that comes from the symptoms of ADHD. That’s why I call them symptoms because of ADHD. It’s how I’ve learned to cope with the pain that comes from being the way that I am. And that pain actually comes from the people around me not knowing what to do with me. Not understanding me. And so the more people are educated about what’s actually going on here, we reduce the need for that coping stuff. We’re intervening way further upstream and not just trying to keep him from going over the waterfall.
I’ve seen statistics that say probably 70 percent of people with ADHD have a comorbid anxiety disorder.
Rachel Cram – Have a what?
Ted Leavitt – Comorbid – meaning occurring at the same time. 70 percent. That’s a lot. And yet it’s predictable. I mean if you’ve dropped the ball 100 times, it makes sense that you would anticipate dropping the ball.
Rachel Cram – You expect to fail?
Ted Leavitt – Yeah, your brain is just conditioned to expect the worst. Right. And that of course starts to take its toll on your self-esteem, and you start to feel like a loser and hopeless, and here comes depression, and I hate these feelings. Oh somebody passes me a joint. Oh they went away! I’m going to keep doing that. And these things start to feed on each other.
Musical Interlude #3
Thanks for listening to family360 and our interview with Family Therapist and ADHD specialist, Ted Leavitt.
Our next episode is a popular repeat from our past with Child Psychologist, and bestselling author, Dr. Gordon Neufeld. This was our first interview with Dr. Neufeld and it’s fascinating as he describes his world renowned work on attachment. Join us!
And now back to our conversation with Ted Leavitt as he describes the difference between validation and positivity when encouraging someone who has ADHD.
Rachel Cram – I think right now culturally, giving positive feedback is something that we do to encourage others. We say, “I believe in you. I can see you can do this. I can see your potential.” And I think what I’m hearing you saying is, when you have ADHD that’s not actually helpful, when someone comes along and says, “You’ve got so much potential. Like that rat. Start swimming.” Is that what you’re saying?
Ted Leavitt – Yeah.
Rachel Cram – Because what does that do to you?
Ted Leavitt – It just feels like pressure that I will inevitably not meet your expectations. Again, this is where that frame of reference pops up, because now when I do well on an assignment, I think, “Oh, it’s because he likes me.” Not because I did well on the assignment. Because the brain has a quick way of putting things back to our baseline state of beliefs.
Rachel Cram – You talk about mindful encouragement. The necessity from mindful encouragement when you’re working with someone with ADHD, or living with somebody with ADHD
Ted Leavitt – So, the ‘mindful encouragement’ really is about leading with validation. Saying, “I know this might be hard for you to accept,” or, “I know that you might have a hard time recognizing why I might think this about you.” So, we encourage the ADHD person in our reactions to their reactions. Not so much in coaching them on what to do and to try hard, but when they fail, absorbing that failure.
Rachel Cram – Can you give an example? You’re talking about a difference between validation and positivity. I’m wondering, can you give us an example, even from your married life? Because those are fuzzy lines to me.
Ted Leavitt – Yeah, I guess how a validation and positivity would look different would be like saying “Well, you know I have to give this talk and I’m going to do terrible at it.”
Instead of saying, “No, what are you talking about? You’re going to be great!”
It’s like, “Well you might do terrible at it. I mean, you do have some of those experiences in your life that have taught you that you’re going to be terrible at it. But you also have experiences where you’ve done fantastic.”
Because this idea that I’m going to inevitably fail is not built on imagination. It’s built on actual experiences of failure or setbacks. So to ignore that and say, “No no. It’s fine, it’s fine.”
Now they know you’re not telling the truth because these are demonstrable tangible things that I have messed up on. To say, “No, no. You’re fine.” No, I have messed up, so I would come at it like that.
So sometimes a kid will say to the parent, “I feel like I’m such a burden. I make your life so much harder.” And the parents are, “No! You’re not a burden!”
