← Your Anxiety Toolkit - Practical Skills for Anxiety, Panic & Depression
Your Anxiety Toolkit - Practical Skills for Anxiety, Panic & Depression
464 Anxiety vs. ADHD: Are You Misdiagnosing Yourself? (with Kati Morton)
00:40:54
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- [00:03]
A
Welcome to youo Anxiety Toolkit. I'm your host, Kimberly Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big fat virtual hug. Because experiencing anxiety ain't easy. If that sounds good to you, let's go.
- [00:36]
B
Have you ever wondered if what you've been calling anxiety might actually be something else? Like maybe adhd? If so, you're not alone. So many of you have shared how confusing and overwhelming it feels to untangle these two experiences. And that's exactly what we're here to have a conversation about today. Welcome to your Anxiety Toolkit, your Go to podcast for learning how to make manage anxiety, panic and OCD through compassionate science based strategies. I'm your host, Kimberly Quinlan and I am so thrilled you are here. I am joined today by a licensed therapist and beloved mental health educator, Katie Morton to explore the overlap between anxiety and adhd. We'll talk about how similar they can feel, why misdiagnosis is so common, and how to start understanding your brain with more clarity, kindness and hope. So let's get started. Thank you so much for being here, Katie.
- [01:29]
C
Of course. Thanks for having me.
- [01:30]
B
I'm actually really excited. As I said to you before, you have been on my list of someone I wanted to have on the show for quite a while. So I'm thrilled to have you here.
- [01:37]
C
Yeah, thanks for reaching out. Excited to chat about this. Such an important topic.
- [01:41]
B
Yeah, and I think it's important for us too because I feel really specialized in anxiety, but not so much in adhd. And as I have clients who exhibit similar symptoms, we are often sort of using that word, untangling the two. Just, let's just get straight to it. Can you maybe help us to understand the. The differences between anxiety and adhd? Go as deep as you want to get started and if we can go deeper and deeper as we go.
- [02:08]
C
Yeah, of course. I mean, the first thing that I want to like validate everybody is there's a ton of overlapping symptoms. I think that's the problem is that like, people with ADHD do have a lot of similarities with people who have anxiety. For example, like feeling really restless or having a tough time sitting still. If you're feeling really anxious, you can be very fidgety. You can find yourself with your legs crossing. That foot is shaking. Like the whole chair. You know, and it can be very similar if we have adhd, if we have that hyperactive activity piece of it. And so because of all of these symptoms, and they're probably, I don't know, 10 that I could list that overlap, it's really hard for people to untangle. Not to mention the fact that I think that one can sometimes lead to the other or feed the other. If we have both, because you can have both. Also. The biggest, I guess the takeaway that I want everybody to remember about ADHD versus anxiety is that it's all about what is driving that symptom. So it's not so much of the restlessness, it's not so much of the. My brain just can't focus. Right. Because it. Lack of focus. If I'm anxious or if I have adhd, they can. I can feel that way. It's not really about that. It's like, am I unfocused because there's other things I want to think about that are more exciting, something that's a little bit more interesting, or is it because I'm so stressed and worried and I can't stop the worry and my brain is spiraling out? Those are two different reasons for the same symptoms. And that is really the crux of the difference between ADHD and anxiety is the driver. What is driving the behavior. And I know for some people that might be hard to realize, but just start trying to be a little bit curious about it. Where is this coming from? What do I think is causing this symptom?
- [03:45]
B
Okay, so let me break it down just so that I get really clear here, because this is sort of like a masterclass in me learning too. So let's say they are sitting down to study and they're worried about the exam that they are studying for. But they're. And they're trying so hard to focus on the material, but their brain keeps like ping ponging away in that circumstance, would it be that it's a combination in like a generalized anxiety about the test, but the ping ponging can't bring our attention to one thing. Would that be a way to understand.
