Host: Welcome to the Iowa Specialty Hospitals and Clinics ISH DISH podcast, practical health advice from Iowa Specialty Hospital experts. We want to connect the members of our communities with the latest healthcare information that's understandable, relatable and useful to your daily life. Oh my goodness. In the studio today we have Tiffini Toliver and Tiffini is an ARNP, Advanced Registered Nurse Practitioner. How are ya?

Tiffini Toliver, ARNP: I'm good. How are you?

Host: Good! You and I go back a long way.

Tiffini Toliver, ARNP: Yes we do.

Host: I I I think we met when our daughters were four? Or three? Yeah.

Tiffini Toliver, ARNP: I was I was thinking probably three.

Host: Yeah and my daughter is now 31.

Tiffini Toliver, ARNP: Allison just turned 32.

Host: Right, right. So, holy moly.

Tiffini Toliver, ARNP: Lots of fun memories.

Host: Oh my gosh. So many.

Tiffini Toliver, ARNP: Lots of sleepovers.

Host: Exactly. That's a whole other podcast.

Tiffini Toliver, ARNP: Absolutely. How to survive sleepovers with girls.

Host: Right. So, give me a little history on you and how you came to be a nurse practitioner. Because it's pretty interesting. Where you started from?

Tiffini Toliver, ARNP: Sure. I actually started at Iowa Specialty Hospital in the summer of 1988. I know, right? It's crazy. And I started as a CNA, I was going to nursing school, and then went through nursing school, and then worked as a floor nurse for several years, and then, went to public health for a while, which was a great experience. I really feel like that helped, really develop some critical thinking skills because when you're out in a house by yourself, you, you don't have that extra person to come and help you. You have to start that IV or know that medication.

Host: And then you ended up being the maternal health coordinator.

Tiffini Toliver, ARNP: I did. Yep. I did that for a long time, which was really very much of a passion of mine. I loved working with these young moms and helping them be their best healthy pregnancy and, helping them be that first time parent, because as we know, these babies don't come with instructions, right?

And then I did WIC for many years, and so it's, I'm at that age now though, I'm seeing the kids that I saw as babies now having babies. So, you know, I remember when Dr. Witters had said that once, I'm like, I am there. I am there now.

Host: That's awesome.

Tiffini Toliver, ARNP: Yeah, so I did that. And then I came back to Iowa Specialty Hospital and came back as the Director of Nursing and did that for, gosh, I don't even know it, 10 years maybe.

And then I went back to school during that time and got my master's degree in healthcare administration and master's in nursing. And then I went back to public health and was the administrator there for a couple years.

Host: Gosh, I forgot about that.

Tiffini Toliver, ARNP: Right. And then we had, in the midst of that, were adopting some children. So life was a little crazy at the Toliver house. And Gabriel, who is our seven year old, will be eight in November, had some health issues. If you kind of remember that when he was born, he had some health issues.

Host: I do.

Tiffini Toliver, ARNP: Which now he's well. But it really kind of took my focus. And I realized I couldn't at that time, try to balance a important job of public health and try to take care of two other little children at home and, Gabe, who was sick. So I chose to, not do that job anymore and I just worked PRN here. OB, of course, the floor a few times, but mostly OB. And then Dr. Witters and Steve Sivanen and, Dr. Aronson had approached me and said, Hey, what do you think about going back to school and being a nurse practitioner? And I thought, have you lost your mind? I've been in school so long and I have these three little ones now, not to know the fourth was going to be coming along shortly after that.

And so I'm like, okay, no, you know what I think back, I did, Issa was born in February and they talked to me in like March because I was like, oh my goodness, like this is crazy. But then there's this part of me that thought, why not.

Host: You've never backed away from a challenge. Ever. So, I'm not shocked at all.

Tiffini Toliver, ARNP: I liked school, so I like learning. So, I took the challenge, and I thought, gosh, if I'm going to do this, I don't know if I'm going to get into school, you know, I have to apply. So, I applied, did all this paperwork quickly, and in April, like the end of April, I'd gotten in. So, I went to Allen in Waterloo and, I did that and here I am and I love it. Absolutely, I can't imagine doing anything else.

