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ADHD or Anxiety? The One Question That Changes Everything · Pearls and Prep

• 0:00
  Foreign.
• 0:05
  Welcome
• 0:06
  back
• 0:06
  my
• 0:06
  friends
• 0:06
  to
• 0:07
  another
• 0:07
  episode
• 0:07
  of
• 0:08
  Pearls
• 0:08
  and
• 0:08
  Prep.
• 0:08
  Npz.
• 0:09
  Here,
• 0:09
  your
• 0:09
  preceptor
• 0:10
  in
• 0:10
  your
• 0:10
  pocket,
• 0:11
  your
• 0:11
  go
• 0:11
  to
• 0:11
  place
• 0:12
  for
• 0:12
  pearls
• 0:13
  that
• 0:13
  prep
• 0:13
  you
• 0:13
  to
• 0:13
  practice.
• 0:14
  My
• 0:15
  friends,
• 0:15
  you
• 0:15
  have
• 0:15
  a
• 0:16
  31
• 0:16
  year
• 0:16
  old
• 0:17
  female
• 0:17
  named
• 0:17
  Carly,
• 0:18
  a
• 0:18
  mock
• 0:19
  patient
• 0:19
  who's
• 0:20
  knocking
• 0:20
  on
• 0:20
  your
• 0:21
  door
• 0:21
  in
• 0:22
  the
• 0:22
  outpatient
• 0:22
  practice
• 0:23
  and
• 0:23
  she
• 0:23
  is
• 0:24
  requesting
• 0:24
  an
• 0:24
  ADHD
• 0:25
  evaluation
• 0:26
  from
• 0:26
  you.
• 0:27
  It's
• 0:27
  a
• 0:27
  very
• 0:27
  typical
• 0:28
  request.
• 0:28
  You're
• 0:28
  going
• 0:29
  to
• 0:29
  get
• 0:29
  a
• 0:29
  lot
• 0:29
  in
• 0:29
  your
• 0:29
  career.
• 0:31
  And
• 0:31
  Carly
• 0:32
  is
• 0:32
  here
• 0:32
  because
• 0:33
  specifically
• 0:35
  she
• 0:36
  submitted
• 0:37
  a
• 0:37
  request
• 0:37
  to
• 0:38
  her
• 0:38
  school's
• 0:38
  disability
• 0:39
  service
• 0:39
  office
• 0:40
  requesting
• 0:41
  for
• 0:41
  extended
• 0:42
  time
• 0:42
  because
• 0:43
  she's
• 0:43
  a
• 0:43
  second
• 0:43
  year
• 0:43
  law
• 0:44
  student
• 0:44
  and
• 0:45
  so
• 0:45
  she
• 0:45
  wants
• 0:45
  to
• 0:46
  substantiate
• 0:47
  the
• 0:47
  fact
• 0:48
  that
• 0:48
  this
• 0:48
  request
• 0:49
  is
• 0:49
  necessary
• 0:51
  via
• 0:51
  your
• 0:52
  diagnosis.
• 0:53
  So
• 0:53
  if
• 0:54
  you
• 0:54
  diagnose
• 0:54
  her
• 0:54
  with
• 0:54
  adhd,
• 0:55
  she
• 0:55
  can
• 0:55
  bring
• 0:55
  it
• 0:56
  back
• 0:56
  to
• 0:56
  her
• 0:56
  school's
• 0:56
  disability
• 0:57
  office
• 0:58
  and
• 0:58
  maybe
• 0:59
  get
• 0:59
  extended
• 0:59
  time.
• 1:00
  But
• 1:00
  it's
• 1:00
  your
• 1:00
  job
• 1:00
  to
• 1:01
  understand
• 1:01
  what
• 1:02
  the
• 1:02
  heck
• 1:02
  is
• 1:02
  going
• 1:02
  on
• 1:02
  here.
• 1:03
  Is
• 1:03
  this
• 1:03
  actually
• 1:03
  adhd,
• 1:04
  is
• 1:04
  it
• 1:05
  not?
• 1:06
  Now,
• 1:06
  before
• 1:06
  we
• 1:06
  even
• 1:07
  get
• 1:07
  into
• 1:07
  this,
• 1:08
  I've
• 1:08
  spoken
• 1:08
  to
• 1:09
  you
• 1:09
  guys
• 1:09
  a
• 1:09
  lot
• 1:09
  about
• 1:10
  this,
• 1:10
  I've
• 1:10
  warned
• 1:10
  you
• 1:11
  all
• 1:11
  a
• 1:11
  lot
• 1:11
  about
• 1:11
  this,
• 1:12
  how
• 1:13
  prevalent
• 1:14
  the
• 1:14
  anchoring
• 1:15
  bias
• 1:15
  is
• 1:16
  in
• 1:16
  psychiatry.
• 1:17
  It's
• 1:17
  one
• 1:17
  of
• 1:17
  the
• 1:17
  most
• 1:17
  common
• 1:18
  biases
• 1:18
  that
• 1:19
  I
• 1:19
  think
• 1:19
  can
• 1:19
  really
• 1:19
  turn
• 1:20
  you
• 1:20
  upside
• 1:20
  down
• 1:20
  in
• 1:20
  practice.
• 1:21
  It's
• 1:22
  a
• 1:22
  very
• 1:22
  dangerous
• 1:22
  bias
• 1:24
  with
• 1:25
  respect
• 1:25
  to
• 1:25
  your
• 1:25
  patients
• 1:26
  too.
• 1:26
  You
• 1:27
  are
• 1:27
  frequently
• 1:28
  going
• 1:28
  to
• 1:28
  be
• 1:29
  handed
• 1:29
  information
• 1:30
  that
• 1:31
  may
• 1:31
  bias
• 1:32
  you
• 1:32
  into
• 1:33
  how
• 1:33
  you
• 1:33
  view
• 1:34
  your
• 1:34
  next
• 1:34
  patient.
• 1:35
  In
• 1:35
  this
• 1:35
  case,
• 1:35
  ADHD
• 1:36
  is
• 1:36
  like
• 1:37
  this
• 1:37
  huge
• 1:38
  billboard
• 1:39
  that
• 1:39
  all
• 1:40
  of
• 1:40
  a
• 1:40
  sudden
• 1:40
  is
• 1:41
  in
• 1:41
  your
• 1:41
  office
• 1:41
  and
• 1:42
  you're
• 1:42
  staring
• 1:42
  at
• 1:42
  it
• 1:43
  and
• 1:43
  yet
• 1:43
  it
• 1:43
  might
• 1:43
  not
• 1:44
  be
• 1:44
  the
• 1:44
  problem
• 1:44
  at
• 1:44
  all.
• 1:45
  Maybe
• 1:45
  it
• 1:45
  is,
• 1:45
  maybe
• 1:46
  it
• 1:46
  isn't.
• 1:46
  But
• 1:47
  try
• 1:47
  not
• 1:47
  to
• 1:48
  anchor
• 1:48
  yourself
• 1:48
  to
• 1:49
  what
• 1:49
  everybody
• 1:50
  suspects
• 1:50
  right
• 1:50
  away,
• 1:51
  because
• 1:51
  not
• 1:52
  everybody
• 1:52
  is
• 1:52
  a
• 1:53
  licensed
• 1:53
  clinician
• 1:54
  that
• 1:54
  has
• 1:54
  studied
• 1:54
  this
• 1:55
  very
• 1:55
  carefully
• 1:56
  and
• 1:57
  reads
• 1:57
  the
• 1:57
  DSM5TR
• 1:59
  and
• 1:59
  understands
• 2:00
  the
• 2:00
  various
• 2:01
  dynamics
• 2:01
  that
• 2:02
  can
• 2:03
  feed
• 2:03
  into
• 2:03
  our
• 2:04
  ability
• 2:04
  or
• 2:04
  inability
• 2:05
  to
• 2:05
  pay
• 2:05
  attention.
• 2:06
  Right?
• 2:06
  And
• 2:07
  so
• 2:07
  you
• 2:08
  throw
• 2:08
  in
• 2:08
  TikTok
• 2:09
  and
• 2:09
  social
• 2:09
  media
• 2:10
  and
• 2:10
  other
• 2:11
  just
• 2:11
  lay
• 2:11
  people
• 2:12
  making
• 2:12
  guesses
• 2:13
  and
• 2:14
  all
• 2:14
  of
• 2:14
  a
• 2:14
  sudden
• 2:15
  you
• 2:15
  have
• 2:15
  this
• 2:15
  thing
• 2:16
  that
• 2:16
  looks
• 2:16
  like
• 2:16
  ADHD
• 2:17
  based
• 2:17
  on
• 2:17
  a
• 2:17
  list
• 2:18
  of
• 2:18
  recommendations
• 2:18
  and
• 2:19
  social
• 2:19
  media
• 2:19
  videos
• 2:20
  and
• 2:20
  yet
• 2:21
  we
• 2:21
  really
• 2:21
  don't
• 2:22
  know
• 2:22
  what
• 2:22
  it
• 2:22
  is
• 2:22
  because
• 2:22
  we
• 2:22
  haven't
• 2:23
  evaluated
• 2:23
  it.
• 2:24
  So
• 2:24
  just
• 2:24
  beware.
• 2:25
  It's
• 2:26
  not
• 2:26
  a
• 2:26
  horrible
• 2:26
  thing
• 2:27
  when
• 2:27
  you're
• 2:27
  teed
• 2:27
  up
• 2:27
  with
• 2:28
  a
• 2:28
  hey,
• 2:28
  this
• 2:28
  might
• 2:28
  be
• 2:28
  adhd,
• 2:29
  please
• 2:29
  check
• 2:30
  this
• 2:30
  out.
• 2:30
  But
• 2:31
  you
• 2:31
  could
• 2:31
  also
• 2:32
  make
• 2:32
  a
• 2:32
  major
• 2:33
  mistake
• 2:33
  by
• 2:35
  thinking
• 2:35
  that
• 2:36
  it
• 2:36
  is
• 2:36
  adhd.
• 2:37
  You
• 2:37
  anchor
• 2:37
  yourself
• 2:38
  to
• 2:38
  that
• 2:38
  bias
• 2:39
  and
• 2:39
  then
• 2:39
  you
• 2:39
  have
• 2:39
  this
• 2:39
  confirmation
• 2:40
  bias
• 2:40
  where
• 2:41
  everything
• 2:41
  she
• 2:41
  says
• 2:42
  is,
• 2:42
  is
• 2:42
  put
• 2:42
  through
• 2:42
  this
• 2:43
  ADHD
• 2:43
  filter
• 2:44
  and
• 2:44
  it's
• 2:44
  really
• 2:44
  not
• 2:44
  adhd
• 2:45
  in
• 2:46
  Carly's
• 2:46
  case,
• 2:47
  we're
• 2:47
  going
• 2:47
  to
• 2:47
  find
• 2:47
  out.
• 2:48
  I
• 2:48
  don't.
• 2:48
  She
• 2:48
  might
• 2:48
  have
• 2:48
  it,
• 2:49
  she
• 2:49
  might
• 2:49
  not
• 2:49
  have
• 2:49
  it.
• 2:50
  I'm
• 2:50
  going
• 2:50
  to
• 2:50
  share
• 2:50
  some
• 2:51
  more
• 2:51
  information
• 2:52
  about
• 2:52
  her
• 2:52
  with
• 2:53
  you
• 2:53
  and
• 2:54
  you
• 2:54
  can
• 2:54
  decide
• 2:55
  whether
• 2:56
  she
• 2:56
  has
• 2:56
  it
• 2:56
  or
• 2:56
  not.
• 2:57
  Okay?
• 2:59
  But
• 3:00
  at
• 3:00
  any
• 3:00
  rate,
• 3:01
  I
• 3:01
  think
• 3:01
  this
• 3:01
  is
• 3:01
  going
• 3:01
  to
• 3:01
  be
• 3:01
  very
• 3:02
  interesting.
• 3:02
  So
• 3:02
  let's
• 3:03
  learn
• 3:03
  a
• 3:03
  little
• 3:03
  more
• 3:03
  about
• 3:04
  Carly.
• 3:04
  I'm
• 3:05
  going
• 3:05
  to
• 3:05
  give
• 3:05
  you
• 3:05
  some
• 3:05
  information
• 3:06
  for
• 3:06
  about
• 3:06
  two
• 3:06
  to
• 3:06
  three
• 3:07
  minutes
• 3:07
  on
• 3:07
  her
• 3:07
  here
• 3:07
  and
• 3:08
  then
• 3:08
  we're
• 3:08
  going
• 3:08
  to
• 3:08
  talk
• 3:08
  about
• 3:08
  it
• 3:09
  and
• 3:09
  figure
• 3:10
  out
• 3:10
  what
• 3:10
  she
• 3:10
  really
• 3:11
  has.
• 3:12
  Now,
• 3:12
  Carly
• 3:13
  does
• 3:13
  say
• 3:13
  that
• 3:14
  she
• 3:14
  thinks
• 3:14
  she's
• 3:14
  had
• 3:15
  ADHD
• 3:15
  her
• 3:16
  whole
• 3:16
  life,
• 3:16
  but
• 3:16
  she's
• 3:17
  been
• 3:17
  masking
• 3:17
  it.
• 3:18
  And
• 3:18
  she
• 3:19
  says
• 3:19
  now
• 3:19
  that
• 3:19
  law
• 3:19
  school
• 3:20
  is
• 3:20
  so
• 3:20
  demanding,
• 3:21
  I
• 3:21
  can't
• 3:21
  really
• 3:21
  keep
• 3:22
  up
• 3:22
  anymore.
• 3:22
  Okay.
• 3:23
  And
• 3:23
  you
• 3:23
  will
• 3:23
  hear
• 3:24
  that
• 3:24
  very
• 3:24
  often
• 3:24
  with
• 3:25
  your
• 3:25
  ADHD
• 3:25
  patients,
• 3:26
  right?
• 3:26
  You're
• 3:27
  going
• 3:27
  to
• 3:27
  hear
• 3:28
  that
• 3:28
  there's
• 3:28
  usually
• 3:29
  some
• 3:29
  kind
• 3:30
  of
• 3:30
  life
• 3:30
  stressor
• 3:31
  that
• 3:31
  has
• 3:31
  made
• 3:32
  it
• 3:32
  impossible
• 3:32
  for
• 3:33
  them
• 3:33
  to
• 3:34
  compensate.
• 3:34
  But
• 3:35
  there's
• 3:35
  no
• 3:35
  amount
• 3:35
  of
• 3:36
  post
• 3:36
  it
• 3:36
  notes
• 3:37
  or
• 3:37
  checklists
• 3:38
  or
• 3:38
  external
• 3:39
  reminders
• 3:39
  and
• 3:39
  alarms
• 3:40
  that
• 3:40
  can
• 3:41
  really
• 3:41
  overcome
• 3:42
  their
• 3:42
  own
• 3:42
  executive
• 3:43
  dysfunction.
• 3:43
  So
• 3:44
  if
• 3:44
  I
• 3:44
  saw
• 3:45
  this,
• 3:45
  then
• 3:45
  yes,
• 3:45
  I
• 3:46
  would
• 3:46
  actually
• 3:46
  very
• 3:47
  much
• 3:47
  consider
• 3:48
  this
• 3:48
  a
• 3:48
  red
• 3:48
  flag
• 3:49
  for
• 3:49
  adhd
• 3:50
  because
• 3:51
  it's
• 3:52
  kind
• 3:52
  of
• 3:52
  like,
• 3:52
  well,
• 3:52
  why
• 3:52
  are
• 3:53
  you
• 3:53
  here
• 3:53
  now?
• 3:53
  Right?
• 3:54
  You
• 3:54
  had
• 3:54
  your
• 3:54
  whole
• 3:54
  life
• 3:54
  to
• 3:55
  have
• 3:55
  adhd.
• 3:56
  And
• 3:56
  it
• 3:56
  is
• 3:57
  frequently
• 3:57
  missed
• 3:57
  in
• 3:58
  females.
• 3:59
  They
• 3:59
  can
• 3:59
  kind
• 3:59
  of
• 3:59
  daydream
• 4:00
  silently.
• 4:00
  They're
• 4:01
  not
• 4:01
  as
• 4:01
  boisterous.
• 4:01
  They
• 4:02
  don't
• 4:02
  jump
• 4:02
  on
• 4:03
  school
• 4:03
  tables
• 4:04
  and
• 4:04
  poke
• 4:05
  the
• 4:05
  substitute
• 4:05
  teacher
• 4:06
  in
• 4:06
  the
• 4:06
  eyes.
• 4:06
  They're
• 4:07
  much
• 4:07
  more
• 4:09
  like,
• 4:09
  they're
• 4:10
  more
• 4:11
  pacifist
• 4:11
  about
• 4:11
  it
• 4:12
  all.
• 4:12
  They're
• 4:12
  just
• 4:12
  a
• 4:12
  little
• 4:13
  more
• 4:13
  discreet,
• 4:13
  if
• 4:13
  you
• 4:14
  will.
• 4:14
  So,
• 4:15
  so
• 4:15
  yeah,
• 4:16
  if
• 4:16
  she
• 4:16
  came
• 4:16
  to
• 4:16
  me
• 4:16
  saying
• 4:17
  that
• 4:17
  law
• 4:17
  school
• 4:18
  precipitated
• 4:18
  something
• 4:19
  where
• 4:19
  I
• 4:19
  can't
• 4:19
  focus,
• 4:20
  I'm
• 4:20
  listening
• 4:21
  and
• 4:21
  I'm
• 4:21
  very
• 4:21
  open
• 4:22
  to
• 4:22
  adhd,
• 4:22
  but
• 4:23
  that
• 4:23
  still
• 4:23
  doesn't
• 4:23
  really
• 4:24
  crack
• 4:24
  the
• 4:24
  code
• 4:24
  because
• 4:25
  we
• 4:25
  have
• 4:25
  to
• 4:25
  understand
• 4:26
  what
• 4:26
  specifically
• 4:27
  is
• 4:27
  competing
• 4:27
  for
• 4:28
  her
• 4:28
  attention.
