Episode 47: Medications and Executive Functionings

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Medications and Executive Functioning

Executive Functioning and Medications

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        Erica: Welcome to the personal brain trainer podcast. I'm Dr. Erica Warren.

        Darius: And I'm Darius Namdaran and we're your hosts. Join us on an adventure to translate the scientific jargon and brain research into simple metaphors and explanations for everyday life. We explore executive function and learning strategies that help turbocharge the mind.

        Erica: Come learn to steer around the invisible barriers so that you can achieve your goals. This podcast is ideal for parents, educators, and learners of all ages. This podcast is brought to you by Goodsensorylearning.com, where you can find educational and occupational therapy lessons and remedial materials that bring delight to learning. Finally, you can find Dr. Warren's many courses at, Learningspecialistcourses.com. Come check out our newest course on developing executive functions and study strategies.

        Darius: This podcast is sponsored by Dyslexiaproductivitycoaching.com. We give you a simple productivity system for your Apple devices that harnesses the creativity that comes with your Dyslexia. So, Erica, what are we going to talk about today?

        Erica: Hey, Darius, I think today we're going to talk about medication and executive functioning. What do you think?

        Darius: Yeah, I really wanted to talk about this because executive, function is often associated with ADHD, because ADHD really affects your executive function. But there's other things that affect your executive function, as we've talked about Dyslexia, your health, your stress levels, all sorts of things. And so I thought it would be really useful just to get a sort of 360 view of how people use medications in different ways to aid with their executive function. Or maybe sometimes even it doesn't help with your executive function. It would be just really good to talk about it. And we kind of need a bit of a disclaimer here, don't we, in that this is not medical advice, et cetera. I'll leave that over to you.

        Erica: Right, so we are not offering any medical advice here, but we're just really discussing what are the various options that are out there. Some people like to go down the medication pathway. I personally believe that if I were to even consider something, I would do all the natural means first. I, as a child, had attentional difficulties, and it turned out that I was allergic to preservatives. So that cured my problem. As soon as I got off of preservatives, I didn't have attentional problems anymore, because attentional problems can be the result of allergens. It can be the result of not having the right nutrients in your body. So there are a lot of other causes of attentional difficulties. So I think ruling that out is really important. Everybody has their own choice and pathway to take. But, yeah, I have definitely seen in my years of being in a practice, that there were those students that I worked with that had profound changes after trying medications. And so I've witnessed some close to miracles from that. I've also witnessed those that have had terrible side effects where they developed ticks and stuff like that. So it's just something that you have to explore, dabble in yourself, do your research, find the right types of professionals that can guide you in the right ways. They even have neurological testing that you can have done to see whether the different types of medications are appropriate for you to take. So that's always, an avenue that you can explore as well.

        Erica: So, yeah, let's talk a little bit about the types of drugs. One particular type of drug that they use to help people usually with attention deficit disorder are stimulants. The idea of a stimulant is I actually heard someone speak about this once and I really liked their presentation. He said it's not that they have attention deficit disorder, it's that they have attention surplus so that they are attending to everything and they're unable to focus on one thing. And he described it as that the brain has inhibitors and those inhibitors allow you to focus. And he was saying that their inhibitors are inhibited so that they're unable to limit their focus and they're open to all stimulation, which is what makes them kind of dart around from thing to thing. And a good metaphor that really describes, I think, what it's like for a lot of people that have ADHD is it's like watching three movies at once. your kind of darting between the movies, but you're never really diving fully into any one thing. So, although we don't realistically have that in life, their reality is that maybe one movie is what's going on outside and another movie is what the teacher is saying, and another movie is what's happening to the student next to them. And they're kind of simultaneously darting between those different things. So they're ultimately constantly multitasking in a way or multiprocessing, they're switching between these things. And when you can uniprocess, that benefits, particularly the learning process. Now there are times where it's wonderful to be able to attend to everything, and that's going to be a really vital skill in certain cultures and in certain situations. But in the educational system, we do like people to learn how to focus. So stimulants, stimulants are often used for individuals with attention deficit disorder. What stimulants do is it increases the levels of dopamine and norepinephrine in the brain. And these neurotransmitters play a role in attention and impulse control. So I would suspect that they increase your inhibitors so that you can inhibit. And there are different types. There's Methylphenidate, which are medications like Ritalin. Concerta metadate are some examples. There are amphetamines like Adderall or Dexedrine, and then there are Dextroamphetamines, which are like Dexedrin. And ProCentra are just two examples. So a lot of people will dabble between these and see which type of stimulant works for them because they are all slightly different variants of stimulants.

