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184. You're Not Lazy: How Undiagnosed ADHD Could Be Derailing Your Health Goals with Dr. Ida Salusky

Aug 03, 2026
 

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You've spent years believing you're undisciplined, inconsistent, bad at adulting. But what if you've been white-knuckling undiagnosed ADHD this whole time?

More than half of my clinic has some form of attention deficit, and I see the impact on health every day: the routine slips, appointments get missed, workouts fall off, and healthy habits never quite stick. Then comes the shame: Why can't I just get it together?

I recently sat down with clinical psychologist Dr. Ida Salusky, who explained how executive function and undiagnosed ADHD can derail your health goals, especially for women who've spent years being told they're "not trying hard enough." Here, we’ll dig into why consistency can feel so difficult, and how to start working with your brain instead of against it.

What is executive function?

Think of executive function as the administrative assistant of your brain. It lives mostly in your prefrontal cortex (right behind your forehead) and handles planning, organization, prioritizing, focus, task-switching, working memory, and emotional control. In other words: basically everything you need to build a new habit and stick with it.

Everyone forgets things sometimes. Everyone has unfocused days. The difference, Dr. Salusky explains, is when those struggles are persistent, have been there since childhood, and genuinely impair your day-to-day life. That's when we start thinking about something like ADHD and without the right interventions, it doesn't course-correct on its own.

Why consistency keeps falling apart

Knowing what to do was never your problem. Most people know they should move more and eat better. The breakdown happens in the doing, and that's an executive function job.

When a habit keeps collapsing, Dr. Salusky suggests getting curious instead of critical. 

Are you actually planning when it will happen? Are you cramming a workout into an unrealistic 45-minute window? Are you pushing it to the end of the day, when you're too exhausted to follow through?

Identifying the real barrier matters, because an organization problem and a motivation problem need completely different solutions.

Change is smaller and slower than you think

You're not going to radically change your life overnight. And trying to is exactly what sets off the failure spiral. Dr. Salusky's approach: pick one small, specific, achievable change and work on it for six to eight weeks (at minimum) before adding anything else.

Walking 3,000 steps a day? Aim for 4,000 steps, three days next week. When people see success, they're motivated to keep going. When they don't hit big, vague goals, the shame kicks in and the protective mechanism becomes "I'm not going to try, so I won't fail."

When Dr. Salusky started her own health journey, she didn't begin with diet and nutrition. She began with exercise, because her body craves movement and it was the thing she was genuinely excited about. Starting from zero days a week (during lockdown, with a newborn), she built up to two days, then three, and over about two years reached five or six days a week.

She started with the change that felt most accessible and that she actually wanted to do. Because that's the one you'll stick with long enough to become a habit.

Only add something new when two things are true: you've been consistent with the current habit for a couple of months, and you genuinely feel you have the time and mental bandwidth for more.

Three strategies that work for ADHD brains 

You can't fix a working memory problem by trying to remember harder. What you can do is build scaffolding around it. Here are three things Dr. Salusky sees work again and again:

  • Make it visible. Timers, calendars, and scheduled time blocks compensate for working memory struggles. If it's not written down somewhere you can see it, it doesn't exist.
  • Build in accountability. If a friend is waiting for you at 7 AM for a walk, you show up. Support systems — non-judgmental people who get it — are one of the most powerful tools there is.
  • Take things off your plate. People with executive function challenges often overload their days. When the schedule is unrealistic, the first thing to fall off is always the habit that only benefits you.

The "lazy" lie and why so many women are missed

ADHD is dramatically under-diagnosed in girls and women. Girls tend to present as inattentive rather than hyperactive, and schools notice the disruptive kids. So a whole generation of women grew up hearing "you're lazy" or "you're not applying yourself" instead of getting answers.

Dr. Salusky is clear on this: she doesn't believe people are lazy. People struggle with motivation and executive functioning, and that's legitimate. If you're chronically late, forgetful, or starting projects you never finish  (and you don't want to be ), that's not a character flaw. It's a cue to get assessed.

