Effective Strategies To Help Children With ADHD Thrive

Episode Transcript

Dr. Nicole Beurkens: 

Hi everyone, welcome to the show, I am Dr. Nicole, and on today’s episode, we’re talking about ADHD in children and adults. You know, ADHD continues to be one of the most commonly diagnosed conditions in children. And more adults are being diagnosed, as well. We’ve had a lot of new research in the last several years that allows us to better understand ADHD symptoms, the ADHD brain, underlying physical and neurological components and effective strategies for supporting people with ADHD. There are actually many strengths that people with ADHD bring to the table and I’m a firm believer that when we recognize the uniqueness of each child in their abilities and their challenges, we can help them to thrive. To explore all of this with us, I’m thrilled to have Dr. John Ratey on the show today. Let me tell you a bit about him.

He is an Associate Clinical Professor of Psychiatry at Harvard Medical School and an internationally recognized expert in Neuropsychiatry. He has published over 60 peer-reviewed articles, and 11 books, including the groundbreaking ADHD “Driven to Distraction” series with Dr. Ned Hallowell. With the publication of “Spark:The Revolutionary New Science of Exercise and the Brain”, Dr. Ratey established himself as one of the world’s foremost authorities on the brain-fitness connection. His new book, ADHD 2.0 delves into the new science around ADHD and essential strategies for thriving with distraction from childhood through adulthood. He has been rated by his peers as one of the best doctors in America, he has been honored with the award for Outstanding Psychiatrist of the Year for advancing the field, and he has been frequently profiled in the media. Dr. Ratey is also a father to two grown children and has grandchildren. I’ve long been a fan. Dr. Ratey, welcome to the show.

Dr. John Ratey:

Thanks for having me, I look forward to telling people about our new book!

Dr. Nicole Beurkens: 

It’s exciting because as I mentioned, in the intro, we’ve got so many kids and even adults now with this diagnosis. I’m curious, as we start to delve into this, how you got interested in ADHD because really, a significant portion of your career has focused on understanding and researching, and providing strategies for this population.

Dr. John Ratey: 

Well, it was way, way back. Actually, the end of the 70’s, beginning of the 80’s when I began to see people who were very sick and had a history of learning and attention problems. They weren’t called that back then as much, but learning problems, certainly, and it needed up with all kinds of other diagnoses in hospital and went on to various treatments: Depression, addictions, anxiety and various other disorders. In delving a bit deeper, I found that a lot of them as kids had attention problems and problems in school, problems with learning. And this led to a difficult life for them.

So I began to talk about it, think about it and one day a person came to see me who was a professor both at MIT and at Harvard, and a really renowned author and speaker. He said, “Look, I haven’t been able to do anything lately because I had to stop running, which I had done all my life, because I have a knee problem now.” So he was rehabbing that, but in the interim he first got depressed and then had all the symptoms of attention deficit disorder as an adult. This was very new and different. So I began to treat him, he got better with some medicine, but then his knee got better and he began to run again and his ADHD symptoms went away. So it began two careers for me: One pursuing ADHD, the second, always paying attention to the incredible benefits of exercise. So it’s led to my career basically, and along with the pursuit in ADHD, I began to really delve into how the brain works and what the brain is doing and not doing in so many of our disorders. 

Dr. Nicole Beurkens: 

Absolutely, and you’ve contributed so much to the field and I think particularly in that area of fitness and exercise and physical movement, and how that connects to how our brains are functioning, and I want to circle back to that a little bit. Let’s go into really talking about ADHD, how you define and understand ADHD, because I think that there are a lot of things in pop culture we flippantly talk about, “Oh, you know, kids who can’t pay attention” or “Oh, I’m ADHD, I can’t get things done.” But really, you have a great way of distilling the research and describing what ADHD really is and also, you tend to have a strengths orientation to ADHD that I think is really important, recognizing the challenges, but also the strengths of these individuals. 

