The Aspiring Psychologist Podcast - Could It Be ADHD? Understanding Adult Diagnosis & Coaching

Starting point is 00:00:00 Do you struggle to concentrate, to finish tasks, or feel like your brain is constantly jumping channels? It might not just be stress, it could be ADHD. More and more adults are learning that what they've been battling for years wasn't just laziness or lack of willpower, but undiagnosed ADHD. In this episode, I am joined by Dr. Cara Davey, a clinical psychologist who herself has ADHD, but also specializes in the assessment and coaching of people with ADHD. We unpack the signs, the diagnostic process, and what it's like to finally understand yourself.

Starting point is 00:00:36 I hope you find it super useful. Hi, welcome along to the Aspiring Psychologist podcast. I am Dr. Marianne, a qualified clinical psychologist. Now, unless you've been living under a rock, you cannot have failed to have noticed the rise in people talking about ADHD and neurodiversity. That's led lots of people to consider whether that might be something which could help them to understand themselves or someone that they care about or maybe even both. I thought it was time that I met with someone who's qualified and experienced to talk us through all of these considerations, you know, about what the diagnosis is, what the assessment is, what it means about ourselves. And so I am delighted

Starting point is 00:01:26 to welcome Dr. Kara to the podcast. Let's dive into our conversation and I'll catch you on the other side. If you do find the content helpful, please do subscribe, follow the show, like, comment, tell everybody. I will see you very soon. I just want to welcome along our guest for today, Dr. Kara Davie. For anyone who's a regular to the podcast, if you ever hear me talk about Dr. Cara, this is she. Hi, Cara. Hi, Mary Ann.

Starting point is 00:01:54 Lovely to see you. Thanks for inviting me on. So nice to have you here. And you know, you have so many interesting things I could have invited you on to talk about. And in fact, later in the year, we're to be talking about Baby Loss Awareness Week but today we're thinking about adult ADHD aren't we? Yes we are. Can you tell me why that's resonated with you if that's okay? Absolutely so, I specialize in ADHD. I was diagnosed myself as an adult about five

Starting point is 00:02:27 years ago now. And I suppose, so a little bit about my kind of journey, the reason that I will come on to talk about kind of baby loss and infertility later in the year, I had a difficult fertility journey, including kind of numerous losses and a stillbirth. And around that time also became a parent. So most of my infertility was kind of secondary infertility. And around that time, noticed repeatedly kind of struggling with executive functioning type tasks. So for anyone who doesn't know what I mean by executive functioning type tasks, things like remembering, you know, things like I was forgetting my keys often and just struggling with things that weren't so much

Starting point is 00:03:04 of a problem before. And I think as someone who's worked in trauma for a long time, initially my thought was, well, of course, like there's a lot going on in terms of the infertility and the grief and trauma. So I thought probably that's what's going on. But as I did trauma work to work that through and felt really much better emotionally, it was still struggling with, you know, kind of more ADHD type tasks and that kind of, yeah, forgetting things, etc. And started to look for what else is going on here. And after kind of lots of reading and research, kind of managed to put together the dots that actually it was ADHD, and that the kind of trauma and grief had kind of turned up the symptoms of ADHD. And that although they'd always been there, I'd managed to kind of compensate and find ways around that, but actually they were

Starting point is 00:03:49 becoming much more problematic. So that's my kind of personal interest in it. And then professionally I've gone on to kind of train to assess ADHD. I also provide specific therapy and ADHD coaching to support people after diagnosis. Okay, that's really interesting. And actually, what you're kind of saying is that maybe a change in someone's personal circumstances can affect their resilience, which actually means that they're less able to cope kind of with everything that's going on and therefore dropping more balls, like rubber ones as well as glass ones and like you know just not getting done the things that are actually quite important for your functioning. Is that kind of what you mean, Cara? Yeah, I mean I don't know if I would like the word resilience as such but I think

Starting point is 00:04:37 yes, essentially a lot of people who are diagnosed with ADHD as an adult have found ways to master cope, to function despite the kind of challenges they have. And there can be a change in circumstances that suddenly mean it exceeds your ability to juggle and cope. And suddenly the things that before you were managing to get by on it's like, oh, I've made a mistake there. Oh, I've made a mistake there. And it's like, why do I keep doing these things that I wouldn't have done before? And so I think it's to do with exceeding the capacity. There's only so long you can go on trying to function in a neurotypical way and do everything and compensate before the brain starts to say, oh, I'm not sure if this is getting a bit much. And I think personal circumstances, trauma, grief can certainly be ways that one can exceed that capacity

Starting point is 00:05:29 quite quickly and just generally parenting for lots of women too is another one that suddenly exceeds capacity. Yeah, I hear you on that one. Can you tell us how ADHD might look different in children compared to adults. Yeah, I mean, just to say around ADHD, firstly, it does vary for different people how it presents. So it's, you know, for some people, they might be diagnosed with what we call inattentive ADHD. So they're struggling with kind of attention and concentration, but actually, they don't show many signs of hyperactivity, where they're kind of struggling, the kind of classic thought of hyperactivity where they're kind of struggling,

