For some, ADHD is a debilitating disorder. For others, it’s seen as a conspiracy designed by lazy teachers, parents, and an aggressive pharmaceutical industry. And many reasonable people believe that ADHD is something that only impacts children and not adults.
What is the truth? Today’s guest, Dr. George Sachs, has written extensively on ADHD in both children and adults and helps us better understand exactly what ADHD is – and isn’t.
Dr. George Sachs is a licensed child psychologist and adult psychologist, specializing in the treatment of ADD/ADHD and Autism Spectrum Disorders in children, teen and adults. Dr. Sachs is the co-founder of Inflow, a science-based app for adults with ADHD. He is also author of The Adult ADD Solution, Helping the Traumatized Child and Helping Your Husband with Adult ADD. Dr. Sachs has appeared on NBC Nightly News, CBS and other major media outlets, discussing his unique holistic approach to ADD/ADHD treatment.
Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.
Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without.
To book Gabe for your next event or learn more about him, please visit gabehoward.com.
Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.
Gabe Howard: Calling into our show today, we have Dr. George Sachs. Dr. Sachs is a licensed psychologist specializing in the treatment of ADD and ADHD and autism spectrum disorders. Dr. Sachs has appeared on NBC Nightly News, CBS and other major media outlets, and we are very happy to have him here with us. Dr. Sachs, welcome to the show.
George Sachs, PsyD: Thank you. It’s a pleasure to be here.
Gabe Howard: Now I am willing to wager that everyone listening has heard of ADD and ADHD. It’s discussed everywhere, but let’s make sure that we all have the same understanding of this diagnosis. Can you define ADD and ADHD for us, Dr. Sachs.
George Sachs, PsyD: I can. Yes, I think there’s a lot of misinformation and myths about ADHD and ADD. The first is that technically and diagnostically, there’s only one term and that’s ADHD. The word ADD is a kind of colloquial term now used by many doctors, but the technical term is ADHD. You can have inattentive type or you can have hyperactive impulsive type, or you can have the combined type, which most people have. Now, the problem is the H is hyperactive and a lot of adults say, well, I’m not hyperactive so I don’t have ADHD. I have this thing called ADD. This word hyperactive really didn’t fit. But you’ll notice in the diagnostic name it’s hyperactive, impulsive type. There are many adults who are impulsive, impulsive shopping, impulsive eating, impulsive speaking. And so when we remove the word H, we kind of remove the word impulsive. And it just it doesn’t serve because then a lot of the adult symptoms of impulsivity are kind of overlooked. What ADHD really is, is a neurodevelopmental problem or challenge, as we can say, because I think the word disorder pathologizes people to a degree that may not be needed or necessary or helpful, but certainly a challenge. And it usually manifests very early in children as young as three, but often around third grade when school becomes a little bit more difficult. And instead of learning to read, you have to have mastered reading. And you’re now you’re reading to learn, which means that the work and the pace increases. And that’s where you see a lot of the symptoms around third grade.
George Sachs, PsyD: But for adults, myself included, I have ADHD and have had it my whole life. And there are different kinds and presentations of ADHD, the kind of spacey space cadet kid who’s staring out the window, but not really a problem for the teacher because they’re quiet. And that was, that was me. The other presentation is kind of the hyperactive child who is always running, moving. Then this kind of behavior manifests more as a problem of executive functioning, especially towards high school and college. And what is executive functioning? Executive functioning is the real problem with ADHD in adults, and that is basically in a nutshell getting things done. Executive functioning is a host of skills and behaviors. For example, managing time, organizing yourself, self-control, emotional regulation, getting started on tasks, not procrastinating. This all is part of executive functioning, which really starts to be needed in middle school and high school. That’s why parents start getting worried because they have to do a lot of the scaffolding that they don’t see other parents doing for their child regarding homework and getting things done and planning and organizing papers. And then in college, it increases even more because you don’t have somebody telling you to wake up in the morning and get to school and everything is on your own.
