452: Inattentive ADHD Misdiagnosis with Dr. Michelle Frank

Oct 27

Dr. Michelle Frank is a clinical psychologist specializing in providing diagnostic and treatment services to individuals with ADHD. She joins us today to talk about inattentive ADHD and the struggles that come along by way of misdiagnosis.

Nikki shares the story of her own family’s struggle with getting an inattentive diagnosis and Michelle walks us through the difference between inattentive and predominately hyperactive types to give us a sense of how and why inattentive ADHD gets missed. In addition to coming away with a clearer picture of why inattentive type is missed so often, Michelle offers us a set of questions to ask of ourselves, our children, and their teachers and care-givers that will help us uncover the hidden signals of inattentive ADHD.

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Episode Transcript

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Pete Wright: Hello everybody, and welcome to Taking Control: The ADHD Podcast on True Story FM. I'm Pete Wright, and I'm here with Nikki Kinzer.

Nikki Kinzer: Hello everyone. Hello, Pete Wright.

Pete Wright: So weird recording during this live stream on a non-Monday. I'm all cattywampus.

Nikki Kinzer: I know. It's going to really throw you off.

Pete Wright: It is. I'm really going to have to listen to those soothing Dave Matthews albums after this. Ugh. You know how it is. I'm very excited about this. There was risk that I wasn't even going to be here. With so many scheduling updates, so it just shows you, just keep rescheduling. Eventually, the planets will align, and here we are, one of our very, very, very favorite guests is back to talk to us about ADHD misdiagnoses, inattentive misdiagnoses, I should say. Before we do that, we're going to head over to Take Control: ADHD, so you can get to know us a little bit better. You can listen to the show right there on the website or subscribe to our mailing list and we will send you an email each time a new episode is released. And of course, if this show has ever touched you in any way, shape, or form, preferably the good kind, we would love to invite you to visit Patreon.com/TheADHDPodcast. This is listener supported podcasting. For a few bucks a month, you can help us grow the show, focus our attention on the show, most importantly, and you get access to some great perks like the online community, like early access to the show, like actually watching us livestream. I know you're sitting there, you're praying, your fingers are crossed for those hot mic moments where Nikki and Pete screw up. We try to avoid those, but my goodness, it happens.

Nikki Kinzer: It happens.

Pete Wright: So anyway, thank you so much for those who are already dedicated supporters, we so appreciate you. And for those who are just considering, thank you very much. Patreon.com/TheADHDPodcast. We have some announcements, yes? Very brief?

Nikki Kinzer: Very brief. Study halls. We are still doing study halls on Thursday afternoons. So we have a few weeks left. If you're interested in getting some work done and working with a great group of people online, we are body doubles for each other, and we do the Pomodoro Method, so check out my website. Under study halls, you'll put that in the show notes, I'm sure, Pete.

Pete Wright: Oh sure. Why not?

Nikki Kinzer: Of course. And sign up for that. And then, I also want to make an announcement again about the ADHD International Conference, which is online this year, and it is from November 5th through the 7th, and we will have a link to sign up for that as well. Great opportunity to listen to some great keynotes, great speakers. Pete.

Pete Wright: Joyous speakers, you might say.

Nikki Kinzer: Joyous speakers, that's right. And since you don't have to travel and if you've never been to a conference, this would be a great opportunity to check it out and see what it's like.

Pete Wright: There you go. Links in the show notes. Thanks.

Pete Wright: Dr. Michelle Frank is back with us today, y'all. Michelle Frank is a clinical psychologist specializing in providing diagnostic and treatment services to individuals with ADHD. Her work with clients is all about finding strength based approaches to learn how to live with ADHD. She co-authored a fantastic book with Sari Solden, A Radical Guide for Women with ADHD: Embrace Neurodiversity, Live Boldly, and Break Through Barriers, and she's a regular around these parts. We so appreciate her joining us again today. Michelle, how are you?

