Mclean Hospital

Podcast: Adolescents, Adults, and ADHD

January 7, 2020

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Trevor talks to Roberto Olivardia, PhD. Dr. Olivardia specializes in the treatment of attention deficit hyperactivity disorder (ADHD) and challenges facing students with learning differences.

Dr. Olivardia discusses what ADHD is, myths around the diagnosis, and strategies for managing ADHD. He also shares his own experience of living with ADHD and raising a son with the same condition.

Episode Highlights

  • Dr. Olivardia discusses that the concept of adult ADHD didn’t exist until the mid-90s (03:52)
  • According to Dr. Olivardia, ADHD isn’t a mental illness but a “condition of neuro-diversity” (37:25)
  • Dr. Olivardia shares some strategies for managing ADHD (01:03:47)

Relevant Content

Episode Transcript

Trevor: Roberto, I know you work in ADHD, but this looks like somebody who has ADHD. I mean, no offense. I got this and I looked at this and I was like, “No.” There’s like eight hours here.

Roberto: Yeah, it’s a lot of material. We could have a two-parter.

Trevor: Yeah, we could. A four-parter. So, I did read a few of these links and specifically the one on myths and ADHD and I want to talk about one in particular. Because I don’t know if it’s one that has hung around much, maybe it’s a myth that’s gone by the wayside. But I remember growing up that the myth that ADHD wasn’t legitimate or was not a medical condition. I mean, that was everywhere.

Roberto: Absolutely.

Trevor: That was everywhere. So where are we with that myth? Is it still everywhere?

Roberto: It’s still there. Although, there’s so much great research that is starting to educate people as to what we know about the neurology of the ADHD brain and understanding that this is a real thing and that ignoring it can have pretty devastating consequences. But yeah, you’ll still hear that. You’ll still hear people say, “Well, aren’t we all a little ADD?” And, “Oh, I’m so ADD, I forgot my keys.” And that sort of thing.

Trevor: I used to say it.

Roberto: Right.

Trevor: Until you witness somebody that actually has it and then—

Roberto: Right.

Trevor: Yeah.

Roberto: And I think a lot of it too, just comes down. ADHD, unlike a lot of the other issues, conditions that, that I work with OCD, eating disorders. ADHD is one that a lot of people think they know a lot about and it is so vastly misunderstood, so much so.

And that’s what I feel very passionately always talking about it because when I often give presentations or talks, the most common feedback I get from people is, “Oh wow, I didn’t realize that’s what ADHD was.” Or, “I didn’t realize that it wasn’t just the kids with conduct disorders that could have ADHD. I didn’t realize you could be a straight a student and have ADHD. I didn’t realize that ADHD had more ... The academic domain was one of many life domains that are impacted by ADHD.” And then in a clinical arena, understanding that the impact of ADHD on other issues that people may have, depression, anxiety, OCD, that if that ADHD is not managed, it will affect the presentation of the other disorders. So, you have to pay attention to it.

Trevor: Is ADHD truly that prevalent or no offense, have, not specifically you, but has the medical community been irresponsible and how much they’re diagnosing it or being too quick to diagnose something as ADHD?

Roberto: Well, the truth is that there are lots of people that are diagnosed with ADHD that don’t have it. However, what studies show, and I can tell you clinically what I see is I see more of the opposite. People who are vastly underdiagnosed, particularly adults who have ADHD. And honestly it wasn’t until the mid ‘90s, which isn’t that long ago that the concept of an adult having ADHD was even seen as legitimate. Somehow, I don’t know, people thought when you turned 18 you just mysteriously ... Your ADHD just packed up at suitcase and just went away somewhere, when what we know about ADHD is that it takes on different shapes depending on where you are in your life.

I have ADHD and my own experiences that all of us are in the same box basically for the first 18 years of our life, this place called school and most school operates pretty much the same way. So there are very few options and you’re going to see it in very different ways. Now when adults who have ADHD start to have more options and more choices as to what they do after 18 and your environment is everything for someone with ADHD. And that’s what I think is so difficult for people to understand about it, is that it’s not this kind of, it’s unlike ... It’s not something like depression where you can feel depressed and feel disconnected and feel alone despite what’s happening around you. It’s this very consistent kind of feeling for some people, not all people, but for some people.

With ADHD you can have ... I mean my experience, I remember when I was in seventh grade, my parents came home from a PTA meeting and I said, “So what did my teacher say?” And they said, “Well, one of your English teachers says you are the star student and if every student could be like Roberto, her job would be wonderful. Your math teacher said that you’re a class clown and you’re very disruptive in the class. Your history teacher thinks that you have a problem with sleep because you are falling asleep and literally drooling on yourself.” Which I was, in his class. “Your reading teacher isn’t really sure, you’re always asking to go to the bathroom all the time. She didn’t know if you had a problem with your bladder.”

I said, “All of those things are true.” So here you have four teachers who have very different presentations, but I can tell you why. My English teacher was an incredibly dynamic personality, very energetic, very stimulating. She had the desks in a circle. So you’re like making eye contact with various people. There was stuff happening in that class and that made a huge difference. When you have ADHD, it’s not this that your attention or ability to attend is consistent. It all depends on the environment, but to a much more significant degree than it does for someone without ADHD.

Meaning that sure, if anybody is bored, they are going to be less attentive or less connected. But for someone with ADHD, I think of the analogy of like a dimmer switch for a light. For people who don’t have ADHD, they have the dimmer switch that yeah, of course it’s going to be brightest if they’re stimulated, but less so. But there’s a regulation. For someone with ADHD, it’s like a classic light switch. Either I’m all on or I’m just completely disconnected and tuned out. And it was really ... My history teacher, he was a nice guy, but he was very monotone in his speech and I just didn’t find history interesting. And so, I regardless of how much sleep I got, regardless of how energetic I was the class before, I would constantly fall asleep in the class. I mean, in high school, that was a lot of my experience.

I was virtually narcoleptic through many of my classes. I don’t even remember first period, half the time. I mean, it was so much energy to just keep my eyes open and just be attentive. Whereas take another class and it was very, very different in that way. But it wasn’t that I couldn’t pay ... Even the term attention deficit is a misnomer. People with ADHD don’t really have a deficit so much in attention. If anything, we’re paying too much attention, sometimes to too many things. And if it’s not stimulating, we’re onto the next thing. We’re looking for the shiny nickel to sort of pay attention to. And that’s where the neurology and what we know about the brain validates why that is, it validates how much we’re oriented that way.

Trevor: Did you watch a lot of MTV growing up?

Roberto: So, the interesting thing is my parents kind of knew what they were doing. So I wasn’t diagnosed with ADHD as a kid. I’m of the generation where the kids who were diagnosed were the trouble ... The conduct disorder kids, the kids that often didn’t have great social skills, some of whom dropped out of school. A lot of those kids were my friends. I mean, birds of a feather flock together and it’s just that I was socially savvy. I had good social skills and I was bright enough to sort of get through what I needed to get through in college. But those were the kids I gravitated more to. They were more fun, they were more stimulating.

There was more stuff going on. But those were the kids who were diagnosed and nowadays it’s different and that’s a good thing. We’re diagnosing it better now. But that’s where I talk about the under-diagnosis because I wasn’t diagnosed as a kid and if you look back, I mean it was so many classic symptoms, but because if you did well in school, that was sort of just ruled out. But if you asked me what my experience in the classroom was and then what doing homework was like and the procrastination and the doing things at the last minute and the difficulty reading, I think I probably had a minor, mild dyslexia as well. I have a son with dyslexia and ADHD. I hated reading. I hated it.

