A Cognitive Psychologist Shares Her 5 Pillars of ADHD with Dr. Amy Moore

Today Dr. Amy Moore takes off her hostess hat at The Brainy Moms podcast and takes on the role of guest expert. Co-host Sandy Zamalis interviews Dr. Amy about her 5 Pillars of ADHD and her own experience being diagnosed at age 18 with attention deficits. Join us for this in-depth conversation from a leading expert on attention and cognitive deficits!  

About Dr. Amy:
Dr. Amy Moore is a cognitive psychologist at LearningRx in Colorado Springs, Colorado, at the headquarters of the largest network of brain training centers in the world. She specializes in cognitive training and assessment for neurodevelopmental disorders like ADHD, brain injury, learning disabilities and age-related cognitive decline. Her research has been published in peer-reviewed medical and psychological journals and presented at conferences around the country. 

She has been a child development specialist, education administrator, and teacher of teachers with a PhD in psychology and a master’s degree in early childhood education. Dr. Amy has been working with struggling learners for 25+ years in public, private, and government organizations, so she knows a little about thinking and learning. She is also Editor-in-Chief of Modern Brain Journal, a TEDx Speaker, host of the Brainy Moms podcast, a licensed pastor, and a board-certified Christian counselor.

Dr. Amy is married to Jeff Moore, a retired Air Force fighter pilot now working as a surgical nurse. They have three incredible sons (ages 18, 22, and 24) and a very mischievous but soft Siberian cat. Originally from South Carolina, Dr. Amy has called Colorado home since 2006.

Connect with Dr. Amy:
Website: www.AmyMoorePhD.com
FB and LinkedIn: @amylawsonmoore
Watch her TEDx talk, Lessons Learned from Training 101,000 Brains
Read her research: https://www.learningrx.com/brain-training-research/

CONNECT WITH US

Website: www.TheBrainyMoms.com
Email: info@TheBrainyMoms.com
Social Media: @TheBrainyMoms

Dr. Amy's website: www.AmyMoorePhD.com
Sponsor's website: www.LearningRx.com

Transcript

DR. AMY: Hi, smart moms and dads. Welcome to another episode of the Brainy Moms podcast. I am your host, Dr. Amy Moore, and I am joined by Sandy Zamalis coming to us from across the country. We're going to do something a little bit different today instead of interviewing an expert guest from outside of our inner circle, Sandy's actually going to interview me today about my five pillars of ADHD, a topic I'm super passionate about.

SANDY: I am super excited about this. So listeners, in addition to hosting Brainy Moms, Dr. Amy is a cognitive psychologist at LearningRx in Colorado Springs, Colorado, at the headquarters of the largest network of brain training centers in the world. She specializes in cognitive training and assessment for neurodevelopmental disorders like ADHD, brain injury, learning disabilities, and age-related cognitive decline. Her research has been published in peer-reviewed medical and psychological journals and presented at conferences around the country. So she is a wealth of knowledge and we want to hear from her today. And we're super excited about it. She frequently gives presentations and interviews on ADHD. So we wanted to share some of her expertise on our own show for you. And she's going to talk about the five pillars of ADHD, which I had the pleasure of hearing her give at a homeschool conference recently. So Amy, I'm going to give the floor to you. Let's get started. 

DR. AMY: Awesome. Yeah. So I want to say before we get started, that I am an ADHD mom and a mom with ADHD. So I don't just research ADHD. I don't just talk about ADHD. Like I live ADHD. And so I think that is what has made me even more passionate about talking about it and sharing what I have learned from, you know, two and a half decades of working with kids with ADHD and adults, too. 

SANDY: Were you always diagnosed with ADHD? 

DR. AMY: No. Fascinating story. I was not diagnosed until college. 

SANDY: Oh, wow. Yeah. 

DR. AMY: You know, I grew up in the ‘70s and ‘80s. And at that time, you know, hyperactive boys were the ones who got the ADHD diagnosis. I had the inattentive type, so I kind of fell through the cracks. Now, my parents were educators, and so they created this very structured environment for me in which to do my homework, and then what happened was, I went away to college at 16 and had no structure. And I failed out and my mom, who was a child development specialist said, “I think you have ADD.” That's what it was called at the time. And she convinced me to go get tested and I was off the charts. 

SANDY: Wow. 

DR. AMY: Off the charts. Yeah. And looking back, there were so, there were so many red flags. I had those big emotions, the emotional dysregulation that we frequently see in ADHD, even though that's not part of the diagnosis. I look back over my childhood and go, “Wow, if I were growing up right now, I would have had a diagnosis at age six, right?” Not at age 19. So, or 18. 

SANDY: Was that helpful when you got that diagnosis? 

DR. AMY: Well, it was for a couple of reasons. One, it explained the struggle and that was a relief. I think some people are embarrassed to have the label, you know, they don't necessarily want anyone to know, but I was super excited to have an explanation for why I couldn't pay attention, for why I couldn't complete tasks for, you know, why school had been so hard. So, yeah, I was, I was thrilled to have it. And then, you know, at the time, there weren't any alternative interventions just, medication. But it helped. I mean, it helped enough that, you know, I was able to … I didn't have a learning disability, so I wasn't fighting that struggle at the same time. It was just the inability to concentrate. 

