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Speaker 1: Today this is the Happy Families podcast, and tomorrow it

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Speaker 1: is one of the most important days on.

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Speaker 2: The calendar.

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Speaker 1: For people who love traditions like running around neighborhoods looking

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Speaker 1: like Goblin's guls which is skeletons and those europumpkin and

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Speaker 1: knocking on the doors of strangers and asking for treats.

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Speaker 1: Today it's a doctor's Desk episode with a difference. Recent

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Speaker 1: research indicates that one of the most popular, one of

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Speaker 1: the most common childhood diagnoses is related to Halloween. We're

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Speaker 1: going to explore that, what it means, what the implications

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Speaker 1: are for us as parents, and for this specific diagnosis

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Speaker 1: not to mention Halloween right after the break.

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Speaker 2: Stay with us.

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Speaker 1: Real parenting solutions every day in Australia's most downloaded parenting podcast.

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Speaker 1: That's just one the Happy Family's podcast where Justin and

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Speaker 1: Kylie calls some parents of six kids.

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Speaker 2: I'm the co host and parenting expert.

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Speaker 3: Show Parental seriously slowed down, what do you mean you're

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Speaker 3: like and energizer Bunny.

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Speaker 1: It's a doctor's desk episode. I get very excited about

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Speaker 1: doctor's desk.

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Speaker 3: That's one of us.

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Speaker 1: Yeah, I can see the enthusiasm oozing just oozing out

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Speaker 1: of your pause. You know it's going to be oozing

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Speaker 1: out of everyone's paws tomorrow. Sugar, sugar, Yeah, Halloween tomorrow.

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Speaker 1: Our opinion this year, like we've gone gung ho a

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Speaker 1: couple of times with Halloween, our opinion this year is

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Speaker 1: not couldn't be bothered too much, sugar, too tired, too

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Speaker 1: much else going on too hot?

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Speaker 2: Can you come up with another to something just just

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Speaker 2: not happening?

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Speaker 3: I came up with the best Halloween decoration. Oh yeah,

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Speaker 3: our new pool has colored lights. I'm just going to

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Speaker 3: make the pool.

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Speaker 2: Red blood red.

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Speaker 3: Done.

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Speaker 2: That's gross, It's done, all right.

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Speaker 1: Today's Doctor's Desk, Kylie, you set it up because I'm

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Speaker 1: going to do a lot of talking in this one.

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Speaker 1: This is probably that's why you don't like the doctor's Desk?

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Speaker 1: Isn't it because I do all the talking. I get

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Speaker 1: science y? Is it the science or is it the

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Speaker 1: fact that you're not talking as much as you want to?

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Speaker 2: Look?

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Speaker 3: I don't. I don't keep very quiet about the fact

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Speaker 3: that I don't really enjoy many of the doctor's desks.

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Speaker 3: But I am actually intrigued about this one.

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Speaker 2: This one's a cracker.

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Speaker 3: So there's been some research done recently that would suggest

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Speaker 3: that ADHD diagnoses actually increase during Halloween.

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Speaker 2: Correct. Okay, so this is a brand new study.

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Speaker 1: It came out a couple of months ago, and it

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Speaker 1: caught my attention because over the years, ADHD, even though

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Speaker 1: more and more people are aware of it, more and

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Speaker 1: more people are being diagnosed with it. ADHD has become

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Speaker 1: an increasingly provocative diagnosis. I mean, most diseases, as we

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Speaker 1: learn more about them, they become easier for us to understand.

