← This Is So Awkward
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- [00:00]
A
Monday.com AI agents took over my work and I absolutely love it. Chasing deadlines, writing status reports, updating stakeholders. Agents handle the daily grind. Now I stay in the loop only when it matters. Create your own AI agent in minutes
- [00:14]
B
on Monday.com Vanessa There's a very obvious reason why we are re releasing our episode about how ADHD shapes friendships and relationships and romance and sexual decision making. Do you want to guess what that is?
- [00:32]
C
Because it was really popular and people freaked out at how helpful and interesting it was.
- [00:39]
B
I mean, bottom line, yes, if you haven't heard it before, it is worth a listen. Now if you have heard it before, it is honestly worth a re listen because it's a super candid conversation with an unbelievably insightful psychologist and ADHD expert, Ari Tuckman, who has been addressing this very specific issue for the past quarter of a century.
- [01:06]
C
Yeah, I mean, you'll hear in our conversation with Ari how extensive his experience is and how things like attention and impulsivity and emotional intensity affect social dynamics amongst kids during the tween and teen years. And what are the risks of the intersection of the natural kind of ups and downs of teen identity and relationships with ADHD and how that gets amplified, exacerbated or not depending on the ADHD diagnosis. So we learned an incredible amount from Ari. He's just like a fascinatingly non judgmental and empathic guy. And understanding how the intersection of these things impacts teen relationships was totally mind blowing to us. And we know it will be for you as well.
- [02:11]
B
Hi Vanessa.
- [02:12]
C
Hi Cara.
- [02:14]
B
Vanessa, I'm very excited for our miniseries on ADHD.
- [02:19]
C
I know it feels like the 1980s when the miniseries were all the rage. The Thornbirds. This is not the Thornbirds.
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B
This is not the Thornbirds. This is also not an after school special, another fun feature of the 1980s.
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C
It sure was.
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B
It sure was.
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C
Is one to grow on. Remember those?
- [02:40]
B
But this is just as formative because we get incoming about ADHD all the time, in every possible way. When we are out on the road speaking, every single audience that we speak to has a question about ADHD in some way, shape or form. We get emails, we get DMs. And it's fair because there is so much to know about this particular brain type and how it intersects with puberty and we haven't really covered it in great detail on this podcast yet.
- [03:21]
C
So it was actually really fun. We have a guest, Ari Tuckman, who works closely with kids and adults and has done for 25 years people who have ADHD and looking at the ways their social interactions, their romantic relationships, their sexual relationships can be affected by differently wired brains. And he's so thoughtful in the conversation, and he explains things that feels like we should all know, like what does the acronym ADHD truly stand for? And why should it actually have a slight slash after AD before the HD and things like that? So there's some baseline, fundamental information about adhd, how ADHD symptoms can manifest and change during puberty. And then we really get into how it can affect kids relationships at a time when their relationships are really in flux and the kinds of relationships they're having are in flux.
- [04:28]
B
Right. From friendships to crushes to dating to sexual decision making. And all of these things are impacted by and affected by their adhd. So, Vanessa, without further ado, here's our episode with Ari Tuchman. Hi, Ari.
- [04:51]
A
Hey. It's good to be here. I'm looking forward to this.
- [04:53]
B
Oh, we are very excited. It has been several years of podcasting for us to get to an episode explicitly about ADHD and attentional issues. We have had tons of incoming asking for us to do this, and frankly, it's such a massive bucket that we didn't know the right way in. And of course, we're following our own advice, and we're just starting at the beginning and going broad and getting some definitions. And who better to do this with than someone who has worked in the field for decades and who really, really understands this whole spectrum of issues that are facing kids? So I want to begin from the perspective of neurodiversity in general. You know, Vanessa and I do speak to a lot of different people about a lot of different topics under the neurodiversity umbrella. And it's feeling to us, it has felt to us for some time now, like, is there even neurotypical anymore, or is neurodiversity the norm?
- [06:07]
A
Sure. I mean, I suppose some people have to be dead average, right? But, you know, I mean. Neurodiversity. Yeah, exactly. But, like, I mean, the whole neurodiversity thing is if you take any human ability, so let's say the ability to pay att. But I don't know, I suppose we could also do like, what's your free throw shot? Like, you know, most people kind of somewhere in the middle, some people are really good at it, some people are really bad at it or really struggle with it. And, you know, I think neurodiversity is just basically, it's those people at that sort of like, thinner end of the bell curve who have more struggles with something. But, you know, as we know, intelligence and abilities are really pretty multifaceted. Right? We're all better at some things. We all struggle more at others. Some things we could learn and get better. And, like, I could take 4 million art lessons. I'll never be a good artist, but, like, that's okay. I can. I can take it.
- [07:06]
C
Ari, I feel like you're really missing a growth mindset with respect to your art, but we can revisit that.
- [07:12]
A
I'm choosing to focus my efforts elsewhere, so.
- [07:16]
C
Fair enough. Fair enough. So people are average. I can tell you that Kara's free throw would be less than average.
- [07:26]
B
But I make up for it in other ways.