Starting point is 00:06:05 the kind of classic thought of people struggling to sit still or kind of needing to move, like that's your more hyperactive and you can be combined, which is a combination of both. So firstly, when we think of children, I think the kind of old school before we knew more about how ADHD presents, we think of children who can't sit still in class or might be behaving in a way that some people might have labelled in the past as kind of naughty. So often that's how we think of it and often that's how it's kind of seen and picked up in children. By the time someone becomes an adult, if they were presenting in that way, that hyperactivity tends to be much more internalised. They've learnt ways to mask, to hide it, to...

Starting point is 00:06:41 If they've received, you know, the average is that someone will receive about 20,000 more kind of negative messages if someone is kind of has ADHD as a child, then an adult who doesn't have ADHD. So they are constantly told sit still, be quiet, don't do that, you're too much or too sensitive. You know, all of these comments that mean by the time someone becomes an adult, they've often refined, I need to behave in a way that makes me seem more kind of neurotypical. So it's harder sometimes when you're diagnosing an adult to be able to pick up on, okay, what's there and what's the coping strategy, whereas for children, often children act more in line with what they're experiencing and have done less of that masking. So yeah, but it will depend if someone is more inattentive or more hyperactive, what you're looking for. But yeah, as a result, normally when you're working with adults, you're seeing the fallout of what has that masking done for them? So what is the emotional impact? How has it affected their self-esteem?

Starting point is 00:07:40 How have they gone from perhaps over-functioning to try and mask those things to suddenly struggling to over-function? Yeah, people are trying to understand the impact that hiding their ADHD has had even if it wasn't consciously. Whereas as children there's less of that. If you can get it early on you're actually helping with the ADHD rather than the impact of it. Yeah, absolutely and I'm me think about my own school reports and they were always, Mary-Anne talks too much. Struggles to kind of do this and that.

Starting point is 00:08:13 But at the time, the setting wasn't the kind of the awareness really that girls could have ADHD or it wasn't quite so mainstream as it is now and how does that pan out for women? Are there differences in the way that kind of different genders would present with ADHD as an adult? I think what we know is that often women are more likely to be diagnosed with kind of inattentive ADHD, so less of that kind of hyperactivity. If they are hyperactive, it tends to be more internalised or it might show more as anxiety or kind of internal fidgeting under their desk or moving their feet where people can't see kind of. know now is that that presents differently and it's more likely that women present that way. But actually, I would say even to go further than that, I work with a lot of people

Starting point is 00:09:12 who are quite high functioning, who've not had diagnosis as children, but when they look back it kind of makes sense. And that's the same for men too. There are other reasons that somebody who's quite high functioning might have been missed. It's not just women who struggle with inattentive ADHD. There can be men too. There are lots of factors. But yes, typically with women, you see more of the inattentive type presentation. It's more internalized.

Starting point is 00:09:39 It might come out more in subtle things like friendship issues. You might see more of that kind of anxiety, as friendship issues, you might see more of that kind of anxiety as I say, as a result of that masking, they might be trying to overcompensate, be overly perfectionistic or yeah, that's more the kind of presentation you'll see in women but it's certainly not exclusive to women. And what we know with women is it's also much more affected by hormones, which is obviously something that's less of an issue for men, but in terms of the monthly cycle, in terms of pregnancy, postnatally, menopause, all of the times that women's hormones are fluctuating up and down, actually that affects ADHD symptoms in a way that is, you know, kind of less understood because a lot of the research is

Starting point is 00:10:21 still on men where that's not present. Thank you. And something called rejection sensitive dysphoria, RSD, is that more commonly expressed in women or does that seem to be kind of universal, do you know? I mean I've certainly worked with men who talk about RSD too. I think RSD is, yeah, for anyone who doesn't know this, finding rejection incredibly difficult and being very sensitive to that feeling of rejection. Some people argue it's part of emotional dysregulation, that people are likely to be more emotionally dysregulated. Often women express emotions more freely than men, and men have encouraged less to do so. So

Starting point is 00:11:05 you might see that women are more likely to talk about it or express that kind of RSD, but it's not solely women at all. Again, it depends on people's experiences. And with everything ADHD can be there, but it also interacts with someone's own history. So people with ADHD might struggle with friendships, so they might make friendships very easily, but they might struggle to maintain those friendships. It's kind of a novelty, you know, they meet someone, it's all exciting, and then they move on and find a new interest, and they find a new friendship, or it's harder to sustain it because people find it more annoying that they keep talking, or you know, whatever it might be, there are things that get in the way