- [04:21]
C
Adhd, do you think? Yeah, I would say. Say that would be ADHD driven. Yeah. Because the reason you can't study or focus actually isn't the worry. Yeah. You're stressed about the exam or you're worried about it, but that's not what's preventing you from doing the study. It's the ping ponging. And my question if that. If you were like a patient in my office, my question Would be, where is it ping pong into? So when, when you're sitting there and your brain's kind of ping pong around, be like, oh, I was thinking about, like, oh, my God, I really want to get that skateboard. Or my friend, oh, forgot about that party that's coming up. And it's going to what I would call, like dopamine basings that, right? Like, oh, I get to see my friend. Or, oh my God, I'm gonna have that burger tomorrow. And, you know, like, things that feel good, things that we like, things that are exciting. Those are all like dopamine hits. But when I was researching for a video, this is like, I don't know. Ages ago, I went down a deep rabbit hole of why an ADHD brain works the way that it works. And it's because of two pieces. We always think like, oh, it has lower dopamine, which is true, but not fully true. It's actually missing a protein that is a dopamine transporter, meaning it gets the dopamine to good parts of the brain, the parts that feel good, the parts that you want the dopamine to. And because it's lacking that, we spend all our energy and time trying to seek out dopamine hits, things that feel good. So going back to your example, if the brain is ping ponging around at things that are like, feel good things. Oh, I was, I was thinking about, I'm excited for this. Or, oh, I, I am really into old cars. So I was thinking about this old car I saw up for auction the other day. Whatever it is, if your brain is pinging around that, to me, I'm like, oh, adhd, adhd. It's trying to get that dopamine.
- [05:54]
B
Interesting. So before we move on, because I have a specific question I want to ask you, but before we move on, can you give a clear set of symptoms that are present for folks with adhd? What is required in order to get that diagnosis?
- [06:10]
C
For a diagnosis of adhd, it's important to understand, like, it's. There's two pieces, right? We used to say there was ADD and there was adhd, and now it's all under the same umbrella, which is, Is great. But it also can make some people feel like they're left out. And that's why there's kind of like two I in my brain. I always visualize it as two lists and one is hyperactivity. And that's kind of like the things, the restlessness, the. I think of it like the kid in school, what we always Thought like the quintessential ADHD child. Like, usually it's a boy and they can't sit still, and they're like, shouting and bouncing around. If sitting still, either physically or mentally is hard for you, that's part of that hyperactivity piece. And yes, I mean, we could say, like, restlessness in body feeling. Like your. Your thoughts are so quick it's hard to capture them. Those would be kind of those symptoms. Then we would get into more of the, like, attention. So it's really hard for me to. To focus. It's really hard for me to recall what I've just read. And I'm trying to think if there's another example I could offer, but it's kind of that, like, more internal restlessness. I know we've teased them out a little, but that's how I visualize and that's how I interpret ADHD is when you have either from one part of the table, like, let's say it's only hyperactivity. You don't actually have to have both. Most people have a little bit of both. Or if it's more of the attention, like, I just can't focus. I just can't remember. My recall is scattered. Like, one of my friends has really wicked adhd, and he always feels like he's really selfish in his relationships because he's like, he pulls. He wants to do a certain thing, and he, like, essentially won't take no for an answer. And it's not because he's being selfish. It's not because he's rude. It's because he's seeking that dopamine. And so that's kind of the attention. He can't focus on this other thing until he gets that need met. And it can be very, like, that hyper focus that people talk about that happens. There's also something called time blindness, which I would put in that bucket of, like, the attention piece where I could get so enthralled with something that I don't even realize. It's been like four hours and maybe I missed an appointment or I forgot about this meeting or, you know, I let somebody down or I let myself down. That happens also. So having these symptoms of adhd, like the impulsiveness, the disorganization, difficulty sitting still, difficulty focusing, you have to have these symptoms present for most days for six months in order to be properly diagnosed. And I always encourage people to see someone who does test for this specifically and diagnose it, like, often. It's like a big part of their practice because like you and I are saying, you know, when you don't specialize, it's kind of its own thing. It's. It's very particular, it's very specific. I always still refer out. I have, you know, a couple of psychologists I've worked with for years who. That's all they do is test for adhd. And I think it is really key, even just going over just a few of the symptoms. It's important for us all to be diagnosed, especially if we're in a school setting, because we can get more time on tests. I even had a girlfriend who'd taken the LSAT to become a lawyer like five times and kept failing. Got a letter from her psychiatrist, got to take it in a class all by herself, passed it the first time. Because you had adhd.
- [09:15]
B
Yeah, yeah. And those accommodations can be so helpful. I think in the, in the anxiety field, we are constantly talking about, like trying not to have accommodations. Right. Like not to avoid your fear and always face your fear and, and so forth. But with adhd, it is so important that you do get those accommodations because it's important to give yourself that opportunity to be able to like, like you said, be able to concentrate in a test setting and so forth. What about folks who. And maybe I'm misquoting this, but. But there tends. Tends to be more talk these days about ADHD on TikTok and so forth about the impulsivity, the dysregulation, even the association with suicidal ideation. What's your experience of that? I mean, it's definitely the case with having anxiety, but can you help us to understand the ways that those symptoms show up when it's with anxiety compared to adhd?
- [10:10]
C
Yeah, it's interesting, the impulsivity piece. We can talk about that first. Again, that's why it helps to realize that ADHD is just. They're like dopamine seekers.
