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Ying: Welcome to ADHD Gathering, a podcast, highlighting diverse narratives within the ADHD community and amplifying strength from real ADHD folks. I’m your host Ying, also known as ADHD Asian Girl across all social media.
Let’s tune in to today’s show. Dr. Zoe Smith. AKA Dr. Z is a child and adolescent clinical psychologist who focuses on developing and providing culturally responsive mental health services for black and or Latina, Latino youth with ADHD. She currently lives in Chicago and provides free psychodiastric assessments for black and or Latiné teens (grades 6th-12th) suspected of having ADHD and provides recommendations on how they can use their strengths to navigate the neuro-typical world. In her free time Dr. Z loves watching basketball, being outside and [00:01:00] learning.
Hi, welcome Dr. Zoe Smith. I’m going to refer to you as Zoe as you requested from now on. Thank you so much for being on my podcast. To get us started, would you like to give us a little self introduction?
Dr. Zoe Smith: Yeah, sure. As you said, I’m Dr. Zoe Smith, but Zoe is perfectly great. My pronouns are she, her. I’m currently an assistant professor at Loyola University, Chicago, and the Director of Action at the ACCTION team, which is advancing community centered interventions. And so our focus has really been on supporting and providing services for mental health related to ADHD specifically for black and or Latina, Latino teens with ADHD.
Ying: That’s awesome. We met last year at the CHADD conference and Zoe received a reward there. I don’t know what the reward is, but I heard from the academia that it’s a big deal yeah. So that’s great. So tell me more about the ACCTION team. What [00:02:00] kind of community center intervention do you do? What services do you provide? What kind of service do you develop? And most importantly, what does culturally responsive mean?
Dr. Zoe Smith: So I’ll start with culturally responsive. So first project for our team is called CRAFT, which stands for culturally responsive assessments for teens. I’m a clinical child adolescent psychologist. I’m licensed here in Illinois. We have to do a one year residency. So my residency was here in Chicago at University of Chicago medicine. And I did a rotation in the trauma clinic. And what we were seeing is that a lot of the youth that were coming in ended up having an ADHD diagnosis, and I came from a background of working with youth with ADHD, but not a big trauma background, and so what I realized is that doing the assessments that I was taught [00:03:00] was not enough, that we were not being thoughtful about the complex experiences that youth particularly with youth with systemically oppressed identities like being black in the United States, like being indigenous in the United States, like being Latina, Latino in the United States can affect mental health, affect ADHD symptoms.
And so what I realized is that we needed to do a better job of assessing ADHD because what we’ve learned is that Black and or Latina, Latino youth and adults with ADHD are much less likely to get a proper ADHD Diagnosis much less likely to be treated. And so being culturally responsive means that we need to be very thoughtful about the context of systemic oppression and its associations on mental health.
And so how we do that in an interview [00:04:00] is really first understanding the context of where the teens live, understanding their neighborhood environment, family environment, but also thinking about like the bigger implications of systemic racism and how that is affecting youth.
And we ask questions about discrimination. And a lot of things that have been popping up is not only is it focused on race, but it’s also this intersection of race and ability. And so we know that there’s a lot of ableism in our world, particularly against youth with ADHD and neurodiverse youth.
And really, we’ve been just learning a lot about teens’ experiences and really just providing a space for them to tell their stories, like not being so focused on symptoms and diagnosis. Of course, yes, we do ask those questions, but we also ask about identity, about things they love, about things they wish for in this world and [00:05:00] understanding how they want to be viewed and how they see themselves being viewed by other people. And unfortunately, we’re seeing a lot of discrimination and we need to understand that so that we don’t pathologize normative reactions to oppression.
And having that context and having that understanding and also providing mental health diagnostic services is being culturally responsive. But there’s lots of different ways to be culturally responsive. It’s understanding the context and identities and how they interact, how our own identities and cultures interact with how we are assessing or talking with or serving families and just understanding all of that to then help us draw those conclusions.
