SuccessFULL With ADHD

Navigating the Intersection of ADHD and Anxiety with Dr. Sharon Saline: A Favorite Rerun Episode

• Brooke Schnittman MA, PCC, BCC • Season 1 • Episode 73

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This is A Fan Favorite Rerun Episode

In this episode, I welcome Dr. Sharon Saline, a clinical psychologist with over 30 years of experience and a top expert on ADHD, anxiety, learning differences, and mental health challenges. Dr. Saline shares her personal experience with ADHD and anxiety and provides insights into the relationship between these two conditions. She also offers strategies for managing anxiety and ADHD, emphasizing the importance of understanding triggers and developing proactive strategies.


Episode Highlights:

[0:43] Introduction of Dr. Sharon Saline

[3:11] Dr. Sharon Saline's story of an ADHD Diagnosis

[8:37] Research on Generalized Anxiety Disorder in kids and teens

[8:55] Connecting ADHD and Generalized Anxiety Disorder

[13:03] Triggers of anxiety and ADHD

[15:02] Signs of anxiety

[17:57] How ADHD impacts people dealing with their anxiety

[20:28] Making a list of choices for when triggered

[22:19] Thinking about what could go right instead of focusing on negativity

[24:02] The importance of distraction

[25:59] Why we need connection

[28:05] Blending cognitive behavioral therapy, insight-oriented psychotherapy, and mindfulness positive psychology

[30:30] Number one pro tip


Resources Mentioned:

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Dr. Sharon Saline:

What the research shows us is that 34% of kids and teens have a bonafide Generalized Anxiety Disorder. Okay, I think that's low. I think my colleagues think it's low. Yeah, I

Brooke Schnittman:

was gonna say it's, I feel like it's going out.

Dr. Sharon Saline:

That's what the research shows. There hasn't been new research since COVID. So I can't say adults however, 50% of adults with ADHD have a generalized anxiety disorder 50% 50% Right. 50% which is a pretty high amount. And then there's a bunch of people who experience anxiety but may not qualify or have received a diagnosis.

Brooke Schnittman:

Welcome back everyone to successful with ADHD. I'm your host, Brooke Shipman, CEO and founder of coaching with Brooke and award winning globally recognized ADHD and executive function coaching company for all ages. And today, we have something a little different for you. As many of you know, I love to bring you the best content. And sometimes that means revisiting some of mine and my listeners favorite episodes. Whether you're a longtime listener, or new to our show, today's rerun is one of those must listen moments, originally airing in 2023. This episode features some of the most popular and needed information for ADHD ears out there today. All right. Without further ado, let's jump back into time and enjoy this classic episode of successful with ADHD. Hi, everyone, and welcome back to successful with ADHD. Today I had the pleasure of introducing and welcoming my good friend Dr. Sharon, saline. Hi, Dr. Sharon, so good to see you.

Dr. Sharon Saline:

Hi, Brooke. It's so great to be here. I'm really excited to spend some time talking about ADHD and anxiety.

Brooke Schnittman:

Yes, I know you are the guru of both of those. And for those of you who haven't had the pleasure to see what Dr. Saline has put out and learn more about her I just want to give you a very quick glimpse of her very long bio because she has so much experience. So Dr. Saline is a clinical psychologist and has over 30 years of experience. She's a top expert on ADHD anxiety, learning differences, mental health challenges and their impact on the school and family. She's written a book called what your ADHD child wishes you knew, working together to empower kids for success in school in life, and the ADHD solution deck with strategies to help your children learn. And I know that she is working on another book that hopefully will grace us sooner rather than later. She's very highly acclaimed, has won awards, you'll probably have seen her on attitude magazine 1,000,001 times she's a regular contributor to Psychology Today. Yeah, so the list goes on and on and on. But I wanted to bring Dr. Saline here because not only is she an expert in ADHD and anxiety, she also has ADHD and anxiety herself. And she is no stranger to coaching with Brooke we had Dr. Saline on as a keynote speaker to our ADHD Ed camp, which is our ear summit that we do with ADHD experts worldwide. So she's dedicated her time to help for free for a bunch of ADHD ears worldwide. So anyway, Dr. Saline share with us what growing up with undiagnosed ADHD and anxiety was like