There's also a common misdiagnosis pattern: women are over-diagnosed with anxiety and under-diagnosed with ADHD. The two can overlap and co-occur (along with depression), which is exactly why a proper assessment matters. Often, it's a woman's child getting diagnosed that finally connects the dots: "Everything they're asking my kid... I've struggled with my whole life."

It's never too late

A neuropsychological assessment (a comprehensive battery testing working memory, processing speed, attention, and more) can be done at any age, and insurance should cover it. Dr. Salusky has never had an adult client regret getting one, whatever the outcome.

And treatment works in midlife, too. Dr. Salusky was 43 the first time she took medication for ADHD, and she describes it as transformative. No more Pomodoro timer every ten minutes just to stay on task. For adults who've spent decades hyper-functioning on self-built coping strategies, medication management is often the biggest bang for your buck, alongside behavioral techniques.

One important note: ADHD is a lifelong condition with symptoms present from early childhood. Symptoms may look different at 40 than they did at 16, but they don't suddenly appear in adulthood. If that's happening, something else is going on.

Dr. Salusky's recommended resources

Dr. Salusky kindly shared her list of well-regarded, evidence-based ADHD resources:

Websites

Books

Magazines

Podcasts & Interviews

Connect with Dr. Salusky

Dr. Ida Salusky runs a virtual practice working with adults (18+) on ADHD, boundary issues, caregiver stress, depression, and anxiety, using evidence-based treatments through a culturally informed lens. She provides therapy in English and Spanish, holds PSYPACT licensure allowing her to practice teletherapy across most US states (check the PSYPACT map here), and accepts Blue Cross Blue Shield PPO as well as cash-paying clients.

Find her at her practice website here.

If any of this sounded uncomfortably familiar: the chronic lateness, the abandoned projects, the shame spiral… consider it your cue. It's not a personal failing, and you don't have to handle it on your own.

 

TRANSCRIPT:

Disclaimer: The transcript below is provided for your convenience and may contain typos, errors, or grammatical inconsistencies, as it has not been professionally edited or proofread. Please enjoy it as-is and read at your own discretion.

Please note: The content shared in this podcast and blog post is for informational and educational purposes only and is not intended as medical advice. Always consult your healthcare provider for personalized medical guidance.  


