And welcome to another episode of ADHD Women's Wellbeing Wisdom.

Little short, bite sized pieces of wisdom that I've curated from all the many, many episodes that have been recorded over this time.

And I really hope that this short insight will help you on the week ahead.

And today I am welcoming back a fantastic conversation with someone who I love.

I genuinely think she's amazing.

She's got so such great energy.

And it's Tamara Rosier.

Now you might remember my conversation with Tamra back a few years ago now.

We talked about her fantastic book which is called you'd Brain's Not Broken.

And she now has a new book coming out called you'd Me and you'd ADHD Family.

Now I'd just give you a little bit of a heads up about Tamara.

If you don't know about her, I would highly recommend you read her first book and her second book.

She has been a college administrator, professor, a leadership consultant, a high school teacher, a national public speaker, and now an ADHD coach.

She's also a mum of three daughters and she has, I guess, developed through all these different adventures a really valuable insight into ADHD and how it affects our lives, also how it affects this interaction between ourselves and our families, our dynamics.

And she's also the founder of the ADHD center of West Michigan where she helps individuals, parents and families develop an understanding and learn effective skills to live and thrive with adhd.

And her book, which I mentioned, your Brain's Not Broken, provides strategies for navigating the big emotional aspect of ADHD in a healthy way.

I have this book on my desk most days and I'm always referring to it.

And you will hear a new conversation with Tamra coming out around the end of February where we talk about her new book and all the dynamics that that brings with ADHD in the family.

So I really hope that you enjoy today's wisdom episode.

I know something that you're really passionate about is our big emotions, the emotional regulation side of adhd, where I don't think it's talked about enough when people, first of all, there's a stigma of adhd, of sort of concentration, focus, disorganization.

But actually from speaking to many clients of mine and myself and I see it in my family that losing our temper, keeping calm, keeping balanced is actually really hard work with adhd.

So why is this part of it so important to you as well?

Well, emotional regulation isn't just when we lose our stuffings and get angry at a parking spot or as my husband called today, he was driving in traffic and commenting on every car passing him.

And, you know, that was even that little bit.

He wasn't angry, but there was a lack of emotional regulation even as he was driving in traffic.

By the way, I need to stop talking about my poor husband, because I have adhd, too.

I just like to pick on him because it's easier.

Because, of course, emotional regulation is something we're constantly struggling with, and it's everywhere in every little nuance.

So it's not just about getting angry.

It's about feeling too big of emotions all the time and we don't know what to do with them.

Yeah, yeah, absolutely.

I think that's so well described, because I think what you just said then is that we only see the temper, the anger, the big emotions.

But sometimes, like you say, it's.

It's hard to maybe articulate what's going on.

It's hard for us to recognize when we are about to lose control.

That's the thing.

I mean, these big emotions, again, I'm not saying we can't get rid of them.

I think it's part of how we're made.

You know, my emotions get tamped down a little bit when I'm medicated, but they're still there.

And it's just this big pool of big emotions that I can trip and fall into my pool at any time.

And frankly, you know, sometimes I'm really embarrassed by my big emotions.

I cry very easily, and if anyone knows me, they know that I'd rather not be that vulnerable all the time.

But if I'm at a baptism, a wedding, I mean, happy things, I'll cry if a friend tells me that they're having a baby, and I'll cry over that.

I literally can feel the swell of joyful emotions.

That's just as embarrassing to me sometimes as my anger and frustration, really.

So I see that as beautiful and empathic.

And sometimes, I mean, that is a very touching thing to do.

And I agree with you.

I'm very similar.

I will cry very easily, but actually more with happy stuff and watching tv, and I'll cry.

But when it comes to something really catastrophic, it's almost like it goes the other way.

Like what you mentioned.

It's just.

I'm almost kind of, like, numb.

I don't even know what to do.

Well, because my brain goes, whoa.

Too big.

Shut down.

Yeah.

And so these big emotions, this.

I think this is the starting place where we should be talking about adhd.

Everyone's so hooked on how can we get Tamara to focus more.

How can we get Tamara to do her schedule better instead?

