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Raising Good Humans
To Medicate or Not to Medicate? Dr. Jaffe on ADHD & Anxiety: Finding the Right Path for Your Child
00:49:36
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- [00:01]
Dr. Jaffe
The following podcast is a Dear Media production.
- [00:10]
Host
We'Re recording and I just wanted to introduce you to everyone, if that's okay. I just wanted to give a little bit of your bio. Dr. Jaffe is a board certified child and adolescent and adolescent psychiatrists and he's an associate professor of psychiatry and pediatrics at the Mount Sinai Hospital here in New York City. Although I'm not in New York City, so I don't know why I just said that. And he's the program director for the Child and Adolescent Fellowship as well as the psychiatric director of the Children's Integrated Pediatric and Psychiatry Clinic and school based program in East Harlem serving our city's youth and the director of the Mount Sinai Tourette association of America's center of Excellence. He's currently leading research trials looking at novel treatments for Tourette's disorder and adhd. And today we're going to talk about some of the ways that parents and caregivers can think about how to take steps to get support for kids who they feel are experiencing. We're going to talk specifically about ADHD and anxiety. But in general, if you are concerned that there is something beyond a subclinical diagnosis, how do we understand talking about treatment? Especially because right now there's a real conversation happening culturally, which is there's too much medication or there is no access and there isn't enough medication. And what does all of this mean? And I think it can make parents so scared and confused about what to listen to. So that's what we're talking about. And Dr. Jaffe, can you just maybe give us your overview of how parents can think about when to seek support and how to think about that support, whether it needs to go in the direction of psychiatry and medication.
- [02:11]
Dr. Jaffe
Yeah, I mean, I think, I think you set the landscape nicely right, which is that it's, it's overwhelming and confusing and we. So we hear all sorts of things, right? Exactly. Like you said. Is it, Are we over diagnosing? Are we under diagnosing? Are we over prescribing? Are we under prescribing is probably all of these things. Everything has sort of exploded over the last several years. I mean, there were all these headlines about a mental health pandemic coming out of the COVID pandemic. Of course. And we were seeing skyrocketing rates of really, really many disorders. And trying to understand that has been quite challenging and quite confusing. And you get different answers depending on what you look at. The optimist would say, hey, maybe we're diagnosing These things more because there's a lot more awareness, There's a lot less stigma out there. And so people are more comfortable talking about it, and they're more comfortable seeing professionals and getting diagnosis for things. I'm not so sure that it's all that positive. I think when you start looking at, like, tangible outcomes, you know, in particular suicides, and you see that suicides have gone up, there's no way to interpret that as anything short of tragic. And so I think the picture is confusing. I think there definitely are rising rates of mental illness across our young people. And so I think people are understandably antsy and nervous about what to do. And there's certainly not a one size fits all for this. But my first and foremost recommendation always to parents is, is to trust your gut, trust your parental intuition. I put quite a bit of stock when I'm meeting with the parents of what they kind of their gut feel of what's going on. Parents know their kids best, and so obviously, you know, they come to professionals, and we have our. We have our professional hat, we're trained on things, but there's quite a bit of stock that's put on parental intuition. So I think that there's something as a parent that's saying, something's not right here. And you know, what that might look like will vary depending on where your kid is developmentally. But if you're seeing any market change from baseline. Right. That they're not there, there's a shift in their academic performance. They're not enjoying the same kind of things that they used to. They don't want to. They don't want to engage in their extracurriculars the same way. They just seem off to you. That, to me is as good a sign as any to say, hey, something. Something just off. Something's different with my kid. And I just want to kind of make sure that everything's okay. And so that. That would be a good starting point of saying, hey, what's going on here?
- [04:31]
Host
Okay, so you mentioned the. The increase in suicide and also just the general mental health crisis that people talk about and we're hearing about it so much. So I, I wanted to ask you a little bit more about that. And since it feels like culturally we're talking about, like, the reasons behind all of this and we want a simple answer, and I know there isn't a simple answer, but do you have a sense of how to frame this uptick in diagnoses and harm that is a little bit more complex so that I.
- [05:08]
Sponsor
Don'T know, I think it would be.