 Welcome back to another episode of the podcast. Friends, I am super excited today. We have Dr. Ida Celeksi on today she is going to talk about executive function. We're gonna get into so many things today that hold people back with their health because you can know all the information, but if you don't actually understand why your brain might be working in a certain way, you really can't get very far. Can we start out today with you introducing yourself, and just tell people everything that you do? 'Cause you are... You just have such an impressive resume. Is that the right word to say? But just what you've accomplished and what you do. Thank you. My name is Dr. Ida Celeksi. I am a clinical psychologist. I have a PhD in clinical community psychology. I am an associate professor at Northwestern University in the School of Medicine, and I also, am the founder and principal of a clinical practice, Dr. Salusky Clinical Psychology and Consulting. I love it. We were talking before this, 'cause I knew at one point, okay, I wanna bring you on, and we were trying to hone in on what we wanted to talk about, 'cause there's actually a lot of areas that you are really, specialized in. And we decided to talk about executive function. And so I'm wondering if we can just start out with just even explaining what does that mean, in general terms? Sure. Yeah. So executive functioning, it's a broad term, and it refers to a few different things. It refers to planning and organization, so think about being able to juggle multiple tasks, prioritization. Your ability to focus your attention, that's a part of your executive functioning. Being able to what's called,, task shift or think about, switching your gears. Your working memory is a part of your executive functioning. And so when we talk about executive functioning, the brain's a network. But executive functioning is most frequently associated with the prefrontal cortex, which when you think about what's behind your forehead, that's the prefrontal cortex. And it's like your administrative assistant of your brain. It's what helps you map out, and get through the world, right? In practical terms. I mean, basically what you were explaining here is, so you're talking about planning, organization, task shifting, working memory. I mean, that's basically everything when- It is everything ... you said. And it's a part of emotional, right, emotional control too, right? Yes. So it's a lot of, it's a lot of things, yes. How would someone know if they're struggling with... I mean, I know there's a lot of different categories that we said here, but what's the difference between, "Oh, shoot, I forgot that," or, "Oh, I'm having a day where it's hard to focus," versus it's actually, a problem that they need help on? So the clinical disorder that's most frequently associated with, deficits or difficulty, with executive functioning, when I talk about deficits, we think about functioning as a spectrum everybody's somewhere on the spectrum. But people who are outside of kind of what we would think of as a typical range, that's when we talk about somebody potentially having a deficit or a clinical challenge. Yeah. It's normal to be forgetful. It's normal to lose your focus. But if it's something, that is impairing your ability to function in your day-to-day life and if it's something, that has been persistent from childhood, then we're starting to think about- Things like attention deficit hyperactivity disorder, or ADHD. And people who have ADHD, forgetfulness isn't just, occasionally forgetting your car keys or occasionally forgetting to pay a bill. It's something that's persistent, it's ongoing, it's regular. And without, specific interventions, it doesn't course-correct by itself. Yeah. Okay. Thank you for giving that. Lots of clarity on what specifically we're talking about. More than half my clinic has some form of attention deficit, and I find that it greatly affects health because those same activities With exercise or things like that, it comes in. I find that everybody knows what to do. It's not massively something new when we talk about exercise and different nutrition things, but that consistency I find is really hard for some people, so let's just give the example of exercise. Maybe they three times a week, we wanna start to bring in strength training, and it just falls apart at some point. Yeah. Do you... What thoughts do you have for a person where that's occurring for them, the consistency part isn't there? I think questions I would start to ask myself or ask somebody else if I was working with them, because it could be about, actually, the planning of are you programming it. It could be, when we think about, deeper levels of organization, are you struggling to plan your days in such a way that you're loading too much in and that's what's getting in the way, you think that you can fit it into this 45-minute window when you have something bookend on either end, and that's just not realistic. So it's the thing that always falls off. The prioritization piece? Is it that you're pushing the exercise until the end of the day? Like, "I'll get to it, I'll get to it, I'll get to it," and then you're exhausted so you can't do it. I always like to start, and I would encourage people to think about, what specifically are you doing in terms of thinking and mapping out when the exercise is gonna happen to try and understand what the barrier is. And if it is really an issue of kind of organization or planning versus motivation, which is something else. And the way you would address