- [10:20]
B
Yeah.
- [10:20]
C
Which means that if something all of a sudden pulls my attention and is like a higher reward. Right. It feels really good. Maybe it's really new. Maybe I have to do it now because it's going to go away. When you think of all the pieces that lead someone with ADHD to focus in and get really excited about something that leads to extremely impulsive behavior. And if we're seeking dopamine out, that can also mean that we over drink. We could engage in risky sexual behavior, think of things that maybe feel good in the moment. Binge eating, it's another big one that's kind of overlapping my specialty in eating disorders. We can do these things because they feel good in the moment. We don't think long term when we're in an ADHD brain. Often it's, it can be really hard for us to plan and organize. That's not our strong suits, right? So that impulsivity can lead to reckless behavior or even what I would just call like harmful to our relationship behavior, where it's like we can be doing things that again, aren't for a greater good, aren't thinking future focused, are more now and in me getting that dopamine hit, feeling better now. If we aren't able to do this, this is kind of why I wanted to go in this order. If I can't get that dopamine hit, let's say I'm in this monotonous job and like, I just don't have any flexibility with what I do and I'm stuck here. That can lead to dysregulation. That can mean that I just don't feel good. I'm very frustrated, I'm irritable, I'm forced to do this thing I don't want to do. My brain is ping ponging, right? You can see like the layers of it. So first is like I, I don't feel fulfillment or enjoyment through this, which is really important for someone with adhd. That's why they tend to do. They tend to thrive in creative environments. Thus. So I don't feel good about it then. Also I have been, maybe I've been trying to act a little bit impulsively. That's not getting me anywhere. I feel worse, so I feel even more frustrated. Then maybe somebody asks me for something else, I fly off the handle because it's essentially me not getting that dopamine hit. Me not feeling good about what I'm doing lowers my resilience and makes me more apt to lash out to say something. I mean, think of, I always like to think of a person, an ADHD person who's untreated is important, no medication, who is doing something that's super monotonous, let's say like, I don't know, editing a paper and then is asked to do something else that they don't want to do. It's like you and I, when we haven't slept and we haven't ate and it's just not good. And so I think that leads to that in the reactivity. Because I feel like impulsivity and reactivity are like cousins and they, they really like to hang out together and they can leave, they can like fuel one another. And then moving on to the final piece that you kind of talked about here is like suicidality. So if we don't feel any enjoyment, we aren't pleased with what we're doing, whether it's work or school or whatever our relationships. We maybe were drinking a lot to cope, we're acting impulsively, maybe we're spending a lot of money, we found ourselves in debt. We've kind of created a very unhealthy environment for ourselves. And that can lead to symptoms of depression, symptoms of anxiety, and thoughts of suicide. And again, that impulsivity piece can mean that we can act out without thinking about the future.
- [13:15]
D
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- [14:31]
B
Big hugs.
- [14:31]
D
And now let's get back to the show.
- [14:34]
C
I mean, we've talked or I've talked years, I'm sure you have as well about how, you know, suicide is really like a short term problem that you're giving a long term solution to. And that is like goes hand in hand with that impulsivity piece, especially with adhd.
- [14:48]
B
And so if you were to like compare that and contrast it to anxiety, I think sometimes when we are anxious we do respond with a degree of urgency. Right, but that again, I think what you're saying, and I hope I'm, you can correct me if I'm wrong, that urgency is again, the driver is to relieve the anxiety instead of to get that, that dopamine hit. So they might look similar. Right. The urgency to, you know, do something, you know, people with generalized anxiety are tend to be like busy bodies running around fixing things like, so it could from the naked eye observing it might look similarly.
- [15:26]
C
Yes, I think from people on the outside, again, because it's more of the internal driver, that's the difference. But for those of us on the outside, we wouldn't be able to tell the difference necessarily. Yeah, I think if we really knew what we were looking for, which most people wouldn't know, we could see, see whether it was anxiety driven or dopamine driven. But that's why even as a there, as therapists, we have, you know, we have to ask extra questions. Like it's not just, oh, I feel restless and oh, I can't focus. It's like, okay, well when you, when you struggle to focus, can you tell me if you know of a trigger? Does that mean something's going on in your life? No, I just never have been able to, you know, and kind of asking those follow ups to find out where this is coming from again, where it's driving the behavior right now.
- [16:05]
B
For the folks here listening who have ocd, they often quite. I have a lot of close clients with OCD who have questioned because they have intrusive thoughts that ping pong. Right. Like always, like flip flopping, what if this, what if that and so forth. But again, just for those folks, and I know I'm repeating myself, but I want to be really clear, like for those folks, the intrusive thoughts feel out of their control. They're intrusive and repetitive and usually not in line with their values.
