Hi, and welcome to the ADHD Kids Can Thrive podcast, real talk, practical tools, and hopeful stories for parents and educators supporting kids with ADHD.

I'm Kate Brownfield, your host and a certified whole person and ADHD parent coach.

It's my joy to bring you advocates and experts in ADHD to help you on your own journey.

For resources and coaching, visit ADHDkidscanthrive.com.

Now, please enjoy this conversation.

Hi, I'm here to introduce you to Dr.

Blaze Aguirre.

He is a child and adolescent psychiatrist.

He has been a staff psychiatrist at McLean Hospital in Massachusetts since 2000 and is nationally and internationally recognized for his extensive work in the treatment of adolescent mood and personality disorders.

He serves as the lead psychiatrist for the Mood Tools app.

It's a free app available to download on both iOS and Android that aims to empower tweens and teens to manage their intense and confusing feelings with effective, simple tools to build long-term emotional resilience.

Dr.

Blaise specializes in dialectical behavior therapy, otherwise known as DBT, and through his work with the Mood Tools app, he hopes to bring valuable tools to a broader audience of adolescents, empowering them to manage and navigate difficult emotions.

We're going to dive in and kind of talk a little bit to get us started on this conversation about the Mood app that you've developed, along with some others, and the support of helping teens grow.

Adolescents in becoming more aware of their mood and maybe get some strategies that can help them during the hard days.

So let's start with, can you just tell us a little bit more about that project and what mood.org is trying to do and where the focus is?

You know, first of all, thank you for having me on your show and incredibly grateful for all the ideas and wisdom that you share with your audience, bringing on guests that may be able to help in ways that they do.

So thank you again.

So maybe if I go a step before the mood app, and that is I work at a hospital, at Harvard's largest psychiatric teaching hospital, known as McLean.

And what we see is a lot of young people who struggle with all kinds of emotional dysregulation, meaning that they can't control their emotions, they don't control their sense of self, they can't control their behaviors, they can't control their relationships.

And we run a program for kids and teach them the skills that they need in order to be able to manage.

And it starts off with the idea that But someone who is, for lack of a better word, misbehaving, it's not that they wake up in the morning and say, you know what, today I think I'm going to misbehave.

It's that they don't have the skill set to be able to manage difficult situations for them.

And so rather than assuming that they are intentionally trying to misbehave, it's assuming that they don't have the skill set.

So the compassionate thing is to actually teach them the skill set.

Now, because my program is a very, what we would call high-end program.

And by that, I mean it's sort of when children are doing a lot of self-destructive things, including things like cutting and self-injury, the level of attention that they need is very, very high.

So you have a lot of psychologists and psychiatrists trying to teach them these skills, as well as some medication use.

But it seems to me that we lost something along the way.

And that is that we're trying to teach these kids these skills in moments of crises when things have gotten really, really bad.

And when Jane, who really was the person who spearheaded, Jane Hoffman, the person who spearheaded this project, and came to me and said, what do you think about developing an app where parents and kids can begin to think about some of these skills way, way, way before they need, expensive psychiatric care or way before, you know, even if you can find a psychologist, good luck with that.

Yeah.

Because there are very long wait lists and there's insurance issues.

So it was the idea of.

Beginning to introduce at a non-crisis level, non-clinical level, the kinds of tools and skills that kids, if they were able to use them, would probably never need my program in the long run.

So that's what the thinking was.

Yeah, that's fantastic.

And so listening to you talk about this in more detail now, I mean, this would be something even for like a small child to do with their parents, right?

And just really start laying the foundation for.

Thinking about your feelings and your emotions and how you're internalizing all of that and really building the skills over your whole life, right?

Exactly right.

See, one of the things that I hear parents complain about is how tied their children are to their devices and how distracted they are.

But I look at the parents and they're just as tied to their devices and as distracted.

And maybe they didn't grow up with none of us who are of a certain generation grew up with these devices, so maybe we're less distracted.

But most of us are just as distracted.

I see parents who end meetings, who immediately pull out their iPhones, their iPads, their mobile devices, their multitasking.

And so there's an irony to this, that yes, 100%, this is a tool for children.

The irony to it is that if the parents do it alongside with their kids, it's doing two things.

One is helping the parent as well.

And two, it's modeling the kind of behavior that is going to be helpful for the child.

Because how many times have I seen parents on devices telling their children to get off devices?

Saying, you know, you're on your device all the time.

And saying, okay, but...

You know, I had a doctor once.

and this was before I got into medical school and I was thinking of having, maybe experimenting with cigarettes and I'd go into his office and he'd be smoking a cigarette and he'd say, Blaise, you should never smoke.

