Elaine Taylor-Klaus: Welcome back, everybody, to another conversation in the Parenting with Impact podcast. That's what this is: a podcast. 

Diane Dempster: Different day, different recording, right?

Elaine Taylor-Klaus: Absolutely. Today's conversation is with Diane and me. Once again, we've chosen a topic that we hear coming up one of the themes that comes up in our conversations with parents and professionals and clients, and so today, Diane, what are we talking about?

Diane Dempster: We're talking about whether to diagnose or actually, let's say it this way, what difference does a diagnosis make?

Elaine Taylor-Klaus: Right, and here's why.

Diane Dempster: And there's so many different pieces to this, and parents come all the time, it's like, well, my kid doesn't have a diagnosis, or my kid has this other diagnosis, or I'm not sure whether the diagnosis is right, or do I even talk to my kid about their diagnosis or all of those different moving pieces so we thought it'd be worth having a conversation and talking about all that stuff.

Elaine Taylor-Klaus: So I've been doing a lot of work with Dr. Tom Brown because we're speaking at the XR conference, which is the medical conference in the ADD world in January of 2022.

So I've been reading his book on ADHD and Asperger's Syndrome in Smart Kids, and I've been really brushing up on this, and what I'm noticing, they're two pieces here.

One is we have so many people in our community with multiple diagnoses and then the other is sometimes we may be missing a critical diagnosis. And so that's really where I wanted to start this conversation. What difference does it really make?

Like,why does it matter from our perspective? When you do behavior therapy, the work is the same whether a kid has ADHD or anxiety, or autism or depression, or the behavior approach for parenting is very, very similar.

Diane Dempster: Let's say that real clearly. The work that you're doing to learn how to help your kid is the same regardless of what these diagnoses are. You want to get good, strong parenting skills that are focused on helping your kids change your behavior and meeting them where they are from a neurobiology perspective.

Elaine Taylor-Klaus: And become more independent, and hold that positive framework, and set appropriate expectations. All of that work is going to be the same regardless of what your kid's diagnosis is, so here's what is different.

Diane Dempster: Yeah, exactly. So the places that it gets different are in terms of getting services and support, particularly in a school environment, and then also therapeutic treatment and medication management, if those are things that are part of whatever diagnosis you're facing.

Elaine Taylor-Klaus: So let's break those two apart. So, let's start with the last one. Therapeutic management: what's involved with providing treatment for complex kids?

As we said, parent behavior, interventions, behavior training is always going to be one of your primary areas of focus because you get to know, understand what's going on with your kid to help them manage it. And then, depending on what your kid's issues are, there may be other therapies involved.

There may be medical therapy. There may be talk therapy, there may be play therapy, there may be occupational therapy, there's all kinds of other kinds of interventions that could be involved. Those various therapeutic responses are going to vary depending on what the diagnoses are.

Diane Dempster: Right. And sometimes, it's behavioral. There are two pieces of it. There are kids who would big emotions that sometimes working with a therapist on coping mechanisms or kids with anxiety, working with a therapist on coping mechanisms-

Elaine Taylor-Klaus: Or DBT or CBT.

Diane Dempster: -or DBT or some of these other sorts of things. So therapeutic intervention, and then-

Elaine Taylor-Klaus: Wait. Can I just stick with that for a second because even that can be broken down a little bit more? So oftentimes, what happens when a kid is diagnosed with ADHD or anxiety executive function is part of the recommended treatment is behavior therapy training.

Well, a lot of physicians don't understand what that means and so they think that means talk therapy. And so what you're pointing to, Diane, is that for a kid who has let's just use anxiety as an example, learning coping strategies, learning ways to refrain for themselves, talk therapy or play therapy or something can be really valuable tools to help them manage that.

If a kid's diagnosed with ADHD and their executive function impulsivity is off the charts, talk therapy is not going to change the impulsivity. So the change there needs to happen at the point of performance where the challenge is taking place, which is why the parent piece is so important. So matching the therapeutic response to the issue is really important.

So some kids do really well, particularly teenagers with DBT, dialectical behavior therapy, where they're really learning strategies for coping, or with cognitive behavioral therapy, where they're learning concepts for self-talk, but that's not always going to be the solution. It's going to depend on the problem you're trying to address.

