ADHD: Causes, diagnosis and interventions - Avigail Gimpel
In this episode, we explore Attention Deficit Hyperactivity Disorder (ADHD). Joining us from Israel, is Avigail Gimpel. Avigail is a teacher who has worked with students in NY, Moscow, and Israel. While teaching, she developed an intervention program for students struggling with ADHD symptoms. Avigail has spent a great deal of her life immersed in studying and developing treatment options for ADHD for her own six kids and many struggling students. She collaborated with Dr. Amnon Gimpel (psychiatrist and neurologist), and developed a parent training program. She recently published her first book “HyperHealing”, a powerful, easy-to-follow program for parents of HEALTHY children struggling with ADHD symptoms. Connect with Avigail: www.hyperhealing.org Instagram @hyperhealing.adhd This episode is sponsored by Skill Samurai - Coding & STEM Academy. www.skillsamurai.com.au
Automated Transcription of the Podcast:
Welcome to the Parenting in the Digital Age podcast, many parents are concerned that their child might be falling behind. Others are just looking for ways to help their children thrive, not just in the classroom, but socially and well into their future careers. Each episode, we explore the challenges facing parents in the modern world, from behavior, education and nutrition, to device and gaming addiction. We interview a range of leaders in the area of childhood development to help you successfully navigate parenting. In the digital age, here is your host, Jamie Buttigieg. Speaker 2 (00:38): Goodo, hello parents, and welcome to another episode of parenting in the digital age podcast. Joining us from Israel today is Avigail Gimpel. Avigail is a teacher who has worked with students in New York, Moscow, and Israel, while teaching, she developed an intervention program for students struggling with ADHD symptoms. Uh, Avigail has spent a great deal of her life immersed in studying and developing treatment options for ADHD, for her own six kids and many struggling students. She collaborated with her father-in-law Dr. Amnon Gimpel, psychiatrist and urologist, and developed a parent training program. Recently she published her first book called "Hyperhealing", which is based on many years of research and practice both as a mother of children, diagnosed with ADHD, as well as a classroom teacher of children, struggling with ADHD symptoms. And in this episode, you guess that we are talking about attention deficit hyperactivity disorder. Now, before we get into all of that, uh, Avigail, welcome to the show and please share with our listeners, uh, a little bit about yourself and what you are passionate about. Speaker 3 (01:45): Absolutely. Thank you so much for having me on it's a real pleasure talking with you. Um, a little bit about myself. I think, the most interesting thing about me is my six amazing children. And, uh, they have always been the ones who have demanded of me to be my best self. And, uh, I think all parents out there know what I'm talking about. Um, our children, our children kind of hold up this big giant mirror and like, look at yourself, be better. Look at yourself, take the next step. So, uh, that's really my, obviously my, my journey begins before that as a classroom teacher. And, uh, I had a lot of kids with ADHD in my classrooms, and as a special education teacher teaching in an inclusion setting where we had kids of all ability, levels, and challenges in one classroom that really gave me my primer for becoming a mom. Speaker 3 (02:41): And, uh, as my children were being diagnosed with ADHD one after the next, whereas I had thought I really had this. I really, I had figured this all out. I knew what I was doing. I was very much caught by surprise by the diagnostic process and by the lack of treatment options. So my, my oldest was diagnosed within 10 minutes without very much conversation with, with the, uh, neurologist. And then the only option I was given was here's a prescription. And, uh, and basically I'd walked in with a healthy child in my mind and walked out with a disordered child. And, uh, at, at the beginning I felt like, oh, okay. So I guess that's just the way it is. They know better than I do. But as time went by, I said, one second. There's, there's something very shallow and missing about what they're offering here. So I got to work because I couldn't find any, uh, books or resources written by parents for parents. So I had to really not reinvent the wheel because there's excellent resources out there, but I had to personalize it, not, not from a perspective of a psychiatrist, a neurologist, a professional who had not raised children, but, um, really personalize it to a place where a mother, a father can look at the program and say, oh, I can do this. I understand this. You're talking about my child. So that's where I am now. Speaker 2 (04:14): Yeah, yeah, absolutely. And you mentioned in there, you talked a bit about the diagnostic process for ADHD, uh, in your view, is that reliable and you know, what, what could a parent learn from that diagnostic process? Speaker 