Host: You have a huge patient base. I see your stats every month and I just think, oh my gosh, girl.

Tiffini Toliver, ARNP: Yeah, I do. I do. And I love it. I remember when you first were starting out and I see like six people in one day and I was like, wow, this in incredible.

Host: I'm rocking it.

Tiffini Toliver, ARNP: I'm rocking it. And now you're like 21, but the downside is when you do have good population base, that means you're busy and sometimes your patients can't always get in to see me. And that's one of the things I don't like, you know, I really try to see my own patients. But unfortunately, sometimes, especially with kind of our call schedule and stuff, it happens. And right now with Dr. Aronson going to Antarctica his new adventure I'm going to help pick up some of his patients, which really makes the most sense between myself and Karin Johansson because we tend to probably do the most with the autism and ADHD patients, although all of the providers, do that.

I feel like that's probably more of our population base. And the three of us Dr. Aronson, Karin Johansson, who's the PA for us, and myself, we have been what's called MAPS trained. And which was another like back to school thing. So MAPS stands for Medical Academy of Pediatric Specialists. I would say I'm not a specialist in anything, just have some knowledge in a lot of things. But it was actually a quite an intense training. We traveled, like I've been to California, North Carolina. And you do with some self studies and you have to actually take tests. And so I actually took my last and final test to be MAP certified in December this past year.

It took me five years to get there with COVID in there as well. So again, I would say it doesn't make me an expert in anything, but just have some more knowledge base. And with MAPS they do talk a lot about autism, ADHD, kind of neurodivergent health issues, a lot more of homeopathic based, obviously medicine based, but we look at more natural ways too like healthy eating and sleeping and, supplements and things like that. So just thinking outside the box a little bit more.

Host: So this is an excellent segue, what you have just told us and thank you for that. I think your story is incredible and having known you all these years, you have never in, not, one iota backed away from anything.

Tiffini Toliver, ARNP: Except snakes. I don't like those.

Host: So we really brought you on today to talk to you about ADD, ADHD because you do deal with that a lot and.

Tiffini Toliver, ARNP: And as a parent.

Host: Right.

Tiffini Toliver, ARNP: Yeah, of my four adopted children, two have special needs and three have the ADHD. So, I know what it's like as a parent to have those morning struggles and get those phone calls from school and try to figure out different medications, so.

Host: Yeah, so you really are the perfect person to talk to this about. I want to first start by asking you to define what is ADD or ADHD and how do those two terms differ because it seems like they're used a lot interchangeably.

Tiffini Toliver, ARNP: Correct. And they really are used in, or they are considered interchangeably. So ADD stands for attention deficit disorder. And I would say that that was maybe the original term that came out years ago. You know, you had attention deficit. And then the diagnosis code or formatting of the word went to ADHD, which stands for attention deficit hyperactivity disorder.

Well, as we know in the medical world, things change and diagnoses has changed. For example, in autism, even though we know that some people are considered in the Asperger's category that's no longer a recognized diagnosis under what we call mental health disorders or DSM five. And now ADD is not considered a diagnosis either ADHD is.

So how that works is when I am coding something or putting in a diagnosis code. So let's say Gina, I, let's say I saw you as a patient and we say that you have ADHD. There is, you can further define it as ADHD with inattention, with hyperactivity, or with both. And I've had that before where I've had a patient say, Hey, I see my chart says ADHD. Well, I don't have the hyperactivity part. And then I'll explain to them. I agree, but then I'll, put underneath it that they have the inattention part. Sometimes you can even code it as just inattention. Inattention is a diagnosis of itself, but basically they are interchangeable, but ADD not really considered a true medical diagnosis anymore, ADHD.

Host: Okay, so what are, I'm curious, what are the main signs and symptoms then of ADHD? Because I feel like out in the public, in the real world, people just loosely use that term, and probably inappropriately.

Tiffini Toliver, ARNP: Right, right, because sometimes kids are kids, you know, and, especially like with boys, you know, I want to just with boys, because I've had three girls and three boys now and they're really, quite different, but at what point are kids just kids? You know, that they're bored or they're busy. Um, my son Jack, he's got a lot of energy and so he's not going to be the kid that's going to probably sit and play with the kitchen at daycare or at school. wants to be up pushing trucks and running and jumping and he's just got a lot of energy.