SANDY: Oh, wow. I just can't imagine the relief. You know, when you finally have that answer and a solution, you know, that helps you function and feel like you can tackle the world when, you know, before you couldn't juggle all the balls, you couldn't get everything to work the way it needed to work, to be successful in your life goals. How super exciting. But you know, we have that tool today. What do you think, you know, looking back was the most helpful part of learning that you had ADD? As like the hook of like, “Oh, okay. That's why.”

DR. AMY: Wow. No one has ever asked me that question before, Sandy. So I'm not even sure how to answer it. I think because I am a knowledge sponge, like I just have to know why things are the way they are. I mean, that's how I was as a child, right? My parents couldn't just say “because I said so,” right? I wanted to know, well, like, I don't understand why I can't touch a hot stove. Right. Not because you're telling me no, but because it will burn me. Right And so, I think even as a young psychology major in college, just knowing that I had an answer for what was going on with me, and then a launching place to start researching it, to read more about it, to find out more about it. You know, this was pre-internet by the way. So, it was a little harder. I just had to, you know, interview experts and read books. But my mom, like I said, as a child development specialist, had an inner circle of professionals who, you know, I was able to pick their brains and find out what was going on.

SANDY: Do you have—do any of your kids have ADHD? 

DR. AMY: Two of them. 

SANDY: Two of them. And were you able to recognize it right away? 

DR. AMY: Yes, absolutely. So, you know, my oldest, we knew right away, um, because he ran laps around the house until he collapsed. And so, it was, he was an easy one to diagnose. And then our youngest also had ADHD. No, we had a living psychology laboratory in our home. Because, you know, my kids had more than one diagnosis, which is super common, right? Over 50% of kids with ADHD have another diagnosis as well. And so, you know, we had ADHD, anxiety, OCD, Tourette's syndrome, mood disorder, dyslexia, right? Like we had a living psychology lab when our kids were little.

SANDY: What did you use as your tool when the kids were young to help them manage and, you know, self-regulate or co-regulate with them to help them, you know, figure out what to do with this brain that wasn't necessarily as cooperative as we would like it to be sometimes?

DR. AMY: Yeah. So with my older son, we went the traditional route of trying different medications and nutritional supplements, which I'll talk about in a few minutes. So, you know, we did supplement with omega 3s and GABA. He had Tourette's syndrome, so he was not able to tolerate central nervous system stimulants like Ritalin, and it made the ticks worse. So we really had to focus on diet and lifestyle with him. With our youngest, at that point, I was in the cognitive training world, and so I knew right away, well, this is going to be the answer, you know, for Evan that he needed cognitive training, in addition to diet and lifestyle modifications.

I think that we need to take a holistic approach to ADHD, which is why I've developed these five pillars, because if we only hit it from one side, we miss the opportunity to really give our kids a leg up. 

SANDY: I love that because, you know, when we talk to parents, you know, when I talk to parents in my center, whenever they come in for whatever issues that their child is struggling with on that learning side, I always try to help them see it's never just one thing. Right? There's, there's a lot, the brain, the body is taking in so much, and we've got to hit so many different areas. It's like a quilt. You're just trying to pull all the seams together to get things covered. So there's never one quick fix solution to anything. We've got to individualize and really dig down and figure out what this child needs or what this individual needs in order to help them function more efficiently. So I love that. Do you want to jump in and start sharing what those five pillars are? Because I love them. I just, I love it just covers the whole gamut of kind of how we can approach helping ourselves, if we have ADHD, but also our loved ones. 

DR. AMY: Absolutely. And let me just preface this by saying these five pillars are applicable across the board, right? Not just with ADHD, but any neurodevelopmental disorder and cognitive struggle. Yeah, absolutely. And then the other thing I want to say about them is these are not five pillars of intervention. These are five pillars of looking at ADHD holistically. So not only how do we intervene, but how do we determine if ADHD is really what's going on as well. So it's kind of, you know, from the assessment angle as well as the intervention angle. So the first pillar is sleep. So when a parent comes to me and says, do you think my child might have ADHD? One of the first questions I'm going to ask is how well do they sleep and how long do they sleep? Because children 6 to 13 need 10 hours of sleep a night to function well, and teens need 9 to 10 hours of sleep in order to function well. And so if our children are sleep deprived, that will show up in terms of their ability to focus and pay attention in school the next day. And so the answer could be as simple as are they getting enough sleep? But let me tell you why sleep is so important. Right? So we know what it looks like in the classroom the next day. We know that the inability to manage emotions, right, shows up with lack of sleep as well. So you get some of that oppositional behavior in addition to that inability to focus. But sleep is like putting your brain through a car wash. And so, what do I mean by that? When we fall asleep, there's like a valve system in our brains. It's actually beautiful how we're designed. And so we fall asleep and this valve opens and releases cerebrospinal fluid that washes our brain. So why do our brains need to be washed while we sleep? Well, as we go about our day, we use up neurotransmitters. And neurotransmitters are those chemicals that help our neurons communicate. And as we use them up, they leave behind toxins. And there's also some new research that suggests that beta amyloid proteins are also building up during the day in our brains. And for those of you who follow Alzheimer's research, we hypothesize that beta amyloid collection is part of the problem in Alzheimer's. So that research is kind of fascinating too, right, on what the correlation between sleep deprivation and cognitive decline in aging. So anyway, this cerebral spinal fluid rush that happens when we sleep cleanses the brain of those toxins left behind from using up neurotransmitters and from that beta amyloid that's collecting in the brain. So it's super important. It's one of those things we just don't think about. You know, we might off the hand say, yeah, our kid didn't get enough sleep last night. They're cranky today. Well, there's why. 

