We have Izabella Risteski. Izabella is an ADHD coach based in Sydney, Australia dedicated to supporting individuals with ADHD. Izabella's personal experience led her to observe a gap in the management of ADHD. Izabella's research study into firsthand ADHD diagnosis experience was showcased during the twenty twenty four ADAPT Conference. Izabella earned an academic scholarship and graduated from the University of Sydney with a Bachelor of Psychological Science, a Bachelor of Arts, and Social Legal Justice. Wow, Izabella. Pretty impressive. You've furthered your education to completing an ICF and PAC course, an ADAPT course, becoming a certified ADHD behavioral coach. Izabella, we are extremely fortunate to having you here today.

And, I'm really looking forward to hearing your presentation, looking at the critical gaps in ADHD management, for individuals with ADHD. Thank you.

Cool. Thank you. Hello, everyone. Okay. So before I begin, I would like to acknowledge the traditional custodians of the land from which I'm speaking today to the Gadigal people of the Eora nation. I pay my respects to their elders past, present, and emerging. I also extend my respect to any Aboriginal and Torres Strait Islander people joining us today. So my name is Izabella Risteski. So I am an ADHD year old coach, and today, I'll be discussing the critical gaps in ADHD management as highlighted by a recent study I conducted. So before I begin, I wanna share a story time about how I even got diagnosed with ADHD and how I was masking it for most of my life. So I was diagnosed when I was 22 during my final year of uni.

So despite studying ADHD and many psychology classes and growing up for tutor who actually specialize in ADHD management for children, I was not even considered to have it nor did it even cross my mind. So I was masking it pretty well. So growing up in primary school, I thought I was so smart and then the teachers had accidentally put me into special education classes. So I got made fun of for attending special maths and reading recovery classes. I was slower than average. But in hindsight, the term reading recovery, it tends to imply that I was recovering from some sort of illness, but I still never received a get well card. But why I was put in these classes again makes complete sense given that research has shown that people with ADHD.

Have a developmental delay of thirty percent, and this has nothing to do with intelligence. So meaning an 18 year old with ADHD is more likely to have a similar mental maturity to a 12 year old. So this delay, again, it affects can affect motivation, interests, goals, trust, friendships, finances, driving, and emotional regulation. So here was the problem. So I'd gotten very, very good at masking my symptoms. Masking for me was unfortunately my brain's capacity to recognize patterns in my neurotypical peers. So I noticed that a lot of people around me at high school and uni, they studied hard and got good grades. But I tried to follow those same patterns, and I kept falling short.

So report cards saying that if only you applied yourself or tried harder were a little bit offensive and embarrassing considering I probably spent more time trying to achieve less than them at the time. But, by the time I was in high school, I'd gotten very good at masking my symptoms, and I realized that in order for me to get the same grades as my peers, I had to work even longer hours. So pulling all night as consistently since year seven, which is not good for your brain, and I do not recommend this. Working overtime to get those grades and hiding it at the same time. So, technically, I am quite good at multitasking.

But my reasons to masking as hard as I did was because I came from a single parent family and a low socioeconomic background. I'm from mastering immigrant background, so my grandparents sacrificed a lot to come to this country and leaving their family and friends behind where they don't speak the the native tongue, face really hard work conditions, and here I am being threatened to get kicked out of school. So I was trying to apply myself, but it was terrifying. So I felt like I need to prove that I was smart and capable as my peers so I could fit in and not get kicked out. Because it was a privilege for me to be at that school. So I spent at least 90% of my lunch times in the library. It was very dorky.

I was always crisis driven, so leaving assignments last minute. I'm sure we're all familiar with that one. And I got really good grades, but at a cost. So despite my achievements, I felt like an impostor. And this only got worse when I got accepted into Sydney Uni on an academic scholarship. It was my dream uni, but I was like I felt like an alien. I thought they had made a mistake. So when I was 22, I met a girl in my psychology class. She told me that she was diagnosed with ADHD. I told her that I had no clue that she even had ADHD. And she told me she didn't either, that her brothers had all been diagnosed with ADHD. And this makes sense as genetically ADHD has a heritability rate of above eighty percent.

