Today we have Caitlin O'Brient Bauer, she's an ADHD coach and she's going to be talking to us about creating your ADHD support team.
When you're first diagnosed, it can be so overwhelming; just trying to figure out who you need on your team, what your first steps are. So Caitlin's going to help us with that journey. Welcome, Caitlin.
Thank you. Thank you so much for having me. I'm excited to be here today.
Glad you're here. Tell me tell me a little bit about your ADHD story, your background.
Absolutely. I was diagnosed when I was eight years old. I was I was one of the lucky ones that people actually caught it. I was the combined type (of ADHD).
I had some teachers who essentially kind of noticed that I was a little bit quiet and spacey in class, but then very energetic and almost aggressive on the playground. So something kind of like stuck out to them as being like, "oh, what's going on here?"
Essentially, my parents decided to look into this due to a lot of the emotional regulation issues I was having, myinability to like stay focused and on task. We were referred to our pediatrician who then referred us out to some child psychologist and I was diagnosed.
Basically, I had a combo of therapy (which consisted of like playing games and talking) and figuring out meds but eventually we got referred to a really amazing child psychiatrist in Houston, Texas.
Who, to this day, I'm eternally grateful for because I feel like he really kind of helped set us on our path and not only worked with with me, but he worked with my family, which I think was a really important part of that journey. He was telling my parents about everything that they could know and how to support me as a kid because it is so much more than just medication. Right?
Absolutely.Yeah. I mean, working with parents is key for kids and it doesn't always happen.
Yeah, absolutely. Absolutely. I remember bits and pieces of the medication journey back then; we tried Ritalin and Dexedrine and Prozac, and it was it was tough. As you know, an eight year old, trying to figure out what that fit was.
With the Ritalin the focus was there, right? But then there was irritability and intense anger issues, like the emotional dysregulation was really intense.Then with Dexedrine, it was like the appetite suppression was so extreme that we had to get off that.
Then with the Prozac, I remember my mom saying you suddenly had zero inhibition. She was like, you already had impulse control issues to begin with, you know, and it was kind of a crazy journey.
We landed on Ritalin. Weighing the pros and cons, my parents decided that the emotional regulation part was hard but it was it was the least of the side effects, right?
This is the thing that helped me to to manage in school, and then, you know, we did the best we could do otherwise.
It was when we moved back to California, when I was in middle school, that our new doctor had a kid who had ADHD, and he was the one who recommended that we look at Adderall. And we found that it was better than Ritalin, right?
The irritability and anger issues were left, right. So that's where we that's where we landed. I remember going to see a therapist back then and she just clearly didn't have an understanding of ADHD, so I tuned out pretty quickly. I remember within like three or four sessions, I just started being like, "everything's fine", even though it wasn't.
Right. What kind of things did she attempt?
Unknown Speaker 3:06
You know, I don't even remember. I just remember that I just tuned out and started basically telling her that everything was peachy in my life when I was sobbing every night at home. In middle school, like hard time to move as a kid, especially for someone with emotional regulation issues.
Yeah, middle school is hard no matter what, I think. And then you add all that in, it's particularly tough.
So yeah, basically at that point, we were like, we're just going to get by with meds. I had found musical theater. It was fun and engaging. Back then we didn't know that we have an interest based brain wiring, right?
But, we saw that there was something that I was very passionate about. Essentially, I was able to use that to pull me through high school. Like, I remember my first day of freshman year, I went into my guidance counselor, and I was like, Alright, I want to go to Carnegie Mellon University for musical theater. So, what do I need to do to get there?
She pulled out the book and she was like, "Okay, this is the GPA, these are the SAT scores. I was like, "great. done." and then I went and did it.
I love it. And it's true, right? When you have the right thing that lights you up, it helps so much.
Yes, exactly. I was able to use that with medication with some of the skills that we built. I remember I always had my planner with me, I was always writing things down. I learned "early is on time", which, you know, time management is so hard for so many of us with ADHD.
I remember back then, learning how to set my clocks ahead by like, 10 minutes. Then I would get places 30 minutes early and bring a book. Figuring out these things so that I could be on time, so that I could remember things. These were skills that I didn't even know that were serving me.
Were these ones that you were taught /had help to develop, or you just figured this out?
Unknown Speaker 5:21
Some of this was stuff that my mom did, who, she's undiagnosed, but definitely, like, we're same person. I think some of it was stuff that she had just picked up along the way.
Then some of it was very much learned from Dr. Pesecoff. He was very adamant about creating these specific structures so that I could be successful, right?
We talked about memory, it was going to be hard for me. So, writing things down was crucial. And creating a schedule and routine for me was really crucial to keep me going.
These were things that we had learned when I was younger that we carried on and I just didn't even realize, right? They were just what I had learned how to do. It was interesting, because when I got to college, that's where things started to really fall out for me.
Which you hear a lot, right? No longer had the parents doing your laundry, cooking for you, telling you, "Hey, did you get that thing done on time?", or like, "You've got to be somewhere at this time". Suddenly it was up to me.
I struggled a lot. I masked, right? ADHD was something I didn't want to talk about with other people, I carried a lot of shame. I questioned whether I even had it. You know, you hear these doctors and therapists who say, "Oh, well, you know, you got good grades, there's no way you have ADHD."
That is my pet peeve, I've got to tell you. It drives me crazy.
I know. It's like, I get offended when I hear it.