Diane Dempster: Yeah. So that's one of the places that diagnosis can be very helpful. Another place where diagnosis can be very helpful in terms of therapeutic intervention is if it's something that might involve medication treatment.

So, a kid with anxiety, putting them on an anxiety med or an antidepressant, those sorts of things. Kids with ADHD, if you want to explore ADHD medication, all of those things, having a diagnosis is an important piece of the puzzle.

And I'm going to talk a minute, Elaine, about anxiety and ADHD because I know personally and professionally this is one of the things that ADHD causes anxiety-like symptoms, and anxiety causes ADHD-like symptoms, and the two interplay.

Elaine Taylor-Klaus: Or they're easily used.

Diane Dempster: Yeah, absolutely. And so working with a prescribing provider who understands the interplay between those two and how to figure out do I treat it as ADHD? Do I treat it as anxiety? Do I treat it as both is an important part of the process so you really want to have someone probably beyond a pediatrician if you suspect ADHD and anxiety going on?

Elaine Taylor-Klaus: And you know I'm thinking about? So all my kids had a combination of ADHD and anxiety, plus, plus, and so sometimes it was about which is presenting most profoundly right now that really needs to be addressed.

So there were some times that the anxiety was in the lead, and it needed to be treated more directly than the ADHD, and vice versa.

I remember one time one of my kids was so clever that the psychiatrist, we were trying to determine whether a kid with pretty significant anxiety at the time was going to be able to tolerate ADHD meds because sometimes ADHD meds can amp up anxiety for some kids and for some people.

So he suggested that we give her chocolate-covered coffee beans- you've never heard the story?

Diane Dempster: No, I haven't.

Elaine Taylor-Klaus: -to just test out whether she could handle the stimulant because she was not a coffee drinker but she was a sugar eater. So, we tried chocolate-covered coffee beans to just check her system to make sure it could tolerate the stimulant on top of what was going on before we started trying stimulant meds. I thought it was so clever. It was really understanding the nuances of what was happening with that particular child.

Diane Dempster: So again, we're going back to this sort of diagnose versus not diagnose. And I think we've been giving you a few examples from a medical management perspective, where and how diagnosis makes a difference. Let's shift and talk a little bit about services both in school and out of school. Do you want to?

Elaine Taylor-Klaus: I guess here's what I really want to say is that there's a difference sometimes that we're beginning to see with girls and boys. And so part of the reason diagnosis can be important is because we have these assumptions about what it means for a kid to have ADHD or autism.

And those assumptions tend to be, what does it look like in boys? Tends to be hyperactive tends to be not less verbal or not making eye contact. We have these notions of what it means. So the other reason I think diagnosis is really important, in particular with girls, is because I think sometimes what we're seeing is that we're missing key diagnoses because it looks different in girls.

So girls may be spacing out with ADHD facing out the window. Girls with autism may be sort of disappearing from the classroom or taking a walk and particularly if they have both ADHD and autism. And so it doesn't look the same. And so oftentimes, we're not catching it. So, really, getting an expert in there who understands all these different nuances can make a big difference.

Diane Dempster: Yeah. And 10 years ago, we were under diagnosing ADHD in girls and I think that it's still a challenge and a struggle. We're catching up with ourselves right now.

Elaine Taylor-Klaus: And now we've got this autism layer on top of that where we're beginning to see because 10 years ago, a doctor was not allowed to diagnose both ADHD and autism together.

Now, we understand that they coexist. Remember, that didn't start till the DSM-5. DSM-IV, they weren't allowed to be diagnose the same person.

Diane Dempster: The way I think about it is that you've got the executive function challenges. You've got the social challenges. They're kind of in a bucket.

Elaine Taylor-Klaus: The emotional regulation.

Diane Dempster: The emotional regulation pieces. And back to your comment about behavioral therapy in parents, I mean, what we're doing as parents is really looking at their challenges, whether their executive function challenges, whether their emotion management challenges, or whether their social engagement challenges and addressing those, rather than worrying about the diagnosis.