Meaning, if your parents or siblings have it, it is very likely that you may also have it. So she told me that she had been overlooked for many years because of her masked symptoms. And it's very common for females, and I still see this with my male clients, of course, to present ADHD with more internalized symptoms. And for me, this meant daydreaming for hours and being in my head and procrastinating a lot. And after this conversation, I went to my doctor and asked her for a referral for a psychiatrist to see if I had ADHD and her response. She asked me what my end of high school exam mark was. I told her and she responded saying, oh, you don't have ADHD.

I was like, oh, okay. Cool. Great. I guess I'll cross that off the list. Thank you. I was done. But regardless of my doctor perpetuating that stigma about good grades did not mean that you could have ADHD, I am glad that I'm extremely annoying and persisted. And after three to four months, I had an appointment with a psychiatrist, I was immediately diagnosed. Because on the way as well, to my appointment, I had lost my car keys, lost my referral letter. And then I had an example for every DSM five component. So I was pretty prepped. So afterwards, I was prescribed ADHD medication. And my experience, it felt like seeing the world with glasses on. For context, I used to go to my uni library staying up till four to 5AM there.

And before I was diagnosed, I would go to the library for eight hours. And without medication, I would do two lectures in eight hours. I would break down. It was a constant cycle of self shame and crying. And the first time I ever took my ADHD medication, I went to the library. I studied eight lectures in eight hours. So ADHD meds was my first experience of seeing my brain in an altered state. The constant song lyrics, they're still going now. Music, like what my crush was doing on Instagram, the daydreams, the clapping monkey, everything in my head, it was silent. Everything was quiet. I could focus and maintain my attention for longer.

So I was annoyed that it was only now that I'd gotten diagnosed, and I can't imagine how it must feel for the clients that I have that receive a diagnosis even later in life. Because you see, we no. I tend to gaslight myself in and out of ever getting a diagnosis, and I think it's quite common because it's due to the paradoxical nature of ADHD. So meaning there is hyper and hypofocus. So you can stay up till 7AM researching things that you're obsessed with, and this makes sense.

Given that research suggests that our dopamine is interest driven, not importance driven. So So it doesn't matter how important something is. We're gonna wanna do the most interesting task first, like watching a movie and not really focusing on taxes for five seconds. But so in going on, research also suggests that intense concentration may also even be a coping mechanism for people with ADHD for dealing with distractions. In one case, a woman with ADHD was so hyper focused on a project that she didn't even notice that her whole house was on fire until the fire brigade came and was searching for anyone left inside, and she only realized then. So the struggle is real. I wish that I knew that ADHD.

Did not mean that you couldn't focus on anything. It's instead that we're focusing on everything at once. So we're struggling to filter out what's important, what's important to focus on. So the head of the nucleus accumbens in the brain is smaller in people with ADHD. This is found in one of the studies I've researched. So this area is associated with rewards, decision making, processing emotions, desires, impulse control, and aligning your motivation with action. So and also, if ADHD were so bad, then why would one in twenty Australians have ADHD? Don't we think Charles Darwin may have had a point with passing on adaptations From generation to another, adaptations make us more fit for our environment, helping us with our survival.

And during the hunter gatherer period, the typical caveman may have even benefited from being able to divert their attention to multiple stimuli in order to survive. So we clearly didn't get extinguished for a reason. But furthermore, my own personal ADHD diagnosis, it led me to observe a pronounced gap in the management of ADHD. So after I was diagnosed, I felt like I left the appointment with all the tools and no instructions. The irony here is that we're essentially putting patients who are struggling to grapple with self regulation at the forefront of the management of their self regulation. So not a lot of resources as what to do and where to get support. So or even how to process years of thinking.