I’m like, “Well they kind of are. But they are a burden gladly born, right? We’re willing to carry heavy things because it’s worth it. And it doesn’t make me care about you any less.”
Rather than denying the reality that it is harder to parent you than your non ADHD sibling because I don’t have to e-mail their teachers twice a week to find out how much homework you’re missing. I don’t have to argue with them about every little thing.
So, to deny what is obvious becomes not a genuine relationship. So if someone says, “I’m afraid I’m going to forget.”
You say, “OK. Well what can we do to help you not forget?” So that’s the difference between validation and this blind positivity, “You’re gonna do great!” You have it in you to do great but we might need to get a plan built around you to help you do great. And if you don’t do great, who cares. It doesn’t mean anything about who you are as a person, it’s just another experience that we chalk up.
My son likes this band AJR. They have a song called A Hundred Bad Days, and the chorus is, “100 bad days makes 100 good stories and 100 good stories makes me interesting at parties,” which is kind of how I frame it with my kids.
I’m like, “Hey, it’s gonna be a good story one day,” to the point where they’re now excited to come home from school like, “Oh man, you wouldn’t believe this ADHD thing I did today!” Or, “I forgot this, and then I blurted this thing out,” and it’s not like a source of shame for them.
So that’s the biggest symptom because of ADHD, is the shame. The feeling of, “I’m less than other people. I don’t have the capacity, the abilities that other people do. I’m less likable than other people.”
And so all of the things that arise from that; depression, anxiety, self-harm, addiction, risky behavior, all of those are coming generally from the need for approval, for belonging, or soothing the pain of not belonging. Soothing the pain of alienation in one way or another. Whether it’s being the class clown to get attention or it’s using heroin because it provides endorphins to my brain which I should be getting from loving relationships. Since those don’t seem to be an option for me, then maybe I’ll just use these other ones. The synthetic form of relationship.
Rachel Cram – I’ve heard you talk about the important distinction between capability and capacity and I’m wondering, does that tie into what you’re talking about right there?
Ted Leavitt – Yeah, absolutely. The analogy I use a lot is; let’s say you walk into a gym and you see this person hit a half court basketball shot. Is it safe to assume that they can always hit that shot? No. I mean that’s a ridiculous shot. Usually luck. And if they did hit it, they probably shot 50 misses before they hit it.
Now that they’ve hit it, is it safe to say, “Ah, so you can do it. I know that you have it in you.”
So do they have the capability to hit that shot? Apparently. They just did it. But do they have the capacity to always hit that shot? On demand? When you want them to? Or even when they want to? No. A whole bunch of things have to come together at the same time for that capability to be turned into capacity.
So that’s a big difference. Whether it’s adults or kids, we might pull it off one time and then people say, “See! You can do it. I knew you could do it. I knew you had it in you.” But it’s framed as if, “You’ve been holding out on me.” That’s a big difference.
Rachel Cram – Yeah. And you can see how that is so confusing for teachers or for caregivers because again, it’s under that perception of choice. You’re making a decision to do something or not.
Ted Leavitt – Right.
Rachel Cram – I think the whole conversation around to medicate or not to medicate is a really challenging one for parents once they know their child does have ADHD and their behaviours are not merely choice. Where do you land on that?
Ted Leavitt – Well, as I said, I was not a medication person until I saw it work a miracle in this guy’s life. And in my experience with my adult clients, I would say I have never had an adult client who is diagnosed as an adult, start medication and come back to me and say anything other than, “This is amazing! I cannot believe how well my brain works. I can’t believe that I’m now doing stuff that I always wanted to do but could never quite do.”
It’s a bit different with kids, partly because the part of their brain that recognizes ‘how am I doing?’ isn’t really well developed yet. Until you ask a kid, “How does it feel?”
“I don’t feel anything.”
But outwardly it’s very different. They’re doing their homework, or they’re fighting less with their brothers and sisters, or they’re not bouncing around driving everyone crazy. But they don’t have the ability to be subjective about it.