Starting point is 00:11:43 annoying that they keep talking or you know whatever it might be there are things that get in the way of friendship issues and again it's more common but not always for women and girls to have friendship issues kind of especially in schooling you find that girls kind of often fall out more than boys do. Now if they've had lots of experiences of being rejected throughout schooling for those kind of things you're more likely to be sensitive to rejection. So there's a combination of people's life experiences as well as things that you might be prone to as a result of having kind of a neurodiverse brain. Thank you and you know I'm extra glad that we've been able to nurture and sustain our friendship since 2008 as well because it's just been a pleasure having you in my life. You know, personal, professional, I just value you, Cara. Can we think, you know,

Starting point is 00:12:31 when we're commonly screening for ADHD, sleep can be a big one, that basically you need to perhaps to have been problematic in the sleep criteria for that to be given the green stamp of approval in the past. Is that still given the same weight, do you know? So firstly, just to say I massively value your friendship too, before I move on to that question. Sleep is an interesting one. So sleep isn't a criteria on its own. When you're looking to diagnose ADHD, people might ask around sleep,

Starting point is 00:13:04 but it's not a kind of, it you're looking to diagnose ADHD, people might ask around sleep, but it's not a kind of, it doesn't have to be there. It's not an essential criteria for someone to have a diagnosis. Again, what we might see is people who are internalizing hyperactivity or kind of on the go a lot during the day or kind of holding in so busy that they're not really thinking about any worries or they've got quite a busy mind. As soon as they go quiet to go to bed at night, suddenly that's when their mind's kind of very busy and it might affect sleep. So we do see sleep issues in people with ADHD quite common. And yeah, that's where lots of people are kind of overthinking, but it's not an essential criteria. People don't have to have struggled with sleep. Sometimes you find people

Starting point is 00:13:43 are the opposite where they are so busy in the day and they're so active and they're using exercise and things to manage kind of hyperactivity type symptoms that they just crash out instantly and they're like, oh no, I have no issues at all. I would say I've seen quite a few people where there's an overlap between neurodiversity and sleep apnea as well, where people were actually struggling to get the right quality and sleep apnea as well, where people were actually struggling to get the right quality of sleep and kind of waking. And so yeah, there's some questions at the moment and kind of research around whether there's any link between that. But certainly if there are sleep apnea symptoms, that's likely to make ADHD symptoms worse and kind of exacerbate that. We know that poor sleep

Starting point is 00:14:20 doesn't help with ADHD symptoms. Very interesting. And I guess also, it really depends how people have been sleep trained or not in their younger years as to whether they are good sleepers or not, but what distress that has cost them to kind of get there. Yeah, just talking to you has made me think, oh, I really miss the sleep of my late 20s, my mid to late 20s, because my sleep patterns are certainly not like that anymore. And it's not for a lack of trying. Yeah, absolutely. It's so much harder.

Starting point is 00:14:57 Yeah, absolutely. Can we think then about what an adult ADHD assessment might look like? A great robust one, I guess. Let's give that as an example. Yeah, and I think it's worth, as you kind of mentioned, a kind of robust one. There are a range of different kind of qualities of ADHD assessment out there from people who are giving a diagnosis quite quickly, and, you know, kind of that might be cheaper as a result of that to people who are doing much more in-depth assessments. I think sometimes people can be attracted to the quick, cheaper assessment because people with ADHD have often researched things a lot

Starting point is 00:15:35 and go, I already know that I've got it, I just want the piece of paper or something official because it helps me to understand my life and to make sense of things. So sometimes people will be drawn to that. I think the downside of that is that sometimes these cheaper assessments are not being actually done by people who are approved to do an assessment. So they might not actually meet the nice guidelines kind of criteria. So sometimes people are being assessed. And as a result, if they wanted to access medication, for example, if

Starting point is 00:16:04 they've not been assessed by the right person, they can't but also they tend to be sometimes these shorter assessments can be a kind of the same report is used again and again and they're not personalised and I think a good assessment should not only use the kind of diagnostic interview you know that we that goes through the kind of questions and explores with someone the kind of looking at the different symptoms and examples of that. It should also speak to somebody within their ideally a parent, but if not somebody else that can speak to kind of how, what they notice and how they're presented as a child. But it should also look at the wider kind of factor, what else is playing a part in this? So as we've said, has there been trauma in their life?

Starting point is 00:16:46 Had there been other difficult life events as a child? Are there medical issues that might be playing a part or contributing? And there's a whole host. It should be a kind of real holistic assessment. And I think that's not just to answer the question of is ADHD there or not. It's to answer the next question of, okay, so if I have ADHD, what do I do about it and what would help me? And I think so many people come out of an assessment that's less robust and kind of less comprehensive and less holistic with, you know, kind of, you can try medication or you can try coaching or, and that's it. Whereas actually, there's no focus on, okay, for you, it looks like

Starting point is 00:17:26 this, this, this and this are contributing, you know, this might help if you want to help with that. Or there's no kind of putting together of a personalised kind of treatment plan of what would help that person because just because people have ADHD traits in common doesn't mean they will benefit from exactly the same treatments and recommendations. Yeah, I guess that they might almost like pick and mix choose different things at different times. So it might be, for example, that you actually don't want to try medication right now. But it might be something that you would consider in future or the other way around, you might be like, actually, I would really like to