Dr. John Ratey: 

Exactly. I think that’s what we’ve always focused on because both Dr. Hallowell and I have the trait of ADHD which we relabeled as the Variable Attention Stimulus trait in our new book. We basically try to de-pathologize so many people who are now called ADHD, and in fact, it really isn’t a deficit of attention, it is in fact an overabundance of attention that people with ADHD have, or a variable trait. We all have this trait of variable attention and we’re always looking for something to pay attention to, and this is what we really emphasize in our new book to sort of de-pathologize and make it a much better way of understanding. Dr. Hallowell was big on saying we have to teach people to open their gifts, because so many of the gifts of ADHD, if not managed correctly, are pathologized. And the people that manage them correctly have a super life. They’re entrepreneurs. Leaders in so many fields have ADHD for sure, but they’ve either through luck and good parenting or good connections as well as having high IQs, which makes things easier, but they have to get behind it and therefore use their traits, which is to use their passion and develop it in a way that they can profit greatly. 

Dr. Nicole Beurkens: 

I think that that’s such an important perspective, and it is one that unfortunately isn’t shared with a lot of children, teens and young adults with ADHD. I see so many parents and kids who come into my practice who have gotten this label or they’re having their challenges, and as you said, there’s so much pathology and negative around it. And I’ve seen so many young adults who were diagnosed as kids, who really, this has sort of defined them, not in a strength-based or positive way, but sort of this, “Oh, this is what I have and I can’t do things.” I think that unfortunately, we’ve really, in a lot of ways, perpetuated that in kids to their detriment.”

Dr. John Ratey: 

Yes. They begin to think of themselves as defective and bad, and so much of the time not being able to hold their attention and not being able to control their emotions and impulses. They get into weird behaviors and antisocial kinds of behaviors or just being too impulsive and not being able to sit still and not being able to complete a task. So they begin to develop a poor self-image, poor self-esteem. When we used to debate all the time whether medicine was useful or not, or whether it led to long-term deficits or long-term brain changes, it was easy for us to say, “Well, look at what not using medicine can mean for certain people, certain children.” The brain changes that come about from having a poor self-esteem, having a depressed mood or a glum look on life really changes the brain. And in a way that leads to all kinds of difficulties later on in life that we’re all too familiar with. So in our new book, we really emphasize that, looking at ADHD in a positive way. To look at the traits that are useful and develop strategies that really help us perform maximumly in our lives. 

Dr. Nicole Beurkens: 

Absolutely, and I think that really gets it, especially when we’re talking about children and teens who are still living as part of family units with parents, with teachers, spending a lot of time. That really necessitates us as the adults, understanding more of what it is that’s going on so that we can provide appropriate support. So I want to go back to that term that you used, the Variable Attention, and that trait. I’d like to have you unpack that just a little bit more because I think that’s so key for parents, for teachers, for any adult in these kids’ lives to understand that because so often these kids get blamed for, “Well, you can pay attention when you want to!” Or “You don’t feel like doing these things in school so you’re not doing them. This understanding of really what’s going on with being able to focus and attend, and the variability of that, I think that’s really important for people to understand. Can you say a bit more about that?

Dr. John Ratey: 

Yes, I think it really is — they are on the far end or the end of the spectrum of variability of attention, and they need to learn how to manage it. The family can be a great influence. We talk about reimagining the environment to help the intention stay focused. Doing whatever, learning quickly what helps, what kind of environment helps a child or the adults stay with their attention, whether it’s listening to Greenday while they’re doing homework or in a quiet space. It will vary from person to person, we’ve known that. Whether it’s finding — we have a chapter called finding the right difficult, meaning ADHD people love challenges, and the idea is to really put them in a situation where they can have a continual challenge that they will embrace and get excited about and perform well. They may not right away be a reader, but Dr. Hallowell, for instance, had dyslexia as well and he was a horrible reader at first, but a patient teacher helped him begin to read. But he got into poetry, believe it or not, as a kid. And this helped him love words. That’s very difficult. It led to his career as a writer and now he has written 20 books or so, but it’s finding the right difficult. Finding the thing that will turn you on and keep you engaged, which is really, really what’s important with an ADHD child that can lead to success. Something, a hobby, an interest, video games, which are a big problem, but they can be something that really stimulates the imagination and simulates the child to do well. 

