Elaine Taylor-Klaus: Welcome back, everybody, to another conversation in Parenting with Impact. We are psyched to have a conversation with Dr. Gene Carroccia. Gene and I met at an International Conference on ADHD a couple of years ago when you came out with one of your two fabulous books and really wanted us to talk about it. And since then, we have collaborated many times because you've really put a labor of love into the books you've created and the work you've done, really trying to pull back and look at the big picture of what is it to treat these complex kids with ADHD. And what providers need to know what parents need to know. And truly, it's a life's work that you've done in these books. So we are thrilled to have you in this conversation and talk about mental health and complex kids, and the world we're living in today.

Diane Dempster: Yeah. So Gene, why do you want to kick us off by talking a little bit about what you do with families of complex kids? And how you ended up doing this work in the first place? 

Gene Carroccia: Yeah, thank you. Well, first of all, I'm thrilled to be back. And just really appreciate and respect, and honor your work, Diane and Elaine. Thank you for all you do and all of our collaborations. So yeah. I'm a licensed clinical psychologist, author of two books. I also write original articles that are on my website. I have a lot of resources on my website. And really what my mission has really been to share information in a very user-friendly way for families, parents, and then also providers and really try to come up with some models and some approaches to evaluate ADHD and other coexisting conditions. And how do you do that in an evidence-based way, effectively, comprehensively? And then how do you treat it? So coming up with a treatment model of bucketing the different areas and approaches and do that in a comprehensive and evidence-based way. So that's what my books and articles are really about is really advancing that information. Really trying to forward that really trying to help people conceptualize the evaluation and the treatment process and user-friendly ways.

Elaine Taylor-Klaus: And what I want to offer to people, and we'll have information about your books in the show notes. Why is this important? It's important because this condition is complicated. And in a significant number of mental health professionals and medical professionals are not yet well educated about it. And so I really want to say what your work has done is it's created a framework. Yes, there are standard protocols, but understanding them and knowing what to do with them as a practitioner is a whole different ballgame. And that's really what you've made the effort to do and have done really quite beautifully. So all that information will be available for you all. So let's talk about where we are now. We're living in this bizarre, complex world where mental health is at the forefront of a lot of people's minds. What do you think's important for us to talk about? Where do you want to guide this conversation?

Gene Carroccia: Yeah, wonderful. So current state is we have a lot of challenges. I think we all know that. But let's dig into that a little bit. Child and adolescent mental health has really deteriorated over the past two decades. And then it's gotten even worse and really accelerated during the pandemic. So there's been a great increase, unfortunately, a dramatic increase in the rates of adolescent suicide over the past year. And then, particularly with adolescent suicides, there's been over a 51% increase since 2020. So that's dramatic. That's concerning. That's really sad. There's just more severely depressed and anxious children that are needing higher psychiatric, psychological services, in addition to all the challenges that have been out there. And so it's just really, unfortunately, been a perfect storm. If we go back a little bit. If you're looking at data 20 years ago, there was an increase that was shown where so many children were underserved and were having higher rates of depression, anxiety, self-harm, and suicide over the past two decades before COVID. And so, yeah.

Elaine Taylor-Klaus: So that's my question is this a recent phenomenon, or are we just aware of it now? Diane, what were you going to-

Diane Dempster: What I was going to say is, and I don't want to belittle this because I know we want to talk about adolescent child mental health, but our mental health system is stretched to its limits right now. And that has some advantages and disadvantages, but a lot of us are feeling it, and a lot of parents are struggling with that.

Elaine Taylor-Klaus: Right. So you're saying historically, this has been going on for a couple of decades? Is that new, or was that just newly aware of it?

Gene Carroccia: Yeah. Fascinating topic and this is some of the discussion that's been around autistic spectrum disorders and other conditions. Are we better identifying, or is there truly an increase, or is it both phased both? I would really love to say, probably, it's both. In the zeroes, adolescent depression doubled. Suicide rates for kids and individuals ages 10 to 24, went up more than 57% and the zeros to 2018. So there was this whole process that was going on. I'm going to talk about in a moment. There's just not enough providers and give you a few stats. And then we hit the pandemic. So let's talk about the pandemic. What happened in the pandemic? A perfect storm happened. What we had is children and adolescents that were in homes with sometimes dysfunctional families, complex kids that didn't have families that were maybe understanding them in the best way. So we have a lot of unhealthy dynamics going on at home, and we don't have any release valves. The kids weren't out at school. They weren't socializing. And so though, a lot of the mental health just imploded because there were a lot of challenges at home. People weren't getting out to get the treatment. Treatment providers were overwhelmed. I'll talk about that. And they didn't have normal school and social outlets to help them as the natural release valves to deal with it, and so here we are. 

