This podcast is brought to you by the Association for Child and Adolescent Mental Health, ACAMH for short. You can find more podcasts and other resources on our website www.acamh.org and follow us on social media by searching ACAMH. Hello, and welcome to ADHD, A Young Person's Guide. This podcast series focuses on attention deficit hyperactivity disorders referred to as ADHD and is designed to help young people and their families. It is produced by the mental health charity the Association for Child and Adolescent Mental Health, ACAMH for short, in partnership with Clinical Partners, the UK's largest private mental health partnership. Search for Clinical Partners ADHD or visit www.clinicalpartners.co.uk for more information. I'm Dr. Blandine French. I am a researcher at Mindtech at the University of Nottingham. My main research interests are on neurodevelopmental disorders, but more specifically, ADHD and dyspraxia. I work with young people and parents of children with ADHD. And I, myself, received a diagnosis of ADHD, as an adult, which helped me make sense of my life as a child and adolescence and helped me go to university and put the right support in place. The focus of today's discussion is managing impulsive and risky behavior. This topic will deal with some triggering content, including substance abuse, sexual consent, and other behaviors that can be described as impulsive or risky. If you or people you know have been affected by this, do please be aware that we will be talking about this in the podcast. We will be hearing from young adults who have explored their boundaries and found what is right for them, how it is [INAUDIBLE] these small challenges, how to recognize impulsivity, the dangers of risky behavior, plus, of course, the key strategies to manage this behavior. Today, I am delighted to be joined by Ruth Pearse, who is the founder and CEO of Parenting Special Children, a charity based in Berkshire. Parenting Special Children's mission is to provide specialist parenting support to parents and carers of children and young people with special needs, so they can create positive change in their lives. You can find out more Ruth, welcome. Can you please start with a brief introduction about who you are? Hi, everyone. So as Blandine said, I'm founder of Parenting Special Children and set that up 16 years ago. Of course, I'm a parent of three young adults now, but two of whom have got ADHD. And my daughter, she's autistic and has a learning disability as well. Really, I've spent the last 16 years parenting them and really sharing that knowledge and experience with thousands of families and learning so much from them. So I'm really passionate about ADHD. So really pleased to be here. The first young person we will hear an extract from is Alex. We first give us a brief insight into some of the impulsive behavior that he acted on. I guess we're like 16, 17 was when a lot of it was going on. And me and my mates going out on our bikes, and going to abandoned buildings, and climbing up buildings and cranes, and going on the roofs of Red Inn, and I guess climbing over these fences, and just not thinking about it at all. And we'd start running up to the buildings and jumping from building to building, and then ended up-- yeah, end up getting chased by police quite a few times, or people would get hurt, or there's been quite a few close ones, where there's some of my friends have almost fallen off places or have hurt themselves. Yeah, definitely, I haven't thought about a lot of stuff until it's literally happened. There's some close ones on the road, where I end up being out at night. And my mom is worrying. But we're out to 4 or 5 o'clock in the morning just ride around on the bikes, not really thinking about anything else that's going on, I suppose. And all these cars almost like flying past us. We now have an extract from Emily who talks about how her ADHD has impacted her behavior. In terms of impulsivity, as a quite-- when I was quite young, it contributed to having quite an eccentric character, which wasn't necessarily a bad thing. Although, unfortunately, in high school, difference isn't really celebrated when you're first there. So often, I would speak out of turn, maybe get overexcited, and shout things or say things just randomly in a lesson. And those behaviors then impacted me because people thought I was weird and strange. And that often just makes you a target. When we talk about risky behavior and impulsivity, can you tell us a little bit about what does it mean in teens and young adults with ADHD? What kind of impulsive behavior do they engage in? What do we know? I really want to start with ADHD and mental health because it has such an impact. As Blandine said, that some of the information you hear today might be triggering, but I also really want to celebrate ADHD. So what you hear me talking about now might feel daunting. But what we want to do is help you know more about ADHD so that you're aware of how your brain works. And your family and friends also so that you can avoid some of the risks associated with ADHD. Mental health with ADHD. So much more likely to have depression or depressive episodes, which might be when life feels out of control, which can be common with ADHD. And so therefore, there may be a higher risk of suicide. So statistically, there's a 30% higher risk for attempting suicide or dying by suicide. But what we want to do is address those so that we're aware of those times when depression is more likely to hit, and we can avoid the outcomes that are so devastating For families and friends. Can you tell us a bit more about other risky and impulsive behavior that young people with ADHD can engage in? Other areas might be substance misuse. So that can be