By Gene Beresin, Executive Director, Khadijah Booth Watkins, Associate Director and Anthony L. Rostain, M.D., M.A.

Posted in: Multimedia, Podcast

Topics: ADHD

ADHD stimulant medication shortages are affecting more people than ever.

In this episode of, Shrinking it Down: Mental Health Made Simple, Gene and Khadijah take a closer look at the ongoing shortage of ADHD stimulant medications and the real impact it is having on children and adults. Joined by Dr. Tony Rostain, they explore the biopsychosocial approach to how ADHD is treated and why medications like Adderall and Ritalin remain so important. They explain what is driving the shortage, from supply chain issues to growing demand, and share practical ways for parents and caregivers to help their teens cope. Listen now to feel more informed, prepared, and supported.

Media List

• Anthony L. Rostain, MD, MA (Cooper University)
• Manufacturing Supply Chains and Imports in the ADHD Drug Shortage (JAMA Network)
• ADHD Medication Shortage Continues as the School Year Begins (The New York Times)
• The Rolling Stones – You Can’t Always Get What You Want (YouTube)

Episode Transcript

SPEAKERS: Gene Beresin, MD, MA; Khadijah Booth Watkins, MD, MPH; Anthony Rostain, MD, MA

[INTRO MUSIC PLAYS]

Gene 00:28

Welcome back to Shrinking it Down: Mental Health Made Simple. I’m Gene Beresin

Khadijah 00:32

And I’m Khadijah Booth Watkins.

Gene 00:34

We’re two child and adolescent psychiatrists at the Clay Center for Yount Healthy Minds at the Massachusetts General Hospital.

Khadijah 00:42

When we discuss ADHD treatments at the Clay Center, we’ve often focused on finding the right stimulant medication to enhance the cornerstone of ADHD care, which really also includes behavioral treatments such as, you know, executive functioning support and coaching CBT. There is even a CBT for ADHD psychosocial interventions and many other things. But what happens when the medication just suddenly runs out? I thought this was really something that was limited to some of the supply and demand challenges related to covid, but this is continuing to happen across the country. For many years, many families have been navigating unexpected disruptions in their children’s ADHD care due to an ongoing shortage of similar medication,

Gene 01:23

Not only kids, but also adults. And the shortage is pretty scary, because it’s important for their care. So, while these shortages may stem from global supply chain disruptions, and we could talk more about that many families are left coping with emotional ups and downs, disrupted daily routines and ongoing uncertainty.

Khadijah 01:49

And so, in today’s episode, we are going to focus on the real-life impacts of treatment interruptions and disruptions. You know, how they affect children’s behavior and learning, as well as what parents and caregivers can do to support their kids through this uncertainty,

Gene 02:03

and here to help us understand navigate these shortages, is Dr Tony Rostain, one of my best and oldest friends.

Dr. Tony Rostain 02:12

Yep, we go back a long way Gene.

Gene 02:15

A long way so. Dr Rostain is a nationally record, recognized expert in lifespan developmental Neuropsychiatry with a clinical and research focus on ADHD, autism, learning disabilities and related conditions through the whole lifespan, I might say, from childhood through adulthood. Dr Rothstein is also an accomplished author co-writing the adult ADH toolkit and cognitive behavioral therapy for adult ADHD, that are two essential guides for managing adult ADHD and his book The stressed years of their lives offers crucial insights for parents navigating the mental health challenges of the college years. So hey, it’s great to see you here. Tony, welcome.

Dr. Tony Rostain 02:58

Yeah, I’m happy to be back.

Gene 03:00

So, to start off, are we correct that the backbone in treating ADHD is largely behavioral, but the medications are critical for assisting the treatment process, and if so, why are they necessary? What’s causing the shortage? Is this something that happens often?

