ADHD, sleep apnea, and symptoms beyond the DSM (Roberto’s story)

Dr. Roberto Olivardia is a clinical psychologist and ADHD expert who was diagnosed with ADHD as an adult. As he learned about ADHD in his career, the signs felt familiar: impulsivity, trouble with focus, and more. He procrastinated constantly in college and was mischievous as a kid. He was even kicked out of Sunday school.

Once he got his sleep apnea under control, his ADHD difficulties became even clearer — and it wasn’t just what you’d typically find in the DSM. (That’s the handbook health care professionals use when diagnosing things like ADHD.)

Roberto is the host of Season 2 of Understood Explains, where he unpacks the ins and outs of adult ADHD diagnosis. He also has two kids with ADHD. Listen to this episode of ADHD Aha! to learn about ADHD and trouble sleeping, plus ADHD time zones (the “now” and the “not now”).

Related resources

• Driven to Distraction, by Edward M. Hallowell, MD, and John J. Ratey, MD

• How ADHD affects sleep — and what you can do to help

• Is it ADHD or a sleep disorder?

• Understood Explains Season 2: ADHD diagnosis in adults

Episode transcript

Roberto: So, my "aha" moment was realizing, "Oh, this is beyond attention. This is beyond school." That this is how I eat food and how I spend money and how I sleep and how I plan activities and all of these other things that just made so much sense. And the "aha" moment was recognizing how ADHD really was connected to so many things.

Laura: From the Understood Podcast Network, this is "ADHD Aha!," a podcast where people share the moment when it finally clicked that they or someone they know has ADHD. My name is Laura Key. I'm the editorial director here at Understood. And as someone who's had my own ADHD "aha" moment, I'll be your host.

Laura: I'm here today with Dr. Roberto Olivardia. He is a clinical psychologist in Massachusetts. He's also an Understood Expert and the host of Season 2 of the "Understood Explains" podcast, which covers everything you need to know about ADHD diagnosis in adults. Super relevant to the show. This show is all about ADHD "aha" moments, as you know, Roberto, and a lot of folks who are listening to the show may be wondering, "Should I get diagnosed for ADHD?" So, we'll talk more about Season 2 of "Understood Explains" as we get further into the interview. But welcome. Thanks for being here.

Roberto: Oh, it's my pleasure, Laura. Always a pleasure to be talking about things ADHD.

Laura: Well, let's get started. You were diagnosed with ADHD as an adult, right? That makes you an apt host for Season 2 of "Understood Explains." So, why don't you start by telling our listeners when you were diagnosed with ADHD?

Roberto: So, I was officially diagnosed at 35. However, when I realized myself that, "Oh, this is it, like I have ADHD," was probably 30, 31, you know, and I tell people to keep in mind, I'm 50. And so, when I was young, the kids that were diagnosed with ADHD were kids with pretty serious conduct disorders, probably a lot of undiagnosed learning disabilities, kids who might have had poor social skills, very hyperactive, impulsive.

And even though I was hyperactive, I wasn't hyperactive in an antisocial way or an oppositional way. I was very mischievous, don't get me wrong, but within that sort of boundary, and I did well in school, even though I hated school. So, I wasn't identified back then.

So, there was nothing throughout my life that ever had me see an affiliation with what we knew at that time about ADHD. Even in graduate school in my late 20s, when we learned about it, which frankly wasn't a lot, and that's not an indictment on my particular program. I ask a lot of my colleagues this: "How much did you learn about ADHD in your clinical psychology PhD program?" And most people say "very, very little."

So, it wasn't until I had patients when I started my private practice, who I was treating for other issues like eating disorders and OCD and bipolar disorder, and they also happened to have ADHD. And suddenly I'm like, "Oh, let me learn more about ADHD," and I would read about it. And then it was one of those things that I'm reading about it, and it was like slowly, like, "Oh, I understand that. Oh, that makes sense to me. I relate to that." And it wasn't so much this like fireworks epiphany like it can be for some people, and certainly a lot of patients who are diagnosed with ADHD. It was this very just familiar sense of, "Oh, this is me. Oh, yeah, this makes sense." It was actually something that was very validating, and I felt very good about.

Laura: Which signs or stories were you relating to the most, like which angle of ADHD? Which flavor?