Ying: Wow. That was amazing. And I literally got chills when you talk about let them tell their [00:06:00] stories, understand their identity, like what they love, what they wish for the world. And that’s so not talked about in the world in a way, especially for oppressed youth a lot of times. They’re probably on fight or flight and just trying to survive in this world and trying to brace for the worst things that will come next and to have somebody that wanting to hear their stories and wanting to understand them. I could see that alone would make a huge impact in their life and tell me more about, how do you get people trained to become culturally responsive? Because you probably need many people to talk to these youth, right? What do you do to train them, to help them to become the bridge between the youth and the world?
Dr. Zoe Smith: So as a faculty member at Loyola, I get to work really closely with PhD students in clinical psychology. The students I have are just brilliant, amazing people. And so it’s been really easy to talk to them about this because again, there are people [00:07:00] like me who have similar lived experiences to the families we serve.
Now, that’s not necessary to being culturally responsive, and it’s really helpful to value their lived experiences and helping shape the interviews that they do and how their own interpersonal interactions and abilities help families and help teens feel comfortable, parents feel heard, like all of these things are so important.
The way I talk to people when we’re training on project CRAFT is really reminding them that like the number one goal. I know this is a research project. I know we have a lot of questions, but the number one goal is to make the family, make the teen feel seen and feel heard and have a positive experience with the mental health system.
Because unfortunately, most of our families have had a really long history of bias and discrimination and negative [00:08:00] experiences in mental health. And the fact that they’re even willing to try again is amazing. And I want them to come away feeling okay, those weren’t easy things to talk about, and I felt really heard. And we asked the youth what it’s like, we have a youth and parent advisory board to talk about what that experience was like, and we’re hearing that yes, it was long, and it was hard, And it was really important and really validating and we’ve had a lot of families get really emotional because it’s so easy to listen to people, but we don’t do it. Like we are not trained to just listen and we’re not trained to ask specific questions like around topics that may feel really hard like trauma, like racism, like discrimination, like identities and identity development. And we created an interview that asks those specific questions because we as [00:09:00] a society tend to just stay away from asking these important questions, but we need to. And the fact that we’re the first people asking these teenagers about themselves and what they hope for and what they want and how they’re perceived really shows again, this continuous problem that children are the most oppressed people and then if the children’s rights are a huge issue and giving them just like that little bit of autonomy to feel heard by a caring adult is so meaningful.
And so when I’m training, I’m like that is the goal. Yeah. Do I want you to also talk about the diagnoses, ask the questions we have, of course. But if we don’t get through all of those, that’s okay. What we want is to hear and listen and validate their experience. And I think that can be really hard for new clinicians.
It can be hard for clinicians that have been working for [00:10:00] years because that’s not necessarily how we’re always trained. We’re trained to identify and get information and get as much information as possible. Yeah, I guess I keep saying the same thing. The number one thing I train people is to make that experience be positive. Make them feel heard and validated. And if you’ve done that, you’ve done a good job.
Ying: That’s amazing that you guys come up with specific questions to talk about these very less talked about topics. And like you said, it’s not topics we like to venture in every day, but those are things that impact every one of us, the nerve systems we carry, like how we react to things, how we perceive this world, what do we even believe about ourselves that are all impacted by these things.
And I love what you said about slow down enough to make people feel like they’re heard and they’re held in a way that’s safe and give them a positive experiences.
We’ll take a little break from the show and talk about my ADHD coaching. So if you’re interested in accomplishing [00:11:00] more by doing less, building your ADHD resiliency, amplifying your strengths, as well as craft your own ADHD toolbox and narratives. I’m currently taking 1 on 1 coaching clients. So feel free to visit adhdasiangirl.com/coaching and book a free coaching introductory call with me. My background are in positive psychology, mindfulness, as well as lots of ADHD tried and true tools. I’m looking forward to working with you. Now let’s turn back to the show.
So tell me more about the questions you would ask do the symptoms you guys look for are any different from a regular DSM diagnostic questionnaire.
Dr. Zoe Smith: I think that we do ask the DSM symptoms, because yeah, we do want to provide a diagnosis that is seen and understood by school districts, pediatricians, other psychologists, mental health providers. And there are differences [00:12:00] in the way people describe their symptoms.
And also we see that a lot of times, particularly for black and brown youth, like they need to mask their symptoms because society punishes them more for ADHD symptoms. A black boy being impulsive and shouting out an answer because he’s so excited and he knows it and he’s like learning gets punished and then he learns not to be excited about learning and then it like just becomes this really negative experience with education, with learning, with school, and there’s a lot of internalized issues there.