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Speaker 1: But ADHD seems to be going the other way. And

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Speaker 1: in a recent working paper that was published in the

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Speaker 1: National Bureau of Economic Research, and the paper is called

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Speaker 1: Halloween ADHD and Subjectivity in Medical Diagnosis, some Harvard research

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Speaker 1: has spotted an opportunity for a wonderful natural experiment that

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Speaker 1: the calendar provides with the Halloween holiday and kids getting

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Speaker 1: a little bit hyper because of all the sugar and

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Speaker 1: the social opportunity and the running around the neighborhood and

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Speaker 1: doing what they're doing. So, though, were really curious where

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Speaker 1: the changes in young patients' behavior related to the excitement

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Speaker 1: of wearing a costume and collecting lawies on Halloween might

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Speaker 1: influence the diagnosis of ADHD. Now analyze the data on

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Speaker 1: more than one hundred million pediatric visits. Okay, so this

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Speaker 1: is no small sample. This is legitimately a serious study.

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Speaker 1: And what they found is this, there's a fourteen percent

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Speaker 1: increase in childhood ADHD diagnoses on Halloween compared to the

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Speaker 1: ten surrounding weekdays. I'll say that again, a fourteen percent

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Speaker 1: increase on Halloween compared with the ten surrounding weekdays.

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Speaker 3: So when you're talking about a hundred.

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Speaker 1: Million pediatric visits, yep.

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Speaker 3: Fourteen percent is a big deal.

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Speaker 2: That's a large number. That's huge.

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Speaker 1: Yes, Yes, for that particular diagnosis on that particular day

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Speaker 1: compared to all the other days around it. There must

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Speaker 1: be something particularly unique about October thirty first that makes

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Speaker 1: for ADHD diagnoses more likely.

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Speaker 3: As you're talking, it reminds me of a conversation I

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Speaker 3: just recently had with your mum. She actually was going

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Speaker 3: through some old journal entries and she shared the funniest one.

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Speaker 3: She's acknowledged that she's been on a bit of a

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Speaker 3: rampage and she was really unkind to everybody. And then

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Speaker 3: she kind of paused and she said, I wonder if

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Speaker 3: it had anything to do with the fourteen Ferrera rishiance

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Speaker 3: that I hate that day, so I don't think this

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Speaker 3: is just a kid thing.

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Speaker 2: Yeah, that's such a good story. I was hearing where

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Speaker 2: you're going there. I do remember that story. I ate

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Speaker 2: fourteen Ferrero risches and.

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Speaker 1: Then I was horrible to everybody. For us today made

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Speaker 1: me feel good, but it made everyone else really really annoying.

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Speaker 3: But the funniest part was she says, I'm never going

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Speaker 3: to eat chocolate again. Right, Your mom is the biggest

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Speaker 3: chocoholic I know.

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Speaker 1: I think that I've heard her say that over the

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Speaker 1: years since I've known her at least four hundred times,

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Speaker 1: at least probably four thousand times.

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Speaker 3: And you tell her that you're giving up chocolate and

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Speaker 3: she just keeps skipping.

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Speaker 1: She yeah, that's right because when she gives up chocolate

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Speaker 1: as meaningless. So if anyone else is giving it up,

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Speaker 1: they mustn't be giving it up either. All right, let's

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Speaker 1: talk about this study. Does that spark any questions for you?

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Speaker 1: Is there anything that you'd like to know?

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Speaker 3: Well, I guess let's go back to the beginning. How

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Speaker 3: is ADHD actually diagnosed?

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Speaker 1: So this is really important because in medicine, the first

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Speaker 1: step is you've got to get the diagnosis accurate.

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Speaker 2: And yet there's a whole lot.

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Speaker 1: Of conditions including attention deficit hyperactive. I can't say now

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Speaker 1: ADHD attention deficit hyperactive hyperactivity disorder that requires pediatricians and

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Speaker 1: GPS and mental health professionals to rely on much more

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Speaker 1: subjective criteria like the observation of symptoms and behaviors. See,

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Speaker 1: you can do a blood test and work out whether

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Speaker 1: somebody is diabetic. You can do an X ray and

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Speaker 1: work out whether somebody's broken their arm, but you cannot

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Speaker 1: scan a person's brain or take a blood test and

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Speaker 1: discover whether they have ADHD. We do not have objective

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Speaker 1: measures for it, and this is one of the major

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Speaker 1: criticisms of ADHD. So to diagnose ADHD, which is getting

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Speaker 1: to the core of the question you asked, there is

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Speaker 1: a formalism that goes into the diagnosis, but ultimately it's

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Speaker 1: a snapshot of somebody's subjective opinion. So pediatricians, shod mental

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Speaker 1: health specialists, whoever it is. What they do is they

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Speaker 1: assess a pattern of behavior across school life and life

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Speaker 1: at home, maybe other context as well, if they're relevant.

