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Hi everyone, I'm Dr. Patrick McGrath, the Chief Clinical Officer for NOCD. And today we're going to break down OCD and ADHD. How do they interact, how are they similar, how are they different and what does it mean for your treatment if you've got both? So here's a few things to keep in mind. The prevalence of co occurring link OCD and ADHD is there. We know that from research about 1 out of 5 children with OCD also has co occurring ADHD and only 1 out of every 12 adults with OCD has ADHD. Now that may sound weird, right, because wouldn't you think that it would be the same if you go from childhood to adult? But we're still kind of behind on assessing ADHD in adults, so maybe we'll catch up one day. Maybe we're overdoing it a little bit in the area of children and adolescents, but I think as our assessments continue to improve and we recognize where does OCD stop ADHD begin, we'll be able to kind of really see some differences in there. Now, adhd, again, Attention Deficit Hyperactivity Disorder. It's a neurodevelopmental condition. It's characterized by a lot of inattention, hyper hyperactivity, impulsivity, and it can make it really difficult to function in day to day life. Now the symptoms can vary across people, but they commonly include difficulty focusing, excessive movement, restlessness, maybe acting without thinking about it. ADHD is just usually diagnosed in childhood and can continue into adulthood. But we know that adults can get diagnosed with it as well because maybe they didn't have the opportunity to be diagnosed with it when they were children. I could tell you being my age, ADHD did not exist as a diagnosis. Not saying it didn't exist, but at least as a diagnosis when I was a kid. And it can affect all areas of life like work, school and even relationships. So a few things to pay attention to when we're talking about adhd. People can have trouble staying focused on things. They can get very easily distracted. They have difficulty following instructions and completely competing their tasks. There's a restlessness that might occur, that hyperactivity aspect, there's a lot of movement. Maybe they have trouble staying still, maybe even in situations that require having to stay still. That is a very hard thing for them to do. And in that impulsivity part, it's acting without thinking, maybe interrupting other people constantly and struggling to have any kind of self control whatsoever. Now some similarities are that both can be misunderstood and misdiagnosed. We know that they can share. Things that seem to be different on the surface, like racing thoughts can happen in OCD and adhd, feeling very stuck mentally and even challenges in living day to day life or functioning in day to day life. Because when people are stuck in doing compulsions, well, that becomes the most important thing for them. Right? And when people have ADHD and it may be hard to stay on task to do anything, what's the differences between them? Well, the main difference is OCD involves intrusive and distressing thoughts and images and urges. Those are our obsessions. And then there are ritualistic behaviors, be they mental or physical compulsions that people do to reduce that anxiety, distress, discomfort, shame, guilt. Well, in adhd, most of this behavior is really characterized by intense inattention, hyperactivity and impulsivity. Now they may share the same executive functioning. Difficulties like poor planning and focus. And OCD symptoms may be coming from distress leading people to have trouble focusing and maintaining their attention on stuff that's more important than where the OCD wants them to go. And ADHD symptoms can come from difficulties with attention and regulation and impulse control. And therefore it's hard for them to focus on things that might be really important for their day to day lives like work or school. School. And yet both can have, as you can see from those examples, I think, very detrimental kind of consequences in the lives of people. Here's the thing. OCD can respond well to exposure and response prevention therapy and medications, typically in the SSRI class. And ADHD is also treated with behavioral based treatments like cognitive behavioral therapy and stimulant medication. So a different class of medication is often used for people who have adhd. Now I know I mentioned in OCD there could be shame and guilt that OCD uses as a way to drive people to do compulsions. Because OCD will pick whatever kind of emotion it can to get people to do those compulsions. But people with ADHD might experience shame and guilt too for their inability to get get things done even though they have the desire to do so. Now when they interact, it can be confusing. How do we know which is which? Right? For example, procrastination can be experienced in individuals with both OCD and adhd. Maybe someone with OCD puts off doing something until the very end due to their perfectionistic nature of needing to accomplish it in just the right way. And the idea is that if I get it done early, I'll just keep going back and checking it and checking it. So I'm going to put it off to the very end. Procrastination is common in adhd. People with ADHD may experience procrastination because of their difficulties to even get themselves started on doing something. This could be something that we call an executive function deficit, right? It can lead to trouble initiating tasks, setting a deadline that's realistic, and even breaking down a large project into smaller, smaller steps that they need to have done. There could be impulsivity, right? Like it makes it challenging to stay focused on completing a task because maybe something else comes up and suddenly they're like, oh, I'm going to go do that instead. That seems more exciting or more fun or maybe more stimulating than the thing that they're doing. Motivation can be a trouble for people with ADHD because maybe what they're doing seems really boring to them or overwhelming and something else might grab their attention more. When you have trouble perceiving time in a certain linear kind of way, knowing how long something will take, that procrastination may be there and someone will think, oh, I'll just get it done, I'll get it done, I'll get it done. Until there's just no way to get it done because they took so long in putting something off, right? Or maybe there's even things that evoke anxiety and fear that lead people to procrastinate. That can happen in both ADHD and in OCD too. That one doesn't have to be common to only one of them. We know also that there may be routines that people have to follow. There could be a lot of checking that people do. All of these things come across in both OCD and adhd. Now, we know that ERP is the treatment for Obsessive Compulsive Disorder. But we also know that OCD can interfere with OCD treatment. Because OCD could say, you know, if you don't do treatment for me perfectly, it's not going to work. So then people try to take a perfectionistic aspect of treating ocd and that's what undermines OCD treatment. Something for everyone to pay attention to if you have ocd. Also, if you're a therapist who treats OCD to make sure that that isn't happening with cognitive behavioral therapy based treatments and the behavioral side for adhd, you definitely want to help people learn how to slow down, witness your thoughts, choose your words, be patient, become a better listener, and try to fit in better in social situations, right? But there's always that urge on the back end to maybe do that other thing that might be more fun, more stimulating, or just has grabbed the attention more in this situation. That's how adding structure and support can be helpful for both OCD and adhd, because we want supportive environments that really help to reward people for following through on the treatment and help people to kind of stay in their lane to make sure they're really doing the things that they need to do that are best for them. Now, medications can play a role in both. And sometimes people with OCD may say that OCD feels a little bit more difficult to manage when you take a stimulant medication for adhd. But others report the opposite. Even someone in the NOCD community once said they found that their OCD went away almost when they went on ADHD meds because they felt that it just calmed everything down in their mind and that it had a positive effect on their OCD as well. Always talk to your medication provider about any risks of combining medication. That's the person to speak to, right? Your therapist can help with the behavioral therapy side. Your provider for medications are the one to ask any medication or interaction question questions. Now at nocd, we're trying to really help people with ADHD understand how ADHD may impact their ocd and we'll do what we can, right? Flexible session pacing, reminders to people to attend their sessions, developing good structures and plans. You've got the NOCD app that has support built right into it and we've got clinical leaders that do case consultations to help people make sure that cases run smoothly. We're excited to do more in the area of ADHD and to make sure that people with the combined OCD and ADHD also get the best treatment, that gold standard of care that's available to them. And we'll be doing more and more training with our therapist on ADHD so that everyone can come to NOCD and feel like we are the place to go for your best care treatments available for both of these conditions. I encourage you to seek specialized care for both OCD and adhd. If you're looking for help for OCD related conditions, please go to the NOCD website, that's nocd.com and book a free call with us and learn more about how we can help you. You don't have to live the life that OCD wants you to live. You can live the life that you want to live.