Host: But that doesn't mean he has ADHD.

Tiffini Toliver, ARNP: just means he's busy. Yeah. Yeah. So it's like, how do you decide? Is it just business or is it ADHD? So the three main signs are inattention, impulsivity, and in some cases hyperactivity. So, if a parent were to come in to see me for maybe consultation of how do we diagnose or does my child have an inattention or hyperactivity diagnosis, there is a standardized form and it's called the Vanderbilt. And so it's a scoring sheet where the parent and sometimes the child when they're older, I'll have the parents do a sheet and compare. And it's just answering like, often, very often, never, sometimes seldom that kind of answers.

And it has questions like, do you feel like you're like the energizer bunny? Like, do you feel like you're go, go, go all the time? Questions like that. And I always tell them there's no right or wrong answer. Just answer like what comes to your mind. Don't answer what you think somebody wants to hear.

And then based off of that, it gives us a score. And one of the nice things with that is then if we were to try some different treatment options and it's not always medicine, it might be like cleaning up your diet, getting some sleep, trying some other activities like, okay, maybe they do need to get off the couch and run around outside and burn off some energy, regardless of what we try; coming back in for a re-evaluation, we would retest that same Vanderbilt, and the goal would be is that those numbers would be in lower, not higher. Might be the same, but the goal would be is that you want them to start moving down. We also do a test called the TOVA test. And I can't tell you what that actually stands for off the top of my head, like, to break down what the TOVA stands for.

But basically, it's a computer test that we do offer here. And you can do that for children and adults, as long as they are old enough that they can play a computer game, can do it. So, we've had kids as young as like three or four do it. And so with the TOVA, often we'll have you do it not on any medication to see how you do.

Typically, if you have some inattention or hyperactivity, what happens is you'll start to see, it's like four quarters on this, game test. And then you'll see that people start out doing really well, and then they start missing stuff because they lose focus and attention. We're done with it.

Yeah. And I'll even say to them afterwards, like, how did you think that went? And they're like, yeah, I didn't do well at the end. Like I started really good in the beginning. And they, know, they're like, and then, I don't know, I just like, I didn't care anymore. Right. Yeah. So then, again, you go back and you try some form of treatment again, whether it's medication, whether it's diet, sleeping. There's some more natural kind of things sometimes you can try too, and then you retake the test and you, the goal would be is that you're able to do it a little more focused.

Host: Sure.

Tiffini Toliver, ARNP: One of the things I probably hear the most from parents with children in school is they do well in the morning and then by mid afternoon things are starting to kind of wear off. So we have to look at medication adjustments for that. So, yeah.

Yeah. Okay

Host: Yeah. That's a lot.

Tiffini Toliver, ARNP: It's a lot. Yeah. So it's not just an easy diagnosis oh, that's what they have. We really, really do also focus, like I said, on sleep and diet. If we haven't slept well that night, I don't know about you, but I know I'm not so focused. And so, diet is also important. One of the things we really encourage is watching red dyes. And that doesn't mean that every child or every person is going to react the same to red dyes. It's kind of like sugar. You can ask a thousand different providers and you're going to get a thousand different answers if sugar affects children. Some sugar does affect children, some does not, just like you or I. But, it's worth trying to see if it make things better. For example, red dyes, lots of foods have red dyes, and some children and some adults just have more of a reaction to it, and it tends to be more of a hyper reaction.

For an example, I had this, young, school aged child who was doing really, really well. We really got his meds figured out and he was having a great school year and his mom was happy and they weren't fighting and no crying and things were really going well. I'm like, yes, we got this. She comes in and she's like, I don't know.

I don't know what's going on, but he is just like off the wall. He's getting in trouble in school. The school has been calling and I can't handle him at home. I'm like, anything changed? And she's like, no, nothing. And so we're going through some stuff and I go, what about his diet? Has anything changed in that?

She says, all he wants to do is eat Takis, Takis, Takis, Takis. And I'm like, red Takis? And she's like, yeah! It's like, a, Mexican kind of, chip, okay? And they come like blue and red, and they're kind of spicy. Same thing with flaming red Cheetos, or Cheetos, okay? And I'm like, oh, okay, yeah, stop.