Starting point is 00:18:00 experience perhaps what it is like to have less noise, to have less distractions, to have less distractions, to be able to perhaps get through a task without being distracted by other tasks or exciting or novel things to do. Just to experience, I think it was a really nice idea of kind of if you've got a fence and you need to look over the fence, you kind of need to think about what steps you need to get yourself to be the same height as somebody else, to be able to perform kind of the same way in the task. And actually, it's taking you all that much more effort to get the same performance as somebody else. You know, is that fair? Is that kind to yourself? Is that compassionate? And, you know, my experience of working with clients sometimes is that they're like, actually, oh, when I take medication, actually, I can

Starting point is 00:18:48 meet the targets that I would set for myself a whole heap easier, but it is a personal choice, isn't it? It's not like you're going to get an ADHD assessment and you must, must have medication. It's always a personal choice. Absolutely. Yeah, As you said, some people want to try it, some people don't want to try it, some people can't because of certain health things, like you might be heart conditions or things that exclude it. You know, it's a choice that someone might be drawn towards and they might, you know, kind of want to immediately or in the future. But

Starting point is 00:19:20 likewise, there are many other options too that that can help whether that be, you know, therapy, whether it be coaching, whether it be changes to lifestyle factors, whether it be kind of equipment and things, whether it's, you know, one of the things I really like doing with people in ADHD coaching is trying to find out what is the block for you, and it will vary. You could have five people who all come and say I'm struggling with procrastination and you might say okay what are the strategies to help with that but actually the reason that each person is struggling might be quite different. Yes they have ADHD but one is finding it you know the block is emotional, one the block is to do with trauma, one is the block is actually they've got

Starting point is 00:20:01 too much to do and they're completely overwhelmed. Or so there might be a whole host of different reasons one just needs to break the task down or change their environment or so there's a whole host of different reasons why someone might be struggling with the same thing. And I think that's really nice to look at with someone. You can Google all the strategies you like, you know, kind of online, but what is specifically the issue for you and how can we help you move through it, which I think is so much more personalized. And yeah, medication may be a part of that, but it might not need to be, it might just be someone understanding and walking you through that. For me, you know, I think you and I have discussed in the past that we think I probably do fulfill

Starting point is 00:20:41 criteria, but I've never actually got assessed yet for ADHD. For me, actually having structure really helps. So I you know, I find myself thinking back to when I was younger, and my mum would put all the washing on my bed that kind of come out of the airing cupboard or whatever. And it would then sometimes end up on the floor, it would kind of be shoved in cupboards, like there was no order to that. And actually what I needed was probably someone

Starting point is 00:21:11 to come in and sit with me and do it with me, or sit and kind of, actually now it's time to put your washing away. Could you put your washing away before you go to bed? You know, or actually I've just put your washing out, go and put that away. And then when we've done that, we can do this. bed, you know, or actually I've just put your washing out, go and put that away. And then when we've done that, we can do this.

Starting point is 00:21:31 Like, whereas if there's not like clear structures, someone might be listening to thinking, of course you need to put your washing away before you go to bed. But like if I've got into bed and I'm exhausted, I don't want to do that. I just want to put that on the floor. And yes, still now, I think thinking about to A levels, actually, I was doing really well until I got to A levels and without kind of the strong foundations and the accountability of GCSE teachers, for me, I had too much freedom and what I needed was someone to say actually you need to you need to read that book, Marianne, and then I want a summary because that would have really held me accountable in a way that

Starting point is 00:22:10 I just didn't seem to be able to do for myself to the extent where I got three Cs and a D at A level, but I do think that I was capable of far more. So still now, I have to hold myself quite accountable. I use Trello for that. I look at what the component parts of a task are and try not to let all of the tasks overwhelm me, but to kind of break it down into smaller bits and get those done and kind of give myself deadlines. Do you remember when we published a book in a month in September 2020. And actually, for many people, that would be like a book in a month. But for me and you, we were like, amazing, a fixed period of time where we'll get a product at the end. Let's go. Let's go. So yeah, still

Starting point is 00:22:54 now, I'll try to think, well, I want that done by that time. So what are my kind of backward steps that I need to do to make that possible? Yeah, absolutely. It's so important that accountability, but also the kind of, as you were talking, like when we did that kind of, I was going to say competition, it wasn't really a competition, but like, yes, let's both see if we can write a book in the month of September. Like for both of us, there's that kind of competitive novel, excitement kind of interest, like actually, if it's harder to get motivated to do a task, then great to have someone to do it with, but also to have that bit of kind of competitive element, that kind of, oh, at the end of it, you know, we're going to have a conversation, did you manage it? Or, you know, so it creates that kind of motivation that might not be there so much