- [16:33]
C
They're ego dystonic.
- [16:34]
B
Yeah.
- [16:35]
C
Super uncomfortable. You honestly, they usually hate them. I wish you could make them stop.
- [16:39]
B
Yes. And so that is the difference for those folks because I again, I've had clients say I think I have adhd. Like, my brain doesn't stop. I saw something online that ADHD is these racing thoughts. And so that must be maybe what I additionally have. So do you have any additional kind of differentiating points to discuss when it compares OCD to adhd?
- [17:01]
C
Yeah, and that's a great, it's a great point to make because there again, there's so much overlap. And I always, you know, OCD we put under the umbrella of anxiety. And I think the question I would have if like a patient was in my office talking about this, like, hey, my thoughts race and I can't stop thinking about this one thing. My question then would be like, okay, so when you do that thing, can you tell me what that would be? Right. Okay, I looked up this item, I checked the door again. Or I internally, if we're talking about intrusive thoughts, if it's like I have like the pure O piece of OCD where I obsess. Did you have to do something. Something. And then the feeling went away briefly, because for someone with adhd, that feeling doesn't really go away. It only goes away through hyperfocus, usually. I mean, everybody's a little bit different. Again, there's a lot of overlap between anxiety and, you know, adhd. However, my ADHD patients would say, like, oh, I didn't realize. I was just so focused on this. I didn't even realize that. That I wasn't seeking it out anymore.
- [17:57]
B
Yeah.
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C
But in person with OCD would say, yeah, I felt really good right after that. Felt good. Yeah. Yeah.
- [18:02]
B
And that urgency to do the thing to relieve that anxiety.
- [18:06]
C
Yeah. Or that uncertainty builds where adhd. I don't really feel like. I mean, maybe I just haven't heard it expressed that way to me, which leads me to believe that's not the case. I don't think adhd, like, builds and builds and builds and builds. It's just this constant state of seeking out something more enjoyable.
- [18:22]
B
Tell me a little bit about the sensory experience of someone with adhd. You know, back to the day when fidget spinners were really cool. But that was originally, like, developed, I think, for folks who needed that more sensory stimulation is that, you know, we always know the one guy or girl who sits up and clicks the pen or bounces the knee, which could be anxiety, but it also could be that need to fulfill that sensory experience. Can you share a little bit about that and where that, you know, what. Which camp that rising?
- [18:54]
C
Yeah. This can get a little bit more complicated because we have to introduce autism, which I. I do not specialize in, and can. I can speak to it, but, you know, very minimal level. There's, you know, the stemming behavior where you feel like you need to do something repetitive, repetitively to, like, soothe your nervous system. So, again, the way that I would approach that type of behavior is understanding why it's happening. So somebody with anxiety would often, like, if you ask, like, hey, you're clicking their pen. They'd be like, oh, I'm sorry. I was thinking about. They'd honestly probably take you on a little roadmap of, like, where their brain was going, oh, I was worried about. Blah. Oh, and you might even do a deep breath out because it's been so stressful. That's different. Autism. Someone with autism or ad, asd, Autism Spectrum Disorder would say something that, you know, they probably, first of all would be aware of it. Most people are, but maybe they're not. They would just. They'd be like, oh, I didn't realize. I was doing it. It just feels nice. If you ask them why, they would say it just feels good. Right. It's regulating. And someone with ADHD most likely is doing some of that behavior because they're being forced to do something they don't want. So, again, if I. Hyperactivity, like, one of my friends who has ADHD says it almost feels like he wants to rip his skin off. When he's, like, stuck in, like, a meeting for more than 30, 40 minutes, he's like, oh, my God. Can we just. It just feels. It's like it's uncomfortable.
- [20:14]
B
Yeah.
- [20:15]
C
And so, again, it's kind of the driver. And I don't want anybody to feel like, oh, if mine doesn't line up exactly as what Katie says. It's not this. Everyone's experience is different, but it just. Again, it comes from a different place. And so just ask yourself, is this something I'm doing to regulate because I, like the tag on my shirt is driving me crazy, Then we might want to be assessed for ASD or autism spectrum disorder. Sensory stuff can be very overwhelming. Do we feel the urge after a busy day to, like, go in a hidey hole and not talk to anybody and be in the dark? We might want to be assessed for that. If we feel so uncomfortable internally, like, we jump out of our skin. I can't be here anymore. We can't even focus. We can't. We're just. Thoughts are bound for adhd. Or is it. I am just so stressed out. I feel so overwhelmed. I have so much to do. I'm. I'm just like. The physical manifestation of the worry is coming out through, you know, jitters and fidgets. You know, then it's probably anxiety. And again, you know, I know there's overlap, and that's why we're having this conversation, but it's. It's about that driver going back to, like, what's. What's creating that behavior in you. If you can be curious about it and kind of tap in, because, again, I know it's very nuanced.