Roberto: Yeah, I think at first it was I specifically remember I had a patient who had sleep apnea. And he was struggling with depression. He had an eating disorder and he also had sleep apnea and he had ADHD. And I was reading about sleep apnea, and I thought, "Oh, like I have had a lifetime of sleep issues." I mean, I was a sleepwalker, sleep talker, sleep paralysis. I do have very severe sleep apnea, night terrors, you name it. So, when I would read about sleep apnea and then when I would read about this connection with ADHD and sleep, and I thought, "Oh my gosh, this makes so much sense." So, that I remember was like the first angle was from that perspective.

And then when I was reading from the executive function issues around procrastination, and a lot of times I think in the past, I would think, "Oh, people..." and this is honestly how I think culturally people still solely see ADHD, is the person that procrastinates and doesn't get it done. And certainly, that does affect a lot of people with ADHD. But for the most part, at least with school, I was the one that always got it done. I would be up all night. I would literally, I mean, in college running across campus to get the paper in my professor's mailbox by 5 p.m., I mean, was that, but I would get it done.

And so, when I started reading that, like, "Oh, wait a minute, people with ADHD, they can procrastinate and pull it off," that was me. And then when I started sort of reading this more broad sense of impulsivity, it's like, OK, well, maybe I haven't had an issue with this, this, or that, but I always identified myself and knew intuitively I have a very addictive personality — that anything I like I can like too much very quickly. And, in some level, and I had friends growing up in people who had issues with that and I related to it.

I didn't see myself as that different from those individuals — or even the individuals who might have had conduct disorders and issues. I hung out with a lot of those kids. I have a very mischievous side to me that when I was younger, kind of liked being a little bad. A little dangerous.

Laura: I'm going to ask you all about that, don't you worry.

Roberto: So, when I read all of that, I thought, Oh, but honestly, so much. I don't think a lot of that was written about ADHD in the '80s, in the mid '90s. I mean, when we think about Ned Hallowell's book, "Driven to Distraction" was written in, I think '94, '95, and that's when adult ADHD was even talked about, which is kind of nuts. Which is like "Where do people think this went? Like at 18 it just vanished?"

Laura: Right. Suddenly your executive functioning issues, they won't be a problem in college.

Roberto: Or life, right?

Laura: Yeah, exactly. So, OK, that's, so I was taking some notes. So, number one, ADHD and sleep, which some folks may recognize Roberto's voice because we actually published a bonus episode from "In It" where you were talking about ADHD and sleep in the "ADHD Aha!" feed, which was great. But I want to ask you a little bit more about that. The next thing you mentioned was procrastination, but still getting it done. So, like latching onto that urgency, it sounds like. Do you mind if we go back a little bit to ADHD and sleep?

Roberto: Sure. Absolutely.

Laura: It was a quick explanation of the connection between ADHD and sleep. I encourage folks to go back to our feed to listen to the full explanation, but I'm more curious about how they interact, but also how that played out in your life.

Roberto: Yeah, so there is a lot of research being done on ADHD and sleep, and I think honestly, we only know the tip of the iceberg. We know that there are centers in the brain that are, particularly in our frontal lobe, that are activated or implicated with sleep. One of the best quotes I ever heard, and I don't, I wish I could credit it because I don't know who said it, but it was actually the first ADHD conference I went to in 2008, which I speak at every year. And they said, "For someone with ADHD, going to sleep is lying in a dark room waiting for nothing to happen." And that was, and it totally made sense because I thought it's so unstimulating and it's kind of boring. Like you're just waiting to, "OK, when is happening? Like, when am I going to...?"

And then of course, your mind is thinking about it, you know, too much. And it's so easy when there's no stimulation for an ADHD person to generate stimulation because we're so, we need that. Like our brain, we have this dopamine deficit. So, we're always seeking stimulation. And with sleep, you're kind of, the job is de-stimulate, which is really hard.

And then there are these psychological components to it as well. I mean, the nighttime was also less distractions, no one's expecting anything of me in the nighttime. When I was in college and grad school, there was nothing to distract me, so I was in a better zone to work. And sometimes the nighttime was just the level of procrastination I would get through in the day. It was OK now it's a do-or-die situation kind of thing.

So, there's something about that. But it's not even just work. Sometimes it could just be, "I don't want to let go of the day until I've had my fun or my downtime." Now I'm very, very productive throughout the day, but years ago it could be that I literally did nothing all day. I was just kind of wasting the day procrastinating and then yet still had the sense of, "Oh, I want to make the most out of the day."

