Kids' Wellness Matters Podcast Ep. 10: Understanding ADHD in Kids

Attention deficit hyperactivity disorder, or ADHD, is one of the most common neurodevelopmental disorders of childhood and may cause children to be overly active and have a tough time paying attention and controlling impulsive behaviors. But, there are effective treatments and ways to manage symptoms and help children with the disorder thrive. In this episode, Andrea Spencer, MD, a child and adolescent psychiatrist and physician scientist at Ann & Robert H. Lurie Children's Hospital of Chicago, offers helpful information and advice to help families navigate an ADHD diagnosis.

“One thing I really want to say to families is: please talk to your pediatrician if you have any concerns about your child. I can't tell you how many families I've talked to who didn't think to talk to their pediatrician about their concerns. [They] don't realize how much their pediatricians have to offer for a kid with hyperactivity or attention problems." 

- Andrea Spencer, MD

Show Notes

• Symptoms of ADHD include difficulty paying attention, hyperactivity, and/or impulsivity, especially if these issues affect multiple categories of day-to-day activities.
• ADHD is diagnosed clinically and often at a young age. Many families initially perceive symptoms as normal childhood behavior which can lead to hesitation in seeking a diagnosis.
• Boys have historically been diagnosed more often and earlier with ADHD because their symptoms may be more obvious. In older age groups, the prevalence amongst boys and girls is more even.
• Similarities of symptoms between autism and ADHD can lead to confusion in families regarding a potential diagnosis. Dr. Spencer describes that it is often the case that both disorders are present in the same child.
• ADHD has biological origins, but there are also environmental factors such as premature birth or environmental toxins that can increase risk. 
  Treatment for ADHD includes medication, behavioral therapy, and school accommodations. Dr. Spencer advocates that parents and families also seek self-care as they manage the wellness of a child with ADHD.
• Dr. Spencer’s six steps to support parents managing a child with ADHD are: normalization and hesitation; concern and stigma; readiness and advocacy; communication and navigation; validation and care; and preparation for the future.
• She has found through her research that Financial barriers, access to care, and school resources are some challenges that many socioeconomically disadvantaged and minority families face. But even more challenging for these families are fears of discrimination or stigma in seeking diagnosis and treatment.
• Dr. Spencer encourages parents to talk to their pediatricians about any concerns regarding their child's behavior, as pediatricians can offer valuable support and guidance beyond traditional medical issues.

Transcript 

[00:00:00] Nina Alfieri, MD: Welcome to Kids Wellness Matters. I'm Nina Alfieri, MD.

[00:00:07] Rob Sanchez, MD: And I'm Rob Sanchez, MD. We are both parents and pediatricians at the world renowned Ann and Robert H. Lurie Children's Hospital of Chicago.

[00:00:15] Nina Alfieri, MD: On this show, we'll chat with a wide range of experts about caring for children from newborn to young adult. Because Kids Wellness Matters.

[00:00:29] Rob Sanchez, MD: ADHD is one of the most common neurodevelopmental disorders of childhood and may cause children to be overly active and have a tough time paying attention and controlling impulsive behaviors. But there are effective treatments and ways to manage symptoms, and we will be exploring those today with Andrea Spencer, MD. Dr. Spencer is a child and adolescent psychiatrist and physician scientist here at Lurie Children's, who specializes in ADHD care. She is also vice chair for research in the Pritzker Department of Psychiatry and Behavioral Health and a member of Stanley Manne Children's Research Institute at Ann and Robert H. Lurie Children's Hospital of Chicago. Her research focuses on discovering and testing strategies to improve access to quality care and improving outcomes for all children with ADHD. Thank you so much for joining us.

[00:01:13] Andrea Spencer, MD: Thanks for having me.

[00:01:14] Rob Sanchez, MD: So to start off, I wanted to ask, what drew you to the field of psychiatry and behavioral health and what do you like about working in pediatrics? 