• 4:29
  That
• 4:29
  is
• 4:29
  one
• 4:29
  of
• 4:29
  my
• 4:29
  favorite
• 4:30
  questions,
• 4:30
  by
• 4:30
  the
• 4:30
  way,
• 4:31
  in
• 4:32
  all
• 4:32
  of
• 4:32
  my
• 4:32
  diagnostic
• 4:33
  questioning
• 4:33
  ever.
• 4:34
  I
• 4:34
  encourage
• 4:35
  you
• 4:35
  to
• 4:35
  write
• 4:35
  this
• 4:35
  down.
• 4:37
  I
• 4:37
  ask
• 4:37
  patients
• 4:38
  point
• 4:38
  blank,
• 4:39
  what
• 4:39
  do
• 4:39
  you
• 4:40
  think
• 4:40
  is
• 4:40
  competing
• 4:41
  for
• 4:41
  your
• 4:41
  attention?
• 4:42
  What
• 4:42
  do
• 4:43
  you
• 4:43
  think
• 4:43
  is
• 4:44
  competing
• 4:45
  with
• 4:45
  your
• 4:45
  ability
• 4:46
  to
• 4:46
  stay
• 4:46
  focused?
• 4:47
  I
• 4:47
  ask
• 4:47
  that
• 4:48
  all
• 4:48
  of
• 4:48
  the
• 4:48
  time.
• 4:49
  And
• 4:50
  it
• 4:50
  is
• 4:50
  such
• 4:50
  a
• 4:51
  high
• 4:51
  yield
• 4:51
  diagnostic
• 4:52
  question
• 4:52
  because
• 4:53
  depending
• 4:53
  on
• 4:53
  what
• 4:54
  they
• 4:54
  say,
• 4:55
  you're
• 4:55
  going
• 4:55
  to
• 4:55
  get
• 4:55
  a
• 4:55
  lot
• 4:56
  of
• 4:56
  information.
• 4:57
  You
• 4:57
  know,
• 4:57
  if,
• 4:57
  if
• 4:57
  they're
• 4:58
  thinking
• 4:58
  of
• 4:58
  old
• 4:58
  trauma
• 4:59
  memories
• 4:59
  and
• 4:59
  they
• 4:59
  don't
• 5:00
  feel
• 5:00
  safe,
• 5:00
  think
• 5:01
  ptsd.
• 5:02
  If
• 5:02
  they're
• 5:02
  thinking
• 5:02
  of
• 5:03
  future
• 5:03
  worst
• 5:03
  case
• 5:03
  scenarios
• 5:04
  that
• 5:04
  may
• 5:04
  happen,
• 5:05
  it's
• 5:05
  very
• 5:05
  fear
• 5:05
  based
• 5:05
  or
• 5:06
  threat
• 5:06
  Based,
• 5:07
  I
• 5:07
  think
• 5:07
  of
• 5:07
  generalized
• 5:08
  anxiety
• 5:09
  disorder.
• 5:09
  If
• 5:10
  they're
• 5:10
  thinking
• 5:10
  about
• 5:10
  something
• 5:11
  embarrassing
• 5:11
  they
• 5:12
  maybe
• 5:12
  said
• 5:12
  in
• 5:12
  the
• 5:12
  past
• 5:13
  and
• 5:13
  they
• 5:13
  can't
• 5:13
  quite
• 5:13
  get
• 5:14
  over
• 5:14
  it
• 5:14
  and
• 5:14
  they
• 5:14
  feel
• 5:14
  really
• 5:16
  low
• 5:16
  and
• 5:17
  self
• 5:17
  critical.
• 5:17
  I
• 5:18
  either
• 5:18
  think
• 5:18
  like
• 5:19
  social
• 5:19
  anxiety
• 5:20
  or
• 5:21
  like
• 5:21
  depressive
• 5:22
  guilty
• 5:22
  ruminations.
• 5:23
  Right.
• 5:23
  So
• 5:24
  what
• 5:24
  is
• 5:24
  frequently
• 5:25
  competing
• 5:25
  for
• 5:25
  their
• 5:25
  attention
• 5:26
  is
• 5:26
  a
• 5:26
  very
• 5:26
  important
• 5:27
  question.
• 5:28
  If
• 5:28
  they
• 5:28
  say,
• 5:28
  oh
• 5:29
  well,
• 5:29
  what
• 5:29
  competes
• 5:30
  for
• 5:30
  my
• 5:30
  attention
• 5:30
  is
• 5:31
  something
• 5:31
  that's
• 5:31
  more
• 5:31
  interesting,
• 5:32
  like
• 5:32
  a
• 5:32
  cool
• 5:33
  video
• 5:33
  on
• 5:34
  my
• 5:34
  iPhone.
• 5:35
  I
• 5:35
  definitely
• 5:36
  think
• 5:36
  adhd.
• 5:37
  Right?
• 5:37
  It's
• 5:38
  more
• 5:38
  ego
• 5:38
  syntonic
• 5:39
  with
• 5:39
  adhd.
• 5:40
  They
• 5:41
  might
• 5:41
  not
• 5:41
  like
• 5:41
  the
• 5:41
  fact
• 5:42
  that
• 5:42
  they're
• 5:42
  being
• 5:42
  interrupted
• 5:43
  all
• 5:43
  the
• 5:43
  time,
• 5:43
  but
• 5:43
  the
• 5:44
  interruptions
• 5:44
  that
• 5:44
  are
• 5:45
  happening
• 5:45
  are
• 5:46
  usually
• 5:46
  in
• 5:47
  that
• 5:47
  moment.
• 5:48
  More
• 5:48
  ego
• 5:49
  syntonic
• 5:49
  in
• 5:50
  my
• 5:50
  experience.
• 5:50
  Right.
• 5:51
  They,
• 5:51
  they
• 5:51
  like
• 5:52
  to
• 5:52
  watch
• 5:52
  that
• 5:52
  video
• 5:53
  of
• 5:53
  a
• 5:53
  squirrel,
• 5:55
  you
• 5:56
  know,
• 5:56
  jumping
• 5:57
  off
• 5:57
  a
• 5:57
  diving
• 5:57
  board
• 5:58
  and
• 5:58
  getting
• 5:59
  eaten
• 5:59
  by
• 5:59
  a
• 5:59
  walrus
• 6:01
  while
• 6:02
  a
• 6:02
  magician
• 6:02
  is
• 6:02
  hula
• 6:03
  hooping
• 6:04
  in
• 6:05
  the
• 6:05
  background.
• 6:05
  Like
• 6:06
  whatever's
• 6:06
  going
• 6:06
  on
• 6:06
  in
• 6:07
  that
• 6:07
  viral
• 6:07
  video
• 6:07
  that
• 6:08
  totally
• 6:08
  hijacked
• 6:09
  their
• 6:09
  ability
• 6:09
  to
• 6:09
  pay
• 6:10
  attention.
• 6:10
  They
• 6:11
  usually
• 6:11
  like
• 6:12
  it
• 6:12
  in
• 6:12
  the
• 6:12
  moment.
• 6:13
  And
• 6:13
  so
• 6:13
  ask
• 6:13
  that
• 6:14
  question,
• 6:14
  what
• 6:14
  is
• 6:14
  competing
• 6:15
  for
• 6:15
  their
• 6:15
  attention?
• 6:16
  That's
• 6:16
  very
• 6:16
  important.
• 6:17
  So
• 6:17
  we
• 6:17
  have
• 6:17
  a
• 6:17
  lot
• 6:17
  of
• 6:18
  work
• 6:18
  to
• 6:18
  do
• 6:18
  here
• 6:18
  with
• 6:18
  Carly
• 6:19
  still.
• 6:19
  Right.
• 6:19
  She
• 6:20
  suspects
• 6:20
  she
• 6:20
  has
• 6:20
  adhd.
• 6:22
  Now,
• 6:22
  she's
• 6:22
  telling
• 6:22
  you
• 6:23
  specifically
• 6:24
  that
• 6:24
  she
• 6:25
  has
• 6:25
  difficulty
• 6:26
  concentrating
• 6:26
  during
• 6:27
  lectures,
• 6:27
  reading
• 6:28
  cases
• 6:29
  and
• 6:29
  completing
• 6:29
  assignments.
• 6:30
  She'll
• 6:31
  read
• 6:31
  the
• 6:31
  same
• 6:31
  paragraph
• 6:32
  five
• 6:32
  or
• 6:32
  six
• 6:32
  times
• 6:33
  without
• 6:34
  really
• 6:34
  absorbing
• 6:35
  the
• 6:35
  content
• 6:35
  of
• 6:36
  it.
• 6:36
  She
• 6:36
  loses
• 6:37
  her
• 6:37
  train
• 6:37
  of
• 6:37
  thought
• 6:37
  even
• 6:38
  mid
• 6:38
  sentence.
• 6:39
  And
• 6:39
  she's
• 6:39
  missed
• 6:40
  several
• 6:40
  assignments
• 6:41
  this
• 6:41
  semester,
• 6:42
  which
• 6:42
  has
• 6:42
  been
• 6:42
  really
• 6:43
  frustrating.
• 6:44
  She
• 6:44
  says
• 6:44
  her
• 6:44
  mind
• 6:44
  is
• 6:45
  just
• 6:45
  always
• 6:45
  going.
• 6:46
  She
• 6:46
  can't
• 6:46
  turn
• 6:46
  it
• 6:47
  off.
• 6:47
  She
• 6:48
  can't
• 6:48
  really
• 6:48
  fall
• 6:48
  asleep
• 6:49
  very
• 6:49
  easily
• 6:49
  because
• 6:50
  her
• 6:50
  mind
• 6:50
  is
• 6:50
  racing
• 6:50
  with
• 6:51
  thoughts
• 6:51
  about
• 6:51
  upcoming
• 6:52
  exams,
• 6:53
  her
• 6:53
  class
• 6:53
  ranking,
• 6:54
  and
• 6:55
  whether
• 6:55
  or
• 6:55
  not
• 6:56
  she
• 6:56
  even
• 6:56
  chose
• 6:57
  the
• 6:57
  right
• 6:57
  career.
• 6:59
  So
• 7:00
  just
• 7:01
  pause
• 7:01
  right
• 7:01
  there,
• 7:02
  my
• 7:02
  friends.
• 7:02
  That
• 7:02
  sounds
• 7:03
  very
• 7:04
  GAD
• 7:05
  and
• 7:05
  not
• 7:05
  very
• 7:06
  adhd.
• 7:07
  I'm
• 7:07
  open
• 7:07
  to
• 7:07
  both.
• 7:08
  I'm
• 7:08
  not
• 7:09
  going
• 7:09
  to
• 7:09
  shut
• 7:09
  the
• 7:09
  door
• 7:09
  on
• 7:10
  adhd,
• 7:11
  okay?
• 7:11
  Because
• 7:11
  the
• 7:12
  mind
• 7:12
  always
• 7:12
  going
• 7:12
  is
• 7:13
  very,
• 7:13
  very
• 7:14
  similar
• 7:14
  to
• 7:14
  adhd.
• 7:15
  But
• 7:16
  it's
• 7:16
  not
• 7:16
  enough
• 7:16
  to
• 7:16
  tell
• 7:16
  you
• 7:17
  if
• 7:17
  it's
• 7:17
  adhd.
• 7:17
  The
• 7:18
  content
• 7:18
  is
• 7:19
  absolutely
• 7:20
  key.
• 7:20
  I
• 7:21
  want
• 7:21
  to
• 7:21
  repeat
• 7:21
  that.
• 7:22
  It's
• 7:23
  not
• 7:23
  enough
• 7:23
  to
• 7:23
  just
• 7:23
  know
• 7:24
  that
• 7:25
  a
• 7:25
  patient
• 7:25
  can't
• 7:25
  focus
• 7:26
  and
• 7:26
  they're
• 7:26
  distracted.
• 7:27
  That's
• 7:27
  a
• 7:27
  process
• 7:28
  issue.
• 7:28
  Right?
• 7:28
  That's
• 7:29
  the
• 7:29
  pro.
• 7:29
  They're
• 7:29
  describing
• 7:30
  the
• 7:30
  process
• 7:30
  of
• 7:31
  their
• 7:31
  brain
• 7:32
  being
• 7:32
  these
• 7:33
  racing
• 7:33
  thoughts.
• 7:33
  You
• 7:34
  can
• 7:34
  see
• 7:34
  that
• 7:34
  in
• 7:34
  bipolar.
• 7:35
  You
• 7:35
  can
• 7:35
  see
• 7:35
  that
• 7:35
  in
• 7:35
  anxiety.
• 7:36
  Right?
• 7:36
  Flight
• 7:37
  of
• 7:37
  ideas,
• 7:37
  racing
• 7:38
  thoughts.
• 7:38
  These
• 7:38
  are
• 7:38
  diagnostic
• 7:39
  features
• 7:39
  of
• 7:39
  these
• 7:40
  illnesses,
• 7:41
  but
• 7:41
  it's
• 7:41
  not
• 7:42
  enough
• 7:42
  because
• 7:42
  those
• 7:42
  are
• 7:43
  processes.
• 7:43
  ADHD
• 7:44
  has
• 7:44
  the
• 7:45
  same
• 7:45
  thing.
• 7:45
  Kind
• 7:45
  of
• 7:45
  the
• 7:46
  hyperactivity
• 7:46
  Component,
• 7:47
  you're
• 7:47
  driven
• 7:47
  like
• 7:48
  a
• 7:48
  motor,
• 7:48
  okay.
• 7:49
  You
• 7:49
  can't,
• 7:49
  you
• 7:49
  have
• 7:49
  a
• 7:50
  hard
• 7:50
  time
• 7:50
  listening
• 7:50
  to
• 7:50
  instructions,
• 7:51
  you
• 7:52
  interrupt
• 7:52
  other
• 7:52
  people.
• 7:53
  Okay.
• 7:54
  It's
• 7:55
  all
• 7:55
  very
• 7:55
  similar.
• 7:55
  Those
• 7:56
  are
• 7:56
  process
• 7:56
  issues.
• 7:57
  But
• 7:57
  content
• 7:58
  is
• 7:58
  how
• 7:58
  you're
• 7:58
  going
• 7:59
  to
• 7:59
  separate
• 7:59
  the
• 7:59
  wheat
• 8:00
  from
• 8:00
  the
• 8:00
  chaff
• 8:00
  here
• 8:01
  to
• 8:01
  figure
• 8:01
  out
• 8:01
  if
• 8:01
  it's
• 8:01
  ADHD
• 8:02
  or
• 8:02
  anxiety.
• 8:03
  Okay.
• 8:04
  And
• 8:04
  she
• 8:04
  told
• 8:05
  you
• 8:05
  right
• 8:05
  here
• 8:06
  that
• 8:06
  she's
• 8:06
  worried
• 8:06
  about
• 8:07
  her
• 8:07
  class
• 8:07
  ranking.
• 8:08
  She's
• 8:08
  worried
• 8:09
  about
• 8:09
  upcoming
• 8:09
  exams,
• 8:10
  she's
• 8:10
  worried
• 8:11
  whether
• 8:11
  or
• 8:11
  not
• 8:11
  she
• 8:11
  chose
• 8:12
  the
• 8:12
  right
• 8:12
  career.
• 8:12
  These
• 8:13
  are
• 8:13
  fear
• 8:13
  based
• 8:14
  threat
• 8:15
  level
• 8:15
  worries.
• 8:16
  They
• 8:16
  are
• 8:16
  much
• 8:17
  more
• 8:17
  consistent
• 8:18
  with
• 8:19
  generalized
• 8:20
  anxiety.
• 8:21
  The
• 8:21
  class
• 8:22
  ranking
• 8:22
  is
• 8:22
  something
• 8:23
  she
• 8:23
  can't
• 8:23
  control,
• 8:24
  that
• 8:24
  she's
• 8:24
  worried
• 8:24
  about
• 8:25
  excessively
• 8:25
  and
• 8:26
  can't
• 8:26
  turn
• 8:26
  off.
• 8:27
  Notice
• 8:27
  how
• 8:27
  different
• 8:28
  that
• 8:28
  is
• 8:28
  than
• 8:29
  she's
• 8:29
  just
• 8:29
  distracted
• 8:30
  and
• 8:30
  does
• 8:30
  the
• 8:30
  laundry
• 8:31
  instead
• 8:32
  or
• 8:32
  watches
• 8:32
  a
• 8:33
  video
• 8:33
  on
• 8:33
  TikTok
• 8:34
  instead
• 8:35
  or
• 8:35
  is
• 8:35
  half
• 8:36
  paying
• 8:36
  attention
• 8:37
  to
• 8:38
  her
• 8:38
  to,
• 8:39
  to,
• 8:39
  to,
• 8:39
  to
• 8:40
  the
• 8:40
  spaghetti
• 8:40
  western
• 8:41
  she's
• 8:41
  watching
• 8:42
  on
• 8:42
  TV
• 8:43
  as
• 8:43
  she's
• 8:43
  trying
• 8:44
  to
• 8:44
  fall
• 8:44
  asleep.
• 8:44
  And
• 8:44
  she
• 8:45
  can't
• 8:45
  fall
• 8:45
  asleep
• 8:45
  because
• 8:45
  she's
• 8:46
  kind
• 8:46
  of
• 8:46
  intrigued
• 8:47
  still
• 8:47
  and
• 8:48
  wants
• 8:48
  to
• 8:48
  watch
• 8:48
  the
• 8:48
  end
• 8:48
  of
• 8:49
  that
• 8:49
  spaghetti
• 8:49
  western.