Starting point is 00:23:37 kind of internally. And you're right around structure. And I think this is sometimes one of the differences we see in assessments between people who are more kind of fit more with that inattentive subtype and those who fit more with the kind of the hyperactivity element, the more kind of combined presentation, is that often people with that combined presentation, the hyperactivity as much as they know structure would help, they just cannot get it in place. Or if they do, it's in place momentarily, and then they've suddenly forgotten the system even existed, or they've kind of moved on. And they often really, really struggle with that. Whereas those with inattentive, and I would say that inattentive often, in my experience, overlaps with people who are also some of the time that inattentive is actually people who are autistic as well as ADHD, then often they have managed to find structure in an organization and they know that it's really helpful for keeping some of that ADHD disorganization or kind of chaos in check and therefore, you know, they're able to stick with that or if it is in with someone who's got autistic traits as well, sometimes the kind of

Starting point is 00:24:43 autism craves more of that structure, order, organisation, and that helps to really keep it in check, which is why often people don't present until maybe later or they present differently. So yes, order and organisation structure is really important for ADHD, but sometimes people can't get it no matter how much they try or no matter how much they use those systems. And again, that's why it's really helpful to look at what is the block for this person or why, or do they need another outlet for the hyperactivity or do they need external reminders? Do they need another person for accountability?

Starting point is 00:25:19 Like, what is getting in the way? Because that will be harder for some people to action than others. Yeah, absolutely. And I think also I didn't realise as a teenager, even as someone in my twenties, how physical exercise and activity would really help me to, I don't know, to optimally thrive. It always felt like a punishment exercise to me, like something that you made to do. And certainly when I was at school, I was made to do it in a pair of red massive briefs with white stripes down the side. So it was humiliating as well. Anyone that went to school in the 80s and 90s would be like, oh yeah, I remember those briefs. But it was never

Starting point is 00:26:02 something that I was choosing, that I was, you know, honouring my body and looking forward to doing. And I know we've had different experiences of exercise, because I think you were very active when you were younger. I just, I'd never had that, I think perhaps because I've got kind of maybe some dyspraxic tendencies as well. Marianne is not very good at this, she's not very good at that, she's not very good at that. You know, my mum didn't ever want to play tennis with me because I was rubbish and poor me. And I think it's only really probably 2020 really that I suddenly had more time at home and I started running and then I started strength training and it's

Starting point is 00:26:41 gone from there and that really, you know, I think, especially when I was grieving with my dad, God, exercise would have been so helpful to me, Kara. But it's only really when we begin to learn the way that our bodies and our minds work best that it, I don't know, it can kind of give you a different way of understanding yourself, I think. But again I think that's really important is that people with ADHD, you know neurodiversity, often people don't just have one type of neurodiversity like it's not uncommon for people with ADHD to have dyspraxic tendencies and if you have those experiences of being told you're rubbish or you're you know you have been in a school that makes you do every single type of exercise and

Starting point is 00:27:25 actually maybe you only enjoy one out of the ten you've been forced to do. A lot of people then come away feeling like, oh, I don't like exercise, it's aversive, it's related to more difficult experiences. But if you can find the motivation, ah, I may hate a lot of sport, but I really enjoy dance, or you can find the one thing that you do enjoy, then a lot of people, yeah, it's a really, really helpful outlet. And it's great for physical well-being. It's good for channeling hyperactivity. And sometimes I will do an ADHD assessment with someone and they'll say, oh, no, I didn't have any hyperactivity as a child. And they'll go to list every club that they did after school. And they're like, I was in the rugby club, I was in the football club, I was in the network club, you know, and they list

Starting point is 00:28:07 everything that they did. And I was like, it was being channeled elsewhere, like no wonder it didn't show in other ways, because it was, you know, kind of really being channeled. But yeah, it is really important to find the exercise that lights you up. And that's the same with ADHD generally, find something you're good at and you will find something you enjoy, and you will become good at it, like find your passion, and you will absolutely thrive in it. And you know, as you say, if you've got ADHD traits, you're so good at what you're doing, you found your zone of genius, you found the thing you love, and you you know, kind of throw yourself in it. And you know, we can see the results, you know, as a result of that that if you were in a job you didn't enjoy you probably wouldn't be you know kind of presenting and as productive and able to do things in the way that you are. Yeah I think if when I've been in jobs that I don't enjoy I create extracurricular responsibilities for myself so I don't have to do the job. So I think just before we met, I was working for Argos head office, and I really enjoyed my colleagues.