        Darius: Got a few questions. You say dabble, I mean, I think your kind of meaning because these are all prescription drugs, aren't they? So they're experimenting with doses and levels and so on. I had an interesting interview on my other podcast, dyslexia explored with a couple who talked about the relationship with ADHD and Dyslexia. And they had this little ADHD test, a visual computerized test that you go through it, and you respond, and it measures your attention levels. What, they found was that their daughter who did it, they do it for other clients, but their daughter was also identified with ADHD. And she was taking the medication. But when they did the test, they realized it wasn't actually affecting her attention, although she was taking the medication. They actually changed the dosage and reduced it or increased it. And then they did the test again a few days later, et cetera. And they could see that there was a significant improvement and change. So help me understand, it's not just a case of taking the drug. It's a case of levels, isn't it? And could you go into that a little bit more? Because that's a bit of a mind meld for some people. They think, oh, well, I take it, and then it works a bit, and I take some more, and it works a bit more. But it's not as linear or direct as that. Sometimes it's more like an on off switch where it just kind of suddenly flicks and starts to work, and it's, like, not working, not working, and then works, and then you take more, and then it stops working. And it's not as linear as we might imagine, is it?

        Erica: Well, the term that they use is a therapeutic dose.

        Erica: You have to determine a therapeutic dose. And typically what they do is they start you off on a very low level that is not typically therapeutic. Now, some people are more sensitive than others, so there may be times where they would think it would not be a therapeutic dose, and it is. So I think typically with these medications, that they start on a low level and then they slowly increase it over time until they reach a therapeutic dose. Occasionally, over time, the body adjusts, and they have to then increase the therapeutic dose again. Sometimes, I know of individuals, over time that will switch to a different type because they feel that they've kind of gotten used to it, so to speak, and that they want to try something different. I've also known of other individuals that take the medications for some time and feel that they've kind of trained themselves how to maintain attention on the medication. And then now that they've kind of learned how to do it, they don't need it anymore. That's not as common, but it does happen. So I think it's very individualized. And when I say dabble yes, you always are dabbling with a professional, with a doctor, a psychiatrist that can make sure that they're, keeping track of everything that's going on. And you have to be aware of so many things because for some people, these stimulants can damage their appetite and they're just not eating enough. And now some people, love that. They're like, well, my appetite is too big anyway. That's going to help with overeating as well. But everybody's very different, and everybody's very different in how it reacts. And you have to be very careful that you're not taking other medications and that shouldn't be mixed with the different types. So it's very important to work with a medical doctor or psychiatrist that knows all about the medications and can guide you in the right direction.

        Darius: So is this just for people with diagnosed ADHD?

        Erica: Well, yes and no. I mean, I've known of pediatricians that have given families a prescription for this, so you have to get a prescription. and it's interesting because these are all stimulants, and there are other stimulants just within our society that are accepted that don't require medication. So, for example, if you have a child that has ADHD and you notice that anytime they have caffeine, they're much more focused. Caffeine is a stimulant. It's a short acting stimulant. So what ends up happening is they're not able to focus for very long, and then all of a sudden, you're drinking an awful lot of caffeine or consuming a lot of caffeine in a day, which isn't great for you either, because it can definitely have other impacts. So what's better about a lot of these stimulant medications is that they can determine how long it lasts. So they have short acting ones, long-acting ones. You can take it more than one time a day. You definitely don't want to be taking it in the evening because you probably won't be able to sleep. So all of these things have to be taken into consideration when consulting with a psychiatrist or a medical doctor.

        Darius: Yeah, I know of someone, a friend of mine, and they take the medicine first thing in the morning, and then they have to eat straight away while they're still a bit hungry, a big breakfast, because they know that once it kicks in, their appetite will just die right down, and then that's them. And then it fades away for evening, and then they can sleep. The thing is, I've always had this question about some people take it on one day, but then they don't take it on another. They think, I'm not going to school today. I'm just going to hang out and chill out. I'm not going to take my medication. What's the deal with that sort of approach?