• 8:49
  You
• 8:50
  see
• 8:50
  how
• 8:50
  one
• 8:50
  is
• 8:50
  more
• 8:50
  innocent
• 8:51
  and
• 8:51
  benign
• 8:52
  and
• 8:53
  the
• 8:53
  other
• 8:53
  one
• 8:53
  is
• 8:54
  more
• 8:54
  fear
• 8:54
  based,
• 8:55
  it's
• 8:55
  more
• 8:55
  threatening.
• 8:56
  So
• 8:56
  the
• 8:56
  content
• 8:56
  is
• 8:57
  markedly
• 8:57
  different
• 8:57
  there.
• 8:58
  So
• 8:58
  I'm
• 8:59
  definitely
• 8:59
  leaning
• 9:00
  way
• 9:00
  more
• 9:01
  towards
• 9:02
  generalized
• 9:02
  anxiety.
• 9:03
  But
• 9:03
  I
• 9:04
  also
• 9:04
  kind
• 9:04
  of
• 9:04
  want
• 9:04
  to
• 9:05
  know
• 9:05
  like
• 9:05
  what
• 9:05
  else
• 9:05
  do
• 9:05
  you
• 9:06
  worry
• 9:06
  about?
• 9:06
  Right,
• 9:06
  because
• 9:07
  maybe
• 9:07
  you're
• 9:08
  just
• 9:08
  in
• 9:08
  law
• 9:08
  school
• 9:08
  and
• 9:09
  it's
• 9:09
  particularly
• 9:09
  stressful
• 9:10
  and
• 9:10
  this
• 9:10
  is
• 9:10
  an
• 9:10
  adjustment
• 9:11
  disorder.
• 9:11
  This
• 9:11
  is
• 9:12
  circumscribed
• 9:12
  to
• 9:12
  just
• 9:13
  you
• 9:13
  being
• 9:13
  in
• 9:13
  law
• 9:13
  school.
• 9:14
  Right.
• 9:15
  So
• 9:15
  I
• 9:15
  need
• 9:15
  to
• 9:16
  figure
• 9:16
  out,
• 9:16
  is
• 9:16
  this
• 9:17
  something
• 9:17
  you've
• 9:17
  been
• 9:17
  doing
• 9:17
  your
• 9:18
  whole
• 9:18
  life?
• 9:18
  Have
• 9:18
  you
• 9:18
  had
• 9:19
  generalized
• 9:19
  worry
• 9:20
  and
• 9:20
  anxiety
• 9:20
  your
• 9:20
  whole
• 9:21
  life?
• 9:21
  And
• 9:21
  this
• 9:22
  is
• 9:22
  just
• 9:22
  another
• 9:22
  feature
• 9:23
  of
• 9:23
  it.
• 9:23
  Right
• 9:24
  now
• 9:24
  you're
• 9:24
  in
• 9:24
  law
• 9:24
  school
• 9:24
  and
• 9:25
  the
• 9:25
  same
• 9:25
  worry
• 9:26
  process
• 9:27
  is
• 9:27
  at
• 9:28
  play
• 9:28
  and
• 9:28
  the
• 9:28
  same.
• 9:29
  And
• 9:29
  it's,
• 9:29
  and
• 9:29
  it's
• 9:29
  consistent
• 9:30
  in
• 9:30
  content,
• 9:30
  right?
• 9:31
  It's
• 9:31
  fear
• 9:31
  based.
• 9:31
  It's.
• 9:32
  What
• 9:32
  if
• 9:32
  it's.
• 9:32
  It's.
• 9:33
  I
• 9:33
  can't
• 9:33
  control
• 9:33
  this,
• 9:34
  but
• 9:34
  I
• 9:34
  can't
• 9:34
  stop
• 9:34
  thinking
• 9:35
  about
• 9:35
  it
• 9:35
  anyway.
• 9:36
  It's
• 9:36
  usually
• 9:36
  very
• 9:37
  future
• 9:37
  oriented
• 9:38
  with
• 9:38
  anxiety,
• 9:39
  depressive
• 9:39
  rumination,
• 9:40
  self
• 9:40
  critical
• 9:41
  depressive
• 9:41
  ruminations,
• 9:42
  very
• 9:42
  much
• 9:42
  in
• 9:43
  the
• 9:43
  past.
• 9:44
  That's
• 9:44
  kind
• 9:44
  of
• 9:44
  a
• 9:44
  nice
• 9:44
  pearl
• 9:45
  for
• 9:45
  you
• 9:45
  to
• 9:45
  remember.
• 9:46
  As
• 9:46
  a
• 9:46
  general
• 9:46
  rule,
• 9:47
  if
• 9:47
  somebody's
• 9:47
  thinking
• 9:48
  about
• 9:48
  the
• 9:48
  past,
• 9:49
  I
• 9:49
  tend
• 9:50
  to
• 9:50
  view
• 9:50
  that
• 9:50
  more
• 9:50
  as
• 9:51
  in
• 9:51
  a
• 9:51
  depressive
• 9:52
  construct
• 9:52
  than
• 9:53
  what
• 9:53
  will
• 9:53
  happen
• 9:53
  in
• 9:53
  the
• 9:53
  future.
• 9:55
  Which,
• 9:56
  which
• 9:56
  is,
• 9:56
  which
• 9:57
  is
• 9:57
  much
• 9:57
  more
• 9:57
  consistent
• 9:58
  with
• 9:58
  anxiety.
• 9:59
  So
• 9:59
  let's
• 10:00
  learn
• 10:00
  a
• 10:00
  little
• 10:00
  more
• 10:01
  about
• 10:02
  Carly
• 10:02
  here.
• 10:02
  Okay?
• 10:03
  So
• 10:04
  she's
• 10:04
  telling
• 10:05
  you
• 10:05
  she's
• 10:05
  also
• 10:05
  restless.
• 10:06
  She
• 10:06
  can't
• 10:06
  sit
• 10:06
  through
• 10:07
  a
• 10:07
  full
• 10:07
  90
• 10:07
  minute
• 10:08
  lecture
• 10:08
  without
• 10:08
  getting
• 10:08
  up,
• 10:09
  fidgeting
• 10:09
  or
• 10:09
  checking
• 10:09
  her
• 10:10
  phone.
• 10:12
  And
• 10:13
  okay,
• 10:13
  that's
• 10:13
  a,
• 10:14
  that's
• 10:14
  a
• 10:14
  big
• 10:14
  deal.
• 10:15
  That
• 10:15
  definitely
• 10:15
  sounds
• 10:16
  like
• 10:16
  adhd.
• 10:17
  However,
• 10:18
  however,
• 10:19
  I'm
• 10:19
  not
• 10:19
  sure
• 10:20
  either,
• 10:20
  because
• 10:21
  why
• 10:21
  is
• 10:21
  she
• 10:21
  getting
• 10:22
  up
• 10:22
  and
• 10:22
  fidgeting
• 10:22
  and
• 10:22
  checking
• 10:23
  her
• 10:23
  phone?
• 10:23
  There's
• 10:23
  been
• 10:24
  plenty
• 10:24
  of
• 10:24
  times
• 10:24
  I
• 10:24
  do
• 10:25
  stuff
• 10:25
  like
• 10:25
  that
• 10:25
  when
• 10:25
  I'm
• 10:26
  really
• 10:26
  worried.
• 10:27
  Maybe
• 10:27
  I'm
• 10:27
  about
• 10:27
  to
• 10:27
  give
• 10:28
  a
• 10:28
  presentation
• 10:28
  in
• 10:28
  front
• 10:28
  of
• 10:29
  200
• 10:29
  people.
• 10:30
  Maybe
• 10:31
  I'm
• 10:31
  not
• 10:32
  sure
• 10:32
  if
• 10:32
  my
• 10:33
  flight
• 10:33
  is
• 10:33
  getting
• 10:33
  in
• 10:34
  on
• 10:34
  time
• 10:35
  or
• 10:35
  I'm
• 10:35
  waiting
• 10:35
  on
• 10:36
  some
• 10:36
  news
• 10:37
  about
• 10:38
  my
• 10:38
  cousin
• 10:39
  and
• 10:40
  their
• 10:40
  health
• 10:40
  problem,
• 10:40
  right?
• 10:41
  So
• 10:41
  I
• 10:41
  might
• 10:41
  be
• 10:41
  very
• 10:41
  fidgety.
• 10:42
  I
• 10:42
  might
• 10:42
  be
• 10:43
  kind
• 10:43
  of
• 10:43
  scatterbrained
• 10:43
  and
• 10:44
  disorganized
• 10:45
  because
• 10:45
  I'm
• 10:45
  so
• 10:45
  nervous
• 10:45
  I
• 10:46
  can't
• 10:46
  think
• 10:46
  straight,
• 10:46
  right?
• 10:47
  If
• 10:47
  you've
• 10:47
  ever
• 10:47
  had
• 10:48
  a
• 10:48
  piano
• 10:48
  recital
• 10:49
  and
• 10:49
  you
• 10:49
  wanted
• 10:49
  to
• 10:49
  wet
• 10:49
  your
• 10:50
  pants
• 10:50
  before,
• 10:50
  and
• 10:50
  I'm
• 10:51
  not
• 10:51
  talking
• 10:51
  from
• 10:51
  personal
• 10:52
  experience,
• 10:52
  but
• 10:53
  if
• 10:53
  you've
• 10:53
  had
• 10:53
  that,
• 10:54
  you'll
• 10:54
  know
• 10:54
  that
• 10:54
  that
• 10:55
  wasn't
• 10:55
  adhd.
• 10:56
  You're
• 10:57
  just
• 10:57
  so
• 10:57
  nervous
• 10:58
  that
• 10:58
  you
• 10:58
  can't
• 10:58
  even
• 10:58
  think
• 10:59
  about
• 10:59
  what
• 10:59
  you
• 10:59
  ate
• 10:59
  for
• 11:00
  dinner
• 11:00
  last
• 11:00
  night
• 11:00
  because
• 11:00
  that's
• 11:01
  all
• 11:01
  you
• 11:01
  think
• 11:01
  about,
• 11:02
  right?
• 11:03
  And
• 11:04
  so,
• 11:05
  and
• 11:06
  I
• 11:06
  haven't,
• 11:06
  I
• 11:06
  haven't,
• 11:06
  I
• 11:07
  didn't
• 11:07
  ever
• 11:07
  wet
• 11:07
  myself,
• 11:08
  but
• 11:08
  I
• 11:08
  was
• 11:08
  extremely,
• 11:09
  extremely
• 11:10
  nervous
• 11:10
  before
• 11:10
  my
• 11:11
  piano
• 11:11
  recitals.
• 11:13
  So.
• 11:13
  So
• 11:13
  you
• 11:13
  get
• 11:13
  my
• 11:14
  point,
• 11:14
  right?
• 11:14
  It's,
• 11:14
  it's.
• 11:15
  Yes,
• 11:15
  that
• 11:15
  looks
• 11:16
  like
• 11:16
  adhd.
• 11:16
  Like,
• 11:17
  oh,
• 11:17
  she
• 11:17
  can't
• 11:17
  sit
• 11:18
  still.
• 11:18
  That's
• 11:19
  a
• 11:19
  hallmark
• 11:19
  sign
• 11:19
  of
• 11:20
  that
• 11:20
  hyperactivity
• 11:21
  where
• 11:21
  you
• 11:21
  can't
• 11:21
  sit
• 11:21
  in
• 11:21
  one
• 11:22
  place,
• 11:22
  you're
• 11:22
  driven
• 11:22
  by
• 11:22
  a
• 11:23
  motor,
• 11:23
  you're
• 11:23
  fidgety.
• 11:24
  Those
• 11:24
  are
• 11:24
  literal
• 11:25
  features
• 11:25
  in
• 11:25
  adhd.
• 11:26
  Hyperactivity.
• 11:27
  Distractible.
• 11:28
  Checking
• 11:28
  her
• 11:28
  phone,
• 11:29
  not
• 11:29
  paying
• 11:29
  attention
• 11:29
  to
• 11:30
  the
• 11:30
  lecture.
• 11:30
  But
• 11:31
  think
• 11:32
  about
• 11:32
  the
• 11:32
  last
• 11:32
  time
• 11:32
  you
• 11:32
  were
• 11:33
  really
• 11:33
  nervous.
• 11:34
  And
• 11:34
  I
• 11:34
  guarantee
• 11:35
  you
• 11:35
  didn't
• 11:36
  really.
• 11:37
  You
• 11:38
  weren't
• 11:38
  able
• 11:38
  to
• 11:38
  really
• 11:39
  focus
• 11:39
  that
• 11:39
  well
• 11:39
  either.
• 11:40
  But
• 11:40
  let's
• 11:41
  give
• 11:41
  her
• 11:41
  the
• 11:41
  benefit
• 11:41
  of
• 11:41
  the
• 11:41
  doubt
• 11:42
  and
• 11:42
  say
• 11:42
  that
• 11:42
  does
• 11:42
  overlap
• 11:43
  a
• 11:43
  little
• 11:43
  bit
• 11:43
  with
• 11:43
  adhd.
• 11:45
  Now,
• 11:46
  when
• 11:47
  asked
• 11:47
  what
• 11:47
  she's
• 11:48
  thinking
• 11:48
  about,
• 11:48
  when
• 11:49
  she
• 11:49
  does
• 11:49
  lose
• 11:49
  her
• 11:49
  focus,
• 11:50
  she
• 11:50
  pauses
• 11:51
  and
• 11:51
  tells
• 11:51
  you,
• 11:52
  well,
• 11:52
  honestly,
• 11:52
  I'm
• 11:53
  usually
• 11:53
  worried,
• 11:53
  like,
• 11:54
  what
• 11:54
  if
• 11:54
  I
• 11:54
  fail
• 11:54
  this
• 11:54
  exam?
• 11:55
  What
• 11:55
  if
• 11:55
  I
• 11:55
  can't
• 11:55
  pass
• 11:56
  the
• 11:56
  bar?
• 11:56
  What
• 11:56
  if
• 11:57
  I'm
• 11:57
  not
• 11:57
  smart
• 11:57
  enough
• 11:57
  for
• 11:58
  this?
• 11:59
  And
• 11:59
  then
• 12:00
  she
• 12:00
  tells
• 12:00
  you
• 12:00
  that
• 12:00
  sometimes
• 12:01
  she
• 12:01
  worries
• 12:01
  about
• 12:01
  things
• 12:02
  that
• 12:02
  have
• 12:02
  nothing
• 12:02
  to
• 12:02
  do
• 12:03
  with
• 12:03
  school,
• 12:03
  like
• 12:03
  whether
• 12:03
  her
• 12:04
  mom's
• 12:04
  cough
• 12:04
  is
• 12:04
  something
• 12:05
  serious
• 12:05
  or
• 12:06
  whether
• 12:06
  she
• 12:06
  locked
• 12:07
  her
• 12:07
  apartment
• 12:07
  door.
• 12:08
  And
• 12:09
  she
• 12:09
  does
• 12:09
  acknowledge
• 12:09
  that
• 12:10
  her
• 12:10
  worrying
• 12:10
  is
• 12:11
  excessive
• 12:11
  and
• 12:11
  difficult
• 12:12
  to
• 12:12
  control
• 12:13
  more
• 12:13
  broadly.
• 12:14
  So,
• 12:14
  bam,
• 12:14
  we're
• 12:14
  definitely
• 12:15
  entering
• 12:15
  GAD
• 12:15
  territory.
• 12:16
  Did
• 12:16
  you
• 12:16
  see
• 12:16
  what,
• 12:17
  what
• 12:17
  she
• 12:17
  just
• 12:17
  said,
• 12:18
  right.
• 12:18
  All
• 12:19
  of
• 12:19
  this
• 12:19
  is
• 12:19
  very
• 12:20
  gad,
• 12:21
  very
• 12:21
  much
• 12:22
  GAD
• 12:22
  territory.
• 12:23
  What
• 12:23
  if
• 12:23
  I
• 12:23
  fail
• 12:23
  this
• 12:23
  exam?
• 12:24
  What
• 12:24
  if
• 12:24
  I
• 12:24
  can't
• 12:24
  pass
• 12:25
  the
• 12:25
  bar?
• 12:25
  These
• 12:25
  are
• 12:26
  fear
• 12:26
  based,
• 12:26
  threat
• 12:27
  based,
• 12:27
  future
• 12:28
  oriented.
• 12:28
  What
• 12:29
  if
• 12:30
  worries
• 12:30
  she
• 12:30
  cannot
• 12:31
  control.
• 12:31
  They
• 12:32
  are
• 12:32
  not
• 12:32
  ADHD
• 12:33
  type,
• 12:34
  distractible,
• 12:35
  benign
• 12:37
  issues.
• 12:38
  Now,
• 12:38
  that's
• 12:38
  not
• 12:38
  to
• 12:39
  say
• 12:39
  people
• 12:39
  with
• 12:39
  ADHD
• 12:40
  can't
• 12:40
  have
• 12:40
  a
• 12:40
  few
• 12:41
  thoughts
• 12:41
  that
• 12:41
  are
• 12:41
  very
• 12:41
  distracting,
• 12:42
  that
• 12:43
  are
• 12:43
  fear
• 12:43
  based.
• 12:44
  But
• 12:44
  the
• 12:44
  predominant
• 12:45
  theme
• 12:45
  with
• 12:46
  ADHD
• 12:46
  is
• 12:47
  I
• 12:47
  want
• 12:47
  to
• 12:47
  do
• 12:48
  something
• 12:48
  else
• 12:48
  that's
• 12:48
  more
• 12:49
  interesting.
• 12:49
  Not
• 12:50
  I
• 12:50
  can't
• 12:50
  stop
• 12:51
  thinking
• 12:51
  about
• 12:51
  something
• 12:52
  that
• 12:52
  is
• 12:53
  super
• 12:53
  fearful
• 12:54
  that
• 12:54
  I
• 12:54
  can't
• 12:54
  control.