motivation would be a little bit different than you would... than the way you would address an issue with executive functioning, and l- doing something like getting into an exercise routine. So you talked about you have to think about what you're thinking. You map it out. You're trying to find the barriers. When you're working with people, do they, do you do, one thing at a time? Okay, this week we're gonna do this thing, or is it more broad? How do you start to work on these things? So, I wouldn't encourage anyone to be like, "I'm gonna work on this this week and this next week," there's clear science around how change happens and how long it takes to develop new habits. Yeah. And it takes more than a month to develop a new habit. Yeah. So if I'm working with someone and they have a specific, behavior that they're trying to change, we're gonna be working on that for multiple weeks. Mm-hmm. Probably for, a month and a half, two months, until we see sufficient change to maybe move on to another, behavior change. And again,, the behaviors or whatever the goal is for change, it's small, it's incremental, and it's specific, because You're not gonna radically change your life overnight. You're not gonna radically change your diet. I think people think that. Yeah. I think they think that they're gonna do that, though. And so I'm loving what you're saying, 'cause I'm like, yeah, we don't... You could a whole year work on increasing fiber, right? People think, next week they're gonna see me and it's solved. And it- No ... it takes time. Yeah. So as a concrete example, if you're, getting in, I don't know, 3,000 steps a day- Mm And so you want more movement in your life in general. If that's your goal, then we're gonna start with, can you get up to 4,000 steps a day three days for the next week? Yeah ... very small, very achievable. Because when people see success, they're motivated to move forward. When people experience I don't wanna say... People think of it as failure, but when people, don't achieve goals that they set out for themselves, that can be demoralizing, right? And that can get into, a cycle of self-defeating thoughts and negative thinking and, I didn't do it. I feel... I have negative emotions about I didn't do what I said I was gonna do." Yeah. So now, the coping mechanism, or the protective mechanism is, " I'm not gonna try, so I won't fail." Yes. Oh, that whole cycle. Everyone listening can relate, right? Where you've, you, you haven't achieved it, and then you're just down in the pits because of it. But I like what you're saying, how you need to see success. You need to be able to show yourself evidence that it can work. How long do you think,, it takes to develop that habit, then? For it to actually stick around? Depending on the habit I would say a couple of months at a minimum. Yeah. And I always say, even if you can, like certainly you could develop a habit in, in, in, in 30 days. Like, it- Mm-hmm ... it's possible. But I think it's also always good to give yourself latitude, 'cause not everybody is the same, and what we know about, research and the time it takes on average to do anything, right? That's an average. It's gonna be different for... Some people can achieve things more quickly, some people take longer. Yeah. So my approach is to always calibrate and set expectations, that provide a little bit of flexibility, a little bit of cushion. So if people take a little bit longer, again, they don't feel like, "What's wrong with me? I'm not gonna be able to do this. I'm not gonna be able to be successful," and those... that, that cycle- Yeah ... that comes into play. Yeah. Where could people get started when they're... let's say they're feeling, overwhelmed with all the things they maybe need to do for their health. Where could be a place that they could start? With something that they're excited about, and they like, and they want to do. Don't start with the, the thing that you're least, that you're least enthusiastic about. So as a personal example, we haven't said this, but we work together, clinically. You're- Yeah ... you're my obesity medicine doctor. And when I started my journey many years ago, the place I started wasn't with diet and nutrition, because that wasn't what was most accessible. What was most accessible actually was exercise, because, my body just craves a lot of movement. Yeah. I worked into developing a routine where, I exercise four, five, six days a week. But I started in the lockdown of the pandemic when I had just had a newborn with exercising zero days a week, right? Yes. So that was a long journey, but I started there because it was the thing that felt most accessible and that I was most excited about. And I'm- I, I love that you gave this example because you are a ninja at exercise. Honestly, like when I think about the most consistent exercising person, I think about you. And so to think that you had built that... I mean, it doesn't even feel like that long ago, right? When we think about the years here. Yeah. And in, and the other thing I would say with that is... and I had, years before- Yeah I'd had a routine and then life, kids, career, all of that. But when I started again, it wasn't like I went from zero to five. I went from zero to two days a week, 30 minutes. From two days a week eventually to three, and literally over the period of probably two years, I got to the point where I was doing, the four, five, six. Yeah. That's to say, a- again, you can develop a habit in 30 days, but the consistency and, the ability to fit things into your