Laura: I mean, this can't be it.

Roberto: Yeah, this can't be it. Exactly. So, there's a lot of that. But it's also what we have to deal with, people with ADHD, particularly if you're more of the hyperactive, impulsive type, which I am, to just calm the body down, to be mindful, to even sleep cues, because people with ADHD were more externally oriented, which means like if there's fun to be had, well, I'm not tired.

Laura: And sleep apnea. Can you define that for our listeners and how it affects you?

Roberto: Yeah. So, this is something which was a game-changer. So, when I was even a kid, I was this very short, skinny kid and my brother and I shared a room. And I remember when I was 9, he said to my mother, he's like, "I don't know what" — my nickname is Beto in my family — "Beto, he sounds like a drill. Like, I don't know how this sound is coming out of this small body, but it is so loud. His snoring."

And throughout my life, I could never relate to someone who said "I had a restful sleep." Like I woke up and I felt restful. I never felt that way. And sure enough, the same patient I had mentioned earlier who had sleep apnea, I started reading about sleep apnea and I thought, "Hmm, hmm, I don't relate to some of these things, but these other parts I really relate to. Why not get a sleep study?"

Well, I got a sleep study. And so, what sleep apnea is, is basically you're either having moments where you're not breathing at all, or your oxygen levels are very, very low. And now it can be due to anatomical features, deviated septum in the nose, and large tonsils, or just the way that your throat passageway is as to how much air, neck size. So, all of these different factors.

And so, I got the sleep study and I was told that you need an average of 20 events where you're not breathing or desaturated oxygen levels in a three-hour period of time to be diagnosed. So, I got the sleep study. They told me would take about five weeks to analyze all the data. They'd get back to me. And I said, "OK, well, I'm free any Friday because I don't work on Fridays." I got a call a week later, they said, "Oh, the sleep doctor has an opening." And I thought, "What? I thought it was going to take five weeks." They said, "Oh, no, she had an opening." Well, what they didn't tell me over the phone was they needed me in there ASAP because I had 98 events in an hour.

Laura: Oh my God, wow.

Roberto: 98. She said, "Roberto, let me tell you, I've been doing this for 30 years. The highest I had ever seen was someone at 68 events. And he was double your age, triple your weight. He smoked two packs of cigarettes a day. Like this is really serious." So, thankfully, I'm a pretty healthy guy overall. Because I was over 30 when I got the sleep study, and untreated sleep apnea at some point starts to cause cardiac damage to your heart because your heart is working so hard to basically — it's almost like equivalent to someone putting a pillow over your face for a second or two, taking it away, putting a pillow over your face, taking it away.

So, she says you have to have a CPAP for the rest of your life. And this is the part I hope the audience can really hear because I can't even tell you what an amazing thing this equipment is. I didn't like that I had to use this. But now I call him Pappy, and me and Pappy are good buddies because for the first time when I — the first night I used that CPAP, I woke up and I thought, "Oh my gosh, I feel rested."

Laura: So, you finally felt that experience of restful sleep around the time when you were starting to wonder if you, or to spot that you had ADHD, it sounds like.

Roberto: Right.

Laura: I have a question, I wonder, and this has come up with a number of my guests, when they learn to cope with one thing in their life, that's when they really start to notice the ADHD symptoms, right? Because they get something out of the way.

Roberto: Mm hmm.

Laura: Because I imagine that not having restful sleep probably was exasperating your trouble with focus or trouble with attention and hyperimpulsivity managing your executive functions. So, was it that you were still struggling with those things, but you were, you could see it more clearly?

Roberto: What I did notice was, like I think about in high school, if I was, it could take me, I don't know, two minutes. If I'm bored, I'd fall asleep. I'd either be the class clown or I was drooling down my face, literally. Now, it's funny. I still can fall asleep if I'm bored. Actually, tonight, I'm meeting with my accountant for tax time. And I love my accountant, she's wonderful. But the last time we met...

Laura: Oh no.

Roberto: ...I was literally arm's length away from her, and she's talking about numbers in the spreadsheet, and I'm just nodding off. But I notice it takes me longer for that to happen. That definitely improved. But it did make it clearer of looking at this idea of attention. And then honestly, the parts of it that didn't change at all, as far as my ADHD, you know, with the sleep issue being remedied.