cannabis, alcohol. And it's much more likely, again, we want to avoid this that young people with ADHD and young adults are likely to experiment. And part of that is with a dopamine that's released or not released for them, they're trying to get those highs or that hits. And often as well with those symptoms with ADHD, where there's hyperactivity, restlessness, overthinking, then using something like cannabis or alcohol, young people may think that that is going to relieve some of those symptoms, and may well do. However, with alcohol, really, having to manage that because it can increase those hyperactive impulses. So it's really being aware of that risk. We asked Emily and Alex what type of impulse and risky behavior they felt that their ADHD had led them to take part in? As a young person, I tended to engage in a lot-- a lot of people would say it's like peer pressure. But it was more like if I was around lots of people, and they were doing something like drugs or alcohol. Even though I knew I never wanted to do it or to engage with it, often, if people said to me like, oh, I dare you to do this, or you're too scared to do this, or something like that, I felt like it was almost an invitation for my ADHD. Because even now, I still struggle with having this the middleman that tells you, why you should or shouldn't make a decision. But back then, he just didn't exist really, so it was mostly just I thought, and then I did. And unfortunately, that just made me then have a lot of anxiety and feel very uncomfortable in a lot of social situations, because I didn't want to end up just doing something that I didn't actually want to. I'd say the worst kind of impulsive behavior I think I had to deal with was probably self-harm. And I think that that was one of the most frustrating as well because amongst having other difficulties with my mental health and stuff like that, then-- Initially, self-harm was almost like a way of giving myself a sense of relief. But then it just became so meaningless because it was like it was just something that I did without really thinking and immediately regretted. And unfortunately, it did become progressively worse and worse. And especially since I didn't realize I had ADHD as well, that meant that I was putting a lot of the blame on myself thinking, why am I doing this? And the same with other people around me were saying, why are you doing this? Although, most people didn't really know that it was happening to be fair, not until a lot later on. But probably could have killed me at some point because of that lack of reason and the lack of having time to think through a decision, which was it's quite scary to look back on, I think, because-- yeah, I had no idea that the ADHD had that influence. Thank you for saying that one of the effect of having ADHD and the impulsivity is the lack of thinking. You just think something and you just do it straight away. You don't think through things. And it has many different impact. And I'm really sorry that it's impacted your mental health and your physical health. But thank you for sharing that. That's really important. These are the kind of testimonies we're trying to get to make people aware that it's not just being a bit hyper or being saying things. Thank you. When we were like-- I suppose, it was going on 17 quite a lot, smoking cannabis was massively in everyone at the skate park was doing it. And I think constantly, people being by you doing it, and then you work up your way to, I'm going to finally try it or something, like, I'll go and try it-- try it and makes it seem so easy before you're not-- you're smoking with everyone else and trying to hide it in your pockets. And you get in place at the skate park, and then suddenly, you've got a stash at everywhere. I've had open conversations with a lot of my mates that definitely have ADHD. And smoking definitely chills them out because I think almost sometimes you feel like you just saw it everything's go, go, go with the ADHD, and you're just wired to do something. And then suddenly, it lets you sit back and just chill you up for a second. It slows down your brain thoughts. And I think sometimes it helps you almost like you'll just be thinking about one thing instead of loads of other stuff at once. So I definitely reckon sometimes it was-- after a whole day of almost being wired with the ADHD, and finally, you have a bit of weed, and it chills you back, and relaxes you. Obviously, we must point out that substance and alcohol use can, in some cases, lead to mental health issues. Both in terms of self-medication from the research, it tends to happen with young people and young adults who are not medicated already and are not following any treatment. So they're more at risk when they're not receiving ADHD medication and trying to seek that help through the unhealthy substances. What are your thoughts? That really shows the importance of good healthcare that young people can see clinicians and that the medication that is prescribed rather than the self-medication, which can spiral out of control. And then we know that leads to other risky behavior. Other areas of risk are sex and relationships. So teenage pregnancies are much more common in adolescents who have ADHD and more vulnerable to risky sexual behavior. And that can increase with alcohol. Ruth, any more risky behavior that are typical of ADHD in young adults and young people? Driving, which is an obvious one. And from my experience of parenting, I've seen the consequences, where the wanting the fast car, driving fast, and that sort of impulsive. Or especially if there's challenge by another car, then, of course, the consequences are very dangerous, or that you lose your license, and insurance goes up, et cetera. So