It's so damaging, on so many levels. I mean, the first is just obvious, assuming those are mutually exclusive, but then it has people doubting and not getting help. Then when they do go to college, or someplace where the executive functioning demand rockets up, it all falls apart. It's so difficult, and it doesn't need to be. They could they can have that support earlier.
Unknown Speaker 7:04
I know.I have such a great example of this. I didn't tell people about it when I got there. You know, freshman year went really well for me, sophomore year was where things started to fall apart.
I was inconsistent with the medication. I was partying and exploring and all that stuff. There are all these different pieces of the puzzle, and also just given developmentally, where we're at, you're basically sending a middle school or maybe young high schooler into college like developmentally. Right?
That's the thing. Apart from the intelligence, the maturity with ADHD, a lot of people don't realize, is a couple years behind, often. It's not an intelligence thing, it's a maturity thing.
Yeah, yeah, exactly. There were a lot of factors involved in some of the struggles that were happening for me back then. But, the biggest problem was around that masking because Igot to the point I knew that medication worked for me. I would use, I would take my medication as prescribed, right? When I had a test or when I remembered, right?
I was good about taking it in the morning, but not at lunch, that kind of thing. Right. I was very fearful about losing that. I had not been reassessed for ADHD since I was eight. It was one of the things were like, we were still buying into the story that this was something you grow out of.
I think that's what we were told, really, is that you outgrow this.
Yeah, yeah. So, I was like, have i outgrown this? I said, if I have, then they're going to take away my meds and then I'm not going to be able to do too well. I'm not going to be able to stay focused. And then I'm really going to fail, right? So there was like this extreme fear that I was carrying.
I was carrying this because I remember, we tried to ask for accommodations for the SATs when I was in high schooland they basically said, "Well, yeah, but you need to go get a more current confirmation of your diagnosis". And I was like, "I'm not doing it. I'm just going to suck it up and get through it, and it'll be fine". And my parents were like, "Okay".They didn't want to push me.
And were you resistant to that because you just didn't want to deal with it or were you concerned that you weren't going to be diagnosed?
It was both. It was both. I remember being like, "This is a pain in the butt. It's gonna take effort and then I was legitimately fearful, because I did know that medication worked for me and I didn't want to lose that.
So in college, there was this one test. There was this scale test that we had to take. It was timed, a five minute test. I had practiced and practiced and practiced and practiced, and I was actually really good at it. But then when I would get into the room for the test, I would choke. I would just be like "I can't".
So I failed it three times. You had to pass the test, it was not negotiable. I was beating my brains out and I was like, I don't know what to do.
My mom was like, go to your advisor and talk to him and just talk to him about your ADHD, see if there's something you can do. I'm wondering if like, you know, maybe we could ask to take the time restraint off of the test as an accommodation, and just see what happens. He was like, "yeah, let me go talk to the woman who's running it".
Well, lucky for me, it turns out this woman's kid had ADHD. So she was like, "Here's what we're going to do. I'm still going to train you, but you're not going to know it. Don't worry about the clock, you do what you got to do, we'll do the test. And if you go over, that's fine. It's all good.Let's just take that off the table". I went in, I did, I passed and the funny part was, she goes, "that is the fastest that anyone has ever passed".
Now see, this is such an important thing to recognize: that when your nervous system kind of bumps up, you're stressed and you're worried about this, that all of the things that let you focus, they're offline. That accommodation is such a fair and good accommodation.
Yeah, I mean, pressure shuts the ADHD brain down. It just does. Seeing when you take that pressure off what we can do, it's pretty remarkable. I think that must have been my junior year becauseI did almost fail out. I was put on triple probation. If you'll believe it, like, it's a thing, apparently.
Wow. It's like winning, winning probation.
I know. It was one of the things were I had I had fallen so far and come back, and after seeing this happen, I was like, "Alright, so I can ask for help. I can ask for accommodations, I can ask for extensions on things, I started getting more comfortable. I'm going to take my medication regularly, ask for support when I need it.
When I came back after being put on probation, that was my first adult attempt at getting support. I came back and I was like, "I'm going to get a therapist". I need all this all the support that I can get.
I went to the student center and you know, asked to be matched with somebody and I found it was nice to have somebody to talk to, but again, she just didn't have an understanding of ADHD. To be honest, neither to did I, right?
I got through and actually ended up doing really well. Once I had started asking for the accommodations, taking the medication, I ended up making dean's list my senior year.
A big part of that journey was learning how to ask for help, right? And being okay with it.
I think that a lot of people often find themselves doubting and then wanting to take the minimum help and just really trying to muscle through.
Unknown Speaker 12:35
Exactly, willpower doesn't do it. If it did, we wouldn't be having this conversation.
Exactly. So that was a success story, it was bumpy, being able to advocate for yourself and being able to find what you needed.
It was the first time I'd really done it on my own, without my parents doing it for me. After graduation, I was still buying into the belief that medication was for school or work. Period.
So, when I graduated and moved to Los Angeles to pursue a career in the arts, I decided I was going to stop taking my medication. I made the choice to stop and I fell into this deep depression, I couldn't get out of bed.
I couldn't go to auditions. I couldn't empty the dishwasher. I couldn't take a shower. It was really, really, really hard. We moved somewhere where I didn't really know anybody. It was not a good first year, things really fell apart for me. I got lucky enough that I had a doctor that I got matched with who read my file.