- [05:10]
Host
Helpful for everybody to stop sort of trying to find the one reason, but maybe thinking about just more holistically, like how we might help support our kids and create a more healthy environment.
- [05:22]
Dr. Jaffe
Yeah, I mean, it's. I think everyone's looking for a magic bullet, right? And so all of these very good ideas and theories come out, all of which are correct. I mean, the problem is that there isn't just one magic bullet that explains all of this rise. Right. I mean, there are so many multifactorial things that go into a human's life, and for kids and teens in particular, they are under a lot more pressure. Right. I mean, things, life at least appears to be objectively harder for a high schooler now than it was when, certainly when I was in high school and I would imagine for everyone else here as well, the world feels more chaotic. There's a lot more information. I'm not sure that our brains were really meant to, to process infinite data at all times, you know, and I think, you know, technology is, is incredible, but it's like very hard to wrap your mind around all of the data and information that's out there and things that we sort of took for granted as being sort of objective facts. And now you've got 10 different opinions on what you thought was an objective fact and what is, what is even real anymore. And that, that dives a little bit, of course, into social media, which I think is an easy boogeyman. You know, what is it? What does that even mean? I think there's lots of good things about social media, but there's also, you know, certainly a lot of potentially negative things. And we're living out a real life experience. Right. This stuff just kind of comes out. It's not like it's a drug that gets tested for several years before it comes out. It needs to be proven safe. It just, it's out there because it makes money. And now we're kind of learning in real time what are the possible consequences of this. And so there are a lot of different ideas and theories, all of which go into it, all of which are relevant, but of course not one is going to explain everything. I myself have my own, my own, not magic bullet, but my own thing that I think often gets overlooked, which is, which is sleep.
- [07:06]
Co-Host
Yeah.
- [07:06]
Dr. Jaffe
When I'm with the fellows and we're, and we're doing an intake and they'll ask the high school, what time do you wake up? 6:30. I say, okay, what time do you go to bed? They Say, oh, two. And they go, okay, how's your appetite? And I'm like, wait, wait a minute, that's right. That is an insanely small amount of sleep. And I think, you know, anyone who's had a bad night's sleep knows how lousy they feel the next day. And they're not firing on all cylinders. And so again, that's, that's not going to explain everything, but I do think just, you know, establishing good, healthy habits and having good, good balance in life is, is certainly a, excuse me, starting point for helping just kind of set the stage to, for better mental health. I don't actually remember what the question was.
- [07:44]
Host
No, I, I think I really was sort of, because there's such an uptick and there's so much language around, like this crisis that's going on for our young people and frankly for all people. And there is a tendency to kind of want to find a magic bullet to say, like, this is exactly what it is. And I imagine that's because it makes us feel like we can control it in some way. So it did answer my question, which leads me to another question, just to clarify. Can you help us understand, like, how much of this, like when we're talking about ADHD or we're talking about anxiety disorders or, you know, any of these things, how I know we can't like, exactly say, but can you speak to the part of this that's about DNA and, and sort of lifting some, you know, like, what part of the environment can help support, can best support a child who has a diagnosis versus, you know, what? Because I think there's a little bit of, oh, it's, it's me as a parent or it's society. And I wonder how much of that is also attributable to genetics and if you could speak to that.
- [08:54]
Dr. Jaffe
Absolutely. I mean, everything that we see in psychiatry has a genetic component. The percentage of that is going to differ based on the specific diagnosis. ADHD actually being one of the highest genetically diagnoses that we have. But it's everything right there. There are very few things that I can think of that are exclusively environmental or exclusively biological as well. Right. I mean, you think about, you know, something like exercise induced asthma. Right. There's obviously some biological propensity, you know, to have reactive airway, but if you're not in a certain environment, you're not going to have those symptoms. And the same thing is true for anxiety disorders, for depressive disorders, for, for inattentive disorders, that there's going to be some combination of the environment that one is in that's mixing with one's individual genetic makeup that's going to produce these symptoms. And this is, this is why a comprehensive evaluation is, is critical to treatment. And I see, you know, Blair's here. And Blair will laugh, you know, because I always, you know, if I could treat ADHD in three minutes, I wouldn't, it wouldn't take me three hours to do it or, sorry, assess it. And that's because you want to get all these factors that are going into it. Many times we can really, really mitigate symptoms just by impacting the environment. There's not a need to go to a medication right away or kind of target the underlying biology right away. And so we want to understand what is it that's going on in this environment that's combining with this person's genetics that's producing these symptoms. And how can we come up with a plan that will reduce the symptoms, be it by, by medications, but ideally by impacting the environment as well.