Dr. Tony Rostain 03:23

Absolutely, that is what prompted this conversation. Two weeks ago, there was a paper published in The JAMA Network about the source of the disruption of supply, and I want to talk about that in a moment. But let me get back to the first point. I envision ADHD as a biopsychosocial developmental disorder, meaning we have to approach it from multiple directions in order to get maximum outcomes. And because it’s a developmental disorder, we want to help kids as young as we can get back on track, because what it really signifies is a deviation from what we would expect in most people’s development, they get distracted. They can’t do well in school. They have trouble with peer relationships. They have problems with self-esteem. By the time we see kids who are in crisis, we think, oh, my God, we should have started this earlier. And what do we mean by starting this? Well, all the things you mentioned, first and foremost, understanding the child their strengths, their vulnerabilities, understanding how the child fits into their environment, whether that’s in the family, in school, in community, and looking at what’s ahead for them. Where are they getting stuck, and how can we help them learn skills to become more able to take advantage of the resources around them? So, it’s all about learning, and it’s all about helping kids achieve resilience, which is what the Clay Center is all about, is helping families help kids reach their potential, okay, but ADHD is a constant obstacle, and in some cases it’s such a big. Obstacle that it really requires what we would call a real, serious treatment plan, not just to do it yourself. You know, coaching a kid here or there, or having them sit up in the front of the room. I mean, those are minimal interventions. But most times, when I see a child coming to me for help, what I usually say is, let’s look at the medication side of the equation. Let’s look at the way in which we can increase environmental receptivity and give people skills, both the child and the family, the skills, to quote, live with ADHD to the best possible outcomes. You don’t get rid of ADHD; you learn to master some of the challenges. It’s all about mastery. Okay, now I would like to focus first and foremost on what we know is the best treatment medically for ADHD are the stimulant and class of medications. They come in two big groups, amphetamines. I know the common ones. Brand names are Adderall, Vyvanse and methylphenidate like Ritalin, Concerta, Focalin, brand names, those two classes of medications have been shown to be highly effective in getting the child to pay better attention, to control their impulses and therefore to learn more effectively, both in the classroom and in the social world. What’s happened in the last decade is that the number of kids and adults being diagnosed with ADHD has gone up. So we now have the result of a perfect storm of several factors that have led to what we could call disruptions in the supply of ADHD meds, which is to say, these, these, these, these factors all interact. Okay, we’ve got fragile global supply chains, because stimulants are made in with ingredients that come from all over the world. We have got this growth in demand that I just mentioned. We’ve got DEA production quotas and forecasts about what’s going to be needed next year. Well, if they are not forecasting the growth that we’ve seen, then that’s going to cause a shortage. And then on this, to me, was a big part of the article that I found very useful is that there were manufacturing delays and concentration of the supply in certain markets. Okay, so with respect to that, for example, one of the generic companies, you know, Teva, is one of the largest producers of generic medications. Starting in late 2022 there, they started to switch their source of supplies, of the ingredients, and there were all kinds of bottlenecks that they ran into. And there was a lot of disruption in the supply from this big distributor. And finally, there’s all kinds of regulatory complexity, I mean, and this gets into a really what I think of is some people describe it as regulatory friction or regulatory constriction, and that means that it’s these stimulant medications are over regulated. They’re treated like by the DEA, like they are public menace number one. So everybody who’s prescribed this medication is seen like, Oh, you’re you know, there’s a potential for abuse here that gets a look through the lens of it being a controlled substance, which unfortunately makes everybody involved, people who prescribe the medications, people who distribute the medications, like the pharmacies and the consumers, the patients, etc., they’re suddenly having to fill out lots and lots of forms. There’s lots of group, you know, oversight, to the point where I would say that, you know, it really, it really is another bottleneck. So, you know, lately what we’ve seen, and this is, I mean, you know, since the pandemic, you know, we’ve seen increasingly longer periods of time when the supply is not readily available from your usual pharmacy, when you’re when you’re a person who’s prescribed these medications. So lately, in the last month or so, I’ve had patients telling me they go around and go to several different pharmacies looking around to fill the same prescription that they were able to fill a month or two before the pharmacy says, No, it’s on back order. Well, when’s it coming in? I don’t know. Okay, they go to another pharmacy, same deal, okay? And to the point where they are so upset that they’re calling me to say, well, what can I do about this? Dr. Rostain, so we can talk a little bit about strategies for dealing with the with this, these disruptions, but it doesn’t come from one source, and yet, as you point out, it’s also made even worse by the quote suspicion that’s given. Towards these medications. And I think we’re really still living in the shadow, if you will, of the Nixon era administrations. We’re classifying stimulants as abusable drugs, rather than helpful medications to treat not just ADHD, but conditions like narcolepsy, you know, and other conditions like it’s a great medication to enhance antidepressant effects. You know, we could talk go on and on. Stimulants have a wide use in medicine, and yet so many people are given a hard time for trying to get their prescription filled the FAR. Here’s one thing that good example of what I think of as bias, anytime you have a refill ready for you from CBS or some other chain, they’ll call you to tell you it’s ready, but not for stimulants. They do not regularly notify patients that their stimulant medication is ready to be picked up. Why? Because they don’t want to advertise that they have a stimulant ready because they’re afraid. So it’s very defensive. You know, practices in on the level of the pharmacies, and I just think that we’re all