Dr. Michelle Frank: I'm doing great, I'm glad to be here again. Thanks for having me.

Pete Wright: Oh.

Nikki Kinzer: Thanks for being here, you're welcome.

Pete Wright: Yes, thank you for being here. And Nikki, you need to kick this off. This was your brainstorm.

Nikki Kinzer: This was, yes. So we're going to be talking today about ADHD, inattentive ADHD, and I want listeners to get a better understanding of what it is and how it can be misdiagnosed and why it gets missed. So this situation, this type of ADHD is often more missed with girls and women, however, it does affect all genders, so I definitely want people to understand that and be listening to what Michelle and I have to talk about because this could be a family member, this could be you if you're not sure if you have ADHD or not or if you're thinking that one of your kids does or whatever. It's a very easy diagnosis to get missed, and one of the things I want to share first off, before we get to Michelle's experience and ideas and thoughts is I want to share my own experience with my daughter that I had. And it's funny, when we start talking about really personal things, my heart starts to race a little bit, so I hope that this comes out okay.

Nikki Kinzer: As we know, I'm an ADHD coach, so my whole life is around ADHD. I do a lot of talking about it, and I have talked a lot about it to my family. And a couple years ago, late summer, my daughter came downstairs and says, "Mom, I think I have ADHD." And I'm like, "Really? Why?" Like, where did this come up? Now I will be honest, I have had ideas, thoughts that maybe this might be the case just from some certain things she was doing, but not enough to actually say, "I think you need to get tested." Right? But she actually came down, said, "I was working on a homework assignment with a friend of mine, and what took her 20 minutes to do, I know would have taken me at least two hours to do." And I'm like, "Well, that's interesting."

Nikki Kinzer: And of course, the coach in me, red flag. That's interesting. So we ended up taking this test together online. She took it, I took it, and it showed that there was a very high possibility that she might have ADHD. And it does run in our family on her father's side, she has several cousins and some uncles that have ADHD, and there were little things that I noticed that was happening. Not just the assignment, because I wouldn't have known that unless she had actually said to me it was taking her longer. But her organization. She showed me her binder that she was using for homework, and you know how a typical binder might have some categories?

Pete Wright: Yeah, your subject binder, right? Yeah.

Nikki Kinzer: I don't know what I'm trying to say, like, a file. Yeah, you have a subject and then you pull the tab and you have another subject.

Pete Wright: Yeah.

Nikki Kinzer: Well, the way she was organizing is she was putting everything all just in the binder. However it came to her, she put it in there.

Pete Wright: Yeah, by date.

Nikki Kinzer: So there were no categories.

Pete Wright: Organizing by date.

Nikki Kinzer: Yeah.

Pete Wright: Less effective.

Nikki Kinzer: It was very chronological.

Pete Wright: Yeah, it's okay. That's a strategy.

Nikki Kinzer: Yeah, it's a strategy. And she would do homework, but then she would forget to turn in the completed assignment. In her, I think it was seventh grade, we did a conference, and the teachers would say, "She's so great in class, she's paying attention, she's listening. She does everything that she needs to do, but there are times where she sometimes forgets to turn in her homework or she'll forget to put her name on there." Or something like that. So these were all things in my mind, knowing ADHD as well as I know it, I started getting these red flags. So I said, "Okay, let's go to the doctor." And we went to her primary physician and the doctor gave us a couple of questionnaires to give to her teachers. Well, this was right before her eighth grade year, so her eighth grade teachers didn't really know her very well, so we went ahead and gave it to the seventh grade teachers to fill out. And of course, they all filled it out as, "She's great," and none of these symptoms came out to them.

Nikki Kinzer: Her evaluation from the teacher compared to how I filled it out were completely night and day. I mean, you would think that we were talking about a different kid all together. So when we went back and talked to the doctor about this, I told the doctor, I said, "I know this is what's happening, this is what you see at school, but I really think that there's something else going on." And the doctor said, "Well, I think you're too close to ADHD," because of what I do, and that she sees it more as a depression, anxiety issue.