That I was simply lazy or not smart enough. Was I suddenly meant to be this wildly confident girl after getting diagnosed? No. I remember straight after I was hiding my medication in vitamin bottles because I was embarrassed about the stigmas associated with me even taking medication that actually worked and helped and just in case someone thought I was cheating during an exam or thought something different of me. Perception is really important. Unfortunately, when my story takes a bit of a wrong turn, I had been mistakenly told to take my medication like a Panadol. That is not correct. After my appointment, I lent heavily on online forums that gave suggestions on how often, when, and how to take meds.

So during a stressful exam period, I was balancing again full time managing a suit store and full time two degrees, and I started peeing blood. I ignored it. I left it until after my exams, which was a bad idea. I developed a dinosaur sounding diagnosis called rhabdomyolysis. It is a life threatening condition where damaged muscle, it leaks protein into the bloodstream. So it is not too nice. In other words, bad. Not good. So I don't want this to stop you from taking a medication, by the way, if you're on it. There are multiple factors that led to me having rhabdo. And in full transparency, I'm still on different stimulant medication, but this is only.

But I'm sharing this to highlight what happened to me. It's due to a lack of guidance and support at a young age about ADHD. And I think it's important to raise awareness surrounding this because had I known what I knew now and developed interceptive skills and had support, I don't think I would have forfeited that, my body, for grades. So on the third day, I took myself to the hospital. So my grades were great, and my body, not so much. I could not bend my legs without crying, and walking was excruciating. So after several months, I luckily had a full recovery recovery. And reflecting back, I fought about what went wrong exactly. It It took many years to look back and be like, oh, I can see it now.

So, yeah, I wish that I had more guidance and support post diagnosis, and I wondered if others did too and what help there was out there. So I wish at the time I knew about ADHD coaching. And since the tools and knowledge that I have learned through my studies at ADCA have been so valuable, I want to be able to help and share this with others as well. So after I finished my studies, my training hours, and became accredited as an ADHD coach, I have been interested in exploring what the gaps are in ADHD management. So early this year, I created a study that I presented at the AADPA, the Australasian ADHD Professional Association Conference in this year in July.

So I ran an online study with the objective of exploring the firsthand experiences encountered by individuals with ADHD during their appointment with their psychiatrist or psychologist. So when they received their ADHD diagnosis, what was that experience like? And the focus was on identifying common patterns, narratives related to their diagnosis because I wanted to pinpoint exactly where they needed support, what was falling short, what were their challenges and barriers. Because overall, I would my aim was to enhance and overall improve collaborative care. So in my results, I found that sixty percent of participants were unsatisfied with the guidance and support that they received post ADHD diagnosis.

So participants raised concerns about appointments lacking support beyond simply providing prescriptions, so medication did not feel like enough. When participants were asked as to whether they would have been interested in receiving a referral from a psychiatrist or a psychologist for ADHD coaching. Ninety percent said they were interested, but only fifteen percent said they actually received a recommendation for ADHD coaching during their appointment. So I have a full study on my site and that with some highlights of participants response. That's an adhdinyourcoaching.com, but I'm just handpicked a small amount to share with you. So study highlighted some challenges and barriers towards accessing diagnosis.

With some people having to see three to four psychiatrists prior to even obtaining a diagnosis. So participants raised concerns about the need to show academic transcripts in order to obtain a diagnosis. This reminded me about the comment that doctor had made to me about my grades. ADHD isn't an academic impairment. You can still get good grades, and you can still mask your symptoms. Participants highlighted that school records records did not always show that they even had ADHD due to the masking effects. So saying it it is a barrier to even have to show academic records based on the fact that some people in the sorry. Some of the participants were stating that they had issues surrounding family abuse.