SANDY: So does medication affect sleep at all? I know if, for example, when my son was prescribed some ADHD medication, it really affected his appetite and his sleep. And so it was almost a no-go for him because those two alone just made it unbearable, even if there was benefit on the medication side. So does that happen? Is that typical? And what can a parent do in a situation where maybe there's a, you know, medication that's interrupting that sleep process or some other outside issue that's coming up that's causing that sleep to be interrupted?

DR. AMY: Yeah, and it's kind of a double bind that we see right when we put kids on stimulants and I'm not anti-medication. Please don't hear that at all. But it is a lot of trial and error with stimulant medications for ADHD, which ones work the best for your child. And when do you take it what's the minimum dose that they need to be effective? Right? We don't need to hit them with the highest dose. If a tiny dose is actually helping, right? And then what time of day, you know, is, is it going to give them the most benefit, you know, so that they can get through the school day without impacting their sleep in the evening. And so, sometimes kids that are on the extended-release medications, it does last too long for them and it will. I mean, that's a central nervous system stimulant. So of course that's going to have an impact on sleep for people who are sensitive to that. So knowing that, maybe that child would need one that isn't extended release. You know, or maybe the dose is too high, or maybe your child is just super sensitive to stimulants. And so maybe that is not the right type. Because there are other types of ADHD meds too, not just the stimulant medications.

SANDY: You had talked about that car wash effect of just cleaning out the toxins, but what about that effect, or kind of how the brain processes memories when we sleep? Because that's also really important too, right? 

DR. AMY: I love, yeah, I love that question. So sleep actually helps us consolidate memories in the hippocampus. And so that's why, if we pull an all-nighter studying, we may be able to do well on the test the next morning because we're still awake, but we aren't going to be able to remember that a week later because after we've learned, we need to sleep so that our brain can consolidate what we just learned. Right? So that they can our brain can bank that away in our long-term memory. And so sleep absolutely is essential. That's why I always recommend, “Hey, study until bedtime. And then go to sleep for the best performance and long-term retention of what it is that you're studying.” And even a nap will help.

SANDY: I love that. That's so cool. It is cool. 

DR. AMY: I mean, our brains are so intelligently designed, right? Like God obviously knew what he was doing. 

SANDY: Well, and I think I heard, I think, I don't remember if it was in another podcast that we did or a conversation you and I had, but you know, the brain is actually more active when we're sleeping. So, and that's just something we don't really think about. Like it's, it's actually doing a lot of work while, while we think we're resting, you know, all that blood flow and oxygen and while our bodies are taking a rest, all go to the brain so that the brain can reorganize and, you know, bank away those memories and put things where it needs to go and clean out clean house so you can have a fresh day the next day. 

DR. AMY: You got it. 

SANDY: I love it. I love it. What's the next one? So, sleep, really important. What's the next pillar?

DR. AMY: Okay, so the next is physical activity. I typically will use the word exercise, but that people have like a visceral response when we say the word exercise. So, physical activity, especially when we're talking to kids, right? Like I mean running around and playing in the backyard isn't how we would like—we don't have to say that's exercise, but that's physical activity. But as we get our heart rate up, so get into the aerobic zone, you know, whether that's actual participation in after school sports or just general playground tag, if we can get our heart rate up and get into the aerobic zone, then our brains produce a protein that we have abbreviated, BDNF, that's short for brain derived neurotropic factor. And simply, it's like miracle grow for our brain. And so, in that aerobic zone, our brains are producing this BDNF, and that actually helps our neurons communicate and grow. So, that exercise is super, or physical activity is super important, especially for kids with ADHD, because we know that neurotransmitter function is compromised in ADHD. And remember, neurotransmitters are those chemicals that help our neurons communicate with one another. And so BDNF helps that communication. So any leg up that we can give our kids, we need to give our kids. And so by encouraging and creating opportunities for them to participate in some sort of physical activity every day is really important for their brain. And so that's another question that I would ask. Do you think my child has ADHD? Well, let's talk about sleep and let's talk about how much physical activity they're getting. 

SANDY: Does that affect the hippocampus as well? Like the BDNF and just really, again, in that memory, part of our brain to help build stronger connections if we can really utilize our body to help get things happening in the brain?

DR. AMY: Yes, actually, that's a really interesting question. So, we used to think that only new neurons were capable of being generated in adulthood in the hippocampus, but there's some new evidence that suggests that they can be generated elsewhere as well. And that BDNF is essential for that process. So it doesn't necessarily discriminate.

SANDY: Right. 

DR. AMY: Cool. Miracle grow!

SANDY: I had heard a podcast one time where they were talking about, you know, exercise and it helps. I guess, keep that hippocampus nice and fluffy is the image that they gave, which I thought was a fun image to, you know, as we go old, we were on a nice, fluffy hippocampus. So the point of that podcast was even as we age, we need to be exercising because that BDNF is so important throughout your life, not just if you're a kid and you're developing. So, you know, thinking about even going into our senior years and wanting to keep that BDNF working in our brain and keeping a strong hippocampus as much as we possibly can so that we can have the most independent, lively senior hood that we, that we want. Right?