that can have a big impact on young people. In this clip, Alex tells us about his experience with driving as a form of risky behavior. When my mates sound like, let's do it, let's do it. There's no two second gap of thinking. It's just straight on with whatever you going to do ahead. And then a few minutes that you find out something gone wrong, or even like driving the cars and stuff, where you'd be so eager. We built quite a lot of cars in the driveway, and you'd be so eager to just like, yeah, let's take them for a drive, and then you just completely forget about the insurance, or the MOT, or tax. And luckily, I never got into any trouble. But quite a few of my mates had just done it, and then just gone out, and then you wouldn't think about it until you suddenly got stopped by the police. And the fun's over. So can you tell us a bit more about the mechanisms about this impulsive and risky behavior? Impulsivity is one of the main symptom of ADHD, and engaging in risky behavior drives this dopamine release. So that's what we're touching on with the reasons behind this behavior and the inability to control your impulsivity. This is why, for example, people find it much harder to say no to drugs, or they have more driving accidents because they will drive-- they just think, oh, what happens if I go up to 100, or whatever? But why is it so prominent at that particular age in the late teens, young adults. Can you explain to me a bit more? Yeah. I think it's obviously such a strong aspect of ADHD, the impulsivity, not for everyone. Of course, but we're talking about risky behavior. Also, those are that emotional hyper-arousal, so that excitement that comes and that regulating emotions. So for other young people, even teenage years are development years. And so there will be some level of experiment for all young people. But, of course, with ADHD, it goes to a different level. So it's understanding that with maturity can come a reduce in that passivity. They're challenging years for young people. And guidance is needed, and where, as parents, you can really help with that so that you can give them the cues that you can be a sounding board. For where they are unable to stop that impulsivity, it's really difficult for them encourage young people to find that safe adult or peer group that's safe who can guide them. That's very interesting, Ruth. Thank you. Am I right in understanding that the risky and impulsive behavior is aggravated by the age? I mean, we know that the teenage brain is still developing quite a way to adults at 21, 25. So is that an impact of how impulsivity and control emotions are controlled, and therefore, that's why this age group can be more at risks? Yeah, definitely. I think you put that perfectly. It is a more difficult time. Lots of development going on. But the brain is working differently for young adults with ADHD. So it's more challenging for them. So we've talk about quite strong risky behaviors, such as substance abuse, sex. We also know something we haven't mentioned that young people with ADHD are more likely to commit criminal behavior and be in prison, and suicide as well. But these are very strong risky behavior, which are important to highlight. But there's also some more subtle ways that impulsivity can have an effect on young adults with ADHD. So, for example, what I'm thinking about is as you mentioned with driving, you are a lot more likely to get into a driving accident if you have ADHD, or you're in the car and you think, oh, I wonder what it's like to if I put my foot down on a motorway. And that's what I see in terms of how impulsivity can affect you, and it's risky, but it's not necessarily as dangerous as other behavior we know. So what are some of the more subtle ways that impulsivity can affect young people? The driving one's quite an interesting one because the consequences, or they're not the most drastic are there and you learn, unfortunately, by those consequences. So as I said before, insurance can double, and you won't be able to then drive, and you might need that for a job. So actually, again, where you can get somebody that might explain to you, not judging. So I think those more subtle ones are really important because if you're able to manage them at the early stages before it gets to actually I've now lost my job because I can't drive, or I've lost my job because I can't pay to get to work because I've overspent. So I think it's what they appear to be not so drastic. Actually, the longer term outcomes can be. So I think that's where with young people, you can really be putting in that support to help them so that they don't get to that situation. Yes. Thank you, Ruth. What are the effects of ADHD on sex? You touched a bit on it early on. Again, I think it's important to understand so that we can help with situations. So with sex and relationship, so some people are affected by hypersexuality, so very high sex drive. And that can mean an increase in sexual behavior. So that's all linked to ADHD. If that's taking place, it might be unprotected sex. It could be a high number of partners. So it could be more susceptible to STDs. You might have a challenges with pornography use that is actually excessive, so it's causing real problems. And other people have maybe referred to it as compulsive sexual behavior disorder or sex addiction. So quite challenging and maybe a little bit overwhelming to hear that, but some of that might mean that there's less consistent contraceptive use, more alcohol before sex, and we've talked about alcohol and the fact that can increase impulsive behaviors, more intercourse with uncommitted partners, and impulsive sex. So quite a challenge there. So all these risky behavior, am I right to understand that it's not