Trevor: Me too.

Roberto: And as I got older, what I did, even to this day, I haven’t read a fiction book in 25 years, 26 years. Give me a music biography of a rock star or psychology related stuff, I’ll read it, but I’m not a fast reader even today.

Trevor: Yeah, that’s funny you say that. I can pretty much only read autobiographies and if it’s fiction, I’ll read a fiction once in a blue moon, but it has to be just dog shit prose.

Roberto: Yeah.

Trevor: And just bottom of the barrel narrative because it’s just not accessible to me.

Roberto: Yeah.

Trevor: And I get a lot of frustration from that because music means a lot to me, filming means a lot to me. And if I’m attracted to an art, I want to understand that art, but I feel like I’ll never be able to understand prose because I just can’t stay with it.

Roberto: Yes. I can totally relate. And the last book I read, last fiction book was Gerald’s Game by Stephen King.

Trevor: Oh yeah.

Roberto: And the only reason ... I would have been so intimidated to read a Stephen King book, but the only reason that had me read it, I had graduated college and I was ... My parents very generously, my gift was a trip. I went to Aruba, and in the pocket of the seat was the copy of the book, Gerald’s Game and my Walkman, before the iPod, my Walkman batteries died. And I thought, “Oh, I’m on this flight.” And I get very antsy on plane flights. I definitely was of that more hyperactive, impulsive type. So, here’s this book that somebody left and I thought, “Well, let me just read a chapter of it.” That book within five pages. It’s sucks you in. It’s a really, really good book. I thought, “Well, let me take it with me.” And then I ended up reading the entire book, and the week that I was on the beach and everything-

Trevor: That happened to me with Gone Girl.

Roberto: Yeah. So, if it grabs me ... I wasn’t diagnosed as a kid, but then looking back, all of the signs and everything were there. And that’s why a lot of people of that generation, I work with a lot of ... I work with people of all ages. But what’s interesting is when I’m working with a child who’s been diagnosed with ADHD, oftentimes their parents get diagnosed when their kids, adults often get diagnosed these days when their kids do. And so I was talking to a dad of this 13 year old boy, I’m working with him. I’m describing kind of what ADHD is and actually to the ... The parents were sitting there, but the wife looked, the mom looked at the dad and the dad sort of laughed and he said, “I feel like you’re literally describing me and my experience. But I never had a name for it.” And unfortunately for the dad, he just assumed he was stupid, that he assumed he just wasn’t that smart.

He did well, he was a very successful person, but he felt like he had to put in five times the amount of work to sort of do that. Unfortunately, it took a toll on his self-esteem. So I think that’s where I often see this sort of misdiagnosis is, and frankly the people that are diagnosed with it who don’t have it, I find are often not adequately diagnosed, or seeing trained clinicians who really understand ADHD. Because I wouldn’t just say, “Oh you have a problem paying attention. Oh you get bored easily. You have ADHD.” That it really takes a very thorough clinical interview. Getting family history, understanding. It’s not enough to say, “Did you get A’s in school? Okay, well you don’t have ADHD.” Because that happens a lot. People get excluded from the diagnosis simply because they did well in school or through neuro psych testing, which has found has a very high false negative rate.

So a lot of people who have ADHD may not test as having ADHD and neuropsych testing because if you think of neuropsych testing, you’re one-on-one with someone, it’s highly stimulating, there’s a lot of pressure to perform well. Some of the activities might even be fun, highly stimulating environment. How that carries to executive functioning and time management and decision making and adult life or an adolescent life, it just doesn’t carry over. So actually it’s ... I would say very underdiagnosed.

Trevor: I want to get back to my original question. Did you watch a lot of MTV growing up?

Roberto: Oh I’m sorry. I see there’s my ADHD.

Trevor: Yeah, I know.

Roberto: I’m glad that you brought it back. So my parents were ahead of their times that although we didn’t have this label, they intuitively knew who I was because we didn’t have cable in my house. So, I didn’t have ... I grew up in Somerville, Massachusetts, and typical middle-class family. We didn’t have a color television until I think I was in high school, even though I know we could afford a color ... We weren’t wealthy, but we could afford a color TV. And there was only one television in the house who was in the living room. So it’s not like I can sneak in the middle of the night and watch TV, but we didn’t get cable and I wanted MTV so badly and I’m like, “Come on.”

I would have watched it constantly. The funny thing is I, when I went to college, my first day I went to Tufts University, first day I call my parents and I’m like, “Yeah mom, moved in, everything’s good.” And I hear some commotion in the background. I said, “What’s that noise?” My mother said, “Oh, it’s the cable company.” And I said, “What? You couldn’t even wait 24 hours to get cable.” And she’s like, “Your father wanted the ESPN.” So they got cable the day I went to college.

Trevor: Yeah. Are you an only child?

Roberto: No, I have a brother who’s six and a half years older and a sister who’s five years older.

Trevor: Okay.

Roberto: But they didn’t push for that—

Trevor: I would have disowned my family if that was the case, immediately.

Roberto: They didn’t push for that. They didn’t need that in the way that I did. Because, I loved ... Always a fan of television and film. I was obsessed with the show Three’s Company.

Trevor: Sure.

Roberto: I loved John Ritter and Lucille Ball. I loved physical comedy but yeah, so we had this one TV and so they knew that I would probably be really distracted.

Trevor: So let me follow up. I already know the answer to this one. But did you play too many video games growing up? I’m assuming? No. Because you didn’t have a television.

Roberto: No. So that’s the other thing is that I was the last kid to get an Atari and all my friends got it. Honestly, by that time, I didn’t ... For me and I know for a lot of kids that I work with with ADD, they love video games and maybe because the video games now are so much more immersive in the graphics. Atari was pretty simple graphics.

Trevor: I don’t know man. I mean, I grew up with every generation and at the time it was mind blowing.

Roberto: Yeah. I mean, for me, that was the first, and then I remember my friend got a ColecoVision.

Trevor: Oh, yeah.

Roberto: And then that improved and then television and then the Nintendo. So, I didn’t ... By the time I got it, it just didn’t really appeal to me.

Trevor: Okay.

Roberto: But I was upset with, I’m like, “Why am I not ...” But I’m glad because I wouldn’t have managed that well.

Trevor: Did you eat a lot of foods with complex synthetic sugars in it like corn syrup?

Roberto: So again, I grew up in a house, we—

Trevor: I’m getting to a point here with these questions and I think you know where I’m going.

Roberto: Yes. So, no sugar cereals in my household were allowed, no soda. My parents were very health conscious. However, I go to my friend’s house and we need a box of boo-berry cereal or I would put sugar on top of the flakes.

Trevor: On top of the food, yeah. I did the same thing.

Roberto: I love sugar. And what we know now about the ADHD brain is not that sugar causes ADHD, which is one of those myths out there. However, people with ADHD love sugar because it boosts levels of dopamine, which is a neurotransmitter in the brain that the ADHD brain is deficient of basically. So we’re always looking for stimulation. So I didn’t eat any of those things. I ate pretty healthy, but trust me, I pushed hard for those cereals and Coca Cola, Pepsi and all that. But nope.