Nikki Kinzer: Well, I knew my daughter had anxiety, I mean, that wasn't a surprise. But I'm like, "No, but there's still more to this." So she's like, "No, I think it's more anxiety." Well, I wasn't going to let that go, so I was like, "Okay, whatever." So I went and I looked for a psychiatrist who diagnoses ADHD, and I'll be honest, it took a while for me to find one who was open to seeing her that wasn't a year waiting list. I mean, it is hard. It is hard to find somebody to do this. But I found somebody, and it wasn't covered under my insurance, but I said, "I don't care. I will pay however much it costs because I want her to be properly evaluated." So he got her in probably about a month, a month and a half, which was the shortest list I could find, and sure enough, after doing a whole day of testing, which has to do with a lot of different avenues and different evaluations that we had to fill out, he came back saying that, "Yes, she has inattentive ADHD with some depression and anxiety, and you need to watch out for those things just as much as the ADHD."

Nikki Kinzer: It was one of those things that, I went to a conference, the ADHD conference, which is fabulous, and I purposely at this conference took courses that had to do with girls and ADHD and why this was so common, to be misdiagnosed. So I want to bring in Dr. Michelle Frank because I know that if I didn't have the expertise that I have, she would have been missed. There's no doubt in my mind that somebody would have just taken the word of the doctor and just say, "Okay, this is what she has," and she would have continued to struggle. So I guess a good place for us to start, Michelle, is what is inattentive ADHD? What's the difference here? Why is it so hard to not see?

Dr. Michelle Frank: So, there are a few different questions in that.

Nikki Kinzer: All right. I know. I'm not supposed to stack them, but I do anyway.

Dr. Michelle Frank: I know. I do too. Okay, so let's start with what inattentive is. ADHD, it's not described this way in the DSM, but it really is a spectrum condition. It's a chronic condition, and there's a lot of variability even within the diagnosis. And in trying to deal with that over the years, the folks studying the diagnosis and making all the manuals have had a whole lot of fun with naming this condition. I mean, a lot of people think inattentive type is the same as ADD and if you're hyperactive, then you have ADHD. So the name has changed a lot over the years, and right now, what it is is Attention Deficit Hyperactivity Disorder, so it's the global condition, and then you specify, and there are three specifiers. One is predominantly hyperactive, impulsive type. The other is predominantly inattentive presentation. It's presentation, not type anymore. And the third is combined presentation.

Dr. Michelle Frank: Basically, the predominantly inattentive presentation and combined and hyperactive, they all struggle with executive functioning skills in similar ways. They all struggle with regulation. What's unique about predominantly inattentive is that they do not present with the hyperactivity, the restlessness, and oftentimes, they don't present with the impulsivity either. There can be more of a processing lag sometimes for inattentive folks, memory stuff and organizational stuff is very front and forward for them. And then, obviously, as the name says, the inattention, distractibility piece is their primary challenge, whereas you look at someone with combined or hyperactive type, they're going to have distractibility and inattention, but they're also going to describe some pretty forward facing challenges with the impulsivity and hyperactivity.

Dr. Michelle Frank: Where this gets extra tricky is that what we're doing is we're breaking the diagnosis down based on the presence of externalizing symptoms versus internal experience. This is why ADHD is so hard to measure. That's a different podcast.

Nikki Kinzer: Right.

Dr. Michelle Frank: But there are a few things that, I think, went wrong, really, here with the initial assessment for your daughter. The first is this continued gender bias and this assumption of presentation of psychiatric condition based on gender presentation. Most people, what they know about ADHD is still white, hyperactive, school-aged boys who are struggling behaviorally in school. The second is her performances tied to academics. There's another problem we have there, right? That if you have ADHD, it will show in school. Well, not always. Especially these inattentive kids who aren't displaying the externalizing hyperactive behaviors, it's a felt sense of struggle, and they will go home and they will work for hours to try to make up for it, and no one will really, quote, see it the same way.