You know, just, just, try that. Just don't let him have that anymore. And he looks at me like, thank you for, telling my mom I can't have these. But I'm like, just, just try it. Like, just try it. That's literally the only thing that they changed was, mom took away the Takis, behavior's gone back.

Host: That's crazy!

Tiffini Toliver, ARNP: Yeah. And so, I've seen that, even in my own children, I've seen that.

Host: So really, it's know your own child, and not that one size fits all for everybody, but hone in on your child and their behavior, and...

Tiffini Toliver, ARNP: Right. And not that and that particular child, they could eat cookies, they could eat sugar, and didn't really seem to have any reaction to that. But give that kid red dyes, and it was like the Energizer Bunny times ten.

Host: Wow, what a great thing for him to know for life though.

Tiffini Toliver, ARNP: It was an eye-opener for him as well. Like, okay, maybe this is making me feel that way.

Host: Mm-hmm. Yeah, So I know the topic of today was to really talk about children and this diagnosis. Is it pretty prevalent in adults?

Tiffini Toliver, ARNP: Yes. And so what I say is, if you are diagnosed as a child with ADHD, when you turn 18, it just doesn't go away. Unfortunately, insurance companies think it does, you might be on medication and it's been paid for for years, and then all of a sudden you turn 18 and then 21, and then they don't want to pay for it anymore, so then you have to go justify that, because it doesn't go away.

What happens is, as adults, some people were never treated, but you learn coping skills, you learn study skills, and you learn how to adjust. So, the diagnosis is still there, but most adults have just learned to adjust. I had a really good example of this a while back. I had a guy, probably about my age ish, which is really young who came in and he had had ADHD diagnosis when he was younger.

Took medications pretty much through elementary, junior high, and high school. Then when he got to college, just stopped taking it. Didn't think he needed it. I think part of it was probably insurance and paying for it. Worked at a job that was more of a labor job. So, the same thing every day.

And he did fine. And he didn't need any medications. It was a very monotonous, routine job. He did great. Then he got promoted to, like, a supervisor. And he's like, something that should take me like 30 minutes like doing a schedule is taking me three hours. Like, and he's like, I don't want to lose this job.

So got him back on medications and he was doing great, but he went a long time without it. And then he realized he just couldn't focus long enough to do something that was, it was just taking it far too long. Kind of showed to him that it didn't go away. But in the meantime, he had adopted some learning curves.

Host: Yeah. So, with your experience with your own children and the fact that probably it's more prevalent in children and school is coming, whether we like it or not, right around the corner. What are some tips and tricks that you can give to parents or caregivers of how to make the beginning of the school day go a little more smoothly if there is this diagnosis?

Tiffini Toliver, ARNP: Right. So in some cases, some parents have chosen, which is absolutely fine, to give their kids what we call a drug free break. So sometimes they don't give medication over the summer, some don't give medications on the weekends, and that's okay. That's just whatever they prefer to do. And so, I'm seeing a lot more visits right now because school is starting and making sure the one, the medication is still the right medication as we grow. We have to sometimes change doses but getting back on track before school starts because you want to be ready now and not in the midst of school trying to make it work. So getting back to your medication regimen, getting back to that sleep cycle, healthy eating, that maybe, we haven't all done so over in the summertime. I know my kids are definitely not on a best sleep schedule right now either, so we just were talking about that too, getting them back into that routine.

Host: Right

Tiffini Toliver, ARNP: But this is a time where you want to start thinking about your goals for that school year. So setting some reasonable goals for the school year helps set the tone and gives clear expectations that can lead to a more successful academic year. Goals revolve around completing assignments and turning them in, getting them ready for school on time, good reports on behavior at school, getting to bed on time. Each family will have their own views on what is important. It's important that you meet with the teacher it may even be meet with a teacher earlier if you're able to.

I know sometimes you maybe not know who the teacher is, maybe it's a new teacher. There's lots of new teachers every year. So just start off the school well and they know that maybe your child needs to be the kid that sits in the front of the room because if he sits in the back of the room, he gets easily distracted.

