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Sasha Raskin (ADHD Coach) and Dr. Peter Robbins (Psychiatrist) Talk ADHD Coaching, Diagnosis & Meds


Sasha Raskin (ADHD Coach) and Dr. Peter Robbins (Psychiatrist) Talk ADHD Coaching, Diagnosis and Meds

Sasha Raskin (ADHD Coach / Career Coach): Hi, Dr. Robbins.

Dr.Robbins (Psychiatrist): Hello there.

Sasha Raskin (ADHD Coach / Career Coach): Hi. I'm very excited to have this conversation with you. I'm an ADHD coach and a counselor and yoga psychiatrist, and you're managing a multidisciplinary center which I think is incredibly important since there are different ways of working with ADHD. And I think different professions need to definitely be in a more closer dialogue with each other and working as a team (a), and (b) learning from each other, what really is working, what is working less. And I think just for the benefit of the clients and also the professions as a whole.

So we met since we have a shared client and we connected over that, and we thought it would be a good idea to have a conversation about ADHD. So take it away, maybe say a few words about who you are and what do you do.

Dr.Robbins (Psychiatrist): Sure. So I'm Peter Robbins, I'm a child and adolescent psychiatrist. My practice is in Fairfax, Virginia, just outside of Washington DC. Historically I've worked in inpatient, day treatment and outpatient settings, but for the last 20-something years exclusively doing outpatient child and adolescent psychiatry. And as Sasha mentioned, I'm the medical director of a multidisciplinary team, the child and family counseling group. We have ... there are five child psychiatrists, seven PhD psychologists and four masters level clinicians, MSW's and LCSW's. And we try to work as much as we can as an integrated team.

My approach to child psychiatry has very much been informed by Engel's bio psychosocial model, trying to integrate the biological factors, the internal psychological factors that affect a person's development and the environment in which the person lives, their cultural, social, even physical environment. And trying to pay attention to all of those factors when looking at treatment.

ADHD was something that I kind of almost inadvertently got involved with. It really was something that I think in my original training programs probably got maybe an hour of time cumulatively in three years of adult psychiatry.

Sasha Raskin (ADHD Coach / Career Coach): Interesting.

Dr.Robbins (Psychiatrist): As a total. And in child psychiatry, yeah, probably got two lectures about it in two years. And as it turns out, of course, almost everything that I do nowadays from a medical standpoint is completely different from what we did back in the 1980s. So then maybe a little bit of Ritalin, most of the medicines we use nowadays are different formulations or very different dose delivery systems. And the idea of integrating medical treatment with coaching, with IEP's and specialized educational plans, with family support services, it is something that has sort of evolved over the last 20, 30 years.

Sasha Raskin (ADHD Coach / Career Coach): Yes. And as the idea of ADHD in general I think in the first edition of the DSM, the diagnostic statistic manual, it was called if I'm not mistaking the injured baby brain syndrome.

Dr.Robbins (Psychiatrist): Yes, indeed. And then after that minimal brain dysfunction was one. So MBD, it went on to ADD, either with or without hyperactivity, and then when you got to DSM 3 they sort of ... the lump is one up over the splitters, and so everything became ADHD and then with little subheadings, whether hyperactivity or distractibility was prominent.

Sasha Raskin (ADHD Coach / Career Coach): So the view on ADHD keeps on changing. The way to treat it starts changing ... well, it changes a lot. And also what I noticed that it's moving more towards at least in the coaching and counseling professions, towards the strengths-based view. And well, let's talk not just about the pathology but also about the incredible gifts that sometimes come with it, like the ability to hyper-focus and the open-mindedness, creative thinking. And I think one of the biggest challenges with ADHD is growing up and feeling that you're so different, and things that seem to be so easy for others seem to be extremely difficult if not impossible for you.

Dr.Robbins (Psychiatrist): Uh-hmm.

Sasha Raskin (ADHD Coach / Career Coach): Right? So isn't it wonderful to realize usually as an adult, "Oh, I actually am gifted in many ways," right? If it's something that really interests me, with someone with ADHD, I can hyper-focus for five, six hours and the world seems to disappear, and I can just zero in on what I need to do.

So I'm curious to hear your specific view of ADHD, maybe expanded outside of the ... the last definition was 2013 I think. They've changed since then. So how do you view ADHD?

Dr.Robbins (Psychiatrist): I see it as in its origins a delay in neuro development. We know from some of the very good neuroimaging studies done at the National Institute of Mental Health, which is right near my practice in nearby suburban Maryland, they've looked at where the brain centers are that are under active in children with ADHD and how that compares to age and gender match controls, and what the impact of medications are. When you look at neuroanatomy though, that doesn't necessarily tell you very much about functioning.

A little story - a number of years ago I had a family came to see me and I helped to treat their little girl for ADHD that was primarily inattentive type. And in the course of the treatment at one point I remember the mother turned to the dad and kind of gave him an elbow and the ribbon said, "You know they're talking about you." And he says, "I know, I know." And of course, he had not told me that he had been diagnosed as hyperactive when he was a kid, put on medicine which he didn't like the effect of and so on. And he asked ultimately to come to see me himself for a consultation, and that was how I got interested in working with adults with ADHD was being involved in treating the parents of the child patients. So I knew that I was confident about the diagnosis of the child, diagnosing the adult not so much.