- [21:23]
B
Yes. Yes.
- [21:24]
C
Okay.
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B
Generally, where would somebody go to get a very clear diagnosis? Where would you send them?
- [21:32]
C
There are a ton of psychologists, so I know we use a lot of terms like therapist, counselor, social worker, a psychologist. Although therapists can do it. It's someone who's trained to offer these assessments. Yeah. So when you're looking online, usually, or ask your therapist or other mental health professional or even the doc, if you're seeing a doctor, they should be able to give you a referral we're looking for someone who does testing and assessment. That's essentially what it's called. And I mean in la, there were a ton of people I worked with at ucla, which is one of our big medical centers there, who offer testing and assessment for autism, ADHD and things like that. You're going to want to find someone who can do that. You can take the tests online yourself. But that's not the same. Right. When I tell you that's not the. It's just not at all the same. And you, you can ask your therapist, if you see a therapist, like, I'm an lmft, it doesn't matter what the letter letters are after our name. We're either trained or not trained to offer this testing.
- [22:23]
B
Yeah. And just to let people know I'm an lmft. And in our center we could assess all day for anxiety disorders. I feel so on like I could assess for any of the anxiety disorders, but I do not feel like I could assess for adhd well, to where I would serve clients. So we actually feel super confident assessing for anxiety conditions, but we refer out for adhd. So just to sort of give context to people listening, like, just because they can assess for one group of conditions doesn't mean that they can assess well for others.
- [22:55]
C
Just, you know, everybody has their specialty. Yes, right.
- [22:57]
B
Yes.
- [22:58]
C
Yeah.
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B
Yeah. Amazing. Okay, so let's talk about treatment. What specific treatments would someone engage in? We know with anxiety, everyone listens here. They know. We talk a lot about cognitive behavioral therapy and exposure and response prevention and, and different forms of cbt. What do folks with adhd, what's the best or gold standard treatment for those folks?
- [23:19]
C
I mean, the gold standard is really medication. We're talking, you know, like a Ritalin or a Vyvanse or something of the stimulant family. Now, I'm not a doctor, so you'd have to talk to your psychiatrist and see if medication is right for you. There are side effects you need to be concerned with. I have a friend who is a recovering addict, so he does not take Ritalin because he knows he could abuse it. That's something to consider my eating disorder patients. It messes with hunger, fullness. We don't like that. So there are reasons to be medicated and there are reasons not to talk with your treatment team to decide what's best for you. However, there are amazing therapeutic techniques to work with, not against your brain. So if again we go back to like the driver of adhd, this dopamine seeking behavior, what can we do to make life more enjoyable. What can we do to work with our brain? That might mean that we don't schedule meetings for an hour because we know we're only good for 30 minutes. Maybe we have, you know, an assistant or a study buddy. A beautiful technique, whether you're in school or in work is called, like, body doubling. And you can do it in person or you can do it over zoom. And it essentially means that somebody else will be with you working, too. Now, you don't have to be working on the same project. And you might be thinking, katie, why in the world would this help? Because it almost tricks our ADHD brain into looking around and being like, well, there's nothing else going on. They're working. I guess I'll work, too, if somebody else else is around and doing something more fun. We're not going to want to focus. We're not going to study. Are you out of your mind? So having someone that's doing the same thing we're doing is really great. Then there's also just managing breaks and putting in those breaks, things that we like doing. And I even do this myself, so anybody can use this, but it's setting up these little rewards for doing X, Y or Z. So, okay, I really need to get through this script for a video. If I can get halfway through by lunch, then I'll let myself go for a walk or I'll have a cookie, or I'll get to spend time with my dog. Whatever your thing is, you let yourself do it as you reach those little bits of reward. I also really encourage people with ADHD to exercise. And you would never hear me say this because I'm an eating disorder specialist. So exercise is a very tricky thing. But when I tell you if you can do 30 minutes of some kind of cardio, walking, running, taking a class, anything like that, do that. That's going to give you this almost like, I don't want to call it a high, but we'll call it a focus section. Like, you get this little period of focus for about two hours after you exercise. So put your most or your least desired projects or to dos right after your workout. So you work out and then you edit that email, that paper, you send in your, you know, I don't know, your receipts, and you do your invoicing. We do that then. And just setting up your data again to work with, not against. And I will say that, like, life doesn't always work out this way. But as much as you can, try not to fight your brain. So when Your brain is like pulling in a million directions. You're like, no, I have to focus. And you almost, you talk badly to yourself. You are trying to force your brain to do something it can't. And so you're going to be let down because you're not going to get done what you need to get done. It might be time to go for a walk around the block. It might be time to just let me just do a little hiit workout or let me do, you know, whatever. Try to notice when you're doing that and work with, not against.