Dr. Nicole Beurkens: 

Yeah, it’s really this idea of looking at how we can change the environment and the circumstances to best support this child’s brain, as opposed to looking at it as there is something wrong with them and they need to fit in the box that everybody else fits in. 

Dr. John Ratey:

Exactly. And this is the advice we have for parents as well as for kids and adults, it’s doing and finding the thing that really promotes your enthusiasm and your interest, because these ADHD people and kids have an incredible store of passion, of emotional positivity that they can unleash rather than turning it in on themselves when they fail, when they’re blamed and they feel that they’re defective. Which really leads to trouble and misunderstanding of who they are what they have and by really engineering the environment correctly and helping them find that passion and develop it and support it, it can help all the other difficulties diminish a bit. But also the enthusiasm will be there to help them meet new challenges. 

Dr. Nicole Beurkens:

Yeah, and let’s face it, we all, as human beings feel better and function better when we feel competent with something, right? Even if we have one thing that we just can feel really good about ourselves and our abilities in our lives, that goes a long way, regardless of the diagnosis. 

Dr. John Ratey: 

Right, right. We know, and Billy Crystal in one of his movies, I forget what it was, but there was an old cowboy that he was meeting there who said “Finding the one thing.” The one thing that keeps him motivated, that keeps him focused, that he wakes up for in the morning. That was his secret, to this cowboy’s long life. Finding the one thing, whatever that might be. And it really does help all the rest of life go much, much better. 

Dr. Nicole Beurkens: 

Absolutely. I want to come back in a minute to some of the specific strategies that you advocate for and that you talk about in the book, but before that, I just want to touch on — I’m curious, because you and Dr. Hallowell in the book pull together a lot of the newer most current research about ADHD. Obviously we don’t have time to delve into all the specifics of that, but I’d love to hear what you think, having spent such a lengthy career in this field, what do you think is some of the most exciting or interesting new research that’s been done in this area, or insights that we’ve been able to get from current research? What are you most excited about in that realm?

Dr. John Ratey:

Really, what in part stimulated us to write the book was the finding that was emerging in 2006-2007 about the way we understand the brain differently. I had written a book in the 90’s about it called The User’s Guide to the Brain, so I thought I knew quite a bit, but things changed radically as we began to use the FMRI, which is a way to picture the brain moving or acting. And then we discovered something called the Default Mode Network. When you send a patient or a person into the FMR scanner, the first thing you say is “Just lie there and do not think of anything. Just let your mind wander.” Well, it came to pass that seeing the mind wandering across everyone, that there was a specific signature, a specific activity in certain parts of the brain that were linked, and we call this the Default Mode Network, and it became a very big deal. Then we began to look at the brain as a series of networks, and one of the major ones for ADHD is the Task Performance Network, which has to do with the executive function area, but paying attention and staying attention so that we can function, so we can do a task. And what we’ve learned is that in most of us, most non-ADHD people, or non-variable attention folks that have trouble, when you turn on the task performance network, when you’re trying to pay attention, the Default Mode Network shuts up, it goes down. It’s no longer as active. Still there, but it’s no longer pressing.

Well, with ADHD, it continues to press. It doesn’t shut up. One person said “It’s always blah, blah, blah, blah, blah.” Talking in the background to you and pulling you away from your performance, from your task, from your attention, if you will. It wants you to pull into this default mode, which is a store of past memories and current wishes to do, in the two parts of the brain that are linked. And it pulls you away so that you get into this mind wandering, and this can lead to lots of good things, it’s one of the reasons we think ADHD people are so creative, because they have all this store that they continually access, but at the same time, it can lead to trouble, because within that default mode, you have memories of your failures, and you can get into the hidden part of the default mode, which can lead to ruminations. When you begin to ruminate, you just begin to drive yourself down, take away from your positivity and focus on, “Oh, I haven’t done this/I haven’t done that/They think I’m bad/I am bad/I’m no good/I’m never going to success/I haven’t done anything/Blah, blah, blah.” It is blah, blah, blah. You get into that and this keeps you from performing well.