Dr. Michelle Frank: And then, there's this idea that depression, anxiety, and ADHD, that all of these things are standalone categories and don't have anything to do with each other as opposed to the intersections of mental health challenges, the ways maybe some of these other challenges lead to anxiety, not just the other way around. We're used to looking at, anxiety causes decreased concentration. It's this very linear flowchart, and that's really not how it works in real time.

Nikki Kinzer: So, the ADHD going undiagnosed, I mean, I know she's young, but not being discovered could have easily caused the anxiety because she was working so hard to do what somebody else was doing in 20 minutes or whatever.

Dr. Michelle Frank: It definitely can. I think, too, with ADHD, the bouncing around of thoughts, the default mode network, that ESPN ticker at the bottom of the screen that's going in your head all the time. ADHDers, the natural mechanism to turn that off doesn't always work, so there's this difficulty tuning out even your internal experience. We're talking about distractibility, we're definitely talking about external stimuli, but not alone. We're also talking about difficulty tuning out internal stimuli. This is where you see some people with ADHD have some sensory issues, they cannot ignore the tag in their shirt. So the tuning out kind of goes both ways because it's a, really, focusing of the mind. So in that, I think a lot of ADHDers, because of the default network problem, can have a lot of repetitive thought loops, a lot of worry. ADHDers also have some disregulation of the amygdala, hyperactive emotion mind, so it all plays together, and I don't think we do ourselves a very good service by trying too hard to say, "This is where one thing begins and this is where the other ends, and you fit into this box, not that box." Human beings are fluid. We need to treat them as such.

Nikki Kinzer: Say that I wasn't an ADHD coach and somebody that's listening to this ... Well, take me out of it. Just say that somebody that's listening to this is wondering if their child may have inattentive ADHD. What would be some good questions to ask as a parent to a child? Because you're talking about, it's more about how you feel, not the external factors, so what would be some good questions to actually get at maybe how they feel?

Dr. Michelle Frank: The external is there if you know what to look for. Things like forgetting their lunchbox over and over. Really asking questions, "Tell me what it's like when you read a book." "What happens when we're watching a movie? What happens when you're sitting in class? What's that like for you? Tell me about what it's like to do your homework. Tell me what it's like when you're playing." Really get a curious, inquisitive frame of mind going to ask about what their lived experience is when they're doing certain things. We just assume everybody does homework the same or should or shouldn't be in a certain state. So being curious about what their experience is like in those moments, but you want to be looking for things like daydreaming, you want to be looking at things like, "Do you have a hard time tuning out things happening around you?" Sights or smells or sound? Which is worse? Which is better? Is it easier to be in a quiet space or in a loud space? People with ADHD will answer that question differently because it's all about adjusting the stimulation to meet you where you're at.

Dr. Michelle Frank: Asking about memory. "How often are you losing your phone, and your homework, and your book, and your keys?" When they get older, looking at inattentive driving patterns, that's huge. Fender benders, inattentive accidents, bumping into mailboxes, things like that. Versus the impulsives, they'll get a lot of speeding tickets.

Nikki Kinzer: Pete's raising his hand.

Pete Wright: This whole conversation makes me so mad, you guys. Ugh. For crying out loud.

Dr. Michelle Frank: I have both. I'm combined, and I bumped into poles and got speeding tickets. We have one for everything. So it's looking at the nuances of daily life. You're not always going to be able to get at it unilaterally, with one line of questioning.

Pete Wright: We're talking about this first in the context of our kids, but I am suddenly, as you're assessing what to look for in the external presentation, I've never asked that myself. I was 28 when I was diagnosed by our marriage therapist, and he was the one who said, "Your marriage is fine. Pete, let's talk about your ADHD." First time I've ever heard about that. That was total news to me. And I'd seen him only for three or four weeks, and he picked that up and answered so many questions in that one line that I'd had all my life because I'm inattentive. And as such, I got speeding tickets, I lost my license, and I would do this impulsive thing where I would just go driving and I would drive to places I'd never been before and I'd get horrifically lost without having a map in the car because I wasn't thinking that far ahead. That happened more than once.