When I came in, and I was talking about the weight gain and the depression and I was like, "I just can't figure out what the heck is going on with me". He's looking at me and he was like, "It says here that you have an ADHD diagnosis". I said, "Uh huh". And he goes, "Well, are you taking your medication?" I said, "No, I went off of it". And he was like, "Well, would you be open to maybe trying going back on it and seeing what happens?" And I was like, "I guess?"
You were like "yeah, whatever".
Yeah, and he was like just throwing this out there. And so we did, I went back on. I think we went back on a higher dosage because he was like, "sometimes it might be that the dosage you were on when you were younger was fine back then, but you might need a higher dosage now".
He was the one who suggested giving a slightly higher dosage a try and seeing what happens. Suddenly, I could get out of bed. Suddenly, I could go on auditions. Suddenly, I could empty the dishwasher. And I was like, "Huh."
This is kind of an important discussion, right? This is so tricky, because there's an overlap in traits with depression, anxiety, ADHD, they can exist together, they can share traits. It becomes really important to trust who is working with you to tease all this out.
Yes, yes. This is where it's like this really came to a head. Mid 20s, my husband and I got engaged and we were about to get married.We were asked to do some premarital counseling. During that time, I think we filled out some stuff with a survey and I am a very honest human being, sometimes to a fault.
I talked about my emotional regulation issues in the survey, and it had some red flags for them, where they were kind of worried about, you know, emotional abuse from me.
You know, my anger issues and things like that. Never like physical but very verbal and very intense. They were like, we really want you to seek additional counseling for you guys, before we sign off on you guys getting married.
It was intense.It was one of the things where I was like, "Am I broken? Am I an alcoholic? Like, I don't know."
That had to be really tough.
It was really scary.It was one of the things, like I knew that alcohol... I was one of the people, I was the messy drunk in college where I would be sobbing one minute and super excited and sometimes it looked a little bit like bipolar, you know?
I wasvery s exually liberal in college.There were behaviors that when I went to seek out this new therapist, that they were like, "I'm kind of wondering if this might be bipolar?"
And this guy was like, this really seems like bipolar. He was really leaning into that, sexual promiscuity, the impulsiveness, which, now I look back, I'm like, No, it's a classic ADHD lack of impulse control, it's the impulsivity, that lack of inhibition. But, I didn't know that back then.
I'm sitting there going, "Oh, my God, is it bipolar? Is it ADHD? I don't know". It was very confusing. It was hard, because like, again, he was still like... my blood boils just thinking about this guy...
Unknown Speaker 17:00
I can tell we don't like this guy.
I mean, he's part of my journey. And I'm grateful for that. Right?
He can ride in the back for the journey.
I mean, it was it was the story that you hear about: You could not possibly have ADHD, you got a college degree. You graduated dean's list, right? But let's talk about how I almost got kicked out. And, you know, like, there's other stuff going on.
It was interesting going through that because he was maybe suggesting maybe look at Strattera, some other medications. But then I remember feeling like very lethargic, very foggy.
I quickly realized that that medication was not a fit, because it just like made everything so much worse. I was even angrier. Right?
So I was like, back to the stimulant that has been the baseline. The focus is the thing, I'm still trying to figure out the emotional part. I finally ended up firing this guy, because there was a day where, he was actually not very consistent about when we were meeting, and so I had the wrong time in my calendar.
He's like, "Oh, I'm going to have to charge you". And I was like, "I literally have this in my calendar right here. We put it in at the end of the session, your calendar was wrong.
I was like, "You know what? I'm not paying you. Come after me. I don't care bill, my insurance, but I'm not paying you and we're done. I'm out". And at that point, I was like, forget it. Therapists suck! I'm not doing this anymore. Like, I so "err", you know?
It's hard, though. It's good to advocate for yourself for that reason, because you're going to meet some amazing therapists and you're going to meet some that should probably be doing a different job, just like anything else.
Yes, yes. I promise, for your listeners, I promise it gets better. I'm actually going to be like, "I love therapy therapy!". There's a journey here.
I went back to like, alright, I got meds. You know, at that point, I started reading more about ADHD. Anytime Justin and I would get into a fight, I'd be like, maybe we should do therapy or like couples therapy or something. It was one of those things that we threw around, but we never really followed through on.
When I had been trying to find that therapist in my mid 20s, it was the whole "go to your insurance provider". Back then it was like print out the list of providers and then you don't know who they are and you're having to call all these numbers, which, Hello, ADHD?
That's the worst. That's the worst.
I basically picked the person who was closest to my condo. I was like, All right, you'll do. Everybody back then listed ADHD, and they still do, actually, people list ADHD as a specialty and maybe spent a short session on it in their training and they know a textbook, dated, surface knowledge of it.
If this guy had understood what was going on with me, he would have been able to ask that key question of those ups and downs emotionally. One: How long does it last? And two: Can you name the trigger? Right?
Yes. Which then, that really rules out what's ADHD and what's bipolar.
Yeah. Like, again, I know, I'm not a doctor here, I don't pretend to be, but hearing Dr. William Dotson talk about looking at like RSD and the emotional dysregulation component, they often can confuse that.
There was some situational things, I wasn't taking my meds or I wasn't working, and so there were things that were making the depression seem like longer, right? But there was never a long manic up. That was one of the things, where if we could have pinpointed that this was situational and there were literally triggers for the emotional things, that's very much in line with ADHD. He didn't see that.