I think what was so exciting was that when we used this with our patients and we explained how this sets them up for failure, that they pay too much attention to this default mode area and don’t learn to manage it, that this can lead to the poor outcomes that we see with ADHD. Now it’s interesting that the use of medication, meditation and movement really helps correct this, what we call, this glitch connection between the two different major networks in the brain that is not quite a smooth transfer and it keeps one on, etc. But the big treatments, meditation, movement and medication, which we know, all help in a very big way impact ADHD and symptoms, and make us more in control of this connection. So this was revolutionary for me because I had spent so much time worrying and learning about the brain, and it makes so much sense and it makes so much sense to our patients when we explain that the default mode sort of acts as a magnet to pull you away from your attention. And what you need to do it is learn how to manage that, and to learn that this is what’s going on and that this is part of the big problem that people have. 

Dr. Nicole Beurkens: 

That is such helpful information and gives those of us who don’t have that challenge much better insight into what’s going on, and I think, as you said, it’s so powerful for kids and adults alike to understand: “Oh, this is actually what’s going on. This is why I’m struggling with this.” Because I think so often, people, even from a very young age develop this idea of “If I just tried harder/This is a choice that I’m making.” It’s like, no, there is actually something real going on here in your brain that’s making this difficult, and I think just understanding that is really empowering and therapeutic in and of itself. 

Dr. John Ratey: 

Exactly. And one of the things that certainly, I’ve focused on, is the use of exercise to help the brain in general, but certainly to help correct that, and we have a whole chapter in our new book on a little appreciated part of the brain called the cerebellum, which is about movement, management, making our movements smooth and coordination and balance. This part of the brain has gotten in the past 15 years or so, much more interest in the neuroscience community, because it used to be just thought of as a movement vehicle or a part of the brain that’s all about movement. But it’s all about everything in terms of balance and coordination of our higher brain functions, and especially attention, and the reason why we could really change it. So by doing balance training, yoga, martial arts, ballet, gymnastics, you are training your cerebellum. Standing on one foot, doing various balance exercises can really make a big difference in your attention, and it doesn’t seem logical or it doesn’t seem immediately or intuitively obvious but it really has an impact. And we just completed a study with a group of very autistic adolescents who we put through a very rigorous balance and coordination training sequence and it led to big improvement in their attention and their social attention as well. So we know this happens in all of our kids and adults. By training up your balance and coordination, your attention improves.

And I think this is another one of the big elements in our new book, as well. What we talk about and talked about all along is the healing power of connection, which I know you emphasize a lot, which is terrific because we know that connection, being connected to one another has so much powerful positivity, healing nature, preventative from getting sick to getting depressed or getting anxious. The more we have good connections, the better our lives work, as well as, in our book, talking about it, for our attention. The better connections you have, the more attention you’re likely to have. So by emphasizing for parents to be very positive about their kids, very moving, very encouraging, letting them know, especially if they’re having difficulty in school with other kids, letting them know that you still love them. Holding them, touching them. all the things that I’m sure you emphasize in your general wellness agenda, but it’s really important. It’s not just a good thing. It’s a healing thing.  

Dr. Nicole Beurkens: 

Well, I am so glad that you raised that specifically about how it connects to attention because I think there is more of a general recognition that from an emotional standpoint that’s beneficial, focusing on human connection and love and empathy and those things. But the fact that you’re emphasizing that yes, that’s all true, and that it’s critical for supporting attention and focus on how the brain is functioning, I think that’s new information for a lot of people.

Dr. John Ratey:

Right. And especially in our time of COVID. It’s one of the areas that I have been really focused in out of created and continued wellness within COVID, and why? Because it really is important to — and you have to work at it, it’s not something that just will happen. You can do video games or you can do Netflix or do as many things to watch as you want, but the more connected you are, the better the result of your life. And it’s so important and very important for the attention system.  