- [07:28]
C
But she makes up for it with incredible attention elsewhere. How do we understand the terminology that gets used around attention? Because even in the last five years, add, adhd, you know, even that terminology has changed. So can we start with a little vocab lesson?
- [07:52]
A
Yeah. So first of all, let's just start with the name. So, you know, ADD often gets used, but technically it's all adhd. But within that, there are the folks who are kind of the predominantly inattentive presentation, which doesn't exactly roll off the tongue. So these are the folks who are distracted, disorganized, forgetful, struggle with time management, struggle with kind of sequencing. Like, do this first and then that second and then that third, as opposed to the folks who have the more kind of hyperactive, impulsive symptoms, which are more kind of the typical, what you would think of that, like, hyperactive boy who can't sit still. But that could also then become an adult who's better at sitting still, but has the luxury of not having to sit in a. In a classroom all day. Right? So they might have a job where they're up and they're moving and they're active. They may direct that energy a little differently. And then, of course, the impulsivity piece is basically kind of leaping without looking, right? It's doing something without pausing for a moment to think what happens next year. So, you know, there's the inattention, there's the impulsivity, There's a hyperactivity. And folks can have just the inattentive side, or maybe the hyperactivity in girls shows up a bit more as, like, talky, talky, talky, you know, as opposed to, like, running around the classroom like a nut, like their brother is going to do. So it shows up a little differently. But, you know, I think what we're learning is that, as with many things, right, ADHD has many faces, but it's
- [09:27]
B
so confusing to me because. And I'm the one of the two of us. Vanessa does not trip over the letters like I do. I was taught in medical school add, Attention Deficit Disorder was the general category, and then the subtypes within them are exactly what you've just described. Inattentive, impulsive, hyperactive. Can you just take us one step further down the path? Why then does adhd, which is Attention Deficit and Hyperactivity disorder, become the category name?
- [10:06]
A
Sure. I mean, it's Attention Deficit slash Hyperactivity Disorder. It's kind of like Andor.
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B
It's acdc.
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A
It is. It's exactly like acdc.
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C
Sara, you have to be careful making those comments on episodes that talk about sex. Also just saying.
- [10:23]
A
Right.
- [10:24]
C
Continue, Ari. Sorry.
- [10:25]
A
Yes, exactly. So a preview of where we're going, Right? Yeah. So, like, it is confusing, and people still use the word abd, but we're really talking about a lot of the same stuff. It's all the same strategies and treatments and everything else. The genetics all kind of line up also. So, you know, so it's sort of like it matters, but it doesn't in a way.
- [10:47]
B
Just to sort of help my brain reconcile all of it, then it's really attention deficit, which is the inattentive side of this slash hyperactivity. And that impulsive part is separate. It's a third leg of the stool. But it's a little bit part and parcel of the hyperactive piece, right?
- [11:09]
A
Yeah. Yeah. Generally, the more hyperactive folks tend to also be more impulsive. But, you know, the thing of it is, like, the inattentive folks, and again, broad brushstrokes, but maybe girls more than boys are less sort of visibly. Like, everybody knows a hyperactive kid, right? Everybody knows who that kid is, whether you're his brother or you're in the restaurant with him. You know, like, you know who that kid is who doesn't sit still. But the inattentive folks can sort of fly a little bit more under the radar. They're not drawing attention to themselves now. They're not paying attention, and they can't find the worksheet that we're working on where they left their, you know, soccer cleats at home, even though they really love soccer and they barely made the bus and, you know, all of that, but they're not, you know, causing a bunch of trouble. So they will tend to sort of float under and then get diagnosed later.
- [12:03]
C
We might know some people who fit that bill. We might know some people. You ask them to bring things from the kitchen to the bedroom. Things still get left on the kitchen counter. Not through malice, but just through inattention.
- [12:19]
A
Yep. Through distractibility. Yeah.
- [12:21]
C
Yeah. You've made some references to girls and boys. And I want to dig in before we get to puberty. I want to dig into what do we understand on sort of the gender differences in terms of how it presents versus what gets under diagnosed in certain folks.
- [12:44]
A
This is where it begins to get nuanced. Right. So there's. How does ADHD itself show up in terms of how someone sort of, let's just say, navigates the world? But also there's the intersection of, like, what are the expectations placed upon this person if you're a girl versus a boy? You don't get the same expectations, you don't get the same corrections, you don't get the same sort of like just explicit and implicit guidance on how to be. And then of course, there's all the other things, you know, culturally, where's your family from and are you in the city or are you in more rural setting and, you know, race and everything else. Right. So all of that sort of interplays among all these different facets of who someone is and what their context is. But in general, you know, again, broad brush strokes by girls tend to get more messages to kind of look like you have it together. Right. Don't be a bother, don't draw attention in a negative way. Boys have a little bit more sort of implicit permission to get away with that, like, oh, boys will be boys, you know, so it creates a situation where girls often then with the more inattentive adhd, will work much harder to keep it all together, to look like they're keeping it all together while inside kind of secretly dying. You know, maybe that's a bit dramatic, but, you know, it's more of that internal experience which then over time, especially as you sort of leave elementary school and you get into middle school, where the demands to be organized and on top of things go up and you get into high school where also then the social demands increase. They're having a harder and harder time, like wrapping their arms around it and keeping it all together. So maybe they seem like they're doing okay at school, but they're losing it at home because they're white knuckling all day, where they stayed up till midnight to finish the paper. And it's a good paper because, like, she's a smart kid, but like, it was a nightmare those last couple hours.