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Speaker 1: They get information from parents, from teachers, and then they

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Speaker 1: pretty much what's going on here. But the actual diagnosis

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Speaker 1: will happen on a specific day, So when the doctor's

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Speaker 1: making that diagnosis, the conditions that are occurring on that

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Speaker 1: specific day could influence whether or not. Let's say that

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Speaker 1: mental health specialist is on the fence, but on that

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Speaker 1: particular day, it's Halloween and the kids are a bit

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Speaker 1: hyper and there's a whole lot of sugar and junk

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Speaker 1: and costumes and excitement, and they're like, yeah, your child

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Speaker 1: does seem pretty edgy today. And they're not thinking hm,

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Speaker 1: because it's Halloween. They're just going, your child seems edgy.

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Speaker 1: And we're talking about ADHD. So ADHD is diagnosed subjectively.

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Speaker 1: There are no objective measures for it. The criteria are

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Speaker 1: loose and are becoming looser. They have become looser over

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Speaker 1: the last couple of decades, and that is problematic. I'm

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Speaker 1: not gonna lie about it, like that is a really

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Speaker 1: big problem for ADHD diagnosis.

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Speaker 3: Can you elaborate a bit more on the subjectivity of

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Speaker 3: this diagnosis.

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Speaker 1: Yeah, So we've been through this with our own kids,

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Speaker 1: so you.

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Speaker 3: See, Well, I'm thinking back to that experience, and I'm

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Speaker 3: thinking back to the day I walked in. I mean,

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Speaker 3: I was convinced that we had a very different child

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Speaker 3: to the rest of our children. But that particular day,

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Speaker 3: it was like she pulled out every conceivable behavior challenge

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Speaker 3: that we'd had and displayed it for the psychologists. Literally,

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Speaker 3: I had never seen her that bad before, but she

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Speaker 3: had displayed all of those things individually at different times.

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Speaker 2: Yeah, that's right.

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Speaker 3: It wasn't Halloween eitherm No.

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Speaker 1: Well, who knows it could have been, but it wouldn't

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Speaker 1: have been a big deal for us anyway, because we

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Speaker 1: don't really do much about it.

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Speaker 2: So the diagnosis, the.

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Speaker 1: Diagnostic criteria for ADHD is literally subjectivity is baked in.

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Speaker 1: It's part of how you assess ADHD. You cannot assess

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Speaker 1: ADHD without the subjective responses. So, and I remember you

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Speaker 1: saying this as we went through the checklist for our children.

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Speaker 1: There's a question like, is this child fidgety?

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Speaker 2: They restless?

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Speaker 1: Do they move their bodies a lot? Do they talk

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Speaker 1: when they should be talking? They interrupt and.

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Speaker 3: They are all childlike behaviors.

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Speaker 1: Well, every child does, that's right, And so to adults,

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Speaker 1: what do you mean. I would never interrupt anybody, my goodness,

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Speaker 1: And so obviously, when you're talking about parents, they don't

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Speaker 1: necessarily know how everyone else's kids are. Teachers will have

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Speaker 1: a much broader population to sample from and say, oh

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Speaker 1: my goodness.

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Speaker 3: But I guess that's why part of that testing process

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Speaker 3: involves other professionals to kind of collaborate.

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Speaker 1: Well supposedly, but they're going to be guided by what

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Speaker 1: the parents are saying and by what the teachers are saying.

