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Addiction, anxiety, mental health.

How do we address our traumas?

And how do we begin to move forward?

The path to healing and understanding is through candid conversation.

I'm Aisha Sultan, and this is Things We Don't Talk About.

Imagine a teacher who knows exactly what it feels like to sit in a classroom and struggle to focus, to have a mind that won't slow down no matter how hard you try, not because she studied it in a textbook, but because she lives with it herself.

Today, we will hear from educators who have ADHD and who have turned that experience into a gift for the students who share their diagnosis.

They've found ways to reach the kids that others have struggled to teach because they know firsthand what those kids are going through.

We'll also talk to a researcher at Washington University who's made new discoveries that are changing how we understand what ADHD medication actually does to the brain.

This research is opening up new ways to think about the condition entirely.

Right now we're joined by Nicole Ashraf, who will tell us a little bit about her journey and how it's changed the way she teaches.

Hi, Nicole.

Hey, how are you?

Good.

And so tell me about how you figured out that something was going on and how you got diagnosed.

Well, when I started teaching, colleagues would make comments about how I was like a ping pong ball.

I could never stay on one task.

I was always doing 10 things at once and never fully finishing what I started.

I couldn't hold a steady conversation.

I would get a thought in my head and then all of a sudden be talking about something completely different.

So they had brought up the fact that they thought that I had ADHD.

Wow, your colleagues mentioned this to you.

Yes.

And so then did that prompt you to think, okay, let me get tested?

- Yes.

So I went back to school back in August for my master's degree.

And I was starting to panic because am I gonna be able to do all the work?

Am I gonna be able to handle the caseload when I can't focus on things like in my normal job?

And I went initially just to see if my colleagues were right.

And also try to get on some medication that might help me be able to like complete tasks and things that I started.

- And so then what did you feel like when you heard that yes, you actually do have ADHD?

- It wasn't a surprise at all.

It's kind of, it's a part of me.

It's who I am.

I'm different and being different is okay.

- And then how did that change the way you think about your classroom because you were just diagnosed in August?

- I think it changed the way that I looked at students with ADHD, like I'm thinking about one of my little kiddos that I have now.

I was the teacher because of my inability to stay focused.

I did like the quiet classroom and like not giving kids as much freedom, more of an authoritarian opposed to someone who is more free.

- Like keep it strict, keep it under control.

- Exactly.

- To keep your mind on focus and on task.

- Exactly, so this year I kind of restructured how I do things and it has like, my students with ADHD have been thriving because of it.

So they're free to sit where they want, like in the middle of a lesson, if they're rolling on the floor, I don't care as long as they're doing what they're supposed to be doing.

And I think that teachers look at kids with ADHD as, oh my gosh, there's such a disruption, like no one else is able to learn because of what's going on with them, when that's not the case at all.

They're actually some of your brightest, smartest kids.

And I really came to see that more now that I realize that I have it myself.

- Well, and so tell me about concrete changes that you made and how you run your class and how you set up your class.

- Yes, so I am very flexible with what my students need.

Like if we're doing a read-aloud on the carpet and my kiddo needs to get up and move, they don't even have to ask.

They can just get up and go to the back of the classroom.

- Right.

- If they need to go take a walk in the hallway and get a drink for a quick break, they don't have to ask.

They just go and do it as long as they sign up.

- Oh, that's so different than most elementary school classrooms.

- Yes, it's very different.

I get some pushback and interesting comments from other teachers in the building.

- I'm sure you do, because then they're like, "Well, our kids, we don't allow our students to do that, "and now you're creating confusion, "or you have a different standard in your classroom."

- Yeah, there's like this sense that they don't learn in my room because it's not quiet, and everybody's not sitting conformed at a desk, when that's not the case at all.

I have some of the highest test scores.

So just being flexible, like, and that's hard being someone with ADHD, 'cause I'm very rigid.

I have to stick to my own routines.

- Right.

- But being able to open up and like allow kids to really get what they need has been so beneficial.

- So how have you managed that for yourself?

Like allowing additional flexibility in seating, in movement, in even, it sounds like some of the activities and curriculum, like the way that, not the curriculum, but like the way students are assessed or show what they've learned.