You know, okay, modeling that.

It's having a parent on a device and saying, get off your devices.

So if, you know, now, I mean, here's another part of the irony is that a lot of these tools are actually on an app.

But I think if you could, You look at, learn the skills, learn the tools, do them with your kids in many situations, model for the kids in many situations, model from very early on.

It becomes integrated into the way that they think, in the way that riding a bicycle does, like skipping rope does, like speaking a language does, like playing a musical instrument does.

You know, that the earlier you start to teach the skills, the sooner they become second nature to the child.

Yeah.

And the idea, you specialize in DBT skills, too.

And with the app is, I think as parents get frustrated, right, with the child's behavior, and then the parent reacts, and then the kid reacts, and you get into the cycle.

But all of this is kind of taking, like, externalizing what we're all feeling internally.

In helping us kind of learn the steps.

What feels like a fireball inside, I think, everybody, I don't know how you describe that, but it's kind of taking that feeling and bringing it outside of ourselves, correct?

To think about how we think about our feelings?

To a certain extent is that, I mean, we live in a world where we are reinforced for not paying attention.

And by that, I mean this.

And that is, I mean, we're not reinforced for paying attention to our own mind.

What I mean by that is so many things are automatically done for us.

Our apps tell us how to drive from point A to point B.

Our apps tell us how to make a meal, how to study for a test, etc.

So a lot of executive function skills are taken away, including our ability to pay attention to who we are, how we think about things.

And I mean, how many times do we maybe have a big reaction to our child being out of control or maybe throwing a tantrum and the child throws a tantrum, you then start yelling at your child.

Well, that's your tantrum.

But then think about, wait a second, every time my child throws a tantrum, I start yelling.

What's actually happening to me?

Can I name and label what's actually happening to me?

Can I start to pay attention to what's happening to me?

And then maybe think that my response hasn't actually been helpful in reducing the child's tantrum.

And that maybe I can model a different way of reacting so that this mindless interchange between child and parent doesn't continue.

And that's why I think that having these very easy, easily accessible tools on mute.org or on the mute app, just, you know, it, it, It moves from the automaticity of a tantrum reaction response to, wait, this is our interaction which isn't working.

Let's do something else.

Let's do something different.

Let's do something collaborative.

Let's do something that connects us rather than pushes us apart.

Yeah.

And the idea is so they don't end up in your hospital, right?

Yeah.

That's really what we're all working for, right?

Exactly.

So you don't get to this point of major, major crises and unwinding all of that.

Exactly, exactly.

And, you know, for all of us, we know that learning something much later on in life is a little bit more difficult.

Now, there's definitely neuroplasticity that takes place throughout a lifespan.

People used to not think that that happened.

But that neuroplasticity is much much more vibrant in childhood and adolescence than it is when you're 50 years old yeah you know so so so ideally it becomes second nature i you know i growing up in south africa i never learned how to ski and then at 40 i went to a mountain and you know i didn't know what to do with it it's not intuitive and my kids started when they were three or four and And they're just like zipping up and down the mountain, no problem.

So all of these ideas that, you know, the sooner that you can start to embed them.

But they're not ideas that are luxury ideas.

It's not like saying, well, you know, I have the privilege of learning how to ski.

It's I have the duty to my child and to myself to really pay attention to how automatic I am and to teach the skills for them to regulate and for me to regulate as well.

Because a lot of the conditions that bring children into a hospital, depression, anxiety, personality disorders, was something like ADHD, which you talk a.

Lot about on your show.

Yeah, that's awesome.

Is that when a child is distracted and they're not focused on the things that you want them to be focused on, they're focused on the things that they want to be focused on, now you see interpersonal struggles.

Now you see the child getting frustrated and you're getting frustrated in return.

Now you see inability to tolerate difficult moments.

Now you see people worrying about a future that hasn't happened.

So this is where a lot of the skills on the Mood app that evolve from cognitive and behavioral therapy and dialectical behavior therapy are so useful.

And easily accessible.

And they're fun activities as well.

We wanted to make them fun and easily accessible to both parent and child.

Yeah.

And speaking of the ADHD thing, a lot of these kids can, anxiety becomes part of it.

Depression can be part of the journey as well.

And so I think for parents, this is just useful for kind of learning how to, or helpful tools to kind of help from moving in and out of those kind of moods that may take place so they don't get too serious.

Is that part of that?

Yeah, I mean, I'd love to ask you, like, you know, can working on these kind of things, we're talking about kids with ADHD who may struggle with anxiety, they may be prone to depression.