Khadijah 11:09

I didn’t know that. That is like… That, my jaw is like hitting the floor,

Dr. Tony Rostain 11:14

yeah, well, I’m talking about what happens in Pennsylvania and New Jersey. I don’t know if that’s true in CVS in Boston, but you can ask your patients, right? They do not get that’s why I get my patients routinely asked me to refill prescriptions for them that are already at the pharmacy. And when I say to them, well, why didn’t you check with the pharmacy? They go, well, I was expecting them to get in touch with me. I go, they will not let you know that it’s time to pick up your stimulus. That’s a perfect example of a systemic bias against this medication now. Now last thing, and I’ll just we can move away from politics now, but our current head of Da of the Department of Human all the way at the top, HHS. HHS is a real big anti stimulant and anti-medications for all other things. So we’ve got another bias now that’s just been introduced. Robert F Kennedy, who does not only not like vaccines, but he also doesn’t like psychotropic medications, especially for kids.

Gene 12:20

Well, he doesn’t like antidepressants. No, he doesn’t Anyway, okay, and what’s it? What’s into? What’s interesting about this, too, and we can come to it, is, is the addictive potential of stimulants is actually quite low compared to other things. I mean when kids or adults don’t miss their dose. They don’t get a withdrawal. They do for men, they do from antidepressants, they do from caffeine, they do from nicotine. They do from lots and lots of other things, you know. And so what is so odd about this is that the paradigm, as you stated, Tony, was crystal meth or speed, which you which is a very different animal than the stimulants that are being used for ADHD.

Dr. Tony Rostain 13:08

So let me get you one other, one other factor that’s affecting the act, the ability for adults with ADHD, for example, to get their medication. Many, many, if not most adult primary care physicians will not prescribe stimulants. They don’t want to be hassled by them, so they insist that patients go to a psychiatrist. Well, they’re not enough of us, you know. And so and then once they’re diagnosed, for me to send them back to the primary care practitioner requires me to convince the practitioner that it is going to be okay. Well, it is going to be okay. But guess what? The DEA stipulates that you have to have a visit every three months to maintain a patient on a medication. Now that may be good practice when you’re starting someone out, but once a patient reaches a stable dose and it has uncomplicated ADHD does not have depression, does not need to be in psychiatric treatment, this is a real big demand, a big overhead on primary care practices. The one group that has jumped into the breach are advanced practice nurses, because they’re willing to say, okay, if my patients need this, I will do this. But you know, the ABS Sara, the American professional society of ADH and related disorders, is about to issue a set of guidelines to help guide all the work we’re doing. And I’m looking forward to reading about this whole problem of disseminating the skills so that it isn’t just concentrated in a small group of providers where there’s a bottleneck to reach us. So that’s one other concern I think public health concern is that people you know are people are getting the care they need.

Khadijah 14:59

It’s been really. Really awful to watch the parents and kids struggle with trying to get their medication, and, you know, feeling pretty helpless, but also, in a way, feeling like, to some degree, we’re also contributing. So, the prescriptions are electronic. You can’t transfer prescriptions from one pharmacy to another, so the patients are constantly calling you. You’re calling them back. You’re calling pharmacies. They’re calling pharmacies. But you know, for families who rely on stimulant medication, because, again, it does have great benefit for some for some kids and some adults, it really does. It’s a real game changer. These disruptions are often sudden, like, you know, don’t, don’t expect it, and they’re ongoing. So you know, you couldn’t get your prescription this month. Last month, it was a run around. What does it actually look like? What does this disruption actually look like in the day to day of a child’s life, or an adolescent’s life? Like not being able to do there is, are they able to do their