- [14:45]
C
Yeah. It's so funny that you Sort of use the word dying inside. And then you were sort of like, maybe that's too dramatic. But it's the word that came to mind for me. And I just want to recognize how hard these kids are working to keep up while keeping the surface. Right. The swan metaphor of, like, beautiful and gliding on the surface while the feet are paddling as fast as they can. And I think I want to bring that empathy to the rest of the conversation and empathy for how exhausted these kids are, how hard they're working, how much they are not purposefully doing these things. You know, whether it's the impulsive stuff or whether it's the forgetfulness or whatever else. I wanna bring that tone and that empathy into the rest of the conversation. Because these behaviors are so frustrating to parents. The way things present can be so infuriating. And just a reminder, these kids are working really hard and they're not choosing to be this way.
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B
I mean, what are the numbers of these kids? Because that empathy piece is not only critical, it's massive.
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A
Yeah. You know, kind of. Vanessa, like you said, it's really important to consider this because it looks like they're just making bad choices. Right? Like, why would you choose to wait till the last night to work on this paper? Right. Or to let me know that you need four giant, you know, poster boards for your science project or whatever Said
- [16:20]
C
every parent everywhere in the world.
- [16:22]
A
Exactly, exactly. And some of this is just kids, right? This is why children live with adults, because they don't survive on their own. But these kids with ADHD have sort of a delay in the development of what are called the executive functions. It's that ability to sort of organize and think ahead and plan and follow through. And it can look like it's intentional at times. I mean, it's sort of like if you forget your math book, like, ah, shucks, I guess I can't do math homework tonight, you know? But where it you begin to wonder about ADHD is when they're shooting themselves in the foot, more so than getting out at weaseling out of things. Right? So like I said, leaving your soccer cleats at home and they really want to play, or they keep losing their cell phone, you know, God forbid. Or they show up late not just for the boring, like, math tutor, but also to meet their friends. And now their friends, like, don't invite them or they kind of rip on them when they show up or. Right. That they're doing things that do not work in their best interest, but even beyond that. Right? Like what kid Wants their parents mad at that. Right, right. He wants to be grounded. He wants to be punished. It's sort of if it would have worked, it would have worked. If punishment isn't working, then it doesn't seem to be the right solution for this problem, you know, so that's when you begin to think beyond the diagnosis. Rate in boys in, let's say, elementary school years is much higher with adhd, more the high proactive. Those are the hyperactive, impulsive symptoms. You know, the girls begin to show up more, maybe middle school, maybe high school, college, you know, when they just can't sort of hold it together anymore. And then in adulthood, they begin to even out a little bit more. But there's still, as of 2025, there's still more men than women or more males than females.
- [18:14]
B
And do we have a ballpark of actually how many kids, how many kids in a classroom will have adhd sort of by middle school, by high school? And how many adults walk around with a known diagnosis? We can't really say. Unknown.
- [18:29]
A
Yeah, as you said. Right. To get to true numbers, a little bit hard to specify, but, I mean, I see numbers as high as 9%. That feels high to me. But I don't know. Others numbers say maybe in childhood like 7, 8%, in adulthood, like 4 or 5%. So, you know, not an insubstantial amount. And, you know, if you got 30 kids in a class, probably one, maybe two. But, you know, obviously it depends what else is going on and, you know, what are the other resources available and all of that.
- [19:02]
C
And Ari, with boys. So we talked about what it can often look like in girls. In boys, you mentioned some of the, you know, hyperactivity, the impulsivity. But I assume, you know, they also have the inattentive adhd. Just one sex, get diagnosed more often with one or the other. To your point earlier, is that more sociological? Like sort of cultural expectations versus biological?
- [19:31]
A
Yeah, I think it's both. I think in some ways boys tend to be more sort of physically hyperactive and more sort of visible in the ways that it shows up. But I think it's both biology and also sort of acculturation and expectations. So I think it's both. There's a sort of thing that sometimes happens where girls or teenage girls, you know, begin to get kind of anxious and depressed because they're aware of the gap between what they should be doing and what they are doing, and they're aware of how much effort it takes to try to close that gap or keep it as small. As possible. So like indeed they are anxious or depressed. Right. And I mean, I don't, I, I say this somewhat facetiously, but like if you have unmanaged ADHD and you're not at least a little bit anxious or depressed, then you're not paying attention. You know, like you genuinely have more things that are anxiety provoking and depressing. Right. More things work out negatively. You should expect negative outcomes. That's not unreasonable in that case. So, you know, the anxiety or depression is indeed there and certainly worthy of addressing. But kind of the analogy I use is like painting the water stains on the ceiling but not fixing the roof first. Right. So she continues to have the same struggles but maybe doesn't feel as bad about it, which to me seems like a rather unsatisfying solution.