• 12:54
  You
• 12:55
  see
• 12:55
  how
• 12:55
  the
• 12:55
  two
• 12:55
  of
• 12:56
  those
• 12:56
  are
• 12:56
  qualitatively
• 12:57
  opposites
• 12:57
  almost
• 12:58
  again?
• 12:59
  One,
• 12:59
  the
• 12:59
  content
• 13:00
  is
• 13:00
  fear.
• 13:01
  One,
• 13:01
  the
• 13:01
  content
• 13:02
  is
• 13:02
  just
• 13:02
  kind
• 13:02
  of
• 13:02
  benign
• 13:03
  distractibility.
• 13:05
  Okay.
• 13:05
  And
• 13:05
  yes,
• 13:05
  there's
• 13:05
  overlap,
• 13:06
  but
• 13:07
  if
• 13:07
  you're
• 13:07
  entering
• 13:08
  that
• 13:08
  fear
• 13:08
  column
• 13:09
  too
• 13:09
  frequently
• 13:10
  and
• 13:10
  too
• 13:10
  intensely,
• 13:11
  you're
• 13:11
  in
• 13:12
  the
• 13:12
  GAD
• 13:12
  column.
• 13:13
  Okay?
• 13:13
  Okay.
• 13:14
  That's
• 13:14
  a
• 13:14
  good
• 13:14
  way
• 13:14
  to
• 13:14
  put
• 13:14
  it.
• 13:16
  Now,
• 13:16
  she
• 13:16
  also
• 13:17
  reports
• 13:17
  chronic
• 13:18
  muscle
• 13:18
  tension
• 13:18
  in
• 13:19
  her
• 13:19
  neck
• 13:19
  and
• 13:19
  shoulders,
• 13:19
  tension
• 13:20
  headaches
• 13:20
  that
• 13:21
  happen
• 13:21
  a
• 13:21
  few
• 13:21
  times
• 13:21
  per
• 13:22
  week,
• 13:22
  some
• 13:22
  GI
• 13:23
  issues.
• 13:23
  Her
• 13:23
  PCP
• 13:24
  just
• 13:24
  chalked
• 13:25
  it
• 13:25
  up
• 13:25
  as
• 13:25
  stress.
• 13:26
  She
• 13:26
  is
• 13:26
  pretty
• 13:27
  tired
• 13:27
  despite
• 13:28
  sleeping
• 13:28
  seven
• 13:29
  to
• 13:29
  eight
• 13:29
  hours
• 13:29
  a
• 13:29
  night.
• 13:31
  Kind
• 13:31
  of
• 13:31
  a
• 13:31
  restless,
• 13:31
  unsatisfying
• 13:32
  sleep.
• 13:33
  And
• 13:33
  she's
• 13:33
  been
• 13:33
  a
• 13:34
  little
• 13:34
  more
• 13:34
  irritable
• 13:34
  with
• 13:35
  her
• 13:35
  partner
• 13:35
  since
• 13:35
  she
• 13:35
  was
• 13:37
  accepted
• 13:37
  into
• 13:38
  law
• 13:38
  school
• 13:38
  and
• 13:39
  has
• 13:39
  had
• 13:39
  increased
• 13:40
  workloads.
• 13:41
  She'll
• 13:41
  even
• 13:41
  snap
• 13:41
  at
• 13:42
  classmates
• 13:42
  sometimes.
• 13:43
  She's
• 13:43
  not
• 13:43
  depressed.
• 13:44
  No
• 13:44
  anhedonia,
• 13:45
  no
• 13:45
  changes
• 13:45
  in
• 13:45
  appetite,
• 13:46
  no
• 13:46
  si.
• 13:47
  No
• 13:47
  substance
• 13:48
  use.
• 13:48
  She
• 13:48
  does
• 13:48
  have
• 13:48
  three
• 13:49
  to
• 13:49
  four
• 13:49
  cups
• 13:49
  of
• 13:49
  coffee
• 13:50
  daily.
• 13:51
  That
• 13:51
  is
• 13:51
  a
• 13:52
  kind
• 13:52
  of
• 13:52
  soft
• 13:52
  sign
• 13:53
  for
• 13:53
  me,
• 13:53
  typically
• 13:54
  for
• 13:54
  adhd.
• 13:55
  Actually,
• 13:56
  um,
• 13:56
  when
• 13:56
  patients,
• 13:57
  I,
• 13:57
  I
• 13:57
  find
• 13:57
  that
• 13:58
  the
• 13:58
  patients
• 13:58
  I
• 13:58
  see
• 13:59
  that
• 13:59
  do
• 14:00
  have
• 14:00
  ADHD
• 14:00
  and
• 14:01
  maybe
• 14:01
  don't
• 14:01
  know
• 14:01
  it,
• 14:02
  they
• 14:03
  are
• 14:03
  usually
• 14:03
  consuming
• 14:04
  large
• 14:04
  amounts
• 14:04
  of
• 14:05
  Red
• 14:05
  Bull
• 14:05
  or
• 14:06
  espressos
• 14:06
  or
• 14:06
  coffees.
• 14:07
  It's
• 14:08
  not
• 14:08
  diagnostic.
• 14:09
  You're
• 14:09
  probably
• 14:10
  not
• 14:10
  going
• 14:10
  to
• 14:10
  find
• 14:10
  that
• 14:10
  in
• 14:10
  the
• 14:10
  DSM
• 14:11
  5,
• 14:12
  but
• 14:12
  I
• 14:12
  find
• 14:12
  a,
• 14:13
  an
• 14:13
  unusual
• 14:14
  correlation
• 14:14
  between
• 14:15
  people
• 14:15
  who
• 14:16
  are
• 14:16
  trying
• 14:16
  to
• 14:16
  focus
• 14:17
  and
• 14:17
  they
• 14:17
  can't
• 14:18
  and
• 14:19
  they
• 14:19
  consume
• 14:19
  a
• 14:19
  lot,
• 14:19
  a
• 14:19
  lot
• 14:20
  of
• 14:20
  caffeine.
• 14:20
  But
• 14:21
  that
• 14:21
  could
• 14:21
  also
• 14:21
  be
• 14:21
  again,
• 14:22
  because
• 14:23
  sleep
• 14:23
  is
• 14:23
  impaired
• 14:23
  in
• 14:24
  gad.
• 14:24
  And
• 14:24
  she's
• 14:25
  trying
• 14:25
  to
• 14:25
  make
• 14:25
  up
• 14:25
  for
• 14:26
  it.
• 14:26
  And
• 14:26
  she's
• 14:27
  trying
• 14:27
  to
• 14:27
  make
• 14:28
  up
• 14:28
  for
• 14:28
  it
• 14:28
  by,
• 14:29
  you
• 14:29
  know,
• 14:29
  consuming
• 14:30
  more
• 14:30
  caffeine
• 14:31
  to
• 14:31
  have
• 14:31
  energy
• 14:31
  to
• 14:32
  just
• 14:32
  stay
• 14:32
  awake.
• 14:33
  Right.
• 14:33
  And
• 14:33
  that
• 14:34
  can
• 14:34
  of
• 14:34
  course
• 14:34
  worsen
• 14:34
  her
• 14:35
  gad.
• 14:36
  So
• 14:36
  don't
• 14:36
  take
• 14:37
  that
• 14:37
  to
• 14:37
  the
• 14:37
  bank.
• 14:37
  But
• 14:38
  it
• 14:38
  is
• 14:38
  a
• 14:38
  little
• 14:38
  soft
• 14:39
  sign
• 14:39
  I
• 14:39
  like
• 14:39
  to
• 14:39
  include
• 14:40
  when
• 14:40
  people
• 14:41
  are
• 14:41
  using
• 14:41
  unusual
• 14:42
  amounts
• 14:42
  of
• 14:42
  caffeine,
• 14:43
  they're
• 14:43
  chasing
• 14:43
  that
• 14:43
  dopamine
• 14:44
  that
• 14:44
  that
• 14:45
  energy,
• 14:45
  that
• 14:45
  ability
• 14:46
  to
• 14:46
  focus,
• 14:46
  they're
• 14:46
  almost
• 14:47
  chasing
• 14:47
  the
• 14:47
  neurotransmitters
• 14:48
  that
• 14:48
  would
• 14:48
  otherwise
• 14:49
  be
• 14:50
  targeted
• 14:50
  in
• 14:50
  ADHD
• 14:51
  treatment.
• 14:52
  So
• 14:52
  that's
• 14:52
  just
• 14:52
  a
• 14:52
  soft
• 14:53
  sign
• 14:53
  that
• 14:53
  I
• 14:53
  raised
• 14:53
  my
• 14:54
  eyebrow
• 14:54
  a
• 14:54
  little
• 14:54
  bit.
• 14:55
  Now,
• 14:56
  when
• 14:56
  you
• 14:56
  ask
• 14:56
  Carly
• 14:57
  if
• 14:57
  she
• 14:57
  thinks
• 14:58
  she
• 14:58
  has
• 14:58
  adhd,
• 14:59
  she
• 14:59
  does
• 14:59
  tell
• 14:59
  you
• 14:59
  about
• 15:00
  that
• 15:00
  online
• 15:00
  quiz
• 15:01
  she
• 15:01
  scored
• 15:01
  really
• 15:02
  high.
• 15:03
  Her
• 15:03
  friends
• 15:03
  are
• 15:03
  telling
• 15:04
  her
• 15:04
  she
• 15:04
  has
• 15:04
  adhd,
• 15:05
  and
• 15:06
  she
• 15:06
  tells
• 15:06
  you
• 15:06
  she's
• 15:06
  always
• 15:07
  been
• 15:07
  kind
• 15:07
  of
• 15:07
  scattered.
• 15:08
  She
• 15:08
  would
• 15:08
  forget
• 15:08
  her
• 15:09
  lunchbox
• 15:09
  and
• 15:10
  lose
• 15:10
  her
• 15:10
  homework
• 15:10
  as
• 15:11
  a
• 15:11
  kid.
• 15:12
  She's
• 15:12
  never
• 15:12
  been
• 15:12
  treated,
• 15:13
  no
• 15:13
  meds,
• 15:13
  no
• 15:13
  diagnoses
• 15:14
  in
• 15:14
  the
• 15:14
  past,
• 15:15
  but
• 15:15
  she's
• 15:15
  been
• 15:15
  a
• 15:15
  warrior
• 15:16
  as
• 15:16
  far
• 15:16
  back
• 15:16
  as
• 15:17
  elementary
• 15:17
  school.
• 15:18
  She
• 15:18
  would
• 15:18
  get
• 15:18
  stomach
• 15:19
  aches
• 15:19
  before
• 15:19
  tests,
• 15:20
  difficulty
• 15:21
  sleeping
• 15:21
  before
• 15:21
  the
• 15:21
  first
• 15:22
  day
• 15:22
  of
• 15:22
  school
• 15:22
  every
• 15:22
  year.
• 15:23
  Her
• 15:23
  mom
• 15:24
  did
• 15:24
  confirm
• 15:25
  with
• 15:25
  you
• 15:25
  that
• 15:25
  she's
• 15:25
  always
• 15:26
  been
• 15:26
  kind
• 15:26
  of
• 15:26
  an
• 15:26
  anxious
• 15:27
  one.
• 15:28
  She
• 15:28
  used
• 15:28
  to
• 15:28
  cry
• 15:28
  before
• 15:29
  school
• 15:29
  all
• 15:29
  the
• 15:30
  time
• 15:30
  and
• 15:31
  that
• 15:31
  she
• 15:31
  did
• 15:31
  very
• 15:32
  well
• 15:32
  academically
• 15:33
  actually,
• 15:34
  but
• 15:34
  kind
• 15:34
  of
• 15:34
  white
• 15:34
  knuckled
• 15:35
  it.
• 15:35
  And
• 15:36
  again,
• 15:36
  that's
• 15:36
  common
• 15:37
  in
• 15:37
  adhd,
• 15:37
  where
• 15:38
  you
• 15:38
  can
• 15:39
  try
• 15:39
  to
• 15:39
  compensate
• 15:40
  if
• 15:40
  you're
• 15:40
  very
• 15:41
  intelligent
• 15:41
  and
• 15:42
  it's
• 15:42
  kind
• 15:42
  of
• 15:42
  masked.
• 15:43
  But
• 15:44
  more
• 15:44
  commonly,
• 15:45
  you
• 15:45
  will
• 15:45
  see
• 15:46
  underperformance
• 15:46
  in
• 15:47
  adhd.
• 15:47
  You'll
• 15:47
  see
• 15:48
  some
• 15:48
  delays
• 15:49
  in
• 15:49
  graduation,
• 15:50
  potentially
• 15:51
  not
• 15:51
  always,
• 15:52
  but
• 15:52
  you
• 15:52
  will
• 15:52
  see
• 15:52
  struggles.
• 15:53
  You
• 15:53
  will
• 15:53
  tell
• 15:54
  patients,
• 15:54
  will
• 15:54
  openly
• 15:55
  tell
• 15:55
  you
• 15:55
  they
• 15:55
  really
• 15:56
  struggled.
• 15:56
  They
• 15:57
  were
• 15:57
  almost
• 15:57
  held
• 15:57
  back.
• 15:59
  They
• 15:59
  just
• 16:00
  couldn't
• 16:00
  quite
• 16:00
  keep
• 16:00
  it
• 16:01
  together.
• 16:01
  They
• 16:01
  were
• 16:02
  in
• 16:02
  specific
• 16:02
  programs,
• 16:03
  teachers
• 16:04
  would
• 16:04
  write
• 16:04
  very
• 16:05
  concerning
• 16:05
  notes
• 16:06
  back
• 16:06
  home.
• 16:06
  The
• 16:06
  parents
• 16:06
  were
• 16:07
  very
• 16:07
  aware
• 16:08
  a
• 16:08
  lot
• 16:08
  of
• 16:08
  what
• 16:08
  you
• 16:08
  do
• 16:09
  when
• 16:09
  you
• 16:09
  get
• 16:09
  into
• 16:09
  practice,
• 16:10
  you're
• 16:10
  gonna
• 16:10
  see
• 16:10
  you're
• 16:10
  gonna
• 16:10
  have
• 16:11
  a
• 16:11
  lot
• 16:11
  of
• 16:11
  help.
• 16:12
  It's
• 16:12
  not
• 16:12
  going
• 16:12
  to
• 16:12
  be
• 16:12
  just
• 16:12
  you
• 16:14
  just
• 16:15
  hysterically
• 16:15
  sifting
• 16:16
  through
• 16:16
  the
• 16:16
  DSM
• 16:16
  in
• 16:17
  the
• 16:17
  middle
• 16:17
  of
• 16:17
  your
• 16:17
  evaluations.
• 16:18
  You're
• 16:18
  going
• 16:18
  to
• 16:18
  have
• 16:19
  patients
• 16:19
  that
• 16:20
  are
• 16:20
  largely
• 16:20
  aware
• 16:21
  of
• 16:21
  what
• 16:22
  they've
• 16:22
  been
• 16:22
  through.
• 16:22
  Maybe
• 16:23
  they're
• 16:23
  not
• 16:23
  aware
• 16:23
  of
• 16:23
  the
• 16:24
  specific
• 16:24
  diagnosis
• 16:25
  per
• 16:25
  se,
• 16:26
  but
• 16:26
  they're
• 16:26
  aware
• 16:27
  of
• 16:29
  a
• 16:29
  lot
• 16:29
  of
• 16:29
  things
• 16:29
  that
• 16:30
  have
• 16:30
  happened
• 16:30
  in
• 16:30
  the
• 16:30
  past
• 16:30
  that
• 16:31
  are
• 16:31
  going
• 16:31
  to
• 16:31
  be
• 16:31
  incredibly
• 16:32
  helpful
• 16:32
  to
• 16:32
  you.
• 16:32
  Right?
• 16:33
  And
• 16:33
  usually
• 16:33
  with
• 16:33
  my
• 16:34
  ADHD
• 16:34
  patients,
• 16:35
  they're
• 16:35
  going
• 16:35
  to
• 16:35
  tell
• 16:36
  me,
• 16:36
  you
• 16:36
  know,
• 16:36
  I've.
• 16:37
  I've
• 16:37
  been
• 16:37
  on
• 16:37
  individual
• 16:38
  education
• 16:38
  plans
• 16:39
  throughout
• 16:39
  my,
• 16:40
  throughout
• 16:40
  grade
• 16:40
  school.
• 16:41
  Teachers
• 16:41
  were
• 16:42
  exasperated,
• 16:42
  exasperated
• 16:43
  by
• 16:43
  how,
• 16:44
  you
• 16:45
  know,
• 16:45
  hysterical.
• 16:45
  I
• 16:45
  was
• 16:46
  in
• 16:46
  class
• 16:46
  and
• 16:46
  unruly.
• 16:48
  And
• 16:48
  I
• 16:48
  would,
• 16:48
  you
• 16:48
  know,
• 16:49
  I
• 16:49
  would,
• 16:51
  you
• 16:51
  know,
• 16:51
  flick,
• 16:52
  flick
• 16:52
  other
• 16:53
  kids.
• 16:53
  Like,
• 16:53
  I
• 16:54
  would
• 16:54
  flick
• 16:54
  them
• 16:54
  in
• 16:54
  the
• 16:54
  ear.
• 16:56
  I
• 16:57
  would
• 16:57
  spit
• 16:58
  at
• 16:58
  people.
• 16:59
  I
• 16:59
  would
• 16:59
  jump
• 17:00
  all
• 17:00
  over
• 17:00
  the
• 17:00
  room
• 17:01
  and
• 17:01
  holler
• 17:01
  and
• 17:01
  scream
• 17:02
  and
• 17:03
  I
• 17:03
  just
• 17:03
  wouldn't
• 17:03
  pay
• 17:03
  attention.