We really need to focus.

How do we get Tamara to regulate her emotions?

And honestly, by regulate, I mean just admit we have big emotions and notice how close I'm getting to the big emotions and trying to be able to regulate so that I don't fall into that big pool of emotions.

Right?

Yeah.

And it's not, it's not a bad thing.

And I want to point out to your listeners, this isn't bad.

It's the intensity.

There's a lot of times I go through my ADHD life and I realize my emotions are at a nine or 10 and one, that's exhausting.

Two, I think the neurotypicals around us go, oh, well, that's a happy emotion.

And I guess that's nice.

Okay.

And it's almost like they say, could you feel that at a 7 though, instead of a 10?

Yeah.

I think what you touched on, it is exhausting.

And you know, for me, I definitely, I resonate with the overwhelm.

And I know a lot of my clients, you know, we've.

They come to me and the first thing they talk about is just, I'm just so overwhelmed and you know, a compounding layer of lots of different small things that maybe neurotypicals just tick off their to do list for us, it's big and it's big emotions and it's very energy sapping, it's draining, it's exhausting.

But what I wanted to ask you about, I've just got a list here.

I'm just reading on my list because there's lots of things that I wanted to ask you about.

But maybe we could just go back to the prefrontal cortex butler.

Because I really like this analogy of how you explain what this is.

And so I don't.

You don't have to go into the whole sort of neuroscience, but if you could give us a little snapshot of what you mean by the butler and what we're missing, I guess in the bit of our brain.

Yeah.

You know, it's funny, the first time I used this metaphor, I was talking to, I think she was around nine years old.

And I was trying to explain ADHD to her because she's a smart nine year old girl.

And so I said to her, you know, I bet you see this mommy, her mommy didn't have adhd.

And I said, you know, in your mommy's brain she has this butler.

So the child and I started to play like what we thought a butler might and by the way, let's be clear.

Neither of us have a butler.

We just have watched enough tv, maybe BBC kind of TV to tell us what we think a butler is.

Yeah, but my little head, I think a butler is just kind of attending to me to say, excuse me, your AirPods are on the counter, or, don't worry, ma'am, I'm going to get your AirPods back.

You'll just need to wait a moment.

You know, it's this calming voice that is directing my attention and directing my emotions, and it's a very calm voice.

And so with this child, we were pretending to, you know what our.

Our.

The mommy's butler sounded like.

And the child was absolutely hilarious.

She's like I said, so what do you think your mom's butler says?

Don't worry, she's going to remember to put her bike away, you know, and so the butler says this.

And as you guessed this and your listeners guessed, we don't have a butler, I say, mine really left town and is not ever returning.

And so we have the version of an angry neighbor.

And if you would imagine again, taken from TV, I watched too much TV as a child in the 70s and 80s.

But if you could imagine this curmudgeon of a human and just standing on the property line screaming over to you, shaking his shoe, saying, why I.

And threatening to throw his shoe at you.

He's doing obscene gestures, I'm sure.

And all of this is to try to get you to behave.

And so when we have adhd, the angry neighbor is really kind of how our emotions work to try to get us to behave.

Does the angry neighbor technique work?

Of course not.

Does every ADHD person I've ever known try to use it?

Yes.

And that's just because that's how our brain is set up.

Yeah, I like that.

And it's the prefrontal cortex, isn't it, that this is where it's all happening?

Yes.

Why is it all happening in that area of our brain?

Well, the prefrontal cortex is like the butler.

And so the butler is the calm part, saying, please direct your attention here.

Emotions, we don't need you quite now.

And so when we don't have reliable access to the butler, then we go back to the limbic center where the angry neighbor is.

And that angry neighbor gets our attention by screaming at us.

And so that's why we actually have problems with emotional regulation.

It's because the butler just isn't there to help us out.

Thank you so much to Tamara for that.

Really Fascinating to be able to understand ourselves better with all the options that she brings to us with regards to emotional regulation and creating a supportive community and having these routines that we can lean into to help ourselves feel better in life.

Now, I wanted to introduce you back to Dr.