- [20:57]
C
Right. I wonder if we did a more effective job of diagnosing girls, if the statistical differential between girls and boys in terms of anxiety and depression might not be a little closer together in numbers.
- [21:12]
A
Absolutely.
- [21:14]
B
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- [22:32]
B
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- [22:47]
C
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- [23:13]
B
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- [23:34]
C
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- [23:50]
B
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- [24:16]
C
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- [24:37]
B
so Ari, when kids enter puberty and travel through that super fun path of a decade of shifting and changing hormones and body parts and, you know, brain development is happening underneath it all, we certainly see shifts in the symptoms of adhd. Right. So maybe we can go symptom by symptom and just talk a little bit about how does impulsivity look different? Different when estrogen and testosterone are surging, how does focus look different? How do things like restless leg? I would love to talk about restless leg and understanding that one very clear physical cue. Do the sex hormones impact any of these? All of these?
- [25:27]
A
Yeah. I mean, there is this kind of supercharging that happens just in general in puberty. Things get, let's just say, bigger and more intense. So, you know, but also what happens is our young adolescents, like their worlds expand, you know, where are they? Who are they with? What are they doing? What do they want? You know, when your kids are six, I don't know, we still have pretty tight control. Like there's some adult who's watching over what's happening, hopefully. But, you know, God help you if you're, you know, even looking at your 12 year old, let alone, you know, acknowledging their existence when there's other 12 year olds to be found. So, like horrors. Yes, exactly. So obviously it's developmentally appropriate. Right? They're supposed to go out into the world, they're supposed to explore, understand how the world works, find their place in it. That is the job of adolescents. Unfortunately, their desire for independence far outpaces their ability to handle independence. Right. All this just terrible, terrible ideas, whether
- [26:36]
B
or not they have adhd, let's be very clear.
- [26:38]
A
Right, exactly.
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C
I mean, Ari, you should hear when we speak to a room of middle schoolers and we mention we do a scenario around shoplifting, and you can just see the room goes silent and you can see all the sidelong glances that they're giving to each other while trying to, like, stifle their giggles. And it's just like, it's the most amazing thing. And you talk to the administrators and they're like, no one at our school shoplifts. And we're like, sure, right. You keep. You keep telling yourself that.
- [27:11]
A
Yeah, yeah. And let's also just say these kids are not going to get recruited by the CIA, because clearly. Right, like, yeah, exactly. They're hardly the perfect criminals, you know, I mean, I remember a few years ago when my son was, I don't know, let's say 13, 14, he wanted, we have like a bow and arrow set for, like, shooting at targets. He bought these, like, rubber covers for the arrows, and he wanted me to shoot the arrows near him so he could catch them out of the air. Oh, my God, that sounds like an awesome idea. Great planning.
- [27:47]
B
That's diagnostic of age 12, right? Yes.
- [27:52]
C
So, like, in general, they're not going to make the best decisions, and they're at a stage where they have increasing opportunities to make bad decisions because they have more independence. Yeah. So where does that impulsivity fall into that sort of messy soup?
- [28:11]
B
And how do hormones, like, where is that role, Right. That direct? Or is there not one? Is there not a direct line?
- [28:17]
A
Yeah, no, I mean, there definitely is. Right. All of this is additive or multiplicative, perhaps. So exponential, Right? Exactly. You should call this podcast why the Parents can't sleep at Night. So, you know, the problem is it takes but a moment to get yourself into some big, big trouble. Right. And especially, like, if we're talking about hormones, like, you know, all this sort of social hierarchy and the posturing and all the nasty things, you know, adolescents do to each other, you talk about, like this, like, sex drive that they don't Know what in the hell to deal with and where to point it at and how to modulate it. Like, it takes a moment to cause some massive trouble for yourself or others. And as a parent, I mean, unless you lock your kid in the basement or if they're adolescent, somebody else's basement, you know, like, what are you going to do? Right? Like, we need to accept that we do not have full control. I mean, we didn't have full control at 6 either, but we could let ourselves believe it more easily. But, like, I've had so many of these kind of young adolescent clients who are like, good kids, right? They're just nice kids. And God, did they do stupid things to get themselves into trouble, right? It's like all it takes is the wrong text or the wrong thing on the wrong group chat or some comment or like, you know, I'm not helping any of the parents. I know more to feel bad about.
- [29:48]
B
Are you giving them a shovel to do that?
- [29:50]
A
We're just a reassurance somehow we all, somehow, almost all of us survive into adulthood without, like prison tattoos on our neck. So, like, somehow it works out.
- [30:01]
C
Let's talk about testosterone for a second, right? We know that testosterone can present as anger and aggression. We are waiting for the scientific data, we have the anecdotal data of testosterone presenting as silence and withdrawal. But more on the anger and aggression side, right? When you couple that with impulsivity and crappy decision making, there are some really serious consequences there. When a parent is watching a boy with, you know, surging testosterone, a maturing brain, and potentially ADHD in the mix, what does that decision making, what does that impulsivity look like?