Dr. Sharon Saline:

Well, this is a very interesting question because I, I was not the person in my family who was identified with ADHD that was my brother. I mean, I was pretty high achiever. I went to a fancy designer labels school for college. I graduated magna cum laude did very well in high school. So there was no sort of indication of what we would call typical ADHD. What I was was intense and very sensitive. So I thought had big feelings. And I was kind of driven and I you know, kind of driven Yes, okay. driven, and was quite capable of, of juggling several things at the same time. And I see this with a lot of people, women with ADHD who are, you know, they sort of have a high capacity, you know, for for both still elation and output. It wasn't until I really went through menopause, that I realized that I actually had some ADHD because it wasn't, it's not typical, you know, because it's around managing time. It's around emotional control, but also sensitivity. You know, when I get upset, I get very upset. I don't get a little upset. General,

Brooke Schnittman:

you do not want to piss up after saline for those of you listening? Not

Dr. Sharon Saline:

really no, no, no. But I'm still pretty productive. I think where I'm struggling now, you know, as an older middle aged adult, is in, in really understanding that I actually have limits, and that I can't do as many things simultaneous as I would like, because I start to get this intense feeling of overwhelm. And I think when I was younger, I could push through that more. And I think that's the the thing about estrogen you know, it has a modulating effect, both on you know it both on your serotonin, both on a set of choline, which is the these are neurotransmitters and that has to do with memory. Serotonin has to do with mood, and on dopamine, which has to do with both your focus and your satisfaction and reward systems. I think that's kind of where I've come to at this point in my life, you know, I've never received a final diagnosis and it doesn't, you know, again, it doesn't look how it looks. Everyone has their own flavor of ADHD, and that's mine. What you would have identified me with from childhood would be anxiety. You know, I'm kind of a worrier. I am a worrier. You know, I don't think first about the best case scenario, I think about the worst case scenario.

Brooke Schnittman:

I do that too, you know, and

Dr. Sharon Saline:

there's an intense feeling of, you know, I was thinking about this recently about how in college, I'm feeling like I just wasn't good enough. You know, I wasn't, you know, I wasn't part of the in crowd of the theater department, but I sometimes hung out with them. And I also felt a lot of pressure, I'm socially and then I would feel bad about myself after being around people who really just weren't that nice. Yeah, so there were a lot of times where, you know, being genuine and, you know, that kind of ADHD enthusiasm that we have and excitement, excitability? Yeah, it's just too much. And so that's more of what I heard, like, you're just too much, you're too intense. We all don't have to do the same thing, whatever. And I think that that's sort of where I've struggled more, which is managing the worried part of my brain, which is why I'm writing a book about adult ADHD and anxiety because as I've gotten older, it's gotten worse in some ways and better in others, like I, I am more resilient in ways and things don't bother me as much. But I know many people, including my clients, and people I talked to in various realms, you know, it's hard, it's really hard to sort of slough something off, you know, something that's unkind or that's purposefully exclusionary, or that is concerning. All of these things, you know, grow into something more we you know, sort of a catastrophizing mentality. That's the thing that I think, had you known me 20 years ago, you might have noticed first, not necessarily my attention. Yeah,

Brooke Schnittman:

no, I appreciate you saying that. Because I also was diagnosed with anxiety. First, that Generalized Anxiety Disorder, some psychiatrists or psychologists thought it was also social anxiety. So I don't know which one it is. But right now, the current diagnosis is generalized. It was only me who recognized that I had ADHD in 2019. But can you share with us and I know you're gonna put this in your book? And once that comes out, I would love for you to share that with our community as well. Can you share with us the relationship then? So I know that some people have a disorder and some people have anxiety related to their ADHD?