        Erica: Yeah, I know of a lot of families that choose that approach, where they'll give their children stimulants or a medication, or even non stimulants, which we'll get into shortly during the school year, but they take them off during the summer, or they might even take it during the school week, but not on the weekends. And I think it's a preference if you're finding that the attentional difficulties don't really impact anything but academics, that makes a whole lot of sense. But if you're finding that the attentional difficulties are impacting quality of life all the time, I think those people are more apt to take it more consistently. The other thing is that if you take some time off, then you're not as likely for, your body to get used to it as much. Then you don't have to be increasing the dosage. I'm just not crazy about any medications, personally. I think if there's anything you can do to figure out what the cause is and address the cause, that's the first thing to consider. Because these things don't cure you. They're just a Band Aid. Right. And if we can get to the cause of it and for some people, there is a cause.

        Erica: For some people, it's just a genetic disposition. And of course, now remember, too, that people that have attentional issues I don't even like to say that because it's just a different way of processing. In some environments, being open, having an open attention is going to be really beneficial.

        Darius: Sports.

        Erica: Yeah. There are times where you want to be focused, and there are times where you have to be open because you want to be aware of everything in your surroundings. So, yeah, for example, if somebody is in sports where they need to be aware of their surroundings, then maybe they don't want to be taking medication near that time because it might actually impede their abilities. So it's very individualized.

        Darius: Yeah. I mean, I have a vested interest here because it's annoying, but I think I've got ADHD as well as Dyslexia And well, I think isn't it funny whenever you think there's some revelation, like I hear it from people more on the Dyslexia side because I've focused more on that in the past, is that, oh, such and such thinks I'm Dyslexic. And then you speak to a family member, do you think I'm Dyslexic? And they go, yeah. And they're like, really? And then you speak to someone else, and they go, yeah. And everyone is like, yeah. And you're the last person to know. Do you know what I mean? And I think sometimes it's with ADHD as well. So it's like someone said that they think I might be ADHD, and they're like, yeah.

        Erica: Do you know what I mean? Totally. Yeah, I do. Right. And have you ever explored with any types of medication?

        Darius: No, I haven't. And I'm just being honest. And we've had this conversation before, but, personally, more than publicly. And one of the purposes of this podcast is for us to not just talk about what we know, but what we're experiencing, what we're going through, and how we're processing it as professionals, life and our, professional practices, etcetera, and current affairs, and everything else. What I've noticed in me is the same experience I had when I went to go and get my Dyslexia test and I was 35, I was like, well, I might be mildly dyslexic. What's the point in finding out just now I've finished school, et cetera, but I had a particular reason I was at university for a second time, and I wanted to be able to type out my essays. The only way to do that was to, be identified with Dyslexia if I had it. So I did it for the sake of it, and I said, well, if I'm mildly dyslexic, whatever, at least I can type. And so I was just kind of doing it for whatever. It's not such a big deal. But since I got it and I got woken up to it, I realized how much it was affecting my life and the things I could do to improve my life by being aware of that particular self-aware in that particular area. And I've got the same nagging feeling again that I should be doing something about the ADHD side of things. But you know what? To be honest, sometimes I just say to myself, I don't know if I've got the energy to take on another thing. But then there's another side of me where it's like, Darius, though you had some difficulties with initiation, know, self-initiation, initiating some tasks today, didn't you? I'm, like yes, I know I did. Well, maybe there might have been something that could help you with that and that could have helped you. And I'm like, yeah, I know. Just go away. Stop being so sensible. Do you know what I mean? And I've got this dialogue going on with the adult me and the child me sort of thing going on. And I'm wondering if there's maybe other people who are listening as well to this podcast and who are kind of thinking, Should I be? you know what it's like? What you say to yourself is, I've done okay up until now, so why change anything? But then if I'm honest with myself, I say to myself, yes, I've done okay until now, but maybe I could have done better than okay. And maybe, like, some of my friends and relatives who take some of these drugs, maybe I should be thinking about just and, then there's the whole nightmare in the UK. I don't know what it's like in America, right? What is it like in America? In America, you've got, like, health insurance, okay? And health insurance gives you kind of certain rights and categories where you can go and get help and things that are included and things that aren't. And in the UK, we've got the NHS, and the NHS is everything's included. Part blanche? Everything's included. The only thing is the process of being identified with ADHD can take, like, two, three, four or five years. Wow. If you find a GP that's willing to sit down with you and then refer you to the right person. It's all free, but it goes on and on and on and on and on. And you're thinking it's hard enough to get a GP. We call them GPS. Do you call them GPS over there in America? Some people, right general, know local GP. It's hard enough if your legs falling off to go and get a GP appointment or you've got some very significant illness or whatever that's besetting you. And to get their time is really, really hard. So what a number of people do in the UK, I've heard, is they go privately to a private GP, and they go through that process until they get identified privately, and then they transfer that over to the NHS GP. And then the NHS GP is in maintenance mode, can monitor and maintain.