Trevor: The point is that in the ‘90s, when you heard about ADHD, I specifically remember, and I’m sure there were other elements that were blamed, but I remember three things were blamed for ADHD. MTV, video games and sugar.

Roberto: That’s right.

Trevor: I mean, and that was it.

Roberto: Yes.

Trevor: I have a close friend of mine whose mom, once she heard about video games because he has ADHD, she took his Nintendo out to the garage, smashed it to pieces. It was really frustrating, especially at film school because MTV ushered in this new form of editing, aggressive media editing and you would read a trade or you would read a review or a magazine from Europe like Sydney East or something and you would constantly come across the MTV ADHD style editing. You’d come across that phrase all the time.

Roberto: Interesting.

Trevor: ADHD was creating a sub-genre of film and television that both kind of had an effect on ... That caused the ADHD mind but yet encouraged it at the same time. It was ridiculous.

Roberto: It’s ridiculous. And the problem with that is the causality is in the wrong direction, is that people with ADHD love sugar, people with ADHD, love video games. But it’s not that video games cause that and that’s ... I mean, especially the sugar myth, I’ll still hear it from people and study upon study shows, no.

Trevor: To be honest, part of me still kind of ... I never believed it and yet part of me in the back of my head is like, “Maybe.” Because it wasn’t like sugarcane, for the most part went by the wayside in the ‘70s early ‘80s. We bring in synthetic sugars and corn syrups in the ‘80s and that’s pretty much how it’s been for the most part.

Roberto: Right.

Trevor: ADHD ... We’re a reactionary society, I’m very guilty of this. It’s, simple to put two and two together without doing any due diligence with regards to science.

Roberto: Right. Exactly.

Trevor: And then you end up with, “Oh sugar is the culprit.”

Roberto: Well, I think the thing too is for people to understand, the term ADHD is a fairly new term. I mean, it used to be called hyperkinetic syndrome. It was once called minimal brain dysfunction. How great is that?

Trevor: Is ADD even used anymore? That’s what it was in the ‘90s, it was ADD.

Roberto: Correct, it’s now ADHD inattentive type, ADHD hyperactive type or ADHD combined type. ADD used to refer to just the inattentive type without the “H”, without the hyperactive impulsive person. But it’s now all called ADHD. But people will still say ADD, because it’s just easier, kind of flows off the tongue better. But people have to realize the name is new, but the phenomenon and what we see is not. And so when you do family histories, my mom is 85 years old and that’s where the ADHD comes from.

So it doesn’t come from sugar or video games. It’s a highly, highly heritable condition, highly genetic. So if you have ADHD, there’s about a 70% chance you’re going to have a child with ADHD. So my wife was pregnant with my son, who’s now 14 years old. I said, “Be prepared.” And every ultrasound we got, I’m not kidding. Every ultrasound we got, they were like, “Wow, this kid is kicking and moving. I’ve never seen before.” He came into this world. I mean, he is his father’s son—

Trevor: So you must have been terrified.

Roberto: The funny thing is I wasn’t, because I intimately understood.

Trevor: I apologize, that was a judgment. I assumed you’d be terrified.

Roberto: I wasn’t. I think, well, the interesting thing is because I understand it so well and I know that some of the ... I mean, I got myself in very impulsive situations as a teenager and I did risky things and things that I look back at and I’m thinking, “What was I thinking?” But knowing that I know what I need to do to parent him in a way where ... Because I don’t see ADHD as a wholly bad thing. I like my ADHD brain as long as long as it doesn’t get me into trouble. I attribute it to a lot of the successes in my life and I attribute it to a lot of the big mistakes and downfalls.

Trevor: Yeah. This is the area where we’re going to have to get into the steel cage match and rumble because I have the exact opposite take on this, but continue, continue.

Roberto: Okay. So, I knew I could parent him in a way where he can understand himself from the get-go. I can give him a language to things that I didn’t have a language to until I was in my late 20s, early 30s with the research that we have and help him understand why we need to do things X, Y, and Z way. Why setting up your environment to study might have to do this way. Or what other people might get things done in a certain way, we might have to do it in a different way. And that’s okay.

Trevor: So, do you think that ADHD I and ADHD H, do you think that it’s a possibility that these are actually the next evolutionary steps for the brain and instead we’re treating it like it’s a detriment or a deficit of the brain?

Roberto: Well, it’s a great question because there’s a great book called Attention Deficit Disorder: A Different Perspective written by a man named Thom Hartmann, who talks about ADHD as basically a Hunter gene. That in our evolutionary cycle we had the farmers and we have the hunters and the farmers how to be incredibly routine. They went to bed when the sun went down, they woke up in the sun went up, they had to monitor their crops and then the hunters had very erratic sleep cycles. They were nomadic. They were up at 2:00 in the morning.

Trevor: Just last night.

Roberto: Yeah, same here. His argument is that we are basically ... These are genes that have been in our cycle throughout history and they’ve been very adaptive in certain regards. Again, if you put somebody who has that kind of genetics in a building called school for seven hours a day, that’s really difficult. There’s a phenomenal study done, actually, looking at these tribes in Kenya now. Now, there is a ... They’re now genetically mapping and trying to understand the genes involved with ADHD. And there’s one called the DRD4 gene that is mapped to novelty seeking, sensation seeking, impulsivity. And when they went to this Kenyan tribe, this tribe is basically divided by people who are more domestic. So they are like the farmers basically they, they tend to the food, to the children, everything is a very regular cycle.

And then the nomad, the nomadic part of the tribe, which hunts for food, which has the erratic sleeping. And they looked at this gene and what they found was the people who are nomadic, who are high in this gene, high novelty seeking, high stimulation seeking were healthier and happier. The nomads that were low in this gene were depressed and miserable. The domestic people that were high in the DRD4 gene, very unhappy, irritable, moody. The domestics who are low in the gene, happy, healthy.

So to me, that’s one of those studies that say, “Well, if you have this DRD4 gene, you probably need to be in a different environment.” I can’t do any job. When I was an adolescent, I was terrified of being an adult because I’m like, “I can’t do something that I don’t like. I don’t like to do. I don’t know how people work at a job that they just don’t like.”

Trevor: Yeah. I’m still waiting to grow up.

Roberto: Yeah. Even though my dad loved ... My dad was a teacher, he taught Spanish at Berlitz School of Languages and he would have clients like Polaroid and the Boston police department, and he loved what he did, but I felt, I knew that was somewhat of an anomaly because my best friends and my friends’ parents, they hated what they did and the only thing I knew I loved was music. So I was like, “Okay, I don’t think I’m going to go to college.” I hated high school, but again, I did decently enough in it, I cut whatever corners and I would do things at the last minute. But I did well enough that I got into Tufts. I don’t think I would get into Tufts today, but I excelled in college because ... And it was all because in high school I took a psychology class and that was the first, the only class in high school that I was excited about.

I did 100% of the homework in, I did beyond what was even assigned. I remember just reading, I couldn’t get enough of it. And I thought, “Now this, I can read and study and go.” And then I went from, “I don’t think I’m going to go to college.” Which didn’t go over well with immigrant parents who sacrificed everything, having two older siblings, college was a very important value—

Trevor: And not having cable while you grow up, the atrocity.