- [10:23]
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- [13:39]
Host
What are the things to look for? Let's say we're talking about ADHD and your school has spoken to the school, has spoken to the parents. Some indication that something's going on. Can you walk us through kind of the process? And then what I want to get to because I think the part of this discussion that everyone's afraid to have is about the medication. So I would love to kind of talk about how you, how you come to the conclusion that medication in addition to environmental changes and support systems is the right move. And I do have a like a hope or a spin, which is just that it's frustrating to see families suffering because they are either very for medication or very against medication and have strong opinions about it either way. And so hearing from you about the individual need and kind of alleviating this idea that we should have, like, a strong opinion about what other people should be doing for their diagnoses would be so helpful. I can't tell you how many parents have come to me feeling like they. They whisper or they have shame because they're. Or they're angry or they're arguing with their spouse or their family members because medication was recommended and they have like a, you know, kids are being over medicated. This is a disaster. And so, no, for my kid, even if they need it, that can't be the answer. And then on the other side of it, of course, jumping right to medication. Yeah, that was like 12 questions in one.
- [15:11]
Dr. Jaffe
But all of these questions are right, and this is what comes up. I will use this opportunity to make a plug. So myself, our division chair, Alex Collison, and one of our colleagues, Pilar Trellis, we actually wrote a book that's coming out in March all about psychiatric medications and kids. It's called Start Low and Go Slow, A Parent's Guide. I actually don't remember the whole name for it, but it'll come out in a few months. And it's got all of these questions in there because we were faced with these same things, and we realized we're getting the same questions over and over again. You know, there's a lot of misconception, there's a lot of trepidation. And you're right, sometimes the opposite is true, that people are way too eager to jump to medications as. As well. And so all of this is what we're thinking of. I can tell you. You know, my process for me is, of course, it starts with a phone call, right? Or in today's world, an email or sometimes even a text message. But. But someone reaches out, and it's usually a parent who's noticing that there's, you know, something is off in their kid. And in the world of adhd, it's generally, you know, they're underperforming in school based on, you know, their historical norms or what would be expected of them, and based on what we know their. Their potential is. And so the challenge for us, of course, as clinicians is that the differential, meaning the different options that could be explaining that are essentially infinite. And so we have to try to kind of really figure out exactly what is going on and come up with our best explanation for why this is going on. And so for me, my evaluation process, it starts with 90 minutes, just with the Parents and we really go over everything from pregnancy until the present day. Obviously we're focusing heavily on the current symptoms that are getting in the way of this person's life, because those are, those are front and center. But we really want to be painting a much more holistic picture of who this individual is. We're trying to pick these symptoms out and seeing does this neatly match, you know, a known disorder out there like ADHD or depression or anxiety or autism, whatever it is, or OCD or trauma, there's many, many things out there. Or is it maybe no disorder at all? Right. Is this completely normal and typical and everything is actually okay? But the point is we're trying to kind of make sense of the symptoms that we're seeing in the family, environmental, social landscape that this kid is living in. And so we get a whole sense of their routine from the time they're getting up into the time they're going to bed, what their extracurriculars are, how their social life is doing, how their self esteem is, and just as importantly, what their strengths are. Strengths are going to be pivotal to our treatment plan. We're going to need to incorporate what they like, what they're good at, and what gives them a sense of self esteem and self confidence in order to actually really kind of help help them progress along. That's the first part of my evaluation. I then will meet with the kid or teen or young adult or even, you know, full grown adult, depending on who's coming in and meet with them for 45 minutes going over a whole range of things. Obviously what we do will depend on their developmental age. The younger being more projective based and more play based. And as they're getting older, much more kind of verbal and insight oriented. And then there's a wrap up with the parents where we over everything and say, okay, this is what I'm thinking. This is my formulation, meaning this is my explanation of how I'm, I'm understanding what I'm seeing. And these are our different options of what we would do from a treatment standpoint. If it was my kid, this is what I would do. And so this gets to your point about, you know, when, when and where to do medications enter the mix. And it's highly, highly individualized. But I think there are some generalized points that I can, I can relate to you, which, which will be helpful. And so there's certainly no. Well, there probably is some