And so sometimes we have to go just like a little bit more into depth. Like we asked the typical question about interrupting, but then we also ask when you get that urge to interrupt what’s your experience like?
We dive more into the masking aspect of ADHD and also a lot of other mental health conditions [00:13:00] that are comorbid with ADHD to get a better sense of their experiences. We just had a family who was surprised by the ADHD combined presentation diagnosis. For those who maybe don’t know, there’s three presentations of ADHD.
There’s one that’s predominantly inattentive presentation, combined presentation, which includes like ADHD inattention, hyperactivity, impulsivity. And then there is a much less common diagnosis of ADHD, hyperactive, impulsive. And so the family was really at first surprised by the combined presentation diagnosis.
But again, he is a black boy, he’s in middle school, he’s in a predominantly white school. And so he has learned to mask a lot of his hyperactive symptoms and they’ve become more like thoughts racing or have become like fidgeting, but he gets yelled at for fidgeting. And so using all of his executive functioning to keep his [00:14:00] body still and so like just trying to hold in that restlessness. And we notice it when you start to think about it that way you notice in the room and I like often we say Hey, like sometimes when I want to fidget, like I want to get up. Do you want to get up and talk?
Do you want to walk down the hallway and talk? Just like recognizing those things can be really helpful. I was trying to get a treadmill in our office actually, so that a kid could just walk and talk and do that. So far hasn’t been approved by the university as a research item, but still just thinking through those things, not just asking the DSM symptom, but like going more in depth into that aspect of masking those symptoms.
Ying: I love you said to ask about when the urge happens. What exactly do they do? Because that’s something I noticed when I first started learning about masking is whatever the external manifestation of me does not equal to the internal situation. [00:15:00] Like people may look at me and be like, Oh, yeah, she seems like she’s paying attention.
And my mind is going 1000 miles an hour and thinking about all those random things. But Outside looking in you wouldn’t be able to tell because it’s an internal lived experience.
Dr. Zoe Smith: Yeah. Exactly. And we have so many people experiencing that. And also women with ADHD, that’s often something that we’re socialized that we have to be smaller, we have to be engaged in certain ways, that we have to mask those symptoms. And I’m seeing that a lot in our teens with other identities that are oppressed or socialized, that it’s not safe to be loud, it’s not safe to be impulsive. And it’s heartbreaking because we know that if we actually valued neurodiversity and actually valued ADHD and the divergent thinking that comes with ADHD, I know it sounds so cheesy, but it’s so true, our world would be a better place. If our education system valued our [00:16:00] neurodiverse learners, we would live in a more interesting, more caring, and more exciting society. And it sometimes just breaks my heart. And I recognize that the work that we’re doing is making a difference, and that we’re helping provide families with specific things that they can do to then ask for accommodations, like to get services that are going to be helpful.
And also just the fact that a psychologist validated that it’s not them, it’s the system, it’s not them, it’s education is so meaningful.
Ying: Absolutely yeah, and for the teens you and your team serve what are the most common comorbidities they have. For me I can think about I have this really bad exam anxiety when I was younger like even up to college and grad school. When it’s exam season, I’m like, Oh my God, I just can’t handle it.
And I do much better with homeworks and quizzes and whatnot. But when it comes to exams, I’m like, why is this so hard? And now I know [00:17:00] because I have undiagnosed ADHD.
Dr. Zoe Smith: Exactly. Yes. Definitely a lot of testing anxiety. We see that a lot. We see a lot of behavioral observations of shame around like not doing well or Oh, did I do that right? Like checking in? Yeah, just a lot of shame around having ADHD because again, we like get punished for those symptoms.
But actually the most common comorbidities we’re seeing right now are generalized anxiety disorder, so like having a lot of anxiety in our bodies, different diagnoses of depression, and then also trauma, trauma related diagnoses, whether that’s PTSD or acute stress disorder or adjustment disorder related to a traumatic experience and what would actually be more developmentally appropriate would be something that’s called developmental trauma disorder that is not in the DSM. It’s like complex PTSD. [00:18:00] And because the youth that we work with hold identities that are systemically oppressed and deal with oppression daily.