- [26:32]
B
Yeah, I have a client who if they have to study in high school, they listen to a music that they, that is the like not a vibration.
- [26:42]
C
Ish.
- [26:43]
B
Like that is good for them. Like it's not like music, like a sing along music because that would distract them. They would be like dancing around to Hamilton or whatever. But, but more like a music that they've picked that keeps them sort of a little more focused so that they can, you know, there's sort of like that additional piece that helps them to be able to. Whereas if I had to listen to music while I studied, nothing would go in. Nothing. But for them, that doubling is like a beautiful recipe to keep moving forward with the thing that they don't really want to do. And they often will also say like, if I have like a little like a, like a bag of candy, like they've put let's say three or four candies out and so every 30 minutes they'll just like pop one as that's the reward that they're keeping track of almost. And that's been very beneficial for them. Whereas with anxiety we wouldn't say, you know, have a candy every 30 minutes to manage your anxiety.
- [27:38]
C
It would, it wouldn't actually help because it wouldn't. Because it's not dopamine. See.
- [27:41]
B
No, exactly. Yeah, so, so it's, it's, it's funny then I think that might be it too of like what works for ADHD sometimes, like exercise, medication, you know, maybe. What about meditation could help?
- [27:55]
C
I don't find it to be beneficial. I'm going to tell you that you'll probably look it up and people be like, yes, they say it works. In my experience with my friends and patients, I do not recommend it. No, another thing that's actually helped, it made me think of it when you're talking about the, the music because there are different Hertz. You can like listen to different like green music or green notes and stuff like that. And you can find one that works. But there's a certain chair that's on TikTok that is. My audience loves it. My ADHD folks say it's the best thing ever. You essentially, it's a seat and then there's a whole little extra piece of chair right below the seat, maybe like six inches. You can put your feet and sit cross legged if you want. You can spin around, you can push it with. It's almost like a fidget chair.
- [28:35]
B
Yeah. Yeah.
- [28:36]
C
And again, that helps them focus and they love it. And yeah, it's just, it's again, finding a way to work with your brain.
- [28:41]
B
Yeah.
- [28:42]
C
Like what feels good to you, what keeps you going.
- [28:44]
B
Yeah. I remember in the fifth grade my daughter, the teacher would have chair options for her kids. So you could have, you could pick your regular like steel framed LAUSD chair or you could sit on a ball. She had like these sort of smaller balls or she had a, what's called a wobble board if you want, if you needed. And if she was talking and she's like, if you need to stand or be on that, she's like, it's not to play, but if that helps you to concentrate, by all means use it. And for the kids, for the kids with adhd, it allowed them to stay engaged. Whereas again, we might offer that for folks with anxiety, but some people might find that actually makes their anxiety worse because they're already feeling overwhelmed with that overwhelm. So very, very helpful. One thing I will quickly mention and sorry, Katie, I will say also for folks who have hair pulling and skin picking, I will also mention, again, I'm not a doctor, but we always assess when someone has hair pulling and skin picking on ADHD meds because it sometimes can exacerbate those symptoms.
- [29:50]
C
So really. Because it's a stimulant.
- [29:52]
B
Because it's a stimulant so often that we now just. I'm just putting that as a side note for folks who are listening, if you have noticed your hair pulling and skin picking increase after an ADHD med, go speak to your doctor because it could be the medication that you would need to assess.
- [30:06]
C
And I also want to say, I said earlier, I think adults, in order to get diagnosed with adhd, you needed four symptoms. It's five. And children need sick.
- [30:14]
B
Okay.
- [30:14]
C
Of the hyperactivity and the attention.
- [30:17]
B
Great, thank you. We have some listener questions that I'd love to ask you if we have some time. So a listener said that their psychiatrist told them to, quote, unquote, get their anxiety under control before being screened for adhd. And then they would, you know, take a look at that. So how would you respond to that as a clinician?
- [30:37]
C
That's really frustrating. I swear, some. Sometimes we get feedback, you know, from doctors or psychiatrists that I'm like, well, clinically, how do we treat that as, you know, therapeutically? And I if the assessment, I don't agree. To each their own. And getting your anxiety, quote unquote, under control. What does, you know, what does.