wrong answers, but there's, you know, there's, there's not always, there's not always one answer, meaning that there are different options and there are pros and cons of these different options, and we really have to kind of weigh those out. One of the maybe easiest things to look at is of course, severity. Right. If things are really, really not going well, this is a straight A student who is suddenly not getting out of bed or doing anything. You might be more eager to kind of throw the kitchen sink at it. Right? I mean, so, so the more impairing, the more problematic symptoms are, the more I'm kind of like, let's, let's empty the toolbox here, because I want to get this person firing on all cylinders again as, as quickly as possible when things are a bit milder, per se. Meaning there's not heavy impairment. Right. I mean, you know, they're forgetting to hand some assignments and they're kind of rushing. You know, they're still getting A's because they're like super bright, you know, and the demands aren't that high yet. And we know that as they probably are, forget progressing through middle school and high school, it may be, but we can kind of keep a super close eye on it. Or particularly with anxiety, is a hard one because these kids and teens and adults tend to be such perfectionists that they're victims of their own success. Meaning that there aren't, there are. There's going to be a lot of impairment. Right? They're not bombing out of school. They're just like really, really, really distressed and on edge. And we have to say, like, how much distress is, is, is too much. And so all of this is factoring in. We're lucky. In New York City, we have a lot of amazing therapists who are out there, still, still are not enough. And so even though the evidence tells us in some things like anxiety and OCD and depression, that the combination of meds and therapy is better than either one alone. If it's mild or moderate enough or not getting in the way that much, I'll often tell them, start with therapy first and let's keep a close eye on things. If it's six, eight, ten weeks in and the symptoms are so bad that we're not able to actually engage in the behavioral therapy or whatever type of therapy it is because the symptoms are so high, then it makes sense. Let's add a little bit of medication so that we can turn down the volume, turn down the intensity a little bit, and actually allow the therapy to really unfold in combination with it.
- [20:33]
Host
Okay, so what is it that worry. And by the way, when you mentioned that, you know, we're lucky. In New York City there, there are therapists and there are clinicians. That, that is one of the big points is that across the country there aren't. And so it's really hard to find care, which I only wanted to point out because people that are listening are coming from all from different places. And when we talk about over therapizing or over medicating, I think it's like very much in pockets of the country and for most of the country we should be so lucky that there could be that much care. But I am wondering what are the downsides, what are the things that worry parents the most when making this kind of decision?
- [21:18]
Dr. Jaffe
I mean, specifically as far as starting a medication. Yeah, I mean, I think there's, it's, there's a lot of unknown to it. Right. I mean I think it's, it's the brain. Right. And, and it bleeds into our sense of who am I, what's my identity, who am I as a person? I think, you know, one of, one of the most common questions, you know, will this change, you know, who, who he or she or they, you know are. When I say, you know, only if, only if you define your child by their anxiety or their adhd, then, then potentially. But no, these are not personality changing medications. If, if you don't recognize your kid in date on day 10, one, we're probably going to write a case report because this is not typical. And two, even if it's less than that, you know, and we just don't like what we see, you know, we're not going to stick with it. There's no lifetime contracts that are, that are being signed here. And so I think there's, there's a sense of uncertainty. There's a sense of, it's, it's the brain, there's a sense of is it going to alter personalities are going to make them a zombie? My favorite question, because it means they're thinking the right way is how long are they going to be on it for? And the answer of course is we don't know. We're taking it one day at a time. We should be so lucky that we're in a good place where we're like, you know, things are actually kind of going great. Like could we think about peeling back on the meds a little bit? I'm usually the one who ends up bringing that conversation up and the family is like, what? No, why would we do that? Things are going so well. And so I think once you kind of get a foot in the door. It feels a lot less scary. Obviously, as a child and adolescent psychiatrist, you know, I'm working with medications every day, so it's a lot more comfortable for me. But it wasn't always this way. And I understand exactly where parents are coming from. And I get nervous when there isn't a little bit of hesitation on behalf of the parents. And I think there are lots of questions. You should be asking these questions to your doctor if they're not able to answer them. You shouldn't start something until you feel comfortable with everything. And again, this is why we wrote that book, to try to just at least have something else out there to help maybe lower that barrier a little bit so that people feel a little bit more comfortable with all the questions that surround medications.