[00:01:21] Andrea Spencer, MD: Before I went to medical school, I actually moved to Chicago for a year, straight out of college to take a position with AmeriCorps at an adolescent health clinic and I was an adolescent health educator in that clinic working with pediatricians. I just loved it. And I worked with pediatric healthcare providers and I worked with mental health professionals and that's where I really learned about child psychiatry and fell in love with child psychiatry as a specialty. So when I went to medical school I already knew that I wanted to do a pediatric health specialty and probably child psychiatry. I went into medical school with that idea and I considered other things along the way, but never kind of wavered from that passion that I had developed working in Chicago. And then I was in Boston for 20 years where I went to medical school and was practicing and became a researcher there before my family and I moved back to Chicago last year.

[00:02:16] Rob Sanchez, MD: That's remarkable. I mean, AmeriCorps, I've had many friends who have done it. is such a huge, turning point in people's lives. It's a wonderful way to get service. Did you happen to express an interest in a type of placement or was part of that, already kind of fostered within you and then just kind of grew from there?

[00:02:30] Andrea Spencer, MD: I grew up with two physician scientists as parents, so I knew, you know, I was interested in medicine. I was interested in health. In college, I became interested in public health, and so that's how I became interested in AmeriCorps. I was trying to decide, do I want to go to medical school? Do I want to be a public health person, or do I want to blend these two things somehow? So learned that AmeriCorps had a specific subset of their positions that were called health corps positions, where you could have positions that were related to healthcare and often participating in direct service and had a couple of places to choose from. I picked Chicago because I was interested in that pediatric position. I was really interested in Chicago and also because it was a position at a bilingual health clinic called the Infant Welfare Society at the time and I really wanted a position where I could speak both English and Spanish as part of the AmeriCorps position. So that's how that came about.

[00:03:24] Rob Sanchez, MD: Let's talk about ADHD, which is Attention Deficit Hyperactivity Disorder. What is it? How is it diagnosed?

[00:03:31] Andrea Spencer, MD: ADHD, or Attention Deficit Hyperactivity Disorder, is a really common condition in pediatrics. As you noted, it's a neurodevelopmental condition. Parents typically start to notice symptoms in the preschool years, not always, but most of the time. And it includes difficulty paying attention, so things like focus problems, distractibility, difficulty completing things, difficulty getting things started, and hyperactivity, which includes things like fidgeting or running around and climbing when you're not supposed to be or constantly going like you have a motor inside you. And then impulsivity includes things like interrupting or difficulty waiting or not thinking before doing things. And all of those things can be part of ADHD. Different kids will have different groups of symptoms, so not every kid with ADHD has exactly the same symptoms. And that's one of the things that's really interesting about ADHD and making a diagnosis.

[00:04:27] Rob Sanchez, MD: Given that there are various types of symptoms that could go along with it, how do you find that it's commonly diagnosed in children and at what ages?

[00:04:34] Andrea Spencer, MD: ADHD is diagnosed clinically, so that means that it's diagnosed by a health professional who's trained to make a diagnosis of ADHD, which could be a pediatrician or a mental health professional or a neurologist. And that health professional will go through the symptoms of ADHD and those health professionals will be able to calibrate their understanding of what is developmentally appropriate based on the age of the child and that child's particular situation. And they will assess the symptoms, and a certain number of symptoms is what will lead to a diagnosis of ADHD. Families will often ask, well, is there a test for it? There is no test for ADHD. There's no lab test. There's no brain imaging that we can do to detect ADHD. There are researchers who are looking at the association of ADHD symptoms with certain brain changes, but we're not at a point where we can use those to diagnose. And really the best way to diagnose it is clinically. I often tell parents who are skeptical about this that this is actually how we diagnose most things in medicine. We diagnose asthma that way, We don't do a blood test for asthma. We don't do x-rays for asthma. The pediatrician will listen to the symptoms and listen to the lungs. And with all the information they collect from the family a diagnosis of asthma and it's a very similar way that we diagnose ADHD.