Right. And I think that like you make a good point, too. Differential diagnosis is very complicated. Figuring out what's what is no easy thing.You need somebody with curiosity, and who is up to date.
Yes, yeah, absolutely. So, yes. 20s, after after that experience, I was like, "I'm done. I'm done with this, at least for now", Right?
Meds are good enough, we'll get through. I did what I did before. Meds will be fine. I'll get through it. I was definitely more consistent about the medication. I was better about exercising and sort of like being more mindful about my alcohol intake and things like that, just to better manage things.
Things came to a head in my late 20s. We moved back to San Francisco from LA, my husband was taking a job up here in the tech community. San Francisco being insanely expensive, we had to take out a loan to move back, right?
I had to go get, as I as I referred to it then, "a big girl job". I haven't talked too much about my career in LA, but just to fill that in real quick, I had been in the industry for about five years. Finally, I just couldn't take the rejection and the up and down.
I ended up leaving my performing life behind and I went into doing social media marketing. I found something that was creative enough and people wanted me to do work for them. There was like nobody doing it. I was one of the first people to work in social media marketing. It was just primed for the picking, you know?
I built my own company during that time and I was working for myself, which is an important thing to note. But, I was not making that much money. When we came to San Francisco, I knew I needed to go make a salary somewhere, essentially, to pay our bills.
I landed a job to run social media for a startup in the fashion space and I worked there for about three months. What I didn't know at the time was how toxic that company was, but I also became acutely aware of the fact that my ADHD was playing a huge role in my stresses and frustrations.
I found myself overcompensating . The company had a very "always on" culture. So, I would be working until one in the morning. I was constantly spinning my wheels, one of the people on the leadership team was constantly disagreeing with me. They wouldn't let me do my job. I was confused; is this ADHD that's at play here? Or like, you know, is this that they're shi**y people? And it was a little bit of both.
Hopefully, they don't hear this. Not naming names.
It's okay. If they did, they're probably in a different place right now. If they listen to my podcast, they're in a different place in life.
That is fair, that is fair. Anyway, when I left, myself self esteem was in the tank, right? I was very much like, "What is wrong with me? Why can't I adult?" I can't hold down a job. I can't I can't keep up with my workload. I can't keep things organized. I was just really, really low.
Were you thinking at this point, "Hey, this is about unsupported ADHD", or was this not even on your radar at that point?
Yes, I was. It was one of the things where I was like, "What do I do with that?" Right? I was really still asking that question of, is my diagnosis accurate? Did I outgrow this and I just suck at adulting? Or is this actually ADHD? What's the answer here?
I dragged my feet about getting an answer for maybe another year or so. Something like that. And there was somebody close to me who attempted to take take their life, and luckily, they did not succeed. But, it was it was a wake up call for me. Right?
You know? It was one of those things where I went, nobody's gonna do this for me, right? Nobody's going to model this for others. Yeah, something just snapped in me and I was like, I have to figure this out. I can't go on like this.
I decided after that, It's done, I'm going to go find myself somebody, I'm going to answer the question of is this ADHD or something else? Because once we can answer that, then we can figure out how to proceed.
I analyzed what I felt was wrong with my previous attempts, right? What hadn't worked, right? There were some common threads that I saw. One of which was that they didn't have an understanding of ADHD. They would say that it was a specialty, but they didn't.
That was a huge. They really only had a surface level knowledge.
Number two: in network versus out of network. This is one of the things that breaks my heart, and I could be wrong. I don't want to say that this is an all or nothing type of thing, but, from my experience, who was available to me in network, fell into the category of claiming that they had an ADHD specialty, but they did not.
We didn't have amazing insurance, but we had good enough insurance. They offered out of network reimbursement. We basically budgeted that I was going to find somebody out of network and we were going to figure this out financially.
It's great when you can get a specialist who's in network who's able to address your specific needs, but it is hard for therapists to be in network. Insurance companies make it very hard on them.
A lot of therapists just can't sustain that. So, being able to budget and, if it's possible, find people that have the qualifications you need, the background you need can really save you lots of heartache and time in the long run. And money. Honestly.
Crucial. It's crucial. It was the game changer for me. We did the assessment, I think it's important to talk about what that looked like, so that people know what to expect.
When I reached out, I said, "I've been diagnosed, I want to actually confirm that this is accurate". She sent me a variety of questionnaires, some that I was going to fill out about myself, and then one that I was going to give to my husband, she basically said somebody close to you. I chose my mom and my dad to help fill out the other one, so that they can get a whole picture, knowing those of us with ADHD aren't always the best at our awareness.
It's good to have outside input. That was a big part of it. The other piece of that was actually doing a two or three hour session where we came in and did a deep dive interview so that she could hear my story and learn about my past.
I will never forget the relief I felt on that day because I went in and I was so nervous, like, I'd made all these notes. And I was just like, "oh my god, please, let this be accurate so that I have an answer".
I remember like sitting there, we're starting the conversation. I was like,"Can I just ask you? Like, I have to know, is it ADHD? And she was like, "Oh, yeah, I know it's ADHD.
You made it, congratulations!
It's confirmed, I have an answer. Okay, then it was like, alright, what does that actually mean?
Well, right? That's the next really important question; what does that actually mean? Not the ideas that we have, right?
Yes. And that's been the journey. Right? That's been a big part of the journey, because it has been an education.
