What is the cause of ADHD?

Devon: [00:00:00] Hi there. I’m Devon and I’m your host for the new podcast, Dr. D on ADHD. The show where we’ll be breaking down attention deficit disorder with Dr Dismond. Today we talk about his background in medicine, how Dr D sees ADHD, what causes ADHD, and a handful of other interesting things. This is episode one.

[00:00:21] So, before we dive into ADHD, can you tell me a little bit about your clinical background?

Dr. D: [00:00:27] Sure. I was born in Michigan. I actually Flint, Michigan back in the day when it wasn’t so bad. I was fortunate. when I was on a conveyor belt for brains, I got, I put my finger in the gear and got an extra helping.

[00:00:38] So I was fortunate enough to get a full tuition scholarship to the university of Michigan medical school. I did some post graduate training at the,Catholic hospital associated with university of Michigan. And then I was fortunate enough to get a fellowship from the Kaiser family foundation to do two more years of a postgraduate work at Stanford.

And then for the past 30 years, I’ve been a practicing primary care and, mostly to people who don’t have access to high quality care, people with low income, no income, homeless, and working people. Uh, not,entrepreneurs so much, but the ups driver, the post office worker, the Tesla line worker, engineer, um, families.

[00:01:30]The biggest joy I got when I first started working in the Bay area was families would invite me during the holidays. It’s little school failing practice to their house for the holidays. And I would go, cause I treated the whole family. I’ve had the pleasure of, uh, taking care of an infant all the way up through her graduating high school and going to college, and she would send me letters and keep me posted on, how she’s doing.

I met her very first boyfriend. So at that, you know, old school family practice.

Devon: [00:02:00] Wow. Yeah.

Dr. D: [00:02:02] 30 years of that. Very rewarding. 

[00:02:04] Devon: [00:02:04] So how did you get there from Family practice into ADHD?

Dr. D: [00:02:12] Just, I met some very nice men who had the idea. They saw that, people with this particular sensitivity were not getting high quality care. And, I’d like to think that my reputation proceeded me a little bit. So they, chose me to help them out with this project. And so, we are putting together concierge care, for people who have the sensitivity and wants something different than the systems providing.

[00:02:44] Devon: [00:02:44] Can you tell me about your ADHD, philosophies when it comes to diagnosis? And I’ve heard, various types of treatment from medication to ADHD coaching. Is there a difference from coaching and therapy?

Dr. D: [00:03:00] Yes.

Devon: [00:03:01] What some of your philosophies?

Dr. D: [00:03:04] So I’m an evidenced based doctor. I feel very self conscious about winging things.

[00:03:10] So, I like to keep up on the literature and I like the feeling of using something that if the patient asks me, “Why are we doing this?” I can point to a journal article that they can read themselves. I like that. And so,  there is very little research supporting using therapies, any kind of talk therapy coaching to directly help the sensitivity that goes with being on the spectrum. Okay. Medication is the only thing that reliably helps people turn down their sensitivity so that they can get done the things they want to do. Now, being a sensitive person in this culture is really difficult. Uh, from the get go, we’re dealing with a lot of emotions.

[00:04:09] Most people don’t know that we have, and most people don’t feel because they’re not sensitive. Okay. So, having all those emotions, most of which are not resolved, coming from family members, from friends, from the educational system, from lovers, that’s really difficult. And so, what has been demonstrated to help is talk therapy for unresolved, held in emotions, things that are trapped in our bodies. Mindfulness therapy, personal coaching, cognitive based therapies.

All those have been proved to be very beneficial for dealing with the emotional injury from being a sensitive person. But, it doesn’t help the sensitivity directly. So, if a patient is coming to see me, I do as much as I can to help with the emotional sensitivity. Um, generally that requires,  face to face work. Um, we have some patients that schedule phone calls. They feel comfortable talking on the phone. And so, I’ve spent an hour at 3:30 on Sunday in the afternoon talking with the young, patient who is sensitive and helping her get the emotional support she needed. And people seem to appreciate that.

[00:05:48] So as much as I can, I do both. But, my eye is very clear that the mindfulness talk based coaching part is for emotions and that medication is consistently been the only thing that helps people with the sensitivity.

Devon: [00:06:11] So how do you see ADHD? What is ADHD through your lens?

Dr. D: [00:06:18] First of all, as a rule. I do not call it ADD or ADHD.

I refer to sensitive people who meet the clinical standard as falling on the attention disorder spectrum. Because it is a spectrum. Anybody who has worked with sensitive people, who’s thoughtful and sensitive themselves, even just a little bit realizes people don’t fall into neat categories when it comes to these kinds of things.

[00:06:52] It’s not like having strep throat, you know, either have it or you don’t, or being pregnant. You either are or you are not. Uh, these kinds of things fall on a spectrum. And so, approaching sensitive people with a “One size fits all” attitude is asking for frustration, um, hurt feelings. Of course, for the patients, feelings get hurt. Misunderstanding, and just not a good experience. So I approach,  people who suspect they have a problem with attention and the amount of activity they feel in their body, the energy they feel in their body, just as a sensitive person. And my focus is on quality of life.