And what we want the medical community to do is to look at the diagnoses and support them from that direction.

Elaine Taylor-Klaus: And I guess part of what stimulated me wanting to have this conversation was I've had a number of clients, whereas we've been working together, I'm beginning to say I'm not a diagnostician. This is not my realm.

And this sounds like it's more than ADHD. Sending the parent back with more information to a physician has led to different diagnoses and to improve treatment. It's led to changes in the IEP, which is a great transition.

It's like changes and all kinds of ways, just because we're looking for things that other people may not yet be seeing because we're seeing so much of it.

Diane Dempster: Yeah. And we're talking about IEPs and things like that. One of the things that I had was a client, a kid with ADHD, behavior issues, and class behavior issues at home, and was getting a lot of pushback from school. This kid can't be this way.

I don't even think he was expelled, but he was definitely suspended and kicked out of the classroom. She went back and got clarification of diagnosis, found out that it was autism, in addition to ADHD, and all of a sudden, the school can support him in a very different way because he's got a different diagnosis, which broke my heart because it's the same kid with the same behavior.

Elaine Taylor-Klaus: With the same presenting issues. 

Diane Dempster: But it's like this sort of suddenly, with the diagnosis, the doors do start to open, and I wish it wasn't that way. The reality is that part of what happens is that our systems are designed for particular buckets.

And so sometimes parents who don't take the step to get a diagnosis end up falling between buckets, and their kids can't get the services that they really do need in the school environment. 

Elaine Taylor-Klaus: Right. Let's talk a little bit more about the services in the school environment because we've been on our high horse about this year because we really are seeing. In the pandemic, it's really highlighting where people aren't getting services.

And so what we've noticed is that typically, kids with ADHD can have eligibility for accommodations around executive function. Very typically, kids with autism get accommodations around social and emotional kinds of stuff.

What happens when an ADHD kid needs the social and emotional stuff or when an autism kid needs the executive function stuff?

Diane Dempster: Because there's such an overlap, and I think that that's the piece of it, there's this opportunity, and add on top of it, the limited amount of information that our education system has about this stuff.

And if you think about it, we've been on our high horse about this for a while. But when you look at the amount of things that educators have to learn to manage a classroom, and you add on top of it, the fact that what we've been really focused on over the last two years is how to help these kids to continue to be in a learning environment, even in the middle of a pandemic, with remote learning, with kids in and out all the time, hybrid learning, all these different pieces it hasn't been able to be our focus for the last two years, the brain science is catching up.

And it's not realistic for educators and teachers to really know everything that there is to know. So sometimes it means that we as parents know more than the teachers do about what our kids need. I see parents go into schools all the time saying, okay, please take care of this, but the schools aren't well-equipped enough to respond, and so the dynamics shift a little bit.

Elaine Taylor-Klaus: This is where our advocacy comes in. But if we start by advocating, assuming they need our support, instead of by advocating assuming they're not doing what they're supposed to do, it's going to change the dynamic considerably. And so it's on us as parents and the professionals working with parents to really understand what the nuances are with these kids and what they need, and that can be hard.

If you're just sitting there at home trying to figure out I don't know how to help this kid, how am I supposed to figure out what the school needs to do to help this kid? It can be really frustrating. Again, this is where diagnosis becomes really useful and supportive and I guess the place I would point people to is to really look at, what is the kid able to do independently? What are they able to do with support?

And so that we can say, well, this kid can remember to do what's required of them when it comes to getting their sports stuff together, but they need support and reminders when it comes to doing homework. So we know that there's an executive function problem going on, where if the issue is this kid gets emotionally upset, or the frustration tolerance is off the charts.

And every time they get something wrong, they're having a fit, then we know that what they need is some emotional support. We really want to begin to break down what's behind the problem we're dealing with. It's not just the kids having a tantrum, but the kids having a tantrum because they're having a hard time regulating around an emotion. 

Diane Dempster: Something that's coming up, as you're saying that just as a reminder, because all of you parents probably know this, but I want to say it anyway, is that you're talking about inconsistency.

And you're talking about sometimes these kids need this and sometimes they need that. It's just a reminder that these kids don't always present the same way from day to day.