Dr. Sharon Saline:

So what the research shows us is that 34% of kids and teens have a bonafide Generalized Anxiety Disorder. Okay, I think that's low. I think my colleagues think it's low. Yeah, I

Brooke Schnittman:

was gonna say it's,

Dr. Sharon Saline:

I feel like it's going out. That's what the research shows. There hasn't been new research since COVID. So I can't say, adults, however, 50% of adults with ADHD have a generalized anxiety disorder 50% 50% Right 50%, which is a pretty high amount, and then there's a bunch of people who experience anxiety but may not qualify or have received a diagnosis. So, you know, that's why I think those numbers are a little bit low. And what happens in the ADHD brain is that there are lower amounts of dopamine and norepinephrine and they do different things. But when we are stressed, or when we're anxious, what happens is that cortisol, adrenaline and norepinephrine kick in, and so fill in the gap where dopamine is not, oh, there's a very complicated and important relationship between these things. So, for example, I may not notice that I'm feeling distracted, but I'll notice that I'm super activated, and I'm feeling anxious. Like, that's the first thing that comes from me and similar to you, my official diagnosis is, is a generalized anxiety disorder. And that's how I, you know, that's when I know I just have too much adrenaline going, and I don't know, like, I might wake up and feel just, I just wake up and I'm like, Wow, I'm super anxious today, I have a lot to do, and, or it just made me feel anxious for no reason. And I think that has to do with the fact that, so there are some people who have ADHD, who are like, I don't get anything done until the last minute, I don't get anything done until the last minute, because that's when the fire is under me, ie the adrenaline has kicked in. And now your body is running as if you're in a crisis. So your whole body is responding as if you're in a crisis, so that you then are fleeing the bear, you know, or you're preparing to fight the bear that Hunter mentality, correct, you're in an act up position. And so when that occurs, that all the neurotransmitters in our brain affect each other. And you know, I'm not a brain researcher. So I can't exactly say how and even brain researchers don't exactly know how. But we do know that when you rely on adrenaline for motivation, when adrenaline is the source of your activation, over time, it becomes depleting, and it becomes depleting in the glucose centers of the brain are fuel. And so after that burst of hyper focus, you have adrenal fatigue, exactly. And you're tired. And during that period, people may not eat, they may not drink, they may not use the bathroom. And so there are all kinds of things that are happening physiologically, which is why I actually work very hard with my clients to help them structure their hyper focusing. So you want to hyper focus, okay, great you that you want to get in the zone and stay there, an hour and a half, 90 minutes, because after 90 minutes, you need fuel. You need to use the bathroom, and you definitely need some a beverage or something like some water. Because if you keep going, when you're finished, you're going to be depleted. And what does that kind of depletion lead to burnout.

Brooke Schnittman:

Wow. So people who have anxiety, and I know it's not black and white, but people who have anxiety, they might very often wait until they get that rush of adrenaline to then complete the tasks because that fight or flight feeling. So it could be really hard for a diagnostician at that point then to diagnose someone with ADHD, because the symptoms with the neurotransmitters play in with one another. Fascinating, right?

Dr. Sharon Saline:

They look similar and but the difference is that with anxiety, there is a consistent trigger, a type of trigger with ADHD, there are a series of inconsistent triggers, right? Because having ADHD is living with inconsistency. Having anxiety is living with more consistency in terms of the things that bother you. So for example, I was talking with one of my clients and is regularly triggered when he has a physical ailment of any kind. And then he goes into this sort of rumination about something that happened 30 years ago with his wife, you know, and the thing that happened 30 years ago has is not relevant topically to what's going on except for thematic ly it is he was he felt vulnerable. And he felt scared. And so when something happens to him physically now that he's in his 60s and he's lived longer than either of his parents He goes back to that place, and the thought comes into his head. And so what we're working on is to see that thought as a red flag going up the pole, that, okay, you're feeling vulnerable and scared. Let's address that, rather than listening to this, you know, obsessive kind of rumination that's irrelevant in your current life with your wife, have you been married to for 40 years?

Brooke Schnittman:

Right? Yeah, no, that's fascinating. Because when I had Dr. Matej, on, we were talking about encoding into the memory of events that have taken place 30 years ago in your childhood, and it creates this physical reaction, when something like that happens, even if you feel you have done the work. And you know, you move down from it, you still and you can't explain it, it's this physical emotional reaction that you have.