Dr. Tony Rostain 15:53

daily Oh, it’s horrible. First of all, yeah. What happens is, first of all, let me just say we’re all in a learned helpless situation at the moment. We’re all feeling discouraged, and there’s a certain amount of giving up that goes on. I think some parents just cut back on the amount of medication they give, and they’re putting up with whatever they can put up with in the way of providing support. But they’re very frustrated. The children are upset too, that they’re feeling guilty that they’re causing some, you know, problems, that their parents are having trouble getting their medication and then the teachers, of course, are saying to the parents, what’s up? You know, Johnny’s not doing as well, because this month, well, I’m sorry we’ve had a delay in getting the medication. So, what we’re at, we’re called upon to do, as clinicians, is, number one. Try to see well, is it the formulation itself? Maybe we need to, we examine each child and think about what could we give an alternative if, if an amphetamine preparation isn’t that you’ve been using isn’t available? Are other are their other ones available? And you have to talk to the pharmacy about what’s available, and then in order, you might have to switch from one from amphetamine to methylphenidate or vice versa. So, I just think we have to actually add time into our clinical care pathways that factor this in, okay, expecting that we have to have these conversations and providing parents with support and hope, because it’s not like there is no medication. It’s just that you have to wait for it. So, what I’ve also often told parents to do is, a week before the refill is due, call the pharmacy and see how is the back order. What’s the story with the back ordering? And again, it’s month to month. It’s not always bad. Some months is better, but it’s like, sort of like it kind of the unpredictability itself is very stressful. You know, if you read literature now, what’s the most stressful thing to the brain is not certainty of something bad. It’s uncertainty of not knowing what the hell is happening. That’s actually more toxic to our nervous system than you know anything else. Obviously, we know toxic stress is horrible, but I’m just saying, not knowing when your next medication is going to be available to you is causing my patients a lot of anxiety.

Gene 18:15

And oftentimes what I found is, is that it takes time to find the right medication, the right stimulant. Oh yeah. I mean, because they’re all, they’re all they, you know, kids react differently and if that one is not available, and they have to go into a different one, like, I’ve had patients on amphetamines, on Vyvanse, or an Adderall, and they had to switch to, say, Concerta or Focalin, which is a Ritalin based medication, yeah, and they don’t tolerate it?

Dr. Tony Rostain 18:40

Well, no. So, they have to, have to be ready for that as well. This may not work as well. So then, what do you do? Then sometimes we do add non stimulants that we might not have used before to try to enhance the, you know, the effect of the reduced amount of stimulant supply. It’s, it’s like, I think we have to say that it’s about it’s really about being open to innovation when, when you’re when your plan a isn’t working, how do you deal with Plan B? And that’s a big that’s a good lesson to learn in life in general. What if? What if? What if this isn’t available? What do you do next? Most of all, you have to explain to the child, hey, it’s not your fault if you’re having a little more trouble focusing. I’ve even, by the way, I’ve even had to write to us a teacher. Well, it was it was a student was in college, and she was not able to get her refill, so she got really behind in her schoolwork. Her teacher did not believe her. I had to write a letter. Now, the student had not disclosed to the teacher that she was taking medication. When she did, the teacher said, ah, get me a doctor’s note. So, I wrote a doctor’s note to get her an extension. Okay, but that’s like, that was, it was not. Fault she couldn’t find the prescription it was out in the school that she was going to in that community.

Khadijah 20:06

Can we just go back a little bit to the disruption and how this impacts kids and families? Because so often, not necessarily providers, but families so often think about ADHD as a school disorder like it really only affects us in school. How do these disruptions affect their kids and maybe look differently at home. So, you know, the we know that ADHD affects us everywhere, but I think, you know, we really see it in school, but,

Dr. Tony Rostain 20:32

oh, it’s huge. It’s huge. I’m so glad you brought that up. I mean, not being able to participate in sports if you’re not on your medication, for example, not being able to sit at your dining room table at night when it’s time to eat dinner, you know, being unable really to settle down at bedtime because you haven’t had a day that you know you’ve had an it’s a lot of anxiety and a lot more friction and a lot more exhausting for parents, when they are when their child usually is able, you know, when you’re able to plan a day out with a child on a medication. What I always tell the parents is, figure out, when in the Day Are they coming off the medication. So, give them a chance to do something less demanding for the period of time when the medicine is wearing off. And all those routines and all those rituals get thrown off weekends, especially, you know weekends are time for the child and the family to do things together. Maybe, do you know, sports, music, lessons, other kinds of activities? Well, if you don’t have your medication, and used to having it tends to be harder to do it. And I’ve actually had kids refuse to go, like to Sunday school, and because I’m not gonna be able to sit in Sunday school, sorry, and yeah, that’s the kind of whole life disruption, which may seem like not a big deal to us, but to the child and to the family, it’s like, oh God. You know more postponing of our of our usual we finally learned to have a predictable life, and now life becomes much more unpredictable. Again, by the way, we didn’t talk about this when you first described ADHD, but Russ Dr Ross Ramsey and I used to used to explain that ADHD was being unpredictably unpredictable, like or predictably unpredictable. You know how there are certain heart rhythms that are, you know, predictable and unpredict? Well, ADHD is, by its nature, unpredictable, and when you have an environment that’s unpredictable with a person who’s whose nervous system is always, not always online, you’ve got a perfect storm for something that we could call stress, really bad stress.