[00:05:57] Rob Sanchez, MD: One of the things that parents might be commonly curious about is if there's differences between boys and girls and ADHD symptoms or diagnosis. Can you speak to that a little bit?

[00:06:06] Andrea Spencer, MD: ADHD really used to be thought of as a diagnosis mostly for boys, and in fact, in the school age years, the epidemiology shows that about two thirds of kids with an ADHD diagnosis are boys and the other third are girls. Interestingly, when you look at ADHD across the lifespan, so you look at adults with ADHD, it's about 50/50 the epidemiology shows. The other thing to know about how ADHD manifests in girls versus boys that helps a little bit is that girls have fewer hyperactive impulsive symptoms and few of those disruptive behavior symptoms that often mean that they are more likely to be missed when they're younger because they're not as disruptive, right? And they're kind of quieter, not all girls, right, but overall, those are the girls that do tend to get missed. So we do think that we under-diagnose ADHD in girls and that there are many girls who will be diagnosed later because of that. What we see across the lifespan is that hyperactive impulsive symptoms do improve considerably more than inattentive symptoms. So, inattentive symptoms are the ones that tend to be pretty stable, whereas hyperactive impulsive symptoms do actually, thankfully, get quite a bit better for most people across the lifespan and as kids grow. So you see, I think more of those boys, kind of, improving over time, but those girls with inattentive symptoms, continuing to show impairment over time. For boys, too, those inattentive symptoms are really consistent across the lifespan.

[00:07:30] Rob Sanchez, MD: Another common thing, Dr. Spencer, that might come up is about the differences between ADHD and other diagnoses, such as autism. Can you speak to the differences there and what makes you more concerned for something like ADHD or something like autism in a family or in a child?

[00:07:44] Andrea Spencer, MD: Autism is another neurodevelopmental diagnosis that has increased quite considerably, actually a lot more than ADHD, over the past couple of decades, and people are much more aware of it. The symptoms are different, but there is some overlap. Autism is a neurodevelopmental condition that's related to how a kid interacts with others and about repetitive behaviors and difficulty with back and forth conversation. On the flip side, ADHD is really about difficulty paying attention and hyperactivity. But you can see how a kid who is hyper or inattentive might not make great eye contact and might have social difficulties. They often do. The other thing just to complicate things a little bit further is, that of kids with autism, there's a good percentage that actually have an ADHD diagnosis as well. It used to be that in previous iteration of our diagnostic manual that we use as mental health professionals, that we couldn't actually diagnose the comorbidity, but some of my colleagues had done a lot of work in this area to really show that you can see that you have both disorders present in a subset of kids and that you should think about treatment for both. It is important to recognize ADHD symptoms in kids with autism because there are actually medications that might be able to help ADHD, whereas we don't have any medicines to help the core symptoms of autism. To add just sort of another curveball there can be what we call traits of autism symptoms in the subset of kids with ADHD. But a subset of kids who actually don't meet criteria for autism. And so what I'll talk to parents about are these traits that kind of look a little bit like autism, but they're not the same as a diagnosis of autism and that could be, you know, difficulty with eye contact, difficulty with back and forth conversation, but not kind of enough symptoms to meet criteria for autism. And we think about that and consider that as part of the picture for an individual child but that child might not have a diagnosis of autism.

[00:09:38] Rob Sanchez, MD: Yeah, and, another common concern that might come up is, is ADHD, something that you're born with or is it something that develops over time? What do we know about that?

[00:09:46] Andrea Spencer, MD: We know that ADHD has very biological origins, which means that a lot of the risk for ADHD comes from genetics. If a parent has ADHD, then a child is much more likely to have it. Often, we don't know exactly why a particular child develops ADHD versus another child who doesn't. But there are things that will increase the risk. For example, kids who are born early or kids who are born small for their gestational age, those kids have a higher risk for ADHD. Certain environmental toxins will lead to higher risk for ADHD. So we do know that there are some environmental influences, but it is true that ADHD is one of the most heritable conditions that we have in psychiatry.