Figuring out, what are the books to read? Right? Where are the resources? It takes time to build that relationship with the therapist. It takes time to learn these exercises. For me, it wasn't necessarily an issue of focusing or task initiation, I had issues with that, sure.
But,one of the big things that stuck out that I was still really struggling with the emotional regulation piece, right?
What was really cool about this provider was that she not only does CBT work, but she does DBT work (dialectical behavior therapy). You're familiar with it?
I am. I don't know if all the listeners are familiar. If you wanted to give a little quick explanation. I know there's not really a quick explanation with DBT. But...maybe how it's different from CBT, because that might be a place to start.
I'm probably going to mess this up.
Let's do the the announcement, "We are not therapists..."
Exactly. I've done therapy, not a therapist. You probably can add to this, but from my understanding of DBT, this was something that was designed for people with borderline personality disorders. Is that right? Originally?
But they have found that it's been very successful for people with ADHD, especially around learning specific skills around emotional regulation and distress tolerance and things like that.
I think the emotional regulation piece is a really big difference from CBT. CBT is powerful, right? But, it's a thought-based approach, not really looking at regulation. I mean, your thoughts can impact your regulation. But it's different in that way.
Yeah, I mean, I think of CBT is like you're looking, you're looking at your thoughts and how those affect you. With DBT, it's very much the actual like skill. I found that was very actionable, right? There were things that I could do and practice and put into put into place given that emotional regulation was one of my biggest struggles.
Learning that I could shove my face in a bucket of ice water, kid you not, and that that could calm me down. There would be times when an argument would be coming and my husband would walk to the kitchen and grab an ice pack and hand it to me. Sometimes I'd be like, "you're amazing" and other times, I'd be like "I just want to throw this at your face".
Depends on how quickly he got you the ice pack.
Exactly. I was learning these skills, but I was still really, really, really struggling. When I'd be in the moment, it was like the train had already left the station. You're doing a lot of mindfulness work, right? A lot of like, building awareness, so that I could start to recognize the triggers , but often where I was getting caught up, and this is why I was so frustrated, is that I just couldn't do the skills in the moment.
That is true of these skills, you can't do these skills in the moment. This is why, you know, practicing this matters so much. Because when you're already elevated, when the trains left the station, like you said, it's just not available, you're not going to be able to do it "real time".
Exactly, exactly. That was like where I was so frustrated. Now I'm going to pivot a little bit into psychiatrist. My therapist referred me to a psychiatrist here in San Francisco who had an ADHD specialty.
I kind of want to talk a little bit about what that looked like. Because going in with her, it was kind of similar, because I had already been assessed and was working with this therapy group, I didn't have to go through a similar type of assessment with her.
She had me fill out some form so they could share their notes and assessments with her. She could see my case file essentially. From there, I went in and did like an extended (I think it was like maybe a 60 minute, maybe an hour and a half) session to kick things off with her so that we could talk about my medication history and some of the things that I was struggling with.
From there, then I basically said, "I have two goals, I want to make sure that the medication I'm on is the right fit and that the dosage is correct and then I said the other piece is that I'm thinking about getting pregnant. I want to talk about how we handle that, because I'm really fearful of going off of my meds because I did it for a year in my 20s and it was a disaster. I wanted to know what my options were.
The first piece of this figuring out the right medication. We talked about some of the options and ultimately, I was like, I think Adderall seems to be working for the most part. Her recommendation was trying to switch from an immediate release format, which is what I had been on, and move over to an extended release, because some of the things that I was describing about how I'd forget to take my medication the middle of the day, or that there was like a really steep drop off in terms of my energy levels.
I was really irritable whenever my meds would start to wear off. I think I metabolized it rather quickly. So she was like, "let's see if like an extended release form might work better for you".
And it did. I noticed a big difference in my ability to focus and then I just didn't feel as irritable at the end of my day when that was wearing off.
Another piece of the puzzle was that she also said, "you can have a booster dose if you if you're needing to do work later or there's like something you need it for in the evening.You can take a lower immediate release dose as long as it's not affecting your sleep. It wasn't. I'm the kind of person who can pound a double espresso and then fall asleep 30 minutes later. I know. I'm lucky that way.
So, she helped you kind of figure out how to tweak the medication piece, to match maximize that.
And this was new, I don't remember this from when I was a kid, because my parents are the ones who were basically managing it for me. What I really appreciated was that she was very explicit with me about how this was going to work with titration.
She gave me written and verbal, we went through the written instructions together in session, where she was like "I'm going to be sending you three different dosages to your pharmacy, and then here's how we're going to do this".
She had it written out from here, she was like, "This is the dose that you're going to take for X number of days, then you're going to move up to this, then you're going to move up to this". And then she said, "but, these are the things to look out for...".
She was talking about the specific side effects that I could look for, if I start to feel really jittery, or I'm noticing more irritability or anger, certain things like that. She got very granular with me about these are the things to look for. What you want is the lowest comfortable dosage, right?
That is supportive for you, where you're not having these major side effects. And there are caveats where she said, "you know, there may or may not be a perfect medication, right? There really isn't such a thing as perfect, so it's really important to know that this may be you weighing the pros and cons as well. Right?"
Knowing that, like appetite suppression, it's a very real thing with stimulant medication. Is it harming you? Or is it something that you can learn to manage? Right?