Starting point is 00:29:12 We had such a great time. It was a really nice team, but I was really quite bored of logging in at 9 a.m., logging out at 5 p.m., and taking customer service calls. And so I could log myself out of the system and not be accountable. I would take on Excel spreadsheet duties to look at team performance and stuff, because then my data would be completely skewed and it would be useless to anybody. But yeah, having something extra to keep myself busy

Starting point is 00:29:42 in quite a mundane job, really, really because it was I guess in terms of stimulation I needed more I needed more like I needed other stuff to be going on under the desk so that I could sit still in this really boring repetitive role I can still say it good afternoon store support Marianne speaking how can I help Like sometimes when I go to pick up the phone, that still wants to come out. It wasn't enough. I needed more. Yeah, absolutely. And again, that's not uncommon. The ADHD brain is often moving quickly. There's lots going through your mind and doing something mundane isn't enough. It will be looking for more than that. And so yeah, I mean, it's helpful that you were able to create ways to stay in that. But, you know, that's what you might see in the classroom

Starting point is 00:30:30 with the child who's always doodling or the, you know, the child who looks like they're not listening because they're, you know, kind of doodling, writing, drawing, whatever, they're distracted by something, actually, they're probably looking for more stimulation, because it's not enough and their brain is kind of craving more. So yeah that's not uncommon. And sometimes that is treated negatively as well, you know, always fiddling with pounds, always rocking on a chair, you know, never seems to be paying attention, you know, staring out the window looking at this, doing that. Whereas in actual fact they may still be able to tune into exactly what you're saying but they're

Starting point is 00:31:03 just, you know, doing other things as well so that they can, I don't know, show you respect. So they can pay attention, but they need more. I think when we're looking at schools, for example, and I'm not talking about children now, but what behaviors are exhibited when sitting still is expected? And I think it's just useful as a question for all of us to think about when I need to sit still, am I right with that? You know, do I need to do other things?

Starting point is 00:31:31 Do I need to sit like this or sit in constrained ways or, you know, rock or fiddle, a little thing that I fiddle with off the front of my diary here sometimes. Yeah, like just having a little look at what it takes for you to show up in the world. Absolutely. And I think that's the thing, you know, thinking about children, but also adults in the workplace, actually, the more someone is forced to do it, the neurotypical way or like trying to get someone to sit still, be quiet, do things in line with something that doesn't fit with them, the more you're going to see a child who struggles and often then a child might end up being labelled as naughty or difficult or someone in the workplace might be considered kind of difficult when

Starting point is 00:32:14 actually they're just trying to conform to standards that don't fit and don't work for them, rather than being able to adjust and think, ah, what does someone need? Children often in the classroom, it might be like, right, can they do a few laps of the playground because they need to burn off a bit of energy before they're able to then sit still and to be able to listen. So yeah, I think that's really important to think about accommodations if you want someone to be able to thrive rather than labelling them as, you know, kind of naughty or not doing what they're told, as if it's a kind of conscious choice. Absolutely, yes.

Starting point is 00:32:50 Can we think about what people's options might be if they did want to explore an ADHD diagnosis? I'm guessing most areas of the country will have some sort of NHS provision, is there a right to choose pathway and then of course private options as well. Yeah so if you are considering an ADHD assessment for you or for your child the first step if you want to go down a kind of NHS route would be to contact your GP surgery. Most GPs will ask you to fill in, there are different questionnaires depending on if it's an adult or child and different practices have a different one. So check with your GP, but they normally do like a screening questionnaire to look at, does it look like there are symptoms present?

Starting point is 00:33:31 And then you can be referred for a assessment in your kind of local NHS team. As long as they feel you kind of meet the criteria. In some areas of the country, the wait is about five years for that. It varies depending on where you are, but actually the waits for NHS assessments are quite big at the moment. Now we know more and more about how it presents and more and more adults are looking back and realising that they've always had it. So, yeah, they're quite long wait lists. There is a right to choose pathway, as you mentioned, and that's the same for children as well, which is you can choose a provider that's a private provider that is funded by the NHS. So there will be some private options.

Starting point is 00:34:18 So it's worth asking your GP surgery. They might say, okay, there's only a two-year wait list instead of a five-year on right to choose. Some areas it's quite fast, some areas it's not. It is a real postcode lottery. So you can go down the right to choose kind of option. Again, if you think a child might have autistic traits as well as ADHD, you might want to look carefully at the providers that they give you a choice of, because some will do both and some won't. So you might find that you pick a provider and actually they

Starting point is 00:34:40 don't have a full understanding of, say, autism and that affects how they feel about the assessments, that's something to look at. And then some people will say actually the wait is too long, my child needs to have an assessment before that. For example, I think you need to try and remember, I think it's two years before someone's GCSEs they have to have a diagnosis in place to have any accommodations in their GCSE exams. So for some people they might notice tendencies in their child, the child might be struggling and the wait list means that they would then not get accommodations in exams like extra time or someone reading out the questions or things that would support them. So they might say I don't want

Starting point is 00:35:17 to wait that long or I can't wait that long, it's impact in well-being and they might choose to go privately instead or they might feel more confident in a private diagnosis being more holistic and so yes some people might choose then to go private and again you've got bigger companies that might do shorter and lower cost assessments and then you've got more kind of individuals that specialize in it that might do a more in-depth and kind of personalised assessment. It is worth thinking if people are wondering about medication, if you go for right to choose or private, sometimes that will be accepted by your GP. Sometimes it won't.