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Speaker 1: So that's only so helpful. But that's how the subjectivity

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Speaker 1: comes into play. This is the Doctor's Desk episode of

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Speaker 1: Heavy Families podcast. We're talking about ADHD and Halloween and

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Speaker 1: whether or not the diagnosis that you get are actual

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Speaker 1: diagnosis or whether there's too much subjectivity involved. More on

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Speaker 1: this in just a sex Stay with us. We're back

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Speaker 1: with the Happy Families podcast, Real Parenting Solutions every day

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Speaker 1: on Australia's most downloaded parenting podcast. You have another question

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Speaker 1: on the tip of your ton.

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Speaker 3: Well, from what you've shared previously, it would suggest to

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Speaker 3: me that you think that often there's misdiagnosis happen and

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Speaker 3: if that's the case, what is problematic with that?

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Speaker 1: So this is really really difficult because this whole conversation,

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Speaker 1: I know that we're going to get emails from people

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Speaker 1: who say that I'm invalidating their diagnoses or that I'm

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Speaker 1: giving short shrifts to ADHD. I mean, I've got a

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Speaker 1: course out there to help parents who are raising kids

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Speaker 1: who have a diagnosis. Right, So I recognize that if

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Speaker 1: you've got a constellation of behaviors that are challenging, then

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Speaker 1: you need help with them. And you can call it

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Speaker 1: ADHD or you can call it challenging behavior. It doesn't

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Speaker 1: really matter. What we've got to do is work out

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Speaker 1: how to help. And I'm concerned about treatment pathways. That's

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Speaker 1: the medical jargon, the technical term for when you get diagnosis.

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Speaker 1: Here are the steps that are supposed to be followed.

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Speaker 1: This is what most people will be focused on. So

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Speaker 1: let's say, in the context of this study, you take

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Speaker 1: your child in on the wrong day and the likelihood

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Speaker 1: of them getting a diagnosis is significantly higher. Let's say

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Speaker 1: you've got two or three kids that are being diagnosed.

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Speaker 1: Two might be diagnosed on in a given day, but

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Speaker 1: on Halloween that goes up to three because the subjective

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Speaker 1: cultural environment that's changing things. And the problem to answer

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Speaker 1: your question with misdiagnosis is that means that that's one

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Speaker 1: more child that's wearing a label. It means it's one

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Speaker 1: more child who is going to potentially end up with

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Speaker 1: a medication prescription, one more child that's going to end

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Speaker 1: up on speed, one more child who's going to now

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Speaker 1: feel like not only do they already feel different, but

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Speaker 1: now they've got a label confirming they're different. And I've

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Speaker 1: always been pretty clear on the podcast, I understand that

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Speaker 1: in some cases labels can be really, really helpful, but

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Speaker 1: I find all too often that labels are used to

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Speaker 1: explain away, rather than support change in behavior.

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Speaker 3: Recently, I had a conversation with a specialist in relation

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Speaker 3: to our daughter, and they definitely wanted to push me

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Speaker 3: down a specific line of treatment, and I just said

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Speaker 3: to her, I said, at this point in time, she's

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Speaker 3: completely unaware that she's different. And I said, I just

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Speaker 3: I'm going to bubble that for as long as I can,

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Speaker 3: because she doesn't think there's anything wrong with her.

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Speaker 1: So this goes to what I think is a much

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Speaker 1: deeper and broader discussion about ADHD. And it's also a

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Speaker 1: really hard one to talk about. And again, this is

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Speaker 1: the kind of thing that gets people really upset. I'm

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Speaker 1: not trying to be insensitive. This is a sensitive but.

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Speaker 3: The reality is there isn't anything wrong with her, thank you.

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Speaker 3: There isn't anything wrong with her, right she just doesn't

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Speaker 3: fit the mold of what we consider normal.