• 17:04
  I
• 17:04
  failed
• 17:05
  physics.
• 17:06
  I.
• 17:07
  I
• 17:07
  loved
• 17:07
  photography.
• 17:08
  I
• 17:08
  got
• 17:08
  an
• 17:08
  A
• 17:08
  in
• 17:09
  that.
• 17:09
  But
• 17:10
  other
• 17:11
  than
• 17:11
  that,
• 17:11
  I
• 17:12
  I
• 17:12
  couldn't
• 17:12
  really
• 17:12
  finish
• 17:13
  a
• 17:13
  semester
• 17:13
  successfully
• 17:14
  for
• 17:14
  the
• 17:14
  life
• 17:14
  of
• 17:15
  me.
• 17:15
  They're
• 17:15
  going
• 17:15
  to
• 17:15
  help
• 17:15
  you.
• 17:16
  Right.
• 17:16
  And
• 17:17
  so
• 17:17
  don't
• 17:18
  think
• 17:18
  that
• 17:18
  you're
• 17:18
  going
• 17:18
  to
• 17:18
  just
• 17:18
  go
• 17:19
  in
• 17:19
  blind
• 17:19
  the
• 17:19
  whole
• 17:20
  time.
• 17:22
  A
• 17:22
  little
• 17:22
  more
• 17:22
  about
• 17:22
  Carly
• 17:23
  and
• 17:23
  then
• 17:23
  we're
• 17:23
  going
• 17:23
  to
• 17:23
  talk
• 17:24
  about
• 17:24
  what
• 17:24
  this
• 17:24
  is
• 17:25
  specifically.
• 17:25
  But
• 17:26
  she's
• 17:26
  been
• 17:26
  in
• 17:26
  a
• 17:26
  stable
• 17:26
  relationship,
• 17:27
  no
• 17:27
  history
• 17:28
  of
• 17:28
  trauma
• 17:28
  or
• 17:28
  abuse.
• 17:29
  Although
• 17:29
  that
• 17:29
  is
• 17:29
  extremely
• 17:30
  important
• 17:30
  for
• 17:30
  you
• 17:30
  to
• 17:30
  ask,
• 17:31
  because
• 17:32
  when
• 17:32
  there
• 17:32
  is
• 17:33
  underlying
• 17:33
  trauma,
• 17:34
  it
• 17:34
  can
• 17:34
  be
• 17:34
  very
• 17:34
  hard
• 17:34
  to
• 17:35
  focus,
• 17:35
  especially
• 17:35
  if
• 17:36
  there
• 17:36
  is
• 17:36
  an
• 17:36
  unresolved
• 17:37
  threat
• 17:37
  that
• 17:38
  is
• 17:38
  pervasive
• 17:39
  in
• 17:39
  Carly's
• 17:39
  environment.
• 17:40
  Right.
• 17:41
  That
• 17:41
  if
• 17:41
  that's
• 17:41
  unresolved,
• 17:42
  it
• 17:42
  can
• 17:42
  be
• 17:43
  very
• 17:43
  much
• 17:43
  like
• 17:44
  running
• 17:44
  from
• 17:44
  a
• 17:44
  bear
• 17:45
  all
• 17:45
  of
• 17:45
  the
• 17:45
  time
• 17:45
  for
• 17:46
  her.
• 17:46
  And
• 17:46
  that
• 17:46
  can
• 17:47
  exhibit
• 17:47
  itself
• 17:48
  in
• 17:49
  very
• 17:49
  similar
• 17:49
  ways
• 17:50
  to
• 17:50
  adhd.
• 17:50
  Right.
• 17:51
  If
• 17:51
  you
• 17:52
  and
• 17:52
  I
• 17:52
  were
• 17:52
  running
• 17:52
  from
• 17:52
  a
• 17:53
  bear
• 17:53
  or
• 17:53
  we
• 17:53
  knew
• 17:54
  there
• 17:54
  was
• 17:54
  a
• 17:54
  bear
• 17:55
  in
• 17:55
  our
• 17:56
  neighborhood
• 17:57
  somewhere,
• 17:58
  it
• 17:58
  would
• 17:58
  be
• 17:58
  very
• 17:59
  hard
• 17:59
  for
• 17:59
  you
• 17:59
  to
• 17:59
  even
• 17:59
  pay
• 18:00
  attention
• 18:00
  to
• 18:00
  a
• 18:00
  conversation
• 18:01
  I'm
• 18:01
  trying
• 18:01
  to
• 18:02
  have
• 18:02
  with
• 18:02
  you,
• 18:02
  because
• 18:02
  all
• 18:02
  you
• 18:03
  would
• 18:03
  be
• 18:03
  thinking
• 18:03
  about
• 18:03
  is
• 18:03
  that
• 18:04
  bear.
• 18:04
  Where
• 18:04
  is
• 18:05
  that
• 18:05
  bear?
• 18:05
  Is
• 18:05
  it
• 18:05
  close
• 18:06
  to
• 18:06
  me?
• 18:06
  Is
• 18:06
  it
• 18:06
  going
• 18:06
  to
• 18:06
  get
• 18:06
  me?
• 18:07
  What
• 18:07
  do
• 18:07
  I
• 18:07
  do?
• 18:08
  Right.
• 18:08
  So
• 18:08
  trauma,
• 18:09
  I
• 18:09
  find,
• 18:09
  is
• 18:10
  actually
• 18:11
  even
• 18:12
  more
• 18:12
  so
• 18:12
  than
• 18:12
  gad,
• 18:13
  I
• 18:13
  would
• 18:13
  argue,
• 18:14
  is
• 18:14
  even
• 18:15
  more
• 18:15
  confusing
• 18:16
  when
• 18:16
  patients
• 18:16
  have
• 18:17
  a
• 18:17
  complex
• 18:17
  trauma
• 18:18
  history,
• 18:18
  because
• 18:19
  I
• 18:19
  find
• 18:19
  that
• 18:19
  it
• 18:19
  can
• 18:19
  absolutely
• 18:20
  look
• 18:20
  like
• 18:21
  ADHD
• 18:21
  if
• 18:22
  you're
• 18:22
  not
• 18:22
  careful.
• 18:23
  So
• 18:23
  you
• 18:23
  definitely
• 18:23
  want
• 18:24
  to
• 18:24
  ask,
• 18:24
  as
• 18:24
  a
• 18:25
  general
• 18:25
  rule,
• 18:26
  in
• 18:26
  your
• 18:26
  first
• 18:26
  visit
• 18:26
  with
• 18:27
  the
• 18:27
  patient,
• 18:27
  you
• 18:28
  know,
• 18:28
  have
• 18:28
  you
• 18:28
  had
• 18:28
  any
• 18:28
  near
• 18:29
  death
• 18:29
  experience,
• 18:29
  serious
• 18:30
  threat
• 18:30
  to
• 18:30
  life
• 18:31
  or
• 18:31
  loss,
• 18:31
  or,
• 18:31
  you
• 18:32
  know,
• 18:32
  bodily
• 18:32
  injury,
• 18:33
  or
• 18:33
  go
• 18:33
  through
• 18:34
  the
• 18:34
  criterion
• 18:34
  A
• 18:34
  traumas
• 18:35
  and
• 18:35
  understand
• 18:36
  what
• 18:37
  their
• 18:37
  childhood
• 18:37
  was
• 18:38
  like?
• 18:38
  Did
• 18:38
  they
• 18:38
  always
• 18:38
  have
• 18:39
  to
• 18:39
  be
• 18:39
  hypervigilant?
• 18:40
  Were
• 18:40
  they
• 18:40
  abused?
• 18:41
  I
• 18:41
  mean,
• 18:41
  because
• 18:41
  that
• 18:41
  can
• 18:42
  absolutely
• 18:42
  affect
• 18:43
  their
• 18:44
  ability
• 18:44
  to
• 18:44
  pay
• 18:44
  attention.
• 18:45
  They're
• 18:45
  in
• 18:45
  this
• 18:45
  perpetual
• 18:46
  fight
• 18:46
  or
• 18:46
  flight
• 18:47
  now.
• 18:47
  And
• 18:47
  when
• 18:47
  you're
• 18:47
  in
• 18:48
  fight
• 18:48
  or
• 18:48
  flight,
• 18:48
  you
• 18:48
  can't
• 18:49
  really
• 18:49
  plan
• 18:49
  or
• 18:49
  create
• 18:50
  or
• 18:50
  play
• 18:50
  or
• 18:50
  organize
• 18:51
  your
• 18:51
  schedule
• 18:52
  very
• 18:52
  easily
• 18:53
  because
• 18:53
  your
• 18:53
  lower
• 18:53
  order
• 18:54
  brain
• 18:54
  functions,
• 18:55
  kind
• 18:55
  of
• 18:55
  subcortical
• 18:56
  brain
• 18:56
  functions,
• 18:57
  are
• 18:57
  much
• 18:57
  more
• 18:57
  important
• 18:58
  for
• 18:58
  your
• 18:58
  survival.
• 18:59
  Right.
• 18:59
  So
• 19:00
  definitely
• 19:01
  look
• 19:01
  at
• 19:01
  trauma.
• 19:02
  Now,
• 19:02
  Carly
• 19:03
  also
• 19:03
  talks
• 19:03
  about
• 19:04
  a
• 19:04
  younger
• 19:04
  brother
• 19:05
  diagnosed
• 19:06
  with
• 19:06
  adhd.
• 19:06
  He
• 19:07
  does
• 19:07
  take
• 19:07
  Adderall,
• 19:08
  so
• 19:08
  that
• 19:08
  would
• 19:08
  immediately
• 19:09
  shoot
• 19:09
  up
• 19:10
  my
• 19:10
  index
• 19:10
  of
• 19:10
  suspicion
• 19:11
  that
• 19:11
  she
• 19:11
  has
• 19:11
  adhd.
• 19:12
  She
• 19:12
  also
• 19:13
  says
• 19:13
  her
• 19:13
  dad,
• 19:13
  though,
• 19:14
  has
• 19:14
  been
• 19:14
  treated
• 19:15
  with
• 19:15
  generalized
• 19:15
  anxiety
• 19:16
  with
• 19:16
  sertraline
• 19:17
  for
• 19:17
  ten
• 19:17
  years.
• 19:18
  Um,
• 19:19
  and
• 19:19
  her
• 19:19
  mom
• 19:19
  is
• 19:19
  a
• 19:20
  worrier,
• 19:20
  but
• 19:20
  functional.
• 19:21
  Functional.
• 19:22
  So,
• 19:22
  again,
• 19:23
  that
• 19:23
  does
• 19:23
  kind
• 19:23
  of
• 19:24
  muddy
• 19:24
  things
• 19:24
  up
• 19:24
  diagnostically.
• 19:26
  But
• 19:27
  I
• 19:27
  think
• 19:28
  by
• 19:28
  and
• 19:29
  large,
• 19:30
  this
• 19:30
  is
• 19:31
  definitely
• 19:31
  looking
• 19:31
  more
• 19:32
  like
• 19:32
  gad.
• 19:32
  It's
• 19:33
  not
• 19:33
  to
• 19:33
  say
• 19:33
  that
• 19:34
  ADHD
• 19:34
  is
• 19:34
  completely
• 19:35
  off
• 19:35
  the
• 19:35
  table.
• 19:35
  It's
• 19:36
  also,
• 19:36
  by
• 19:36
  the
• 19:36
  way,
• 19:36
  not
• 19:37
  to
• 19:37
  say
• 19:37
  that
• 19:37
  you,
• 19:38
  you,
• 19:38
  you
• 19:38
  can't
• 19:38
  just,
• 19:39
  like,
• 19:39
  you,
• 19:40
  you
• 19:40
  know,
• 19:40
  call
• 19:40
  it
• 19:40
  a
• 19:41
  day
• 19:41
  and
• 19:41
  say,
• 19:41
  okay,
• 19:42
  it's
• 19:42
  gad.
• 19:43
  Treat
• 19:43
  gad.
• 19:44
  And
• 19:44
  let's
• 19:44
  say
• 19:44
  you
• 19:45
  treat
• 19:45
  her
• 19:45
  worry
• 19:45
  very
• 19:45
  successfully.
• 19:46
  And
• 19:46
  if
• 19:46
  she's
• 19:47
  still,
• 19:47
  if
• 19:48
  it's
• 19:48
  still
• 19:48
  very
• 19:48
  hard
• 19:48
  for
• 19:49
  her
• 19:49
  to
• 19:49
  focus,
• 19:49
  don't
• 19:49
  just
• 19:49
  cross
• 19:50
  your
• 19:50
  arms
• 19:50
  and
• 19:51
  abandon
• 19:51
  ship
• 19:52
  on
• 19:52
  adhd.
• 19:52
  You
• 19:52
  still
• 19:53
  have
• 19:53
  a
• 19:53
  patient
• 19:53
  in
• 19:53
  front
• 19:54
  of
• 19:54
  you
• 19:54
  who
• 19:54
  might
• 19:55
  come
• 19:55
  back
• 19:55
  and
• 19:55
  say,
• 19:56
  you
• 19:56
  know
• 19:56
  what?
• 19:56
  I
• 19:56
  am
• 19:56
  worrying
• 19:57
  so
• 19:57
  much
• 19:57
  less.
• 19:58
  My
• 19:58
  attention
• 19:59
  has
• 20:00
  improved
• 20:01
  tenfold.
• 20:02
  But
• 20:02
  maybe
• 20:02
  she
• 20:03
  is
• 20:03
  still
• 20:03
  endorsing
• 20:05
  symptoms
• 20:05
  that
• 20:06
  are
• 20:06
  uniquely
• 20:07
  impairing
• 20:08
  and
• 20:08
  they
• 20:09
  are
• 20:09
  kind
• 20:09
  of
• 20:10
  distinctly
• 20:10
  ADHD
• 20:11
  and
• 20:11
  not
• 20:12
  generalized
• 20:13
  anxiety.
• 20:13
  And
• 20:14
  if
• 20:14
  that's
• 20:14
  the
• 20:14
  case
• 20:14
  and
• 20:15
  they're
• 20:15
  impairing
• 20:15
  and
• 20:16
  distressing,
• 20:17
  then
• 20:17
  you
• 20:17
  need
• 20:17
  to
• 20:17
  do
• 20:18
  something
• 20:18
  about
• 20:18
  it,
• 20:18
  right?
• 20:19
  So
• 20:19
  this
• 20:19
  is
• 20:19
  not
• 20:20
  always
• 20:20
  as
• 20:20
  simple
• 20:20
  as,
• 20:20
  that's
• 20:21
  gad,
• 20:21
  and
• 20:22
  that's
• 20:22
  absolutely
• 20:22
  not
• 20:23
  adhd.
• 20:23
  Sometimes
• 20:24
  patients
• 20:24
  live
• 20:24
  on
• 20:24
  a
• 20:25
  spectrum.
• 20:25
  Now,
• 20:26
  you
• 20:26
  know,
• 20:27
  it's
• 20:27
  also
• 20:27
  pretty
• 20:28
  common.
• 20:28
  You
• 20:28
  can
• 20:28
  treat
• 20:28
  her
• 20:29
  gad,
• 20:30
  and
• 20:30
  lo
• 20:30
  and
• 20:30
  behold,
• 20:31
  she
• 20:31
  is
• 20:32
  quite
• 20:32
  functional
• 20:33
  and
• 20:33
  that
• 20:33
  was
• 20:33
  the
• 20:34
  root
• 20:34
  problem.
• 20:35
  And,
• 20:35
  and
• 20:36
  you
• 20:36
  don't
• 20:36
  even
• 20:37
  have
• 20:37
  to
• 20:37
  initiate
• 20:37
  stimulant
• 20:38
  therapy.
• 20:38
  But
• 20:38
  I
• 20:38
  just
• 20:39
  want
• 20:39
  you
• 20:39
  to
• 20:39
  remember
• 20:40
  it's
• 20:40
  not
• 20:40
  always
• 20:41
  that
• 20:41
  obvious.
• 20:42
  And
• 20:42
  sometimes
• 20:42
  you're
• 20:42
  gonna
• 20:43
  have
• 20:43
  to
• 20:43
  do
• 20:43
  both
• 20:43
  treatments.
• 20:44
  You
• 20:44
  might
• 20:44
  have
• 20:44
  to
• 20:44
  start
• 20:44
  her
• 20:44
  own
• 20:45
  Zoloft,
• 20:45
  treat
• 20:46
  the
• 20:46
  anxiety
• 20:46
  as
• 20:46
  best
• 20:47
  you
• 20:47
  can.
• 20:47
  And
• 20:48
  if
• 20:48
  she
• 20:48
  still
• 20:48
  has
• 20:49
  some
• 20:49
  residual
• 20:49
  impairment,
• 20:50
  you
• 20:50
  may
• 20:50
  need
• 20:50
  to
• 20:50
  start
• 20:51
  methylphenidate
• 20:52
  or
• 20:52
  something.
• 20:52
  If
• 20:53
  you've
• 20:53
  ruled
• 20:53
  out
• 20:53
  everything
• 20:54
  else,
• 20:54
  which
• 20:54
  you
• 20:55
  know
• 20:55
  that
• 20:55
  of
• 20:55
  course
• 20:56
  ADHD
• 20:56
  is
• 20:56
  a
• 20:57
  diagnosis
• 20:57
  of
• 20:57
  exclusion.
• 20:58
  You
• 20:58
  have
• 20:58
  to
• 20:58
  exclude
• 20:59
  everything
• 20:59
  else
• 21:00
  that
• 21:00
  you
• 21:00
  can.
• 21:00
  Now,
• 21:01
  okay,
• 21:02
  now
• 21:03
  we've
• 21:04
  talked
• 21:04
  about
• 21:04
  this
• 21:05
  a
• 21:05
  little
• 21:06
  bit,
• 21:06
  okay?