That is a traumatic experience or seeing other kids like you on social media being murdered or be hurt or punished in really scary ways are traumatic events that this generation of youth are seeing more and more. And so what we’ve been finding is that a lot of our teens are experiencing symptoms related to complex stressors, and that’s affecting, obviously affecting everything in their life, but really affecting their ADHD as well, and increasing the severity of those symptoms of ADHD.
And so one thing that we’ve really noticed is that we’re recommending a lot of trauma informed therapy for our youth with ADHD, but it’s a little complicated because a lot of trauma informed [00:19:00] therapists are not informed about neurodiversity, are not informed about working with ADHD, and so it’s this sense of, okay, We need to help support your trauma and your ADHD and your anxiety and your depression.
Like, how does that happen? And most mental health providers are not trained in how to do that and how to support people who have these complex comorbidities. And it’s really disheartening and really scary. And so we talk to families about that. We say, listen, the reality is this therapist might not be the end all be all, or this coach might be really helpful in executive functioning, but may have less training on trauma.
And what the ideal is both like both trauma informed therapy and some kind of executive functioning coach or ADHD related therapy. And the reality is like most of our families can’t do all of that. It just isn’t feasible and it’s not [00:20:00] affordable and it’s not accessible to families. And so trying to figure out and problem solve how to support families is really important.
Ying: Yeah, I’m so curious about how do you guys tease out the difference of ADHD and trauma symptoms? Because like you mentioned before, they may look very similar from the outside. So how do you distinguish that?
Dr. Zoe Smith: So it is hard. It’s doing the clinical interview and getting a really good sense of the executive functioning piece because again, executive functioning is affected by trauma, but we also look at a timeline and a time frame of when did these symptoms happen?
Did executive functioning dysfunction only happen after like traumatic events started happening in their lives. But that’s also hard because for kids who’ve been dealing with complex stressors, they’ve been dealing with it since they’ve been born and that affects brain development. And the other thing you have to think [00:21:00] about is environment and gene interactions. There’s been some research to show that like it’s turning on that neurodiversity because of the need to be able to have these deep divergent thinking patterns to deal with complex trauma and vice versa that youth have ADHD are more likely to experience trauma. And that could be due to like impulsivity or like living in situations where trauma experiences happen, like not attending to the environment and then unfortunately getting into some scary experiences. And so it’s just getting a lot of details and a lot of examples because there isn’t this great answer, I’m like, this is the question we can ask, but it’s more just like hearing about their experiences and most of the time it’s both. It’s that it’s both are happening. That ADHD is increasing the trauma experience symptoms and the trauma experience symptoms are [00:22:00] increasing the ADHD and they look very similar, but there are different cues that you can see are related to ADHD versus trauma.
And it really comes down to examples and hearing what experiences are like disassociation and trauma can look a lot like inattention. And so asking the teen what is your experience? What is that looking like? Are you disassociating from your environment? Or are there other external stimuli distracting you? Or are your racing thoughts distracting you? Are they related to trauma? Are they related to ADHD? And just getting a lot of examples of the youth’s experience, and then making the decision based on those examples and life experiences.
Ying: Yeah. So it’s a lot of getting to know them. Yeah. And there’s no easy answer here. I’m curious about with all the accommodations the team [00:23:00] would recommend to the family. And like you said, the reality is a lot of times we can’t afford to get all the help in the world. And unfortunately, most of the time, the experts are experts in one area.
So that means we have to get a team of experts.
We’ll take a little break from the show and talk about my ADHD coaching. So if you’re interested in accomplishing more by doing less, building your ADHD resiliency, amplifying your strengths, as well as craft your own ADHD toolbox and narratives. I’m currently taking 1 on 1 coaching clients. So feel free to visit adhdasiangirl.com/coaching and book a free coaching introductory call with me. My background are in positive psychology, mindfulness, as well as lots of ADHD tried and true tools. I’m looking forward to working with you. Now let’s turn back to the show.
Tell me some stories about how the lives of some of the teens you guys worked with have changed or how have their lives unfolded after they [00:24:00] have worked with you?
Dr. Zoe Smith: I love that question. It’s so beautiful. There’s so many different things. And so one thing that has been not surprising but disheartening is that about 75 to 80 percent of the families we work with are receiving a first time ADHD diagnosis and so that is life changing. And I tell my team how life changing that is.