You know, if you kind of take the steps inside your family to help get a handle on everybody being more emotionally in tune, more regulated, not make.

Everything a big deal.

You know, can you help your child grow up Does this all work if you kind of really do the effort and stack it, right?

Can you have an outcome where your child does grow up to be more regulated?

So the answer, you know, the short answer to that is yes.

But I worry about a slightly different component to this.

Because, so, bottom line, yes.

Bottom line, these kinds of tools with the right medication, if the kid can take it, are very, very helpful.

But there's a deeper problem from my perspective, because I think that all too often ADHD specialists focus on treating the ADHD with medication and maybe some cognitive behavioral tools.

But what is sometimes missed is that the child with ADHD, over time, experiences a certain kind of invalidation.

You're stupid.

You're distracted.

You're lazy.

You're never getting your homework done.

And what happens is that there's an insidiousness to that messaging over time.

And that is that you are faulty.

You're not enough.

You're not good enough.

And maybe somebody then treats ADHD and they're much more focused.

But the damage done by the messaging over time is not easily undone.

And then when you're saying, okay, I want you to, you know, when you're feeling really poorly about yourself, when you have a very poor self-identity, when you've got very low self-worth, you know, doing 10 jumping jacks isn't going to change that.

So I think that part of the problem is not only are these tools helpful in improving, what might be a disrupted relationship between parent and child, but that.

Very early on, the child learns that it can self-regulate, that it can pay a different kind of attention.

The parent has a more compassionate view towards the kid.

They're able to listen better.

And that in the context of all of that, the child then doesn't integrate a false narrative that it's lazy, that it is stupid, that it is not hardworking, that it's got no motivation, it recognizes its deficits and its strengths, and the parent does as well.

So I think that there's a two-part thing.

So yes, these tools help with ADHD and its adjacent friends, exactly.

But it also helps in the long run because a lot of that internal self-narrative, poor self-evaluation doesn't then begin to take place.

Yeah.

Okay, so you are a psychiatrist, so I do.

You're the expert here on what role does medication play in mood?

Yeah.

And where do you, like, what's the guidance for parents who are hesitant to use medication or the other side is they just want to medicate more to relieve all symptoms to zero, you know, so...

So I've got four kids.

Two of them probably had ADHD.

One of them I put on medication.

It was a total night of disaster.

She was very, very, very, very dysregulated.

The other one took the same medication and did perfectly well.

One of the things I like about many ADHD meds, not all of them, is that you're very rapidly going to know whether they work or not.

They're not like antidepressants, which take four to six weeks to know if you're getting some benefit.

With ADHD meds, you're going to know, for most of them, not all of them, there are some that take longer to work, whether they're going to work or not.

So if you give your child the medication, you're either going to know it's helping or it's not helping.

Now, if it's helping, but it's too strong and they're having side effects, then maybe you can go lower the dose.

And or you can say well this seems to be working but it's got these side effects maybe we need to switch to a different kind but the thing about it is parents get scared and i understand that because they hear horror stories but what i'm saying is you're going to know that day or within a day or two or three days whether the child is benefiting or not benefiting from the medication so i always encourage people to listen sometimes they'll say i don't want my child to be on this medication, but I sit here and give me your prescription for five days.

Just do five days.

You will not have to give it any longer because you've run out of medication anyway than if it's helping in your child.

And then what happens is that there's a lot of flexibility.

I had a very prominent student who went to a very prominent local business school, and I gave him a prescription for 30 pills.

It took him all year to use it because he then learned how to, okay, during times of exams, I take it.

During times of deep studying, I take it.

But at other times, I don't need to take it.

So then people learn how to use their medication for ADD, ADHD.

But I think that we have to be, very honest, and we have to be very observant about the impact.

Is the child benefiting?

Are they paying better attention?

Are there mood shifts that come with being on the medication?

Are there sleep disturbances that come with being on the medication?

Has the appetite changed?

Have they become so focused on one task that they're not able to then expand their awareness and think, no, no, no, I'm just studying for this, but wait a second, it's dinner time, et cetera.

So this is where I think a parent has to be very vigilant, very observant, working together with the child, noticing the benefits, the pros, and the cons.

So I think that anti-ADHD or ADHD medication is an integral part of the treatment, but not for all, not for all.

I mean, there are some people who are going to have very bad side effects, who are going to have insomnia, who are going to have loss of appetite so poor that they start losing tremendous amounts of weight.

And I think, you know, the other thing I've seen is a child gets put on ADHD medication, they start to become more agitated on the ADHD medication.

The prescriber then thinks, oh, they're more hyperactive, let me give them more.