Elaine Taylor-Klaus: In fact, they don't.

Diane Dempster: They don't, and they don't present the same as each other, which is part of what makes it really hard for the education system because no kid with ADHD looks like any other kid with ADHD. I mean there's some patterns that are consistent.

But if you think about executive function and how many different ways that plays out, and sometimes it goes this way, and sometimes it goes that way I mean, that, on top of it, is part of why we as parents are so critical in this process because your kid is the only one.

Elaine Taylor-Klaus: By critical, you mean essential?

Diane Dempster: Essential, sorry.

Elaine Taylor-Klaus: I just want to make sure there's no misunderstanding there.

Diane Dempster: Essential in this process because every kid is going to be a little different. And so the school is going to need you to really get clear with them about what it is that your kid is struggling with. What you see at home might be different than what they see at school and that can be very helpful for them in knowing how to handle it. I can't tell you how many parents who say, "Oh, my kid is fine at school, but at home, I get the worst of them."

I remember really distinctly I had that conversation with my daughter's teacher in second grade and I said, "You're having problems at school because we're having problems at home," and she's like, "No," and keep an eye out for and started sharing some of the behaviors that I was seeing and it enabled them to work with me in a very different way because they weren't seeing it quite the same way at school.

Elaine Taylor-Klaus: Right, which makes sense because our kids hold it together all day long and then lose it. I was talking to a teacher the other day. It was great, interesting because she's holding it together all day long, too because she's teaching all day, and then she realizes that she's losing it when she gets home.

So the first strategy we came up with was, what can you do to break your day so that you can get it out before you go back to your kids? Because she's having the same experience that the kids are having. But anyway, what's really what I'm taking from this is that if we look at this question of what differences of diagnosis make?

The diagnosis makes a big difference in terms of what the medical community will provide in terms of treatment. It makes a difference in terms of accommodations in the school environment. From our perspective, part of our job as parents is to educate the providers to help them make the right diagnosis that we're the ones with the best information to help them identify what's really going on and what's going on underneath so that they can make that diagnosis.

They need us to be observing, paying attention to understanding what's going on with the kids and what behaviors are showing up without judging them. Just labeling them, naming them, seeing them. I was talking about this one client who has a girl with severe ADHD and anxiety.

This is what I'm seeing a lot with girls as they're diagnosed with ADHD and anxiety, and then as we started exhibiting behaviors and talking about what's going on, it turns out this kid has autism because the kid was a wanderer because the kid was having these epic meltdowns, because the intensity of it was disproportionate. And so we were able to see it differently and bring it back to the providers.

Diane Dempster: Yeah. And I think that that's the piece of it is that it is our job and our opportunity. I mean, ADHD, in particular, is a diagnosis of ruling out a bunch of other stuff. And so you've got to be really clear and keep your information clear and where that lens of what are all the behaviors that I'm noticing. Do we have time to talk about the other piece of it?

Elaine Taylor-Klaus: Talking to the kids?

Diane Dempster: Talking to kids? Yeah, because this came up in one of our small groups this week as a mom whose kid just went through a psycho-educational evaluation. Actually, I've had this twice. I've got a parent of a junior in high school and a parent of a kindergarten-aged kid; both of them just got diagnosed. And they're both struggling with how to talk about this.

Do I talk about this to my kid? The parent of the older kid is really worried about his self-esteem as a kid who's been struggling. He's beating himself up like crazy, and they're really worried that, oh, this is going to be one more thing. Yeah, I'm a total loser. I'm never going to amount to anything.

Elaine Taylor-Klaus: Okay, can I get my soapbox about that?

Diane Dempster: Yeah, please.

Elaine Taylor-Klaus: Okay. Kids are going to make up terrible stuff about what's going on with them, and they're going to make up that they're lazy, crazy or stupid, or something else. If we give them an explanation for what's going on with them, if we help them understand why they're struggling with executive function or emotional regulation or whatever, then it takes away that label of lazy, crazy, or stupid.