directly linked to the hypersexuality, it's for everyone with ADHD that do tend to engage more in risky sexual behavior with or without the hypersexuality? I think it comes down to the impulsivity. And obviously, not everyone, but it's a high proportion of people with ADHD that will be a challenge for them. And of course, the consequence is very challenging short term for them as well. And with relationships, hard to maintain those relationships. We mentioned a little bit about criminal behavior. Could you tell us a little bit more about ADHD and criminal behavior and prison within the young adult population as well? Prison rates for around 30% of young prisoners are thought to have ADHD. I don't think that you can discount trauma, either. So that's really important young adults been through challenging experiences as children, but it's still incredibly high. And that will be undiagnosed and diagnosed that illegal behavior that moves on from maybe speeding in a car to actually maybe taking somebody's life. It's not a very far start for some young people with ADHD, which is, again, why they need that support to help them with the impulsivity. Let's move on to the impact that family relationships and the impact that this type of behavior can have. Alex explains more in this clip. I think relationships and stuff a lot of people would be suddenly surprised but it often be to like before I've done whatever I'm going to do. And then it normally, there's an after effect like, yeah, you were right, that someone would warn me, especially my parents. But I don't think that's such a good idea, Alex. And I'd be-- I didn't like listening. I think I was like, I know what's going to be best and I'll show you. And then you do it, and then you realize that maybe they were right, and you shouldn't have done what was being said. And that was constantly land on that, where you're then being told off all the time for not listening to anyone. But it was definitely relationships and family relationships. Maybe getting other people in that maybe aren't so pushy on the ADHD scale of just like, yes, let's do it. Let's go. Maybe I push them into maybe some situations, where they didn't want to maybe be and maybe they just said yes to that's what I should say yes. I should give it the experience. Maybe they're not quite ready for it, or they're just like, I've impulsively gone. Let's go. And then someone else is dragged into that situation straight away, and maybe they don't want to be there. But it's already too late because I'm going 100 miles an hour. So let's talk a bit more about support. How can a young adult recognize when they're being impulsive and how can they create a support system which help them stay safe and in control? I think a really important aspect for young people is to understand ADHD and understand how it impacts their brain and also how important it is for those that surround them to understand ADHD because knowledge is power. And I think that really helps young people to know it's not about guilt. Their brain works differently. So how can they learn about it and then begin to learn how they can control some of the impulsivity and avoid the risky behavior that we've been talking about. I think finding activities that are legal, that will enable them to use that in other sports or exercise, then that is a less risky way to release that dopamine and to also wear you out. Having supportive family and I know not everyone does have that. But if you don't, why is a family or friends who you trust, and you can be open and honest with, who accept you for who you are, who know about ADHD and also celebrate ADHD, and can be a person that you can be accountable to, so you can say when you want to do something. And hopefully, there can be a little bit of a buffer, just that breathing space before you make that next step. You might find a support group or you again talking to family or friends or helpline, and we'll talk about some of the support that there is, and I've got links that can be sent. Being kind to yourself. You're not a failure when things go wrong. You're learning. You're young. Keep on connecting with other people. Find your tribe. Yes, I think this is quite important. I mean, people with ADHD tend to mature later than the average person. And maybe a lot of these behaviors are worse because we're just waiting for that maturity. But from a personal experience, I know now. I can look back on my 20s and think, oh gosh, I can't believe I did that. I got away with it. And I have this insight now. I didn't have it in my 20s. And maybe in terms of as a parent, as a friend, or as a young person yourself, just thinking that it's OK, that's just who you are, you will mature at a different rate. And there will be a time when you will understand the consequences of your action. It's not going to be like that time. You're not going to engage in risky behavior for the rest of your life. You might want to, but there's going to be a time where you understand the consequences of it and you can just control it a bit better. And it's just getting the support through this particular time. In this clip, Alex and Emily talk about being honest and the relationships with families and friends. I was quite open with all of it. And there's some stuff that maybe I wouldn't say, because you wouldn't want to worry. And then you'd say after you've done it, because you don't want her to worry before. But I was like, I'm just going to tell them and I'm going to do it anyway. So at least they know what's going on. They don't have a choice, but everyone can do it or not. But at least say no, know where I'll be, or what's going to go down. A lot of my mates didn't tell their parents at all. So I thought it was quite nice to keep