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Speaker 1: And there's so much variation in normal. That's exactly why

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Speaker 1: I'm reading this book. I'm almost finished Searching for Normal

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Speaker 1: by Sammy Timimi. I love this book. I also hate it,

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Speaker 1: but I love this book. This book is worth so

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Speaker 1: much in terms of the conversations and the provocations and

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Speaker 1: the thoughtfulness that it gives. And what this study does

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Speaker 1: is it reaffirms a lot of what I've been reading

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Speaker 1: in this book and certainly some of my own misgivings

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Speaker 1: about this specific diagnosis over the last decade as I've

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Speaker 1: learned more and more and more about it and gone.

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Speaker 2: Deeper and deeper into it.

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Speaker 1: So about ten percent of Australian kids and now being diagnosed.

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Speaker 1: Boys are significantly more likely to be diagnosed than girls

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Speaker 1: because they mature later, they learn to regulate and inhibit later.

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Speaker 1: And there are really big questions being asked because there

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Speaker 1: is no blood test and there's no brain scan, there's

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Speaker 1: no objective criteria here. Some people are saying, well, is

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Speaker 1: it really a disorder, like these are questions that we

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Speaker 1: were asking twenty years ago, and now we've gone really

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Speaker 1: hardcore for the last twenty years down this Yes it is,

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Speaker 1: diagnose it that path, and now we're having really really

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Speaker 1: smart people, really incredible people, say we need to rethink this.

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Speaker 1: We may not have gotten this right. Is this within

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Speaker 1: some range of normal? To speak to your point, that's

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Speaker 1: what brought me back to where we are here. Medication

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Speaker 1: is the right answer. So this is a massive debate,

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Speaker 1: massive debate in educational circles, in psychological circles, in medical circles,

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Speaker 1: in psychiatric circles. It's a really big thing. People are

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Speaker 1: concerned about overdiagnosis. They're concerned about drugs, they're concerned about overtreatment,

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Speaker 1: they're concerned about harm, and they're also concerned about underdiagnosis

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Speaker 1: and undertreatment of kids in populations where help is often

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Speaker 1: not available. It's a really, really tricky thing to discuss

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Speaker 1: without upsetting people. But again, you look at what the diagnosis,

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Speaker 1: the diagnostic criteria are. You look at the fact that

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Speaker 1: you've got more kids than ever in the younger stage,

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Speaker 1: younger parts of the cohort getting the diagnosis, and you've

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Speaker 1: got to wonder if we're actually diagnosing ABA or immaturity.

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Speaker 3: More than that, though, when we look at the increase

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Speaker 3: of diagnoses over the last decade or so, would it

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Speaker 3: not be wise to actually question the environment our kids

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Speaker 3: are in.

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Speaker 2: You haven't read the book, but this is what sent

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Speaker 2: me to me.

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Speaker 1: Me says, He says, Let's stop saying that there's a

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Speaker 1: problem with this child individually, and let's start saying what

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Speaker 1: is going on in the environment that so many children

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Speaker 1: are now receiving a diagnosis that once upon a time

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Speaker 1: did not even exist.

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Speaker 3: That's exactly right. You take a child out of that

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Speaker 3: specific environment, and all of a sudden, their behavior changes.

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Speaker 2: I had this exact conversation with some parents the other day.

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Speaker 1: I made a glib and strong statement about ADHD, probably

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Speaker 1: much stronger than I really meant to. Someone got offended,

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Speaker 1: and then we had a much broader, in depth conversation

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Speaker 1: like this, And that's the point that I made. You

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Speaker 1: take that child out of the classroom or out of

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Speaker 1: a screen soap setting.

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Speaker 2: And put them into a play basis.

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Speaker 1: Or out of the dictatorship, right and give them some autonomy.

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Speaker 3: And all of a sudden, we see such a different

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Speaker 3: child presented.

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Speaker 2: That's right.

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Speaker 1: So this is an important study. I really think that

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Speaker 1: it's an important study because it's again raising questions and saying,

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Speaker 1: what are we doing here with this diagnosis?

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Speaker 3: So does it actually shed any light on ADHD itself?