- [30:46]
A
You know, some of it is. It sort of begins with some, maybe some inattention of not like, paying attention to who else is here, what's going on, who's standing behind us, right? So some of it is that, right. But when you add that in, it's like, oh, I guess maybe I shouldn't have said that. You know, like, I thought it was just me and my buddy. But like, the impulsivity, it's that leaping without looking, it's the not pausing to think about, wait a second, what else could happen here? Or I only meant it like this. But also somebody else might take it this other way or the school might see it, or another parent might, or another kid might see it. And that's not really actually who I am. And, you know, so it's, it's that kind of a thing. It's. It's thinking only about like, what they're focused on in that moment and not considering beyond that moment or other people's perspectives or someone's having a bad day is a little bit snarky, and then someone just, you know, like, decks them or, like, pushes them over.
- [31:49]
B
That's where my brain was going. I'm having this flashback to a bar mitzvah that I was at, you know,
- [31:55]
C
as a child, or as a child.
- [31:57]
B
As a child, and someone was going out with someone, and they had broken up, and there was bar mitzvah drama, blah, blah, blah. And it was landed with one seventh grader clocking another seventh grader. And it was all the things. It was the rage. It was the showing of the strength. It was the I'm a head taller than you. It was all the things. But it was also, you know, in hindsight, completely impulsive and modeled from the world around, because this is what one does to be chivalrous or to prove one's strength or whatever. You know, there are all these layers. But, Vanessa, you're, like, braiding such a perfect braid. You know, it's like all these things interwoven. And estrogen, too, in very similar ways. You know, Ari, the broad stroke that you painted at the top about talky talky, that is so clearly estrogen surging in a brain that is socialized to be this way, and that talky talky can go somewhere really negative. Negative, Right. And that can get someone in as much hot water, if not more than some of the physical stuff. It's all kind of amazing. Will you explain restless leg and what restless leg has to do with adhd? And, you know, I'm fascinated by it.
- [33:15]
A
Yeah. So the issue for the whole hyperactivity piece is that it. It takes some force of will to, like, restrain movement. Right. So to sit at your desk and fold your hands and just watch the teacher and maybe take some little notes, right? Like, it takes effort to restrain moving and, you know, wiggling your seat and whatever. And, you know, kids who have more of those hyperactive symptoms, they're just not as good at. Like, their breaks don't work as well. They slip more. So they might be, you know, bouncing their leg at their desk where they're, like, tapping their pencil, or they get up and go to the bathroom, you know, four times, and then they get referred to you to see if they have, like, urinary tract infections. And they're not. They just don't like to sit. And they invent reasons to move, you know, so it. It can show up in ways that are more visible, but it can also be annoying to the people around them, you know, and that can def. Whether it's classmates or siblings or parents, it has social implications as well. But also, if you're a kid who doesn't sit still, well, I don't know. You have more opportunities to get yourself into trouble, right? So if you decide to, you know, take a not entirely required bathroom break, who knows what you encounter on your way or who else you meet. I know you have many more opportunities for trouble, Ari.
- [34:41]
C
I want to explore that more. The part before wandering the hallways and getting into trouble, the part about annoying people and the social implications, because there's a point where certain behaviors that used to be okay or tolerated are no longer tolerated, either by adults or peers. And maybe we're even moving into the category of someone, you know, that you have a crush on or romantic interests. What is the impact of ADHD behaviors on kids, social interactions? And then, you know, we're not going to leave our listeners hanging with all of these challenges without getting into ways to support them, but we're just sort of setting the table. So what are, what are some things that come up socially?
- [35:31]
A
I mean, you know, some of this can be sort of to a social benefit in the sense that, you know, like a talkative girl who's otherwise charismatic and is sensitive and likes people and like, you know, she could actually do quite well socially, perhaps, you know, like, some people have that kind of charisma that it works well for them, but then there are also those who will struggle more. And if there's anything about them that puts them a bit lower on the food chain, so to speak, this might be another cut against them. You know, she doesn't shut up. She keeps talking, she keeps interrupting. She didn't, remember I told her something, you know, she didn't send me a text on my birthday or. And maybe this is more for the boys, but like, kids who get into trouble, other kids don't want to sit, be near them. I mean, some kids do, right? Let's be honest. But. But there's other kids who don't, right? And kind of one of the things I a line I often use with adolescents is, you know, who you're standing next to has a really big effect on what happens next, right? And if you're a kid who tends to attract negative attention from teachers or whatever, like, people don't want to sit next to you in class, they don't want to be standing next to you at recess or at lunch because, like, they're going to get swept up in that trouble also. And they don't want that, you know, or they don't get invited to other people's houses or their parents are like, no way, man. Johnny's not coming. He's. He's out of control.
- [36:57]
B
Yeah. I mean, there's such a fine line between charisma and chaos, it strikes me, you know, and if that could be the title of this episode, the fine lines with Chris, mine, Cass. But especially as kids turn into adults, ADHD can present, like, charisma and incredible energy, but it can also present Vanessa in exactly the way you were just describing with physical behaviors. Like a person can't hold it together, that there's internal chaos and that's a social faux pas. We'll be right back, but first, a word from our sponsors.