George Sachs, PsyD: Which is why I actually see a lot of adults with ADHD first show signs in college because their parents acted as a kind of frontal cortex and scaffolded them through high school to a degree that the symptoms were kind of hidden. But in college there’s a lot of executive functioning needed, and then even more so when you get into the real world, a lot of people like Dr. Russell Barclay, who was a scientist who studied ADHD, really wanted to change the name from ADHD to EFDD, which is Executive Functioning Deficit Disorder, because he thought that was really a better descriptor of the problem for adults. And I think it is actually. He also was really clear in defining ADHD as a problem less of attention and focus and more of motivation. And that’s why he also thought motivation deficit disorder would be a better name. And that’s really what a lot of my clients as adults struggle with. It’s like just getting started on tasks is really difficult. That’s why I coach parents that really help your child find their passion, because if they’re motivated, a lot of the symptoms won’t be so present. But if they go through like a kind of a typical liberal arts education, which is not unlike high school, which can be very boring, then they’re going to really struggle. But if they study something that they’re really passionate about, you’re going to see an improvement in their functioning and higher grades and more success.
Gabe Howard: One of the things that keeps coming up over and over again is, well, we’re just drugging our children. We’re just giving them pills. Any child that displays any creativity, the teacher doesn’t like it, and we’re just throwing medication at them. And of course, the whole thing culminates in this is just fake anyways to sell pharmaceuticals.
George Sachs, PsyD: Well, one, yes, pharmaceutical industry is one of the largest in the United States. It has an incredible lobby in Washington. So you’re going to see a lot of what the pharmaceutical industry wants pushed through and enacted. So the laws are going to be friendlier for the pharmaceutical companies and in some cases, there is an over prescription of ADHD medication. But saying all that as a psychologist or psychiatrist, when you meet a family, they want help. They’re not saying, oh, I just want to try these meds because I want my kids to get better grades. I’ve never met a family like that. It’s always, we need help because the teacher is complaining about the child or the child is struggling to make friends and different things like that. That’s why they come to me. Now, my job is to determine what’s happening here and why the child is struggling. And then we go through an evaluation process to see if this child if there’s any trauma, trauma looks like ADHD. So we have to rule that out. And if there’s no significant trauma and the child comes from a supportive family, but the teachers are complaining and the teachers are saying you should get your child tested or evaluated, and we’ve evaluated the child and found that they do have ADHD.
George Sachs, PsyD: Then I say to the parents, Look, nobody wants to put their child on medication, but your child is getting feedback from those in their environment, the teacher and possibly other students that could really damage them. So the teacher is calling your child’s name a lot. Sit down, Johnny. Be quiet, Johnny. Don’t make noise, Johnny. And the teacher is clearly annoyed. And therefore, other students don’t want to play with Johnny or invite Johnny to the birthday parties. And teachers are overwhelmed. Yes, but they’re also good reporters of problems because a teacher has 30 students or 28 students in New York and they’ve been teaching for ten years. They know what students have ADHD in their class. So they’re very good at actually determining the symptoms of ADHD and whether your child might. So when a teacher says to a parent, I think your child needs to be evaluated, I would take it very seriously.
The problem with ADHD is not so much getting a C or a D, which everyone can live with. The problem is, if this is not treated, you have years and years of shame and feeling rejected by teachers and peers. What I tell parents is it’s not to get the A’s or the B’s even. It’s to prevent shame and major depression down the road when they’re an adult because the teachers don’t like them and the students won’t play with them. If the child’s medicated, then symptoms of ADHD dissipate and the teacher engages with them in a healthier and a kinder way, and the other students want to play with them. So that’s my philosophy on the medicine. But we also have to really evaluate well, and at least in my office, we do the very comprehensive evaluation to rule out other things so that the over prescription of ADHD meds doesn’t get out of control.
Gabe Howard: Let’s talk about the hyperactivity portion. How can a reasonable parent, teacher, caregiver or just a member of society tell the difference between a spirited child? You know, you can be all of those things loud, creative, talkative and not be hyperactive. How can they suss out the difference?
George Sachs, PsyD: Well, I do think teachers know the difference. And with any diagnosis of ADHD, the final criteria is always this causes significant impairment in their life. So whether you’re an adult, a teen or a child, you can’t just have the symptoms of being inattentive and distracted and difficulty getting things done. It actually has to affect your life. Otherwise everybody would be diagnosed. And I think it’s the same with a child. Yeah, there’s certainly a lot of spirited kids that a teacher works with, but I think that those children are easily redirected and they can settle down. They may get rambunctious, but they can settle down and don’t require as much attention from the teacher. When the teacher is constantly going to Johnny’s desk every 10 minutes, then it actually becomes a problem for both Johnny and the teacher. To me, it’s a question of degrees. How much redirection, how much attention is required by the teacher?
Gabe Howard: How does ADHD differ between children, teens and 40-year-olds? Is it different? Is it all the same? What’s the spectrum as far as aging is concerned?