Dr. Nicole Beurkens:

The piece that you were talking about with this too, about how important it is for parents to work on strengthening their connections with their child and giving that support and that encouragement and that unconditional love, I think that that’s so true, and I would extend that also to people who other adults in the child’s life, and I’m thinking particularly about teachers and other educational staff and people in the child’s life because I’m sure you have seen this too: School, the whole educational system can just be such a challenge and can be so inherently negative for so many of these kids. And when I consult with teachers and school staff, one of the foundations that I talk about is first, what’s most important is establish a strong relational connection with these kids before we even talk about how we’re going to teach them to read or what we’re going to do with the environment or what else. We have to start with this foundation in our school settings of a strong interpersonal relationship and connection with these kids. Would you agree with that?

Dr. John Ratey:

Oh my gosh, yes. It is so essential. And it’s hard with a COVID world right now because it is even more important to have that connection, and so parents have to supply more of that kind positivity because it is so hard with the Zooming and the Zoom chats or whatever, the remote learning. Before, you were in the same classroom and that could really — that really helps. So it’s worse for our ADHD kids or kids that have this variable attention. They need even more so, that reminder that they’re valuable and loved and that yes, they may have differences, but they’re still wonderful and you need to work on expanding the time spent letting them know that.

We have a wonderful vignette in the book where Ned worked with this child, they never met, in China, and worked with the mother to sort of not only give them balance exercises everyday, but to hold him warmly, embrace him. He was doing worst in his class at school, and now, after two years, is among the top students in a very difficult school. It helped actually change the school because mom went in and informed the teachers of what he needed, not just criticism, not just pointing out his bonehead answers, but to supply him with a lot more love and consideration. It very soon helped him become one of the better students in the class. So you know, it’s really true. This really works. We know, I could go on and on about the value of connection. It’s even more important than taking your medicine as you age. It keeps you away from the healthcare industry. It keeps you away, and it’s amazing. It’s 3 times more powerful than exercise, which is twice as powerful as taking your medicine as you age, and you need medicine for whatever. It’s really, really crucial. 

Dr. Nicole Beurkens:

It’s amazing. We take those things for granted. In our wider culture, this gets dismissed as, “Oh, sure, positive connection. Sure, exercise, yeah, yeah, yeah, those are important.” But then when we get down to developing treatment plans or thinking about how to support a person with a particular diagnosis, we tend not to focus on those as the key interventions. We think of those as, “Well, yeah, those are helpful, but let’s really get to the target of the real strategies, and it’s like, wait a second! These are the real strategies. These are the foundations. And as you’re pointing out, not just for ADHD, the beautiful thing about these things is they support all of us with everything. 

Dr. John Ratey:

Exactly, and that’s what the pursuit of wellness these days is something that every person in the universe should be involved with because it supports the immune system and helps us target COVID directly and helps, and in general keeps us in the positive space that we all need to be in to face this change in our lives. 

Dr. Nicole Beurkens:

Absolutely. So we’ve talked about the critical importance of movement, of that physical activity, of balance, of those pieces of things. We’ve talked about this importance of connection. One more area I’d like to touch on before we wrap up, and you mentioned it early on in our conversation: The importance of creating an environment that supports the person to be able to manage and regulate that attention trait, that variable attention more productively. My mind goes to lots of things, ways that we can structure things and change the environment both at home and school settings. I’d like for you to talk about that a bit more and maybe a couple of things that you think are particularly relevant for these kids in terms of how we create a supportive environment for them.

Dr. John Ratey:

Well, in general, I think you need to establish some structure that the child can depend on. To try to make it, not in a militaristic kind of way but in a real productive way. To have times to do things. To start things. Not to finish. But to do things, to begin with. This is really important to identify that and to help structure the way the day goes. A time for exercise, a time for balance training if you’re into that, a time for jump rope, and for instance in the school setting, if the child has difficulty paying attention to whatever, they use 5 minutes of exercise, of jump rope or calisthenics or push-ups or squats or running in place or jumping jacks to get their brain ready to pay attention and really, setting up the environment in a way that promotes the focus and attention. So as I mentioned, some people need more activity. They do best doing their homework at the kitchen table, others squirreled away in their room without much interference. It’s all different. You have to analyze the situation for each child. So I think in general, those are key factors in helping the attention stay focused.