        Erica: Yep, that makes sense.

        Darius: So what are your thoughts with me in particular and then with other people who might be listening? And it's interesting hearing it from you because you're not very prone medication at all. I mean, you're supernatural. All the rest of it, you've got loads of interesting stories, but what's your take?

        Erica: But I have seen it transform people's lives.

        Darius: Give me some examples.

        Erica: I can think of this one little kid that I used to work with that had such severe attentional problems that he just really impacted his ability just to learn it all. And he was just so incredibly distracted. And I think a lot of people were concerned about him ever being able to kind of function independently. And he started to take it. And now he's graduated from college and is a very successful person and he's always taken it and it's just been magical for him, completely changed him from a kid that was really almost incapable of learning to actually a voracious learner and it was really quite extraordinary. So I would say that that's not always the case. I think that's one extreme, but I think it's a personal preference. I personally think that if you've looked into other things and it's something you're really curious about, I think it's worth exploring. I think it's definitely worth exploring.

        Erica: And since we love to use metaphors, I'm curious, what kind of metaphor would you use to describe a stimulant drug? Because I know you love to use the metaphor.

        Darius: I love a metaphor, don't I?

        Erica: Yeah. Automobile.

        Darius: Right. This is the thing that I find hard to get my head around, okay? And it might be useful to use a metaphor to interrogate this type of thinking to see whether it's accurate or not. So I have, let's say this ADHD individual, a particular person, has attention surplus, okay? So they've got a lot of attention and a surplus of attention. Then you give them something called a stimulant, and it makes them have less attention, that is, reduces attention in certain areas and makes them focus their attention in one area.

        Erica: I don't understand that, think about it as that it's stimulating your inhibitors so that you can inhibit and just focus on one thing at a time. Oh, I see. So this guy that I listened to.

        Darius: Years ago said, stimulating your inhibitors, that.

        Erica: People with attentional problems, their inhibitors are inhibited inhibitors.

        Darius: Okay. I find the inhibitors inhibited quite hard to get my head round that's right. The double negative words, the double negative. So the inhibitors are functioning. I kind of picture them as grabbing things out of your mental bloodstream. I've seen pictures of this, that they grab things, this whole process of your biology, sometimes lots of things get released to do something and then to stop the process, there's things that grab them and pull them back in, so they're not always on. And is that what an inhibitor is doing? Is it's pulling certain things out of the environment to not be so much attention? So what are the inhibitors doing?

        Erica: I would say that we've used in the past a way of describing inhibitory control, which is one of our executive functions right, yes. That we use the metaphor of blinkers. Blinkers are the almost little protectors on either side of the horse's eyes that, prevent them from being able to see to the left or to the right, so that they don't get spooked. So basically, I think that metaphor works really well. So what a stimulant medication does is it puts the blinkers on so that you can just see what's in front of you, so to speak, or you can just focus on one thing instead of being distracted by all the other things around you.

        Darius: Okay. So it's not stimulating your attention. It's stimulating I'm just imagining this kind of like winding up that blinds that are kind of extending out. It's like this extender blinds so that you don't get distracted, along the side, whereas at the moment, they're retracted. And when you take the stimulant, it sort of puts them out. It stimulates them to go out.