A lot of people are afraid of medication but really what they’re afraid of is misinformation.
And so, it kind of sounds bad to say it until you understand what’s behind it, that the easiest way to diagnose someone with ADHD is to give them ADHD medication and see what happens.
Rachel Cram – Because it happens quickly doesn’t it? Like, if it’s going to do anything for you, it’s going to do it in about 20 minutes.
Ted Leavitt – Yeah. If you don’t have ADHD, and you don’t have a dopamine deficit, and you take that medication, you’re high on speed. And so all of the stuff that looked like ADHD will probably get worse if you give that person medication. The good thing is, it gets worse for six hours and then the medication’s out of their system and now we know. It looks a lot like ADHD but it’s not, otherwise it would have responded differently to the medication. Whereas, for myself, within half an hour of taking the medication it’s like someone’s turned on the defog on my windshield. Now I can see where I’m going.
It was probably a couple of weeks after I started taking medication, I called my wife from work and I said, “I don’t think this is working anymore.”
And she said, “Why not?”
I said, “I’m just so bored today. Like, I just want to lock my office door and watch YouTube all day, but I can’t even do that because I can’t even finish one video.”
And she’s like, “Yeah, you actually didn’t take it today.”
I’m like, “What? Yeah I did!”
She said, “No. I found it on the counter next to your cereal bowl.”
I’m like, “Oh, so it does work.” And then I thought, “How did I live like this for 33 years?”
Rachel Cram – Well, and that is part of the question isn’t it.
Musical Interlude #4
Rachel Cram – So when a parent comes to you and says, “So my child’s been diagnosed with ADHD. I’m afraid of medicating them.” What would be your response?
Ted Leavitt – Well I find the best response in those situations is to ask a lot of questions. “So, what is it that you’re afraid of?” “Where did you get your information from?”
Rachel Cram – So they say, “I’m afraid of putting chemicals into my child’s body. I’m afraid of altering the personality of who they really are. I’m afraid of them feeling labeled that they have to be medicated.”
Ted Leavitt – Ok. So, let’s start with the label. I don’t want them to have a label. Well they already have a label and it’s just going to get worse. Right now it’s, rowdy kid or, loud kid but eventually it’s going to become idiot, bad kid. So you can’t escape a label. We may as well have it be accurate.
In terms of what if it totally changes his personality. OK. Well then stop taking it. It’s that simple. You have to balance side effects with main effects. I don’t really experience any side effects from my medication. It doesn’t suppress my appetite. It doesn’t keep me up at night. But other people do. And so sometimes they have to decide, ‘Is the improvement in productivity worth the other stuff.’ And sometimes the answer’s no.
Rachel Cram – And there’s different kinds of medications and different potencies?
Ted Leavitt – Right. The rule is start low, go slow. So whatever medication you start with, start with the minimum dose for maybe a week or two then bump it up if you need to. If you don’t, if that lowest dose was enough, you stay there. If it’s totally zombied your child, as in the early days of Ritalin, if that’s happening it’s either the wrong medication or the wrong dose. So don’t throw out the baby with the bathwater.
And in terms of putting chemicals into our children’s bodies, for people who want to go the natural route, that means a totally unregulated field. Just because it is natural on the label doesn’t mean that it is
Rachel Cram – The organics?
Ted Leavitt – Yeah, all of that kind of stuff. In medicine, if a treatment is not effective or if it’s not safe, it does not last in medicine. And we’ve been treating ADHD with stimulants since the 30s, so it has stood the test of time. And when people say, “Well, we don’t know what the long term effects are.” We actually do know what the long term effects are because they’ve been doing longitudinal studies on kids taking medication into adulthood for decades now and there aren’t really any serious if any long term adverse effects.