Asad Rafi.

We've got another Ask the Psych segment and I hope that you enjoy this, where we talk about the coexisting traits and about what else shows up alongside adhd.

So I think it's really important that we have this awareness so we can understand what else sits alongside adhd, how to help ourselves.

Also, crucially, it's how to help the loved ones, you know, if we're parenting children to ensure that they're getting the best support, the best understanding.

And we're bringing in tools and help and support to help make family life feel a bit easier.

So here is a short clip with Dr.

Asad Rafi.

Where are we looking now?

If someone is first year medical students, you know, or they're considering psychiatry, are things being updated?

As far as I'm concerned, no, they're not.

I, I have been in, immersed in the world of mental health and psychiatry, practicing as a clinician for 24 years.

I don't see a change.

There might have been a slight shift.

The problem's only getting worse.

And the problem is that actually when we look at the diagnostic classification system, so these are the guidelines that are set out, you know, regionally, nationally.

National Institute of Clinical Excellence, the nice.

This is what we refer to as the NICE guidance.

There'll be European guidelines, there'll be global guidelines, but ultimately there's a reference that we will utilize.

We call it the DSM 5, the ICD 11.

And we'll use those classification systems to be able to say, do you fit the criteria here?

Okay, do you, do you fit the bill?

Do you have these particular symptoms?

Now, believe it or not, there are questions in some of those assessment tools that refer to outdated notions like, can you remember people's telephone numbers?

Now, come on, we're in 2024.

If that was 1984, I'd understand.

I just about remember my own telephone number.

And you know who I remember?

My wife's telephone number as well, but no one else's.

Okay, We've got to move with the times.

These diagnostic classification systems don't even include mood and emotions, which I've just said is the most debilitating element.

Right.

It's not talking about coping strategies or, you know, on the other end of that spectrum, the liability towards addictive behavior.

And what hope have we got where we're living in a world where addiction services work separately to the neurodevelopmental services.

Even within, you know, that umbrella of, you know, neurodivergence, neurodevelopmental conditions, you've got an autism service over there, you've got an ADHD service over there, you've got everyone else working separately, okay?

If I want to understand whether someone's got adhd, I'm not just going to look at it from the lens of ADHD because that will bias me and I will find it.

Okay?

I've also got to screen for autism.

People with ADHD are going to have invariably some traits or features of autism and vice versa.

The rates of comorbidity are really high as well.

Okay?

Research tells us that if you take 100 people with ADHD at random, okay, about 20 to 50% of them are going to have autism.

Okay.

Though they're going to fulfill the criteria, the diagnostic criteria.

Take a cohort of people with autism, 100 of them, anywhere between 50 to 70% of them are going to have ADHD.

There's a third neurodevelopmental condition, believe it or not, it's ocd.

Right?

Now let's draw that Venn diagram of adhd.

Autism, ocd, your perceived symptom or your symptoms.

You know, you're going to find an explanation that's going to be explained by one of those three conditions, okay?

And sometimes it's really hard to figure out, is it ocd, is it actually adhd, is it autism?

And I'll give you an example.

If we think about, let's say, interests, okay, and the ability to focus on things, if someone was looking at an individual from the lens of autism, they'll say, Kate really has a significant interest in a particular topic.

She's constantly hyper fixated on it and, you know, it takes over absolutely everything else that she's doing.

That must be autism.

Fair comment.

Yeah.

Now, on the flip side, I might look at that from an autistic lens and, sorry, an ADHD lens, and say, well, hang on a minute, let's understand it, because it looks exactly the same.

Is it the word hyperfocus?

Right.

What's the difference?

Well, the difference is if it's hyper focus, the likelihood is that interest, once the novelty wears off, okay, once the interest is no longer there, it's got boring, it's got harder, it's got difficult, or usually you've got something more interesting to look at, that interest will change it's not going to be persistent in autism.

That hyper fixation's more persistent.

Okay.

That's how you separate the two.

That's all.

That's the.

That's the explanation I would give to someone.

And there are so many other examples that you could give of the overlap between conditions.