Laura: Right. That's what I mean. It seems like, I know you didn't cite this as your "aha" moment, but you were diving deeper, and you were treating patients and noticing things in yourself. But it seems like this, like that, getting the sleep issues more under control was this moment of clarity and this potential "aha" moment.

Roberto: Oh, absolutely. Oh my God.

Laura: That's really interesting. And it's so common in people with ADHD. I wonder if that will resonate with any of our listeners.

Roberto: I think another part too, that so to me is so beyond the diagnostic criteria, is what I call the sensibility of people of an ADHD experience. And that's the part that there are those "aha" kind of moments. Like, so with sleep, this idea of what we now is termed interoceptive awareness, which is the awareness of what's happening in our bodies, understanding how ADHD really can impact that.

And I remember at 10 years old, I was at Chuck E. Cheese. My friend had a birthday party at Chuck E. Cheese, I love, I love food in general, but I really love pizza. And we ate a ton of pizza, and then we're bouncing and doing arcades and all that, and then my friend's mom said, "Oh, guys, eat some of this pizza. I don't want to waste it," because there was a lot left over and one of the kids at the party said," Oh, no, I'm full." And then I said, "Oh, you didn't like the pizza?" And he said, "No, I like the pizza. I'm just full." I said, "Oh, you just didn't like this pizza." And he said, "No, I, I like that pizza. I'm just I'm not hungry." I said, "Oh, you didn't like the topping of it?"

I seriously did not understand how you like the pizza, it's in front of you, and you're not eating it? Like what? Like, how does that even... and realizing those kinds of moments, because to someone with ADHD, we like it, it's just there. Of course, I'm going to take it. I'm not going to tune in to my body, like I couldn't really tune in to even assess, "Am I hungry? Do I need that? Am I...?" It's like, "No, me like pizza. I eat pizza," just like when in college, a similar thing when someone was at a party that we were at and they said, "Oh, I'm going to go home." And I said, "Oh, you're tired?" And they're like, "No, I just know I have to go to bed because I have to wake up early." And I thought, "That's so weird." I don't know if I would have ever done that.

Like, that means you have to get the signal that you're tired and that directs your behavior versus, "Oh, there's no more fun to be had. So, now I'm tired." And it's those things that were the "aha" moments for me, the stuff that's beyond the DSM that you would see in the DSM, a statistical manual of psychiatric disorders. It's those kinds of things. I'm like, "Oh," and similar with the procrastination, like the why. Like, why is this such an issue? Oh, you're saying for a lot of people with ADHD, we joke that there are two time zones, the "now" and the "not now" zone.

Laura: I had never heard that before. That's great.

Roberto: Oh yeah. We have a good sense of humor in the ADHD community. And that idea that if something is due a week from now — that's in the "not now" zone, I'm not looking at it. I'm not even thinking about it. And then as the "not now" becomes the "now," then boom, either one of two things happen: people either completely shut down — it's almost like a power fuse blown — or, in my case, it would be like someone just ignited adrenaline in me. And then I would, that's all I could think about and I would get it done. But I couldn't understand "Why can't I feel this way two days before it's due?" Because I never liked it.

Friends of mine would come and say, "Oh, that's so awesome. You can write a 20-page paper overnight. I wish I could do that." I'm thinking, "No, like this isn't something I feel great about. I am so tired at the end." And then it would take me days to recover, of which I'm then missing other stuff. And it like it's just this catch up and then I get sick. But I, I couldn't understand it because I would say "This is the last time I'm going to wait till the last minute." And then it wouldn't be, it would just happen over and over.

Those are the "aha" moments when I had that scientific understanding of ADHD that I can't even tell you how validating it still is when I read research that still comes out today, that's like, "Oh, yes, yes." It's just, it's an evolution of those moments.

Laura: What you were just talking about actually helped me better understand one of our former guests. Her name is Ange, and she talked about one thing that tipped her off to her ADHD, she saw this infographic of potential signs of ADHD, and one of them was forgetting to go to the bathroom. And even I was like, "How do you forget to go to the bathroom?" But the way that you just described it, it makes a lot of sense.