Pete Wright: All of those questions that, "God, I'd wish I'd had answered in school." But there was no sense that anybody was looking for me when I was in middle school. There was no sense. There was one kid who was living with ADHD and was super pegged on hyperactive. So he was like a showcase of what everybody thought ADHD was, and here I was, dealing with this for years, completely ignored. To the point when I said, when I was 28, I had my diagnosis, I called my mother and I said, "Hey, look what I've got." And she was flabbergasted. Didn't believe it.

Dr. Michelle Frank: I think it's hard for guys with inattentive presentation because it's like, "Well, I can't do ADHD right. It's supposed to be this way." There's supposed to be this split along gender lines. Discussions of gender-related issues are important, we do have to move away when we're trying to work in the diagnostic lane in some ways because I've had hyperactive impulsive clients who identify as women, I've had inattentive clients who identify as men and everything in between. But there are these stereotypes of what it looks like.

Nikki Kinzer: One of the things that my daughter told me was that she could easily sit in class and just nod her head and she's like, "I have no idea what the teacher's saying, but I sure look good. I sure look like I'm paying attention."

Pete Wright: Exactly.

Nikki Kinzer: So I think that's definitely, again, one of the symptoms of trying to figure out where their head is, what's happening in these situations.

Pete Wright: Well, and I think, too, back to your question about how a missed diagnosis or an ignored diagnosis, a mis or missed diagnosis, the whole act of then, let's say, years later, peeling back and figuring out that, this isn't just anxiety or depression, that there are some underlying contexts here. That's the question rolling back in my mind for our listeners who are living with this or have had later in life diagnoses, what is it that we're looking for to assess that lived experience that tells you, "Wait a minute. There might be some other things I can look for that might be related to ADHD and not anxiety, as my doctors have been telling me all this time, as they've been maybe medicating me for," whatever. How do you start to peel that apart? What do you look for in yourself?

Dr. Michelle Frank: That's hard. It goes back to this idea that people aren't one thing.

Pete Wright: Yeah.

Dr. Michelle Frank: And it points to the complexity of the mental health diagnostic system and the spectrum of neurodiversity that we're all on. What I will say is typically, people who have co-occurring conditions, and depending on the study you're looking at, 60, 70 or more percent of people with ADHD have co-occurring conditions. Psychiatric conditions, which makes it even more confusing. But a pretty good tell is, you've done everything to treat the anxiety, you've done the therapy, you've done the meds, the anxiety's gotten a lot better. Not all the way gone, but nobody should have anxiety all the way gone, by the way, it is an evolutionary benefit.

Nikki Kinzer: Right.

Pete Wright: Right. Because of tigers.

Dr. Michelle Frank: Right. But it's gotten a lot better, but I'm still spinning my wheels, feel like I'm treading water every day because I can't keep up with my life because of the organization, because of the time management, because I tune out in meetings or in class and I forget the really important thing, and I do the paper and I don't hand it in, and I forget about, I have all these parking tickets. The rest of your life still is not coming together. Well, that doesn't really look like anxiety anymore, then, does it? Now we're talking the executive functioning and self-regulation piece, which is different. There are some overlaps. With anxiety, we do see trouble with concentration, we see some real repetitive thought loops, and ADHD folks can get stuck in a lot of thought groups, and certainly, decreased concentration is a huge part of it.

Dr. Michelle Frank: The thing is, those symptoms for ADHD tend to persist outside of an anxiety episode, outside of an anxiety trigger, and once an even more generalized anxiety disorder is treated. So you might get partial treatment of something, but the rest of this is still falling apart. And the other place to look is the domains of your life. ADHD is one psychiatric diagnosis that impacts every domain of functioning, and actually, as a result, has some of the, unfortunately, poorest life and health outcomes if it's not treated appropriately, and it impacts every domain of your functioning. So it's very pervasive and usually there's a pattern of that pervasiveness looking back, where, "You know, my anxiety and depression, they were really good then, but these other pieces of my life were really falling apart."