        Erica: It gives you that tunnel focus. Yeah. So you're in a tunnel and you're not distracted by all the other things around you. Yeah. So I think that's a good way.

        Darius: Yeah, that's helpful. Thank you.

        Darius: You've also mentioned that there's stimulants, but then there's also non stimulants.

        Erica: That is correct.

        Darius: How does that work? What is a non-stimulant?

        Erica: A non-stimulant is an alternative that also increases the level of norepinephrine, but not dopamine.

        Darius: You're going to have to explain the difference between dopamine and Norepinephrine.

        Erica: how do you say it? Norepinephrine. They're both neurotransmitters in the brain. A stimulant stimulates both dopamine and norepinephrine, whereas a non-stimulant stimulates just norepinephrine. And so some examples of that are Atomoxetine or Strattera is an example of one we've got Guanfacine, and there is an example of one of those is Tenex, and then we've got clonidine, and an example of that is cape or Catapres. So they have all these ridiculous names. But anyway, really the difference between the two is that one increases dopamine and Norepinephrine, which is the stimulant, and the non-stimulant just increases Norepinephrine.

        Darius: What's the difference, in effect, on the individual? What do they feel differently?

        Erica: Well, it's just a matter of which one works for you. Okay, so you can try a stimulant, and if it doesn't really work for you, or if it makes you very antsy or agitated or you have any side effects, then you can always try a non-stimulant. So dopamine tends to be that kind of happy. dopamine you get dopamine bursts when you are in a state of awe, when you're in a state of flow, when you feel really happy. But if that kind of stimulant doesn't work for you, then you always have another option of a non-stimulant.

        Darius: Now, this is a little bit more controversial, but do regular people use these drugs as well to help their focus and attention? Does it work for everyone?

        Erica: I think you'd have to do an experiment to determine that. I think that we are seeing that a lot of college students are accessing a lot of these drugs to help them study for tests. A cup of coffee can often do the same thing for the vast majority of people. And they have these other really high, intense stimulants that have enormous amounts of caffeine, like Red Bull and stuff like that. They're doing something similar. Those are stimulant based. I don't think we have any kind of non-stimulant based. I don't know. There might be certain foods that increase levels of norepinephrine. I've never explored that. Or there might be certain supplements that do. And I do know, and that's a different podcast that there are certain supplements that you can take that help with attentional issues, for sure.

        Erica: So we've talked about stimulants. We've talked about non stimulants. Is there anything else that can be done? Well, technically, yes. There are antidepressants for depression and anxiety, and these do also impact the neurotransmitters. So there are certain anxiety and depression medications that do impact norepinephrine. And then another, neurotransmitter that we haven't talked about, which is serotonin. So just the fact that it regulates the different levels of neurotransmitters in the brain that will affect mood and cognitive functioning. And so there are certain antidepressants that can be used for both depression and or anxiety as well as attention. So, there are some people that explore that as a possibility, particularly if they're struggling with perhaps two things like anxiety and attention, because you can think about well, if you think about it, anxiety is going to impact your attention because you're anxious. And so, yeah, if you have multiple things going on at once, that's always something that you can explore. And you can always ask your practitioner or your doctor or your psychiatrist whether there are medications that can address more than one issue at the same time.

        Darius: Fascinating. So if we think of the three elements of executive function working memory, inhibitory control, and cognitive flexibility, we've very much fixated on, the inhibitory control element here with the stimulants and so on. But executive function is wider than inhibitory control. And we've also talked about inhibitory control being affected by emotional regulation. And in many ways, the whole aspect of the depression, anxiety is that emotional regulation aspect as well. So what about working memory? Are there any, kind of drugs that kind of help with working memory?

        Erica: So I think a lot of these stimulants and non-stimulants can and even the antidepressants can help with working memory and inhibitory control. If you're more focused and you're more filtered, your working memory is less taxed.

        Darius: yes.

        Erica: And so you're able to learn more fluidly. I also think that I've witnessed in my students that take medications where they are really benefiting them, that they do tend to be more cognitively flexible, they're less rigid, they're less overwhelmed. And so because they're not as overwhelmed and they're more attentive and their working memory is working better, they're more able to experience changes or shifts in perspectives and are better able to transition from one task to another.