Diane Dempster: So Gene, just to jump in, not to mention the fact that we're in the middle of a pandemic, which is scary. 

Elaine Taylor-Klaus: Scary. A little anxiety producing, you might say. It wasn't just we're locked in our houses with our kids. It's we're locked in our houses with our kids relaxed, and we're scared about the reason that we're locked in our houses with our kids. 

Gene Carroccia: Absolutely. Yeah. Is my family going to die? Am I going to die? I mean, big scary stuff. Are my friends going to die? Is my grandmother going to die? All this big scary stuff. Absolutely. So a perfect storm.

Elaine Taylor-Klaus: And our kids mean. At one point, my kids looked at us and said, we don't want to kill our parents. Like we're not the only ones worrying about it. So we've got a historical problem brewing that comes to comes to a head if you will.

Gene Carroccia: Right. We do. And then we have something called complex kids. To talk about that topic for a while. I know Elaine and Diane are very passionate about this topic. I am, too, as Elaine was sharing about my books. I call these individuals children and adolescents with diagnostically complex presentations. Elaine calls them something where elegantly complex kids and whatever you want to call them.

Diane Dempster: That sounds very fancy. I like yours. It sounds fancy. I don't know. I like fancy. Say it again.

Elaine Taylor-Klaus: Diane like fancy. I like simple. 

Diane Dempster: Say it again, Gene. Say it.

Gene Carroccia: Children and adolescents with diagnostically complex presentations.

Elaine Taylor-Klaus: Diagnostically complex presentations. Yeah, sound like complex kids.

Diane Dempster: Complex kids. 

Gene Carroccia: I said it was more elegant. Complex kids is more elegant. So we have this complex topic about complex kids. So what is that? My definition of it is when children and adolescents have more than one condition or disorder, and that includes medical, sleep disorders, sensory processing conditions, fetal substance exposure conditions, neurodevelopmental conditions, psychological conditions, and trauma and neglect and attachment disorder conditions. 

Elaine Taylor-Klaus: That's a lot.

Gene Carroccia: So yeah, it's a lot. And there's probably more than a hundred conditions in there. 

Elaine Taylor-Klaus: And they all overlap. 

Gene Carroccia: They all overlap. So I would love Elaine to talk for a moment on your podcast about this topic. But one of the challenges in the soap boxes and things that I'm really passionate about is that people just don't understand complex kids. The part of it is it's hard to identify some of these conditions, which is what I've tried to do in my books and what Elaine has done, and it's trying to talk about it. But it's also another challenge of this is when somebody has multiple conditions, it's now not just one thing. The sum is greater than the parts. This is its own condition, its own complex presentation that is not just ADHD. It's not just a learning disorder. It's not just a sensory processing condition. It's something else. And when families and providers aren't understanding this collective condition, they're not going to be treating and serving the child in the family in the best way. But I know you could share a lot, both of you.

Diane Dempster: And what I want to jump in on is that word complex. I hear what you're saying is that some multiple diagnoses is part of what makes it even more complex. And what I would say is that a lot of parents with kids with one diagnosis or maybe no diagnosis don't quite fit the mold. There's a complexity in that, too, that I don't think everybody appreciates if you don't happen to have a kid who's why would we use the complex kid.

Elaine Taylor-Klaus: Well, you know, at the end of the day, what is a complex kid? It's a kid who is struggling with life learning or both some aspects of life or learning or both. And often that's going on because something's going on in that child neuronally, biologically, whatever. Sometimes that's happening because of the environment or the combination of the two. And we're here, and the people we work we're all just trying to help one family at a time figure that out and figure out how to navigate it. And so maybe that's where I'd like us to move Gene is from the macro because you've set the stage really well for what are we dealing with here. And so then we narrow in on what do we want parents who are listening to this to know that's important for them to be aware of right now.

Gene Carroccia: Okay, great. So let's talk about that. Before we address that piece of it, two quick things. ADHD, which Elaine and Diane, and myself are very aware of and address, is often a foundational disorder. So a lot of families don't know that this often coexists with other conditions. And so part of my soapbox is that a lot of times, providers are just looking at ADHD. They're missing the other components. Therefore, they're not providing the most comprehensive and best treatment plan.