• 21:08
  But
• 21:09
  it's
• 21:09
  really
• 21:09
  important
• 21:10
  that
• 21:10
  you
• 21:11
  get
• 21:11
  to
• 21:11
  the
• 21:11
  root
• 21:11
  of
• 21:12
  the
• 21:12
  problem.
• 21:12
  When
• 21:13
  you
• 21:13
  get
• 21:13
  really
• 21:13
  confused
• 21:14
  about
• 21:15
  a
• 21:16
  particular
• 21:16
  diagnosis
• 21:17
  or
• 21:17
  multiple
• 21:17
  diagnoses,
• 21:18
  you've
• 21:19
  really
• 21:19
  got
• 21:19
  to
• 21:19
  talk
• 21:20
  about
• 21:20
  what
• 21:20
  is
• 21:20
  the
• 21:21
  worm
• 21:21
  at
• 21:21
  the
• 21:21
  core.
• 21:21
  I
• 21:21
  always
• 21:22
  talk
• 21:22
  about
• 21:22
  the
• 21:22
  worm
• 21:23
  at
• 21:23
  the
• 21:23
  core.
• 21:24
  And
• 21:24
  the
• 21:24
  worm
• 21:24
  at
• 21:25
  the
• 21:25
  core
• 21:25
  of
• 21:25
  anxiety
• 21:26
  or
• 21:26
  generalized
• 21:26
  anxiety
• 21:27
  is
• 21:27
  fear.
• 21:28
  Okay?
• 21:29
  It's
• 21:29
  fear.
• 21:31
  Depression
• 21:31
  is
• 21:32
  a
• 21:32
  little
• 21:32
  more
• 21:32
  layered.
• 21:33
  I
• 21:33
  would
• 21:33
  say
• 21:33
  it's
• 21:34
  hopelessness.
• 21:36
  I
• 21:36
  would
• 21:36
  say
• 21:37
  it's
• 21:37
  maybe
• 21:37
  self
• 21:38
  doubt.
• 21:39
  I
• 21:39
  would
• 21:39
  say
• 21:39
  it's
• 21:40
  maybe
• 21:41
  just
• 21:41
  a
• 21:41
  complete
• 21:42
  lack
• 21:42
  of
• 21:42
  pleasure.
• 21:43
  I
• 21:44
  tend
• 21:44
  to
• 21:44
  see
• 21:44
  that
• 21:44
  depression
• 21:45
  has
• 21:45
  many
• 21:45
  flavors.
• 21:46
  That's
• 21:46
  probably
• 21:46
  a
• 21:47
  different
• 21:47
  kind
• 21:47
  of
• 21:47
  episode.
• 21:48
  But
• 21:48
  it
• 21:49
  can
• 21:49
  be
• 21:49
  harder
• 21:49
  with
• 21:50
  depression,
• 21:50
  I
• 21:50
  guess,
• 21:50
  is
• 21:51
  my
• 21:51
  point,
• 21:51
  because
• 21:52
  there's
• 21:52
  different
• 21:52
  worms,
• 21:53
  different
• 21:53
  colored
• 21:54
  worms
• 21:54
  in
• 21:54
  the
• 21:55
  core
• 21:55
  of
• 21:55
  those
• 21:55
  apples.
• 21:55
  But
• 21:56
  I
• 21:56
  think
• 21:56
  with
• 21:56
  anxiety,
• 21:57
  fear
• 21:58
  is,
• 21:58
  is
• 21:58
  a
• 21:59
  pretty
• 21:59
  common,
• 21:59
  simple
• 22:00
  worm
• 22:01
  at
• 22:01
  the
• 22:01
  core.
• 22:02
  And
• 22:03
  with
• 22:03
  adhd,
• 22:04
  it's
• 22:04
  more
• 22:04
  Preferential
• 22:05
  attention.
• 22:06
  Right.
• 22:07
  The
• 22:07
  patient's
• 22:07
  worm
• 22:08
  at
• 22:08
  the
• 22:08
  core
• 22:08
  is
• 22:08
  that
• 22:09
  they
• 22:09
  would
• 22:09
  just
• 22:09
  be.
• 22:09
  They
• 22:09
  would
• 22:09
  prefer
• 22:10
  to
• 22:10
  be
• 22:10
  paying
• 22:10
  attention
• 22:11
  to
• 22:11
  something
• 22:11
  else.
• 22:12
  Okay.
• 22:14
  And
• 22:14
  this
• 22:14
  is
• 22:15
  almost
• 22:15
  why
• 22:16
  sometimes
• 22:16
  I
• 22:17
  have
• 22:17
  a
• 22:17
  trouble
• 22:18
  conceptualizing
• 22:19
  ADHD
• 22:20
  as
• 22:20
  a
• 22:20
  mental
• 22:20
  illness.
• 22:20
  I
• 22:21
  mean,
• 22:21
  we
• 22:21
  know
• 22:21
  it
• 22:21
  is
• 22:21
  one.
• 22:21
  It
• 22:22
  cuts
• 22:22
  down
• 22:22
  life
• 22:22
  expectancy
• 22:23
  due
• 22:23
  to
• 22:23
  substance
• 22:24
  use
• 22:24
  and
• 22:25
  motor
• 22:25
  vehicle
• 22:25
  accidents.
• 22:26
  It's
• 22:26
  very
• 22:26
  serious.
• 22:27
  It
• 22:27
  must
• 22:27
  be
• 22:27
  treated.
• 22:28
  We've
• 22:29
  seen
• 22:30
  how
• 22:30
  it
• 22:31
  spikes
• 22:31
  the
• 22:31
  likelihood
• 22:32
  of
• 22:32
  addictions
• 22:33
  and
• 22:34
  accidental
• 22:34
  injuries
• 22:35
  and
• 22:35
  death.
• 22:35
  So
• 22:35
  it's
• 22:35
  an
• 22:36
  absolutely
• 22:36
  critical.
• 22:37
  We
• 22:37
  treat
• 22:37
  it
• 22:37
  and
• 22:38
  identify
• 22:38
  it.
• 22:39
  But
• 22:40
  you
• 22:40
  could
• 22:40
  see
• 22:40
  how
• 22:41
  it's
• 22:41
  a
• 22:41
  little
• 22:41
  different
• 22:42
  in
• 22:42
  that
• 22:43
  a
• 22:43
  lot
• 22:43
  of
• 22:43
  ADHD
• 22:43
  folks,
• 22:44
  they'll
• 22:44
  choose
• 22:44
  careers
• 22:45
  that
• 22:45
  they
• 22:45
  function
• 22:46
  very
• 22:46
  highly
• 22:47
  in
• 22:47
  because
• 22:47
  they're
• 22:47
  intrinsically
• 22:48
  motivated
• 22:49
  and
• 22:49
  interested
• 22:49
  to
• 22:49
  pursue
• 22:50
  them.
• 22:50
  You
• 22:51
  don't
• 22:51
  see
• 22:51
  a
• 22:51
  lot
• 22:51
  of
• 22:51
  people
• 22:52
  with
• 22:52
  ADHD
• 22:52
  becoming
• 22:53
  tax
• 22:53
  accountants
• 22:54
  or
• 22:54
  like
• 22:54
  DMV
• 22:55
  clerks.
• 22:56
  They
• 22:56
  usually
• 22:56
  are
• 22:57
  entrepreneurs.
• 22:58
  It's
• 22:58
  a
• 22:58
  very
• 22:59
  ego
• 22:59
  syntonic.
• 23:01
  It
• 23:01
  can
• 23:01
  be
• 23:01
  a
• 23:01
  very
• 23:02
  ego
• 23:02
  syntonic
• 23:04
  mental
• 23:04
  illness
• 23:04
  in
• 23:05
  air
• 23:05
  quotes.
• 23:05
  But
• 23:06
  again,
• 23:06
  I
• 23:06
  don't
• 23:06
  want
• 23:06
  to
• 23:06
  undermine
• 23:07
  it
• 23:07
  too,
• 23:07
  because
• 23:07
  it
• 23:08
  is
• 23:08
  a
• 23:08
  serious
• 23:08
  mental
• 23:09
  illness
• 23:10
  if
• 23:10
  you
• 23:10
  look
• 23:10
  at
• 23:10
  the
• 23:10
  morbidity
• 23:11
  and
• 23:11
  mortality.
• 23:12
  Okay,
• 23:13
  Now,
• 23:14
  a
• 23:15
  lot
• 23:15
  of
• 23:15
  what
• 23:15
  we
• 23:15
  see
• 23:16
  here
• 23:16
  with
• 23:16
  Carly
• 23:16
  is
• 23:17
  arguing
• 23:17
  against
• 23:17
  ADHD
• 23:18
  for
• 23:18
  reasons.
• 23:19
  We
• 23:19
  already
• 23:19
  talked
• 23:20
  about
• 23:21
  that
• 23:22
  really.
• 23:22
  She's
• 23:22
  not
• 23:23
  chasing
• 23:24
  more
• 23:24
  novel
• 23:24
  or
• 23:25
  exciting
• 23:25
  activities.
• 23:26
  She's
• 23:27
  not
• 23:28
  focused
• 23:28
  because
• 23:28
  she's
• 23:29
  just
• 23:29
  worried
• 23:30
  and
• 23:30
  she's
• 23:30
  ruminating.
• 23:31
  And
• 23:31
  especially
• 23:32
  in
• 23:32
  childhood
• 23:32
  when
• 23:32
  she's
• 23:33
  crying
• 23:33
  before
• 23:33
  school,
• 23:34
  Remember
• 23:34
  with
• 23:34
  kids,
• 23:35
  stomach
• 23:35
  aches
• 23:36
  and
• 23:36
  crying,
• 23:37
  anxiety
• 23:37
  kind
• 23:37
  of
• 23:37
  presents
• 23:38
  differently.
• 23:39
  That's
• 23:39
  a
• 23:39
  really
• 23:39
  good
• 23:39
  clue.
• 23:40
  She
• 23:40
  also
• 23:41
  did
• 23:41
  pretty
• 23:41
  well
• 23:42
  in
• 23:42
  elementary
• 23:43
  school.
• 23:43
  So
• 23:43
  I'm
• 23:43
  not
• 23:43
  that
• 23:43
  worried
• 23:44
  about
• 23:44
  ADHD.
• 23:45
  She
• 23:45
  got,
• 23:45
  like,
• 23:45
  a
• 23:45
  3.7
• 23:46
  GPA,
• 23:48
  so
• 23:48
  that
• 23:48
  lowers
• 23:49
  my
• 23:49
  index
• 23:50
  of
• 23:50
  suspicion.
• 23:50
  We
• 23:50
  didn't
• 23:51
  hear
• 23:51
  a
• 23:51
  lot
• 23:51
  about
• 23:52
  her
• 23:53
  parents
• 23:53
  or
• 23:53
  school
• 23:54
  teachers
• 23:54
  being
• 23:54
  concerned
• 23:55
  about
• 23:55
  her
• 23:55
  performance
• 23:56
  repeatedly.
• 23:57
  Remember,
• 23:57
  it's
• 23:57
  not
• 23:58
  always
• 23:58
  think
• 23:58
  about,
• 23:58
  what
• 23:59
  am
• 23:59
  I.
• 23:59
  What
• 23:59
  are
• 23:59
  my
• 23:59
  patients
• 24:00
  not
• 24:00
  telling
• 24:00
  me?
• 24:01
  Also,
• 24:01
  that's
• 24:02
  a
• 24:02
  huge
• 24:02
  pearl.
• 24:02
  I
• 24:02
  want
• 24:03
  you
• 24:03
  to
• 24:03
  remember
• 24:03
  here.
• 24:03
  My
• 24:03
  friends
• 24:04
  don't
• 24:04
  just
• 24:05
  collect
• 24:05
  information
• 24:05
  and
• 24:06
  go,
• 24:06
  well,
• 24:06
  what
• 24:06
  do
• 24:06
  I
• 24:06
  have?
• 24:07
  It's
• 24:07
  really
• 24:08
  important
• 24:08
  to
• 24:08
  also
• 24:08
  think
• 24:08
  about,
• 24:09
  what
• 24:09
  did
• 24:09
  the
• 24:09
  patient
• 24:09
  not
• 24:10
  say?
• 24:10
  What
• 24:11
  did
• 24:11
  they
• 24:11
  not
• 24:11
  report?
• 24:12
  Right.
• 24:12
  You
• 24:12
  don't
• 24:12
  have
• 24:13
  the
• 24:13
  time
• 24:14
  to
• 24:14
  ask,
• 24:15
  to
• 24:15
  think
• 24:15
  about
• 24:15
  every
• 24:16
  question
• 24:16
  they'd
• 24:16
  never
• 24:17
  talked
• 24:18
  about,
• 24:18
  obviously,
• 24:18
  because
• 24:19
  it's
• 24:19
  in
• 24:19
  theory
• 24:19
  an
• 24:20
  unlimited
• 24:20
  amount
• 24:20
  of
• 24:21
  questions.
• 24:21
  But
• 24:22
  at
• 24:22
  the
• 24:22
  end
• 24:22
  of
• 24:22
  the
• 24:22
  interview,
• 24:23
  you
• 24:23
  go,
• 24:23
  you
• 24:23
  know
• 24:23
  what?
• 24:23
  Yeah.
• 24:24
  The
• 24:24
  patient
• 24:24
  didn't
• 24:24
  mention
• 24:25
  anything
• 24:26
  about
• 24:27
  having
• 24:27
  a
• 24:28
  really
• 24:29
  difficult
• 24:29
  time
• 24:29
  in
• 24:30
  school
• 24:30
  or
• 24:30
  parents
• 24:30
  or
• 24:31
  teachers,
• 24:32
  teacher
• 24:33
  conferences
• 24:34
  or
• 24:35
  individualized
• 24:36
  education
• 24:36
  plans.
• 24:37
  So
• 24:37
  just
• 24:38
  reflect
• 24:38
  back
• 24:38
  on
• 24:39
  that
• 24:39
  afterwards
• 24:40
  and
• 24:40
  think
• 24:40
  about
• 24:40
  what
• 24:40
  the
• 24:40
  patient
• 24:41
  did
• 24:41
  not
• 24:41
  report.
• 24:42
  I
• 24:42
  think
• 24:42
  that's
• 24:43
  really
• 24:43
  important.
• 25:38
  Right?
• 25:38
  The
• 25:39
  patient
• 25:39
  never,
• 25:39
  Carly
• 25:40
  never
• 25:40
  talked
• 25:40
  about
• 25:40
  the
• 25:41
  fact
• 25:41
  that
• 25:41
  she's,
• 25:42
  you
• 25:42
  know,
• 25:43
  she's
• 25:43
  playing
• 25:44
  Candy
• 25:44
  Crush
• 25:45
  during
• 25:45
  her
• 25:45
  law
• 25:46
  school
• 25:46
  lectures.
• 25:47
  That
• 25:47
  would
• 25:47
  be
• 25:47
  way
• 25:47
  more
• 25:48
  adhd.
• 25:48
  Right.
• 25:49
  There's
• 25:49
  nothing,
• 25:49
  nothing
• 25:50
  fearful
• 25:51
  about
• 25:51
  that
• 25:51
  game
• 25:52
  or
• 25:52
  scary.
• 25:53
  It's
• 25:53
  not
• 25:53
  anticipatory
• 25:54
  worry.
• 25:54
  It's
• 25:55
  just
• 25:55
  crushing
• 25:55
  candy
• 25:56
  canes
• 25:57
  neurotically
• 25:58
  and
• 25:58
  obsessively
• 26:00
  at
• 26:00
  the
• 26:00
  expense
• 26:00
  of
• 26:01
  your
• 26:01
  future.
• 26:01
  So
• 26:02
  it's
• 26:02
  just
• 26:02
  different.
• 26:02
  Right.
• 26:03
  Um,
• 26:04
  now
• 26:04
  we
• 26:05
  gotta
• 26:05
  remember
• 26:05
  though,
• 26:06
  the
• 26:06
  comorbidity
• 26:07
  rate
• 26:07
  is
• 26:07
  very
• 26:08
  high
• 26:08
  between
• 26:08
  these
• 26:09
  two
• 26:09
  syndromes.
• 26:10
  You
• 26:10
  know,
• 26:10
  adults
• 26:10
  with
• 26:11
  ADHD
• 26:11
  have
• 26:11
  something
• 26:12
  like
• 26:12
  a
• 26:12
  five
• 26:12
  fold
• 26:13
  increase
• 26:13
  in
• 26:14
  odds
• 26:14
  of
• 26:14
  having
• 26:14
  an
• 26:14
  anxiety
• 26:15
  disorder.
• 26:16
  So
• 26:17
  we've
• 26:17
  gotta
• 26:18
  really
• 26:18
  think
• 26:18
  about
• 26:18
  this.
• 26:19
  Um,
• 26:20
  and
• 26:20
  again,
• 26:20
  we
• 26:20
  don't
• 26:20
  wanna
• 26:21
  dismiss
• 26:21
  it
• 26:22
  and
• 26:22
  we
• 26:22
  don't
• 26:22
  wanna
• 26:23
  totally
• 26:23
  dismiss
• 26:23
  an
• 26:24
  adjustment
• 26:24
  disorder
• 26:25
  either
• 26:25
  because
• 26:25
  she
• 26:26
  did
• 26:26
  just
• 26:26
  enter
• 26:26
  law
• 26:27
  school.