DR. AMY: Yeah, absolutely. And with ADHD, there's some evidence that suggests that the size of the hippocampus as measured by brain volume is actually smaller in ADHD. So anything we can do again, to get our kids to a benefit, that would be it. And also, we think of the hippocampus as just responsible for memory, but there is some evidence that suggests that it helps with reasoning as well, especially because the hippocampus creates sequential memories. First you do this, then you do this, then you can do this. And so we need those sequences, right? When we're thinking or reasoning through how are we going to complete this task, right? How do we plan for this task, what comes first then what do we need to do? And so that's super important because we know that the connections to our prefrontal cortex are disrupted in ADHD. Again, anything we can do to help those connections and increase volume in the hippocampus—super important. 

SANDY: I'm glad you brought that up because you know one of the primary things that you hear that when people struggle with ADHD is that executive functioning that inability to do sequential tasks to know where to start, what to do next, how to make that plan. So that's really fascinating to kind of think about how that process that you're describing, that is what executive functioning is. 

DR. AMY: Exactly, exactly. And so if we can't remember … So, and this is the thing, like you don't necessarily know how to do that exact task if you've never done it before, but we're able to recognize patterns. So we can say “Hey, I've done a similar task this way. First I did this, then I did that.” And so then you can apply a similar task to the current task, right? When you, when you have that sequential memory and that ability to access the sequential memory. 

SANDY: So it's interesting, you know, that green time, that being outside, being busy, not, you know, not necessarily, you know, doing jumping jacks, but being active, climbing, running, walking, just being active for kids, super important, but also highly individualized, I would think as well. You know, some kids are going to need more, more than you think you. You talked about your son running circles around your house. I had an assessment yesterday and I was talking to this young man and he was, I was asking him what he loved about school and he said he hated everything about school. And I said, why? He said, “Because I live to be outside.” Right? So I can only imagine. That in that family's household, you know, here they have a child who literally would live outside that they have to bribe to come back in the house, probably to eat and bathe and sleep, but would rather be outside at any given point. Whereas, you know, you might also have a child that getting them to go outside would be really, really challenging. They that's just not in their wheelhouse. They have no interest. It's too hot. It could be sensory related or anything like that. Do you have any suggestions for someone who has a child that getting them to be active when it’s actually a challenge?

DR. AMY: Yeah. And again, you know, you said how you kind of have to individualize it. So we know that the reward system in the brain of kids with ADHD doesn't respond the same way that a neurotypical brain responds to rewards. And so it's hard to find what motivates children with ADHD. And so you kind of have to look at what they are doing already and build on that. And so a child who likes to read, then let's suggest that they read in the hammock outside. Right? So it's a gradual process of and these are two different things that we're talking about green time and physical activity, right? There's an amazing body of research and I'm not an expert on it, but there's an amazing body of research on green time and ADHD. And the hypothesis is, you know, that the ground, exists in a frequency that helps reregulate a dysregulated nervous system just by being barefoot in the grass or barefoot on the sand at the ocean. And so, you know, the nervous systems, which I'll talk about in a minute, too, are dysregulated even more in ADHD. So that green time can really be helpful in kind of calming that nervous system down. So back to what I was saying. Any indoor activity that they like to participate in, try to bring it outside. If you can make a race or a contest out of it, you know, that might help make them active. I mean, kids like to be competitive like that, or some kids like to be competitive like that. So again, you have to know your kid, but motivation is going to be an issue. Like, and there's no magic bullet to how to motivate your ADHD child. So we have to come at it from the approach of how do we make their bodies as healthy as possible? How do we make their brains as healthy as possible, given the struggle, but given, you know, the pathology that we're fighting against in ADHD? So that then those other things can fall into place a little bit easier. I'm not sure I answered your question, but it sounded good to me. 

SANDY: I was just thinking, you know, you know, as a parent, both my kids were, well, my son for sure was an outside kid. So he wanted to be busy all the time. As he got older and more into video games, it was a little harder to encourage that outside time. But my daughter was definitely, what I would call the hermit. She would go, she would find the most secluded spot in the house and do her thing. She would read her books or watch a show she enjoyed or, you know, whatever. And so, you know, it was just, you know, maybe having it as a family thing that we do together would be an encouragement of like, “All right, we're all gonna go outside and eat dinner.”

DR. AMY: Absolutely!

SANDY: “We're gonna have a picnic.” I would try to plan things when they were little so I would ensure that they were at least outside a little in the day to have that time because it is so important. And we were talking about the grass and the earth, but the sun as well, just getting that vitamin D. All of that is super beneficial and growing the brain and helping. Hoping skills grow. So I love that. Let's talk about nutrition. That's your third one, right?