Elaine Taylor-Klaus: Or the other way around. They're dealing with the other issue and missing the underlying ADHD.

Gene Carroccia: Absolutely. And so in my book, I talk about, there's a whole bunch of conditions that look like ADHD that are misdiagnosed, or people are assuming that this is an attentional problem. And they can cause potential problems, but it's not true ADHD. So I mean, this gets into the diagnostic piece of it. Another part of it is what Elaine said, which is there's just not enough providers out there that are educated or trained, or aware. So primary care physicians, pediatricians, nurse practitioners, and many behavioral health specialists themselves just don't understand enough about ADHD and other conditions. And this is very frustrating because families are just going to look to doctors and providers and looking for answers, and they're not getting it, and that's very frustrating. And the last thing is-

Elaine Taylor-Klaus: And the last thing is- hold that one second. To their credit, it's not included in their education. Like the reason, they're not well informed. Part of it is because we've had a lot of research in the last 10, 20 years that's new that we understand now, we didn't know 10 years ago, but part of it is that it's not part of the curriculum when they're educated. And so unless they choose to self-select their own learning as a specialty in their learning, they may not be well-informed.

Diane Dempster: And to take it a step further. And we were talking to someone in another podcast about educators and about how little teachers know and understand these conditions. We expect physicians to understand a lot of nuance and detail, and this is not a slam against pediatricians because I think they do amazing work in the world. The number of challenges and disorders and diseases and things like that, that they're having to focus in on being able to understand any one of them, but the level of detail where they can really roll up their sleeves with a parent to say, okay, how do you handle this nuanced kiddo? It can be really very challenging.

Elaine Taylor-Klaus: No question. Alright, so you had a third point, but thanks [inaudible]

Elaine Taylor-Klaus: There's no specialization certificate license degree in ADHD. So to support your points, just what you said, Elaine, they have to go down their own path and develop their own specialization, and they may or may not. We'll come back to that in a moment about the tips for finding providers. The last part is there's a fascinating article that came in the Washington Post this past Saturday that talks about some of the topics we're talking about. And there is an incredible dearth or lack of providers out there. So not only do we have mental health issues that are surging over the past two decades and over the past year and a half, but we just don't have the infrastructure, which is what Diane was talking about. We don't have the mental health system to provide. So one organization, psychiatrist, child and adolescent national organization, said we need four times the amount of psychiatrists that we currently have in the United States. The National School Psychologists Organization said we need more than twice the amount of school psychologists out there. Psychotherapists and psychologists have had a dramatic surge, and they're just not meeting the needs. So that's another real challenge that we're going to talk about, which is there's just not enough people out there, let alone specialists.

Elaine Taylor-Klaus: And if they are, they may or may not be covered by insurance, which is a whole lot of conversation.

Diane Dempster: And the other piece, and I want to just highlight some of the research we did Gene last year, is that parents don't know what they need. It's this you've got a kid who's struggling and the information of do I get training for me as a parent so that I can support my child, which is what we do at Impact Parents. Do I send my kids to a therapist? Does my kid need to be diagnosed? It's all of these things. There's such a dearth of information out there as well of parents. It's like, where do I even start, or what do I do?

Elaine Taylor-Klaus: There's information, but it's not applicable. There's information about the condition, but there's what do I do with that information that is still missing in a lot of places.

Gene Carroccia: So what I did is try to an approach to address what you just said, Diane, which is to write an article, which is on my website. Now, I'd love for people to check it out. If they're interested and it talks about how to find an ADHD specialist provider, particularly in the United States, but you could probably use this for other countries. So I have some steps, five steps on what to do and how to do all this. It's not perfect. I'll talk about those in a second. But the first thing to do as far as how do we address and what are some solutions is families just need to know some of the things we're talking about. Unfortunately, you're going to have to talk to a probably a number of providers. It's definitely a persistence game, unfortunately. Be prepared to talk to providers that might not get it. That's part of the landscape. Now, it's not fair. It's not right. Hopefully, things will be better in the future, but that's what it is. So I really encourage people to understand this is a long run. Hang in there. Keep talking to people, keep getting referrals from people, just keep leapfrogging from one patty to another to keep trying to keep that conversation. And then, of course, the resources can really help impact parenting. The books, websites, there's a lot of information out there. Yeah, it's overwhelming, and people get lost in the ocean of information. But it really is your intention. And if you keep going and don't get beaten down and it's easy to you will find a provider. So there is hope out there. It's a challenge.