[00:10:29] Rob Sanchez, MD: One of the things that comes up is that oftentimes folks feel like, oh, we're seeing this more than in previous generations. I wanted to focus on that a little bit more when we talked about the diagnosis. So have the parameters for diagnosis of ADHD expanded over the years, or are there just more kids with ADHD now than previous generations? How do we understand that?

[00:10:48] Andrea Spencer, MD: Certainly the diagnostic criteria have changed. I think the most obvious reason for the increase in ADHD diagnosis is that we're recognizing it more. What often happens is that when pediatricians and families and psychiatrists are more aware of a diagnosis, then we will make the diagnosis because we're looking for it. And often we start looking for a diagnosis when we know there are better and better treatments. That is one of the things that's happened over the past several decades, is that we really have more and more and more evidence, and really excellent evidence, for ADHD treatments. And so, we're making the diagnosis so that families can have access to those treatments that we know work. I will say that over the past decade or so, ADHD diagnosis rates have started to stabilize at a place where we would expect based on the epidemiologic data, suggesting that for the most part, people are doing a better job at identifying kids with ADHD overall. The other thing I'll say is we've recognized really over the past two decades is that ADHD is really a lifespan condition. And I think in the past, people understood ADHD as a childhood issue that kids would eventually grow out of, so that even though there were treatments recognized, there were lots of families who thought, well, if I could just get my kid through childhood, then they'll be fine because they'll grow out of it. And I'd rather not give them a medicine and just sort of get them through. But we've realized over time that most kids with ADHD actually become adults with ADHD. And that treatments actually work across the lifespan. So that's also fueled, I think, that desire to really recognize it early so that kids and families are prepared for the future and able to access those treatments throughout the lifespan.

[00:12:30] Rob Sanchez, MD: It's so important to what you mentioned about the lifespan and recognizing this so that you can connect them to treatment. For parents who are listening to this, when should parents consider investigating an ADHD diagnosis? Are there certain telltale signs that they might be looking for in their children, especially at certain ages or periods of time in school?

[00:12:47] Andrea Spencer, MD: Parents should think about ADHD at any time they think that difficulty paying attention or hyperactivity or impulsivity is really causing problems for their child in multiple settings. Difficulty sitting still, or impulsivity, not thinking before doing things is causing a problem at school, and if it's causing a problem at home, and if it means that they can't do things with their child that they would otherwise like to do, that they have been able to do with other kids, or they see other families be able to do. Those are the kinds of things that should lead a parent to consider ADHD and bring it up with their pediatrician. Parents can bring that up as early as age 4 or even as early as age 3. Pediatricians may not make a diagnosis at age 3, but the symptoms often start at that time and they can still refer for treatments, for therapies that may actually help in the long term. Parents can also think about it, with a kid as old as in their teenage years. There are rarely some kids who are diagnosed actually as teenagers and some people that are diagnosed as adults because the symptoms didn't cause enough problems when they were younger or maybe they were hesitant or the parents were hesitant and didn't think it was serious enough. But that over time, the difficulty became greater so that seeking treatment actually makes sense.

[00:14:05] Rob Sanchez, MD: Yeah, absolutely. And so I wanted to transition to talk about treatment. What is the gold standard today in the treatment of ADHD? 