Roberto: And so I said, “I think I’m going to just play music.” Luckily though, my parents were ... I credit them tremendously because they didn’t ... I was a bit rebellious. If you pushed, I was going to push harder was sort of like ... So they knew. They were like, “Well, give it some time and yeah, all this.” And I know secretly they were praying and ... But then I went from—

Trevor: Well, okay. Actually, quick question, was your family religious? Did you go to church?

Roberto: Well, I got kicked out of Sunday school actually. My family was more spiritual, I would say.

Trevor: I don’t mean to offend you. I was afraid I wasn’t going to be very engaged in this interview, but anybody that gets kicked out of Sunday school is a hero in my book.

Roberto: Oh no, it takes a lot to offend me. So don’t ever worry about that.

Trevor: So, here’s my hero worship.

Roberto: So very spiritual family, meaning that we grew up, my dad would say, “You’re neither inferior nor superior to anybody. We all have a role in this world.” Actually, a lot of very Buddhist kind of philosophy. In Somerville though, where I grew up, people affiliated with the church a lot. So, I grew up in a neighborhood, it was pretty ... Well, my neighborhood’s a lot of Italian, Irish. And so my siblings went to this parochial school, which I believe was probably one of the oldest parochial schools in New England, I want to say. And I think the nuns knew Jesus personally. I mean they were so old. I mean, these people. A nun slapped my sister in the face.

Trevor: I was just going to ask. Was there physical punishment?

Roberto: There was and my dad pulled them out. And my brother though, it’s interesting because he’s ADHD as well, but we have very different personalities. We’re very close but he’s definitely more introverted. He definitely, he embarrasses easily and he wouldn’t ever would have been like a class clown or anything like that. So when my dad pulled them out, I think my brother liked the structure of parochial school and the structure of the church. And so he is very religious and goes to church every Sunday. He was an altar boy. He was. So, we would go ... It was actually called Monday School, because you’d go after school on Monday, but it was basically Sunday school on Monday—

Trevor: Sounds even worse somehow.

Roberto: Oh, it’s terrible. Imagine you have a full day of school and then you had ... It was an hour. You had to walk a couple blocks to this parochial school.

Trevor: Yeah. Well, the kids when I grew up, the Catholics, they had Monday night, they called it catechism.

Roberto: Yeah.

Trevor: Yeah.

Roberto: And this priest was terrible. I mean, the first time he was talking about what constitutes mortal sins? And he was talking about premarital sex. And so I remember this kid in the class as a joke, said, “What about masturbation?” Thinking that he would say, “No, of course that doesn’t count.” And he said, “Yes, that’s a mortal sin because that’s not for the purposes of procreation.” And I impulsively went, “What? Are you kidding me? Really?” That’s when my friends were like, “Oh my gosh, Roberto.” And hiding their head. I was a kid, I couldn’t let it go. I was the kid that asked why a lot and he just didn’t want to discuss it. And I said, “I don’t understand how that would be a mortal sin.” And I said, “You’re telling me if you masturbate, you’re going to go to hell?” And he said, “Yeah.”

Trevor: Yeah, I remember hearing that.

Roberto: And I was like, “I guess I’m going to go to hell then.” So he was mad at me at that. But the thing that got me out was ... So this is 1985, the AIDS epidemic is hitting, this is when it’s exploding in the ‘80s. And he said that the AIDS epidemic was God’s punishment against gay men.

Trevor: Oh yeah. I remember hearing that.

Roberto: You remember hearing that? And I remember distinctly the day before, or maybe two days before, actually no, if it was a Monday, it would have been the Friday before because 2020, Barbara Walters used to host 2020. And she interviewed a man who was dying, who was literally in the late stages of the AIDS virus.

Trevor: If Barbara Streisand wanted to be a tree, what tree would you be?

Roberto: Yeah.

Trevor: Sorry. I had to say that.

Roberto: Yes. And I was so upset watching this. I mean, I was always a very emotionally sensitive, very empathic person. And so I’m picturing this poor man and his family who are grieving him and this priest saying that this was a punishment. I said, “How could you say that?” I said, “You’re telling me ... Do you think being gay ... Why would being gay, why would God be against that? And he just went on and on and on and I said, “I don’t agree with that. I think that, if you believe in Jesus, he accepted everybody.” And then he said, “You need to just shut your mouth and just learn to just accept what’s being told to you.”

Trevor: Right. Be binary.

Roberto: Yeah. And so that’s where the little, the wise guy, Roberto comes out, who knows, he’s pushing buttons. Now, I know I’m pushing buttons and I said, “Well.” I said, “Back then people got married at like 16.” Right? Because the life expectancy was, I don’t know, 30, 40 at that time. “So, Jesus was 33 when he was crucified and he was single. How do you know he wasn’t gay?” Oh my God. This guy, if I was alone in the room, I think he would have hit me.

Trevor: Well, the insane thing is that ‘85, I mean, we know what was going on.

Roberto: Yes.

Trevor: Now.

Roberto: And to add to that, this priest is now defrocked for allegations of child sexual abuse, which doesn’t surprise me in the least. Exactly. Isn’t that the irony of it? So, he—

Trevor: No, it’s not irony. It’s vile.

Roberto: Yes. Absolutely.

Trevor: No offense. Like most people, my cutoff point is there, it’s vile.

Roberto: Absolutely. Absolutely. And he called me blasphemous, and then ... So he kicked me out and then he found my brother who is the sweetest guy. My brother’s the nicest guy. He found him in the church. I think a couple of weeks after and he said, “I just want you to know your brother.” Being me, “Contributes to the death of the Catholic church.” And I said, “Did he really say that?” And he said, “Yeah.” And I said, “That is awesome.”

Trevor: Yeah, that’s the most rock and roll thing, ever.

Roberto: I want that on a tee shirt.

Trevor: Yeah, seriously. That was great. I wished somebody said that to me.

Roberto: And my parents weren’t bothered by that. I mean they ... My brother was horrified at the fact that the priest said what he said about ... My brother doesn’t ascribe to the beliefs that ate the AIDS epidemic was a punishment. He doesn’t think ... He just is more about why, the idea of why challenge that? And I’m like, “I can’t help myself. That’s just who I am.”

Trevor: I want to take a moment for the listeners to say that I apologize if you have beliefs in God, in Christ and you’re offended by what we’re saying. I don’t mean to do that. I just want ... I know that people have grown up and found peace in their religion, specifically the Christian religion and that’s great.

Roberto: Absolutely.

Trevor: That’s great. All I’m saying is that my exposure to it was awful.

Roberto: As was mine. Yes. And I agree. Because my brother, he is a practicing Catholic, I don’t argue with him about ... I think I could see how it’s done really wonderful things and organized his life and he’s a wonderful person. And so yeah, I have nothing against religion. I really don’t. I hate everything against discrimination and against the idea of subjugating somebody in the name of religion.

Trevor: I mean, I have everything against religion, but I don’t have anything against people who practice. I mean yeah, I got over that a while ago. It’s not going away in my lifetime. So why—

Roberto: Yeah.

Trevor: So, one thing I want to talk about, which we touched on a little earlier, something that I disagree with—

Roberto: About the positives of ADHD.

Trevor: The strengths that ADHD can carry.

Roberto: Yes.

Trevor: Provided that it is being managed. I take umbrage with this ... Not specifically with just ADHD, but specifically with this idea that I’m seeing float around mental health. Not just within the rhetoric, but also in media. I had somebody write on this podcast say is say it, that your mental illness can be a superpower.