3 (04:26): I am very disappointed in the diagnostic process because essentially what we've done is we've taken a, a list of observable, um, behaviours and we've, we've lumped them together. And then we've said, okay, if we can see these observable behaviors in this child, therefore they have some kind of disorder or a neurological issue, lack of dopamine. We've created a very big story, a around a list of observable behaviors. And that is not something that we rely upon in any other area of medicine. If you, if you come in with your child with a sore throat or a tummy ache, the doctor is going to touch you. The doctor's gonna check the doctor's gonna put a little stick down your throat. Uh, she's gonna be curious. She's gonna wanna find out what's causing the problem. Uh, she's not gonna rely on my child saying it hurts on the left side and then say, Aqua must be struck throat, cuz obviously it's the left side. So therefore, um, it, somehow in psychiatry, we, we lose the plot and we, we jump from observable symptoms to, this is the name of the disorder and your child stuck with it probably forever. So it's not only not reliable, it's highly disrespectful and gives you just about no information because there's so many reasons why a child would be suffering with those observable symptoms. Speaker 2 (05:58): Yeah, yeah, you did. Right. And, and, and this is such a complex area I think for parents to navigate. And, uh, you know, as ADHD often requires, uh, you know, medical, educational, behavioural, psychological intervention, it's, it's really multifaceted. And so what are, you know, let, let's look at some of the practical interventions that parents can use, uh, for a child with ADHD. Speaker 3 (06:21): First, I will start with the curiosity part, which is look at your child. And I tell parents, study your child for two weeks. Okay. You know, your child, you have absolutely, um, every idea of what's causing the child's a tantrum and what's causing the child not to move, but maybe you don't take, and I've done this with my own kids. Take two weeks to take notes. What makes a child tantrum? It's usually one or two things, by the way, it's never a hundred things. Although it feels like it's a hundred things. And, uh, take two weeks to ask questions and see what the response is gonna be as if you are just a fly on the wall and you're observing that child. So curiosity stage is very important because when you're looking at a child with fresh eyes, you might notice that the child often has a runny nose. Speaker 3 (07:10): You might notice that the child is crankier when they haven't eaten. You might notice that the child, um, has an emotional situation where they're, we're butting heads with a sibling all the time what's going on with this kid. You might notice that the child's being bullied at school, all of these things we have to do before we jump to any intervention, once we've done that, then we can get an idea of what direction to take. In a lot of these cases, I see that the child is really dealing with an instant gratification personality. And when the doctors will say that ADHD is hereditary, it's really that healthy personality type that they're talking about, the here and now fast, fun, dangerous, uh, that, that kind of personality, which is completely healthy yet in the world of today, the fast paced world, where we have to hit goals and we have to be on target. Speaker 3 (08:07): And we, that child is going to drown and be frustrated all the time. So then I offer a three step program for that instant gratification child, which, uh, and in my children's case, it's very much a hereditary personality type from their father. Uh, my husband is, is probably the most, you know, energetic person you'll ever meet. It would be fun for you to meet him. Of course, cuz he's, he's a great person. But uh, so we, we have to first learn a new kind of communication because this is a child who's instant gratification, which means if we're yelling a lot, then that child's gonna make sure we yell some more. So we've gotta pull ourselves together and learn a calm, respectful communication. And then we have to help that child create habits because they're missing habits. Someone who's always running after what's. The next fun thing to do is always going to give up on things that require too much effort. Speaker 3 (09:09): So we have to walk them through it by adding the fun to it, adding the excitement to it and help them create habits that they absolutely don't have waking up in the morning, doing homework, showering, any, any parent out there knows what I'm talking about with the showering, the, the shower nightmare, where you can't get the kid into the shower, but once they're in there, you can't get them out again. So that all those routines are things that are are playing. They're really being challenged by this instant gratification situation. And finally, it's really important to have very firm discipline. And I actually teach parents how to punish properly, um, in, in the most respectful way possible. And, and parents look at me, they're like, that's not a