But the long term effects are positive in terms of self-esteem and opportunity. And so what I say to parents who are hesitant, I say, “Well you should be hesitant of course, instead of just rushing into it. But after you’ve tried everything you’re comfortable with, you might have to try something you’re not comfortable with and see if that helps.”
Rachel Cram – I think part of the wrestling with this falls back into what we were talking about; the difference between behavior problems and mental health problems.
I’ve heard the analogy that, if your child has diabetes of course you’re going to give them insulin without a second thought. Because you know that is a medical diagnosis. And I think that still in this area of ADHD, we still can think of it as a behavior problem and not see it as a health problem that requires medication.
I know for myself as a parent, that approach was helpful for me, to see this is the difference between my child’s success and life.
Ted Leavitt – Right. So, my approach as a counselor is very psycho educational. It’s informed by philosophy and theories and things like that. But the reality is, 99 percent of people don’t know what dopamine does in their brain. They don’t know what a prefrontal cortex is or a reticular activating system, or any of these kinds of things that are not functioning normally in the ADHD brain. So I find that the more education they have about the mechanics of paying attention, it becomes easier for people to go, “Oh! OK!”
So again, that’s coming back to when someone has concerns, I’m always going to be asking them questions first before I start answering questions because I have to assess, “What do they know?” And most of them have very very little awareness. And that goes with the teachers and other people that are involved with them. So always coming back to educating. This is what it is. This is what it isn’t. So that you know why that intervention that you keep trying isn’t working. It’s not because they don’t want it to work, it’s because you’re pressing the wrong button.
If you’ve got a loud ticking noise under the hood in your car, putting more air in the tires is probably not going to be helpful. But that doesn’t mean it’s a stupid car. So education about the science that’s underlying it is the absolute key and the starting point with medication.
Rachel Cram – So Ted as we start to wrap up this interview, can I put this to you as a closing question? If we are wondering if our child or even if we ourselves might have ADHD, where do you start practically, and where do you start emotionally?
Ted Leavitt – Yeah, probably the ‘emotionally’ comes first. Because if you have a lot of unpleasant emotions, I wouldn’t say negative, but unpleasant emotions about it, it puts a stopper in what are the next practical steps. Because the practical steps are actually fairly simple. You go to your doctor, if they’re uncomfortable assessing or diagnosing you get a referral to a pediatrician. I’d highly recommend that you find a pediatrician who actually specializes in it.
And if you see a long wait list. “Oh man it’s going to be a year!” Get on the waitlist, because that might be your only option. You really do have to be a self advocate and self educate
Rachel Cram – Which is hard when you’ve got ADHD.
Ted Leavitt – Which is hard. Although you can hyper focus and just become like an expert. So the practical side of what to do is actually not that complex. The emotional side, we come back to that EEFB that we talked about at the beginning. So what does this mean to me? So your child has ADHD. Okay. What is your explanation for that?
Does that mean that you did something wrong? That you wrecked them? That your child’s defective? That you’re defective? That their future is over already?
What are the explanations that I have? Because that’s giving rise to my feelings about it, which will give rise to my behavioral response.
So my emotional reaction to the diagnosis, or the label, or the medication tells me what I think of the label and what it means. Now I have to explore, ‘Where did I come by that meaning? Was it given to me by other people? Is it accurate? Because if it’s not, then maybe I need to shift my belief or definition, which will lead to a different feeling.
A lot of times parents that I work with will feel guilt. Particularly if the kid’s older. A teenager. They’re just like, “Oh man! How did I not see this? They feel bad. They look at it as, ‘They did this to their child.’
It’s like, “Well, it doesn’t matter whether you did or not, we can do something about it. So let’s start now. You didn’t know then what you know now, so now is when your accountability begins essentially. So I hope that answers your question.
Rachel Cram – I think it’s a great answer. And I thank you so much for sharing your own story, because I think hearing it in that first person point of view is so meaningful. So thank you so much for your time today Ted.
Ted Leavitt – You’re welcome. Thank you for having me.