routine or your life, whatever that looks like, that's gonna look different for everybody. For me, it took longer, and I was okay with that. Yeah. But that's where I started, and that's where I was able to be consistent over time because it's something that I like and I enjoy, and it's not just something that I know is important to do and is, important for my health. It's something that I actually, want to do. I love it. So you have to be excited about it. You actually have to want to do it. I love that. Yeah. Because I thought you were gonna be like, "Start with," I don't know, like, "Decreasing the minim- like, the list of to-dos," or something. That is... That just sounds a lot more realistic. I mean, do all of that, yes. Like, uh, you know, especially my understanding is your is primarily women so yes, reduce the things you, you have on your list. But start with something. The thing you pick to focus on, pick something you really, enjoy, love, and that, that's the place to start, to... in my mind. Yeah. How... Okay, so let's say someone, they pick something that they love, it's realistic, they're actually sticking with it. How do you know it's time to add something else or to be able to pivot in a way? I would say a good litmus test is, If you have had success- Mm-hmm ... over a period of, let's say, it could be a couple of months, it could be more. Mm-hmm. And you internally feel like or think, " I have a little bit more space." And when I say space, like cognitive energy, emotional energy, in addition to time- Mm-hmm to work on something else, again, small. Oh. So maybe the small is And I'm laughing because this is something that I still struggle with because it's not something I enjoy, so it's not something I prioritize, but I'm gonna do some meal prep for one hour once a week, that's the one thing you're gonna add in, right? Yeah. It's small, and it's specific, and it's very time limited. But that's the moment when you would add that in, When, one, you have observed and you have seen that you're consistent with whatever the previous behavior that you wanted to change- Mm. You've been able to execute and change, and then two, when you think about, your bandwidth and both emotional and time, you think like, "Yes, I have a little bit more time to dedicate to something else." And then what is that something else that you're next most excited about? Which for somebody- Yeah ... it might be meal prep once a week. For an hour. I really love this. Not for me. 'Cause I always see if someone's struggling, they wanna do even more. Like they put- Yeah ... even more things that they're gonna do, and they get even more rigid, and I'm thinking, "Oh my gosh, we need more flexibility right now." Yeah. I love that you're reinforcing all this. And gosh, w- one of the things that's so challenging about this topic is that it's so broad, right? And so are there any, just in general things where you're like, "When I do these... When I do this with people, they really benefit from it." Any strategies or tips? Yeah. So I think it's gonna be different depending on the individual and, their profile- Yeah ... personality, all of that. But for some people, especially I work with a lot of women, I find that having people you're accountable to, oftentimes helps my clients, right? I'll go back to the example of exercise. If somebody is waiting for you at 7:00 AM to go on that walk or jog, many people will be motivated to show up because they don't want to, stand up their friend. They don't, they don't wanna disappoint or they don't want to not be a good accountability partner. So having support, right? Which is basically what I'm s- describing, is critical and that could look different ways. What we find clinically and in research also really helps people who are struggling with executive functioning, is to, develop systems, especially if part of the issue has to do with, the forgetfulness, issues with working memory. Establishing routines that are, visible, right? Mm-hmm. Mm-hmm. So think about timers, think about calendaring,, and think about scheduling time to g- on a, in a consistent way in a calendar, like, every week. And to your earlier point when you said, taking things off of your plate. That's usually a big part of, helping people who struggle with executive functioning- Mm-hmm ... be able to successfully, follow through and integrate, new behaviors. 'Cause oftentimes people with, attention deficit difficulties or difficulties with executive functioning, they struggle with time to, to think through and map out what can realistically be accomplished, and that's where you get into, the situation or the scenario where there's too much packed into your day, it's not realistic, it's not feasible, things are gonna fall off your plate. And of course, the thing that's gonna fall off the plate first is, the behaviors or the habits that you haven't developed or that aren't critical to somebody else, yeah. It's just about yourself. So thinking about what you can take out, and how you can have less, if you think about that calendar, less in your calendar. Yeah. When I think about accountability, I, this is a massive one for me, so I basically always worked with a coach, whether it's weekly, bi-weekly. And I just had my session yesterday, and I showed up and I was like, "I'm so sorry this is Groundhog Day," like, it's the exact same thing we talked about two weeks ago. There's something about it where if I wasn't meeting with her every two weeks, I would not continue to make progress. Yeah. Because, I would not have that