Roberto: I can completely relate to Ange, because I've had those moments where I am — and it's funny because we know ADHD is genetic. And so, when I was a kid, my mom would routinely say "Beto, like, go to the bathroom." And I'm like, "I don't have to go to the bathroom." And meanwhile, she would tell me my legs were like, twisted in a pretzel. Like, it was so obvious that I'm holding something. And she's like, "Go," but I was so into whatever I was into. And right, the FOMO and just the stimulation that whatever that situation would be.

Fast-forward years later, I have a son who's now going to be 18, he has ADHD. And when he was a kid, legs in a pretzel and I'm like, "Buddy, like, why don't we just quickly go to the bathroom?" He's like, "No, I don't have to go to the bathroom." Like, yeah, "Why don't we go to the bath...," and then we would go and then he'd go and he'd go, "Oh my God," and he would feel so much relief after going. He didn't realize it. And I'm thinking, "I get it." And we would have conversations about that, you know, and certainly, as he got older to understand how that is. Because to someone else, it's like, "What is... that's so silly. How do you forget? How do you not know that?" But those are the things that I love sharing because that's what can meet somebody to be like. "Oh, that I relate to."

Laura: I want to hear more about little Beto, the mischievous kid. I want to hear more about the mischievous and what were some of the other words you used to describe yourself? How did your parents perceive you? What was happening at school? Tell me about yourself as a kid.

Roberto: In general, I love humor and my rule was anything is good for a laugh, as long as you're not hurting anybody's feelings. Like as long as you're not hurting anyone or hurting their feelings for a laugh. So I, my brother will tell you, I lacked the embarrassment gene when I was growing up. He wished I had a little bit more. I'm the youngest of three kids, so my brother is six and a half years older and my sister is five years older. You know, I joke because my siblings will say I had different parents than they did because my parents were tired by that time, and they were older.

Laura: Same with mine.

Roberto: And I was definitely the one that gave them the biggest run. And I remember the first time I heard the word "shenanigans" when I was in third grade. I loved that word. It just sounds like what it is. I mean, it's just shenanigans. And I remember thinking, "That's like a cute way of saying, like, I like a little badness," You know, like, I don't know. There's just something about not conforming to how everything's supposed to be. That's just, I don't know, I can't, I still can't explain it, but it's so appealing to me.

Like when I was a high school student, when I discovered, like, punk rock was like, "Oh, my God, this noise. And this is so discordant and offensive and loud. I love it." But I was also, yeah, like my friends and I would just do things that were kind of dangerous. I mean, I remember this hill in the town I grew up in. It was this really, really steep hill and it was a one-way street, but strangely was one way going up as opposed to the cars going down. And the only thing that separated this hill from the highway in Boston was this rickety fence, which is crazy. I mean, now they have a more sturdy fence. And we used to sled down this hill. And someone would go be at the bottom of the hill and they'd yell "Car!" if a car was coming up. And we'd just steer away and bang into this rickety fence that I'm not — literally, easily the fence could have given way and we would have ended up on the highway. And we thought, "Oh, this is like fun." Like it was just stimulating.

Laura: Yeah, seeking out that stimulation, right?

Roberto: That danger. Oh, yeah. Practical jokes, you know, and things like that. And then there were the kind of things that I really, like I got kicked out of Sunday school because I questioned sort of things that were sort of told, like, you have to think this way. I mean, my brother, who's a very good Catholic, he never broke a rule in his life. And we're very close. I mean, we're very different people, though. This priest, after he kicked me out, he sat my brother out and he said, "I just want to let you know, your brother contributes to the death of the Catholic Church." And when my brother told me that, I was 13, 14, I said, "Did he say that?" And he said, "Yeah," I'm like, "That is awesome." I'm like, "I want that on a T-shirt. Can he actually write that on a T-shirt?"

Laura: Oh, my Gosh.

Roberto: Like, even, you know, when I was old enough to go to those kind of punk shows where you're thrown around and everything, that was all like, fun and stimulating. Like one of my motto's was like, "Well, whatever happens, it'll be a story. Whatever happens, it'll be sort of part of our life story." And so, I had very little of that risk aversity.

Laura: Risk aversion. Yeah. Well, it sounds like everything you're saying is very tied up in impulsivity and the seeking out of stimulation. I wonder, did you ever in school, if you were acting like the class clown, was it ever to cover up for any challenges that maybe you weren't aware of, but you could feel?