Nikki Kinzer: One of the things that I learned at the conference a couple of years ago is that if you start noticing grades change or things starting to change in middle school, they were saying around middle school. What is it? Is it because they're going through puberty at that point or hormones or what is it about that age group?

Dr. Michelle Frank: That is definitely part of everything wrong with middle school, right?

Nikki Kinzer: Yes.

Dr. Michelle Frank: But the other piece is the change in structure. Usually then, you're getting lockers, you're walking from class to class. You no longer have one teacher. Some schools start that a little earlier, but the bigger jump tends to be sixth, seventh grade. So usually, if you look at fourth grade, there's a pretty big jump from first, second, and third, and then sixth, seventh, in there, there's another big jump, and then high school, there's another big jump, college, there's another big jump. So there tend to be these markers of where you need more self-organization, you need more self-directed behavior, you need more of these executive functioning skills, more self-regulation, and the support drops off a notch, and then it drops off another notch and another notch, and then that's why I get a lot of young adults in my office because then the supports are fully off. But they've been, quote, good enough students all these years, maybe looking back, they wish some things had been different, but they did okay, they did okay, and then all of a sudden, living on their own, life responsibilities creep up and, boom.

Nikki Kinzer: Are the symptoms different in adults than that you would see in a teenager or a tween?

Dr. Michelle Frank: When it comes to inattentive, no. Largely, the descriptions are much the same. I mean, I ask people, "So tell me, what is ADHD like for you now? What does it mean for you now? What's your journey been?" Or, "What was it like for you as a kid?" And then often say, "You know, I think it was kind of the same. I've learned some different coping mechanisms and strategies, I have some tools now to deal with it, but it still looks the same." I think for inattentive presentation, the context is what changes more and the treatment or lack thereof. Either of those things can change. The presentation itself is pretty similar. The one thing with ADHD overall that does seem to make the biggest shift into adulthood is that the hyperactivity goes underground. Hyperactivity becomes less visibly apparent and hyperactive folks will tell you that they might be bouncing their leg under their desk all day or needing to knead dough in their hands in meetings under the desk to keep the kinesthetic input coming, and they feel restless inside, but it's not something that you can always see on the outside.

Dr. Michelle Frank: The other thing that does make a shift as we age and our brains mature is the impulsivity. I think it's a little bit better. And our executive functioning skills, they do keep developing into adulthood, so you can see some improvement naturally in ADHD into the late 20s. That being said, some things may, for some folks, always lag.

Nikki Kinzer: I've had a couple of clients who have come to me without a formal diagnosis of ADHD, but they think they have it or they identify with a lot of the symptoms. How important is it for someone like that to get a diagnosis? Or is it? I don't know.

Dr. Michelle Frank: Yeah. It all gets very philosophical. I would say it depends. I would say it depends what that person is needing and looking for. How strongly do they rate their distress and impairment? Are they just looking for tools and it's sort of like, regardless of if I have the diagnosis or not, I still want these tools and I want to take things up a notch, or is it that their life is really falling apart and they're deeply distressed? There are a lot of things that can be misdiagnosed when it comes to ADHD. Trauma is a big one. So we don't want to be overlooking some of the treatment needs. So if you're someone, for instance, with trauma, you might need a bit of a different treatment plan than someone without. If you're someone who is pretty high functioning in life and doesn't really feel the need to talk with a provider about a treatment plan now and you're just looking for, for instance, the accountability buddy sessions you do, I mean, should someone need a diagnosis to go? No, absolutely not. So I think it's a matter of degree and it's so individual.

Nikki Kinzer: No. Right.

Dr. Michelle Frank: But that's what mental health diagnoses really come down to are distress and impairment and level of functioning.