How do you manage that while keeping yourself on task and not feeling overwhelmed by all this?

- That is the hard part.

Definitely I have had to learn to have like very strict expectations like with the flexible seating for example like you can sit and you can work with your friends but if you get off tasking you lose those privileges and so when things get too rowdy or like too noisy or too distracting then I do kind of sometimes have to reel it back in right but over the course of the school year the kids have learned those boundaries so now they're more respectful of those expectations so that I can get what I need to get done in small group and they can also still get the movement and the things that they need in order to be successful as students.

What do you wish other teachers knew that don't have ADHD but have to teach students who do?

I wish that they knew everything that's going on inside of our head at one time.

Like say a little bit more about that.

Okay can I give you like a simile?

Yes.

Have you ever been to a Cardinals game?

Yes.

Okay imagine being in a Cardinals game and you go to watch the game right that's the purpose but you have the announcer coming on every two minutes announcing people, there's songs playing, the organist is playing, you got the girl in front of you that's taking a selfie, you got the guy behind you that's shouting out things at the visiting team, you're there to focus on the game, but you're also paying attention to everything else that's going around you at the same time, the smells, the sounds, the feels, right?

And then I'm listening to the guy behind me razzing up the visiting team and I miss the game-winning base hit.

So like, that's kind of what it's like being a student, is they're there to learn and they want to succeed, but there's so many other things going on around them, like the pencils tapping, someone walks by in the hallway, someone drops a piece of paper on the floor, they're focusing on all that along with what they're supposed to be doing, so they might miss those key parts and need a little bit of repetition.

What is a way for a teacher to offer that or notice that when you have so many other students to manage?

It's a great question.

I do a lot of check ins.

Okay, so I'm very active and up and moving around the room.

And I make myself open to those questions, the kids feel comfortable coming to me, almost too much because then I get swarmed by kids.

So building that relationship is definitely key so that they feel comfortable coming up and asking questions if maybe they weren't listening or maybe they were having trouble paying attention.

And also just checking in, giving them those small tasks instead of saying, okay, I want you to write a whole draft of an argumentative essay.

We're just going to focus on our thesis statement right now.

Timers are very, very helpful.

So when you're breaking things into small tasks, like set a timer for 10 minutes, you have 10 minutes to complete this task.

Having those visuals really helps.

It helps me to stay on track and it also helps my students stay on track.

So just incorporating some of those things into your classroom are helpful.

- Well, it sounds like it wasn't just the empathy that changed, but it was really a mind shift in how you imagine what was possible in your classroom.

And then those changes that you made didn't just help those particular students, but it helped all the students in your class.

- Yes.

One thing that I would love for more educators to understand is making those accommodations for other students, being flexible, allowing them that movement time, setting those timers.

So just don't benefit kiddos with ADHD.

It benefits all of your students, everyone in the room, and it helps things run like a well-oiled machine.

Thank you.

Thank you.

♪♪ Welcome back.

Now we're gonna hear from Maggie Klonsky, a former middle school teacher who also works in Gifted Education Now.

Hi, Maggie.

Hi, thank you so much for having me.

Of course.

So tell me a little bit about how you found out that you have ADHD.

Sure.

It was actually just a few years ago.

I started to realize how overwhelmed I was getting with trying to manage so many disparate parts of life.

So being a mom, being a teacher, and just an individual and feeling like all of those tasks were just so overwhelming with time management, and started to kind of look into some of those symptoms and sought evaluation.

- And so once you heard that you did have ADHD, what was your reaction?

- I think my initial reaction was feeling like I probably tricked the test.

Like I was really kind of in denial at first.

I kept thinking, oh, I fooled them, you know, and I was really in that place of denial.

And over the last four years, I've been in all the different stages of acceptance and anger and sadness.

And I still feel like I'm unpacking that diagnosis a few years later, but I am getting closer.

I feel like I'm deeply rooted in acceptance now.

And if anything, it feels like how did I not know sooner?

- That's a great point.

You know, a lot of people who get diagnosed later as adults, they look back and they process all those things that happened to them later.

They look at it a little differently.

How did it make you approach teaching differently?

- Yeah, it's been really eye-opening for me to go back into the classroom with the diagnosis.