Starting point is 00:35:54 Even if your GP says go with this provider from right to choose, they might then say we're not accepting shared care to pay for medication. But other GPs will take it. It's not an absolute no. So it is worth speaking. every GP has their own rules, they can make up their own rules of whether they accept shared care or not. So it literally varies. And sometimes people might have a diagnosis, their GP says, No, I won't accept shared care. And they ring up the other GP in their area 10 minutes down

Starting point is 00:36:21 the road, and they say, Oh, we do. And so they just swap GP surgeries. So sometimes it's as simple as, you know, kind of exploring in the area. But yeah, in terms of medication privately, you might be able to access a prescriber through the kind of so when we do assessments, we're on a prescriber pathway, which means our reports, any reports done within the practice are accepted to be of a quality standard and a prescriber will look and be able to prescribe medication. If you get medication privately again you might be able to then stabilise on a dose and go back to your GP and say will you take over shared care. There are lots of options, it is a

Starting point is 00:36:56 bit confusing. Children's assessments tend to be better done face-to-face so I would recommend getting someone local who does it face to face rather than online for children's assessments, for adults assessments, it's okay to do online as long as they meet the other kind of guidelines. Thank you, that's really interesting, really helpful for people to kind of take on board and consider their options. I know, you know, it's probably quite a big question with perhaps quite a lot of range, but if someone's looking into, for example, a private ADHD assessment for an adult, is there some of a price range for that that people might be able to expect?

Starting point is 00:37:39 I mean, yeah, but it does depend. It depends on how someone prices it. So there is quite a range sometimes in how long an assessment will take. If you go in depth with someone, if someone has had a lot of difficult life experiences or it's more complex, it's gonna be a longer assessment. So some people will price an ADHD assessment as a kind of a one-off fee.

Starting point is 00:38:01 They might say, okay, it's a thousand pound or it's 1500 pounds or you know, kind of, you might get a one-off kind of bulk price. Other people might say it depends on the length of the assessment. So within our practice, we do it by an hourly rate because that means that for some people, otherwise they will be paying a high fee and they're not requiring that amount of time. It feels really unfair for them. So it's actually done much more on how long does this actually take and we're kind of charging you a fair rate based on that. So therefore it could fluctuate. But yeah, approximately, I think some of the bigger companies that were doing a

Starting point is 00:38:36 faster assessment and they might not be a psychologist or psychiatrist, they might be a kind of someone who's just doing assessments. I think you can get them probably from about 500. For most people who are going to a psychologist or a psychiatrist, you would be expecting 1000, 1500 more kind of rate and sometimes higher than that. Again, higher if you're doing a combined assessment. So if someone is assessing for autism too, it's going to take longer. And an autism assessment must be done with two, an MDT, some multidisciplinary routine. There must be two professionals doing that, which means obviously there's a higher cost to do that. But yes, that's a kind of ballpark figure.

Starting point is 00:39:17 And, you know, I wouldn't be hosting the Aspiring Psychologist podcast if I wasn't advocating for qualified, regulated, fully kind of professional, indemnified, experienced clinicians. And so I do think there's so much to gain by going for what seems like a slightly higher price, but you're getting that experience and you're getting that ability to kind of look across the lifespan, holistically drawing in all those different possible hypotheses and situations and clinical or non-clinical presentations. So just to advocate for the qualified regulated providers such as yourself, Kara. Yeah, and I think it's really important that somebody also, you know, part of an ADHD assessment is also being able to kind of

Starting point is 00:40:06 something called differential diagnosis, like look at, does this best fit with an anxiety presentation? Does it best fit with bipolar presentation? Does it best fit with ADHD? Or like what else could this be and what are the other possible explanations? And the problem with some people who aren't qualified and don't have that experience in other areas

Starting point is 00:40:23 is also that sometimes they then go, I think this is ADHD, I think this is anxiety, for example. And what we have a lot is that people come to us saying, we've been dismissed by another practice because they didn't really listen or they didn't really know how ADHD presents in people who are kind of higher functioning or in that kind of more female presentation or that more inattentive. So people have been completely dismissed and at the end of it, they're like, well, someone saw me for half an hour and they said no, but they didn't even ask the questions. Or so you might have spent £500 to be told no when actually it hasn't even been fully explored to really understand what's going on. There have been occasions I've done an assessment on like, oh, this doesn't feel quite so kind of in line with what I expect with ADHD.

Starting point is 00:41:06 And then I hear more and more of kind of autistic type traits coming along. And I'm like, that has that has mastered that also. But as a psychologist, you're formulating and you're like, does this make sense when I've got all of the information? Someone who doesn't get all of the information, hasn't got the experience in formulating that I might miss it. And people can then end up feeling really, you know, kind of if they're sure they have ADHD and they're told no when they do, actually that can be a really unhelpful experience and you know, costly to then have to pay twice. Yeah, absolutely. We don't want people to be in a position where they're having to pay twice to get the service that they need and deserve. Cara, are there any common misconceptions about ADHD and adults?