        Darius: Now, this is something that you probably I'm just going to throw it out there. You may know about it, you may not. I was listening to the All In Podcast and Chamath Palihapitiya, I don't know how to pronounce his name very well, but he keeps mentioning in it this company's invested in which is trying to create an alternative to ADHD by doing exercises on, computer and training exercises that are computer based to help people instead of using ADHD medications. Because many people think that people are just over medicated for ADHD in society. And I think it might be first of all, useful to talk to the over medication side of things first, and then if you know anything about that other might be useful to have a look into that and see how it works.

        Erica: There are certain brain training programs that claim to see some gains. I'm not a huge fan of them. They tend to be very expensive, really time consuming, not a lot of fun to do in general, but perhaps, maybe he'll come up with something that's better, which, I'm always open to. I do a lot of work with that population of learners. I believe that executive functioning training is incredibly valuable. So I find that with a lot of my students that have attentional issues teaching them about working memory, inhibitory control, cognitive flexibility, making them conscious about the subconscious. Ah, so they learn, for example, how to use their inner voice. They learn how many inner voices they have, they name their inner voices so that they are more conscious, again, of what's going on in the background, so to speak. Yeah, I teach. Them how to expand their working memory consciously by teaching them memory strategies. I teach them explicitly how to study. We work together to figure out what are their optimal study strategies or methods. Because, for example, you can look at things like the Pomodoro technique. It's a cookie cutter approach. But you can take the idea of the Pomodoro technique, which is that you study in 20 minutes increments, and then make it whatever increment works best for them. It might be 15 minutes; it might be 30 minutes. It might be more like 45 minutes. Like Andrew, Huberman suggests workflows of about 45 minutes. Or there's the flow Time technique, which says you pick your own amount of time and just making them aware about little things like emotions. So if you're feeling dysregulated, that's not you. It's a chemical. It's a chemical in your brain. And that chemicals only last 90 seconds unless you feed it and just having that awareness so that they're like, wow, okay, I don't like the way I'm feeling right now, so I choose not to feed that emotion. So I'm going to distract myself for 90 seconds so I'm not in that flood of chemical emotion, just teaching them little things like that, teaching them how to manage their mind, teaching them how to focus, teaching them how to memorize, teaching them how to be cognitively flexible. And I'm trying to get into the schools because I think that's what we should be teaching all of our students, even in primary school.

        Darius: I agree, and I think you've been talking a lot about, child range, but the same applies in adulthood, in the workplace, in the home life. All of these skills, especially if you learn them in childhood, leave a legacy for your adulthood and better outcomes in life, because you're actually driving towards your goals rather than being pushed along by the winds and tides and currents of your emotions or distractions, et cetera. What's interesting in this is it's kind of like another metaphor. Sometimes your mind is like a horse. Like, you're riding a horse. You're the horse rider, and the horse is beneath you. And you get different kinds of horses. You get horses that are quite docile, and then you've got horses that are just like wild. And you're on this horse and you've kind of got, like, I've got this wild horse. And I think a lot of very creative people, their minds are like wild horses. They've either got ADHD or dyslexia or some other aspect that amplifies their creativity. And so what do you do with this horse? You could medicate the horse to make it more docile, dope the horse, or you could become a better horse rider, right? And that's what you're talking about here. You get better horse rider. Or actually, also, when I'm speaking with clients, it's like accepting that there's a wildness about you, that there's a wildness about your mind, this horse. And there's a great joy in that, and there's a great strength in that. And that your job isn't to break this horse, per se, or to break yourself, or to break yourself in or subdue yourself, but is to this negotiation, as it were, that we've been talking about in previous episodes. This self-talk is there are times when this wild horse, you've got techniques that are saying, no, we're not going wild right now. But then there's other times where it's like, look, you go wild. Let's just gallop. Let's just jump over the rivers and the bushes and the hedges and so on, and I become like more of a passenger, and there's an interplay between the two. But sometimes with a wild horse, you got to learn more techniques. There's not so much leeway where you're like, yeah, it kind of goes the right direction. But you need to improve your sort of riding technique, your posture, the way you prompt it or don't prompt it. Little things have a bigger effect or a negative effect and positive effect. That's really what we're talking about here, isn't it?