George Sachs, PsyD: Well, there is some research that says that 30% of kids outgrow ADHD. To me, I mean, I don’t know if you outgrow it or not, but I think if you find the right career that actually engages you and excites you at least some of the time or most of the time, I do think a lot of the symptoms will disappear. And that’s why finding your passion is so important, as opposed to just going to law school, because I don’t know what else to do. I mean, I’ve seen a lot of clients like that, but I would say there are some symptoms that stay the same throughout your life, and that would be kind of a distractibility. So whether you’re in school and high school and you’re easily distracted by other things, noises, sounds, looking out the window, your phone that persists and you get into relationships as an adult and then your partner is annoyed because you’re not paying attention to them. So distractibility and inattention, I think continues through the life span. And I think impulsivity, too, in some degree. If a child is impulsive, it’s going to show up as an adult, as I said, with impulsive behaviors, impulsive spending, shopping, but also in communication, interrupting people, talking over people and things like that. Also people with, some people, some kids with ADHD have social skill problems in reading the room and understanding kind of the hidden curriculum of a culture or a social situation. And I think that can persist too, because a lot of behaviors that really are similar, they just may look a little bit different because you’re not a child anymore.
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Gabe Howard: And we’re back discussing ADHD with Dr. George Sachs. Now at the top of the show, you mentioned that you live with ADHD. Can you talk about your own experiences because well, you’re a doctor. And for most parents across the United States, if their children grow up to be doctors, they think they’re doing just fine.
George Sachs, PsyD: So I grew up in the eighties and at that time it was very rare to be diagnosed with ADHD and it wasn’t on everybody’s radar. But I was a strong C student, you know, I just could not basically pay attention to boring things. And much of school, unfortunately, the way we educate our children is boring and was boring. But I also had a lot of other things. Like I started a business in high school selling boxer shorts with your name on it. Back then, boxer shorts were for some reason popular to wear to school. Fortunately, I had parents that really like just let me be. And I think it’s so important for parents out there, just let your child be and discover their talents. So I had a younger brother and older sister that were just straight-A students because they, it came easily and they liked to study. But I was not that I had all these other interests, sports and passions and businesses, and they let me really just do it and express myself. And then I would get validated for those things and not for the C’s. Those were kind of just overlooked, which was, I think, very helpful to me. I mean, if they had harped on my C’s and said, you got to do better, I think I would have felt a lot of shame because honestly, I don’t think I could have done better. I coach parents to focus on the child’s strengths, and that’s what my parents did. And then I was a terrible student in college where, as I said, there was no scaffolding and I was just having a lot of fun.
George Sachs, PsyD: I really enjoyed myself, but barely got through it. And I did major in psychology because I had an interest in that. Also, I had heard there weren’t any papers, so this was the way my mind worked. Like, how can I avoid all the strenuous kind of heavy lifting? Unfortunately, my grades really were terrible. That affected my ability to get into grad school later. But I would have to say after college I traveled, which was a great experience. I lived overseas in Asia for three years teaching English, but when I came back it was my twenties and I really struggled to get a foothold on life, so to speak, because I had a lot of impulsivity. I was let go from some jobs and others, which is what I see a lot of young adults with ADHD struggle with. And then around 28, 29, that’s when I thought about grad school. And I didn’t, of course, because I had ADHD, I didn’t go through the normal process of studying for the GRE because I knew I wouldn’t have done well on that. I did terrible on the SAT. So basically, I found the only grad school, the only APA accredited grad school that didn’t take the GRE. And I got myself in there and I told myself, This is kind of it, George. If this doesn’t work, I don’t know what’s going to happen. I’m going to be even further behind.
George Sachs, PsyD: So there was some fear. Fear is a good motivator and I was actually starting to become interested in the work and therefore the motivation increased. And then I did better in school and a lot of grad school is applied work, you’re out in clinics and things like that, which I enjoyed. I moved back to New York City and I started a private practice and all the talents that my parents had fostered or allowed when I was a kid were needed there. Private practice is still a business and I saw other therapists suffer because they didn’t have that kind of hustle, ADHD mentality of marketing and promoting. And I think it’s kind of an ADHD trait. As I said, I didn’t get diagnosed till I was 30 when I was in grad school, working with children, giving parents the tests. And then I started reading them and saying, Oh my God, this was me. I went to a doctor and got officially diagnosed and then that began the opportunity. So in my thirties I started this journey of personal growth, which I’m still doing today. I mean, I’ve been in a men’s kind of support group for going on 20 years now where we meet every week. And that group was the first one I came late to a meeting, which happens when you have ADHD, but I would always be like, Hey, this is 5 minutes, relax. But the guy there was not relaxed. He’s like, I’m here, you’re not here. And he got pissed at me and it was really kind of eye opening for me about how my ADHD affected other people, and I started really examining my life.