- [23:15]
Sponsor
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- [26:32]
Host
So when you talk about brain development, because that is a part of it, is there something to making this kind of decision while the brain is wiring during adolescence or rewiring or whatever is happening? Is there is, is part of the fear that you're messing with what is developing or is part of the benefit that while this adolescent brain is coming to be that some of the new habits that can come from having medication will now be part of this development? Instead of coming in so late that this is a fully developed person, we're just discovering these things.
- [27:16]
Dr. Jaffe
Yeah, I mean, Elise, I think you've nailed both ends of it. Right, because it's exactly both of those things. I mean, so the brain is never static even in adulthood. The brain is always remodeling, breaking down old connections, building new ones. Obviously there's a lot more activity of this going on in childhood and adolescence. One of the common pitfalls people run into is they compare, you know, bad side effects from medications versus a perfect outcome without medications. And of course that's, that's not the decision that we have when someone's come in and they have their kid is having symptoms that is getting in the way of their academic, social, self esteem, life. We're really looking at what are the consequences of medications versus what are the consequences if, if we do nothing at all. And it connects to, you know, what is going on with, with brain development as well. And that, you know, if we've got, for example, you, let's say you Have a, a teenager who's highly avoidant. Maybe they don't even go to school sometimes, but they've withdrawn from, from ballet and from soccer and they're not doing their extracurriculars. The more they avoid these things, the stronger that avoidance gets. So you're getting that rewiring, you're getting that strengthening regardless. It's a matter of in which direction. And so the meds may reduce the intensity, the desire for some of that avoidance. And I think the therapy is going to help kind of really nudge them into doing it. Ultimately, you have to do it. We see this, you know, certainly with anxiety and with ocd, where there's such an important behavioral experiential component of the treatment. When we get them to do that, then we can actually help rewire the brain in a much more positive loop where they're learning, hey, you know, I can overcome these fears. Even if my tummy's feeling a little bit tight with some butterflies, I know that I can do these things anyway and I feel really good afterwards. Just one more kind of piece of it is of course that we're not just throwing medications at people and kind of hoping for the best. You know, what we do, you know, when medications get FDA labels is, is because they're actually studied in kids of very certain age ranges. Meaning, for example, you know, Prozac may look at, you know, depression in kids, you know, eight and up. And so that means, you know, in the studies that they're done, they're looking at kids 8 and up. Stimulants have FDA indications as little as 3. Some SSRIs are at age 6, 7, 8. The details aren't as important as just the general take home that these medications are looked at and studied in, in kids. And many of the meds that we are using now have been out for several, several decades. And so we have long term data, you know, showing that, you know, over decades these medications, of course there's always potential for side effects of everything, but these medications are self, are safe and extremely helpful over the long run.
- [29:52]
Host
And so how often do you have a situation where there is, because there some of this is heritable or environment, you know, like the parenting environment. If you have parents who are struggling with the same thing, how often do you need to help support the parents to help support the kids? For example, even remembering to take medication, like if you struggle with executive function skills as the adults. Are there tools that parents need to help best support their kids who are learning how to take medication, take And I guess side question to that is, is this the kind of thing where throughout childhood you absolutely need an adult to monitor this and hand out the medication every day versus teaching kids to manage this on their own?