And I know you know, like how life changing that is to be like, Oh my gosh, This is why. This is why this is happening. This is what’s going on in my brain. It’s just so validating to families to just be like, we know what is going on. And all of the families that are receiving a first time diagnosis are just so thankful and so grateful to finally be validated, because a lot of families have tried.
They’ve gone to other providers. I even had a family that had a full neuropsychological test that they said was [00:25:00] inconclusive for ADHD, and then when I read through it, it was 100 percent conclusive. And the fact that they went through that cost them a lot of money, and to get A non answer and then to come to us to be validated in that experience saying honestly, That was probably a biased interpretation of the results, unfortunately, and I’m sorry that you had to go through this again.
And yes, you do have ADHD, and here are these things, and we’ve just seen relief. And also, frustration and sorrow for the fact that they had to work so hard to get this. And Just having the diagnosis has been very meaningful for a lot of families. Another big thing that we help with is because this is their first time diagnosis, they don’t have school accommodations, they don’t have therapy, they don’t have medication.
It’s really cool. We are changing lives. We are helping them get the services that they’re willing to try and help [00:26:00] navigate that with the families. And that was our goal, is to provide a lot of psychoeducation and information about how to make these changes. So we follow up with families and we’ve seen like mental health symptoms kind of decrease, we’ve seen an uptake of services and so that has been really amazing to see in families. I remind my team this all the time, because it can be really hard to hear about trauma, the youth experience, and a lot of times we feel helpless, because although I’m working on it on eradicating racism.
We’re working on breaking down the systems of oppression. Sometimes we can feel really helpless because we can’t necessarily change the experiences that our teens are having and we are changing lives anyway. Like we are still giving this validation this knowledge that they would now get to have for the rest of their lives.
And so [00:27:00] that’s why we do feedback sessions with both the teen and the parent together so that the teen can hear and be validated and ask questions. A few days ago I had a younger teen just Be so excited. When I would talk about ADHD, just be like, Oh my gosh, yes. That is what I experienced.
Yes. And this is a 12, 13 year old boy who just got really excited about some really nerdy stuff, which is amazing. And we want to see that light and see that excitement and keep bringing it up. And I think that sometimes just getting this diagnosis can really help.
And not only the diagnosis with the understanding of the strengths of ADHD. And the frustrations of how the system punishes us for having ADHD, I think is really powerful for families.
Ying: Yeah, I love that. I love the fact that it’s not just diagnosis, but also psychoeducation, because navigating [00:28:00] the mental health area could be so overwhelming, especially for minority families. If they never used the services before, it’s like a foreign world. I remember the first time I went into my college mental health clinic because I was an international student.
I was like, I don’t know any of this thing. Like it’s just completely foreign to me. So yeah, I imagine that’s super helpful. And tell me more about the strength of ADHD that you just mentioned. What do you see in the teens that you think are the strength of ADHD and the light they’re shining through?
Dr. Zoe Smith: People with ADHD are my favorite people. We are funny and curious and smart. Going back to that divergent thinking, we’re really good problem solvers, really good scientists and researchers and engineers and content creators. I know some people like get frustrated about the word creativity and I used to be one of those people because I used to think creativity meant like artsy or crafty, [00:29:00] and I’m not either of those things, but creative in the sense of being able to really think outside the box and not just be in this linear, you do this and then you do this.
People with ADHD can see a problem and see a different solution than others. And it’s amazing. Humor is a huge part of ADHD, not for everyone, but it is a big thing because, you just see things and you attend to different things that other people might not notice or recognize. And then when you say it’s Oh my gosh, yes, that’s exactly my experience.
I also think people with ADHD tend to have this light in them that gets diminished by our education system and my goal is to help them see that light in themselves again. Because there are strong emotions associated with ADHD, [00:30:00] I think that can really be very powerful into increasing that light and excitement for the world and curiosity of learning and engagement that you get to have in a different way when you have ADHD. And as long as that is valued and heard and allowed to thrive, there’s nothing that can stop you. It’s really cool. Neurotypical people are super cool too.