Dr. Nicole Beurkens:

I think that’s really relevant too. You know, one of the things that parents have been struggling with over the course of the pandemic with many kids being home now and doing their school from home and being on the computer is this figuring out of what’s going to work for each child, particularly if they have a child with ADD or ADHD or any of the whole realm of neurodevelopmental challenges, figuring out how to structure things, how to work in that movement. Obviously that’s really important in the classroom, and that’s on parents now too for figuring out how they support their kids in engaging with and keeping up with the things that they need to do for online school, so I think all the things you just talked about are really relevant for families for that reason right now too. 

Dr. John Ratey:

Right, and I think successful schooling over the internet, I mean to have frequent breaks but not just breaks to sort of go into their default mode, but breaks to do exercise or to do fun things that involve movement and then come back and be able to settle in. I think yoga is a great activity and even two or three minutes of trying to adopt a posture and stay with it can really promote their attention for the next 15 minutes or so of their lesson, to really — basically, it’s a free way to build the focus muscles in the brain. So it’s using all these tricks. Then of course, one thing — we also have a chapter on medicine, we talk about it, and the medicine is important. It’s very important for some kids and for some adults. It can really be life-changing. But not to shy away from it, not to avoid it, but to use it in looking at it as part of the program because it’s not just the only thing. It’s one part.

Dr. Nicole Beurkens:

Yeah, and I think the way that you talk about that through the lens of looking at the uniqueness of each child and what’s going to be important and appropriate for each child, there is certainly no one-size-fits-all for any of these things in any of us as human beings, right?

Dr. John Ratey:

Right. We’re all variably different, which is the wonder of the universe. 

Dr. Nicole Beurkens:

That’s absolutely right. This has been such a wonderful conversation. So many excellent insights and strategies. I want to make sure that people know where they can find out more about your work and also the book that is out now, ADHD 2.0?

Dr. John Ratey:

I would like to say your bookstore, but who goes to bookstores? So Amazon or other online purchasing, Google and various other areas that sell stuff online. But we obviously worked with Amazon for a long time and our books are there, you can preorder it today or order it, it will be out on the 12th, and I think it’s a very valuable tool that people need to sort of incorporate with it all. And also, my website and Dr. Hallowell’s website. Also, I have, for those of you who are specifically interested in exercise, I have a Facebook Page, John Ratey, MD. that every day we post a new article on the popular press that’s usually a takedown of a new research or a new way of benefiting, usually the brain or the person in general, and a lot of it has to do with ADHD and learning problems as well as mood issues, which are so important, especially these days.  

Dr. Nicole Beurkens:

That’s such a wonderful resource on your Facebook page there. I also just want to promote, while all of you listening are going to whatever place you’re going to online to purchase ADHD 2.0, I want to make sure you also consider putting the book Spark in your cart as well. Because that, Dr. Ratey’s book, Spark was really so influential to my thinking about movement and exercise and the brain, and I’ve had so many parents and patients and educators over the years who have found that beneficial, so I want to put in a plug for that book of yours as well. I know it’s an older book now, but still very relevant. 

Dr. John Ratey:

Oh yeah. It’s still — in the Asian countries where they believe in science, it’s a best-seller. In Japan, in Korea, in China because it does pack the science for how exercise really works in the brain. 

Dr. Nicole Beurkens:

Yeah. It’s amazing. Dr. Ratey, thank you so much for taking time out of your busy schedule to be here with us today, to share all of this with it. We really appreciate that and congratulations, again, on the new book.

Dr. John Ratey:

Well, thank you for having me. Loved the interview, so thank you. 

Dr. Nicole Beurkens:

And thanks to all of you for listening, we’ll catch you back here next week for our next episode of The Better Behavior Show.