DR. AMY: Okay. So when a parent asks me, do you think my child has ADHD? The first question I'm going to ask is, “Tell me a little bit about their diet.” And when I say the word diet, I mean, what are they eating, right? Not how much are they eating, but what are they eating? Because we know that sugar is inflammatory. So sugar creates inflammation in the body, right? That is a known fact that sugar creates inflammation in the body. Well, we forget that the brain is attached to the body. So if the body is inflamed, so is the brain. And so diets high in sugar that are creating inflammatory responses in the body are also creating that inflammation in the brain, which makes it harder for neurons to communicate with one another. And so, if you tell me that your child eats a very-high-sugar diet, the first thing I'm going to say is, “What can we do to reduce some of that sugar to see if any of the behaviors that you're seeing improve?” So number one is sugar. There is some really interesting research on the neurological manifestations of gluten. So we know that people with celiac disease like myself, you know, can't eat gluten. People who are gluten intolerant shouldn't eat gluten, but anyone with a brain probably shouldn't eat gluten. We all have a brain. Therefore, we probably shouldn't eat gluten. So that research is super fascinating. The simplest way to explain it—this is not very scientific in how I'm going to explain it, but the simplest way is that gluten binds to neurons. So then it keeps the neurons from being able to communicate effectively with each other. So if we can reduce gluten in the diet, then we may be able to see some improvement, in those ADHD symptoms that we're seeing as well. Whether it's actually ADHD or just symptoms that look like ADHD, reducing gluten and sugar in the diet might make them improve. And so I always suggest follow a 90-10 rule. 90% of the time, eat low sugar, low grain. 10% of the time, let them eat cake, right? I mean, because unless they have gluten intolerance or celiac disease, there's no reason to not let them have treats once in a while for sure. So related to that, a question I would ask is, “Does your child have food sensitivities or food allergies?” And if you haven't had your child tested for food sensitivities or food allergies, and you're seeing symptoms that look like ADHD, I would absolutely say, ask your doctor about being tested for food sensitivities or food allergies. Because when we eat foods that we are allergic to, it creates an inflammatory response in the body, and then that shows up as lack of focus, lack of concentration, low energy, things that look like ADHD, but might not be.

SANDY: So you're saying that could really mask by giving off ADHD symptoms, if there's some nutritional things that we're maybe unaware of or not addressing. 

AMY: Absolutely. So my best friend is a clinical neuroscientist. She actually has gone through three doctoral programs. So super smart, right? Super smart. And I know when she has put milk in her coffee. Because she's allergic to milk and she cannot put two sentences together afterwards. And I'll look at her and go, “Did you put milk in your coffee this morning?” She loves it. She loves milk in her coffee, but she's allergic to milk. And so then it produces this response, this inflammatory response, and she's unable to function. I wish I could record it and share it with the world. Anyway, so food sensitivities or allergies can absolutely create symptoms that look like ADHD. And then, oh, did you have a question about that? 

SANDY: Nope. I'll follow up. You go ahead. 

DR. AMY: Okay. And then, um, most physicians who specialize in treating ADHD will recommend an omega-3 supplement. So every cell in our body needs omega-3s to function. And so, talk about really helping neurons communicate well. Omega-3 supplements are absolutely essential for that. And many Americans are low on omegas and that's an easy blood test to find out if you're low in omegas. So if you are low in omegas, then that will show up as fatigue. Lack of focus, inability to concentrate, so that could also mimic ADHD. And then on the flip side, can that help ADHD symptoms? Absolutely. So that's, that would be my next recommendation. Talk to your pediatrician about testing for Omega 3 deficiency and what your pediatrician would recommend that supplementation would look like.

SANDY: Is there any research out there about mineral supplementation? That seems to come up a lot in some things that I've listened to or read, especially things like magnesium, you know, can go into the whole thing that our soil is depleting all that whole argument that we need all those minerals. Is there anything out there that we could look at that can kind of help us to see about, maybe our child has some mineral deficiencies that we need to address as well. 

DR. AMY: Yeah, again, that is an easy, just comprehensive metabolic panel that the pediatrician can run to see, you know, where are they in magnesium, calcium, potassium, all of those essential minerals. Because if you are deficient in essential minerals, yes, you are going to see that show up as brain fog. 

SANDY: So I love that that you hit food first in your first question that you asked a parent. Is there a reason why you hit food first? Is it because of that masking piece or does that feel like the easiest pillar to hit? So let's look at that first. 

DR. AMY: It is one of the most likely reasons that we're seeing symptoms that aren't really attributed to ADHD. So, let me, let me actually rephrase that. So, the food issues—so food intolerances and food allergies—will show up or can show up like ADHD when it really isn't ADHD. And food allergies and food sensitivities can exacerbate a true case of ADHD. So your child has it for real and they're eating things that they're allergic to or sensitive to will make this— it can make the symptoms worse. So, yes.

SANDY: Turning the dial up, right? Yes, I've got an issue, but we've cranked the dial way up to 10. 

DR. AMY: Yes. Oh, and I probably should have mentioned my clinical neuroscientist best friend does have ADHD. So when she drinks milk, it's off the charts. Right? And it's not necessarily the easiest pillar to change because nobody wants to change how they eat. It's intractable. People are just, this is how I like to eat. I don't want to change. It's why we have a diabetes epidemic in America, right? Because we don't want to change how we eat. And so… And you can't make your kid change how they eat unless you're willing to model that, right? So as parents, we have to be willing to commit to a low-sugar, low-grain diet in the house, right?

SANDY: And it's so hard. I mean, that's why I asked because I know getting nutrition, especially if you have an autoimmune issue that you're dealing with, not just ADHD, but just trying to like, you know, figure out how to eat foods that don't have sugar or gluten in them in the American diet is really overwhelming. It's so hard without just going raw or organic. You can't. You know, you really do have to do the circle at the grocery store. You can't do anything in the center. Like everything in the center is going to have sugar or gluten in it. 