Roberto: Yes.

Trevor: And no. That’s where I stand on that. No. So what do you mean by the strengths that ADHD can ... Yeah. Okay. I’m being really lame. I’m not giving it an explanation on why I say no, I just think that it is a very, very dangerous path to go down.

Roberto: Yes. And I totally understand that. See, ADHD is not a mental illness first of all. That, I think when we understand it, is that we look at it as a condition of neuro-diversity. That is a way the brain is wired. That even all the research that we understand about ADHD, it’s not a defect of the brain. When people can sort of learn how to work with it, strategies, medication can be helpful. But there are lots of people with ADHD who aren’t on medication who do very well, given that the strategies ... Even when medication is introduced, people are fundamentally the same people.

I think in fact a lot of people with ADHD are concerned that if they take a medication that they’re going to lose the sort of spontaneity or the kind of creative or ways that their ADHD they feel, can work for them and it doesn’t do that and enhances a lot of those traits. Whereas with something like depression, you are fundamentally a different person when you’re depressed than when you’re not depressed. The way you see the world, the way you interact, the way you take things in. I do make a big distinction between sort of strengths that can come along with something like ADHD and knowing that, that superpower ... Kanye West talked about bipolar disorder as his superpower. I don’t think of it the same way for something like that. I think with ADHD it’s—

Trevor: I’m sorry.

Roberto: Sure.

Trevor: You brought up Kanye.

Roberto: Yes.

Trevor: With Kanye and other examples in that realm, I think money and fame is a way to—

Roberto: Absolutely.

Trevor: Is a way to validate ... If you’re going to surround yourself with people that aren’t going to say no, then why treat it?

Roberto: Oh yeah. Absolutely.

Trevor: So, it’s only a superpower because of wealth and fame.

Roberto: And privilege.

Trevor: And privilege.

Roberto: Absolutely. Without a doubt. And what I say, I mean in the ADHD world, you have these sort of different camps, where ADHD is this debilitating pathology. People like Russell Barkley who is the world’s leading researcher on ADHD who has contributed more to the ADHD world than anybody really, and I highly respect his work. He’s a researcher, he’s not a clinician. So his data shows that, yes, I mean, people with ADHD are four times more likely to develop a substance abuse problem. They’re more likely to end up incarcerated.

Trevor: Did you develop a substance abuse problem?

Roberto: I did not. And I think part of it is I hate, I don’t drink any alcohol at all. I hate the taste of alcohol. I hate the smell of alcohol. I’ve been drunk a couple of times in my life and I was violently vomiting the next day. It thankfully doesn’t ... And neither of my siblings drink alcohol. So I think we genetically just don’t have some that enzyme that metabolizes it.

Trevor: Cocaine, meth, hash, Robitussin, nothing?

Roberto: No. I remember though in high school hanging out with the punks that I would hang out with in Harvard square, when one of my friends took acid and said, “Roberto, you can taste the music. You can taste the notes.” And we were listening to Disintegration, the album from The Cure.

Trevor: Off course you were listening to Disintegration. Of course you were.

Roberto: Of course.

Trevor: I was actually going to ask you that on your flight story when your Walkman batteries coming out, I was like, “Well, you weren’t going to be able to listen to just Disintegration on your long flight.”

Roberto: Disintegration. And he said, “You can taste every note.” And I thought, “Oh, that must be cool.” The thing that stopped me from doing it—

Trevor: I’m sorry, if I tasted every note from disintegration, I would jump off a bridge.

Roberto: Yeah, can you imagine?

Trevor: No.

Roberto: Yeah, I mean that would be quite a substantial—

Trevor: ABBA Gold, yes.

Roberto: Yes.

Trevor: Disintegration by The Cure, no, no.

Roberto: I remember thinking, my first thought was not, “Oh my gosh, this is probably really bad for your brain.” My first thought was I love music so much—

Trevor: Yeah, me too.

Roberto: That if this brought me to a higher level and then I came down from that and now this ... Ruin the threshold where now I’m not enjoying it anymore. That was too big a risk for me. Because there weren’t many things that I felt that passionately about.

Trevor: As a club DJ, I actually resented the drug scene because we were there for the music and that’s not meant to sound snotty, but people were like, “Oh no, when you drop mitsus and this and that, you really feel the music.” And I’m like, “You can’t feel it without dropping E or tripping? You can’t do that?”

Roberto: Exactly.

Trevor: Because it’s beautiful music.

Roberto: And it was sad. I didn’t understand that, because I intimately felt ... I mean, I still go to shows all the time and there’s nothing like that feeling of feeling the base right in your chest. And I mean just it’s a great, it’s a high, I mean—

Trevor: As somebody who does a lot of recreational marijuana, I actually don’t go to shows high and I can’t imagine ... I mean, one of my favorite shows, I think in the early 2000s, I saw Way Out West, one of the most incredible ... It was mental, that show. I remember one track, they dropped a beat so hard and I can’t imagine being anything else but stone cold sober for that moment because I just soaked it in. It was mental.

Roberto: Yeah. And I remember thinking, “Oh that’s too big a risk.” But I was intrigued by it.

Trevor: Yeah.

Roberto: So I’m just thankful that I didn’t like alcohol. So, I mean, interestingly in college I’d go to the parties because I didn’t want to be ... I wasn’t an introvert either. So I go to the parties. One of my friends belonged to one of the craziest fraternities at Tufts and we would go and I would drink water or diet Coke and people would be like, “Oh my gosh, he’s so out of his mind.” And my friends were like, “He’s drinking water.” And they said, “That’s scary.” It didn’t ... I mean, I felt ... And I also don’t like the feeling of being out of control and I like being very present and very in my body and—

Trevor: That to me shows that you had a very supported upbringing for the most part.

Roberto: Without a doubt.

Trevor: Because I hear, I personally know of people who have what you have and they had very destructive upbringings and guess what? They’re very destructive people.

Roberto: Yes.

Trevor: Same thing as you, but they go to parties to destroy themselves.

Roberto: Absolutely. And I had friends like that in high school who—

Trevor: I used to be one of them.

Roberto: Yeah. I used to hang out at, in Harvard square, the Pit, which was where all the punks hung out and they were great. It was a great time in my life—

Trevor: They always managed to get money out of me, always. Because starting in ‘94, I went to The Brattle Theater all the time. That escalator up drops you off in the pit and they don’t even nicely ask. They look at you and sincerely, getting money out of your pocket—

Roberto: See, that’s interesting. Because when I was ... No one asked for money back then. They would just hang around and we just talk about punk music. And then a lot of them were musicians, but a lot of them had problems with drugs and some other—

Trevor: Maybe it was a nicer scene in the ‘80s, but in the ‘90s it was not.

Roberto: Oh yeah, this was in the late ‘80s, ‘87, ‘88. I don’t know, I related though so much to them and I felt—

Trevor: Sure. I wanted to.