[00:14:12] Andrea Spencer, MD: There are typically three things that people will talk about as the gold standard. And I'll add a fourth that often people don't talk about but I think is really, really important. So the first one is medication. Medication for ADHD is really safe and really effective, and there are many options. Families of kids with ADHD will often be offered medicine and should consider it seriously for their child because we know that medicine for ADHD can really improve functioning, reduce symptoms and reduce difficulties across the lifespan. The second is therapy. When kids are younger, that's often behavior therapy. If there are behavioral problems which are really commonly associated with ADHD, particularly hyperactive impulsive type or combined type ADHD, meaning the kid has symptoms of both attention problems and hyperactive impulsive So behavior therapy doesn't really help with those core symptoms of ADHD, but will help with the behavior difficulties. Behavior therapy is not like there's a therapist sitting in the room with a child and working with a child, but actually the therapist works mostly with the parents to teach them ways to help with their child's behavior at home and work with the teacher to help develop a behavior plan at school to really help the child be more successful in both settings. The other kind of therapy that can be helpful for ADHD is for other associated difficulties. So, for example, a lot of kids with ADHD have anxiety or they might have some depression symptoms and we call them comorbidities. Those additional symptoms again, are really common and may respond to therapy specifically for those symptoms. The third kind of treatment that is helpful for ADHD are school accommodations. This has been hard actually to study. So, if you look at the medical literature, it's a bit mixed on whether school accommodations are helpful for kids with ADHD. And one of the reasons for that is because kids with ADHD have all kinds of different associated learning challenges. It's common for kids with ADHD to have another learning disability or just difficulty learning in one subject or one kind of subject. This may look very different depending on the child, but it's really important to help the child succeed in school. School accommodations or services may not take away the symptoms of ADHD, but it's to help the child overcome some of the learning challenges that they have and work through those in the school setting that are made more difficult by ADHD. Now I want to add the fourth treatment that I think is really important that most people don't talk about. And I think that's it's not really a treatment, but I think parents really focusing on their own self care is really critical. Parents are so focused on their kid, they worry about their child, they worry about how successful their child's going to be, but having a kid with ADHD is really hard and sometimes it can feel like, well, why is this so much easier for other people than me? I think it's really important for parents to figure out how to take those moments for themselves. What are the ways that they can support their own mental health and their own physical health to be the best they can be for their child and to have that foundation for their child of health for the family. It's also hard on siblings. So I think making sure that really the whole family is a focus in terms of wellness and self-care, and not just that kid who has ADHD symptoms and who is struggling.

[00:17:35] Rob Sanchez, MD: No, that's also important, as you referred to, these can sometimes be difficult discussions to have with parents, to have with families. How do you approach things such as medication, behavior therapy, these interventions that are helpful? How do you approach those topics with families when it comes to ADHD?

[00:17:50] Andrea Spencer, MD: The first thing that I do is understand what is of most concern to the parent and where they are in terms of their journey. I remind my colleagues and health professionals who I teach about ADHD that families will come to them at very different places in their own journey. Some families have another kid with ADHD. They've been down this road before. This time they want to catch it early. Other families are really struggling with the possibility that their kid might have a diagnosis and worried about that. And other families are reluctant to talk about it at all because they worry about being blamed or they're feeling guilty about it and they're really not feeling enthusiastic about talking with somebody about something that feels actually very private. So families start in very different positions with this conversation and go through their own journey, and we have our diagnosis and treatment model but we need to kind of match where we are with where they are as we offer treatments. As I said, this is a lifelong thing. It's a journey over time that we go on together. The other thing, Rob, that I'll say is that I used to be really, you know, years ago, I used to be really worried about telling families that this is a lifelong diagnosis and your kid may be on medication for a long time because that's a scary thing for families to hear. .But I realized through some of my research that that's not actually helpful. I learned this from families who had a lot of questions, thinking about what the future holds for their kid and wanting to prepare them for the future. So, I now focus a lot more on talking about that really early, about the fact that typically this is a lifelong diagnosis, but that doesn't have to mean that your child can't achieve all the things that they want to achieve and that the most important thing is to recognize it and learn ways to manage it. And as part of that, families will want to know how to talk to their kid about ADHD and what to say to their child and that's another thing that I think we can help families with over time.