Khadijah 22:43

So, what can families do when their local pharmacy just does not have the medication in stock, and the idea of waiting on this back order for two, three weeks is not reasonable?

Dr. Tony Rostain 22:54

Well, I’ve had some parents drive beyond a five mile or 10-mile radius. They actually here’s the other problem, they’ve driven to places that they’ve called lately, those places won’t tell them if they have a supply. So, there’s a collusion going on among those pharmacies, that they don’t want people from far away to come to their stores. So, you know, what they I’ve started to do is go and find the more Mom and Pop type pharmacies around that are not chains, and see how they’re doing. Some of them are actually better at having a regular supply, because they go through other, they go through other sources than what the chains are doing. So, you know, chain versus Wegmans, for example, if the Wegman is CVS doesn’t have, I say, go over to Wegmans, you know, and I will have to spend, like you said, switching the script from one place to another until, until they and you know, what else is interesting is when they do find a place, they are so relieved and thankful to me for having done that, even though it was like It took me just three minutes to fill it out, but it’s almost like, you know, they were, they were, like, rescued from another frustrating encounter with a pharmacy.

Gene 24:11

And sometimes what I found, sometimes I’ll have a brand versus non brand. So, so you have to change the prescription to brand only. Oh yeah, but then the price goes up.

Dr. Tony Rostain 24:21

That’s right, you have to educate families about that. They say the only available one is the brand. Because, like Teva, for example, the generic actually had more of a disruption with it, brand versus non brand. You know, some people notice a difference. Some people don’t. It all depends on what the generic company’s formulation is all about, and they’re not all the same. Not all generics are created equal. So yeah, they’re going to the brand name for a while, and or changing the dosing itself, like if they don’t have 20 XRS of Adderall, they might have. Get 210s you know, you got to work around. You got to be creative.

Gene 25:05

So, what other question that comes up during this is, given that we’re dealing with shortages and, and it’s interesting, you know, I don’t know of any other medication, including the opioids, with their shortages. I mean, this is,

Dr. Tony Rostain 25:22

this is kind of crazy. There’s some shortages with cancer, some cancer treatment, but that’s not in our line of work. This is the only, or in mental health, mental health in general. This is the only medication that right now is experiencing these disruptions.

Khadijah 25:37

The other thing that I find that can be helpful with families and the pharmacies. Pharmacies won’t often tell you if there’s an if there is a medication available, but the pharmacies can usually do an internal search, like CVS. Can search the CVS system, yep, they won’t advertise it or offer it, but I tell patients, let them do the search. Or if I sit then if I send it to a different chain, then if it’s not there, then I have them do a search at that chain to avoid families running down to different pharmacies. But they won’t. They won’t tell you. They won’t offer it. Then you have to ask, which is unfortunate

Gene 26:09

in Massachusetts, they’re supposed to call within a 10-mile radius of other CVS Pharmacies.

Dr. Tony Rostain 26:15

Yeah, but let me say, let me just go back to that question. What you said earlier? Gene the that the biggest shortage have been in the generics of these stimulants. So that’s why bringing up quickly the story of, if they’re short, the generics we may have to use for a short period of time, the brand name, and that may cost you a little bit more, but for a month, hopefully no more than that. You know, you at least have the medication that your child is taking, right?

Gene 26:50

So, so what one other question that comes up is, and that is, is that, should families attempt to ration medications? And so, what are the psychological effects of rationing? What about you know, so there’s one issue of, should they ration? Because I’ve had parents say to me, Well, should I just give them a little bit less? Should I kind of give them weekend holidays like we used to do in the old days, which we’re not doing any more standard of care. And the other thing that they recommend is, should they put in more behavioral innovations, more structure? So whiteboards, lists, you know, setting alarm.