I'm very particular about making sure that I get fed really quickly in the morning, because otherwise I will forget, and then I won't eat. There's things I've had to learn to work around that. But I was like, "okay, I can manage, I can live with that". Right?
Understanding, not only what it is that you're looking for, to find that comfortable dosage level, but also to understand this isn't going to solve everything in a day, right? Pills don't build skills, I will say that over and over again, right? It's just a tool in your kit to help you.
Talking about this being a tool and talking about our team, some people are not sure, especially because ADHD is a neurodevelopmental disorder, they're not really sure who you bring in on the team, when maybe the pediatrician is already doing medication. It's a good thing to recognize that if you need to go deeper with medication, you've got some bumps, this is your specialist that's going to really give you all that knowledge.
Exactly, exactly. There's nothing wrong with like having your regular doctor manage your meds. I did it for years. But, we'd already settled on what I was using at the time, what I was being prescribed. We didn't need to be doing all this tweaking.
I was in this new position where I needed to actually figure out the dosage, I could try that with my with my doctor, but they don't have that specialty or understanding.
Right, They're generalists.
It's really helpful to go see a specialist on your medication when you need to that.
Exactly.. So, we we did this work together, but again the emotional regulation piece was missing for me. I get an email from my psychiatrist, it was titled like, Rejection sSensitivity or something like that. She attaches the paper from Dr. William Donaldson on rejection sensitive dysphoria.
She said, "This just came across my desk, I was reading it and I immediately thought of you. Don't really know much about this, take it with a grain of salt. Read it and let me know what you think because there's some potential medication options that we could consider".
And I read it and I remember, I just sobbed. I had never felt so seen in my entire life. When I read that paper, I still get very emotional just thinking about it, that was the piece that I was struggling with.
Like, I was afraid to have a kid because I didn't want to scream at my kid, right? Like, I could never get a hold of that side of myself. When he was talking about how there were other medication options to pair with a stimulant... because the stimulant, it works for the focus, but the emotional piece.
When he talked about how there was a possibility of something to help with that, the emotional regulation and impulsivity, I was like, "Okay..."
My psychiatrist asked, do you want to try this? And I was like, "Yeah, sure". I'll try anything to help with this. Hearing that it was an old blood pressure medication, guanfacine was the one that we ended up trying and, worst case was that I'd be a little tired, right?
That's worth the trade off. I've got to tell you, I remember like, the third day on it. I was coming downstairs, my husband was saying something, it was just kind of irritating me. I started to see where it going, where it might go. And I go, " can we just table this until Saturday after we've had a good night's sleep and time to think on it and like we can come back to this".
He just stood there. His jaw just sort of dropped and he looks at me and he goes, "What did you do with my wife?".
He's like, "I was already going to get the ice pack. What are you doing?".
Seriously! I remember being like, "I did it!" I did the thing that we've talked about in therapy for years.We've been talking in couples therapy about how do we end a conflict gracefully? I emailed my psychiatrist, and I was like, "You'll never believe what happened". It was just like, the fog had lifted. And I was just like, "Oh, my God, I actually can do this, like, wow, I can stop a train. I can stop the train!".
Yeah, that's awesome, that really is. Tell me then, when you were using some of the other regulation tools, was there a difference? Was it just something that was not available at all yet? What was that experience like?
Yeah. Before finding the medication, I had been practicing in low stakes situations, right? In therapy, or journaling about it, I would try to practice just on my own or at home, we tried to practice in a really low stakes thing.
And it would be okay, but then, when it was something that was really triggering, or really emotional, if I was tired, if there had been alcohol, there were things that we really had to be careful about and like, managing right?
Making sure the body was in a place to be able to handle it. It still didn't matter. Even when I was at my best, I was constantly exhausted, right?
I couldn't stop the train. I called it Hulk, it was like, my Hulk would just rage out. Right? For the first time, I could slow down right? Suddenly, the anxiety lifted, I was always so fearful of what other people were thinking, suddenly I would stop and go, "what what assumptions am I making right now?"
Yeah. Suddenly, I could reach in and grab the tool out of the toolkit and be like, "Okay, let me just do the thing that we talked about", it was a biological thing that we hadn't been able to get for, I don't want to, not like a meds pusher. But if you find the right thing, it can be life changing.
That is this journey of hitting ADHD from different angles, supporting it from different angles, finding your team, which is going to look different. Everyone's team will look different, who they need, and even in different seasons of your life, it's going to look different.
Yes, yeah. And it's fascinating. When I think about this journey, it's a lifelong thing, right? We looked at that when I was a kid, right? We look at high school, we looked at college, I look at my early 20s. Then I look at wherethese last five years of moving into this space where I am now with my team.
I've been working with this team now for about... late 2017 was when I started building my team, this was a journey and it didn't happen....You know, I got hooked up with the psychiatrist. I got hooked up with an ADHD informed couples therapist.
These things all happened within about a year of each other. Then then adding a coach, right? My therapist and I went so far, and she went, "A lot of the things you're talking about, yeah, I can support you from that ADHD perspective, but I think you need to bring in a coach. Right?
So, it was like starting to put these things together, because she was like, "I have this expertise, but you need somebody here who can actually work with you around the action and the business piece". Very much a collaborative approach and something where I have all members of the team speaking to each other and working together so that we can make sure that everything is being looked at fully.
Yeah. So, if you are going to advise somebody then just say, okay, you know, who should be on my team for helping me support ADHD, What would you advise?