[00:19:51] Rob Sanchez, MD: All of those things that you mentioned are so crucial to the work that we do in pediatrics, I wanted to jump a little bit to some of the work that you've done. You've published a paper in the Journal of Pediatrics about the six stages of engagement with Attention Deficit Hyperactivity Disorder and how to support this healthy treatment and continuous care. Can you tell us more about what you learned and how these six steps can support parents?

[00:20:12] Andrea Spencer, MD: So that study that you're talking about, we published in Pediatrics, We interviewed 41 parents of kids with ADHD who had kids anywhere from age 4 to age 17. So wide range of ages. And really, diverse group of families because we wanted perspectives from families of all different races, ethnicities, languages. We interviewed families in three different languages. And we learned a lot of things from families to come up with that six stages framework that encompassed everything families were telling us. Our goal was to understand what are the barriers to getting treatment for ADHD and how do we help families overcome those barriers. What I learned is really kind of what I was hinting at before, which is that, lot of the barriers are actually created by us as healthcare professionals and in the way our systems are set up and how we think about things that's different than how families think about things. Of course, there are concrete things like financial barriers and access to treatment that we can also help. I'm really thinking about how we can help pediatricians and psychiatrists and any health professional who takes care of kids with ADHD and their families to think about things through those six stages of engagement. They go from normalization and hesitation, which is where a family is thinking like, this is probably normal, this is probably not anything. And pediatricians are often wondering that, right? Oh, maybe this is just normal. Maybe they'll grow out of it, to the second stage, which is, families thinking, like, I don't want my kid to have a diagnosis, what is this going to mean, what are other people going to think, and again, sometimes pediatricians or healthcare professionals of any kind thinking the same way, like, I don't want to worry them.All the way through the next few stages of being ready and advocating for care. One thing that was critical about that stage three, which was that advocacy stage is how parents describe feeling so alone like that they were really in charge of deciding to move forward and going forward, that they weren't feeling kind of pushed to do that, which in some way is good, but in another way, they felt like they just didn't have the support around them to go forward and get the treatment that their child needs, to stage four, communicating with healthcare professionals, navigating this really complex interplay of these, as I told you, these four kinds of treatment that their kid needs. That's a lot for families. To the fifth stage of really needing that ongoing relationship and the care and validation that they're doing right by their child. To the sixth stage, which is preparation for the future and transition and thinking about all these things, how do I talk to my kid about ADHD and how do I prepare them for the future. And that was a really eye opening study for me and really has changed both my clinical practice as well as my research direction.

[00:22:53] Rob Sanchez, MD: I wanted to ask a little bit more specifically about some of the barriers that you mentioned. Navigating that, all those stages is difficult for many families. But can you speak more into some of the barriers to engagement especially among those that may be socioeconomically disadvantaged, racial and ethnic minority families, those who speak languages other than English. Can you speak to some of those that you found that may be critical?

[00:23:12] Andrea Spencer, MD: I would put them in kind of two major categories. One is related to insurance, finances, accessing care in their neighborhood and having well resourced schools that will have the money to provide the services that a kid needs. Being able to pay for tutoring, those kinds of things. More kinds of concrete barriers are really about accessing services, and it's particularly critical that we, as healthcare professionals, advocate for more services for kids who are underinsured and whose parents don't have the money to pay privately for additional services, because we know those things help. And we also know that kids with ADHD in certain school settings will have more difficulty than kids in other school settings. So, just as an example, one thing that can be really helpful for kids with ADHD is a smaller class size because it minimizes distractions in the classroom. But schools that have really large class sizes are going to have a really hard time with those kids with ADHD. And then they just get in trouble all the time, and they're in the principal's office, and penalized for those symptoms. So I think there's really, I think of it as like a snowball of difficulty that's set off by the resource issues. Then there are kind of more, what I call soft barriers. And these are things that you can't really see as well, like really having a provider who you trust.A lot of concerns that families have around being discriminated against or stigmatized. Families talked probably the most, actually, about those things in our study and I remember one parent in particular who said, it was so hard to get up the courage to come and actually talk about what was going on with my child to the pediatrician because I worried, what are they going to think. Are they going to call the Department of Child and Family Services? Are they going to think I'm not doing a good job? And then when I finally got up the courage to come say something because things were just really not going well, I felt dismissed as if it wasn't a big deal or it didn't matter. Those themes were really all very common, actually are quite significant for especially families who are racial and ethnic minoritized families in the United States.