Elaine Taylor-Klaus: I love what you're saying. We call it taking a marathon view, right?

Gene Carroccia: There you go. Perfect. 

Elaine Taylor-Klaus: You got to know that you're in this for the long haul. And I'm thinking about a presentation I did at the International Conference on ADHD in 2020. It was a panel with a number of coaches and therapists. And we were talking about the difference between coaching and therapy.

Gene Carrocia: I remember that. 

Elaine Taylor-Klaus: But the universal message that came out of that workshop that every single person spoke to was whatever you do, you need to find someone who specializes in this and really understands ADHD because the number one feature you need in a practitioner is someone who understands the complexity of this condition. It doesn't matter who they are.

Diane Dempster: And going back to Gene, what you were saying earlier about the comorbidities and the complexities, these anxieties. And then we were talking about the levels of fear and anxiety going on in our society right now. The interplay between anxiety and ADHD or those other hundred diagnoses that you talked about that impact executive function, Gene, the interplay there, a lot of times we don't even know, are we really dealing with ADHD? Are we dealing with anxiety, and what is really going on underneath it?

Diane Dempster: Yes, perfect. And I write my books, and I know two of you do this. Anybody that has ADHD is set up to have a certain level of depression and anxiety if it's not well treated or managed. The condition itself causes it.

Elaine Taylor-Klaus: If not well treated or managed, key point. I just want to hit home.

Gene Carroccia: Absolutely. And so providers that don't understand these providers diagnose what they know. They like to stay in their lane. So if providers are comfortable with self-esteem issues and anxiety, depression, and kids, that's what they're going to see. That's the outer ring of untreated ADHD. So yes, they may have that, and that's what it's going to look like, but there's a lot more to it. So that's part of my work, which is going deeper with that. So I know we're just have a little bit more time.

Elaine Taylor-Klaus: Very true.

Gene Carroccia: Here's a few points from my article about the five steps that might give some hope and some direction for families. So the first thing is figure out what provider you want. Now, this can be complex, and a lot of people say, well, I have no idea what I want. Well, what you need to do is think about what do you want. There's basically different types of services. There's the diagnostic services to figure out, do I have ADHD? Do I have another condition to have both? If you've already figured that out, and you've worked with a provider, and you feel like you have a pretty good understanding of what the conditions or condition you have, then you probably need more treatment and coaching services. If you don't know the diagnostics, if you feel like, gee, there's something missing here, or my child is not progressing and nobody can tell me why. I would suspect there's other conditions that are hidden, that haven't been detected or addressed. So then I would say it's time for diagnostics. Diagnostics for ADHD are really two different types of things. There are evaluations which are done on an outpatient basis by therapists, maybe a pediatrician, a lot of them don't. Maybe a psychiatrist, but a lot of them don't. And they're briefer. They're less comprehensive. They're not full testing, but they're easier to get. They're cheaper to get. So that's the first thing to consider to think about or do I need an evaluation or do I need a neurodevelopmental or neuropsychological assessment? That's the more complex one.

Elaine Taylor-Klaus: Also known as a psycho-educational evaluation. 

Gene Carroccia: Psycho-ed evals can be done by the school. 

Elaine Taylor-Klaus: I'm talking about once we're done in a psychologist's office because I think it depends on the state because not everybody is going to get a neuro-psych if they get a psych evaluation. I guess that's the distinction I'm trying to make.

Gene Carroccia: Right. And this can be some of the confusion that different states and different providers call them different things. So yes, there's going to be they're called, sometimes called neuro-behavioral assessments. Sometimes people call them ADHD assessments. So it sort of depends. But the more comprehensive is a larger battery of tests. Neuropsychologists often do these. Sometimes clinical psychologists do them. And they're going to go deeper, and those would be the higher level. So if you have any concerns about, gee, I have more problems or issues. I want to go for that. The problem with that is there's less providers out there, and they're more expensive. So try to figure out those diagnostics. After that, you want an ADHD therapist who specializes in ADHD. I'll talk about that in a second, or medication from a medication provider, or an ADHD coach, or a special ed or school advocate or special education consultant, which provides a different service, or an educational therapist, which provides different services. I'll pause there for a second.