It gives me definitely more empathy for my students that also have ADHD, but I also notice things that I'm aware of as a teacher.

Because of my ADHD, I notice how draining certain things can be, how overstimulating, and I notice how when students who interrupt and yell things out, how much that throws off my own thought that I'm trying to complete in my head.

- And so how do you manage that in the classroom?

Are you more strict about interruptions or do you help guide people back to the conversation if somebody interrupts?

How do you handle that?

- Yeah, I think that's one that I'm still working on for sure around just the interruptions.

But I think what really helps the most is being really transparent about my experience and my diagnosis with my students because then it helps situate all of those other conversations about particular things that come up.

So I try to be really upfront about, hey, this is my situation.

I have ADHD.

This is how it shows up for me.

And I like to be like, I like to really lean into the positive aspects of it and the superpowers that it gives me.

So for me, I feel like that's, it gives me a lot of creativity, problem solving, deep empathy, ability to make connections.

And at the same time, there are some other things because I'm so good at paying attention to so many things at once.

It can be draining.

My attention can get pulled.

You know, I can get overstimulated.

So then when those things crop up in the classroom, I can say, hold on just a second.

I really want to focus on what you're saying, but right now I'm listening to all these different things, you know, and that gives me an opportunity to kind of, you know, make sure that I adjust the rest of the classroom environment so that, and they're aware.

- Of like why you said that.

That is so interesting.

And kids notice so much more.

And they also notice when we speak to them on a level in which we expect them to respect us and we respect them.

And I think that changes the relationship.

- It does.

And I think a lot of them are kind of surprised when I first mentioned it, 'cause I don't think that has happened that often for them.

Maybe that it's been that someone has kind of vulnerably shared that in a position of authority.

And when they hear that, it really helps take some shame away from some of their own diagnoses.

And inevitably, kids will always yell out.

There'll be a few of them that say, "Me too, me too."

And it helps us move more into a strengths-based embracing of our identities and our differences.

Our brains are so different.

Isn't that cool?

As opposed to the stigma around diagnosis.

- You know, that's a really interesting point.

What narratives or stories have children with ADHD, by the time they get to middle school, heard about themselves or they falsely believe about themselves?

- Yeah, I see it a lot at those older ages where particularly if they haven't received a diagnosis yet is an even more difficult aspect, I think, because they've built this narrative about them that the reason that they always turn in things late or the reason they're forgetful or the reason, you know, various other aspects are because there's something wrong with them.

Right.

Or they're lazy or they're stupid.

And so those stories get very ingrained.

And the older you get, the harder it is to to tease those stories apart.

And so the earlier.

Right.

And so from hearing from a teacher that, listen, I have this, too.

And these are actually strengths that come with it, I think, is a way for a child or a young person to think about their own strengths in a different way.

What's a way that you as an educator can help a student lean into their strengths that they might not even recognize that they have?

- Sure, these have actually been some of my favorite opportunities with students is to lean into the ways that their ADHD can often give them a really great ability to hyper-focus on something.

So we often think of ADHD as being constantly distracted or it gets a bad rap, but it means that attention regulation is difficult.

And so if they have something that's of high interest, they can really focus in on that topic.

So I try to stay open and flexible.

If a student comes to me with an idea for how to alter an assignment, maybe they wanna take it in a different direction or expand upon it, I really lean into what am I trying to accomplish with this assignment?

What are we trying to assess?

And can I still do it with what they're suggesting?

And could it possibly be even better with what they're suggesting?

Because oftentimes that's the case, and that helps them build competence and confidence at the same time by really leaning into something they're deeply interested in and going deeper.

- Is that a change in the way that you allow students to work that you've made since your diagnosis?

- I honestly am not sure that it is.

I think I've probably strengthened the ability to do that, but I do think that's probably possibly even related to my ADHD and being very interested in different new ways of doing things.

Because I think differently and do things differently.

I think I have always had an openness, but I didn't necessarily know why I had that openness.

But when a kid would say to me, "Hey, I want to do it this way," I'm like, "Well, I mean, that actually sounds really good.

I don't see a reason why not to do it."

Yeah.

And is that possible?