George Sachs, PsyD: And then that led to other seminars and retreats and books and all sorts of things that just really helped me understand myself better. And I put in a lot of hard work. Over 20 years to learn how to be a better version of myself.
Gabe Howard: You being able to share your experience, you know, getting through college and finding ways that work. I know it will help people. And on a personal note, I have to say, when you were like, well, all I got was C’s. I was like, there are a whole bunch of parents that just breathed like a huge sigh of relief, like, all right, all he got were C’s and he still did okay.
George Sachs, PsyD: Yeah, that’s I deal with those parents all the time and I wish I could just tell them, like, this is not an issue. In fact, I think there’s a correlation between C’s and success in life.
Gabe Howard: There may well be.
George Sachs, PsyD: There’s that old joke from law school. The students that got A’s became judges, and the students that got B’s became professors. And the students that got C’s became rich.
Gabe Howard: I was also a C student, and there’s just a ton of research. It’s like, look, we’re looking at IQ all wrong, you know, people’s ability to pass a test, regurgitate information, write great papers. That’s obviously important. Nobody’s denying that. But IQ has gotten so much over the past couple of decades. It’s like, look, if you can get straight A’s, but you can’t leave your house. If you can get straight A’s, but you can’t talk to people if you can’t express an opinion, or of course, you’re constantly making bad decisions which are making your personal life a wreck, you’re probably not going to succeed well in your professional life. And that’s so true. I know many, many, many happy people who definitely did not do well in school. And I know many people who did well in school that are just miserable.
George Sachs, PsyD: Well, I think you’re absolutely right. And the key is to have parents that support you either way.
Gabe Howard: I think that’s an extremely valuable statement and an important one. Obviously, by seeking out resources, help or just knowledge about their children’s struggles is definitely that support, right?
George Sachs, PsyD: Yeah. Well, it’s just to avoid the shame of mental illness or ADHD, just the shame of not succeeding. That’s what I mean. That can turn into lifelong problems. But if a parent supports the other aspects of your personality, then you can. I never really cared to be because my parents never made it an issue. I never cared to be an A student. I never really saw the value in it, but I saw the value in having a lawn mowing business or other things that I was working on, you know, and my parents were okay with that.
Gabe Howard: Now you have developed an app for folks with ADHD called Inflow, and it’s been getting a lot of attention. Can you walk us through that?
George Sachs, PsyD: I was contacted by two entrepreneurs. They wanted to build an app for ADHD to provide CBT, cognitive behavioral therapy like experience to people all over the world. And I had finally got to the point where I could be of service to a company like them because of the knowledge I had and also the executive functioning skills. And so for the last year and a half, I have worked with this company. It’s called Inflow and we built this amazing app for adults with ADHD. It has all of the teachings and learnings and features that I believe will help people with ADHD. And we have we have a huge community of people that are growing every day. And the feedback has been amazing about helping people and not feeling alone. I don’t know. I just feel like all the opportunity of finding out I have ADHD led to so much personal growth. And then now I’m giving it back not only in my private practice, but across the world in the form of this mobile app.
Gabe Howard: And just so our listeners know, where can they find Inflow? What’s the website?
George Sachs, PsyD: It’s a mobile app. So you go to the Apple App Store or the Google Play Store and you just type in Inflow, ADHD, or that’s the keyword. Or you can go to our website, which is GetInflow.io, GetInflow.io.
Gabe Howard: Dr. Sachs, thank you so much for being here. We really appreciate it.
George Sachs, PsyD: Yeah. It was my pleasure. I really enjoyed the opportunity.
Gabe Howard: And to all of our listeners, a great big thank you. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations.” I’m also an award-winning public speaker who is available for your next event. My book is on Amazon because what isn’t? Or you can grab a signed copy with free show swag or learn more about me just by heading over to gabehoward.com. Wherever you downloaded this podcast, please follow or subscribe to the show. It’s absolutely free and recommend the show to your friends. Whether you do it with social media, email or good old word of mouth, I would consider it a personal favor. I will see everybody next Thursday here on Inside Mental Health.
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