DR. AMY: Yeah, right. You have to eat proteins, fruits and vegetables. Proteins, fruits, vegetables, nuts, things that occur naturally, except for grains. I mean, grains are natural. We've just adulterated them in America, right? Like we have changed them so that they have a higher gluten content than they had 100 years ago for sure. And so it makes it even worse for our bodies and brains. So yeah.

SANDY: It can get into a wormhole real fast. Nutrition is hard. But it's so important. So I love that it's one of the pillars that you look at. What's the fourth one? 

DR. AMY: Okay. So the fourth one is chronic stress. And so I actually don't have to ask the question to a parent who says, “Do you think my child has ADHD?” I don't have to say, “Is your child under chronic stress?” Because I know their child is under chronic stress. It is the way childhood is, right? So the amount of homework that schools assign to young children creates stress. The busyness that we create for our own kids by having them in activities every single day creates stress. And if your child is struggling to learn with either a diagnosed or undiagnosed learning disability or just learning struggles, that creates stress. And the brain responds the exact same way to this chronic stress as it does to trauma. So I pause because that's a really big deal. So we know that our brain has this really cool threat-detection system. Our senses take in what's happening in the world around us to tell us if we're in danger, if there's a threat, right? Is there a predator in the bush behind us, right? So that then our body goes into this fight, flight, or freeze mode to maximize our chance of survival from that predator in the bush behind us, right? We have to be able to run from the bear, fight the bear, or play dead in front of the bear, right, to maximize our survival. We don't think about that same process occurring in our brains from chronic stress, but it does. So the stress that our children are experiencing because learning is too hard, right? Because they're hurried, because they have too much to do and not enough time to do it in right? Their little brains get stuck in that fight, flight, or freeze mode, right? They've got cortisol and adrenaline coursing through their veins. It shrinks their hippocampus. It interrupts the connections in their brain and really makes it that much harder to learn, to focus, to pay attention, to make good decisions. I kind of like to use a trauma therapy analogy. And so when we're in fight, flight, or freeze mode, it's like being the Hulk, right, from Marvel Comics, the big green guy. In Hulk brain, right, you're just fighting, right, you don't think clearly. So, being able to reason and think clearly has to happen in Bruce Banner brain, the alter ego of the Hulk, right? So we can't learn or pay attention or make reason decisions in Hulk brain. And so that's what's happening to our children who are chronically stressed. So the question then is, what do we do for our kids, right, to help increase their resilience to this kind of stress? And so one of the ways is that we can teach them mindfulness and grounding and breathing exercises that help regulate their nervous systems. And when we can get our kids in a state where they can regulate themselves—until they can, we have to help them along by co regulating them, staying calm ourselves, modeling breathing exercises. And so, when we can get them into a regulated state, then we can assess whether those ADHD symptoms are real ADHD symptoms or just the result of living in chronic stress state in Hulk brain.

SANDY: So when's a good time to model that mindfulness and chronic stress? Because I'm assuming it's not in the middle of a Hulk brain episode. 

DR. AMY: Absolutely. We have to make this a daily practice. So, you know, if you're a homeschooling parent, you can just roll this into your daily curriculum, right? It can be a health lesson or a PE lesson. If you're not a homeschooling parent, if you are sending your kids to school, spend the first five minutes of the day in a mindfulness or breathing exercise or grounding exercise practice with them, right? The easiest one to do is the sigh, right? So you literally are gonna breathe in and then let out a really long sigh. The exhale is more important than the inhale, so you want your exhale to be longer. And that activates the parasympathetic nervous system, which presses the brakes on that fight, flight, or freeze mode that your kids are living in if they're chronically stressed. And so, there is nothing magical about which mindfulness or grounding or breathing exercises to do. You can Google mindfulness exercises for kids and you will get a thousand hits. All of them are good. All of them. You can buy cards on Amazon. I don't get proceeds from anything I recommend. So you can just Google “mindfulness card deck for kids,” um, and then just play around with them, right? Do a couple before bedtime, do a couple in the morning and then—

SANDY: I love that idea. I love that idea because then it takes the pressure off like, “Ooh, let's try this one today.”

DR. AMY: Absolutely. And so what that does is it gives your child's nervous system a break from that cortisol and adrenaline coursing through their veins. Right? Will they still get upset? Absolutely. If they really have ADHD, will they struggle to regulate their emotions? Absolutely. But this will give their bodies and their brains a little bit of a break, right? By pressing the brakes on that fight, flight, or freeze mode a couple of times a day. And as you lower those cortisol levels, it takes less and less to throw you into that fight, flight, or freeze mode, right? So it's, I like to just say this, you know, makes your resilience bucket bigger because that stress is going to be there. Right? Like, it's really hard to reduce the amount of stress, but what we can do is increase our child's capacity for dealing with it. So mindfulness, grounding, and breathing exercises.

SANDY: And we need to practice a lot, right? Repetition is the key. Because you're not going to use something that doesn't come automatically to you. You're not going to sigh if you haven't practiced sighing a thousand times, right? And exhale, right? 

DR. AMY: Yes. And so, you know, with my teenage counseling clients, I encourage them to take a photograph of two or three of those cards with their favorite exercises on them and keep it on their phone so that if they find themselves getting upset or worked up at school, then they can just pull that up on their phone and run in the bathroom and do a couple of those. 