- [37:37]
D
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- [38:06]
A
Matchday as Doug reaches for a buffalo wing. He's got it. Oh, and he's gone for a can of Pepsi too. What a finish. There's no doubt about it. It just tastes better. Match Days deserve Pepsi. Did you know Sam's Club isn't a store? It's actually a club with cool finds and like a whole community. It's a club.
- [38:27]
C
Of course, Jason.
- [38:29]
A
It's in the name.
- [38:30]
B
Sam's Club.
- [38:31]
A
Oh, yeah. Come join us. Sam's Club.
- [38:37]
C
Right, Cara? Like we know the kids who were hilarious in ninth grade. But when the stakes got higher and higher throughout high school, or maybe even when we were in our 20s, the stakes were higher. All of a sudden, those behavior were not charming. And not only were they not charming, they were scary or creepy or uncomfortable. Like, all of a sudden the tone shifts. It took a turn. And this is just the sort of, as Ari, as you said earlier, as the world presents more opportunities, maybe in terms of sexual relationships or substance use, experimentation or behavior in work settings or college settings. Right. So help us understand, we did the transition from sort of grade school to middle school to high school. But then as the stakes get higher and they get exposed to even more opportunities for risk taking impulsivity. What does that look like, Ari?
- [39:39]
A
You know, if we talk about sexuality, adolescents with ADHD tend to have sexual activity at a younger age and tend to have more partners. Also tend to be less, let's just say planful about, you know, protection and birth control and things like that. I mean, it creates more opportunities for trouble. Right? I mean the whole consent thing is so hard already. Even if you're the most self aware 15 year old ever, you know, it's still, Even if you're 30, it can still be hard. But you know, if you add impulsivity in, that's, you know, you can sort of overlook or override signs from the other person that they're, you know, want to slow things down or if you're inattentive or you just want the attention you may miss kind of red flags of like, wait a second, where did all my friends go? Why am I here by myself in this room in the party or something? Or, you know, why am I with this person? This is not actually someone I want to be with right now. So, you know, you wind up with situations like that that can very quickly become an issue.
- [40:43]
C
Right. So it's not always the kid actually being, I'm going to use the word perpetrator, but what I mean is the actor tour, sometimes it's the kid missing cues or sort of making choices and that puts them in a vulnerable situation, you know, at the end of the night. And I think that's important to hold both of those perspectives in terms of sexual activity. Can we dive in a little bit to why, you know, less planful I get about, you know, using contraception, but why earlier sexual activity is that tied to impulsivity? Like what's happening there?
- [41:23]
A
I mean, I do think some of it is that impulsivity. It's just that in the moment. Okay, let's go with this rather than let me jam on the brakes and think for a sec. So some of it I think is that, I think some of it may also be if we get more kind of psychological, I don't know if you have more struggles in general, if you're getting more sort of negative comments from the adults around you. If your social position is a little bit shakier, you might then see either having a romantic relationship or a sexual moment with someone else as, as a way to either get just sort of validation of these people like me, or there's some thing about like, well, if I do something with this person or if I'm going out with them, this will raise my social standing. It's a way of kind of helping them feel better about themselves. And I mean, I get it, I understand the logic. But of course it doesn't always work out that way. Or it's, let's just say more the outcome is more complicated than just that.
- [42:24]
B
Is there anything about it that is sort of a neurotransmitter based response, the dopamine and other neurotransmitter hits of being with someone you really like and you're really attracted to. Does that quiet the brain and sort of make an ADHD brain feel better? I mean, we know caffeine does, we know nicotine does. Right. These are things that can quiet those brains. So can the intoxication of crush, love, attraction do that as well?
- [43:01]
A
I think it can to some extent. Or at least it becomes. It's sort of like it's a pull you can't resist, you know, and let's face it, the rest of your life of like doing algebra homework and cleaning your room doesn't hold a candle, you
- [43:17]
B
know, like, the goal is not algebra homework for the rest of your life. The goal is romance for the rest of your life. You're winning. Yeah.
- [43:25]
A
Yeah. In this moment, man, does that burn.
- [43:27]
B
Hot, right?
- [43:28]
A
You know, it's as much as for any of us when we're in that sort of moment, it kind of fills our awareness. But you know, for kids with adhd, it even more so. Right. And it just becomes impossible to resist it.
- [43:42]
C
Yeah. I mean, so is that a neurological reality? Like receptors in their brains? Do we have data on like, how sex feels to someone with ADHD versus someone without it?
- [43:54]
A
I don't know if we specifically have that so much as just in general, folks with ADHD have less, let's just say, braking power, you know, to be able to sort of jam on the brakes and pause to consider for a moment, is this really the best thing to do? Or, you know, and that could be. I could keep going and fool around with this person. It could be sitting in class. I just had a thought and now I'm thinking about some other, you know, the video game coming out tomorrow rather than listening to the teacher talk about tomorrow's test. But it's less of that ability to sort of hold back either where their attention goes or where their actions follow.
- [44:35]
C
Can we talk about porn for a second? As it relates to adhd, what does the research tell us about kids with ADHD and their Viewing habits of porn, use of porn. Do we have data on that? On that side of things?