moment of having to actually say I didn't do it, so Yeah. Right ... that accountability is so massive. And I have found in my health journey, I've had several groups of friends where they also care about their health, and that's been massive for me to be able to talk about it, and not have to censor myself that they care as much as me. I get ideas from them, they get ideas from me. But it's the fact that seven years later we're still talking that accountability's huge to me, 'cause I don't ever forget why we're, talking about things. Right. And it sounds like they're people who are not judgmental, who have maybe not the same experience as you, but some- Yeah frame of reference, right? Definitely. They're able to relate. So those are all kind of key components when we talk about, what makes a good social support system. Yeah. Love that. And I like how you talked about with the kind of making it more vis- visual, so using timers, using calendars. Are there any, books or, apps or things that you find are really great with helping with some of these things? Yeah. So there's, and I can give you, I can send you a list. But there's h- a couple of, kind of seminal books that have been written around, cognitive behavioral therapy and ADHD management. And then there's kind of like the, the version for the clinician, and then there's the ver- like, the workbook version for the client or the person, that has ADHD. So I think those are really good, and I can give you names, and I know you like- Yeah ... things. Okay. And then I can, if people are interested in more, first-person accounts, I can, give some names of autobiographies of, kind of- Famous people who have struggled with ADHD amongst other things and have written about how, that's impacted, their trajectories and how they learned to manage and, function in the world, in a way that is authentic to themselves but also allows them to manage and work with their symptoms. Yeah. Thank you. That would be great. I would say the other thing, the other component, of executive function, functioning and deficits in executive functioning that's probably, relevant- Mm-hmm Is this idea of emotional control, yeah. And there is a clear connection, between executive functioning and, emotional, control and emotion regulation. Mm-hmm. Um, which, you can articulate much better than I can the connection between, food intake and emotion regulation. Yes. Right? Yeah. But I would say that's another piece that, is really critical. And the other thing that I would say for just, like, general information, and I know that you work with a lot of middle-aged women. Mm-hmm. So ADHD tends to be under-diagnosed, in girls. Mm-hmm. And certainly for,, the demographic you're working with, at the time when people like me were kids. Like- Yeah ... because girls present- More as inteta- inattentive than as hyperactive, and within schools, the kids that are gonna get noticed are the kids who are disruptive, so the hyperactive kids. Mm. So a lot of women have not been diagnosed. I know in the, the email you said, you use the term lazy, and that's like, I think that's a really good- Mm that's really good language because that's language and verbiage that people are told and taught. You're being lazy. Yeah. And so one of the things that I guess I would wanna communicate to anybody that's listening to your podcast is there's a difference between... and I don't actually believe in general that people are lazy people struggle with motivation, and that's a legitimate challenge. People struggle with executive functioning, and that's a legitimate challenge. But if you're being told or messaged or you have the message you're lazy and you're somebody who struggles to keep track of things or to show up on time that's a huge way that ADHD presents in adults, is like you're late for every meeting, but you don't wanna be late for every meeting yeah. That should be a cue to you that maybe you wanna go and talk or get a referral for an assessment, and the person who would do an assessment could be a psychiatrist. It could be a PhD level clinical psychologist. And what you probably want, is what's called a neuropsychological assessment, which is like a comprehensive battery that's gonna, assess for like working memory, fluid intelligence, which is, your ability to learn novel tasks, your verbal intelligence, your spatial awareness, process and speed. It's a comprehensive battery of tests, and as part of that, a diagnostician would be able to identify if you have ADHD, and if so, what type of ADHD you have. So three types of ADHD, predominantly inattentive, predominantly, hyperactive, or combined type. Mm. And depending on what type you have, the intervention or the intervention strategies would look different somebody who's predominantly hyperactive is gonna need somewhat different, tools than somebody who's predominantly inattentive. Struggling to complete tasks, starting projects and then not finishing them, that's like another kind of, hallmark symptom. Showing up late, being forgetful. That doesn't mean you're lazy. That doesn't mean you're, not bright. It's a sign that something else is going on and that you probably want, if you can, you probably wanna get assessed. And insurance should cover a neuropsychological assessment. What is so common that I saw when I was in primary care is that the woman would have kids. The kids would get diagnosed and then they would realize in the assessments, "Oh my gosh, everything they're asking the kid is stuff I've struggled with," it's exactly what you're saying, that