SANDY: I love it. I love it. What's the last one? We've almost got all five in.

DR. AMY: Yes. So the, the last pillar is cognitive skills. All right. What are cognitive skills? 

SANDY: My favorite. 

DR. AMY: Right. Right. This is the space that we, that we work in. Right, Sandy? 

SANDY: Yeah, exactly. I live here, so this is me. 

DR. AMY: So cognitive skills are those underlying skills. Brain skills that we use for thinking and learning all day, every day, all of us. So working memory, long-term memory, processing speed, visual processing, auditory processing, reasoning, attention. Those are the skills that we need to process information. It's what our brain uses and most of us have one or more cognitive skills that need to be strengthened. And when we have a weakness in one or more of those cognitive skills that we need to use all day, every day, then we struggle. Right? We will struggle in thinking. We will struggle in learning. We will struggle to process information quickly enough. You know, and those show up in everyday tasks, not just schoolwork, right? So my struggle has always been in visual processing. And so, I have a hard time with maps. I have to actually turn the map in the direction that I'm actually driving, right? I can't figure out unless I'm going in the same direction that the map is facing, then it's really difficult for me to process that visual information. So that's just kind of one example. All right. My colleagues and I did this really big study a couple of years ago, about five years ago, on more than 4,000 people with ADHD. We created profiles of their cognitive skills using a gold-standard IQ test that measured each of those skills. And we plotted them on a graph across age groups from age 4 through age 40. So all had been diagnosed with ADHD. And what do you think we should have found? Like what do you think we were going to find?

SANDY: Oh, attention skills. 

DR. AMY: Right. That's what we were expecting to see across age groups that the lowest cognitive skill was attention. But it was not. Attention was average. Average. Working memory, long-term memory, and processing speed were the lowest cognitive skills across the lifespan in ADHD. And so what that says to us is that when we only look at interventions that target attention, we are missing the opportunity to really impact what's happening in the ADHD brain. It's not just about attention. And so that was huge. I mean, now. As cognitive training researchers, as cognitive training clinicians, we know that we need all of those cognitive skills right in order to impact thinking and learning. But to see that as the profile and ADHD was really telling. And so, that is the other pillar. Right? Where I always encourage parents to get their kids cognitive skills tested and when they discover that there's a weakness in something besides attention, then we have to come up with an intervention that strengthens those weak cognitive skills. And so, in our world, that's brain training, right, where we work one on one across the table with every client, children and adults. And we have over 100 different training exercises and those hundred different training exercises have 10 to 12 different variations each. So we have a thousand different hands on activities that we can do to help strengthen and remediate those cognitive skill weaknesses. And we make it fun, right, Sandy? I mean, it's hard work, but you know, we make those activities game-like so that it keeps kids engaged. You know, we set them to timers or metronomes so that we can gradually increase processing speed, really engage those attention skills, and here's the cornerstone, I think, of how this helps kids with ADHD. Not only are we remediating those other skills besides attention that are weak, but we don't remove distractions. Like, what is the first thing that schools do on an IEP or 504 plan for kids with ADHD? They put them in a quiet room for testing. They give them preferential seating that removes distractions, right? They stick them right in front of the teacher so that they don't interact with the other kids. Well, then they get out in the real world and they haven't learned how to pay attention amidst distractions. We don't live in a vacuum. We don't go to school in a vacuum. We don't work in a vacuum. And so what we do in our programs is we train in big rooms. Lots of people, right, in a big room, lots of different training stations, lots of different metronomes ticking, voices moving, so that kids can learn how to pay attention amidst distractions. Because that's what the real world is. 

SANDY: So what I'm hearing you say is that a lot of times our approach in education is to help a child compensate or accommodate this weakness, right? So, that in and of itself is helpful and the survival of working through—living through a classroom setting. However, that's not addressing the problem. Am I hearing that correctly? 

DR. AMY: Exactly. How does putting a child in a quiet testing room improve their processing speed? How does it improve their working memory? How does it improve their attention? It doesn't, right? It just removes distractions to make it a little bit easier to take that test. And I'll give you that. In the absence of an intervention, that kid probably needs to be in a quiet testing room, right? Because they haven't had their weak cognitive skills remediated. So I'm not saying that's bad at all. Of course, they're going to need that accommodation. But if we want to fix the root cause, right, which is those, that collection, that cluster of weak cognitive skills, then we have to do an intervention, not just an accommodation. So exactly right. 

SANDY: So I know someone's going to come and ask us this question because, you know, I'm pretty active on TikTok and every once in a while I'll get a comment in my comment section that says you can't move working memory. “Working memory is static or processing speed can't be addressed. Those claims are false.” You know, what would you say? To that ccommenter because we know that to be untrue. We see it every day. And maybe there's research in the past that has skewed kind of the thinking on this over the years. So, I would love for you to kind of share what you think about those two, because they always come back with, you know, “No, working memory can't move and neither can processing speed,” which I think is such a terrible kind of hopeless position to be in. I hate that. I hate that thought. Of course, you can improve those skills. They're just skills, but I'll let you have the floor. 