- [44:53]
A
I mean, just in general, kids and adolescents and adults with ADHD spend more time on screens because, let's face it, our screens are pretty interesting, right? In many ways they're pretty interesting or at least compelling and hard to resist, which is not the same as interesting, but there's definitely that, right? It's that it just draws the attention more strongly. And, you know, the kid without ADHD might have that same, like, oh, I want to play video games or I want to get back on Instagram or YouTube or porn or whatever. And also, like, I should really do this other thing instead, right? I should do my homework, clean my room, go to bed, or just hear wherever it is I am right now, this is not the place to be doing this, you know, and the kid with ADHD is just more likely to kind of jump to it. And, you know, like, porn is pretty interesting, especially, you know, if you're an adolescent. There's all this desire, but not a lot of understanding. And it's kind of like, I need to figure out what this whole sex thing is about. Everybody seems really sort of fired up about it, and I don't understand what's going on, and I sure as hell don't want to make it look like I don't know what's going on. So, you know, especially given the sad state of affairs of sex ed in this country, porn is your sex ed and it's a terror. It's. I don't know my analogy. My sad joke is it's like, you know, learning driving lessons from watching the Fast and the Furious, Right? Like, sure, there's a lot of driving in those movies, but probably not the place to get your advice. So, yeah, I think it's that.
- [46:26]
C
And if you're already a kid who feels shamed by adults and like, you're letting people down, then the expectation that you're going to come ask an adult a question about a tricky topic like sex, or you're going to admit to having watched porn and not really understood what it is, but knew you were titillated, so you're going to kind of keep watching it. Like, they're even less likely, I feel like, to kind of go to an adult who's busy shouting at them or being disappointed in them on other fronts.
- [46:58]
A
Yeah, because, I mean, in respect to the parents, right. Like, we're all busy too, right? And we're trying to survive the day. We're trying to make sure our kids get done the stuff they need to, whether it's schoolwork or brushing their teeth or.
- [47:10]
E
Right.
- [47:11]
A
So, like, again, none of the parents had bad intent either. They're just doing the best they can to manage all the demands on their plate.
- [47:18]
B
So we've promised we won't just dump on the listeners, but we will land with action and with things that you can actually implement and do. And I'd like to do this from the perspective of, at least in medical school, we always learned a little bit of something. Pathologic can often be really good for you and can go a long way. A little bit of anxiety is protective. A little bit of OCD gets the studying done. I would argue a little bit of ADHD is a phenomenal sort of light up your brain.
- [47:53]
A
Yeah.
- [47:53]
B
You know? Yeah. It's like. So I think the first place to start is if this sounds a little familiar but is not overwhelming your kid, your home, your this, your that. I think sort of to have perspective on there's a range here and be in conversation with a healthcare provider. Please, please, please. But know that there are kids who have debilitating adhd. There are kids who have certain features of ADHD that you can address and manage. But sometimes in some cases, you will look at a kid and you will say, gosh, you know, if they didn't have a little bit of impulsivity, that particular kid might shut themselves in their room all day long and not interact with anyone and might have their own then social hurdles. So I want to start from that place of recognizing that if you hear something that sounds familiar, this is not by and large pathologic. It's just. It's just a set of descriptions that helps people understand how different brains work and how different people are wired. And now here are some things that you can do to address it or even, frankly to diagnose it if you think it's getting in the way of life. Is that a fair framing, Ari?
- [49:23]
A
Yeah, and I think it just to sort of emphasize what you're saying, you know, ADHD is not different in kind. It's different in degree. Everybody gets distracted sometimes. Everybody forgets. Everybody blurts something out that as it's coming out, they're like, oh, don't say that. Right. Like, we all have our moments. And there's also other reasons why people look a bit like they have adhd, at least for a time. So in that sense, parenting kids with ADHD is just parenting. You know, it's just a bit more so. And, you know, I think if there's One thing to remember is that when it comes to these executive function skills, kids, adolescents, and frankly even young adults into their mid-20s have a delay in the development of those kind of like life management skills. So don't say you're 15. You should be able to. Whatever, whatever. Because, I mean, it's just sort of like, well, I don't know if they should or shouldn't, but they can't. So let's go with what they can do.
- [50:24]
C
Ari, can we start with the elephant in the room here? Which is the question we get all the time is to medicate or not to medicate. And how does medicating people worry a lot about before kids are in puberty or while they're in puberty could affect growth and weight. Those are the concerns we hear. What are your thoughts on that?
- [50:44]
A
So let's address the two big concerns that are really overblown. The one you described, sort of growth in weight. Now, obviously, if your kid doesn't eat at all on their medication, then that's not the right medication. Right. That just means you got to go back to the prescriber and figure out something else. Right? So you don't accept terrible side effects. You know, generally speaking, to the extent there is any delay in growth, I think it's less than a centimeter in adult height, which is really like not much. But it shouldn't be an issue anyway if you can manage eating. Second thing is the whole concern about, I'm not giving my kids speed. They're going to become a drug addict. Right. And when you look at the research, it is very, very clear. Untreated adhd, especially kids who have the hyperactive impulsive symptoms, have a significantly elevated risk for substance abuse in adolescence and adulthood.