• 26:27
  And
• 26:28
  I
• 26:28
  think
• 26:28
  if
• 26:28
  these
• 26:28
  worries
• 26:29
  had
• 26:29
  never
• 26:29
  been
• 26:31
  endorsed
• 26:32
  prior
• 26:32
  to
• 26:32
  law
• 26:32
  school,
• 26:33
  if
• 26:33
  you,
• 26:33
  if
• 26:33
  we,
• 26:34
  if
• 26:34
  Carly
• 26:34
  never
• 26:35
  endorsed
• 26:35
  the
• 26:36
  fact
• 26:36
  that
• 26:36
  she
• 26:37
  had
• 26:37
  stomach
• 26:37
  aches
• 26:38
  or
• 26:38
  cried
• 26:38
  before
• 26:39
  school,
• 26:40
  you
• 26:41
  know,
• 26:41
  if
• 26:41
  her
• 26:41
  mother
• 26:41
  didn't
• 26:42
  corroborate
• 26:42
  her
• 26:42
  anxious
• 26:43
  history,
• 26:43
  it,
• 26:44
  you
• 26:44
  know,
• 26:44
  if
• 26:44
  we
• 26:44
  didn't
• 26:45
  have
• 26:45
  a
• 26:45
  lot
• 26:45
  of
• 26:45
  this
• 26:45
  worst
• 26:46
  case
• 26:46
  scenario
• 26:46
  thinking,
• 26:47
  the
• 26:47
  fatigue,
• 26:48
  the
• 26:48
  racing
• 26:49
  thoughts
• 26:49
  before
• 26:50
  law
• 26:50
  school,
• 26:50
  this
• 26:50
  could
• 26:51
  just
• 26:51
  be
• 26:51
  chopped
• 26:51
  up
• 26:51
  as
• 26:51
  an
• 26:52
  adjustment
• 26:52
  disorder
• 26:53
  where
• 26:53
  she's
• 26:54
  just
• 26:54
  bombarded
• 26:54
  with
• 26:55
  a
• 26:55
  volume
• 26:56
  of
• 26:56
  work
• 26:56
  that
• 26:56
  she's
• 26:57
  never
• 26:57
  been
• 26:57
  exposed
• 26:58
  to
• 26:58
  before
• 26:58
  and
• 26:58
  she
• 26:59
  legitimately
• 26:59
  can't
• 26:59
  keep
• 27:00
  up.
• 27:00
  But
• 27:00
  the
• 27:00
  key
• 27:01
  is
• 27:01
  it
• 27:02
  cannot
• 27:02
  be
• 27:02
  part
• 27:02
  of
• 27:03
  an
• 27:03
  existing
• 27:04
  mental
• 27:04
  disorder
• 27:05
  with,
• 27:05
  with
• 27:06
  adjustment.
• 27:06
  Right.
• 27:06
  It's
• 27:07
  also
• 27:07
  an
• 27:07
  exclusionary
• 27:08
  diagnosis.
• 27:09
  So
• 27:09
  again,
• 27:10
  sure,
• 27:10
  if
• 27:11
  she
• 27:11
  could
• 27:11
  have
• 27:11
  adjustment
• 27:12
  related
• 27:12
  issues
• 27:12
  because
• 27:13
  it's
• 27:13
  law
• 27:13
  school
• 27:13
  and
• 27:13
  it's
• 27:14
  a
• 27:14
  lot
• 27:14
  of
• 27:14
  work,
• 27:15
  but
• 27:15
  if
• 27:16
  it's
• 27:16
  tied
• 27:16
  to
• 27:17
  longstanding
• 27:17
  excessive
• 27:18
  worry
• 27:20
  that
• 27:20
  it
• 27:20
  was
• 27:20
  consistent
• 27:21
  well
• 27:21
  before
• 27:22
  law
• 27:22
  school,
• 27:23
  then
• 27:23
  it's
• 27:23
  really
• 27:24
  not
• 27:24
  going
• 27:24
  to
• 27:24
  be
• 27:25
  an
• 27:25
  adjustment
• 27:25
  disorder.
• 27:26
  It'd
• 27:26
  have
• 27:26
  to
• 27:26
  be
• 27:26
  this
• 27:26
  brand
• 27:26
  new
• 27:27
  thing.
• 27:27
  And
• 27:27
  patients
• 27:28
  will
• 27:28
  tell
• 27:28
  you
• 27:28
  usually
• 27:29
  if
• 27:29
  they're
• 27:29
  having
• 27:29
  an
• 27:29
  adjustment
• 27:30
  disorder
• 27:31
  in
• 27:31
  this
• 27:31
  context,
• 27:32
  like,
• 27:32
  hey,
• 27:32
  no,
• 27:32
  I've
• 27:32
  never
• 27:33
  had
• 27:33
  depression.
• 27:33
  I've
• 27:33
  never
• 27:33
  had
• 27:34
  a
• 27:34
  depressive
• 27:34
  episode.
• 27:35
  I'm
• 27:35
  not
• 27:35
  a
• 27:36
  sad
• 27:36
  type,
• 27:36
  I'm
• 27:36
  not
• 27:36
  a
• 27:36
  worried
• 27:37
  type.
• 27:37
  But
• 27:37
  there's
• 27:38
  something
• 27:38
  about,
• 27:38
  you
• 27:39
  know,
• 27:39
  this,
• 27:40
  something
• 27:40
  about
• 27:41
  law
• 27:41
  school
• 27:41
  where
• 27:41
  I
• 27:41
  can't
• 27:42
  balance
• 27:42
  my
• 27:42
  relationship
• 27:43
  with
• 27:43
  it
• 27:43
  anymore.
• 27:44
  And
• 27:45
  they
• 27:45
  just,
• 27:45
  you
• 27:46
  know,
• 27:46
  they're
• 27:46
  kind
• 27:46
  of
• 27:46
  out
• 27:47
  of
• 27:47
  sorts
• 27:47
  and
• 27:47
  they're
• 27:47
  failing.
• 27:48
  And
• 27:48
  in
• 27:49
  my
• 27:49
  opinion,
• 27:49
  with
• 27:50
  folks
• 27:50
  who
• 27:50
  just
• 27:50
  have
• 27:50
  adjustment
• 27:51
  disorders,
• 27:52
  they
• 27:52
  usually
• 27:53
  tend
• 27:53
  to
• 27:54
  deny
• 27:54
  a
• 27:54
  lot
• 27:54
  of
• 27:54
  chronic
• 27:55
  psychiatric
• 27:56
  problems
• 27:56
  in
• 27:56
  the
• 27:56
  past
• 27:57
  that
• 27:57
  it
• 27:57
  makes
• 27:57
  it
• 27:58
  a
• 27:58
  lot
• 27:58
  cleaner
• 27:58
  and
• 27:58
  easier
• 27:59
  to
• 27:59
  diagnose
• 28:00
  the
• 28:00
  adjustment
• 28:01
  disorder
• 28:01
  because
• 28:01
  of
• 28:02
  that
• 28:02
  and
• 28:03
  folks
• 28:04
  who
• 28:04
  do
• 28:04
  have
• 28:04
  chronic
• 28:05
  checkered
• 28:05
  anxiety
• 28:06
  histories
• 28:06
  and
• 28:06
  depressive
• 28:07
  histories,
• 28:07
  those
• 28:08
  folks,
• 28:09
  it
• 28:09
  tends
• 28:10
  to
• 28:10
  align
• 28:10
  more
• 28:11
  with
• 28:12
  what
• 28:12
  they're
• 28:12
  telling
• 28:12
  you
• 28:13
  in
• 28:13
  the
• 28:13
  present
• 28:13
  about
• 28:14
  law
• 28:14
  school.
• 28:14
  Right.
• 28:14
  So
• 28:15
  it's
• 28:15
  more
• 28:15
  of
• 28:15
  an
• 28:15
  exacerbation
• 28:16
  of
• 28:16
  their
• 28:16
  existing
• 28:17
  illness.
• 28:17
  And
• 28:18
  again,
• 28:18
  usually
• 28:18
  that's
• 28:19
  not
• 28:19
  this
• 28:19
  mysterious
• 28:20
  black
• 28:20
  box.
• 28:20
  It's
• 28:20
  just
• 28:20
  a
• 28:21
  matter
• 28:21
  of
• 28:21
  you
• 28:21
  eliciting
• 28:21
  it
• 28:22
  out
• 28:22
  of
• 28:22
  them
• 28:22
  via
• 28:22
  questions.
• 28:23
  You
• 28:23
  have
• 28:23
  to
• 28:23
  just
• 28:23
  talk
• 28:24
  to
• 28:24
  them
• 28:24
  and
• 28:24
  ask
• 28:25
  them,
• 28:25
  you
• 28:26
  know,
• 28:26
  about,
• 28:27
  about
• 28:27
  their
• 28:27
  anxiety.
• 28:28
  When
• 28:28
  does
• 28:29
  it
• 28:29
  worsen?
• 28:29
  What
• 28:29
  does
• 28:29
  it
• 28:30
  look
• 28:30
  like
• 28:30
  on
• 28:30
  a
• 28:30
  daily
• 28:30
  basis?
• 28:31
  Have
• 28:31
  you
• 28:31
  ever
• 28:31
  been
• 28:31
  treated
• 28:32
  for
• 28:32
  it?
• 28:32
  Right.
• 28:33
  Assess
• 28:33
  its
• 28:33
  patterns?
• 28:34
  Is
• 28:34
  this
• 28:34
  long
• 28:34
  standing?
• 28:35
  Is
• 28:35
  it
• 28:35
  just
• 28:36
  social?
• 28:36
  Is
• 28:37
  it
• 28:37
  just
• 28:37
  panic
• 28:37
  attacks?
• 28:38
  But
• 28:39
  in
• 28:39
  her
• 28:39
  case,
• 28:39
  we
• 28:39
  know
• 28:39
  this
• 28:40
  is
• 28:40
  a
• 28:40
  long
• 28:40
  standing
• 28:41
  problem
• 28:41
  of
• 28:41
  fear,
• 28:42
  anticipatory
• 28:43
  worry.
• 28:44
  And
• 28:45
  it
• 28:46
  has
• 28:46
  gotten
• 28:46
  worse
• 28:47
  in
• 28:47
  the
• 28:48
  context
• 28:48
  of
• 28:49
  law
• 28:49
  school,
• 28:49
  but
• 28:50
  the
• 28:50
  kind
• 28:50
  of
• 28:51
  worry
• 28:51
  is
• 28:51
  still
• 28:51
  the
• 28:52
  same.
• 28:52
  It's
• 28:53
  threat
• 28:53
  based,
• 28:54
  future
• 28:54
  based.
• 28:55
  It
• 28:55
  is
• 28:55
  the
• 28:56
  singular
• 28:56
  reason
• 28:57
  she's
• 28:57
  having
• 28:57
  trouble
• 28:58
  sleeping.
• 28:59
  And
• 28:59
  the
• 29:00
  content
• 29:00
  of
• 29:01
  all
• 29:01
  of
• 29:01
  this
• 29:01
  is
• 29:02
  centered
• 29:02
  around
• 29:02
  law
• 29:02
  school,
• 29:03
  but
• 29:03
  it's
• 29:03
  still
• 29:03
  the
• 29:04
  same
• 29:04
  worry.
• 29:04
  So
• 29:05
  I
• 29:05
  would
• 29:05
  definitely
• 29:06
  chalk
• 29:06
  this
• 29:06
  up
• 29:06
  as
• 29:07
  gad,
• 29:07
  and
• 29:07
  I
• 29:08
  would
• 29:08
  watch
• 29:08
  ADHD
• 29:09
  like
• 29:09
  a
• 29:09
  hawk
• 29:10
  and
• 29:10
  be
• 29:10
  very
• 29:11
  careful.
• 29:12
  Um,
• 29:12
  I
• 29:12
  would
• 29:12
  probably
• 29:13
  stop,
• 29:13
  start
• 29:13
  Carly
• 29:14
  on
• 29:14
  an
• 29:14
  SSRI
• 29:15
  and
• 29:15
  reassure
• 29:15
  her
• 29:16
  that
• 29:17
  she's
• 29:17
  never
• 29:17
  been
• 29:17
  on
• 29:18
  psychiatric
• 29:19
  medications
• 29:19
  before.
• 29:20
  So
• 29:21
  this
• 29:21
  is
• 29:22
  potentially
• 29:22
  a
• 29:22
  very
• 29:23
  hopeful
• 29:23
  time
• 29:23
  for
• 29:24
  you
• 29:24
  to
• 29:24
  try
• 29:24
  first
• 29:25
  line
• 29:25
  treatment
• 29:25
  for
• 29:25
  the
• 29:26
  first
• 29:26
  time.
• 29:26
  I
• 29:27
  would
• 29:27
  definitely
• 29:27
  include
• 29:27
  psychotherapy,
• 29:28
  cbt,
• 29:29
  cognitive
• 29:30
  reframing,
• 29:30
  behavioral
• 29:31
  activation.
• 29:31
  I
• 29:32
  would
• 29:32
  want
• 29:32
  that
• 29:32
  all
• 29:32
  on
• 29:33
  board
• 29:33
  to
• 29:33
  give
• 29:34
  her
• 29:34
  the
• 29:34
  best
• 29:34
  chance
• 29:34
  at
• 29:34
  a
• 29:35
  full
• 29:35
  remission
• 29:35
  possible
• 29:36
  to
• 29:37
  help
• 29:37
  her
• 29:37
  specifically
• 29:38
  adjust
• 29:38
  to
• 29:39
  this
• 29:39
  stuff.
• 29:40
  And
• 29:41
  like
• 29:41
  I
• 29:42
  said,
• 29:42
  I
• 29:42
  would
• 29:43
  go
• 29:43
  down
• 29:43
  that
• 29:44
  path.
• 29:44
  And
• 29:44
  it's
• 29:44
  very
• 29:45
  important
• 29:45
  that
• 29:45
  we
• 29:46
  get
• 29:46
  diagnostically
• 29:47
  precise
• 29:48
  about
• 29:48
  this,
• 29:48
  because
• 29:49
  if
• 29:49
  you're
• 29:49
  kind
• 29:50
  of
• 29:50
  wrong
• 29:50
  about
• 29:50
  this,
• 29:51
  then
• 29:51
  you're
• 29:51
  going
• 29:51
  to
• 29:51
  give
• 29:51
  her
• 29:52
  Ritalin,
• 29:52
  and
• 29:53
  that
• 29:53
  might
• 29:53
  make
• 29:53
  her
• 29:53
  anxiety
• 29:54
  way
• 29:54
  worse
• 29:55
  if
• 29:55
  she's
• 29:55
  already
• 29:56
  drinking
• 29:56
  a
• 29:56
  lot
• 29:56
  of
• 29:56
  caffeine.
• 29:57
  And
• 29:58
  here
• 29:58
  you
• 29:58
  are
• 29:58
  mistaking
• 29:59
  this
• 29:59
  because
• 29:59
  you
• 30:00
  had
• 30:00
  an
• 30:00
  anchoring
• 30:00
  bias
• 30:01
  and
• 30:01
  you
• 30:02
  mistook
• 30:02
  this
• 30:02
  for
• 30:03
  adhd.
• 30:03
  Maybe
• 30:04
  you
• 30:04
  don't
• 30:04
  want
• 30:04
  to
• 30:04
  disappoint
• 30:05
  the
• 30:05
  patient
• 30:06
  because
• 30:06
  you're
• 30:06
  a
• 30:06
  people
• 30:07
  pleaser
• 30:07
  and
• 30:08
  you
• 30:08
  haven't
• 30:08
  done
• 30:08
  your
• 30:08
  own
• 30:08
  therapy.
• 30:09
  And
• 30:09
  so
• 30:09
  you
• 30:10
  don't
• 30:10
  want
• 30:10
  to
• 30:10
  let
• 30:10
  her
• 30:10
  down
• 30:11
  and
• 30:11
  say,
• 30:12
  well,
• 30:12
  you
• 30:12
  don't
• 30:13
  have
• 30:13
  adhd,
• 30:13
  or
• 30:13
  I
• 30:14
  think
• 30:14
  the
• 30:14
  principal
• 30:15
  functional
• 30:15
  impairment
• 30:15
  here
• 30:16
  is
• 30:16
  gad.
• 30:17
  And
• 30:17
  so
• 30:17
  you're.
• 30:17
  You
• 30:18
  unwittingly,
• 30:18
  subconsciously
• 30:19
  choose
• 30:20
  this
• 30:20
  methylphenidate
• 30:21
  and
• 30:21
  you
• 30:21
  make
• 30:22
  her
• 30:22
  worse.
• 30:22
  That
• 30:22
  would
• 30:22
  be
• 30:22
  a
• 30:23
  big
• 30:23
  problem.
• 30:24
  Right.
• 30:24
  And
• 30:25
  it
• 30:25
  is
• 30:25
  hard
• 30:25
  sometimes.
• 30:26
  You
• 30:26
  will
• 30:26
  have
• 30:26
  patients
• 30:27
  that
• 30:27
  are
• 30:27
  convinced
• 30:28
  they
• 30:28
  have
• 30:28
  a
• 30:28
  certain
• 30:29
  Mental
• 30:29
  illness.
• 30:30
  And
• 30:30
  they,
• 30:31
  for
• 30:31
  lack
• 30:31
  of
• 30:32
  a
• 30:32
  better
• 30:32
  word,
• 30:32
  kind
• 30:33
  of
• 30:33
  want
• 30:33
  you
• 30:34
  to
• 30:35
  diagnose
• 30:35
  it.
• 30:35
  And
• 30:36
  I
• 30:36
  say
• 30:36
  that
• 30:37
  carefully.
• 30:37
  But
• 30:38
  if
• 30:38
  you
• 30:39
  think
• 30:39
  about
• 30:39
  it,
• 30:39
  it
• 30:39
  makes
• 30:39
  a
• 30:40
  lot
• 30:40
  of
• 30:40
  sense,
• 30:40
  right?
• 30:41
  Patients
• 30:41
  want
• 30:42
  to
• 30:42
  have
• 30:42
  control
• 30:42
  over
• 30:43
  what
• 30:43
  they're
• 30:43
  going
• 30:43
  through.
• 30:43
  And
• 30:44
  it's,
• 30:44
  it's
• 30:44
  very.