Dr. Tony Rostain 27:27

I would do that regardless. I think we all need more we all need more structure and help, especially given the distractions of the digital age, you know, and how we’re constantly like off task, looking at our phones, etc. I think behavioral approaches to focusing are good, setting up times to do homework or to do family time and eating dinner without those distractions. But in terms of rationing, I don’t think there’s a one size fits all, nor is there a great database out there to say, here’s a study, naturalistic study, of what rationing looks like in the world, from what I’ve learned with my patients, experiences of this is occasionally what parents will do is they will not give a late dose in the afternoon and try to schedule around, do things around that, and then build up a little stockpile, which they’re not supposed to do, but they’ll admit to me, I built up a stockpile for when there’s a shortage. And I say, Well, how do you do it? And they might skip on the weekend, they might I tell them, do not ration for school, because that’s really where the kid’s going to have the most noticeable and lasting effect falling behind in their ability in the classroom to learn, or what have you. But yeah, a lot of improvisation people do stockpile.

Khadijah 28:46

So, you mentioned having to have to write a letter to a school of one of your patients when she couldn’t have her medication. What do you recommend parents do to advocate for their kids in the school setting when medication is not accessible or there’s inconsistent, inconsistencies in Canada, yeah,

Dr. Tony Rostain 29:03

patient, that’s a great question. First, first and foremost, I think that having a good relationship with your school, your child’s teacher and or with the school nurse, is really important. Like ideally, the school understands that your child has ADHD, they’re working with him or her to try to behaviorally and use techniques to keep them engaged. And when there’s a shortage, I would just reach out to the school and say, hey, you may notice there’s a change a little bit in in my child’s behavior. Let me know if it’s really disruptive, and I’ll see what I can do to, you know, find a better source, because we’re running we, you know, the shortage is known now, how much detail you want to get into it? I wouldn’t go beyond that. Just say we’re having trouble. You know, with the medication we’re getting, the medication they normally take. And it may be a week or two, I. Hopefully that won’t cause major problems, but if it does, then I think that least there’s an alliance between the parent, parent and school that will like help buffer the will help buffer the impact, and it teachers welcome that. Oh, I get it. Okay. You know, we’ll do a little extra support and redirecting like best thing to do with people with ADHD is non, non-triggering, non-shaming, redirecting, oh, hey, let’s, let’s get back to this. No, and not look at it like, Hey. Why aren’t you listening?

Gene 30:38

Well, this is, there’s so much more we could talk about, but, but in the, in the, in the interest of time. And to wrap up, let me ask what? What’s one piece of advice you wish you could give every family struggling with medication shortage?

Dr. Tony Rostain 30:54

I’d say, first of all, get to know your pharmacies. And who’s get become friends with a pharmacist, they’ll tell you the real deal. They’ll get you the info you need and real and become even. Like, really like, appreciate them, because they hate this. I tell you, they hate saying no to I don’t have this for you. The second thing is to figure out with you with people you know who live in different towns. Like, do you have, how’s your pharmacy doing with this? Like, I think ideally families should get together with other families who share kids, who have kids with similar problems. You know, support groups. I think Chad, I would get in touch with Chad, because there are advocacy efforts at the national level, policy level, and then most of all, I said, just talk to your kid about what the meaning of the medication is and why you’re hoping that you can find it. But you know, it’s not like they’re a bad kid if they’re not taking their Med, they just need more support. You Yeah,

Gene 32:03

so typically, we wrap up and we ask a question, and what I’m wondering is, this is very stressful for kids and for families and for the teachers, and you know, when there’s this kind of disruption, like you said, you know, predictably unpredictable or irregularly irregular for heartbeats, whatever. So what do you do Tony, when you have to struggle with uncertainty and not being able to get what you need, you can’t always get as opposed to what they’re rolling you get what you need, but at times you can’t always get what you need. So, what do you what? What do you do? What do you do when you can’t?