- [30:44]
Dr. Jaffe
Another excellent question. It's going to depend, of course, on the kid and on the family. I mean, yes, lots of these things do run in family. One of my favorite experiences is we'll be meeting with the parents of a kid and somewhere along the line, often, but not always, the dad goes, oh, man, I think I have this. And often, often the mom, but not always says, I've been telling you that for the last 20 years. And we say, all right, let's focus on the kid, and then we'll circle back around. And it's not that unusual that once we're done doing the evaluation for the kid, one of the parents then kind of comes in and has their own evaluation. It shouldn't be startling when we look at the genetic rates of a lot of the disorders that we treat. You know, certainly with, you know, when executive functioning, meaning time management, planning, remembering, appointments, things, you know, when those are the primary symptoms, that actually, that can really be a challenge in families. Right? I mean, it can also be an opportunity because, you know, these are organizational skills that can be learned. You know, I will tell people no amount of Adderall is going to help you remember to click submit or to help you remember to hurt. You know, that is an organizational skill that can be, that needs to be learned and fortunately can be learned. And so sometimes there are opportunities for families to work together on building these skills together as well. I don't generally love kids or teens being in charge of their own medication. That said, you know, I have many very, very responsible ones, and they're, you know, they're more over it. They're more all over it than their, their parents are. And of course, we know that in many of these cases, they're going to be going off to college and living independently. So. So the system doesn't work if the parent is giving them the medication on the last day of senior year, and then suddenly we ship them off to college and we say, you're on your own now. And so a lot of what I'm doing, honestly, starting as early as, you know, 10th graders, so is helping, you know, offload a lot of these parental responsibilities onto the teen bit by bit, because we've got quite a long Runway at this point. So by the time they go off to college, they're able to do a lot of these skills, including Taking their medications and making sure that they have a system for checking their homework. And then it was handed in. And they can do all this independently by the time they go live independently.
- [32:45]
Host
Okay, so when we think about teenagers and social media, how often are you seeing kids coming in kind of self diagnosing because they saw something on TikTok and now they're convinced that something's going on or does it usually come from. There are different, you know, we heard from school, we heard from parents, we've heard from other family members and friends and the child themselves. I'm so curious just because I know that's been, you know, one of the worries about what's happening with social media and mental health is not only like some of the issues around comparison and all of the things that might, we might be more obviously negative. But is there like so much information and not necessarily accurate information that you're seeing people come in with requests about a diagnosis?
- [33:39]
Dr. Jaffe
It's a double edged sword, I would say. On one hand I think it's really helped get a lot out there. Certainly I believe it's helped to destigmatize mental illness. But the content is close to infinite as well. And obviously this isn't vetted. So some of the content might be great and some of it might be not so great. Challenging for us is that the lexicon is fairly universal, but everyone has a different thing that they need. You know, some, you know, anxiety to one person may mean something totally different to another person. And that's like a very broad example. I mean, we had someone earlier this week who came, you know, and they were telling us, you know, that they dissociate. And when we asked them what they meant, they were describing something different. The point is that these words that we use as clinicians and we all have a general agreement, you know, if I tell you, you know, dissociate, you know what I mean? Because we both kind of train from formal definitions of things, but when everyone is kind of defining it in their own way out there, we don't all mean the same things. And so I don't, I don't really, I don't mind that this is all out there and in many ways it can be helpful. But I often will tell them, what specifically do you mean by that? Give me example of these. I don't want the shorthand from it. I want to know exactly what you're experiencing on a day in and day out basis. And that will help me understand, you know, like, are we using this label appropriately? Is There actually a different name that we should be giving this, and it just. So we're all speaking the same language here.
- [34:58]
Host
What I am hearing though, is that you're not just rejecting them outright and saying like, that's all nonsense, but you're trying to expand and understand so that they can really get to the heart of what they're trying to express to you.
- [35:12]
Dr. Jaffe
Yeah, I mean, people are their own experts. I mean, are there people who, of course, you know, every visit they have another diagnosis and then you kind of see that pattern and you're like, all right, let me not be so quick to kind of react to all these things, because this is a separate kind of picture that we're kind of looking at. And we want to, we want to make sure that we're only kind of treating what's durable and persistent and, and problematic. And so. But that's, that's the minority. A lot of the times, you know, they're experiencing something and they're able to kind of tell us what the algorithm does with their searches and their clicks. From there on, you know, can be a whole separate can of worms that gets opened. As you said, generally they're feeling and experiencing something. And this is kind of just all of us working together to kind of pinpoint exactly what that is.
- [35:51]
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- [39:07]
Host
You'Re talking about younger kids or teenagers and their sense of self and their identities being formed, how do you help parents and how do you, in the room help kids understand what's going on with them without feeling like there is a stigma or feeling like they're broken.
- [39:25]
Sponsor
And need to be fixed?
- [39:26]
Host
What's the language that you use?