punishment and, but it is it's discipline. That's very consistent, very loving and uh, and helps children make better choices about the next step they're gonna take. So that's really the beginning of the discipline of the intervention program. Speaker 2 (10:13): Yeah. Wonderful. And it is that curiosity and, and taking notes as parents. We think we know our kids very, very well and to a large extent we do, but it it's that process of stopping, reflecting and observing and taking those notes down that you discover those other things. Right. Speaker 3 (10:28): Yeah. Speaker 2 (10:29): And, um, uh, you talked about discipline maybe before I go to my next question, maybe I can ask about, uh, what, what are some of those examples of, uh, you know, how you teach parents to discipline that maybe they sort of said, oh, that's not discipline. What, what does that look like? Yeah. Can you gimme an example? So Speaker 3 (10:46): What sure. And I actually wanna give credit where credit is due. This is, this is a program that's developed by, uh, Dr. Allen Kaden, uh, and what, what he recommends that it works so beautifully is a two tier, um, punishment program where tier one for, well, before we begin the two tiers, we have to really explain to our children the purpose of punishment and what's gonna be happening. So the purpose of punishment is that this is a good child, a child who wants to make the right decisions. And then that child is challenged and makes the wrong decision. So a punishment really is a parent saying, stop in your tracks. You can do better. Let's help you make a better choice. So that's our goal. Our goal is to stop the child and that's essentially the punishment and then help them do the right thing. Speaker 3 (11:38): That's the correction. So the first part of it and this, this has, this has made many parents very upset at me. Um, but, but it, it's, it's really a powerful tool. So what we do is that we have a, a list of chores that a child can do in the house. And, uh, what we do is when the, when the child misbehaves, we'll say to the child, okay, you do that in our home, we're not allowed to do X. We're not allowed to hit a sibling. Uh, and you broke that rule. And there calmly, because if we yell, that's gonna give them too much instant feedback. And they're just, they, we just rewarded them by mistake. So we are gonna say, calmly, you just broke the rule in our home. And therefore you now have to, um, wash a few dishes, clean a window, take these boxes from this side of the room, to that side of the room. Speaker 3 (12:32): I like doing the physical things because our kids are kind of physical and, uh, and they they've got a lot of energy. So, so the physical things are good. Now the parent, the reason we have to explain this is because parents get nervous. They say, one second. I want my kids to like doing chores, which is kind of funny. And only young parents say that, um, because no one likes doing chores, but when kids are very small, they, they like getting involved. The reason they're involved is because they're having good time doing something with you. Once they're older and you tell 'em this at the table or clean their room or fold laundry, they don't like chores and they never will. So we're using something neutral to negative. And we're saying the stopping is the punishment. You've just done something that was not allowed. And now I'm giving you the opportunity to correct that by doing something positive. Speaker 3 (13:22): So when a child does a chore, that child's doing something positive and we're very grateful and thankful, and we give a compliment when a child finishes a punishment, we do the same thing we say, you've chosen well, you are powerful. And your ability to choose to do well to do right. And we give a compliment on that too. The child organized a drawer. You're excellent at organizing that with some really great listening. So that would be, and then we have the there's a lot of parents kind of shaking their heads and saying, yeah, my kids never gonna do a chore for G you who I dunno who you're talking to. Right. So my kids were the same way we have to then do tier two, which is taking matters into our own hands, which means that we're going to give a child a quick punishment where we're taking away either a privilege or an item. Speaker 3 (14:12): So the child's playing with something right now, a puzzle, a toy. They, they have a little blanket that they like something we're gonna take that away for 20 minutes. They have, uh, they get to watch, uh, you, you are a digital age kind of guy. So, but let's say we're talking about, they get to be on a computer for, for half an hour at night, which that would be the ideal situation. If any parent could pull that off. Good for you. So, so we would take off five minutes of that. Uh, we would, if we're giving out some sort of treat, we would either delay that for that child or reduce it or not give it at all. So those are things, and we never go ahead to have with the child, because we, we have to respect our position. We are more powerful than the child and therefore fighting