Roberto: Yeah. And I think that’s a thing is that people could judge people like that. And at the same time, I felt more like them and that sort of inner freak in some ways than I did what people might assume, that I would feel ... I very much connect. I feel like ... I just don’t like alcohol, but if I liked it, I could easily see it as being a problem. I have that ... But like you say, and I credit a lot, a lot to my parents. I mean, I grew up in a very loving household. I have two siblings that have my back and have always had my back, even though, I mean, I put them sometimes in situations where ... One time I ran off for the weekend and went to this party that I wasn’t supposed to go to down the Cape and called my sister. I’m like, “Just tell mom, dad, I’ll be home on Sunday night.” And I should not—

Trevor: That’s not sociopathic behavior at all.

Roberto: Yeah. There’s no parental supervision. This is after my dad told me I can’t go. That was the most mad my dad ever was actually. But things like that, that I did, but it was, it was very grounded and very present. And so, I think, I recognize how ... And boundaries. I had lots of boundaries. Some things like no cable—

Trevor: See, that’s good. I don’t have any boundaries.

Roberto: Yeah. That was a big, big part. Because I think by nature I’m somebody who likes to kind of push the boundaries and I can have that sort of—

Trevor: But you respect them.

Roberto: Yeah. But I respect them.

Trevor: Yeah. See, I don’t.

Roberto: Yeah.

Trevor: And it’s always been a problem. But that’s because none of my boundaries were respected.

Roberto: Right. Right.

Trevor: So, that to me is just normal behavior.

Roberto: Right. And I think as a parent, with my son, that is what I was excited about is thinking, “Okay.” It was interesting because my wife, we’ve been together for 30 years since high school. She knows me really, really well, but when we have a child—

Trevor: She must be a character—

Roberto: Well, it’s funny, a lot of people with ADHD actually just like we have to choose our jobs that totally make sense, you have to choose your partners really well.

Trevor: Got a clipboard, checking, checking.

Roberto: She used to be an accountant actually and a tax person. She’s a wonderful stay-at-home mom and—

Trevor: First date is at an IHOP at 2:00 in the morning, you’re just going through the list, checking off.

Roberto: We complement each other very well and on paper it could look like we’re opposite. She’s more introverted, but our values are the same.

Trevor: That’s important.

Roberto: That’s important. And I think she understood me more through my son. Because there would be things that, I mean it was like looking at a miniature, I mean, we look a lot alike and I felt like I was looking at a miniature version of myself and asking him questions and thinking, “Wow, I can totally understand why he’s doing this.” And going back to about the history of ADHD. My mom who’s 85 she grew up in Brazil, she would tell me stories. So, I grew up hearing stories of when she was nine, 10 years old, she grew up very, very poor and I mean it would take everything for her mother to buy her a brand new dress. And so, if she went to school with that dress, you don’t play in that dress because ... And my mom loved to climb trees and as a girl that was not seen as socially acceptable. In her dress, she’d climb, climb, climb, climb.

I said, “What made you want to climb trees?” She goes, “I always wanted to just see how far up I can get.” And I totally relate to that. Let’s just see what’s on the other side. Let’s just kind of keep going. So one time she encountered a beehive in her journey up a tree and most kids would probably run away from a beehive. She got closer to, she wanted to see what the bees were going into and brought her face basically at this beehive and got stung by bees. And her mom was like, “What were you thinking?” Which is something I heard a lot as a kid. And she said, “I was curious.” It’s not even like she regretted it. She was just like, “Well, now I know.” Kind of thing. So that was ... I didn’t realize how helpful that was to me because it’s not that my mom was saying, “Put your face near a beehive.” But I grew up with this sense of don’t judge yourself if you’re someone who has that kind of curiosity, don’t judge yourself if you—

Trevor: Oh my God. I wish I had that.

Roberto: And she came ... Her story is very inspiring to me because she had to quit high school because her dad died when she was very young and her and her older brother had to work to basically support the younger siblings. So at 22 she was like, “I need something better. I need to make opportunities, if I want a family.” So she was cleaning the house of this woman, this wealthy woman whose son was going to MIT for grad school and his wife was pregnant and she said, “Could you sponsor a visa for me to go to the U.S. and I’ll be the nanny for this kid.” Her family thought she was nuts. They’re like, “You don’t know a word of English, you’re not educated. You’re a single woman.” America was seen as kind of dangerous. Like, “Oh, what do you ....” And she said, “I’ll figure it out.”

And so that impulsivity, because this is the other thing is that there, evolutionary biologists talk about the prevalence. I mean, ADHD exists all around the world, but the prevalence of it in the U.S., part of what that can be due to, is that we’re a nation of immigrants, of people that ... I mean, now could be fleeing because of persecution. But in my mother’s case was more because of people who are looking for something better. And they were willing to take that risk. And even though all the odds were against ... She did and she learned how to speak English by watching soap operas.

Interestingly, I actually met ... One of her favorite soap operas was All My Children, and I met Susan Lucci because I wrote a book years ago, one of my other areas of specialty is working with men and eating disorders and body image issues. And I co-wrote a book and I was on Good Morning America and Susan Lucci had won the Emmy after losing 69—

Trevor:—years in a row. Wasn’t it 19?

Roberto: Maybe 19. Yeah, it was something in the teens.

Trevor: Yeah.

Roberto: And she was on Good Morning America and we were in the green room and I was like, “Oh, I saw your speech last night. That’s great.” So, I ended up telling her the story about my mom and I said, she ... Erica Kane was this figure in my household, because my mom said she watched, because soap operas are so dialogue heavy and they’re very body language expressive. And she was very touched by that. So, I was like ... I told my mom about that and she thought that was cool. But looking back and hearing my mother’s experiences in school, it was ADHD then too.

It’s just that we didn’t have a name for it when I ... I once did, I did a talk about hoarding to a group, a senior citizen group in this community in Lynn, The Senior Citizens Center about hoarding. And I mentioned maybe 10 minutes about executive functioning issues and ADHD and a little bit about what it was. At the end of the talk, this man who was 90 years old, he said that 10 minutes that you talked about ADHD, that is me to a T. He had tears in his eyes and he said, “When I was in fifth grade, a teacher wrote a note to my mother that said I was too dumb to learn, that I was a dunce.” And he said, “So I ended up getting into construction.” And he said, “I actually became very successful.” He became a general contractor, had this huge business.

He said, “But I have five kids. Four of them were diagnosed with ADHD. I have ...” I think it was, “15 grandchildren, eight or nine of them have ADHD.” And he goes, “And I never connected that to me.” And I thought there was this curse that I sort of passed down to people. But going to what you were saying about how it can be a strength is if it’s managed well. I credit a lot of my imagination, I think when you get bored so easily, lots of people with ADHD get bored very, very easily. And so if you don’t have enough of the stimulation externally, you go kind of internally. I have a very, very vivid inner life in imagination and creativity. And when I was—

Trevor: Yeah, but the negative person in me is going to say, “Isn’t that just disassociation?”

Roberto: No, because I was very connected to it. I saw it more as, “This is really boring here and I need something to kind of stimulate. So where am I going to go?” And then I would go on my head, and the stuff I would think about was often pretty productive stuff. I used to write and I would win creative writing festivals when I was a kid. And a lot of it was just stuff that was in my imagination that I just pour out. And same with music. I’d be writing songs when I was distracted in class and just write verses and collect all of those things. So really what it was, it was a way of managing my attention. It’s that this is fading and there’s nothing here and I’m going to kind of retreat in some ways internally.

The other thing is that as long as again, you have an understanding of your ADHD. I love what I do for work. I don’t even consider it a job. I go, I see. I’m in private practice in Lexington. I see patients’ ADHD, body dysmorphic disorder, OCD, eating disorders. I like to specialize in lots of different things. That’s part of my ADHD, is variety.