I mean, magic wand, you have all the resources in the world?
Yeah, let's go ideal first.
The ideal is that you're able to get therapy first, in my opinion. That's my opinion, right? Because medication as we saw, is useful and I used meds pretty much alone for a lot of my life.
But, as we can see, it doesn't solve all things. I mean, the gold standard that we talk about in ADHD treatment is therapy, meds and coaching, right. So, you know, starting with that therapist, making sure that you're working with a therapist, and you're getting that psychiatrist, if you're going to go the medication route. That's an if, if you decide to do that.
Then, if you if you can swing it, bringing in a coach is really, really supportive. My therapist, I say she has kind of a coaching approach to her work. So I was able to get by with her alone for a while, but then it became clear that there were specific things that I wanted and needed coaching around.
Right. Yeah. I have to agree with you on that one about the therapy first. You see this a lot, (we've had this discussion) about trauma, right? How trauma is not in the coach realm, and it can really impact ADHD traits, symptoms. This is a high priority, I think before looking at the "get It done" coaching phase,
Yes, because the fact of the matter is, if you've got something that's unprocessed or like really intense that you have not worked through, you're not going to be able to get into action.
I'm sorry, you can try all you want, and maybe you'll get a little bit, but you're gonna get stuck, and you're going to keep getting stuck until you deal with it.
That was the thing, I had this emotional stuff that luckily before I had gone to coaching, I had been working through. I think that I was able to make really fast progress in coaching because I'd spent years doing this work already.
It set me up for success when I went into a coaching relationship. My first coach was not an ADHD coach. Thinking back, it's actually pretty impressive to be able to go into something where they were, like, "Go forth and do the thing". I was like, "How?". I would go back to my therapist and be like, "Alright, we gotta like, hack this together".
So,you kind of integrated the coaching and ADHD approach. Okay.
Yeah, I don't I don't think that I really knew that was what I was doing at the time. Basically, I would say I'm going to do something and then I'd be stuck. Then I'd go to therapy and be like, "I don't know what to do. I'm spending all this money, and I feel like I'm not doing anything"
Right. Whether you're going to a therapist or a coach, making sure it's somebody that gets your brain, because therapy, coaching, anything can harm. It can harm if it's not... if the wrong lens is being used.
Yeah. I look back at that guy in my mid 20s who made it seem like these were character flaws, right? Like that I was not caring towards my spouse, maybe there was abuse in my childhood. No, that's not what's going on here. This is a neurodevelopmental disorder. And there's nothing wrong with that.
It's a journey towards self acceptance and self love, self compassion for the fact that this is my brain. Now, yeah, sometimes I get the twinge of sadness around I may not be able to do everything that everybody else does. But then I'm like, but that's just my brain. And that's ok.
Right. I agree with you. I think that compassion piece is so huge. Maybe the biggest piece?
Yes, yeah. And my therapist really has been so incredible about driving that home for me: you are really busy, and you are doing so much. She really validates and acknowledges and has been there to reflect those things, much in the way a coach does, right? Really holding that space and awareness for what's going on in my brain and my body.
There's so many things with an ADHD brain that makes us vulnerable to misassessing ourselves, not judging time, not recognizing what we're doing. You said your therapist is talking about you being busy and sometimes we are so busy, but we don't remember what we've been doing. Just that awareness and compassion together is big.
Yeah, it really, really is.
What are your thoughts...and I know this is a hard one to answer, I don't know if I have a good answer, either, but for people that are saying, "Hey, this is impossible. I can't access these things". Maybe they're in a rural area or financially, for whatever reasons, they just can't access the team like they'd like to, what are your thoughts?
Oh, this one get me.
I know that again, I'm lucky that I live in a major metropolitan city and that I have resources. It's one of the things where I would say, don't be afraid to reach out to these clinics and ask them if they have sliding scale spots. Maybe they're full right now, but can you get onto a list for that, right? Like, be up front, this is my situation.
Another option would be to consider group coaching or group therapy, those tend to be a little bit more affordable options. I know that there's some really, really great group options out there just around either like DBT skills or even looking for certain ADHD education or things like that. You run a group, right?
Yeah, I do. And that's a really good idea. People have them in all different formats, right? I have a group that's eight weeks, some people do a membership, all different price points. That's a good way to be able to access coaching or therapy. I don't have as much experience in the group therapy, but that would be a great idea.
It's a great entry point, if you're not fully sure, or it's a financial thing, it can be something more affordable and accessible to start.
Right. We were talking before about possibilities of employers paying for some of your support when it comes to coaching or strategies and that, sometimes, you might have a work situation where something can be provided for you, some reimbursement for that.
Yeah, exactly. Don't be afraid to ask.
Yeah, don't be afraid to ask.
And see if there's some organizations out there that fund this kind of thing, like nonprofits that will that will help you navigate this. I don't know any specifically, I guess maybe reaching out to CHADD or ADDA as options,see if there's an advocate out there who can help you navigate, right?
This is something I do with my clients, I'll work with them. Not only do I have a list of providers that I know, although most of them are out of network, but I have a list in the area that I know, that I feel comfortable recommending to clients. Then if they're still like really hitting a wall, I'll work with them, just having another person to process it with and walk through it. Sometimes you just have to have hand holding.
Yeah. Your help could be somebody that is in your life that is a paid person or a non paid, it could be a family member or friend.