In even having to ask their parents for such records. So participants who reported experiencing issues when providing evidence for ADHD were asked to describe these challenges, and one female, aged 35 to 44 said, that my school reports were exemplary and did not provide any evidence to show that I had ADHD as I was highly motivated to do well. I masked many of my struggles and worked super hard to excel academically. I also knew how to play the game and be a good student, which made it even harder for teachers to see my struggles. I basically did not allow anyone to see my struggles if I could help it. And then when participants were asked to describe their overall experience with their psychiatrist or psychologist in receiving a diagnosis.

One female aged 35 to 44 responded, I was just medicated. No suggestions of therapies to help process the grief of struggling through life undiagnosed or how to better cope once medicated. Needs to be so much more than medication, especially when diagnosed later in life. And for those participants who indicated that they did not feel like they received adequate guidance to manage their ADHD effectively post diagnosis, I asked specifically to describe what support they felt was missing. And one male aged 18 to 24 responded, there was not really any guidance aside from prescription to medication. Felt like I was just using her to receive medication with some tips on the dosage and time to take it and nothing else.

Another response coming from a 25 to 34 year old female was, I was given tablets and that was all. When I asked for coaching or therapy, they said we don't offer that. We'll need to go elsewhere. And my question is, where is elsewhere? And something additionally I would like to touch on was a comment added by one female aged 25 to 34 years old. She had responded saying that I was unaware of menstrual phases and ADHD medication being less effective. This is common and unfortunately should be common knowledge, but during week before your menstrual cycle during luteal phase, you have a drop in dopamine levels. So luteinizing hormones, LH, and follicle stimulators stimulating hormones, FSH levels decrease.

So for some female clients, I've seen that they don't even feel like their medication is working during these weeks. I would really recommend tracking this if so because a week after your menstrual cycle, you have a burst of energy, and the second week, it's even more productive and more energy. So please do not be hard on yourself, period. But the recommendation that I came to at the conclusion of my study was that we need to implement a patient centric approach for ADHD diagnostic consultations to improve collaborative care. So increasing ADHD coaching referrals. Most of my clients are from referrals from psychiatrists, doctors, psychologists.

Or people who have found me without a referral. So how about however, based on this whole study I did as well as a number of psychiatrists and psychologists I've spoken to, this is not common knowledge as it should be currently. Participants expressed needs for support beyond medication adjustments, including education and tailored behavioral management to improve well-being and issues related to late diagnosis. So clinicians should increase recommendations for ADHD coaching to assist newly diagnosed patients. Reduced emphasis on academic evidence as well. Clinicians should minimize relevancy of academic reports as this may perpetuate stigmas.

Surrounding ADHD academic performance, and obtaining such evidence poses barriers to family abuse or masking effects. What is ADHD coaching? So it's personalized, tailored, one on one support, holding clients accountable and propelling them towards their personal goals. So studies have highlighted the benefits ADHD coaching suggesting that ADHD coaching can be effective in supporting beneficial outcomes and useful in multimodal management of ADHD. So alongside medication or support from psychiatrists and psychologists and cases have commonly illustrated how ADHD coaching can assist in creating successful and sustainable long term behavioral changes.

Helping clients to actually reach their goals. So what I do is I apply neuropsychology with ADHD behavioral coaching tools to empower clients to manage their symptoms and capitalize on their strengths for personal and professional success. So what does this look like? This can involve educating about ADHD, helping clients find their bridges and barriers to accessing attention, rebuilding confidence in the workplace, especially after late diagnosis, understanding emotional dysregulation, the fact that we experience emotions more intensely and for a longer duration than our neurotypical peers is something that's so important and overlooked.

Being able to help and identify the warning signs that lead up to burnout, the different types of burnout, perceptual burnout, all sorts of all sorts of things. So learning what processing modalities we might have as well to help remember information better. So learning to work with our ADHD and not against it. So some broader recommendations that I have at both a macro and a micro scale, they center around promoting social inclusion towards accessing socially valued resources. So one area is subsidized ADHD coaching. So I don't require my clients to have an ADHD diagnosis. To have sessions with me, I'm trying to be as socially inclusive as I can, especially given the lengthy wait list for receiving an ADHD diagnosis. However, in Australia.