Starting point is 00:41:49 Well, I guess you've got the whole kind of, at the moment, lots of people are saying everyone has ADHD or is it being overdiagnosed? Or so I think there's something around people feeling that it's kind of friendly or it's a way to kind of access extra support. Or so I think there's some misconceptions from some people that it's a desirable thing to kind of have all, you know, that people are looking for it because of the kind of things they might get as a kind of support with it. I mean, I think

Starting point is 00:42:19 that's, I think most people you speak to with ADHD would say that even if there are massive strengths associated with it, which there are for some people, being able to hyper focus, being able to lean into your passion like it has great strengths, but at the same time, I think most people would say the reason that they're seeking an assessment is because it's had an impact, whether that is on their functioning, whether it's on their self-esteem, whether it's how they viewed themselves, whether it's the comments made by others or so. I think this idea that people would want to do it or it's desirable I think is a massive misconception. Most people are finding it hard and you know finding that

Starting point is 00:42:54 difficult so those kind of comments are really tough. I think one of the things I notice around kind of medication is for people who are quite perfectionistic in you know doing whirling kinding roles that they're in, even if they're under the surface feeling this imposter syndrome. A lot of people think that medication will almost take away the symptoms. And I think a lot of people don't have so much of an understanding of the medication might help initially with increasing productivity and all of those things. But actually, it can also lead someone to be more likely to burn out in that if they are already

Starting point is 00:43:31 pretty productive and they lean into being more and more productive, people can be overly productive. And actually, they can struggle as a result of well-being. So I think sometimes as well, when you're kind of there's a misconception around medication is the way to go, well, this I need to do I need to be more productive when actually for someone they might not need to be more productive they might need to be focusing more on well being and how do I conserve kind of energy levels or motivation or. Yeah, and I don't think people always talk about the downside of if you become too productive. Now is there a point at which there's a ceiling to that and there might be an impact? Yeah, absolutely. Very good considerations. I think people also worry that if they were

Starting point is 00:44:13 to take medication that it would change them, that they'd be a different person. What do you think about that, Cara? Yeah, I've heard that a lot. People who who say I don't want to try medication because what if it changes me as a person or I mean I haven't spoken to someone who's tried medication who actually says that, who says I feel different. Some people will say that for a lot of people medication improves kind of emotional dysregulation like the kind of emotions being up and down but actually for some people it's the opposite. Some people find that they feel more dysregulated with it. But I don't think, I haven't spoken to anyone who says I feel different as a person.

Starting point is 00:44:54 I don't feel like me or I, yeah, I feel so quick to kind of respond to other people now that, you know, that's a lot of people either find medication helpful or they say it wasn't nearly as helpful as I thought or there's the risk as I say of burnout of you know kind of overdoing it but I haven't I haven't really spoken to anybody who's tried medication and said no I don't feel like me anymore and I need to come off it so I think you're right that is a misconception really. That's really good to know. Thank you so much for your time today.

Starting point is 00:45:27 Could you tell us where the best place for people to learn more about you and your work might be? Yeah, so I have a couple of different websites, but I will link in the, I'll send across to you to link in the notes, just my link tree, which takes people to the website, to free resources. I have a free Facebook group where I share kind of top tips. So everything is on the link tree. So I'll share that with you.

Starting point is 00:45:52 It is in the name of Dr. Davie ADHD coaching. But yes, feel free to kind of reach out if we can help you further. Amazing. Thank you so much for your time and sharing your absolute nuggets of wisdom with our audience. You are very welcome. Thank you for inviting me. You're welcome. See you soon. Bye. Bye.

Starting point is 00:46:13 Oh, thank you so much for watching and thank you again to my guest, the lovely Dr. Carla Davy. I hope you found it helpful. If you have, I would love it if you would rate and review the show, follow the show, like, subscribe, comment, share the content with people who you think it might also help. That really is the kindest thing you can do for any creator that you rate. Please do go and follow Kara on her socials or check out her link tree as she mentioned. The books we mentioned in that challenge were my first book, The Grief Collective, Stories of Life, Loss and Learning to Heal,

Starting point is 00:46:51 and Kara's book, There's a Rainbow Baby in My Mummy's Tummy, is a resource to help young children who've experienced the stillborn or late miscarriage loss of a sibling, and then there's a new pregnancy around and it's to help children understand what has happened and hopefully to feel more confident and hopeful for a happier outcome in future.

Starting point is 00:47:15 It's a lovely book and it gets great reviews. So please do check out that book and The Grief Collective in the description or show notes, if you think either or both of those might be helpful to you or someone you are working with. It's the aspiring psychologist Poshkets With Dr. Mary Endrit

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The Aspiring Psychologist Podcast - Could It Be ADHD? Understanding Adult Diagnosis & Coaching

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