And to the point where they're taking so much medication that they actually start to develop psychotic symptoms.

They start to hear voices or feel bugs crawling all over them and stuff like that.

So I think the other part of it is that to the extent that it's possible to be able to work with a prescriber who is attuned, who's interested, who's able to respond in short order to the things that the parent and the child are seeing.

Not, here's the medication, take it for three months, and then come and see me at that point.

That is not, what a child with ADHD needs, a prescribed that can only see them every three months.

Okay.

Well, if you figure it out, though, then you can kind

Of get it out of that.

If you figure it out, then you can do it every six months.

Then it doesn't matter.

But in the beginning, like you really need somebody to be your partner, a psychiatrist who's with you to figure this out.

Yeah.

Or, you know, a psychiatric nurse practitioner.

Yeah.

Okay.

You know, somebody who's qualified to prescribe these medications who can figure it out.

Once it's stable, I mean, there's some people I see twice a year.

Yeah, okay.

Okay, and you find that that can really help improve.

It can if it works, right?

It can really be helpful.

Very, very helpful.

And I think that if I were a parent who was hesitant, I would say, okay, let me try three days.

Nothing terrible is going to happen in three days.

So I've been a psychiatrist for 35 years, and I have not seen a single case where in three or four days of a child on a stimulant has done poorly.

I just haven't seen it.

I mean, I've seen them do poorly.

Let me rephrase that.

I've seen them do poorly, and then the parent has just stopped the medication.

What I mean to say is I haven't seen some sort of terrible event.

The child doesn't become addicted to it.

the child doesn't, you know, have serious consequences to it.

It's short-acting.

And many of these medications, you know very quickly.

And the other thing is that I haven't seen as children become addicted to these medications, if used as prescribed.

Yeah.

Okay.

I got to ask you, what's your take on the Kids who are on stimulants are less likely to become addicts later because the ADHD reign, there is a high percentage of kids who can fall into that addictive pattern.

But did you see the study that said if you are on medication, you're left?

I just want to get your take on that really quick.

You know, here's an interesting study is that there's some researchers who went onto college campuses and they tried to find all kinds of drugs.

So, you know, whether it was opiates, whether it was benzodiazepines.

What these researchers said that within 90 seconds of walking onto a college campus, the one class of medications that they could find was stimulants.

And my son, who's an RA at his college, says that one of the things that they find is a lot of kids misusing other people's ADHD medication because they themselves want to be able to be more focused and stuff.

And so because during times of tremendous strength and need for focus, if they're not being prescribed the medication, the likelihood that they either take other people's medication or use street drugs or other kinds of stimulant medication, either that is concocted on campus or bought over the counter, is very, very high.

And there is no question in my own clinical practice that the children who've been adequately medicated not only stay on their medication as prescribed, they safeguard it when they're on campus.

And those whose parents were resistant to doing a trial of medication are much, much more likely to experiment with other drugs.

So in other words, I know that study.

I'm saying that that study is true.

And at the same time, it's what I see in my clinical practice.

Okay, good to know.

Okay, so I have one more question for you because I know every parent listening is going to want to know this from you.

So when your child is going bananas in the moment, what does a parent do to kind of...

What's the parent's role when the kid's going bananas in that moment?

Yeah.

Well, look, what we would do on our unit is really do a careful assessment.

Because here's the thing is, imagine a room where there's only a parent and a child, and that the parent tells the child something, the child doesn't like it, the child goes bananas.

So that's scenario number one.

Yeah.

Now, in that case, there's direct cause and effect between something that the parent did and something that the child did.

But sometimes, you know, we see, say, a child's upstairs and they're losing their stuff and they're so angry.

But the problem is that it might have nothing to do with the parent.

Maybe they got broken up with.

Maybe the teacher assigned them a pop quiz that they weren't expecting.

So when you don't know, your biggest ally is curiosity and validation.

It's like, hey, what's happening?

Telling what's going on.

But when it's obvious that it's between you and your child, then just a recognition that something has happened.

Like, wow, I said this and you got really upset.

Can you explain that more to me?

But the brain has a system of neurons in the brain.

It's called the mirror neuron system.

Mirror neuron is that.

What I see in another person gets reflected back into my brain.

So if I look at a very anxious person or a very distracted person or a very angry person, those neurons are going to fire in my brain and I'm going to become more agitated, more depressed, more angry, whatever it is that I'm witnessing.

Now, the reason why I'm bringing that up in the context of your question is that when somebody is very agitated, the worst thing that we can do is to escalate it through our own agitation.

So it's, you know, you've got to calm down, which, by the way, has never, ever, ever worked for me.