• 30:46
  It's
• 30:47
  very
• 30:47
  disorienting.
• 30:48
  If
• 30:48
  you
• 30:48
  come
• 30:48
  in
• 30:49
  thinking
• 30:49
  you
• 30:49
  have
• 30:49
  ADHD
• 30:50
  and
• 30:50
  you're
• 30:50
  convinced
• 30:51
  you
• 30:51
  do,
• 30:51
  and
• 30:51
  you've
• 30:51
  done
• 30:51
  all
• 30:52
  this
• 30:52
  research
• 30:52
  on
• 30:52
  it,
• 30:53
  and
• 30:53
  so
• 30:53
  you
• 30:53
  feel
• 30:53
  like
• 30:54
  you
• 30:54
  have
• 30:54
  the
• 30:54
  agency
• 30:54
  to
• 30:55
  fix
• 30:55
  it,
• 30:55
  and
• 30:55
  then
• 30:55
  all
• 30:55
  of
• 30:55
  a
• 30:55
  sudden
• 30:56
  a
• 30:56
  provider
• 30:56
  tells
• 30:56
  you,
• 30:57
  absolutely
• 30:57
  not.
• 30:57
  You
• 30:57
  don't
• 30:58
  have
• 30:58
  adhd.
• 30:58
  I
• 30:59
  think
• 30:59
  you
• 30:59
  have
• 30:59
  gad.
• 31:00
  And
• 31:00
  here's
• 31:00
  why.
• 31:01
  If
• 31:01
  you're
• 31:01
  really
• 31:01
  good
• 31:02
  at
• 31:02
  explaining
• 31:02
  why
• 31:03
  they
• 31:03
  have
• 31:03
  gad,
• 31:03
  that
• 31:04
  could
• 31:04
  be
• 31:04
  just
• 31:04
  fine.
• 31:05
  Hunky
• 31:05
  dory.
• 31:06
  They'll
• 31:06
  leave
• 31:06
  empowered
• 31:07
  with
• 31:08
  more
• 31:08
  clarity.
• 31:09
  But
• 31:09
  you
• 31:09
  really
• 31:10
  have
• 31:10
  to
• 31:10
  slow
• 31:10
  things
• 31:11
  down
• 31:11
  and
• 31:11
  explain
• 31:12
  your
• 31:12
  rationale.
• 31:13
  And
• 31:13
  I
• 31:13
  find
• 31:13
  when
• 31:13
  you
• 31:14
  do
• 31:14
  that,
• 31:14
  you
• 31:15
  give
• 31:15
  the
• 31:15
  patient
• 31:15
  more
• 31:16
  perspective,
• 31:16
  more
• 31:16
  power,
• 31:17
  more
• 31:17
  agency,
• 31:18
  and
• 31:18
  it
• 31:18
  can
• 31:19
  really
• 31:19
  help
• 31:19
  them.
• 31:19
  And
• 31:20
  then
• 31:20
  they
• 31:20
  leave
• 31:20
  more
• 31:20
  reassured
• 31:21
  and
• 31:21
  more
• 31:21
  convinced
• 31:22
  and
• 31:22
  more
• 31:23
  adherent
• 31:23
  to
• 31:23
  your
• 31:23
  treatment
• 31:24
  plan.
• 31:24
  Because
• 31:24
  if
• 31:24
  they
• 31:24
  don't
• 31:24
  agree
• 31:25
  with
• 31:25
  you
• 31:26
  and
• 31:26
  you
• 31:27
  haven't
• 31:27
  fleshed
• 31:27
  out
• 31:27
  the
• 31:27
  how
• 31:28
  and
• 31:28
  the
• 31:28
  why,
• 31:28
  and
• 31:28
  those
• 31:28
  mechanics,
• 31:29
  they're
• 31:29
  going
• 31:29
  to
• 31:30
  be
• 31:30
  pretty
• 31:30
  reluctant
• 31:30
  to
• 31:30
  start
• 31:31
  Zoloft.
• 31:31
  They
• 31:31
  might
• 31:31
  not
• 31:32
  even
• 31:32
  fill
• 31:32
  the
• 31:32
  prescription.
• 31:34
  They
• 31:34
  might
• 31:34
  not
• 31:34
  be
• 31:34
  that
• 31:34
  adherent
• 31:35
  to
• 31:35
  it
• 31:35
  once
• 31:35
  you
• 31:35
  die,
• 31:36
  once
• 31:36
  you
• 31:36
  prescribe
• 31:36
  it,
• 31:36
  and
• 31:37
  they
• 31:37
  don't
• 31:37
  really
• 31:37
  get
• 31:37
  better,
• 31:38
  Right?
• 31:38
  So
• 31:38
  just
• 31:39
  have
• 31:39
  that
• 31:39
  conversation
• 31:40
  compassionately,
• 31:41
  collaboratively.
• 31:42
  Don't
• 31:42
  come
• 31:42
  out
• 31:42
  and
• 31:42
  like,
• 31:43
  knife
• 31:43
  hand
• 31:43
  everything.
• 31:43
  It's
• 31:44
  okay
• 31:44
  to
• 31:44
  kind
• 31:44
  of
• 31:45
  hedge
• 31:45
  your
• 31:45
  certainty,
• 31:46
  and
• 31:46
  that's.
• 31:47
  That's
• 31:47
  the
• 31:47
  scientific
• 31:48
  thing
• 31:48
  to
• 31:48
  do
• 31:48
  and
• 31:48
  say,
• 31:48
  hey,
• 31:49
  based
• 31:49
  on
• 31:50
  everything
• 31:50
  you
• 31:50
  shared
• 31:50
  with
• 31:51
  me
• 31:51
  in
• 31:51
  the
• 31:51
  limited
• 31:51
  time
• 31:52
  we
• 31:52
  had
• 31:52
  today
• 31:52
  together,
• 31:54
  my
• 31:54
  impression
• 31:54
  is
• 31:54
  that
• 31:55
  we're
• 31:55
  looking
• 31:55
  at
• 31:55
  a
• 31:55
  generalized
• 31:56
  anxiety
• 31:56
  disorder.
• 31:57
  And
• 31:58
  I
• 31:58
  know
• 31:58
  we
• 31:58
  just
• 31:58
  met
• 31:59
  and
• 31:59
  we
• 31:59
  should
• 32:00
  both
• 32:00
  continue
• 32:00
  to
• 32:00
  stay
• 32:01
  open
• 32:01
  and
• 32:01
  vigilant
• 32:02
  about
• 32:02
  your
• 32:02
  symptoms
• 32:03
  and
• 32:03
  what
• 32:03
  they
• 32:03
  may
• 32:03
  mean.
• 32:04
  But
• 32:05
  this
• 32:05
  is
• 32:05
  why
• 32:06
  I
• 32:06
  believe
• 32:07
  that
• 32:07
  this
• 32:07
  is
• 32:08
  consistent
• 32:08
  with
• 32:08
  generalized
• 32:09
  anxiety
• 32:09
  and
• 32:09
  worry
• 32:10
  and
• 32:10
  not
• 32:11
  adhd.
• 32:11
  And
• 32:12
  I'll
• 32:12
  say,
• 32:12
  you
• 32:12
  know,
• 32:12
  patients
• 32:13
  who
• 32:13
  typically
• 32:13
  present
• 32:14
  with
• 32:14
  ADHD
• 32:15
  are
• 32:15
  normally
• 32:16
  distracted
• 32:17
  just
• 32:17
  like
• 32:17
  you
• 32:17
  are,
• 32:18
  but
• 32:18
  their
• 32:19
  thoughts
• 32:19
  don't
• 32:19
  go
• 32:19
  to
• 32:20
  fearful
• 32:20
  places.
• 32:21
  They
• 32:21
  go
• 32:21
  to
• 32:21
  places
• 32:22
  that
• 32:25
  are
• 32:25
  a
• 32:25
  little
• 32:25
  more
• 32:25
  entertaining
• 32:26
  or
• 32:27
  engaging
• 32:27
  than
• 32:27
  where
• 32:28
  their
• 32:28
  thoughts
• 32:28
  currently
• 32:29
  are.
• 32:29
  As
• 32:30
  opposed
• 32:30
  to
• 32:30
  anxiety,
• 32:30
  which
• 32:31
  goes
• 32:31
  to
• 32:31
  fear
• 32:31
  and
• 32:32
  uncertainty
• 32:32
  and
• 32:33
  situations
• 32:33
  you
• 32:33
  can't
• 32:34
  control.
• 32:34
  And
• 32:34
  the
• 32:35
  vast
• 32:35
  majority
• 32:35
  of
• 32:36
  those
• 32:37
  thoughts
• 32:37
  today
• 32:37
  you
• 32:38
  shared
• 32:38
  entered
• 32:39
  the
• 32:39
  fear
• 32:39
  column.
• 32:40
  And
• 32:40
  so
• 32:40
  in
• 32:40
  order
• 32:41
  to
• 32:41
  address
• 32:41
  fear,
• 32:41
  we
• 32:42
  typically
• 32:42
  go
• 32:42
  to
• 32:42
  SSRIs
• 32:43
  and
• 32:43
  CBT,
• 32:44
  that
• 32:45
  is
• 32:46
  the
• 32:46
  neurotransmitter
• 32:47
  serotonin
• 32:48
  that
• 32:48
  is
• 32:48
  most
• 32:49
  aligned
• 32:49
  with
• 32:49
  that
• 32:49
  fear
• 32:50
  based
• 32:50
  circuitry
• 32:51
  in
• 32:51
  your
• 32:51
  fight
• 32:52
  or
• 32:52
  flight
• 32:52
  areas
• 32:52
  of
• 32:53
  the
• 32:53
  brain.
• 32:53
  And
• 32:54
  if
• 32:54
  we
• 32:55
  instead
• 32:56
  prescribe
• 32:56
  an
• 32:56
  ADHD
• 32:57
  medication,
• 32:58
  we
• 32:59
  may
• 32:59
  make
• 33:00
  you
• 33:00
  even
• 33:00
  more
• 33:00
  hyper
• 33:01
  aware
• 33:01
  about
• 33:01
  these
• 33:02
  fears.
• 33:02
  You
• 33:02
  might
• 33:02
  have
• 33:02
  a
• 33:02
  more
• 33:03
  organized
• 33:04
  kind
• 33:04
  of
• 33:05
  mindset.
• 33:05
  Your
• 33:06
  mind
• 33:06
  might
• 33:06
  be
• 33:06
  more
• 33:07
  organized
• 33:08
  and
• 33:09
  less
• 33:09
  overwhelmed
• 33:10
  in
• 33:10
  the
• 33:10
  sense
• 33:11
  that
• 33:11
  it
• 33:11
  can
• 33:11
  think
• 33:11
  of
• 33:12
  thoughts
• 33:12
  more
• 33:12
  clearly.
• 33:13
  But
• 33:13
  if
• 33:13
  those
• 33:13
  thoughts
• 33:13
  are
• 33:14
  still
• 33:14
  fear
• 33:15
  based,
• 33:15
  we're
• 33:16
  not
• 33:16
  really
• 33:16
  helping
• 33:17
  your
• 33:17
  anxiety.
• 33:18
  We're
• 33:18
  just
• 33:18
  allowing
• 33:19
  you
• 33:19
  to
• 33:19
  see
• 33:20
  them
• 33:21
  with
• 33:21
  better
• 33:21
  executive
• 33:22
  functioning.
• 33:23
  That
• 33:23
  was
• 33:23
  a
• 33:24
  mouthful.
• 33:24
  Say
• 33:24
  it
• 33:24
  in
• 33:25
  your
• 33:25
  own
• 33:25
  way.
• 33:25
  But
• 33:26
  that's
• 33:26
  why
• 33:26
  I
• 33:26
  do
• 33:26
  education
• 33:27
  with
• 33:27
  my
• 33:27
  patients.
• 33:28
  All
• 33:28
  right,
• 33:29
  my
• 33:29
  friends.
• 33:29
  Well,
• 33:29
  this
• 33:30
  was
• 33:30
  a
• 33:30
  doozy.
• 33:31
  I
• 33:31
  enjoyed
• 33:31
  every
• 33:31
  minute
• 33:32
  of
• 33:32
  it
• 33:32
  with
• 33:32
  you.
• 33:33
  And
• 33:33
  I
• 33:33
  want
• 33:33
  to
• 33:33
  let
• 33:33
  you
• 33:34
  all
• 33:34
  know
• 33:34
  one
• 33:34
  thing
• 33:34
  before
• 33:35
  you
• 33:35
  leave.
• 33:35
  Now,
• 33:36
  the
• 33:36
  difference
• 33:37
  between
• 33:37
  a
• 33:38
  good
• 33:38
  clinician
• 33:38
  and
• 33:39
  a
• 33:39
  great
• 33:39
  clinician,
• 33:40
  not
• 33:40
  saying
• 33:40
  I'm
• 33:41
  a
• 33:41
  great
• 33:41
  one,
• 33:41
  but
• 33:42
  the
• 33:42
  difference
• 33:42
  I
• 33:43
  and
• 33:43
  I'm
• 33:43
  working
• 33:43
  on
• 33:43
  it,
• 33:44
  is
• 33:45
  that
• 33:45
  we
• 33:45
  understand
• 33:46
  the
• 33:46
  how
• 33:46
  and
• 33:46
  the
• 33:46
  why
• 33:47
  of
• 33:47
  what
• 33:47
  we're
• 33:47
  doing.
• 33:48
  I
• 33:48
  built
• 33:48
  an
• 33:48
  entire
• 33:49
  Patreon
• 33:49
  library
• 33:50
  so
• 33:50
  you
• 33:50
  would
• 33:51
  become
• 33:51
  the
• 33:51
  kind
• 33:51
  of
• 33:52
  clinician
• 33:52
  that
• 33:53
  knows
• 33:53
  the
• 33:53
  how
• 33:53
  and
• 33:53
  the
• 33:53
  why
• 33:54
  behind
• 33:54
  what
• 33:55
  you're
• 33:55
  doing.
• 33:55
  So
• 33:56
  patients
• 33:56
  trust
• 33:56
  you
• 33:57
  and
• 33:57
  they
• 33:57
  are
• 33:58
  empowered
• 33:59
  with
• 33:59
  your
• 33:59
  care.
• 34:00
  And
• 34:00
  it
• 34:00
  will
• 34:00
  transform
• 34:01
  the
• 34:01
  way
• 34:01
  you
• 34:01
  practice
• 34:02
  by
• 34:02
  becoming
• 34:02
  a
• 34:03
  Patreon
• 34:03
  member.
• 34:04
  I
• 34:05
  highly
• 34:05
  recommend
• 34:05
  you
• 34:06
  go
• 34:06
  to
• 34:06
  the
• 34:06
  Show
• 34:06
  Notes
• 34:07
  after
• 34:08
  this.
• 34:08
  If
• 34:08
  there's
• 34:08
  one
• 34:09
  thing
• 34:09
  you
• 34:09
  don't
• 34:09
  forget
• 34:09
  by
• 34:10
  the
• 34:10
  end
• 34:10
  of
• 34:10
  the
• 34:10
  day,
• 34:10
  go
• 34:10
  to
• 34:10
  the
• 34:11
  Show
• 34:11
  Notes
• 34:12
  and
• 34:12
  join
• 34:12
  our
• 34:13
  Patreon
• 34:13
  community.
• 34:14
  Okay,
• 34:15
  that's
• 34:16
  patreon.com
• 34:18
  pearlsandprepagain
• 34:19
  patreon.com
• 34:21
  PearlsandPrep
• 34:22
  and
• 34:22
  it
• 34:23
  will
• 34:23
  transform
• 34:24
  the
• 34:24
  way
• 34:25
  you
• 34:25
  do
• 34:25
  psychiatry.
• 34:26
  You
• 34:26
  know,
• 34:27
  we
• 34:27
  can't
• 34:27
  just
• 34:28
  be
• 34:28
  practitioners
• 34:29
  that
• 34:29
  press
• 34:29
  a
• 34:29
  button
• 34:30
  and
• 34:30
  memorize
• 34:30
  a
• 34:30
  diagnosis.
• 34:31
  Knowing
• 34:32
  the
• 34:32
  how
• 34:32
  and
• 34:32
  the
• 34:32
  why
• 34:33
  is
• 34:33
  Is
• 34:34
  the
• 34:34
  entire
• 34:36
  ball
• 34:36
  game
• 34:36
  when
• 34:36
  it
• 34:36
  comes
• 34:37
  to
• 34:37
  psychiatry.
• 34:38
  And
• 34:39
  so
• 34:39
  we
• 34:39
  built
• 34:39
  beautiful
• 34:40
  visual,
• 34:41
  visual
• 34:42
  ways
• 34:42
  to
• 34:42
  understand
• 34:43
  psychiatry
• 34:44
  immediately
• 34:44
  and
• 34:44
  quickly
• 34:45
  and
• 34:45
  powerfully.
• 34:45
  You're
• 34:45
  going
• 34:46
  to
• 34:46
  love
• 34:46
  it.
• 34:46
  People
• 34:46
  love
• 34:46
  it.
• 34:47
  And
• 34:47
  we
• 34:47
  can't
• 34:48
  wait
• 34:48
  to
• 34:48
  welcome
• 34:48
  you
• 34:48
  as
• 34:48
  a
• 34:49
  member.
• 34:49
  So
• 34:49
  head
• 34:49
  on
• 34:50
  over
• 34:50
  there,
• 34:50
  my
• 34:50
  friends,
• 34:51
  and
• 34:51
  we
• 34:51
  will
• 34:51
  see
• 34:51
  you
• 34:51
  next
• 34:52
  time
• 34:52
  here
• 34:52
  on
• 34:52
  Pearls
• 34:53
  and
• 34:53
  Prep.
• 34:53
  Bye.
• 34:54
  Bye.