with your child is unfair. Speaker 3 (14:58): Don't do it. They're not on your level. Treat yourself as the adult and treat the child as the person that you are responsible to take care of. So therefore, if the child starts going crazy and is all upset about the punishment up it a little bit, and then try to get away because you're the oxygen in their tantrum. So we wanna get that tantrum to calm itself down and it will. And when it does, we are gonna say that was great. You are able, you are very upset and you are able to calm yourself down. That was some excellent self control. So there we have it in a nutshell, Speaker 2 (15:35): That's, uh, that's great. There's actually a lot to unpack there. And, uh, I, I reckon many parents write about now are hitting the rewind button to go back and listen to that two, two step process because, um, you know, uh, so that just so I've got this right. So we go to that phase two or step two, if they refuse to do the chore. Right. Speaker 3 (15:54): Right. Exactly. Speaker 2 (15:55): OK, perfect. Thanks so much. There, there's a lot of common sense in that. And, uh, it's not necessarily the way I would've approached it, but, uh, uh, it's certainly something for us to try. And, uh, uh, I think many parents would be grateful for that tip. Thank you. Now, maybe I should have asked this a little earlier in the piece, but what are some of the causes of ADHD symptoms? I mean, uh, you know, parents listening surely must be interested in that, Speaker 3 (16:17): Right. And that's actually really how my, my book is, is, um, formed. I'm really going through all the causes of ADHD. Not all of them. I can't possibly get to all of them, but the most, uh, apparent ones, uh, the first one would be the, the instant gratification personality. Then we are talking about kids who have a physiological problem. Kids who have asthma allergies, running noses, stomach aches, headaches. And I, I really get frustrated when teachers or doctors say, well, that that stomach ache is, is psychological. Uh, kids don't know that they're supposed to be manipulating by complaining about physical elements. They, they don't know that yet. And if a child's complaining about something, that's hurting them, it's really up to us to take that child seriously and, and respect that child and figure out why the, the child, they, they're not imagining it. So physiological issue is, is another big one. Speaker 3 (17:14): And, and I recommend my, my 30 day challenge to get parents, parents, and children together, back into good health, uh, through diet. Also we have, uh, another major cause and very unfortunate. One is trauma or, uh, or prolonged stress, um, where children have been abused sexually, physically, mentally, or, or bullied. Um, those things will definitely cause a tremendous amount of stress, the another major cause. And, and by the way, all of these produce all of those observable symptoms that your child will be diagnosed for. And that's important for us to know another big one is screen addiction, that children are not able to focus and studies show that the screens are actually causing the ADHD symptoms. Whereas we had thought that kids with ADHD would be more addictive, which they are even kids who did not have an ADHD diagnosis when they spent hours on screens, develop ADHD symptoms. Speaker 3 (18:19): Uh, also our separation from nature and from exercise, we don't move nearly enough and we're not outdoors. Outdoors are incredibly calming in my family. When we're doing an activity together, we actually just got back from a, a five day vacation. Finally, I've got a son in the military, so we never, we never get to go any place as a family anymore. But what we did every single day was be out on the water, out on a hike, out in nature. And, and they, and the kids behave beautifully. They they're happy, they're calm. So those are some of the main symptoms that we're the main causes that we're looking for. And, and each one of them does have a different type of intervention. Speaker 2 (19:03): Yeah. Yeah. It's fascinating. And this, this notion of screen time, you know, uh, we, we teach kids coding at Skill Samurai and that's, and, and we're on screens, you know, and, uh, we really work hard to try and help kids have a healthy relationship with technology, but then there's this other part of it in, uh, and I have no idea, you know, that screens can influence or, uh, impact, uh, ADHD symptoms. And, you know, screens are so much about, I mean, we're on screens right now. I mean, they're, they're literally, uh, or something that's, uh, UN unavoidable. So maybe, uh, sort of an unscripted question here, what do you suggest, or what do you recommend, what's your advice and even just your experience as a mother, how do you, uh, control and regulate the amount of screen time that is healthy? Uh, I know it's a broad question, but just maybe some thoughts for parents. Speaker 3 (19:49): Well, I do wanna add here it's it is a good, good unscripted question, um, that our children are all getting to pornography and that is another cause of confusion, ADHD