Dr. Sharon Saline:

That I mean, that has to do that. So interesting, because one of the things that working memory does is it pulls up from our past experiences, tools, resources, choices, behaviors that we can apply to something that's going on in the present. And when people struggle with emotional control, they become flooded. And this is the thing that happens with anxiety is that the emotional part of the brain, the amygdala takes over the prefrontal cortex. And so the thinking part of your brain kind of goes to the Bahamas for a little while. And this emotional part of the brain starts like, you know, running the show, and it's, it's very chaotic, you know, because it's not boundaried by cognition. And so we want to get the brain back online. And the way the way that we do that is we settle our bodies first. And then we settle our minds. So we identify the signs, you know, that, that are showing that we're becoming anxious, you know, how do I know I'm becoming anxious? I, you know, I don't know how you know, but my neck is stiff my back. Okay, and I feel a tightness in my chest, some people feel it in their gut, some people feel it in their jaw, they might be perspiring, in their hands, whatever it is, that that flush is a sign. Right. And that sign is that you have to do some body based behaviors to settle yourself. And usually that has to do with breathing.

Brooke Schnittman:

We forget to breathe. We forget

Dr. Sharon Saline:

to breathe. Because really, insecurity and uncertainty are all about how breath, you're not breathing. You're not breathing physically, but you're also not breathing, emotionally or cognitively. You've zoomed in so far, that you have lost your perspective. Hmm,

Brooke Schnittman:

that's fascinating. And these are really good strategies for reactive, right, when you're starting to feel that anxiety. What kind of proactive strategies do you have for people with ADHD and anxiety?

Dr. Sharon Saline:

What we want to do is notice when we are triggered, what kinds of situations what kinds of behaviors, you know, I was talking with a client about her 12 year old son today, and she said he's triggered when people are unkind to him. That's really good to know. You know, like, he was playing kicker at school. And the kids said, We don't want you on our team. And he got angry, and he pushed someone out.

Brooke Schnittman:

Yeah. And he probably got in trouble because he pushed someone, right.

Dr. Sharon Saline:

And then he came home that day. So well, I'm doing better. I've only gotten in trouble, you know, three times this year, as a kid who got kicked out of several schools. And so, you know, those things are things that we hold in our memory, and we hold them in our body, too. So we want to understand the things that that challenge us and the triggers that we face. So maybe it's hard for you to go to lunch at work. There's a lunch area, and you know, people because you work with them, but you don't really know them because you don't hang out with them. And so it's like, Oh, what am I going to do? And what comes up is probably some memory of being in school and people were like, We don't want you to sit here. Now adults do that to other adults, which is good, hopefully, hopefully, right? But they might sort of look at you. And whereas we don't encourage kids to say Can I join you? Because other kids will say no, as adults, we want to say Can I sit here or can I join you? Because as adults generally would say, of course, you know, they may not include you in their conversation, but they'll acknowledge your presence. And so what would be good to know and that's it The question is that I am not my seventh grade self, where people are going to say no, you can't sit here I am my 35 year old self, where people will say, Yes, I may feel some of the same anxiety feelings about that. But my response as a 35 year old is different, because I can now make a different choice. And the thing where people with ADHD struggle is in calling up those different choices. In those moments when they feel anxious, because the memory loop, the habit of of feeling left out, will dominate. So we have to really hold on to our successes and write them down, or talk them into your phone. But at the end of the day, I have my

Brooke Schnittman:

lack of awesome right here.

Dr. Sharon Saline:

Yes, there you go, your list your list of awesome, so you want to have, you know, something where you just write down three things that went well, every day I do this, you know, and they and sometimes days are have like five or six. And some days, I am really pulling hard for three, like,

Brooke Schnittman:

woke up and brush my teeth, maybe yeah,

Dr. Sharon Saline:

I liked my outfit. Um, I ate lunch, I went to the bathroom, I went to the bathroom Exactly. So we really want to in the proactive department to identify those times when we're likely to feel anxious. And then have a list of choices and behaviors that are functional, as opposed to reactive,

Brooke Schnittman:

right? So it's practicing and making that list of choices of things that you could do when you get triggered. So because when you're triggered, you're emotional. And like you said, your executive functions get flooded, and then they shut down, so you can't think. So you have to, it's a muscle memory at that point.