them in the loop. But yeah, some stuff I guess you try and keep quiet. So when I was younger and I was going on these all nighters and stuff, I was letting them know I'm going to [INAUDIBLE].. I may not necessarily say wherever I'm going to go. But there's been quite a few times, where we've got in trouble. And then because I've lied to my parents and said, I'm staying at one of my mates or somewhere I can just call them up and just be honest, and they can help me pick up the pieces kind of thing. So yes, definitely helps being honest, and it obviously feels a lot better when you're being honest with your parents. But where it's going, if something goes wrong, after something make up another lie when something else goes wrong. And then when something has gone wrong, and they're like, well, you probably should have done this differently, and that, and then next time you do definitely think about it a lot more. Now someone was right about that. When it comes to my relationships with family and friends, well with all of them, it wasn't necessarily a hugely negative impact, or at least not with my good friends and my close family and stuff. It was more what they would always want an explanation as to why I was doing those things. And I couldn't give it to them, and that made them feel like I was just not sharing things with them, which was very frustrating because then it's almost like they feel like you don't trust them. And that does put a bit of a strain on things, and it did, especially, I would say, with my parents because more than anything they want to be there to protect you. And they just could not put two and two together. They didn't understand why I was the way that I was. It was quite challenging. I suppose, for myself, it was like, I had other difficulties going on at the time. And I think if anything, what it did was it clouded what was really important because people were very focused on their behaviors and the actions and all those things that were occurring. And nobody really tried to focus on what was leading to me having difficulties in the first place or what was leading to having difficult mental health and stuff like that and a low mood. And so yeah, it was very isolating. And then you put a lot of blame on yourself. That's very lonely place as well because I think for a lot of my friends, when I tried to explain things to them, they couldn't really relate to what I was saying about not being able to stop myself from doing certain things. And then that just made me feel crazy. So yeah, it wasn't very nice. Just before you finish, I would really like, Ruth, if you could tell us-- you mentioned that you had a child with ADHD. And what did you do as a parent when your child engaged in risky behavior, how did you support them? Probably one of the key aspects was not judging him and not wanting to shame him when things had gone wrong to listen. Yes, to have that open and honest conversations, so my son will now say that we know almost everything. I think we probably do know almost everything. He was never afraid to share things with us. So it meant that we were the first person he called when something went wrong. There were things I never thought I'd do as a parent, drop my son off in the middle of the night somewhere, and then know where he was so that I could collect him at any point. It's been open and honest, allowing them to share anything, and then helping them to notice the risks in a kind non-judging way. And is there an element of providing a safe environment as well to do this? Someone can pick you up at 4:00, get up in the morning no matter what? I mean, you might not like it, but at least, it's safe. It's keeping them safe and allowing them to make these experiments with some form of safety. Yeah, but also not tightly safe so that they can experiment and slightly push the boundaries but with safety. It's been a privilege because I've also had many conversations with his friends on the topics I've talked about today, so very open and honest. And I think that's so important. Perfect So just to finish off, Ruth, if there was free takeaways for keeping young people safe with ADHD, what would be your three takeaway messages, please? Have a support network around you, whatever they might look like for you, trusted and safe. Know that it's not always going to be like it is now. The times that you feel that you failed or that you've done this again celebrates who you are. ADHD can be amazing. You've got gifts that are needed. It's thinking outside of the box and we need ADHD people in every area of life. So be encouraged and get support. Ruth, thank you very much. And, of course, our thanks go to Alex and Emily for their input, their lived experience examples have been so valuable for this podcast. Do please subscribe to series of podcast titled ADHD, A Young Person's Guide. Other episodes include sleep, adjusting to change, getting the right support, and a two-part special on women and girls. Once again, other things go to Clinical Partners for supporting this ADHD podcast series. With the UK's largest network of senior mental health professionals, Clinical Partners can help ensure your child is fast tracked the right diagnosis and optimized treatment plan. For further information and advice for families and carers, search for Clinical Partners ADHD or visit www.clinical.partners.co.uk. For more details on Ruth Pearse, please visit the ACAMH website, www.acamh.org and Twitter @ACAMH. And don't forget to follow us on your preferred streaming platform. Let us know if you enjoyed the podcast with a rating or review and do share with friends and colleagues. [MUSIC PLAYING] This podcast was brought to you by the Association for Child and Adolescent Mental Health, ACAMH for short.