Yes, it gives them another label but it gives them a little another label they can learn to manage, they can learn to navigate, they can understand and it externalizes it. It takes it out of you being bad, and it gives you a place for compassion. This is you struggling with something, we can help you learn to manage it, so I think it's super, super important.

Diane Dempster: Super important. And the thing that's coming up as you're saying is that one of the tools I like to teach parents to use is that it's not them who's struggling as much as it's their brain. It's just sort of their if it becomes their brain is wired differently or if it becomes their brain uses dopamine differently, whatever it is.

But if it's your brain that's struggling and you help your brain to be more effective, sometimes it's I'm lazy, but my brain is having a hard time. I mean that separation can help.

Elaine Taylor-Klaus: I'm lazy is a judgment. My brain is having a hard time and it is a challenge that can be overcome. I just want to point people to the website. Years ago, my daughter Sydney did a manifesto on this and a video on this because she's a kid with learning disabilities with dyslexia and some other issues. And so she did like a five-minute video for parents that's on the website.

I think if you just type Sydney, S-Y-D-N-E-Y, you can find it. But it's a great piece that you can actually show your kids to empower them to take ownership of their learning differences in their brain-wiring differences.

Diane Dempster: Elaine, would your answer be different? I mean that for older kids particularly, yes, absolutely. But what about for younger kids who may not understand it in the same way?

Elaine Taylor-Klaus: You know, when Syd was diagnosed in second grade, I came to her and I said, "Honey, I think we now understand what's going on with your brain and how your brain learns, so we can help you with that."

And she started to cry and she said, "Mommy, I've been trying so hard." And really, the best gift we gave her was telling her early what was going on and that she wasn't doing anything wrong and really validating how hard she was working because these kids are putting in way more effort than we realize sometimes.

I mean, it takes a lot of effort for a kid with ADD to just get up, get out of bed, get dressed, and go to school is a day's work.

Diane Dempster: Yeah. Part of what you said was that we now know what's going on with your brain, so we can help you. And I think that that's one of the things that I think parents struggle with because it's like this sort of diagnosis shows up, and we have no idea what to do.

I'm going to take us back to our own soapbox about behavior training for parents, get the training for you so that you can say to your kid and I'm taking this class or I'm getting this coaching so that I can learn to help you to help your brain. It's this sort of, I got your back here.

That's what our kids want. They want to feel like we get them and we've got their back.

Elaine Taylor-Klaus: And understand they're not doing it on purpose that they're struggling too, and when we can shift from that judgment to compassion, which we talked about a lot in Sanity School, we really changed the dynamic in the relationship.

Ultimately, what we want most is to be in relationship with our kids in a trusting relationship, where they trust us so that when they are struggling with stuff in life, whether that's in school or later in life, as they get older, that they trust us to come to us.

And so that starts with how we understand what's going on with them and how we begin to support them in it. It's a process. It takes a little time to turn the ship. So what else did anything else wrap? I think we need to probably close on this. Anything else we need before we close?

Diane Dempster: I think this is a great conversation. We talked about the difference a diagnosis can make in terms of getting services, both in the school and also in the medical community. We talked about talking to your kid about diagnosis.

Elaine Taylor-Klaus: We talked about the importance of the role of the parent in managing the behaviors, regardless of what the diagnosis is.

Diane Dempster: And that's the thing I want to just disclose with is just remember, your kid is still your kid. It doesn't matter what their diagnosis is on some level. You have a kid with a behavior challenge, or you wouldn't be listening to this talk.

So, a behavior that you find challenging or that they find challenging, and so supporting them by getting help for you is going to be the same regardless of what the diagnosis is, but also, there are places that it does help to have a diagnosis.

Elaine Taylor-Klaus: For sure. And another one we'll have another conversation about when you decide you want to do medical treatment, what you need to know about, which I wanted to talk about here, but it's just too much.

So putting a pin in that for another conversation. Thank you. This was delightful. As always, thanks to those of you who are tuning in and listening for what you're doing for yourself and your kids. Just remember, you are listening and learning and applying what you're learning and getting support and doing that. That's what makes the difference. 

Diane Dempster: Thanks, everybody.

Elaine Taylor-Klaus: Talk to you soon, Bye, y'all.