- [39:28]
Dr. Jaffe
It's. It can be challenging. And again, the audience I know is not all New York City, but, but in New York City, I think we do benefit a little. You know, there is less stigma. You know, there, there is. Will often run into families and there's a pride. They're like, yeah, that's my psychiatrist. And I'm like, hey, so the first point, you know, the stigma isn't as prominent of an issue, but, but the second point definitely is, right? I mean that there can be this implicit. If I'm taking a med, that that must mean that there is something wrong with me. And I think that's one of the right areas, you know, for therapy is kind of help, you know, how did, where did this conclusion come from? You took a med for anything, does that automatically mean there's something wrong with you? How, you know, how do we get there? Because there's often, there's often maybe an underlying self critical, you know, construct that's already kind of there that the Met is sort of, kind of building upon. And so it's not something to be dismissed at all. And it's, it's something that comes up very regularly just in med management. But it certainly can be attacked in much more depth in the therapy piece.
- [40:27]
Host
Okay, so just with two examples, can you kind of pretend you're talking to a school aged, a school aged child to explain that they have adhd and then maybe a teenager and then perhaps we could do that with anxiety just to give kind of words.
- [40:45]
Dr. Jaffe
We can, I will say, you know, more help is I, I'll usually ask them, right? They're not, they're not naive, they're not like unsure of why they're here. Right. I mean, and when I'm meeting them, I will always ask, you know, like, like, was it your idea to come here? Was it school? You know, was it mom? And, and I'll say, okay, what do you think they were worried about? And they will, some of them will even say I have adhd. And I'll be like, oh, what is, you know, what does that mean? They're like, well, you know, my brain goes too fast. I can't stop from like shouting out the answer. I'm not doing as good in school, you know, as I should. And so teenagers, of course, you know, depending, you know, certainly the older teenagers will have much more, you know, direct insight into it. For me, you know, it's shift, you know, I'm not seeing it as a, there's something wrong with you and we have to treat what's wrong with you. What I'm actually seeing is that there is a tremendous amount of potential that's being untapped here. And this is just going to allow you to tap into that potential. This will allow you to be the best version of you. It is not going to make you smart. I Tell people I say if you are dumb and you take 100 milligrams of Adderall, you will still be dumb. This is not going to give you intelligence. This is going just to allow you to use your God given talent that you already have.
- [41:52]
Host
So I want to open it up to questions from everyone else, but this is so helpful because I think we have a lot of people. First of all, not everybody has access to a psychiatrist who can speak to all of this. And so a lot of times there isn't even a conversation to be had. But also these are such hard issues to talk about. And I, for some reason people have really strong opinions about them. But actually there's, I'm not sure what that's rooted in. I guess it's just so vulnerable and so personal and so it can be incredibly helpful to have someone be able to just kind of sit back and speak about this in a way that sounds just like much more reasonable and not as fraught. So I really appreciate that and I just want to know if anybody here has any questions to take advantage of. Dr. Jaffe, because it is so hard to get an appointment.
- [42:53]
Audience Member
I'll jump in with a question. Thank you, Dr. Jaffe, for being here. I'm curious if you. Every family is different and every situation is different and every diagnosis is different, but I'm wondering if there's some general strategies that you give to parents talking specifically about ADHD and then specifically about anxiety that you think are kind of common things you'll always recommend that that family might implement in the home or at school. That can be helpful.
- [43:23]
Dr. Jaffe
Yeah, terrific, terrific question. You know, your first point of course is right, you know, it's all individualized, but there are a few universals. One, it seems obvious, but to love your kid unconditionally and it never hurts just to kind of remind that as well. But there is, there is no substitute for an abundance of love. I have never seen families overdose their kids on love. And so, so love, love, love on a more kind of tangible sort of level. I mean, I think it's important that families are modeling a lot of the behavior that we want to see in our kids as well. And I'm as guilty as everyone else of being on my phone too much. And so a strategy that I wish I was better at implementing, you know, is, is putting it away, having a space in the house or the apartment, whatever, you know, just, just have it away and really just having completely distraction just immerse yourself, you know, certainly with a, with a kid into, into Play, get into a game, have a dance party, do something. Don't allow yourself to be kind of half distracted on it. Really just be full all in. In their world. And that really, you know, and for teenagers, that also goes a long way toward modeling, you know, of having boundaries from. From your phone as well. It means having your phone outside of the bedroom. It means going to bed at a reasonable time yourself. One of the things that we didn't touch on that I think is relevant as well is the idea of resilience. Right? And so I think for us as parents, it's important that we're modeling resilience as well, particularly, you know, in kids, you know, who are more anxious and who are avoiding. For me, you know, the three most dangerous words, you know, that are out there are, I just can't. And when I hear that say, well, of course you can. Where did you come to this conclusion that you just can't? You are extraordinarily capable. Let's look at what's going on that's led you to that conclusion, and let's break that down and have you go out there and do it. But as parents, we can be modeling a lot more of this for our. For our youth as well.