Telling someone to calm down who's agitated is very terrible advice because no no child has ever said wow that was such great advice i've never thought of it so so the first thing that i do when when somebody with who works with me is very upset is i have to regulate so i have to practice my own regulation techniques me being regulated is an important is a key point the second thing is this.

A human being has to regulate before they can reflect.

You know, right now, Kate, we're having a calm conversation.

But if a fire broke out in your house, we wouldn't be able to have this communication because you would get very riled up.

You'd get very upset.

You'd say, listen, this conversation has to end.

I have to call 911 and all of these sorts of things.

But me telling you, no, wait a second, you made a commitment to me to have this discussion.

It's like, forget about it.

I am going bananas because I'm worried about all the things that are happening.

We cannot reflect.

We cannot use logic.

We cannot use rational thinking if we are dysregulated.

So the first step is to help regulate.

And to help regulate, you as a parent need to be regulated.

But let's just say that you're still struggling with an idea.

One of the quickest ways that we have found to regulate a very upset child is to put your face in ice-cold water.

It calms you down incredibly quickly.

It's the body's way of tricking the brain that things are not as bad as they are.

So if you were at home, one thing that I've done with the kids on my unit is I actually do it with them.

At moments when they're not dysregulated, we all do what we call an ice dive.

We put our face in ice-cold water, and it really.

Calms you down.

When they're regulated, it's just kind of a practice.

Exactly.

Look, we practice for the math exam before the math exam.

We practice for the 5K race before the 5K race.

The time to practice is not in the moment of need.

It's to practice before so that when you need it, it's there.

So when you're dysregulated, then you say, hey, remember that thing that we did?

Let's just do the ice dive.

So that's one thing.

Sometimes that upsetness, that bananas, happens in a restaurant, or a shop, or out in public.

And it's going to be very hard in those moments.

You're not going to say, okay, let's do an ice dive.

But yelling at your child is not going to be the thing that's going to calm them down.

You have to practice for the moments of going bananas before a child goes bananas.

Because once they know that skill, slow breathing, progressive muscle relaxation, self-soothing techniques that we have a lot in the app, the child has practiced those.

And then in the moment of need, they're there.

But if you're saying, hey, I heard this thing that if you do tapping or if you do ice dive or you do slow breathing, that's going to be a great way to calm you down.

The problem is the child can't hear you, and they don't even know what to do because they haven't learned the skill.

So what I'm saying is that, first of all, it's important to practice before going bananas.

So when you go bananas, it's there.

This is a good mantra that we're getting here.

Yeah.

It's practice before you need it.

But that's true.

Think of anything in life where you're deciding that you're going to use a skill set for the very first time when you need it.

You've never practiced playing piano, but you're going to do a piano recital for the very first time in front of people.

You need to practice when you don't need it, so when you need it, it's there.

But in the moment of crisis, if you haven't done this, the best thing that you can do for yourself is to regulate.

So that because you regulated, it's going to be a more effective problem solver than you dysregulated.

When you're regulated, and I know it's hard, that's why you need to practice before you need it.

So that when that moment comes, you're calmer, you see what's going on.

Maybe you have to pick up the child and take them out of the store.

Maybe you can say to the child, hey, there was that breathing technique that we learned.

Maybe you're able to see the patterns of behavior that it's only every Tuesday when I take my child to the store that they go bananas.

When you start to pay more attention, you're able to see patterns a lot more clearly.

And there's some times when there's just nothing.

I mean, there have been times when, I mean, even as a child psychiatrist, my children were really upset.

I just didn't know what to do.

And I just picked them up and took them out.

It was much harder when they were teenagers.

I know, you can't pick them up.

Exactly.

Those are the challenges.

Okay, Dr.

Aguirre, this was wonderful.

As we wrap up, is there anything else that you want to add or share with people?

Well, you know, I truly believe in the wisdom of parents.

I really fundamentally believe that every single parent is doing the best that they can, given their circumstances.

Sometimes parents feel like a failure, but I never see them as a failure.

I see them as, in the same way that I see the kids as not having the skill set, I see parents as not having skill sets.

So if you can have compassion for yourself as a parent, not blame yourself.

You've done so many right things as a parent.

And maybe because you've got a kid who's neurodivergent, who's got learning disabilities, who doesn't think in a very linear way, you weren't taught to parent that child.

And so have compassion for yourself.

Continue to learn.

Continue to listen to Kate's podcast.

Yeah.

And learn everything that you can learn.

And treat yourself with kindness because you're also modeling to your child kindness.

Yeah.

Great.

Wonderful.

Thank you.