- [51:38]
C
That's untreated. I want people to hear that. Treated, untreated, not treated.
- [51:43]
B
Can you be clear why can you help people understand?
- [51:47]
A
So it's the ADHD itself that brings the risk. Right. And it's the impulsive decision making. It's the like, if you're getting yelled at a lot and you're not doing well and your parents are griping at you like you're not hanging out with the kids in the chess club, probably. You know what I mean? So it's a good way to turn kids off of education. It's a good way to turn kids off of, like you were saying before, going towards an adult or a parent when issues come up. Right? So like kids with ADHD who are treated with a stimulant have less risk of later Substance abuse. So, like, it has a protective effect against addiction and substance abuse issues.
- [52:29]
B
And I want to jump in with a couple of very specific points on that front. One is, in practice, what I saw time and time and time again was that kids who were on stimulants who were taught to use the language, hey, man, I can't try that. I can't do that because I already take a medicine and I can't put that in my body. Are kids who are protected from younger experimentation with alcohol and drugs. That is a strategy that I have seen kids with ADHD use, and frankly, I have seen kids without it who pretend to be on. You don't even have to say what kind of medication.
- [53:10]
A
Sure.
- [53:10]
B
But for kids with adhd, for them to understand that polypharmacy, the mixing of drugs in their body, is dangerous. And if they're on this medicine that makes their brain clearer during the day, one of the trade offs is don't put that stuff in you. That is one driver that reduces the risk of experimentation with substances. The other one is, and this is what I'd love your 2 cents on. When kids are unmedicated, and I am not arguing that all kids should be medicated, there are plenty of kids who do not need medication. But when kids are unmedicated and they seek a substance to quiet their brain, to help them focus, and they stumble upon. I'm going to use nicotine as an example because that is a really easy to get substance. And they, you know, they use a vape or they pop a Zyn in, you know, tuck it under their lip, and suddenly they're sitting in Spanish class and they can focus better and they can learn the material and their brain feels a little bit more locked in, what are they more likely to do? They're more likely to go out and use that substance again because it made them feel better. And to me, that's the conversation to have with a healthcare provider, which is like understanding taking a medication that a pharmacist is mixing and making sure it's the right medication for you that a doctor is prescribing versus grabbing some random substance du jour off the street or from a friend or whatnot. And I would love for you to just dive into that for a sec.
- [54:47]
A
And that's exactly right. You know, like when we think about what sets up kids to go towards substances rather than away, you know, it's a lot of stuff about unmanaged ADHD goes there. And by converse, you know, a lot of addressing ADHD kind of points Kids in better directions. You know, it reminds me, I was at a conference a bunch of years ago, and this old pediatrician shared a bunch of quotes from his patients, like his favorite quotes. And one was from a kid, a young kid who said, my medication helps mom not yell at me. Oh, it's heartbreaking, right? But that's the truth. Like, that is the truth that it's not just about his math homework or her cleaning her room. It's about the relationships that they have
- [55:40]
C
and self esteem, Ari. It's about their sense of self and their sense of, you know, agency and confidence in the world.
- [55:48]
A
It absolutely is right. Or as I sometimes say, the neurological becomes psychological. Right. The experiences you have shape the person you become, and they shape how you interact with other people.
- [56:01]
C
So in our last minute, I am picturing parents listening to this thinking, oh, my God, I have blown this. I have screwed this up. I'm failing my kid. What can you say to those folks,
- [56:15]
A
Ari, it is never too late. Deal with where you are now. Acknowledge it, own it. Share the good intentions for why you did what you did. Admit why now you know different or you know better, and just do what you can do now. I mean, that. That's the best any of us can do, right?
- [56:35]
B
We go forward and get connected with a healthcare provider who understands how to assess for attentional issues and how to have conversations about to medicate, to not medicate. This is unfortunately not a quick and easy thing. Sometimes it can be very hard to find someone who has the bandwidth to do the right assessment for a kid. It can be really hard to find someone in your local area who can care for a kid. But, you know, there are so many steps between what you're seeing at home or at school and medicine or, you know, this sort of later part of the road and getting that help. Start with your pediatrician, start with your school. You know, use a school counselor or some. An educator at school who can help you start to think about what to do to assess the situation. Because there are just. There are 15 steps in between here and there that we haven't covered. And maybe, Ari, you can come back and we can cover all of them.
- [57:42]
A
Definitely. And do not reinvent the wheel. Other smart people have come before. You use the resources you have, whether it's stuff online like@understood.org or the people you know, the resources in your community.
- [57:55]
C
And we'll link to Understood.org in the show notes so that people can access resources quickly. Ari, come back and visit us.
- [58:04]
A
It was so great to have you Definitely.
- [58:08]
C
Thank you so much for listening. You can email us with questions, feedback or episode requests@podcastawkward.com if you want to
- [58:19]
B
learn more about what we do to make this whole stage of life less awkward for everyone involved. Our parent membership, our school health ed curriculum, our keynote talks and more are
- [58:31]
C
all@lessawkward.com and if you want products that make puberty so much more comfortable, visit myumla.com.
- [58:48]
E
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