- [45:17]
Audience Member
I have a question. Thank you both for this conversation. It's really great. One thing that I sometimes hear is, as a reason to not go on meds, is you don't want to, like, change your child's personality. And so even though they might be struggling with stuff, it's like, is there. Is the good things that they have or their uniqueness gonna go away? And so just curious your thoughts on that.
- [45:44]
Dr. Jaffe
It comes up all the time, and I, you know, if your child's personality has changed, you, you call me right away because something has gone terribly off the rails. We sometimes will have parents jokingly, you know, say, you know, I wish you could actually give something that would change their personality. They're. They're. They're of course, joking, but our. Our meds are not that amazing and that they could alter one's personality. Now, to be sure, some people, when they take stimulants, they will. You know, they feel like that spark is kind of gone a little bit, and they're not quite as, you know, kind of energetic and as creative. And that can be a challenge. And we may want to work with the dosing or the formulation because the goal is not to tamp down the good parts of it. Right? We just want to kind of tamp down the problematic symptoms of it when it Comes, you know, more to like the SSRIs that we're using often in anxiety and, and, and OCD and depression. It would be pretty surprising, you know, to, to see a personality change. I don't even really know what that would be. You know, I joke again, unless your personality is defined by your anxiety, which probably is, you probably view yourself as a lot more than just your anxiety, I don't think, I think it's actually going to free you to do the things that you really enjoyed doing and really make you. You. But again, I, you know, if, if we're seeing something different, you call me right away because something has gone wrong.
- [46:57]
Co-Host
I was just gonna say one thing that I see a lot in, in managing ADHD is that the parents often are like, well, I want them to learn the skills, to be organized, and I want them to have that and I don't want the medicine. And can't you just have them work with like some type of coach or their teacher or put them in the classroom in a certain way? And I would love to hear how you walk the line of talking about these behavioral things you put in place. But what the data has shown about the benefits of medicine for children who truly have ADHD symptoms, features that are affecting their.
- [47:37]
Dr. Jaffe
Yeah, I mean that. It ends up being fairly straightforward because this is where your evaluation pays dividends because you've targeted, excuse me, the most problematic symptoms. And so we're going to be identifying, you know, some symptoms are great medication targets and some symptoms are not good medication targets. Things like remembering to pack your bag, checking your, your schedule, making sure that you check. Don't check off that box until it's actually submitted. Remembering your water bottle there, there is not a medication for that. Those are organizational skills. This is where, if those are your main symptoms, I am saying this is not a stimulant situation. Let's start with an executive functioning or an organizational skills coach and see if we can really work on that. If the biggest problematic symptoms are really the mind is just wandering, it's too hard to sustain focus in classes, particularly the ones that they're not interested in. If it's a matter of impulsivity and they can't stop from shouting out or interrupting and it's getting them in trouble. I am not aware of any therapy that allows one to sustain their attention for a long period of time. If anyone has one, please message me on the side and we will go into business together. Some symptoms are much better targets for therapy. Some symptoms are much better targets for medications. And this is where the key is really, in identifying which symptoms are most getting in the way. And it may be both. So helpful.
- [48:54]
Host
Thank you so much, Dr. Jaffe. And we, obviously, everybody will know how to find you, but might not be able to get you. That's what I'd say.
- [49:06]
Dr. Jaffe
Well, thank you for having me. An absolute pleasure. And please stay in touch.
- [49:10]
Host
Thank you. Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.