[00:07:48] And I start there. It’s like, “Okay, is your sensitivity getting in the way of something you genuinely want to do?” And then we jumped through the hoops. And if, a sensitive person meets the criteria for the quote unquote “Category of ADD/ADHD” , then that means they are entitled to use stimulants. Very powerful stimulants.

[00:08:20] As a means of helping them dial down their sensitivity so they can do the things they desire. And that pretty much summarizes my view on so-called ” ADHD and ADD” I refer to it as “ADS – Attention Disorder Spectrum”. Someone falling on the ADS.

Devon: [00:08:47] If someone thinks they have ADHD, what should they do?

Dr. D: [00:08:52] Oh, yes. They can come on in. I think they should come in and have a discussion with me or someone like me. And it’s not, it’s not to get the money. It’s, important to get the information and perspective, a different perspective about falling on the attention disorder spectrum.

[00:09:19]I promise you ll get an unvarnished, description of why the healthcare system has failed you thus far. You the patient thus far. The difficulties with getting the powerful stimulants, you’ll get an unvarnished, no bullshit, accurate explanation of why things are difficult with scheduled medications.

[00:09:48] The prescriptions for stimulants. And most importantly, if we jumped through the hoops together and it turns out you meet the criteria to get the clinical diagnosis. That’s valuable because now you are entitled to all the protection of the Americans with Disabilities Act. And that’s a nice thing you can have in your pocket if you’re having problems at work, uh, in particular, they have to accommodate you.

[00:10:18] If you, can demonstrate that it’s, the problems are because of being on the spectrum, they have to accommodate you. And if somebody subsequently treats you badly, get an attorney. I know lots of attorneys that’ll take that case quickly. Now, doesn’t mean you have to disclose it and you don’t have to get on treatment.

[00:10:43] Coming to see me doesn’t put you in a funnel and you’re in a now in a tube from what you can’t escape. That’s not the case. You can decide to not pursue treatment. You can decide not to do anything else. And just keep the diagnosis in your pocket and it doesn’t get reported to anybody. You don’t have to disclose it, but it’s in your pocket and you can pull it out if you need it.

[00:11:11] So, that’s why I think it’s important to convince yourself if you do have this, at least allow yourself to be entitled to all the benefits provided. Sensitive people who fall on the ADS.

Devon: [00:11:27] Yeah. You mentioned that, uh, somebody should go to you or someone like you. Can you identify what to look for if you need to seek help?

Dr. D: [00:11:41] Well, first of all, um, I think people will find there’s a variety of machines and devices out there that proport to diagnose. whether determine whether someone falls on the spectrum, and there is absolutely no clinical literature that supports the use of those machines. And they typically are pricey.

[00:12:06] The visits are pricey, and so it’s pretty easy to conclude that there’s another motive involved. It’s like, you know, the interest is not in helping you. It’s in making some money, and the marketing ploy is his fancy machine. Okay. That’s a possibility. Uh, the only device that has been clinically demonstrated to repeatedly be sensitive and specific for identifying people on the spectrum is a questionnaire called the Diva. The Diva 2.

[00:12:42] And so, uh, first of all. Find somebody who’s interested in spending some time talking to you and going through something like the Diva 2. And that takes time. It takes patience and time. It’s not quick, get you in, do this machine, here you go, stamp, here’s your bills. Get outta here. I mean, you know, for some people that’s okay.

[00:13:09] My experience is most people don’t like that. So, uh. Couple of things to look out for. It has to do with how much razzmatazz goes into making the diagnosis. Less is better. How much time do you get with your clinician? More is better and a follow up care. Is it easy to talk to your clinician if you have some questions 30 minutes after your visit? Is that easy or do you have to wait another month? You know, remember what your question was until you see the doc next month. So, uh, one of the things that, we take pride in the folks that are helping me with this clinical practice is our messaging system. It’s the same one used by UCSF state of the art.

[00:14:06] And, uh, we’re pretty much available. All the time. Sure. You can ping us as much as you want. So that’s important. People have a lot of questions. You know, it’s, it’s a, being sensitive in this world is not easy. So look for somebody who recognizes that and shows up to help you with it. Be convinced of that before you go see them.

Devon: [00:14:34] That’s great. Thanks.

[00:14:36] What causes ADHD? Why does somebody with ADHD have ADHD?

Dr. D: [00:14:46] That’s a good question. Most of the thinking, is that it’s genetic and these people are the, the papers that I read, um, I have the feeling that these are thoughtful scientists. You know, of course they got to get cut there, cut their bones and, uh, you know, make a name for themselves.

[00:15:09] And they are thoughtful scientists. And the feeling is it’s genetic. And I have a whole, perspective on why that genetic variation exists,  that I can go into. But to answer your question directly, state of the art is it’s genetic. It can be worsened. The sensitivity a person has, can be worsened by, exposure to, petrochemicals early on in age, and heavy metals, petrochemicals, and heavy metals.