Like they can do those things as well. And it’s different. It is different. And being able to have that divergent thinking pattern is really powerful. And when we value that, we see big changes. I see it in my research team all the time. We have a lot of people with ADHD or who are neurodiverse on our research team.
And we come up with amazing projects or really beautiful posters that look really cool. Or different project ideas that [00:31:00] are just different and are fundable and are exciting and innovative. There’s so many strengths to ADHD and the only reason that we don’t get to see them is because of those systems in place that punish the symptoms of ADHD that don’t fit into like our capitalistic education system of being a good worker and sitting down and just doing what you’re told.
People with ADHD are really good at thinking. Wait, this rule doesn’t make any sense.
Let’s, change it. This is so silly. Like, why are we doing it like this? Let’s do it like this. And most of the time, that’s not something people want to hear, but it’s true. I know. I hate rules.
Rules that don’t make sense. I feel I’m like, let’s be efficient and understanding and do it like this. And people are like this is the way it’s always been done. So what? We need to make changes. We need to show that anyway not that [00:32:00] we need to, but if we were valued, we could.
Ying: I love what you said, because I work for a mindfulness startup. And yesterday, one of my co workers, she said something about working in the team make her realize that her voice and her views Matters that she needs to share them. I was like, Oh, my God, I’m thinking about exactly the same thing because throughout my life is I’m trying to mimic a version of an adult I’m expected to be.
And I’m never that. No matter how much I want to pretend or mimic, I’m never that. And in doing so of mimicking, A lot of times when I was younger, I lost touch of what my voice was or what my individual view was and now after the diagnosis, I’m slowly getting back to Wait a minute, how do I actually think about this?
Do I want to share this? It’s a slow, like you said, like showing the light again, the light that was dimmed before, I’m slowly cultivating it. I’d be like, huh, maybe I should keep sharing about this. Like it’s a very interesting process. I could talk to you for forever cause I would [00:33:00] like to get to know you as a person as well.
But I would like to end on a note of how can we get more teens connected with you and your team, with this amazing work you’re doing?
Dr. Zoe Smith: We are still recruiting for Project CRAFT. And if you are a Black and or Latina, Latino teen in the Chicagoland area and or are just willing to travel to Loyola, we are welcoming families and still going to provide those services. We also have a survey based study. Right now that it’s actually focused again on Black and or Latina, Latino teens with ADHD, and just understanding what your life is like.
And that is something that you can complete and earn a gift card or money or something like there’s like a raffle but really just also just reaching out to us on social media or emailing or texting is something that we are very open to, we have teens that reach out to us and when we get [00:34:00] like parental consent or guardian consent, like we’re able to help and support and like the teens that are already in project CRAFT, we’re able to work with them.
Like we’ve had teens text or email us and be like, Hey, I actually am thinking about these accommodations for school. What do you think? Could we add those? And I’m like, yes, that’s amazing. Such good ideas. I think we’re just trying to be very Teen and child centered and just the fact that even just asking someone with ADHD about their ADHD is for some reason novel.
That was a long way of saying we have a lot of things. We love talking to teens. We have advisory boards. So there’s a lot of things. We love to hear any thoughts that they may have.
Ying: Awesome. Yeah. Are there any final thoughts you would like to share with the audience before we log off.
Dr. Zoe Smith: I just want to say again the [00:35:00] world really tries to diminish that light that I was talking about for people with ADHD, and if you’re listening and feeling that way, I see you, I hear you, and I just hope that you can unmask A little bit in a safe place and unmask and show that light again because it’s so meaningful and so life changing and world changing if we all were able to do that.
Ying: Love that. Thank you so much, Zoe, for being on my podcast. I’m amazed by the work you’re doing. And if I’m not a host, I’ll be crying.
Dr. Zoe Smith: I know I like almost started to cry. Thank you so much for having me. We both love podcasts.
Ying: Yes.
Yes.
Dr. Zoe Smith: like, yay, this is so exciting. So thank you so much for having me. I appreciate it.
Ying: Thank you so much for listening to today’s episode. If you enjoy today’s episode, please feel free to drop a comment and review on apple podcasts or Spotify [00:36:00] podcast. Or send me a DM on social media or send me an email to adhdasiangirl@gmail.com Sending lots of love to you and have a good day.