Elaine Taylor-Klaus: We need to pause for a bit just because, in the interest of time, it sounds like this article is available for people. Is there a link that we can send them to go find this so that so that they can really get the full expense of it?

Gene Carroccia: I sent that to you yesterday. I can send it again today, so go ahead and post that.

Elaine Taylor-Klaus: We'll put it in the show notes. And what's the website where they will find it? How can they find you?

Gene Carroccia: Thank you. Yeah, adhdology.com. So if you go there, and then you go to ADHD resources. I have a section for original articles. I have a whole bunch of links to CHADD and other national organizations have links and providers. So that's kind of the meat of it to talk about that. And then I also, in the article, talked about what are the types of things you want to say to providers to try to dig in and figure out are they really an ADHD specialist or are they just saying that, but that's not really where their heart or the majority of their practices is. 

Elaine Taylor-Klaus: So ADHDOLOGY.com. And we'll have the notes in the show in the show notes. Will give you the link to the specific article that Gene's talking about. Because I want to be mindful of time. And I know we need to start wrapping it up. And okay if people have heard the first two and want to know what the other three are? I think that's fine.

Diane Dempster: I want to [inaudible] because the one thing you didn't mention, and particularly with ADHD Gene, is parent training and behavior management. And that's what the services that are provided at Impact Parents. And that is key and part of recommended treatment for kids with ADHD. And so none of that resources available at impactparents.com. 

Gene Carroccia: It's a critical part.

Elaine Taylor-Klaus: Yeah, absolutely. So is there anything else you want to make sure that the people listening today take away from this conversation? We start off saying we're talking about access to mental health. We know that there's a shortage, getting really clear on what providers you're looking for and making sure they have an expertise. Anything else you want to make sure people take away before we wrap up?

Gene Carroccia: Just a little ray of sunshine of hope that if you can really take the marathon approach. I've seen many, many parents with many, many stories, and they prevail. They just keep going. And we know that the parents have a lot of adversity and challenges. But we also know that so many parents are so dedicated to their kids. And they don't have the clinical language or the training, but they know something's off. And they keep going. And there's often kind of a feeling in your gut when you find the right person, and you're in the right place with the right provider. And it might be the right provider for now. And then, you might need a right provider in different types and multiple providers. But that's okay. So keep going. Hang in there. You're going to find what you need out there. It just takes some focus. There's a lot of resources; dig in. Use Impact Parents and all the other resources that are out there to help you with each step of the way you can do it.

Diane Dempster: And here's the other ray of hope that I'm going to do. And it's interesting because I had this similar conversation in the education realm, but one of the outcomes of what we've been going through the last couple of years is virtual care. And so I think about five years ago talking to parents in remote parts of Nebraska or Hawaii, or wherever they were, who just literally couldn't get to anybody. We now establishing virtual supports in a way that we never have before. So we're primed in a very different way now than we were two years ago to support parents with access.

Elaine Taylor-Klaus: Range of services, right? We have been for 10 years, but a lot of people joined us about a year and a half ago.

Gene Carroccia: Yeah. And I will say from the provider that it really has been a revolution, and virtual is here to stay permanently. There have been laws, and we have broken through the barrier. Many providers were very reluctant and didn't believe in video. It's here. It's going nowhere. People love it. It does have some challenges, but it also has greatly improved the accessibility of services, and that's a tremendous thing.

Elaine Taylor-Klaus: Yeah, it really is. Okay, Gene, before we wrap up, we always like to ask our fun, our favorite fun final question. Do you have a favorite motto or quote that you want to share with our listeners?

Gene Carroccia: I do.

Elaine Taylor-Klaus: Awesome. 

Gene Carroccia: I would say my motto would be every day, ask yourself, what are you grateful for? 

Diane Dempster: Love that.

Elaine Taylor-Klaus: What are you grateful for?

Diane Dempster: Attitude and gratitude. 

Gene Carroccia: There you go. You got it.

Elaine Taylor-Klaus: Love it.

Diane Dempster: Awesome. Great. Thank you so much, Gene, for being with us today. Having this great conversation. And Elaine, do you want to wrap this up?

Elaine Taylor-Klaus: Yeah. To all of you listening, thank you for being here for tuning in for listening for what you're doing for yourself for and for your kids. At the end of the day, it's what makes the difference. You make a difference. Take care, everyone.