        Erica: Yes, and also compassion. Think about it. If you've got this wild horse and you really open your heart and you're really connected to it and you're really compassionate, sometimes that softens the horse, and they connect with you. So softening yourself to yourself and being open that you can succeed. And really making that decision to reprogram our subconscious patterns, because sometimes there are these subconscious patterns that have been programmed within us and just really becoming a rider of that wild horse that is both compassionate and in control and allows the horse to take off when it's appropriate and reels it in. But that's what being conscious is, being that kind of active versus a passive learner. So teaching kids to be active learners, to be consciously aware, often gives them some of those tools. Now, understand that they're those people that just wow, just a small amount, or whatever they need of medication just gives them that extra boost that they need. It's like it gives them a better saddle or something. Gives them something that just takes the edge off. That could be the case or could.

        Darius: Be literally like riding the wild horse. Okay, join that up with the blinker metaphor. You do put the blinkers on the wild horse because that physical thing really does help them.

        Darius: And in a way, let's join those two metaphors. You've got this wild horse and you're thinking, right, it is time for us to run this race or do this particular task. In Scotland, for example, we have horses that we take up into the Highlands and pull-down trees with still. I know a few of them. I mean, it's still a bit of a niche thing, but huge workhorses because there are some places you just can't get machines up, but there's extremely valuable timber up there, and so they bring them down with the horses. And sometimes in that sort of setting, you need to put blinkers on, and other settings put blinkers on in a race or whatever. And you're still exercising the wildness, you're still exercising that drive and it's being focused on that direction. So you're still being you.

        Erica: Yes. And I do know of, some individuals that only take medications when they're taking very serious tests where they're expected to sit for two, three, 4 hours, which is just beyond their functional capability. And by taking the stimulant, it enables them to be able to finish these tests.

        Darius: Yes. So really what we're talking about here is having a toolkit of a range of things that are sometimes medical as a toolkit, but also practical self-awareness techniques and so on. Riding techniques, posture techniques, the way you.

        Erica: And ruling things out. Maybe the horse is wild because it has a thorn in its foot.

        Darius: yeah, I love it. That's great.

        Erica: it's really important to make sure that it could be something as simple as like it was for me. I was allergic to any type of preservative or filler. And very interesting because later on in life, when I cleaned my diet up even more, I found that my cognition improved even more. So we're living in a society right now where there are a lot of pollutants, there are a lot of things that we're eating that aren't great for us, that have pesticides in them and all of that. Our bloodstream feeds our brain. And so if there are pollutants in our bloodstream, it's going to affect our attention. We've kind of offered a menu of options and take away whatever resonates with you. But listen to your gut. Your gut's a good indicator of what would be a good way to go in the beginning.

        Darius: Well, that would be an interesting episode to talk about the gut and your attention as well.

        Erica: Well, this has been a really interesting discussion and I hope this was helpful for many of you that have really wondered about whether medication was something you wanted to explore.

        Darius: Yeah, it's made me think a lot more. And I really like this metaphor of riding a horse and this wild horse and whether it's wild or not, but having a whole range of different tools and techniques that can help you travel to the destination and be the kind of person that you want to be around others. Because sometimes it can be disruptive or you're not engaging with other people in the way that you want to or your goals or whatever. There's a whole range that we've been talking about throughout this whole series that we've been doing in the Brain Trainer podcast. And it's nice to drop in ah, a little bit about medication as well as all the practical stuff we can do as well.

        Erica: Yeah. And if anybody wants to know more about this executive functioning program that I do have it will put information in the show notes.

        Darius: And one of the other things I was going to mention now you've mentioned the program is often, as parent, we need to model these things to our children. So if we see this difficulty in our children, I'm very passionate about helping parents learn the executive functions they need in their own life to enhance their work life, and also with the awareness that they're simple enough that they can transfer them to their child, model them to their child. So if you're interested in that, come, and get some coaching from me.

        Erica: Excellent. See you later.

        Darius: All right.

        Erica: Take care, Darius. Bye bye. Thank you for joining our conversation here at the Personal Brain Trainer Podcast.

        Darius: This is Dr. Erica Warren and Darius Namdaran. Check out the show notes for links to resource, as mentioned in the podcast, and please leave us a review and share us on social media. Until next time.