Roberto: Oh, yeah. I mean, to me it was just brutal. I mean, high school, especially 10th grade, was probably the worst. I just couldn't focus. It was so painful. I actually have all of my report cards, and it's so interesting looking back because it's there. I mean, Roberto can be super bright, but doesn't always live up to his potential. His biggest mistakes are in being careless and being impulsive. Roberto's handwriting is incredibly difficult to read because he writes so fast. I think I was a bit dysgraphic though as well on top of that. But definitely, I mean, in my writing, I almost don't have the patience to write neatly and just like, you know, let's just get it out. But then there'd be this inconsistency.

The thing that comes to mind, seventh grade, where you have a different teacher for different class, and my parents came home from a PTA meeting and I said, "How was it?" And they said, "Well, we feel like they're talking about five different kids. Like your math teacher said you're a bit of a wise guy, and you can't stop talking, like you're constantly talking. And even though she tells you to not talk, you just are a little bit combative," which I was. It wasn't like I was an angel either.

When I said I wasn't, I didn't have a conduct disorder it means, you know, on that level. But it doesn't mean I didn't butt heads, you know, with some teachers and was a bit of an instigator sometimes.

My history teacher wondered whether I had some medical issue because I was asleep all the time in that class. And then the bell would ring and I'd be like talking to my friends, like, full of energy. And he didn't understand that.

My English teacher said, if every student could be like Roberto, my day would be awesome. He is a star student, he participates — because she was not only incredibly engaging, but we're talking. It's like seminar style, it's not lecture. And she had the desks in a circle.

Laura: Oh, interesting.

Roberto: Is not like, what's so significant is as a kid, you walk in a room and the desks are in a circle. It means, "Oh, we're all interacting with each other here." And then I had another teacher who wondered whether I had some urinary issue because I had to go, quote-unquote, had to go to the bathroom all the time.

Laura: I've heard that a bunch of times on this show.

Roberto: I'd just be roaming. I mean, that was my way of just managing. I mean, I have two kids in high school — my son's a senior, my daughter's a sophomore — and I'm amazed if they say, "Oh, I had a good day in school." And they're both ADHD and dyslexic, and I'm like, "Really? Like what? Huh?" Like, I used to write dismissal notes and forge my mom's signature and just give myself like my own mental health days. And I'd go into Harvard Square, which was near Harvard University. But at this time in the '80s, it was like the punk mecca, like where all the punk kids would hang out. And all the kids that were skipping school would hang out with their mohawks and green hair and everything. And I'm like, "Those are my people." I did that a lot. I mean, and I admitted it to my parents years later, after I got my PhD, I admitted it to them.

Laura: You're like, "I turned out fine." Yeah.

Roberto: I turned out OK. And it's not that I recommend this for any high school students who might be listening to this. But honestly, it was a way to manage. Like if I knew I was going to give myself Wednesday, I remember it was a popular day, I would give myself one of those days just to manage, Monday and Tuesday were so much easier knowing, "OK, Wednesday I'm going to be off and I'm going to skip that day."

But, and this is where that responsibility piece came in. I would coordinate with friends of mine, getting the homework and everything. So, I would still play up like my end of the bargain. And I think that was the difference. Whereas some of the kids who I'd hang out with on those days, they weren't doing that, and then they were getting F's and they were failing. And they didn't care that they were failing.

For me, anything below a C was a no-no, but I was not a straight-A student. I was not a perfectionist. I really didn't care. I would be late, make up excuses. And it was really all to manage just the utter boredom that I would feel and the difficulty of just attending to these seven-hour days. And even now just thinking about it. I mean, I have a visceral, a visceral feeling to it.

Laura: You say you're surprised by your kids having, I think you said a good day. I imagine that that has something to do with your self-awareness and your profession. And you're like, they probably have learned how to cope and what they're struggling with. Obviously, way earlier than then you had the luxury of.

Roberto: Oh, yeah, yeah, definitely. I mean, I think well, one, I mean, what's great is that I think schools still have a ways to go, in my opinion, but there's definitely come a long way in terms of being more attuned to those — just even the needs that not everyone learns the same. Just even that, I mean, let alone, you know, ADHD and those things.

But from day one, there's just a family vocabulary around ADHD. And it's not that they don't have days that they're bored, but these are ways that you manage it.