Dr. Sharon Saline:

Right and you and you can write it down, and you may not be able to get to your list. And so that's what I see a lot of times with people who are very anxious and sort of panicking, or are feeling angry about something because anxiety and excitement are two sides of the same coin. It's how you frame it. And so you may need to say, as soon as I feel that, that little that tightness in my chest, I'm going to, you know, count to 10, or whatever it is that helps you I'm going to step outside, I'm going to get a glass of water, I'm going to go to the bathroom, the bathroom is a really good go to because you are expected to do it alone. And you can pull yourself together in the bathroom and be like, Okay, let's take out my phone and see what that is now, because I have a few minutes, right?

Brooke Schnittman:

Yeah. You mentioned anxiety and excitement being very close to each other. I was listening to Steven Kotler a couple years ago, and he was talking about for someone who's anxious socially, a strategy is to say, I'm excited. I'm excited. I'm excited when you're anxious, because it really does feel like you are excited at that point. Right?

Dr. Sharon Saline:

And instead of you know, catastrophizing and focusing on the worst case scenario, we want to ask ourselves, what could go right? What is something that actually could happen, that would make me feel good. And so that's important for us to really pay attention to, because of the negativity bias in our brains naturally, you know, which helped us survive the millennial where we had to think about what were negative consequences that could occur in order to figure out when we can go pick our berries and the tiger won't be on the trail right? Now, we don't have the same kinds of risks generally, some people live in, in in in areas or have lives where things are dangerous. They have some choices that they may not be aware of. But in general, our body is, is going to that worst case scenario. And for people with ADHD, who tend to receive throughout their lifetime, more negative feedback and positive feedback, it's easy to go to what isn't going to work or what hasn't worked before, rather than to hold on to something that has worked, which is why it's important to write it down. And to remember, okay, what am I supposed to do when I'm starting to feel upset, go to the bathroom, boom, go to the bathroom, boom, go to the bathroom. Get a drink of water, get a drink of water, get a drink of water, like you have a thing to do? Because for many people who are anxious, particularly for kids distracting themselves from the thing, the negative thinking is critical in moving away from it.

Brooke Schnittman:

Yes, I find that distraction is so helpful because when you're emotional, it's really hard to say well Have I thought Is that logical? Let's think about what my unintentional thought is and reframe it. No, I need to give myself some time to calm down. And the only way to do it for me, and it's not for everyone is to go outside or change the physical environment, leave the room where I had that thought, remove myself from it. Right?

Dr. Sharon Saline:

And that's exactly what I'm talking about. Because, you know, it's interesting when we think about babies, right? There are things that when they're crying we consider there's usually four things. So have they eaten? Have they slept? Did they soil, their diaper? Do they need a change of environment? And in a way, we want to ask ourselves very similar things like, Do I need to change in my environment? Have I slept? have I eaten? Do I need to use a bathroom? It's so interesting

Brooke Schnittman:

that if we just look at it as being a baby, you know, and our basic needs? Did we sleep? Did we eat? Did we do we need to go to the bathroom? Did we drink enough water? Do we need to change our environment, if we just think about those things, we can ultimately stop ourselves from getting to a certain emotional place to and I was thinking the other day, because you know, I have a 15 month old, she likes to watch Sesame Street. And a lot of the messages that they send our message is that US adults need to say to ourselves, but we forget about them, after watching them as young kids like the power of yet.

Dr. Sharon Saline:

I talk about that all the time. I talk about that all the time.

Brooke Schnittman:

About it on Sesame Street, I love it stuck in my head.

Dr. Sharon Saline:

That's so cool. You know, I was thinking I might add a fifth thing to that, which is connection. Because sometimes young babies just want to be held. Right? They just need that connection. And sometimes we adults just need that connection. You know, many people with ADHD are verbal processors, like I like to talk something else to solve it. And that's something that I know about myself. And so when I'm distressed, you know, is there someone that I can talk to you know, I have a close friends, you don't need a lot of friends you need like two or three, someone who's, you know, you can hang out with and then other people who you can hang out with when that person's busy. But just want a couple, like, you know, I think and I think that's really important. And I've learned that from a lot of kids with ADHD, some of them really want to be popular and need a lot of friends. But really, when you get down to it, they need like two or three friends. Like I have a few friends who I know have my back period. I was talking the other day with a boy who is in sixth grade middle school. And he's like, I have a few friends who have my back. But a lot of kids think I'm weird. And that's okay, because I like that I'm different.

