Episode 15
#15 | Part 2 Dr Mark Rackley - Running For Relief: Mental Health, ADHD, and The Road To Recovery
As the world grappled with the aftermath of a global pandemic, many of us anticipated a sigh of relief with the return to normalcy; instead, we were met by mental strain.
Marks personal solace? Running! Running became his sanctuary, a beacon of light in regulating stress. In this episode, we unpack the silent struggles that linger and the therapeutic embrace of exercise on our mental health, with a focus on running not just as a physical activity but as a lifeline for emotional stability.
Attention Deficit Hyperactivity Disorder (ADHD) often hides in plain sight, misunderstood and mistagged as mere hyperactivity. We navigate through the hase of misconceptions with guests who share intimate battles with the condition, revealing the profound impact it has on attention, emotional regulation, and, ultimately, life itself.
The conversation then pivots to the problems of those within the NHS system, waiting for a diagnosis or treatment.
Finally, we tread carefully into the dialogue surrounding medications for young people with ADHD, a topic both delicate and crucial. This is about more than just pills; it's about understanding the developmental nuances of a condition that can infiltrate every aspect of life.
--------- EPISODE CHAPTERS ---------
(0:00:00) - Mental Health Challenges During Tough Times
(0:03:54) - Challenges and Treatment of ADHD
(0:18:27) - ADHD and Medication Considerations
(0:22:44) - Medication and ADHD Management
#adhd #Treatment #Medication #Exercise #Running #NHS #PersonalizedEducation #CopingMechanisms #Misconceptions #Challenges #EmotionalRegulation #ExecutiveFunctioning #BrainDevelopment #Adolescents #QualityOfLife #Relatability #Connection
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Transcript
It can be hoards really easily. They can find a hard to regulate their emotions. They might have behavioural problems. It can be hoards really easily.
::Having someone to hold me accountable. So in my case it's my dad mainly. He's like Tom.
::It's mad, isn't?
::it.
::Weird times. Do you think there's also a part of it where people expect that once the pandemic ended, that it would go back to being really great again?
::Yes, we think we'd have this massive upward curve of life's going to be really rosy.
::And then the reality hits that actually it's not all that great. So, there's a huge, huge after effect that's going to last a very, very long time. Do you think we expected that to happen and then maybe didn't?
::Agreed, I think, because you look at what kind of we all went a bit mad, didn't we?
::Completely mad. Like book a lot on the holiday.
::Let's get out.
::It's like the spring on Bones and I'll Over the Place. But I actually Interesting question, joe, because the bit of the pandemic which we were all living at the time but we were just getting on with it was we were traumatised.
::Must have been so. It was trauma Must have been. So, coming back to what Tom asked, you about earlier, when we mentioned about being outdoors. You're a big runner, aren't you?
::I'm a big runner, yeah, so I saw it on your page you love your running and being outdoors, do you?
::Is that a recent thing, or is that a?
::No, I've been running for it's my, it's your thing, it's my thing, yeah, I love it. I Running for me is that's how I regulate my mental health. Love that Like it's the best thing for me. It really is, and I'm very protective of it.
::That's your thing, it's my thing.
::I don't run with people. It's Rain or shine.
::is that what you're saying? It's me, yeah, it's me. It's me. It's not rain, I was running in.
::Rio Love it Like enough. It's Because it just works for me, mm-hmm, and if you speak to any of my patients like that, I can hear I roll, here we go. It's talking about exercise again, but the science is so solid, like, the science is top notch when it comes to mental health and exercise, so it's not just running, I like, do anything, mm-hmm, like just get your Get your nervous system energized? Yeah, and it works Like so I practice when I preach.
Love that and I say that to my patients because they watch my videos I was like you're everyone. And I'm like, well, yeah, but I don't do it for, like, I don't wear a smart watch and I'm not trying to clock the pace. I'm not interested in that. It's the regulation, it works for me, so I'm not going to stop someone unless my knees give, which I probably will.
::But I'm not going to stop it.
::I think if you, I think it's the exact same as Meg, my girlfriend. She runs five times a week and honestly, if she runs three times a week she's a different person. I know it sounds so silly to people watching, but it helps her massively. All the stress when she comes back from a run seems to just go. Yeah Well, for me, I feel more stressed out running.
::I'm like I can't breathe.
::But for me other things work. Yeah, but for her running work. They must be the same for you as well. But I see such a big difference in her when she comes back after a run which is amazing. One thing I wanted to touch on as well you said earlier, but you were in the NHS, that's right seven years, seven years. I've been in the NHS for a while. I have ADHD.
::Yes.