they literally couldn't identify. And I'll never forget when, 'cause I actually had a lot of midlife women that would then get on treatment. Mm-hmm. And they would tell me, one was a real estate agent and she said, "I can't believe that this is how the rest of the world operates," because she just thought it was just her, how she was keeping track of clients and what was going on. And because the kid got diagnosed, she got diagnosed, and then her whole world could change. It's just incredible. Yeah. And that is typical. So it's, 50/50 chance that if you have ADHD your child will. So the... the reverse- Yeah ... engineering, it's very true. And it is. Back to the lazy, people with ADHD who make it into adulthood without a diagnosis and are, operating, doing their jobs, running their households, in many ways they are , they're functioning on a level that is so much more intense. Yeah. And more planful than people who don't have, disruption or dysregulation with their executive functioning. Is anxiety high for them? Because I always found that's they would think it was anxiety, like because they're trying to manage all these different things. I don't know if that's just me. There's... So there's often misdiagnosis, because women are overdiagnosed for anxiety disorders but underdiagnosed for ADHD, yeah. So there's misdiagnosis, and there are some, there is some overlap in symptoms, but there's symptoms that are discrete between all of this, these disorders. There's also comorbidity with ADHD and, major dep- or the depressive disorders mD, major depressive disorder is the most common diagnosis. There, there is comorbidity, and then it's like a chicken or egg. Is it that you're experiencing symptoms of anxiety because you have undiagnosed ADHD and you're dealing with, all of the challenges that come with that without the recognition that you actually have a health issue? Or it could be that these two things just happen in parallel, right? Mm. Because life happens, and that might trigger an anxiety disorder. But there is high comorbidity between the two. And there is misdiagnosis between the two, particularly anxiety disorders, generalized anxiety disorder and, ADHD for women. Yeah, and I guess the other thing that I would say is that, yes, everything you're saying about the woman, the mother that's coming into primary care, and the kid gets diagnosed, and then she becomes aware. There are interventions even in middle age. Medication management can be really helpful. I'll do some self-disclosure. I was 42 the first time I took, or 43 the first time I took a prescription med, for ADHD, and it was. It was transformative. Like, all of a sudden, I didn't have to use a Pomodoro timer for every 10 minutes to make sure I was staying on task, which is what I had done- Yeah throughout my entire, professional adult life as a professor. But there are also kind of behavioral strategies and techniques that can be, that can be done. What I will say is that if you are somebody who has made it into adulthood and, is functioning in your job, is running your household, and you get diagnosed and you're like, "I need an additional layer of support," because you've probably been, hyper functioning and you've, just independently developed a lot of behavioral strategies, medication management. And I'm saying this as somebody who... I'm not a prescriber. I do the behavioral side. Yeah. But medication management might be the biggest bang for your buck in terms of, greatest change at that stage. Yeah. A lot of the behavioral techniques that I teach, oftentimes I'm teaching them to parents to support their children, and then sometimes they're implementing for themselves or they're coming to me and like, "Oh, how can I use this? How can I use this to support, my own symptoms?" But oftentimes for, professional folk or folks who, are running their own businesses- Mm-hmm ... and then they get diagnosed or they have this awareness, what's gonna give them the greatest change is gonna be an amphetamine mm-hmm. Mm-hmm. I'm so glad that we're talking about all this because I think about when someone comes into my world, it's not... it's do they have a sleep disorder? What's happening with the labs? There, there's all these different things that are contributing. I think people think it's just what I'm eating and how I'm moving. It's not. And the reality is, like, oh my gosh, like, that's maybe, 5%, i'm thinking here, I'm like, gosh, if I h- if I could dream up the perfect clinic, okay, it would include neuropsych testing- Yeah ... sleep study. We would just bring you in, and we would assess you for a week. And I know these clinics exist, right? You hear about people going on, medical tourism where they go get all the things done. I just think we would be catching so many things earlier, and we would avoid so much shame. I think it would be radical how different the experience would be for people. Yeah, and I really do think that, a neuropsych assessment, regardless of, what shows up, every adult I have ever, assessed or has ever come to me, with a report and then I'm providing the intervention to address whatever was, uncovered in the assessment. I've never had an adult come to me and not say, "I'm so glad I did this. It's given me personal insight, personal awareness," regardless of what the diagnosis or diagnoses are, "and it's given me clarity," right? Yeah. I definitely would encourage, people who are struggling, who are like, " my motivation isn't great," or, " I wanna make these changes, but I'm just not able to," to, to