Nikki Kinzer: Mm-hmm (affirmative).

Pete Wright: I got stuck a little while ago, which is this whole idea of your executive functioning keeps developing, and I guess the way I see that manifest, I have a certain number of organizational skills that I developed in late college, early career that kind of matured there, and as we're having this conversation, I realize I've been coasting on some of those skills, some of those muscles. And that's why I have that constant feeling of peril, that if I drop one thing, then the whole house of cards comes tumbling down. If that one appointment misses my calendar, then everything else will fall apart. So I suppose, I don't know if there's a question here, but maybe there's just a reflection. I'm suddenly making the connection to that ever present sense of exhaustion that I feel just waking up and living, and I wonder now, that's probably all this stuff. That's probably all this experience of just trying to keep up all the time and not feeling like I can ever afford a break because if I afford a break, I can lose it all.

Dr. Michelle Frank: Right. ADHD is a chronic condition, and we don't always think of it that way because it's just like, oh, this is what I wake up and deal with every day. But it truly is a chronic condition, so I think you're also giving a voice to some of the frustration and the grief around having to deal with it. It's like, "Man, I don't want to deal with this today. I don't want to."

Pete Wright: There's something to the mystery of not knowing and not having these conversations sometimes because the ostrich ability in me is like, "Okay, well I'd rather think of it as something else. So let's go ahead and not make those connections because I really could just use another bowl of cereal."

Nikki Kinzer: Who doesn't need a bowl of cereal? I mean, really. But what I was going to say, Pete, is that kind of also ties back into what we were talking about with Marilyn Paul last week is how important it is to have a day off and have rest and get away from the to-do list and get away from having that pressure of feeling, "I have to make up for something."

Pete Wright: Nikki, that has been so hard for me to wrap my head around. This whole idea of creating a stop day where you don't fall into the trap of check-listing your recreation. Make sure I read book, make sure I go hiking, make sure I do this. Check, check, check, check, check. I have yet to be able to internalize that guidance because, again, if I let my system down, I've trained myself, I have been trained through the blessing of experience that if I let down that guard at all, then it's extraordinarily difficult to rebuild. It's months to rebuild.

Nikki Kinzer: I'm going to call you out on that because I don't think you're giving yourself enough credit because I think you have really solid systems and you trust those systems and you have worked hard on those systems, that you don't have to start all over again. I think there's a little bit of black and white thinking there.

Pete Wright: Well, there probably is, but credit where it's due to you noticing that. You're catching me also talking about this conversation, having this experience on the same day that I'm still dealing with rebuilding from being in bed for a month.

Nikki Kinzer: Right.

Pete Wright: And that was an extraordinary test of systems and I'm exhausted. I'm so tired. So tired of rebuilding and trying to get things organized again. So I recognize that there's some of that, and I surely don't need to make this conversation about me.

Nikki Kinzer: Well, you're doing great.

Pete Wright: But I appreciate that.

Nikki Kinzer: You're doing great.

Dr. Michelle Frank: Well, I think it's important, I think, to bring up something that I hear a lot of, so I think it's an important thing to give voice to, too, because I think it's a very common feeling and experience. My folks were in town and we went up to the mountains, and I don't know about you guys, but every time I do take this break, I need the first day of the break, I'm just sort of restless, aimless, anxious. And then, by the day it's time to leave, then I'm really fully in the mode.

Nikki Kinzer: Right.

Pete Wright: Yeah.

Dr. Michelle Frank: But then it's time to leave, and then I leave feeling like I really didn't get much of a break. So it's building in the space and building in the compassion and permission. I know it's going to take me a week to get back to the systems. I'm kind of going to have a messy life for a week when I get back and that is okay. And the other thing is, there's something about, it could even be an Airbnb down the block, and it's like I have to be in somebody else's house, at a hotel, or in nature. If I am at my house doing nothing, it feels very different than if I'm at an Airbnb, it literally could be nextdoor, doing nothing.