Laura: I'm curious, Roberto, when you got diagnosed, who diagnoses the diagnostician? Who do you go see and what was that conversation like?

Roberto: It was a psychologist who specializes in ADHD, and it was interesting because I went, you know, I told him what I did, he, I think he was actually familiar with me in the community. And I said, "This is something I've done a lot of reading, but I just feel it's important to just have it official." Like, I honestly could have diagnosed myself from my own standpoint, but I said, "I just want to make it official so that for, you know, my kids, for my family, for my patients, like if I'm going to talk about this, I don't want to say, 'Oh, yeah, I just diagnosed myself.'" And it was pretty evident.

Laura: How has getting diagnosed with ADHD officially or even just recognizing symptoms in yourself changed how you interact with patients, if at all?

Roberto: I would say the main thing is, with patients with ADHD, is just sharing my story with them. Because first and foremost, and this is my whole life really, I'm a very empathic person, I was always a very emotionally sensitive kid, which that also can go along with the ADHD, the sort of emotional sensitivity. And it physically pains me when someone feels "less than" in any way.

And so, trying to share with people that they're not less than, that they are different, but different doesn't mean bad and less than. And to validate it is harder sometimes. Absolutely. I would say that's probably the biggest part in terms of how that's kind of played, because my style, I would say, has been fairly consistent ever since I started doing therapy and practicing.

And even in my training, I did find interestingly, when I started in my clinical training, I remember we would audiotape our sessions and then my supervisor would hear the audiotape sessions, give feedback. I had two wonderful supervisors and they both said identical things. They said, "It's clear that you are communicating your empathy really well. You have a knowledge of the theory and the skills. But there are two things: You don't allow for enough silences in the room when you ask a question. And if there's a silence, you kind of fill it." And both of them said "It's clear that you're almost trying to rescue the person, but you don't have to rescue them. Sometimes people just need time to process. And you talk really fast and in a way that it's clear you're enthusiastic, but understanding that some people, especially if they're depressed, that energy could be very intense."

So, that's where I realize it's moments like that, that now if I understood ADHD at that point, I would have been like, "Oh, this is what it is." It's that "How do I ground myself mindfully?" It would have been helpful to have that as like a theoretical model to understand all these disparate things.

Laura: I love the quickness of how you speak. I've heard anecdotally only that a lot of people with ADHD, and I'm speaking now about the "Understood Explains"Season 2, they like to listen to fast-paced podcasts to get through them quickly. Now, that's not true of everybody. Some people like to slow it down and take their time with it, but that's going to be really exciting for people to listen to.

Roberto: I loved that whole process working with Understood and doing that. And even in that process, I'd have to do a couple of takes, because they would say, "OK, you need to slow it down a little bit." And it's that when I'm enthusiastic about something, it's like the speed just could like...

And so, they would give me that feedback. And I think that's the other piece. If somebody doesn't understand that and they're told that and they're like, What do you mean? And that they can get very either defensive about or whatnot as opposed to, "Oh yeah, yeah. No, I have ADHD. And that means that sometimes things are a little bit revved-up that way. I just need to, you know, take a deep breath, slow it down." So it's great. No, I'm excited for the public to hear that. I feel really good about that project.

Laura: Well, Dr. Roberto Olivardia, thank you so much for being here today. It's been a pleasure. It's been great getting to know you and more of a just person level in addition to all the great things I've learned from you as an Understood Expert. So, thank you.

Roberto: Oh, my pleasure. My pleasure.

Laura: You've been listening to "ADHD Aha!" from the Understood Podcast Network. If you want to share your own "aha" moment, email us at ADHDAha@understood.org. I'd love to hear from you.

If you want to learn more about the topics we covered today, check out the show notes for this episode. We include more resources as well as links to anything we mentioned in the episode.

Understood is a nonprofit organization dedicated to helping people who learn and think differently discover their potential and thrive. We have no affiliation with pharmaceutical companies. Learn more at understood.org/mission

"ADHD Aha!" is produced by Jessamine Molly. Say hi, Jessamine!

Jessamine: Hi, everyone.

Laura: Briana Berry is our production director. Our theme music was written by Justin D. Wright, who also mixes the show. For the Understood Podcast Network, Scott Cocchiere is our creative director, Seth Melnick is our executive producer, and I'm your host, Laura Key. Thanks so much for listening.