Trevor: No, really? I didn’t get this from this copy of war and peace, I got about your past.

Roberto: Yes. I like a lot of diversity. But what could be, I guess the downside is I would have a very hard time in a lot of different jobs, but because I knew that, and this is again where knowledge and education and support and that grounded-ness, boundaries, all of that plays a part. I had to do what I love to do and it brought me to something that I feel very, very passionately about. And so, in some ways I have to do this, because I would have a hard time doing a job that I felt even mediocre about. I feel very grateful for that, in that way. I like the way that my mind ... A lot of people, particularly people more on the hyperactive, impulsive end, their minds kind of run quick and in some ways again that’s where the impulsivity comes in.

I’ve had to learn to slow that down a little bit and not make fast decisions or not act so impulsively in certain situations. And at the same time I’m glad that I have kind of fast thinking. I’m actually pretty good in crisis situations. I’m a good problem solver. I don’t know, I’m very good at getting the gist of things which, whether again that’s a compensating factor for the ADHD. In high school, again it was, I couldn’t get through a Shakespeare book if my life depended on it, so I couldn’t even get through the cliff notes of the book. But I was very good at reading a paragraph here, paragraph there, page here, page there and pulling it together.

Trevor: Yeah, I couldn’t even do that.

Roberto: I was very good at synthesizing things and kind of getting the bigger picture really quickly and talking about it in a way where teachers assumed that I read the whole thing, which sometimes I didn’t know what to do with. I thought, “Well, am I a fraud? How do I ... Am I a good student?” I never felt like a student until I was in college. College was when I really felt like I’m a student because I’m connected to this, I’m engaged in it, I feel it’s relevant. And so for that, I guess on some hand there is a benefit of being able to synthesize things like that.

Now, would I be able to do that if I didn’t have ADHD? I don’t know. I just know that, that’s just been there. So on that end, I see it as a good thing. But in the ADHD community ... Ed Hallowell who wrote Driven to Distraction, which is a very landmark book in the ADHD world mainly because he talked about it with adults and when nobody was really talking about with adults. He talks about it very much, his ADHD is a gift. It’s a super power. And I agree with you that I wouldn’t make that blanket statement, I always add—

Trevor: It’s very irresponsible.

Roberto: I always add it as, as long as you’ve managed, treated and understand it, then you can utilize strengths from that same kind of neurochemistry in that, the way that your brain thinks. But I remember having a patient that saw that written somewhere. It was a 14, 15 year old and he said, “If ADHD is a gift, mine sucks and I want to return it.” And I said, “I agree with you because right now, there’s nothing about it that’s a gift. If you have a difficult time getting what seem like very simple tasks done.” And that’s what’s so misunderstood with ADHD is that it’s not about your executive functions, which are all the things we do to get something done. Our organization, our prioritization, time management, decision making, emotional regulation, those are all executive functions.

People with ADHD have very poor executive functions. So their intelligence though could be super high. I work with very high IQ, super bright people who have very poor executive functions and that can be very difficult because if you have people in your life saying, “You should be able to do this, this isn’t that hard, you just have to work harder.” And meanwhile these young people are like, “No, you don’t understand how difficult this is.”

Trevor: Yeah.

Roberto: And so that’s where we learn, but we can, there are strategies to work with those executive functions. But I will never have an internal sense of time ever. I just don’t have an internal clock. However, I’m very punctual because I write things down, I set alarms on my phone, I write post it notes to myself. So my kids think of me as a super punctual individual. High school, I was late all the time in high school. I mean, and sometimes it was because I didn’t really care to be on time and sometimes it was, I’m walking to school and I see a dog, “Oh look at the dog. He’s so cute. Oh look, a nickel on the ground. What year is it?” And before I know it, it’s like, “Where did the time go?”

I mean, I can be late with the best and the rest of them. But I’ve worked at it. And so that’s what as a parent, I’m excited, my son is seeing that and my mom, even though ... She’s definitely an ADHD, but I think in her case it was out of survival. She had to have things in order and in a certain way for her to do all the things that she needed to do. And then my dad is, was a wonderful ... My dad passed some years ago.

Trevor: Oh, I’m sorry.

Roberto: Oh, thank you. He lived a wonderfully long life. He was 90 when he passed. He was almost 50 when I was born, but you’d never know it. He was very methodical and very just very not ADD.

Trevor: Yeah.

Roberto: But the other thing I credit him especially for is because the dynamic when you have ADD and when there’s a parent that doesn’t or doesn’t understand it, it can cause a lot of friction sometimes because you just are doing things in different ways. And I remember in third grade, I had to write an essay on Athena, the goddess of wisdom, and I didn’t even want to do it. I was like, “Oh, I can’t do this.” My brother had a queen tape, a cassette tape.

Trevor: Which one?

Roberto: It was the—

Trevor: Come on.

Roberto: Another One Bites the Dust was the first track on it. So whatever album that was.

Trevor: Disappointed in you.

Roberto: And I loved—

Trevor: Even though I don’t know what the album and I love Queen.

Roberto: And I was eight at the time, but I loved that song. I still love that song, Another One Bites the Dust. All I know is I put that on and I could suddenly start writing, having that extra stimulation actually activated me.

Trevor: Yeah, electronic music helps my brain.

Roberto: Yeah. And my dad was like, “You can’t listen to music while doing work. You’re not paying attention.” I said, “Dad, all I know is once I put the music, I was able to focus and concentrate.” What I credit him for is in that moment he could have said, “No, the music is being shut off.” He could have taken the tape recorder away. But he said, “You know what, I’m going to wait 10 minutes and see where you get. And if you haven’t written more then it’s not working.” And when he came back, I almost had it done. I was like ... And he said, “Okay, I guess ...” And that is what I’m so grateful for because a lot of times it can be hard to understand that and he could have easily done that and I wouldn’t have taken lightly to that. My brother, my sister were more obedient that way.

I would have just not done the essay. I would’ve tried to take the tape recorder back, it would’ve been a fight. And so that ... And now with my son, and I have a daughter as well, she doesn’t have ADD, but I’m recognizing that it’s not identical, obviously not an identical experience because we’re two different people, raised in two different times. But namely he is growing up in a household with cable and with the internet. And let me tell you, if I grew up with the internet, Oh my God, it would have not been a good thing I would have. I don’t think I would’ve ever slept just watch videos, YouTube videos of rock stars being interviewed.

Trevor: We need to wrap up. But if you could, could you provide some simple or maybe some of the most effective strategies that you know for people who are working with ADHD?

Roberto: Yeah, I would say in general what the treatment really is, is externalizing all of the things that internally are difficult for people with ADHD. So, for example, if it’s time management, using clocks, writing stuff down, if it’s issues with impulsivity, trying to help somebody ground themselves and stimulate, things like fidget toys can be very helpful as long as those themselves don’t become distracting. And so, especially for kids, it’s super important for parents to work with their kids and with schools to provide the right accommodations to help kids be able to be grounded, so that they can pay attention. These are not kids that are looking to be troublemakers, even if they’re getting out of their seats or whatnot. It’s that they’re trying to just kind of stimulate themselves and or ground themselves at the same time. And so having external ways of, of doing that.