think about that because there may be legitimate, real things not laziness, not you're just not trying hard enough, that are going on that can be addressed and can be resolved with the right interventions and the right supports. Do you think there's anything that we didn't talk about here that's important for people to hear? Cause, of course we could talk for hours about this. Have difficulties in, with executive functioning or any kind of, cognitive or emotional disorder. It's not a personal failing. It's not something you have to handle on your own. It's not something that has to get bad enough- Yeah for you in order to have support for- I'm so glad you bring this up. Yes ... um, right, and that's a real... I hear that all the time. Like "It's not that bad. I should be able to manage it on my own." Mm. That's our individualistic culture that we're socialized into, and we're taught that it's somehow a personal failing if we ask for help. There are supports out there at any age. Yeah. Earlier is always better, but it doesn't matter if you're 50. You can still benefit from knowing, and there are still interventions that might be useful. And I guess the other thing that people should know about ADHD is it really is like a lifelong- Mm-hmm disorder. So challenges with executive functioning, if you have a clinical diagnosis of ADHD or you meet criteria, that means that the symptoms were present in early childhood. And when I talk about early childhood, you can give a provisional diagnosis to a child that's three, the symptoms are there. Yeah. They may evolve over time, right? Because we know that the brain and our prefrontal cortex is developing until around age 24, 25 yeah. So somebody with ADHD, like the way I looked at 16 or 18 or 20 in terms of my organization was very different than the way I looked at 40 even before I was, doing medication management. But the symptoms are still there. They may be less prominent. They may look different, but it's a lifelong, disorder. Mm. So that's the other thing that I would want people to understand. You don't just start to have symptoms of ADHD when you're 16. That's not the way it works. That's some- that is something else- Yeah If that's what's going on. Thank you so much for talking us through so much of this. I think people are gonna have a better understanding. And honestly, one of the main things I'm leaving this conversation with you is hearing that there's a lot of hope. Yeah. Because I think people are... at least by the time they get to me, they're pretty desperate. 'Cause No one's been telling them any of this. Yeah. And so you've just, you've just kind of been on your own island thinking you're crazy, and that's just the worst feeling in the world. So I'm glad that we brought this up. I'm sure some people are gonna listen and think, "Oh, my gosh, I actually could get tested. I could get help." So along those lines, can you tell us more about how people can find you, more about your clinic? Just because I know that- Sure ... that people are gonna definitely want that help. I run a virtual practice. My website, you can find me and contact me at suleskypsychology.com. And I know, Dr. Rentea, you'll link that in the show notes. And in terms of my practice, I work with adults, so I work with people 18 and over. And my practice is really focused on, helping adults who are experienced issues like ADHD, who are struggling with boundary issues, who, maybe are dealing with caregiver stress, discrimination. And then, I treat depression, anxiety, what we think of as the run-of-the-mill- Mm-hmm ... mental health issues or disorders that people, experience. And I work collaboratively with clients. I use evidence-based treatments, which means I use treatments that have been, tested and rigorously researched, but I do so from a culturally informed lens. I'm a bilingual therapist, so I provide services in Spanish and English, and my practice is a telemedicine practice. I have what's called a PSIPAC licensure, which is an introducial compact. So I actually am licensed to provide services for people living in 43 out of our 50 states. You never told me that. Wait a minute. I just... It just came through, Dr. Rencia. Okay. Okay, 'cause I'm like- So- ... you, you did not tell me that. I'll send you. There's like a, PSIPAC, they have their little website. Yeah. 'Cause I think it's easier for people just to look at it, but it's basically- Because we're gonna list the states. Can you just, spoiler alert, can you tell me, is Indiana one of them? Indiana is. Okay, good. So the- 'Cause I'm like, if- I'll tell you the seven that are not included. Okay. It's Massachusetts, New York, California, New Mexico, I think Alaska, Hawaii. Yeah, I think those are the ones. I'm really sorry everyone listening that's in those, but the other ones, they can all benefit from you. Yeah. So I can... and I now accept Blue Shield Blue Cross PPO. Ooh. So I, I can accept that insurance and then cash pay- paying clients. I'm so glad to hear that because I was thinking, "Oh my gosh, it's only gonna be Illinois." But now- Oh, yeah ... oh my gosh, it's amazing. Okay. This is so great. You are just an incredible clinician and person, and I'm so glad that you came on today. Thank you for giving us your time. And again, like you said, I'm gonna make sure to link everything down below. This is gonna be one of the best show notes to really learn a lot from someone that's been listening to this. So thank you so much. Thank you. Thank you, Dr. Rentea.

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