Always no, but the times that it is are huge opportunities for relationship building and really teaching that student to honor themselves and to trust their own intuition and interest and where their attention is being drawn.

And what do you wish parents knew of kids who have ADHD?

If you could just quickly summarize a few things for us.

Sure.

I really want to encourage parents to not wait for things to all fall apart before seeking answers.

So particularly when you have kids with high abilities that can often mask ADHD and many other things, situations as well.

And so while a child might seem like they're doing really well on the surface, that I was your classic example of that I was people pleaser working really hard, all the good grades and all these mad coping coping mechanisms and all these exhausting things going on underneath until it didn't work anymore.

But a kid might be working twice as hard as their peers just to stay afloat.

And the toll that can take over years is really significant.

And then the ways that we talked about earlier that that can impact negative self concept are really important.

And so as a parent, if you're feeling like things are off, you know, trust that that intuition and don't be afraid to seek some answers there.

You don't have to wait for it to fall apart first.

It's just as simple.

Thank you so much for coming on and sharing that insight with us.

We're back with Dr.

Benjamin Kay, a child neurologist at Washington University School of Medicine, who is going to explain some new research that's come out on ADHD medication.

Hi, Dr.

Kay.

So tell me a little bit about this research that you've been involved in and what it's showing about how medication works on kids' brains.

Of course.

So I do research.

I'm also a practicing child neurologist.

So I've been prescribing medicine for ADHD and therapy for ADHD for over 10 years.

And I was always taught in medical school that this is a disorder that affects children's attention and that these medicines work by enhancing the parts of the brain that help you regulate your attention.

To give you an analogy, kind of the opposite of a way that alcohol would inhibit those regions, make you a little more loquacious, that ADHD medicines would sort of boost those regions up.

And that's how they help children focus.

So I had believed that for a really long time.

This research opportunity came along to look at this very large cohort of children, 10,000 children getting brain scans.

And I thought, wow, what an amazing opportunity.

I bet some of them are taking medicine for ADHD and we can try to understand better how that medicine is working.

I was really, really surprised when I first looked at the data, when we first analyzed it, I didn't see actually any changes in the parts of the brain that are associated with attention.

So I was like, would you have expected to see that light up or?

Oh yeah, absolutely.

And there had been prior studies that had talked about, yeah, we think, I don't want to get into too technical names.

I think the dorsal attention network, frontal parietal network, that these are regions of the brain that are well known to help you regulate and direct your attention.

- So if those weren't lighting up, then what was?

- They weren't lighting up at all, so I thought I had made a mistake, but eventually we looked at it very closely and we saw that a set of regions in the brain that help your body move, but also reflect your level of arousal, that those were lighting up.

And then we also saw that there's a part of your brain that sort of interprets how rewarding something would be that would light up.

And I can talk a little bit more about that if you would like, 'cause when people hear reward, sometimes they think like, you know, like abusing a drug, but we, in research, we use the word salience.

So if you would imagine, if I look at this mug on your set, it's not very, I mean, it's not very interesting, it's not gonna do anything.

If a dog wandered onto the set, I'd be like, wow, is that dog soft if I were to pet it?

You know, would it feel good?

Will it give me kisses?

Is the dog gonna bite me?

And so my brain is automatically drawn to that object because it has a high salience to it.

And we saw the medicines lighting up that region of the brain.

- Okay, so what did that mean to you, that it's lighting up a different region of the brain that's more connected to salience?

Or is that another way of saying maybe your interest level in something?

- Exactly, yeah.

And so sort of to give you another analogy, if you have baldness, eating hair will not necessarily make you not bald, right?

And this idea that ADHD might be one set of, you know, differences in the brain, but that the medicine could actually be working a different way to help people with those brain differences function more normally in the rest of society.

And maybe in this case, by taking things that might seem mundane, that might seem unpleasant to do, like maybe doing your taxes, for some-- - Doing your homework.

- Doing your homework right and make that seem more interesting to your brain, like, yeah, well, I really wonder what would happen if I did this homework and what would I get out of this assignment?

And then simultaneously making the brain more awake and aroused, like, yeah, I have the energy and the focus to go and deal with this problem right now.

- Okay, so then what does that research mean for the way we think about ADHD?