There are lots of great resources. Medication can be also super helpful for people with ADHD who have issues where they don’t feel they even have a decision in being impulsive. That sometimes they’ll say that when they take medication, they feel like for the first time they have a pause button. And that could be very helpful and it’s not ... You’re not a bad parent if your child is on medication for ADHD, you’re doing whatever is going to help them in the long run, be successful.

Trevor: Right. Yeah. When I first tried Ritalin, that’s what it was. It was a pause button and it helped at the time.

Roberto: Yeah. I mean, if you think about what the power of that in social situations, I mean, lots of people with ADHD have problems socially, where they can be socially impulsive, where they’re not processing cues very well because they’re onto the next thing. Where they might interrupt people and not mean to, and they’re not interrupting because they think what they have to say is so much more important. They’re interrupting because they’re going to forget what they’re about to say. And so they’re just going to blurt it out. So the power of the pause has such a huge impact for a child socially or adults, socially.

I worked with a family where the child at four was on medication. The parents felt so guilty, but this was a kid who was almost hit by a car four times. He was so impulsive and when he was on medication, his personality was exactly the same. He was this fun super precocious kid, but he wasn’t running in the middle of the street. He was eight. If his ball ran into the wind to the street, he thought, “Oh, I shouldn’t run out in the street, because a car could come.”

Trevor: So is that ultimately what ADHD is? Is that ... Well, no, it can’t be. But is that a large component of it? Is not having a moment of pause to assess the situation prior to acting?

Roberto: Yes. That it’s a way you’re not regulating your attention to the degree with ... And this is especially true for hyperactive, impulsive types where they’re able to make a decision based upon future consequences. So it’s like, “If the ball runs in the middle of the street, I want the ball, so I’m going to get the ball.” Versus, “The ball’s in the street. I want to get the ball.” However, the pause is, “A car could come down the road and hit me and that is a bad consequence or something else can happen.” Or, “My teacher is making me mad. I want to tell them to go whatever themselves, but I’m not going to do that because that won’t.”—

Trevor: Screw themselves. Is that what you’re looking for?

Roberto: I was thinking of a lot of other—

Trevor: Yeah.

Roberto: “But that won’t be good for me. That doesn’t work for me.” So people with ADHD have a hard time managing sort of sometimes their behavior because their time horizon is more myopic. They’re not thinking about ... They almost can’t see the future in that way. And so that’s where a lot of addictive and impulsive behaviors, binge eating. It doesn’t have to be substances. I’ve worked with people with porn addiction, food addictions, who also have ADHD, and they talk about that thing of this instant gratification. Dopamine raising, which we know medicates that low levels of dopamine in the ADHD brain. And then it’s after they’re thinking, “Oh, that wasn’t a good decision to make.” And they rationally know that. But it’s just that pause isn’t there a lot of the time.

Trevor: So let’s say tomorrow The Cure makes an announcement that they’re going on tour and they’re playing Disintegration and Pornography back to back in completion.

Roberto: Okay. My dopamine levels are rising right now.

Trevor: Okay. Abba is opening. Doesn’t make sense but they’re opening. How quick is your response to that? Do you even look at the price of the ticket?

Roberto: No.

Trevor: No.

Roberto: So, this is ... I mean, it’s—

Trevor: I’m actually trying to make a point, there, isn’t your passion for these two groups and your love of this music is eclipsing your logic and quite possibly your bank account.

Roberto: Yes.

Trevor: Is that possibly what is a component of ADHD, is to not ... Is it passion unfurled?

Roberto: Yes. I mean, I had no sense of money-management when I went to college.

Trevor: I still don’t.

Roberto: And my dad, my parents were so fiscally responsible and—

Trevor: So were mine.

Roberto: It’s of no fault of theirs at all. I went to college, got an ATM card, and I remember my dad calling me and my dad was the happiest person, so he just had to not sound happy, to sound mad, and he never yelled or anything. And so he said, my nickname is Beto in my family. He said, “Beto, you over drafted on your account?” And I was like, “What does that mean?”

Trevor: Oh, that was my entire college—

Roberto: I was like, “I don’t understand.” He’s like, “It means you took more money out than I put in.” I was like, “Oh, okay.” The next week I would do it again.

Trevor: Again. I did it all the time.

Roberto: And it was not deliberate.

Trevor: No.

Roberto: I mean, I honestly ... That’s one of those things I look back on. I thought, “What was I think I really did not appreciate or understand that that money coming out of this machine is money that my parents are putting into it.” I really didn’t get that concept. So, when my kids, I want them actually to have some kind of credit or debit card in high school that we’re going to manage because I don’t want them going off to college and have that be their first experience with free money on a card. Again, I don’t blame my parents for that, but I grew up where my mom to justify, because she’d rarely spend money on things. But if she did splurge on something, she’s like, “Oh, I don’t smoke, I don’t drink.”

So, I say the same thing when it ... My wife is aware of this. When it comes to concerts, my daughter doesn’t know this yet, but her and I are seeing Taylor Swift. She’s a huge Taylor Swift fan. We saw her a couple of years ago.

Trevor: I like TS. I’m not going to lie. I kind of dig her—

Roberto: Epic concert. Epic. She is an amazing ... And we’re seeing her at Gillette Stadium in July and I—

Trevor: 1989 should not be as good as it is.

Roberto: Yeah.

Trevor: That album, it just shouldn’t be. And it’s great.

Roberto: I said, “These are going to be pricey tickets, and I don’t get crappy. I can’t get crappy concert tickets.” So, for that ... But I work hard to be able, I don’t ... It would be one thing if that were the thing, mortgage or concert money. But that’s the thing. Whereas things like a car, I don’t need the fanciest car. Those aren’t things that ... As long as it gets me from point A to point B. I’d like a nice suit, but I’m not ... I’ll go to K&G, so I budget in those kinds of ways, but when it comes to my passion with music, it’s—

Trevor: Okay. So, The Cure, Pornography, Disintegration, back to back. Abba’s opening, nosebleed seats at the garden are 1,000.

Roberto: I’m not going to take a nosebleed seat.

Trevor: Okay. So, up close is 3,000.

Roberto: 3,000 might be a lot, but if you told me it was their final tour—

Trevor: I didn’t say it’s their final tour. I said, they’re playing Disintegration, Pornography, back to back and Abba’s opening.

Roberto: And if you throw in the Go-Go’s.

Trevor: Three grand.

Roberto: It wouldn’t be ... I once flew to San Diego to see the Go-Go’s, just to see the Go-Go’s. Last year was their 40th anniversary. I would do that and I was like, “Why not? I’ve never seen San Diego and ...”

Trevor: It was really nice having you here, Roberto.

Roberto: Yes. Thank you for having me. This was great—

Trevor: Yeah, it was really great. We barely scratched the surface. Maybe we can have you back sometime down the road to talk about body dysmorphic disorder specifically with men.

Roberto: Absolutely.

Trevor: I think that would be good.

Roberto: Definitely.

Trevor: It was really nice having you. I really appreciate it.

Roberto: Yeah. Thank you, it’s a pleasure.

Trevor: Thank you. Thank you for listening to Mindful Things. The official podcast of McLean Hospital. Please subscribe to us and rate us on iTunes or wherever you listen to podcasts. If you have any suggestions for special topics or future guests, email us at mindfulthings@mclean.org and don’t forget mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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