- [30:57]
B
What does that mean?
- [30:58]
C
And then do we. Are we saying, like, we need medication to treat the anxiety? Again, going back to our earlier part of the conversation, we were talking about how much overlap there really is. I could understand that they're worried about a false positive, but from the people I've worked with, again, I don't test for adhd, but there are specific questions that are meant to stand out kind of as, like red flags that, hey, this isn't adhd, this is anxiety. And so there's specific questions that are going to be asked in your assessment that are going to tell them, oh, this is not this, this is that. And proper assessments always plan for that. We know of the likelihood of, you know, either having two things, like a dual diagnosis or, you know, just even the overlap of symptoms. And so my gut is like, let's get another opinion. Let's ask somebody else. Because one struggle shouldn't, like, make it so that you can't get assessed for something else.
- [31:47]
B
Agreed. Thank you. A lot of folks had questions about procrastination and how that shows up differently in ADHD compared to anxiety. Can you speak to whether how procrastination may look in these two conditions?
- [32:00]
C
Yeah, I mean, there's so many different things with adhd. Like, one of the most common is what's known as, like, revenge. Procrastination. Bedtime sounds like gobbledygook, like a word salad. But what it really means is that ADHD people in particular will put off going to bed because we can feel like that's the one time we get to do what we want to do, even if we've already been doing what we wanted to do somewhere. 5pm to midnight, we will stay up until 3 because of that. A searing thing. So we can put off sleep, which to other people would be like, but don't you look forward to sleep? That's not exciting. No, that doesn't drive dopamine. So we'll put it off. There's also this piece where we. I mean, procrastination shows up in so many ways in ADHD because It thinks certain things aren't enjoyable. So if we find ourselves like, oh, yeah, yeah, I'll do that, that thing. I'll fold laundry. That's usually one that gets put off. I'll do the dishes. We can find ourselves starting like seven of them. So it'll be like we half did a bunch of things. Like, there was the best representation I can share with you. I saw on TikTok just the other day where this woman was like, I decided today was the day. And she was trying all her things, she worked out and then she was going to do all these to do's. She had all of her to do. And she was just walking you through her house. And she was like. So I decided you do laundry. And she. You see this huge pile. And she's like, I have some in the laundry. I haven't started it yet because I went to look for the towels. I knew the towels need to be washed. And she goes towards the towel and she's like. And then I realized I need to fill up the soap dispenser. So it's not so much that you're consciously putting something off where someone like me who does not have ADHD would say, I don't want to do that. I'll do it tomorrow. Yeah, I'll do it later. I consciously decide someone with ADHD does not mean to put things off. It's essentially not enjoyable enough and they get distracted and they end up on something else. Like my husband, I believe, has some form of undiagnosed adhd, but I'm not his therapist. I. And he is very much that I was gonna do this and then I got into something else.
- [33:55]
B
Right? Yeah. And you hear that. Like, I was going to. I went to make cookies, but then I noticed the trash needed taking out. So I took the trash out and then I got outside and realized that the garbage is, you know, was overflowing. So I took care of that. And yes, I totally understand. Whereas with anxiety, you're not doing that because you don't want to feel the sensations of anxiety or have the. The feared consequence of whatever is happening.
- [34:18]
C
So, absolutely, it's like, we won't call and make that appointment. Not because we're. We forgot and went into something else. We didn't call and make that appointment because we don't like talking on the phone.
- [34:26]
B
Yeah, exactly. Exactly. Quite. The other big question that a lot of folks had is how it may show up differently, specifically ADHD with girls compared to boys. You did speak to this a little bit at the Beginning. But do you want to sort of help us to. To understand that a little bit more?