There are government funds similar to The UK that are available for those who have ADHD. So if you are diagnosed ADHD in Australia and are working a minimum of eight hours a week, employed or self employed, you may be eligible to have a big portion of ADHD coaching sessions covered by government funding. So I've also talked to the department and have been advised that for the clients that don't feel comfortable disclosing their diagnosis to the workplace, there are options to respect that. However, there needs to be more options beyond just this government grant because in Australia, we literally have the NDIS, which is great in some aspects and not so great in some. So sometimes ADHD coaching can be covered, but it can be tricky. So.

Look, the NDIS quite literally says that if you have an arm and a leg missing, you can't get access to NDIS finding, but because you need to have both arms and both legs missing. So I'm trying to respect the logic that it operates on so much so that I think that maybe we should just move on to government initiatives away from NDIS that can offer subsidized ADHD coaching unless we can improve it. So if we're not gonna fix it, to make something else. So the NDIS currently, it does not accept ADHD as a disorder on its own. You must have it comorbid, meaning have it with something else. It's not bad enough on its own, like one leg and one arm missing, quite commonly seen with autism, ASD, and ADHD. So because apparently.

ADHD has to prove that it is a permanent disability despite the diagnosis constituting a retrospective diagnosis, meaning once you have been diagnosed ADHD, you technically have had it for your whole life, and it's permanent. So you also have to prove that ADHD may affect your ability to work, study, and participate in social life. So this is interesting because in July 2019, Deloitte wrote up an op well, they wrote up a report about the social and economic costs of ADHD in Australia, and they found that ADHD costs socially and economically were up to 20,420,000,000. So that's per person that is 25. So I've been in discussion to universities trying to organize subsidized ADHD coaching. I know that my mentor, Brett, done this before.

Successfully. So where students are out of pocket only a small amount, let's say, for example, 20 to $30, and the university is able to cover the rest of the coaching. So I think this would be a great service to extend, particularly for people who are transitioning from high school into university, as well as alumni, people who are transitioning from uni to the workplace. I did notice my own ADHD because more so after leaving high school because you don't get reminders about assignments over time. Unfortunately, no one calls your parents to tell you that you're about to miss a deadline. So I also recommended in a proposal that I've sent to one university that is pending is extending subsidized ADHD coaching support.

For aboriginal and Torres Strait Islander communities completely for free. But reforming policies surrounding supporting the aboriginal and Torres Strait Islander community needs a lot more than simply subsidized coaching at a uni. So there are several challenges presented by current Australian health care policy, which suggests a need to enhance the structural foundations behind policies as well as enact legislative reform. So currently, the main issue faced by Australian health care policies is a need to guarantee or that all Australian citizens can have access to equal health care. And the prevalence of ADHD for Aboriginal and Torres Strait Islander people is largely suspected to be underdiagnosed.

The WA Aboriginal Child Health Survey reported that Aboriginal children had a high risk of hyperactivity problems up to fifteen point eight percent when compared to nine point seven percent for non Aboriginal children. So currently, the aboriginal and Torres Strait Islander Australian community are facing discrimination and experiencing subpar health care. So this social exclusion is based on the inability to gain access to equal health care and is reflective of a national health care policy played by social inequity and systemic racism. So if we are to make changes, any policy reforms should be evaluated to determine whether they are simply disguised as positive discrimination and should instead be led, informed, and approved by indigenous.

Community members. Again, ADHD is a disorder based on a Western health concept. So it's important that we understand how different cultures view ADHD and have health care workers who are trained in culturally sensitive practices. So granted that this conference is global, I would invite you to reflect on groups within your country who may also be underrepresented, under supported, and othered by health care systems and focus on what we could do to improve social inclusion, raising awareness, and supporting one another. So children belonging from minority groups are significantly less likely to be diagnosed ADHD.