Because I'm aware that this was another one of the questions that was close to us.

However, what you then can have, just to complicate matters further, because that's what we doctors love to do, is hyper fixation and hyperfocus can be present in the same person.

So examine it, look at it.

So I'll give you an example.

Young boy that I saw a few weeks ago actually wasn't that young.

He's 14, 15 years old.

And what we'd understood was his hyper fixation because he had both autism and adhd.

His hyper fixation was wwe.

So the wrestling, and it had been from a very early age, it had not changed.

So that would certainly indicate to me a hyper fixation on all elements of wrestling.

And, you know, transfixed by the.

The characters, the people, everything about it that that was true hyper fixation.

His hyper focus came from the constant need to want to buy the wrestling figures.

Yep.

And once he bought it, the novelty's worn off.

He's wanting to buy another and another and another.

So you can see that this was a hyper focus and a hyper fixation within the same area of interest.

Yeah.

Right.

So you've got to really start to question people and understand, you know, do not take verbatim what they're telling you.

You've got to try and understand it better and help them with examples like that.

Say, which one describes you better?

Let's think about the purpose, structure, and discipline actually serves.

Because automatically we think routine structure means autism.

No, Those of us who have ADHD over time develop what we call adaptive strategies.

If I do not keep a to do list, if I don't do things a certain way on a daily basis and people say, I've got a morning routine, well, if it's functional and it serves a purpose, that becomes an adaptive strategy that you have developed over time to keep your, you know what, together.

Right.

Life together.

Because if.

If you don't do it, you're going to miss something.

Right?

You're going to forget something.

Because what you've done is you've adapted to the problems and the challenges that you've had previously.

Okay, so you can see here where it's very easy to mistake one condition for another.

Can I just Ask with that is when you, when we describe these hyper fixations or hyper focuses, you know, like if you've got a really interesting hobby that has fulfilled you, that's interested you, that's excited you, it's made you curious, all these things is that, that's not a bad thing.

That's what makes us all, as humans, interesting and makes us, you know.

But is it to the point where then we become obsessed?

There's ocd, absolutely impacts our life.

Like if we, if that child missed a game on TV or he, you know, didn't get the figure that he wanted, then, and then there'd be a meltdown.

So it's just understanding because I know a lot of people with ADHD who are hobbyists, and that is what that creativity, that interest is, that that's their fulfillment.

But if that's to the detriment of, you know, their personal lives, their relationships, I go back to what we said before.

You know, what separates a feature from a symptom?

The five Ps.

Yep.

If it's problematic and it's preventing you from achieving your true potential, and that might be impacting relationships, friendships, socially, okay, then it's a problem.

Okay.

If it isn't, you don't need to do anything about it.

Let's not pathologize everything either.

We're armed with so much knowledge these days that there's a tendency that I might have a little scratch or an itch.

I'm like, I think, oh my God, there's something wrong.

Let's Google it straight away.

And you know what?

You, you're going to assume the worst.

You go down, you know, what's.

Maybe an ADHD thing.

But, you know, you go down a rabbit hole, don't you?

And you diagnose yourself with God knows what.

Same applies here.

Let's not become Dr.

Google.

Let's try and find those true experts.

Let's try and understand people who truly get it.

Truly understand it.

They will enable you to get that narrative.

This is not about getting the answer.

You pretty much know the answer.

If you're, if you're going to come to me for an assessment or to any other clinician for an assessment, you are not going to put yourself through that emotional turmoil, that time, that energy that it's going to take, okay, to do all of those assessments without being pretty sure that you've got it and the expense financially.

So getting the answer is, yes, it's validating, it's helpful in every respect, but it's showing them the working out.

How have you got to that point?

So I hope you enjoyed listening to this shorter episode of the ADHD Women's Wellbeing podcast.

I've called it the ADHD Women's Wellbeing Wisdom because I believe there's so much wisdom in the guests that I have on and their insights.

So sometimes we just need that little bit of a reminder.

And I hope that has helped you today and look forward to seeing you back on the brand new episode on Thursday.

Have a good rest of your week.