::Very bad ADHD, yeah, and I got diagnosed when I was 15, 16. So quite late. That's quite late. But when I went to the NHS there was about a four-year wait, which is just crazy. And if I'm not lucky enough to have parents that could have sent me to go private, I wouldn't. It could be even a bit of an exaggeration. But I generally mean is I don't know if I'd be here.
I was in such a bad place for my ADHD that spiralled out into depression and stuff. There'll be people watching this who are like me but won't have the option to go private. What sort of advice would you give them on that aspect of things, adhd-wise?
::Yeah, I'm sorry to hear that. Sadly that'sI don't know because I'm not in there anymore, but I know, certainly anecdotally, because I treat ADHD and I work with psychiatrists, that I use to do the assessments and they come back to me for the psychological treatment. But it's still a massive problem because the rates of ADHD which is good have gone up. Why say it is? Because we know more about it and more people are being flagged, whereas in the past it was quite under diagnosed and maybe there was a lot of misdiagnosis because people didn't know what they were looking for and also it wasn't so exposed as it is now.
But I think it's very challenging for anyone to have that disorder and not have help and I would think if you could do anything, then try and just get into any kind of support that you can. So if that's like watching this podcast, if that's getting into your GP, if it's getting into charities, whatever you can do. The diagnosis is hugely important because the diagnosis opens the doors then to medication and treatment and in lots of cases of ADHD that's what you need. So I'd say most of my patients with ADHD pretty much all of them they're on medication to obviously help chemically stabilize the brain.
::Is that Ritalin?
::It could be Ritalin, yeah, or they could be on Alvan's or just the other ones which are the non-stimulant ones, so the ones that are more kind of, they take a little longer.
::I had that one as well.
::Yeah, I did Ritalin and the non-stimulant one, yeah so it can be a bit with the meds Not every patient. It's like any medication not every patient respond. You hope they're going to respond well to the medication, but it can be trial and error and sometimes it can take a while to get the right medication for that patient. So while we're getting all that sorted, then that the support comes in with me to help them to understand and to manage their ADD, and then we're pulling into psychiatrists as well. So I appreciate it is challenging and even if you go privately the wait can be up to six months.
::It's a shame. I think one of my biggest pet peeves with ADHD is a lot of people like my friends and stuff are like yeah, I must have ADHD, I'm super hyperactive, it's like me. It's not what ADHD is, but it's quite hard to explain if you don't really know because you just think you're hyperactive or you can't focus for 10 minutes.
::That's a subtype.
::Yeah, it really really winds me up where it's. They can't focus for like more than 10 minutes, so I must have ADHD. It's like it's so much more than that. So for the people who don't know, can you kind of explain some of the main core symptoms and things like that, Because hyperactivity is one of the symptoms of one aspect, but I mean there's so much more to it. Can you sort of give it more of a brief so you could?
::do it way better than I way better than I can.
::We could be here for hours.
::Literally, if I jump into this conversation so I like to break down the letters. So A attention. So the person will have a problem with attention. So that's attention on lots of levels. So they may struggle to focus on conversation. Their mind will drift, they will interrupt conversations, their focus will drift quite quickly even if they're struggling to focus on something. The attention is a problem Deficit. So deficit is that comes into deficit. On a more wider level, so one of the big things and you probably realize this on is the emotion regulation, so the deficit in regulating emotions. So why I love working with people with ADHD is they're beautiful, sensitive souls.
They really are. They're very tuned in, they're very they've got, they're very expert and they can read the room in a heartbeat because they're. The emotions are peaking in terms of what's happening in their brain. But the deficit in that is they can be hurt really easily. They can find a heart to regulate their emotions. They might have behavioral problems because their emotions aren't being regulated. So you'll see the deficits in the emotional regulation which comes out in the behavior. The hyperactivity piece is, again, not everybody has that. So that's just where the nervous system is hyperaroused and you might find that they're bent.
They're up and down and I have it in my office with my, the ones that have the hyperactivity piece. They're on the floor and on the sofa and they're doing all kinds of things. That's just. That's just what's going on. And then the DB, which I think is really important and this is what separates out what you were saying about your friends to people who actually have the diagnosis it's disorder. So it's not just a bad 10 minutes of focus. It causes proper, proper problems in day to day functioning. So the the, the young people and the adults especially the young people that I see that have ADHD, some of them have terrible problems going to school, some of them are not going to school. It just doesn't work. So you're not just saying, like, a little bit of difficulty, it's big, it is big and the disorder now is actually disrupting the life of that person and it becomes a massive challenge.
::I found school incredibly hard. We've talked about it quite a few times is it's it's hard to explain, but I think now I'm older and I understand that I spent years trying to figure out like my body and how I work and operate is. I feel like I didn't do school well because it was super regimented. It was done a certain way and if you weren't in that certain way, you were sort of on the edge of things and you were put to the bottom set of everything, even though you're well in my case, I'm actually a very smart guy.