Nikki Kinzer: I totally agree with you. Yeah.

Pete Wright: Yeah. 100%.

Dr. Michelle Frank: These spaces in our minds, we have to create the separations. Yeah.

Nikki Kinzer: Absolutely.

Pete Wright: I just like to rifle through other people's stuff. Airbnb is perfect, it's just really centering.

Nikki Kinzer: How do these people live?

Pete Wright: Yeah, right. I'm cooking in your pans now, Joe and Marlene. Huh?

Nikki Kinzer: Oh, that's crazy.

Dr. Michelle Frank: This is why I love this podcast. This is why.

Pete Wright: Oh my goodness. Well, this has been an exhausting roller coaster of emotional experience for me. Thanks, Michelle.

Dr. Michelle Frank: I feel like you say that every time.

Pete Wright: I know. What are you doing?

Nikki Kinzer: Well, I so much appreciate you being here and talking about this because I know from our family's standpoint, it was a very pivotal point in my daughter's life and in our family's life and it is going to continue to be a journey, for sure. One of the things that I really want to just stress to people out there, especially if you're a parent, is trust your instinct. If you think something's not right, even if the doctor's telling you, "No, everything's fine," or, "It's just a little bit of anxiety because she's a teenager." I don't know. Get a second opinion, keep digging, be an advocate for yourself, for them.

Dr. Michelle Frank: And keep in mind, even on these rating scales of ADHD symptoms, remember that 95 plus percent of the people who respond to them do not endorse these challenges, certainly not all of them. You don't have to convince yourself out of it, just go get it checked out. I think we sort of talk ourselves out of it, but the truth is, people don't come in for treatment and diagnostic services at the rate that they should because of stigma. There's a lot of under-diagnosis of a lot of mental health challenges, so to your point, if there's even a hint of a doubt, the risks that come with not doing anything are a lot higher than going in and them saying, "You know what? It seems okay right now. Come back in two years." I mean, at least then you know. But the risk of not doing anything can be pretty dire.

Nikki Kinzer: Absolutely. Well, thank you. Thank you so much.

Pete Wright: Yes, thank you so much. Hey, where do you want people to go learn more about you? What are you pitching right now? Did you write another book yet?

Dr. Michelle Frank: No. I've just been, I don't know, it's still March in my mind, I don't know what I've been doing for months. You can find me at ADHD underscore doc at Instagram, and you can email me, DrFrank@EnrichedCenter.org, and you can look up our book, A Radical Guide for Women with ADHD, on Amazon.

Pete Wright: You want to know the level of my pathos right now? I had a dream two nights ago, and I was speaking in a conference to talk about my new book, and it was called Look, I Wrote a Book During the Pandemic: A Spiritual Guide to Not Feeling Shame for Not Doing as Much as I Did During the Pandemic by Pete Wright, and it was a book about literally nothing. I had nothing to say about it, but I wrote a book during the pandemic and I needed everybody to know about that, and I woke up feeling like I'd let a bazillion people down.

Dr. Michelle Frank: Really?

Pete Wright: Yeah.

Dr. Michelle Frank: I was just thinking that is the most brilliant, ironic presentation session I could have ever have done.

Nikki Kinzer: Yes.

Dr. Michelle Frank: It's like performance art.

Pete Wright: Yeah, totally.

Nikki Kinzer: That's right.

Pete Wright: Absolutely. All right. Note to self. Michelle says workshop the book during a pandemic thing. Thank you so much.

Dr. Michelle Frank: Blank pages.

Nikki Kinzer: It's just blank.

Pete Wright: Can you get your publisher in on that? I think we have something to do. I'm going to need a contact. We sure appreciate you, Michelle, and we appreciate all of you for subscribing and downloading this show. Thank you for your time and your attention. On behalf of Michelle Frank and Nikki Kinzer, I'm Pete Wright. We'll be back next week on Taking Control: The ADHD Podcast.

GuestDr. Michelle Frank