Devon: [00:15:44] What are Petro chemicals?

Dr. D: [00:15:46]Anything made out of oil.

Devon: [00:15:48] Oh, okay.

Dr. D: [00:15:49] The black stuff that comes out of the ground.

Devon: [00:15:52] Yeah. I am interested more in your take on that. If you’d be willing to talk about it.

Dr. D: [00:15:59] yeah. So, um, mother nature or God doesn’t matter. The, whatever the massive thing is that resulted in our reality being the way it is.

[00:16:18] Call it what you want. We’ve begun to see, wisdom patterns and the most successful organisms have two opposite processes going on at the same time. There’s a process that tries to keep things the same, and then there’s a process that’s always looking for changes out there in the environment or on the inside, and being reacting appropriately to those changes, like early warning system.

[00:16:56] So there’s the, maintenance and repair system. And the early warning adaptation system. Two opposite functions. One looks to keep things the same. The other one looks for change. Okay. The most successful groups of organisms have a distribution. Like the, uh, worker bees are the ones to keep stuffed the same, that go out, do the job, come back with the pollen, make the honey clean up the nest, keep it ventilated well.

[00:17:29] And then, the queen bee and the females around her, the very small number of Unix around her are responsible for producing the various casts of bees. And I choose bees because they’re arguably the most successful species on this planet, they’re also extremely sensitive, but they’re the most successful, uh, colonies.

[00:17:56] Millions of bees successfully live together without war. It’s just remarkable. So, the thinking is that we, human beings have evolved the same way. Some of us have nervous systems that can take a, take a licking and keep on ticking. Okay. And were the worker humans, we just get the shit done and keep the system going.

[00:18:16] Other humans are extremely sensitive and they’re kind of like humanities early warning system, so if they’re uncomfortable in our society, for sure, there’s something horribly bad going on in our society. That’s just a fact. And I just flip it around for people. I say, “Okay, you sensitive person. You have $1 trillion and a blank slate and you can enlist as many experts as you want, but you make the final decision.

You design Oakland, California from the ground up, and you can take as long as you want, but you make a place that makes you happy. A city that makes you happy.” I guarantee you, I will bet every penny I own that what the sensitive person comes up with. Everybody will be happy with it. Worker people will be happy with it.

[00:19:12] The others, the other, the flip is not true. We people with the nervous systems that take a licking and keep on ticking. When we designed shit. It’s stressful on sensitive people. Okay. Case in point, it’s why you’re here today in this office, because you suspect you have, you fall on the spectrum. You’re just really sensitive.

So, my feeling is, people with so-called “ADD ADHD” are humanities gifts because if we make our environment so that they can thrive without medication, everybody will be better. And I’m not alone in this. This is not, I’m not some crazy doctor making this shit up. There’s lots of scientists, philosophers, and, cultural anthropologists that say the exact same thing.

[00:20:04] It doesn’t get any airtime because Hey, that’s, that just calls attention to all the problems in the world. But it’s true.

Devon: [00:20:12] It makes me think that, uh, the people that have moved the world along and, and have innovated two of the places that we are today have been people with ADHD with help, maybe.

Dr. D: [00:20:24] Oh,there’s no question about that.

There’s no question of that. You know, a Asperger famous Asperger Vesper burgers. He’s the one that actually started creating environments for people on various spectrums to thrive. And that called, that’s the Waldorf movement. It’s it. There is no question, uh, probably the smartest human to have ever existed.

[00:20:48] Smarter than Einstein. His name is Richard Feynman. He’s way on the spectrum. There’s no question about it. No question. So yeah, it was a lot of the grit, you know, look at a lot of the greatest artists and architects. Absolutely on the spectrum. There’s no question. Yeah. So, yeah, all the beautiful things in our life, it’s from sensitive people.

[00:21:14] That informs my practice. I like to walk my talk. That informs the way I interact with patients. I feel, that people who are sensitive deserve, and I use that word reserve avidly. I never say deserve, but these people deserve our care and attention. And so I walk my talk into practice.

Devon: [00:21:41] Yeah. What kind things do you tell people that have a lot of big ideas and they have ADHD and they just don’t know how to move forward with them?

Dr. D: [00:21:57] I encourage people to, pay attention to, our environment, particularly the environment immediately around us. That includes the people. Uh, the smells, the sounds, if you don’t like them, you’ve got to change him. Ain’t nothing gonna happen if you don’t or you can, judiciously use medications to turn down your sensitivity.

[00:22:24] And the catch-22 is sometimes when people use medication, what’s turned down is also the source of their good ideas. And so they’re really, they really have to make the hard choice of cutting off the bad people moving out of the toxic place. Drastic changes in, living standards. But the benefit is huge.

It’s a kind of freedom that few people are courageous enough to experience. And I, I view my role if somebody wants that encouragement, if they need that reinforcement, Imma give it to them. I will be your biggest cheerleader. Amen.

Devon: [00:23:07] Thank you very much for chatting with us today, Dr D.

Dr. D: [00:23:11] well, I appreciate you talking with me. Thank you very much.