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Speaker 1: I only and this is a very quick answer. It

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Speaker 1: just highlights how subjective the diagnosis is. To me, that's

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Speaker 1: the critical thing.

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Speaker 3: We've kind of touched on this a few times, but

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Speaker 3: just a little bit of clarity here. It is interesting

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Speaker 3: to me that with all the research we have on

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Speaker 3: ADHD these days, comparative to ten twenty years ago, why

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Speaker 3: is it that we still I feel like we've got

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Speaker 3: less clarity now with all the research we have than

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Speaker 3: we've ever had around ADHD.

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Speaker 1: So Annaple Jenna, who was one of the researchers here,

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Speaker 1: wrote a book a few years ago called Random Acts

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Speaker 1: of Medicine, and there's a finding reported in that book,

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Speaker 1: but also reported in Countless of a PAS that kids

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Speaker 1: who are born at the late part of the year

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Speaker 1: tend to be much more likely to be diagnosed with

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Speaker 1: ADHD than kids born at the start of the year. Okay,

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Speaker 1: so in Australia the school year, if you're born later

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Speaker 1: in the year. It depends on where the cutoffs are,

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Speaker 1: but basically, if you're the youngest kid in the year,

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Speaker 1: you're much more likely to be diagnosed with it. The

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Speaker 1: reason is that you're the youngest person in the class,

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Speaker 1: so your behavior is a bit different and we start

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Speaker 1: to make these diagnoses. So realistically, what I think here

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Speaker 1: is that the implication is that a lot of the

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Speaker 1: kids that are getting a diagnosis may not have ADHD.

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Speaker 1: They're just different because they've been alive for one year

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Speaker 1: less than the older kids in the class. And if

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Speaker 1: you're a general practitioner or if you're a psychologist and

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Speaker 1: you're making an ADHD diagnosis, you want to make sure

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Speaker 1: that you're taking into account birthday, and you want to

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Speaker 1: take into account gender, and you want to take into

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Speaker 1: account what else has been going on in that child's environment.

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Speaker 2: There is so much other stuff that.

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Speaker 3: Screen and how much outdoor time and how much connective

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Speaker 3: time they're having, Like, there's so many factors to a

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Speaker 3: round out a healthy human being.

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Speaker 1: And that is our doctor's desk episode. I mean, I'd

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Speaker 1: love to keep talking about it, but our time as well,

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Speaker 1: and truly up, do you have any other questions?

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Speaker 3: No, I think we've covered it.

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Speaker 2: All all right, nowhere is it all?

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Speaker 1: So we'll link to the study in the show notes.

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Speaker 1: We'll also link to Sammy to Mimi's book Searching for

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Speaker 1: Normal in the show notes. I'm very excited. Just as

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Speaker 1: I started to finish the book, as I moved into

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Speaker 1: the last chapter, I got an email from the publicist

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Speaker 1: of the book and they said, would you like him

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Speaker 1: on your podcast? So We're going to interview him early

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Speaker 1: next year and I'm going to go into a lot

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Speaker 1: of depth on exactly this topic. It's just too important

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Speaker 1: to not talk about more.

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Speaker 3: Oh, I'm looking forward to that one.

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Speaker 1: I love it when you look forward to my interviews

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Speaker 1: with amazing people. Hey, thanks so much for listening to

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Speaker 1: the Doctor's Desk episode of the Happy Families podcast. The

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Speaker 1: podcast is produced by Justin Roland from Bridge Media. Mim

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Speaker 1: Hammond's provides admin, research and additional support.

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Speaker 2: And if you'd like.

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Speaker 1: More info about the stuff we've talked about, please have

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Speaker 1: a quick look at the show notes and we will

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Speaker 1: link to everything that you need there. If you'd like

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Speaker 1: a resource to help because you've got a child who

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Speaker 1: is behaving in challenging ways, check out my book Parental guidance.

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Speaker 1: You can get it online wherever you find books in

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Speaker 1: bookstores and happy families dot com, dot A, you