- I think one thing that it made me think about is just the term ADHD itself stands for attention deficit hyperactivity disorder.

But both through this research and just through my clinical experience, it's a little bit of a misnomer.

We know that some children and adults with ADHD are not actually hyperactive, right?

And so especially women, like one of your guests, Maggie, because they're not disrupting the classroom, they may not be diagnosed until much later in life because they're not causing a problem for the teachers.

And then the idea that there's an attention deficit.

Well, but I have patients who can sit in a deer stand for 12 hours and hold perfectly still, you know, and the parents are like, "Well, Dr.

K, you're wrong.

They can't have ADHD 'cause they can't do this."

I'm like, "Yeah, but your child really is excited and engaged by the idea of deer hunting, not so with math homework, but it's not that your child can't pay attention.

It's just that what interests and motivates your child and how they regulate their attention and can allocate some of it towards things that don't interest them is different from other people.

But it can also be a superpower that they can pay attention to so many things around them.

And maybe people with ADHD could be good at things like being classroom teachers, where there's all these different stimuli going around at once, better than someone like me, who is most comfortable focusing on one thing, but really deeply.

- And so what does this tell us about how parents and educators can think about students that have ADHD?

Because students also, they develop ideas about themselves.

And the teachers talked about that earlier too.

Can you talk about that a little bit?

- Absolutely, yeah.

Just like Maggie and Nicole were talking about, I have patients who really, they come into my clinic with really low self-esteem.

They feel like, well, I guess I just must not be that smart.

Some of them have had neuropsychiatric testing, academic testing, and been told that they have a low IQ 'cause they scored poorly on the testing.

And then when we start to treat them with medicine or through other means, and they go back and retake that test, and of course we find out, oh, you're much smarter than we thought they were.

But then also they're having better interactions with their peers.

They're not interrupting other people's sentences.

They're able to turn in their assignments on time and be recognized for the hard work that they're doing.

And that's really transformative for them.

And it makes me feel warm and fuzzy when I have someone who came in and was like, I don't really know what I wanna do in life.

And then I got to follow that patient longitudinally and now they wanna go be an astrophysicist or an aerospace engineer or a teacher.

I'm like, wow, good for you, that's amazing.

- How important is medication in the role of treatment?

- I think it's gonna be different for every child and every family.

And it's also important to recognize that not everyone can do well with the medicine.

Even though we have many different kinds of medicine we can try, you know, don't be discouraged if the very first medicine you try doesn't work for you or you have a side effect.

We may be able to work around that.

But I really do think it has been transformative.

And these medications that we use, they really can make a huge difference in kids' lives.

And so it may not be for everybody, but having access to that medication is so important.

- And what do you wish that more people understood about ADHD that you feel like a lot of people might have misconceptions about?

- Yeah, again, the idea that these kids are not smart, these kids can be very, very smart.

They may even do better if they're in a special education classroom where they're being challenged, like a gifted classroom.

The idea that they're not motivated or that they're lazy, that's just not true.

It just- Okay.

What motivates them?

What motivates them.

And when you give them that thing, you will see how incredibly motivated they can be.

Right.

And also this idea that children with this difference can also still be incredibly successful.

Absolutely.

In life and careers and you know.

Yeah, one of my close mentors who's a senior author on this paper will brag to you about his ADHD as a superpower.

And yeah, I mean you can do, I think you can be anywhere with ADHD and do anything.

So where do you see this research leading us forward?

Where is it going next?

I think we'd like to understand more about using this idea that you can treat one condition, treat a condition that's caused by one set of differences, sort of by pinch hitting, to borrow another baseball simile, that you can find a different way to make the brain kind of get in the state that you want it to be in.

And I think just it's such a, it's so amazing.

I get fired up every day when I go to work.

I feel like it's such a privilege to be able to take pictures of people's brains and sort of begin to quantify that subjective experience we all have and learn from it and think of new ways that we can understand each other better.

And then, you know, medically try to help people to be their best selves and be successful.

Wonderful.

Thank you so much for coming and telling us about this and helping us have a better understanding about things that a lot of people don't talk about much or really know much about.

I appreciate your time.

♪♪ - This program is funded in part by the following.