Brooke Schnittman:

Can I meet this kid, please? Because he's like, the poster child for every piece of my history and other people who are going through that, like, oh, I need to be popular. I need to have friends. I want to know who that kid is because I want to give him a big hug. And he needs to share his message to every single child out there. That's so cool. That is so cool. But anyway, going back to the basics, right? Like my dad used to say that too. It doesn't matter how many friends you have, as long as you have three good friends, two or three good friends, they're better than having 20 Not so good friends. It's not a popularity contest,

Dr. Sharon Saline:

because those 20 Not so good friends don't have your back. They don't have your back

Brooke Schnittman:

ends. It's also such a time suck to to try to keep in touch with all the people. And you know, we're not good at that with ADHD.

Dr. Sharon Saline:

It is it's challenging. I mean, I think we want to think about you know, when we think about ADHD and anxiety, you know, where are you struggling the most? Are you struggling with focus and distractibility being able to concentrate and apply yourself and perform various tasks or commitments, or are you struggling with worry primarily about whether you'll have focus or be able to produce and these things can often go hand in hand, but we want to try to figure out which which comes first, for some people in terms of how we plan the treatment. For me, I do both at the same time. That's how I work. I do a blend of cognitive behavioral interventions and insight oriented psychotherapy. And that is what I have found has helped my clients to throw in a little mindfulness positive psychology. It's great, Stu,

Brooke Schnittman:

and it sounds like you do some exposure therapy also.

Dr. Sharon Saline:

I do some exposure therapy. Yep. Yeah, I mostly encourage people to take very small risks as experiments, and then to report back. So, for example, if you have some social anxiety about going to that lunch table at work, maybe you don't sit at the table, but you walk into the room and get water, and then you leave. And then you do that for a week. And then maybe the net and maybe after three days or a week, you go walk into a room and you say hi to people, and then you leave, or then you sit down at the lunch table. Like, it's all personal, right? So we figure out what that's going to look like. And we want to do it in a way where you start to build a sense of confidence and competence, rather than feeling like oh, I failed at the one little piece of homework I had from Dr. Sharon, like, No, first of all, that's not how I roll. But you know, it's like, okay, then we're gonna set this small goal. Maybe you do it three times, maybe you don't. Right.

Brooke Schnittman:

So you stack up on accomplishments to then build that self esteem and take bigger risks. So what would be your one? I know you have so many tools. But one big key to success with ADHD and anxiety. The number one pro tip,

Dr. Sharon Saline:

I would say the number one pro tip is to think about the best case scenario, instead of the worst case scenario. What could go right? In a given situation?

Brooke Schnittman:

I love that. What could go right? That's awesome. And Dr. Saline. I know that people could just Google you and your name is everywhere. But But what's the best way for people to reach out to you if they are looking for help with their ADHD or their anxiety or both? Thank

Dr. Sharon Saline:

you so much, Brooke for asking are the best place to reach out to me as my website www. Dr. Sharon selene.com. But you can also find me on Facebook, Instagram, Twitter and LinkedIn.

Brooke Schnittman:

Wonderful. Thank you so much for being on successful with ADHD, my friends. It's always a pleasure talking.

Dr. Sharon Saline:

Thank you so much for having me. I really enjoyed this conversation. And I learned a lot. So I'm very grateful.

Brooke Schnittman:

As did I. Thanks for listening to this episode of successful with ADHD. I hope it helps you on your journey. And if you need any additional support for you or a loved one with ADHD, feel free to reach out to us at coaching with brooke.com and all social media platforms at coaching with Brooke and remember, it's Brooke with any Thanks again for listening. See you next time.

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Brooke Schnittman MA, PCC, BCC

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