::I ended up doing really well. It's got nothing to do with intelligence, yeah, but it's just like.
::I didn't fit the mold and I think that's it makes me incredibly creative from a positive standpoint, and it's also I was so motivated to launch my own business because I don't fit into those regimented things. Is that something you see a lot with?
::ADHD people All the time yeah, all the time. Cause that. That is the the beauty of the condition. I know it can be a bit of a course as well, but what I often say to my ADHD patients is ADHD patients are the ideas people. They come up with the most incredible ideas. The problem they have is the follow through.
::Yeah, the execution of it has me my whole life.
I think I might not be backed by science or whatever, but I just found like having someone to hold me accountable. So in my case it's my, my dad's mainly. He's like Tom, let's stay disciplined on this. I know your mind's going to wander and I can almost see now from a third person point of view my mind's going get out of here, bro, let's go. Yeah, but I just having someone there like my dad, being like stay on the path, just stay on the path, focus. I know you're going to lose it in a couple of days and I've finally understood that now where I've building a line of discipline for myself. But it makes me feel rubbish because my body is like please don't do that, tom, my, please don't do that. But unfortunately you can't really do anything in life unless you have that discipline to do it. And that's something that took me so long and I've only probably got it over the last seven, eight months is it's really hard to stay on one path and not just do like 10 different things at once.
::But that's just your neurodiversity. That is it. That's where ADAT can be brilliant, because, in terms of the, the greater the crisis, because they can think really quickly. And also brilliant at multitasking, but only to a point, because then, as you'll notice, then you fall into procrastination, you fall into that's more interesting and then your brain becomes under-simulating. You think I don't wanna do that. So the follow through is always the hard part, because maintaining the focus is difficult and also then, when your feelings get involved, you'd be like I don't wanna do that.
::Would you say then that I guess it's a two-parter? Would you say that one? It's misdiagnosed in teenagers because of the teenagers that you? Go through and hormones being all over the place. And two, I guess if you are a teenager, you're most likely to be in school. Are schools failing young children because they're not a place for people with ADHD to be able to thrive and cope?
::Yes and yes.
::So totally.
::Joe. So the first bit. It's a great question. Yeah, unfortunately, if you don't understand ADHD, you'll just go on what you see, and the kids with ADHD would be the kids that are disrupting the class.
::Yeah, we're staring at the window, yeah completely daydreaming.
::Yeah, they don't do their homework, they don't turn up on time. They get up and wander around the class. They're those kids. So you look at them and think all behavioral problems. And then they end up getting the tensions and they end up getting all these behavioral disciplines and you're like yeah, it does absolutely nothing Like and the punishments become meaningless.
But then the message that sends to the young person is you're a problem, not you have a problem. And so what that feeds then is it feeds that sense of like very low self-esteem. I am worthless, I am not as good as my friends, and so the second bit of that question is are they failing? Yes, some schools are brilliant. So I work with quite a few schools. It's a mixed bag. Some of them are terrific because they are all over this. They know what they're looking for, they know how to understand it, but some of them are still falling behind when it actually comes to.
Could this be neurodiversity, what we're seeing here? And when they come in I've been training it for so long now you'll pick it up so quickly, like so quickly. You'll just kind of you get a sense for it and you kind of it's like yeah, and you'll explain why. And when you go into the history, I mean it's like it's crystal clear, and I've often especially adult patients. I remember one adult patient. He was in his late 20s and I said like I think, I think you might have ADHD, and he was really. He said what and I said yeah, and he said but why did nobody say this to me before?
I said, well, like sometimes people aren't trained and often, and whatever I said, listen, I don't do the ADHD assessments because I like to, I bounce them to my psychiatry friends because when they do the, I can do them, psychologists can. But why I let the psychiatrist do it is psychologists don't medicate, we do all the psychological treatment. Psychiatrists can do both. They can do the assessments and the meds. So I just think, well, listen, let's just keep it easy and we'll get the assessment done and the assessment comes back positive, then we can get the medication in place straight away. And so I bounced this patient to one of my mates psychiatrist mates to do the assessment. And he was livid, livid, absolutely livid.
::I think it's a breath of fresh air as well when you find out you do have it.
So I just always just thought of some sort of maverick and kid like and then I think it doesn't really click with parents either, because it comes to the point where you might probably find this is is your child just a bit immature or is it ADHD? And I feel like it's such a hard age, especially when you're like 10 or something. How do you spot the difference between immaturity and ADHD if you don't even really know what you're looking for? And that's why I always get so frustrated with people when they're like, yeah, I can't focus.
I should have ADHD, it's like so much more than that, obviously, it's just found out, it's so much more, because the thing is, you've got to look at it from there.