DR. AMY: Yeah. So I would like to just land on the fact that we have worked with more than 120,000 children and adults, and I can look at those test results and absolutely tell you that we can improve working memory, long-term memory processing, speed, attention, and every other cognitive skill, including overall IQ score that we have improved with these many, many, many thousands of clients. But what I can really land on is that we have 42 research studies, 17 of which have been published in peer-reviewed medical and psychology journals that show we have improved working memory, long-term memory, processing speed, and every other cognitive skill that we've talked about. And so it's really difficult to argue with published scientific research. And so that would be my response. Well, let me show you the research that shows that those skills have been improved by what we do by brain training.

SANDY: There's just so much. In that time[WBT1] , I'll probably edit this part out because my brain just went, but I just When I think about, you know, helping families, I do just think there's this pervasive misunderstanding about cognition and when you get an ADHD diagnosis that that's a full stop. When they're, I love that we're thinking of this and pillars that that is a diagnosis, we know that there's a problem. But now we've got tools and things we can key in on and look at to see how we can help ourselves or how we can help our loved ones. That it's more than just the diagnosis. There's lots of different ways we can tackle it to be our best self as we're functioning day to day in the world.

DR. AMY: Absolutely. I mean, that is absolutely a message of hope, right? And it's the phrase that I say all the time, “We are not stuck with the cognitive cards we've been dealt.” Right? Like, that's what neuroplasticity is; the brain's ability to change with targeted experience. And so it's really fascinating to me that people argue against neuroplasticity when that's science. That's science. 

SANDY: Why don't you think that our schools employ this kind of approach? I get that question a lot of, you know, well, we'll see what the school will do to help. And I, you know, I try to let me say, um, that's not their paradigm. That's really not why or how they function. They've got a different, they've got a different purpose in the world. But, you know, I always get the feedback of, well, this should be in every public school. What would you say to that? Because it's a little more complicated than, you know, injecting it into a classroom setting because it's a hard, these are hard things to do, and then the classroom setting, it would be really challenging. But what would you say to that? 

DR. AMY: Yeah, I find that interesting as well. So that's to me like saying, “Why is the school not treating anxiety? Why is the school not treating diabetes? Why is the school not treating a broken arm?” That's not their job, right? Their job is to impart knowledge, subject-matter knowledge upon children, not to remediate weak cognitive skills. Not to treat diabetes. Not to treat a broken arm. Not to treat anxiety and depression. And so, because it is an intensive intervention delivered one on one, that would be super difficult for schools to find that time during the day, that number of interventionists during the day, and you have to take away from instructional time, right? This is an intervention that happens in addition to subject-matter instruction, right? So if we take them out of their reading class to remediate working memory, then they're missing reading instruction, right? Which, oh, by the way, we do have a reading intervention. But again, that's in addition to the school's instruction. And so that's really the core of why I don't think schools could even have the capacity to do it. It's just not what they do. It's what we do. 

SANDY: That's probably a good point to pause and we should probably read a word from our sponsor. So bear with me. I'm going to switch gears. 

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SANDY: We could go on about cognitive skills forever. So let's pause there. Amy, what would, what are two things that you would want to have parents have as a takeaway from today's podcast about those five pillars of ADHD? 

DR. AMY: Yeah, I think the first is that we have to come at ADHD holistically, both in how we determine, is this really what's going on with my child, and then on the other end, if this really is what's going on with my child, I need to come at this holistically to maximize my child's ability to succeed, both in school and in life. Right? And so to be able to look at each of those pillars and say, as parents, “What can I do to help improve each of those areas so that my child struggles less?” Right? Because we're not going to be able to take away that diagnosis. Right? We just can help them function better despite that diagnosis. Like I said, my best friend is a clinical neuroscientist who's been through three doctoral programs with ADHD. I have a PhD. I'm working on a second doctorate with ADHD, right? So ADHD is not a recipe for failure, right? It's just, what do we do to make it a little bit easier so our children can succeed despite those struggles. And so those five pillars are the things that we should look at as parents. And even if you're an adult with ADHD listening to this right now, check those pillars in yourself and go, “What can I do to make my life easier?” So that would be the first thing. 

SANDY: Yeah. I love it. Yeah. 

DR. AMY: And then the thing is, I just want to reiterate that there's hope, right? That this is not a diagnosis that we should just stop dead in our tracks and say, “Woe is me. Woe is my child. I'm stuck with this” and use it as an excuse, right? Like we can take action for our kids, for ourselves. So it doesn't have to be a negative. It's just a challenge to overcome.

SANDY: Beautiful.

DR. AMY: All right, Sandy, thanks so much for having this conversation with me today. I'm really excited that I was able to share this information and my work on our podcast and not just, you know, as a guest on other people's podcasts. So listeners, if you want more information about me and what I do, my personal website is amymoorephd.com. But my professional work website, where you can learn as much as you possibly want to learn about brain training and how brain training can impact ADHD, you can go to learningrx.com or call 866-BRAIN-01 and then you can get connected with a LearningRx Center like Sandy's and find out more about that.

Also, we would love it if you would find and follow us on social media as podcast hosts. So you can find us at The Brainy Moms on every podcast platform. And we will put those links and handles in the show notes. So thank you so much for listening today. Again, if you liked us, follow us, do it right now before you forget. And, if you would rather watch us, we are on YouTube. You can find Sandy on TikTok at the brain trainer lady. We're all over the place. So if you want to find us, you can find us. That's all the smart stuff that we have for you today. We'll catch you next time. 

SANDY:Have a great week.

 [WBT1]I think Sandy wants to edit this out.

 [WBT2]Garbled audio here