symptoms, uh, psychological and emotional distress, especially when they're getting to a too young. I don't think there's any age where they should get to it, not even well into adulthood, but, um, when they get to it at a very young age, when I refer to that as, as screen rape and just as we would never allow someone into our living room, who's undressed, uh, we, we would, we would kick that person out of the house and say, no, thank you. Not here, but yet we leave one door open and that's the screens. So the first thing I beg and plead with parents to do is please put some kind of screen on your children's, uh, some kind of protection on your children's screens. Speaker 3 (20:46): Uh, one that I've been using a lot is custodial. And I actually use it for my, for my clients as well. The, my teenage clients who ask for help with this area, I, I tell them all that they need help, but there are, there are a few brave ones who actually say, please help me with it. We block out any pornography site and seal it. So the kids cannot get to it. And this is the minimum minimum thing a parent can do to protect their children. Um, we are not letting our children go into strip clubs. So stop it. Don't let your strip, don't let the strip club come into your living room, uh, or your kids' bedroom, which is usually where it's happening. Um, anyway, besides for that, I highly recommend that for some people, this ship has sailed, but for parents who haven't yet given their children a, a smartphone, the smartphone really is a privilege and a responsibility and parents have to give it to them under certain conditions, meaning we can control the amount of hours that their children are on screens using custodial or any other kind of, uh, program. Speaker 3 (21:49): There are many good programs out there. And just, just last night, my, my son had quite a meltdown because his screen time had ended on his phone and he was in the middle of sending WhatsApp. And he was just very upset and we had a discussion about, and he said, okay, fine, no problem. What we'll do is we'll, we'll completely block YouTube. And, and then you could leave my, my phone open. And I said, great, what a great compromise, but it's a conversation because, uh, he and I are working together and it's not just like, here's a gift. It's, here's a responsibility. And therefore we have to make sure that that's, that, that we are in that conversation. And our children know it, know it in advance. The other thing is the public screens in our house, the computers, the TVs, things like that. We should be in control of it. Speaker 3 (22:40): We should be locking it and allowing certain hours. I do recommend that as especially families that have young children and we're using the, the screen, uh, as a babysitter that we, we figure out a better method, hire a real babysitter. If you need a break, no problem. Have someone take your kids to the park. You deserve a break, but don't use the screen as that. And, uh, I, I do recommend a screen fast, uh, to reset the entire family. That means mom and dad as well, uh, for, for three weeks. And then allow the safest screen watching would be on a TV, not on a computer that's right near your face, and certainly not on a handheld device. So keeping the screen away from the children's face and also let it be an interactive experience, not interactive, with just screen, but interacting with other people. So children watching a movie together, which is what we do, we have on a Friday or on a Saturday where the, where the children will watch something together as a family, which gets harder and harder as they're they're different ages kind of become more apparent where one lots to watch a cartoon. And the other one was to watch something very bloody. Uh, but definitely something that's interactive with other siblings far away from the face and restricted. Speaker 2 (23:59): Yeah, there, there are some great, uh, things to unpack in there. A again, I'm, I'm gonna re-list and watch my own podcast here because, uh, you know, just especially that point of helping kids understand that having this device is a, uh, responsibility, um, and it's a privilege and then creating these healthy conversations that can happen often, uh, is a great way to have kids introduced and interacting with screens regularly and healthily. That's a great one. And also your point there on, um, uh, you know, how to make TV or how to make screen time. E E even other devices might be a tablet, but how to make that interactive. So I think as a parent, we need to take a more active role in, um, what our kids are, are watching. So, you know, I was playing a, uh, this is my office here and, and I was playing a quiz game, which is the trivia game with my son, the other, uh, weekend. Speaker 2 (24:54): So we, we had screen time, but, uh, we're both interacting and laughing and competing, uh, rather than just, uh, one-on-one experience. So, uh, yeah, some really good points in there, Avigail. Thank you. Um, so a question, well, actually, before I get to the, the last couple of questions and wrapping up, is there anything that, you