The more you understand about your brain, the easier it is to coach people on the support you need. "Hey, I just need somebody here with me. I just need somebody to help me with figuring out my priorities, whatever. To get the support where you can get it.
Yeah. Referrals are great, right? When I was diagnosed with PTSD after my labor and delivery, I sourced that through referral word of mouth, right?
I found a really wonderful trauma specialist who worked with with parents postpartum and she was ideal. That's because I reached out within my community and was like, "Who can help me, I'm looking for this specifically within this budget", right? And I just was relentless.
That is important. When you're looking for somebody who specializes and you need something specific, then that is a great way, getting referrals. People have already done some of the legwork for you. They've been to the duds.
Yes. Exactly. And you've got to hold in your mind, too, that the first person you contact might not be the one, which can be really discouraging, especially for the person with ADHD.
Where it's hard enough to call in the first place, but it's like, give yourself some grace, take some time. Rule of three is my thing. Three is what I aim for, three I can work with. There's bound to be something I can experiment with in there.
That's my magic number for any house repairs, get three estimates for anything. That's what I'm working with.
This is very, very good. Now, are there any any other thoughts about who you can have on your ADHD team? Who's helpful?
Yeah, so a house cleaner is one of the big ones. I despise cleaning. It's one of those things that just like I hate, I like a clean place, but I hate doing it. Once we had the budget for it, I was like, "No",
My husband fought me on it. I was like, no, not only are we going to do that, we're doing this every other week. And eventually my hope is to get to the point of like, weekly, you know, because it just makes such a difference.
For me, it really affects my energy and my mood just knowing that there's somebody who's going to come do it for me. I have just accepted that they work around my piles. I've let go of the guilt or the embarrassment or shame. I was like, whatever. Cool.
Yes. That is good to think about in a broad sense, too. What just exhausts you, or you're not efficient or effective at. I know a lot of people will think "Oh, well, it's not in my budget". But,if you can outsource things that you're not great at, that are exhausting, and put your energy towards the things that you can...either exchange services, there's problem solving that you can do so you can outsource something without just having to write a check.
Yes, yes, yes. I think that outsourcing is my favorite life skill.
I think can be a hard sell sometimes for people because we think "that's extravagant" or I "should" be able to do XYZ.
Right? There it is. No, I mean, that was us for a long time, right? Where it was like, well, everybody else is able to clean their house, or like, my mom did most of that at home.
We look at what other people are doing what we think they're doing. Yeah, there's some stories that we might be carrying around.
It legitimately could be like that you literally don't have the budget...
You know, you've got to ask yourself that question, is it that I can't put food on the table? Or is it that I'm not seeing the value in the money going towards this thing?
It's a big question. Because if there's a value there, and you see it as important, then maybe there's another way you can access it.
For a long time. It was like a division of labor thing where we would say, "what are the things that I hate least?". And then we then we would divide and conquer. I have found that that's been a huge game changer, just in terms of deviating the energy, right?
Yes. There's a theme here: help. Asking for help, paying for help.
Yes. It is the greatest skill you can learn. It's not just about the financial piece, if it's not somebody that you're hiring, can you barter? Can you enlist a body double to make it more pleasant? Are there things that you can do?
For that support team, do you want to hire an organizer? For the airport. before we had a kid, we would just take an Uber or Lyft, it was just worth it to us to do that versus trying to like park, pay for parking, it was just was so stressful.
Again, what's going to alleviate stress for you? Having a professional who's a specialist might actually save you some time in the long run as opposed to you trying to figure it out yourself, right? I know what it's like to be the person who's like, "but I should be able to do this". But then there's that magical question of "who says?", right?
Who's idea is this? And do you want to be following it?
Yeah, yeah. I use Instacart. Right, personal shopper, right? I'll pay the subscription so somebody can do the grocery shopping for me.
That's another thing, a lot of us have sensory issues, all the overwhelm that comes from decision making, doing grocery pickup or Instacart any of that helps.
Exactly. You can get creative. It's not just the mental health component. It's other things in your life, right? Like, is it getting a babysitter so that you can have a couple of hours to yourself?
Maybe at some point, like, do I want to get a personal trainer to teach me how to use the equipment at the gym, right? All these kinds of things that are going to be supportive for you. Finding either like friend who might be able to help you with that, hiring it out, bartering, there's a lot of different ways that can go.
I like that. We think immediately of the team as medical professionals or mental health professionals, but it extends out. That same idea of not doubting yourself or doubting your need for support, that you're deserving of support lets you get this done for yourself. You're deserving everybody.
I know. Hear that.
Well, thank you so much, Caitlin. I know I kept you a little longer, but thank you so much for being here and sharing with us and sharing your life with us and the journey that you've been on.
I hope it was helpful.
Definitely. Thank you so much.
Thank you for having me. I really, really appreciate it.
Caitlin O'Brient Bauer is a certified ADHD & Life Coach and the founder of SF ADHD Coach. She's based in San Francisco, CA and meets with her clients virtually. You can find her online at www.sfadhdcoach.com.
If you want more information on rejection sensitive dysphoria, you can access Caitlin's helpful resources handout here.
Interested in learning more about my group coaching program, Embrace Your Brain? Considering 1:1 coaching or have other questions for me? Please feel free to contact me here.
Learn how to use sensory input to change your energy and focus! Register for my FREE Sensory Strategies for ADHD workshop here.