[00:25:18] Rob Sanchez, MD: And those particular soft barriers, as you call them, they can be interpersonal. They can be relatively hidden, not as discussed. And so your work that's shedding light on that is so important in terms of raising that awareness and providing that care to these families. You mentioned, maybe towards one of the later stages and you talked about a common question that you see your parents are wondering in preparation, how to talk with their kids about ADHD. What are some of the advice or some of the guidance that you give to families? 

[00:25:45] Andrea Spencer, MD: So I will say that there's not that much hard research evidence of what works and what doesn't work. But I can say that we are working on that in my research program. But from my clinical experience, I can tell you what I do and what we think might work. The first thing I tell parents is think about what words am I comfortable using with my child? Do I want to use ADHD? Do I want to use the wiggles? What is the word I want to start out with? What might I need to learn as a parent that will help me have the conversation with my child? The next thing I tell parents to do is really listen to your child and ask them about what they're experiencing and what they know, because often kids will know more than we think they do or they will have perceived things differently than we realize.That's really important to listen to the child. Often if parents are not sure what words to use, the kids might give them a sense of what words they're comfortable with. Next I tell parents to really, really normalize this. You know, diagnoses are actually normal. Everybody has diagnoses. If parents feel comfortable, they can talk about their own diagnoses. They can talk about their own medicine that they take. We make diagnoses not because we want to say there's something wrong with somebody, but because by making a diagnosis, we actually have a whole bunch of things that we know will help. And then to really emphasize a child's strengths and what's positive. Sometimes I will talk with kids about famous people with ADHD to really show them, this is normal. Everybody has a diagnosis. Some people have ADHD, some people have other things,but you can do anything you want, it doesn't mean that you are not smart or you can't do anything. And I think that self esteem part is really critical. And then just lastly, I'll say that there's been a lot of focus on how do we help teenagers transition to adulthood with ADHD. And I've become convinced that that transition happens way back in the school age years. That it really happens with starting that conversation, as one parent put it to us, Like, I want my kid to hear this from me and I want to be able to emphasize the positives to them. I have become convinced it's really critical to start that conversation early so that by the time they're teenagers, it's not a new conversation. 

[00:27:52] Rob Sanchez, MD: I'm so curious, which celebrities resonate the most?

[00:27:55] Andrea Spencer, MD: Oh, like Simone Biles or Michael Phelps, are are two examples

[00:27:59] Rob Sanchez, MD: Wonderful athlete Olympians. Yeah, exactly. As we transitioned out, I wanted to ask, are there any other kind of closing tips for families that you might want to share, about managing a child with ADHD?

[00:28:10] Andrea Spencer, MD: One thing I really want to say to families is please talk to your pediatrician if you have any concerns about your child. I can't tell you how many families I've talked to who didn't think to talk to their pediatrician about their concerns. Sometimes it's that families are worried about talking about it, but sometimes it's that they don't think of it, right? They think, oh, but my pediatrician is for ear infections and vaccines, right? And don't realize how much their pediatricians have to offer for a kid with hyperactivity or attention problems. So, I really want to make sure your listeners know that their pediatricians can help them navigate these things.

[00:28:46] Rob Sanchez, MD: thank you so much, Dr. Spencer, for talking with us today.

[00:28:49] Andrea Spencer, MD: Thank you for having me.

[00:28:50] Rob Sanchez, MD: Thanks for listening to Kids Wellness Matters. 

[00:28:55] Nina Alfieri, MD: For more information on this episode and all things kids wellness, please visit LurieChildrens.org