Dr. Tony Rostain 32:55

get what you need? Well, I’m trying to practice a few new lessons learned late in life. I was talking to someone who said the following. I said, well, what did you learn that was most useful growing up from your family? And she immediately said, Well, you know, my mother always told me that if you can’t do anything about something, don’t worry about it. Now, how does that translate? Well, what it translates is in me reflecting is if this situation, if I can do something about it, I’ll do what I can, but if there’s nothing I can do about it, I have to learn acceptance and not lose compassion for myself for not being able to do something about it. So, at some point, it’s kind of like stepping away from that constant ah and just saying, breathe. It’s not the end of the world. My life, or my child’s life, or my whatever family life, isn’t going to be destroyed by not having a stimulant. And in my life, I mean, I’m not living on stimulus, but I have busy practice. I have a busy job, and every single day I’m faced with this idea of, gee, this is going on here and isn’t much I can do about it itself. For me, a way of learning, practicing acceptance, not resignation. I’m not giving up, but I’m just accepting this battle right now isn’t going my way, so maybe I should conserve my energy and redirect it to something that I can impact.

Gene 34:32

That is great. How about you?

Khadijah 34:33

Khadija, they take a similar approach, where I try to accept the things that I really have no control or power to change. And then I sometimes try to also level set with myself. Or, like, change, like, make sure my perspective is, is, is in line. Like, do I really, really need it, or is it something that I really, really want, I guess, is going to make my life better, smoother, but, but how do I how I try. To reframe it so it doesn’t feel so I don’t feel so, like, downtrodden. And then if that doesn’t work, then I pick up the phone and I call a friend, like, help me think this through. Like, help me solve troubleshoot problems. Like, help me figure, Figure this out. But, but I really tried those first two, first to really, you know, just fall into a place of acceptance, and then try to change my perspective on this thing that I really wanted, that I could that I don’t have, or maybe need that I don’t have.

Gene 35:24

So, it sounds like the 12-step serenity prayer. It is. That’s exactly what I was thinking. It just sounds like, and that’s why the 12-step program is so helpful to accept the things that you can change and those that you can’t.

Dr. Tony Rostain 35:38

What about just I just thought of another saying in terms of that, when I was an intern at the Children’s Hospital of Philadelphia, brand newbie pediatric intern, I had a third-year resident one night after I was on call. It was a bad night, you know? And he looked at me and he said, Tony, sometimes you eat the bear. Sometimes the bear eats you. And that has stuck with me, because it’s like, you win some, you lose some, right? I mean, but the way he said it, it made me laugh after a really bad night, I said, Yep, I got eaten last night. I was a killer.

Gene 36:19

And sometimes you rained out.

Dr. Tony Rostain 36:21

Yeah, sometimes you rain Exactly. Well, all kidding aside. All kidding aside. I do think that practicing mindfulness and ways to reach out to support, like you said. Khadija, I think parents and people with ADHD, they really live with the world much more intense stress than everyone else, and I just acknowledge it in them and say, this isn’t easy. Life can’t be easy all the time. But that’s that doesn’t mean you know you’re doing anything wrong, because that’s the part that kills you, right? Oh, I did something wrong here. And instead, I said, no, you did nothing wrong. But unfortunately, even though you did everything right, it didn’t work out.

Gene 37:08

Well. What I try to do, I think what you’re also saying is the tendency is to blame yourself. Yes, to blame yourself when, when something outside of you, like a medication shortage isn’t happening and things aren’t going right, or when you have a bad night in the in the emergency room, when things are just not going your way, is to just kind of blame yourself and give and give up. And so I think, I think that that’s, you know, a tendency that I have, as well as to kind of, like, get so stressed that you know, and anxious that I can’t do anything this, this, it’s, it’s a, it’s really unsettling to feel helpless. So, combating helplessness means what I try to do is try to do something that I can do. Yeah, but clay, music like, exactly, that’s my stuff. That’s, that’s what I’ll do, if I’ll just go, I’ll go to the piano and I’ll just play something and realize that I can do something. But it also, you know, puts me in a better place emotionally,

Dr. Tony Rostain 38:17

If I might add one coda to that.

[OUTRO MUSIC STARTS]

When I listen to really good blues singers, I realize that that’s it. You know, like the blues are real, and if you can sing about them, it makes life a little less intolerable.

Gene 38:32

Yeah. So, for those of you at home, if you like what you’ve heard today, consider leaving us a review. And as always, we hope that our conversations will help you. I’m Gene Beresin.

Khadijah 38:46

And I’m Khadijah Booth Watkins, until next time.

[OUTRO MUSIC ENDS]

Episode music by Gene Beresin

Episode produced by Spenser Egnatz