know, perhaps I could have asked or should have asked, uh, that, that I haven't asked already again, another broad question, but, uh, um, you know, you being the authority in this space, is there something else that you'd like to share that I haven't asked? Speaker 3 (25:25): Well, so far, I, I think your questions are fantastic. I, I would add that we, we haven't discussed, um, medication at all as a, as a treatment for ADHD, and that's something that really interests a lot of people. And if you like to open that topic, that's, that's the, the topic of my second book. Um, Hyperhealing, showed me the science, where I, I think that a lot of parents, I, I know I teach in, in college and, uh, my students, they will not let me get to the interventions until I've fully discussed medication. And, uh, and they get very impatient with me until I give them all the information that they need to know. And, um, but the thing is that, that I, I do feel that since that is generally the only intervention offered parents really need to know and have informed consent when it comes to medicating children. Speaker 3 (26:21): And, um, and I think that parents would be surprised to find out that in long-term studies, children that have been medicated for three years or more are not better off than their peers who are not medicated. So the, the topic definitely needs to be looked into, and maybe it's, this is not the time for a deep conversation about it. But I would say just as, as a quick comment, that before going straight to the medication option, we should definitely consider really looking at what's going on with the child. And, uh, seeing if we can use that as our last option, I medicated three of my children. So it's not an anti-medication, uh, um, um, comment, but rather in most cases, the reason why the child's suffering is not for lack of Ritalin. And therefore we need to first look at why the child's suffering and never mask the, the symptoms, because in, in some cases you think about it, if a child's, God forbid, being molested or, or other, some other terrible experience. And then we are just looking at behaviors and giving a pill, then what we've done is shut down. The only means of communication that child has to let us know something's going wrong, children will behave well if given the opportunity to. So in terms of that, I think it's important that we just consider that that not be our first line of treatment, but a treatment option once, once we've really respectfully looked at the child. Speaker 2 (28:01): Yeah. Great point. And, and thank you for adding that. Um, so one question we like to ask all our guests, a bit of a fun question at the end of the, uh, each podcast. Uh, if you could go back, uh, let's say to your 10 year old self and give yourself one piece of advice, what would that be? Speaker 3 (28:19): Wow. I'll tell you what I am a is a great question. I am a firm believer that everything happens for a reason and that the journey we're taking is the right journey for us. So, whereas my knee jerk would be like, okay, you gotta get your hairdo in order, because you're gonna look back at those pictures and you're gonna be humiliated. You know, things like that. It was a lot of things I could correct, but I feel like I looked really weird. And that was for a reason, maybe it was, uh, I don't know, I don't know to build my confidence, but, uh, I would say that the journeys is, is precise. And, uh, when I look back, it's more to learn from it and less to change it. Speaker 2 (29:07): Wonderful. That's, that's good insight and very fair. I like that view. Um, now, uh, for our listeners that want to get in contact, find your book, uh, learn more about you, uh, how and where can they do that? Speaker 3 (29:17): So the best way to get in touch with me will be through my website, which is hyperhealing.org. There you could subscribe and get newsletters with tons of free advice. And, uh, also you'd be first to know when I'm, uh, putting out a new product, a new book, a, um, I'm actually, my audio book's coming out pretty soon for those of you who simply don't read anymore. Uh, right. That's a lot of us, I think at this point, that's thanks to the digital age. Uh, we've stopped reading. Um, and, uh, and, and you can also interact with me directly, send a message. I'd be always happy to respond, always happy to hear your thoughts, your contributions, and you also could find me on YouTube. Um, my channel is hyperhealing mom, or just Avigail, like I, and Instagram, hyperhealing. I think those are the best ways to get in touch with me. I'm of course I'm on LinkedIn and Facebook as well, but I don't, you know, I don't like those as much. Speaker 2 (30:17): Yeah. Makes a lot of sense, Avigail. I really appreciate your time, your generosity. Uh, it was an amazing conversation today that I know many parents will get a lot of benefit from and some really practical, uh, takeaways from today's, uh, discussion. So, uh, thanks again for your generosity and your time. Speaker 3 (30:33): My pleasure. Thank you so much.
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