This is completely unfair because children deserve the same and equal access to socially valued resources such as support, such as a diagnosis, such as options to even consider treatments for ADHD. My diagnosis is such a privilege. So I know this conference is global and therefore the recommendations that I'm expressing can still be globally applied. Your country would benefit from offering subsidized ADHD coaching, removing obstacles and barriers towards obtaining an ADHD diagnosis, including lengthy waitlist periods.

So I recognize that getting diagnosed with ADHD is a privilege, I would never have ever had been able to have this privilege had my baba and dad or my grandparents migrate not migrated to Australia from their village in Prilip, Jannishta and Khrushchevich. So they belong to minority groups. I see this privilege that they missed out on. I see the health care that they missed out on. I see so much now. I see that my grandparents may have also been masking their symptoms too. And granted all the chaos and disruption in the world right now, I recognize that it is a privilege for me to be able to share something that I'm so passionate about.

Especially for some children whose survival and access to basic resources like shelter and safety are not an option to them, let alone the privilege of an ADHD diagnosis. So in conclusion, I wanted to leave today with a quote from my baba, Maria Nedelkovsky. So my grandma would always help well, she would help raise me, and she would always tell me growing up. Which means be disciplined, tighten up, and learn. And meaning loosely translating to your learning is the most important. So the one thing that we can all benefit from is learning. So what we focus on grows, increases our neural connections. It can change our brain and make it plastic. When we focus on learning, we focus on redirecting.

That focus in a positive way. We've grown new neural connections, and our brains can change beautifully forever. Education is a privilege and a blessing to learn who we are, to learn our ADHD, to learn how we can turn our weaknesses into strengths, is essentially learning how we can turn our wounds into wisdom. But, yeah, thank you everyone for listening to me. Yeah.

Thank you so much, Izabella. I think, you know, a huge amount of knowledge and wisdom coming from yourself and, you know, just highlighting the, I suppose, what what needs to happen still clearly across the sector. You know, wanting to emphasize, you know, education, you know, we know is a is a basic human right. Everybody deserves the right to education. Really making sure that, people are informed, they're educated, and are able to receive the right supports at the right time to help them to be able to succeed. I know that, there's some significant work happening at this moment in time within the NDIS around.

Looking particularly at, individuals with a range of disabilities to really continue to learn, holding a lot of community groups and advocacy groups to look at how they can, learn from and support individuals with a wide range of, disabilities. And one of those is, particular focus also on those that are neurodivergent and also with ADHD. There's some community groups happening at the moment that, ADHD Australia are part of, in partnership with some research as well. So I'm hoping to see change. I have real positive kind of feelings myself that, everybody has a genuine true commitment to that change and.

Your presentation today highlights some of those barriers. And, I thank you so much for bringing that wealth of knowledge to us at Izabella. It's truly inspirational. So, just to kind of see your contact details are up. My my question to you before I move on to our next individual is, help me to understand a little bit more about if somebody wanted to to reach out and to have an ADHD, coach, who do they, how do they reach out? How do they go about that? Obviously, your details are up here for people to link and connect into. So.

Mhmm. Well, there are so to reach out, people can do introductory consults. But more importantly, it's really important to find ADHD coaches who are accredited. I've had some horror stories from clients who've just had ADHD ADHD coaches that don't have accreditation. So it's really important to know the green flags for finding an ADHD coach. I know in Australia, have the AADPA directory listing, and we also have the Australasian coaches directory listing. These two are great and what psychiatrists, psychologists usually use to refer patients to me, but we need to have more of a global directory listing. So looking for coaches who have ICF accreditation and PAAC accreditation are really important.

So if those two of them, that is a really good green flag, and also investigating into where they've been studying. So in regards to your question, how they get contact would be going through, the directory listing or through websites and reaching out, emailing, doing an intro call, and just getting to know more. I'm happy to answer any questions in regards to coaching too.

Beautiful. Thank you so much, Izabella. Thank you for your presentation. Thank you for your time today, and thank you for your insights from from your perspective. Thank you.