::There's five, I think there's 500 different types of symptoms of ADHD. Now, obviously, you're not going to look for all of those, but you are looking just for the markers that will tell you. And in order for you to be able to understand it, you have to hear the story. You've got to hear the story, yeah. So I listen to the story. If it's my teenager, I'm listening to them. I listen to the parents. I write like what was it like raising this child, tell me. And so, once you start to hear the story, like literally everything falls into place.
Yeah like well, this is it yeah.
::Can you give some advice for the parents out there whose children might have ADHD or they're going through that process of sort of that gray area where they're like do I go down the roof seeing psychologists? What advice would you give to them?
::I would say, with that, first of all, parents will know their child better than anybody else, because they're racist, this child. So I'd be looking for things like have you noticed that your child is showing signs of maybe, that they're repeatedly, on a daily basis, struggling to get through the day, where there is challenges, where there's maybe meltdowns, and the child is maybe showing signs of psychological distress? Because that's kind of what you're looking for. You're looking to see, okay, is there something that's a bit more prolonged? So are we seeing a pattern here now where the teachers are giving feedback, that the child's a bit of a nightmare, where you're seeing signs of maybe, that they're struggling to switch off from devices or they don't want to go to bed or that they're struggling to regulate? So it's a bit of a tricky one time. That question where you said about immaturity because roughly, with ADHD it's not a developmental delay. You're not looking at that because we're not dealing with something that's a like an educational problem, but in terms of brain development, you're looking at about a three year delay.
::Three year delay, okay.
::So what that would mean is that you'd have maybe, say, a 16 year old and maybe the way that they're dealing with their life would be as a 13 year old. Now the reason for that is because the prefrontal cortex, which governs your executive functioning, that develops slower in an ADHD brain than it does in a non ADHD brain. So if we give you, say, adhd meds, then what we're doing is we're trying to speed up that part of your brain so that the brain can regulate itself. But if you have an overactive which you do an overactive emotional brain and then a slower prefrontal cortex, then that young person is going to be far more volatile because they're gonna massively struggle to regulate their emotions.
::That's so interesting. I've got one more question on. Adhd as well, and this is more from a personal standpoint. Obviously, joe and I play rugby. I take a lot of hits to the head. Okay, does this? Obviously not great? But I've stopped playing for a bit because I've had a load of concussions now.
But, every time, if anyone out there is like sort of struggling with that, like I am, and mine have sort of died off, now it seems to spike it and I go drop really quickly in sort of like my mood and how I feel and my clarity of thought and I'm at a perfect level now, like I'm at the right level.
I can tell in my body now. But if you're playing a contact sport and you have ADHD, what sort of advice would you give to someone there? Cause I never even got told like it would make it worse. I just recognized it in myself, spotted the symptoms and was like, okay, maybe I should have a little breakthrough.
::Yeah, I think the problem there. Obviously I'm not a concussion expert, but if you're getting a blow to the head, especially with concussion, then the brain is trying to deal with the impact of the concussion. So it's then trying to accommodate, to deal with the concussion element. So what it's then also trying to do is compensate as well with the neurodiversity. So if you've got the brain there, it's got two big things to try and cope with. Then the body's incredible. It will prioritize one thing over the other. So obviously the concussion is going to be prioritized.
::So it all goes there and then leaves the ADHD sort of floating around being like Interesting, just so interesting On that?
::does that mean you have to be very careful with medicating a, say, a 13 year old boy or girl, because their brains are still developing?
::Yeah, great question, joe. We're very careful with that, very, very careful. So medication is really it's a conversation with the parents, obviously, and it's not taken lightly, because you, if you're going to give medication to a patient, then your whole rationale for doing that is that it's going to help the patient stabilize and it's actually gonna benefit them. So that's your absolute focus there. So the conversation around medication is will this medication help improve the quality of life of this person and also will it help to improve their day to day functioning? And so that's your focus and that's very much. It's a conversation with the parents, it's a conversation with the young person, and so we have those conversations and if everybody's on board, then we try it.
Sure, okay. But so far, I mean, with some medications, yes, the young people don't respond well to them, but that's a given, but most of the time it's okay. Okay, it is okay, yeah, and there's nothing to though you're dealing with a developing brain. These medications, at this point in time I have to say there's no sign that they would cause any kind of. I love it.
::That's the best ADHD chat I've ever had in my life.
::Hi guys, I hope you enjoyed part two. First and foremost, if you are across YouTube, make sure you like and subscribe and do comment below. It really really helps the channel out loads. Here's what you can expect in part three Enjoy. Does that mean you have to be very careful with medicating? I say a 13 year old boy or girl, because their brains are still developing.
::Will this medication help improve the quality of life of this person? Or, if you're not relatable, you're done.