- [34:44]
C
Yes. Oftentimes women, girls in general, are diagnosed much later when it comes to things like ADHD and autism. Not to confuse the two at all, but just saying that the one thing that we're very good at doing as women is masking and, like, fitting in. And a lot of the ADHD symptoms, again, everybody's different, but women tend to not have the hyperactivity component as much as men, so it's more internal. So even if we feel hyperactive, it's internal. And so that can mean that we have dysregulation issues. We can feel very, very sensitive, essentially because we're doing everything in our ability to just hold it together. Yeah. It's almost like we're white knuckling life, like, squeezing so tight to try to keep it all together because we don't want to be a burden or we're supposed to be the ones that take care of others. There's a lot of societal norms that are placed on women that I believe, like, perpetuate this type of behavior. And because of the fact that we. We can also. A bizarre kind of side effect of this is because of our internal, like, dysregulation and all the things, and us just trying to hold it together, we can do fine in school. We. We can, like, out of sheer force. That's the best way I can describe it. Sheer, like, force of will. That's what my audience. That's like. They're just using every little last bit of energy. They can actually be high achievers in school and do funding. Um, and so they get overlooked and they never get tested. One of my best friends just got diagnosed, so I'm 41. She's 39. She just got diagnosed, like, last year or the year before. And I mean, I've known it forever, I would say. But she. School was tricky, but she was resourceful, so she's really good at making friends and getting her notes. Do you know what I mean? And. But the house. I mean, she's so messy. And like, always. Her phone is always running on, like, 2% battery, which you're someone like me. I'm like, oh, my God. You know, it's. It's just. There's certain things that I'm like, oh, sounds a little, you know. But yeah. Never got diagnosed because we. The things that we do aren't what we as a society have agreed is, quote, unquote, adhd, like behavior. Yeah.
- [36:44]
B
And I'm glad you we, we discussed that because I, from my experience, I've had clients, females who have been, whether they are or are not diagnosed with adhd and they'll say they come home from an event and they're completely wiped, completely wiped because they had to hold it together for the whole time and they had to manage their ping pong kind of thoughts. Whereas the folks with anxiety, they're saying, I'm completely wiped because I was managing anxiety, anxiety the whole time. Which I think is, again, looks exactly the same. But as you're saying, and I totally agree, the driver is completely, you know, different. What does treatment like? This is the last question. What does treatment look like for folks with both?
- [37:26]
C
I think to be truthful, it's about finding the right team. Yes. My best advice, because something about the, I guess one of the last things I want to say about ADHD as a whole is I actually don't like to think of it as a mental illness or even the mental health condition. Our brain is just different. Yes. It works differently. And we have to, I think unfortunately our school system and even our work, like the, the way that structures all across the world that are any kind of job, they work with like neurotypical brains. And so we have to find a way to work with, not against our brain. And that can be really tricky. But the reason I bring that up is because the best way to treat ADHD is obviously to work with your brain, potentially medication and anxiety is potentially medication as well. But I feel like the, there's going to be different tools that you're going to want to, to have in your back pocket. Things like, you know, ways to regulate if social anxiety is your biggest crux. You know, you're going to want to know how to bring yourself out of that panic or if you have panic disorder. We want to, you know, how do we let like maybe do full body shake to get some of that queued up energy out where that's not going to work with adhd. So I think it's understanding the symptoms that are most harmful or upsetting to you. For both, we don't even have to break them into two. It's like what symptoms are bugging you? That's, you know, that's the biggest piece when it comes to therapy is like, what is getting in your way.
- [38:45]
B
Yeah.
- [38:45]
C
And then we find the tools that work for us might be medication, it might be, you know, having the candies out or sitting in a different chair. And then it might also be if we have anxiety as well, it might mean that we, you know, do a full body shake. If we're going out into a big event where we know there's a lot of people, we set a little timer on our Apple watch, and it buzzes, and we're like, I'm just gonna go to the bathroom. I'll be right back. And we. We kind of shake it out. We. We reassess and we go back in. You know, it's having these different tools depending on how it affects you, but I want everybody out there to know that they both can be treated simultaneously. It's not one or the other. It's just, again, understanding how it affects you because not everybody's gonna have all these symptoms, and some people will have this and something else. It's. Yeah, working for yourself the best way you can.
- [39:29]
B
Agreed. Thank you. It's been so wonderful to have you on. Thank you so much. This has been so fun for me, actually. Really good for me to also just be thinking it through and, like, you know, going through as you're talking, listening and thinking about some clients and going, okay, like, I can see. I can see, like, pulling that apart. Tell us where people can hear more about you, find out about you and all that you're up to. I know you recently wrote a book.
- [39:52]
C
Yeah, My. My next book, why Do I Keep Doing this? Very Apropos is coming out December 9th. You can get it wherever you get your books. And there's audiobook as well. And then across social media, it's always just Kati Morton. That's K A T I M O R T O N. You know, TikTok, Instagram, YouTube, all good things like that. Yeah.
- [40:09]
B
Thank you so much. Like I said, it's a real honor to have you on. And I feel like this has been a very comprehensive look at something that I think social media confuses people too, right? Is there is so much misinformation or you hear one thing and you're like, that must be me. That must be me. So thank you so much for being on the show.
- [40:25]
C
Of course. Thank you so much for having me.
- [40:29]
A
Please note that this podcast or any other resources from CBTSchool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you.
- [40:42]
B
For supporting CBTSchool.com.
- [40:46]
C
Sam.