Maybe the child needs a fidget toy because they think better. Know when maybe they need a break. If they, if you see that they're starting to getting fidigty, do they need to go get a drink or do they need something?

Host: I think this would be valuable information for any teacher to know upfront, right?

Tiffini Toliver, ARNP: I think the teachers are great. And the other thing is part of the evaluation that we also do with our ADHD kids, it's called a Connors form and it's really a lengthy form that teachers fill out for us that helps us see what's going on in school, because often what's happening at school may not be the same of what's happening at home. Sometimes it is, but sometimes kids are better at home and horrible at school or have challenges at school or vice versa.

Host: So then that's something that they give

Tiffini Toliver, ARNP: to you?

 They give to us. Yeah. So, so I appreciate that teachers take the time to do that because it is extra work. And if you have to do that for five or six kids, it's pretty, complex paperwork, but we do value it and we use that. So thank you teachers. If you are have you been doing that. But just knowing how the school year is gonna start. My children are, very forgetful and they'll forget things and we have really worked on one being responsible for their things, but we have like a check off list to say, okay, do you have your classes? Do you have your, school bag? Do you have your tennis shoes? Do you have you need?

Host: That's a great lifelong lesson to get.

Tiffini Toliver, ARNP: We do it the night before because morning comes early. They have to be on the bus at seven.

Host: Oh my.

Tiffini Toliver, ARNP: And so we do as much as we can the night before even laying out our clothes, because I know that's a struggle for a lot of parents. Mornings are tough and if they don't want to get out of bed and then they don't want to get dressed and then you don't have your backpack and then you're late for the bus, the morning sets the tone for the whole day. At least it does for

Host: Absolutely.

Tiffini Toliver, ARNP: So, one of my best suggestions is plan ahead, lay out things the night before, make sure you have the shoes in the bag. You have everything you need so you're not scrambling and it just sets a better day because if they get to school and they know they don't have those things as well, one they're afraid they're going to get in trouble and two they don't have the things that they need for the day.

Host: Sure.

Tiffini Toliver, ARNP: Rewards. What we're quick to at least I'll say I'm quick to sometimes we're quick to be upset with a child if something didn't go well, or since they may be even upset, but to point it out, like, Hey, you forgot to do this. I'm trying as a parent and I'm trying to help the parents I'm working with to reward when days are good. You we tend to focus on the days that are bad. Let's reward. Hey, you know what? Today you got up and you only had to push your alarm clock twice. Where yesterday you had to push it four times. So the little things can make a difference. I don't expect perfection, but just improvement. So really focus on that and reward them for the little things and because we all want to hear the positives of our day.

Host: And those are really good lifelong skills to build upon because we as adults even don't hear that.

Tiffini Toliver, ARNP: Correct.

Host: We don't get as much praise, but... Sure, people pick up on the things that you don't do right.

Tiffini Toliver, ARNP: Right. Exactly. Exactly. Kind of goes back to Quint Studer, the whole theory of when, um, for those of you that don't know Quint Studer, he's really a guru on healthcare and on service excellence. And I can still remember at one of the conferences I had gone to where he talked about how quick we are to call maintenance to tell them when something's wrong, like, it's too cold, it's too hot, but do we ever call and say, hey, thank you, the temperature is perfect in the office today? We don't, but should we? Absolutely.

But one of the things about rewards I really try to say don't make them food based, for one. We already have issues with childhood obesity. But it doesn't mean they can't be a treat to say, Okay, maybe we can go get that ice cream cone.

But don't make everything focused around food. say, And it doesn't have to be things that cost money, either. I don't expect them to say, Oh, if you have a really good week, you're gonna go get a $30 Lego set. It could be going to the library, it could be having an extra time in the evening. One of the best things I had heard, and I cannot take credit for it, I'm stealing the idea that I actually got from another patient, was one of the kids she got a Lego set, and the other one she got a puzzle, and they earned pieces.

Host: Oh, wow.

Tiffini Toliver, ARNP: And then they put the pieces in a bag, and once they got all their pieces-

Host: They could put it together. Cool.

Tiffini Toliver, ARNP: And they got that one on one time to put it together, whether was with mom or dad. I'm like, that's a great idea. So I've stole that and I've used that and it works great. Sometimes tickets, like in a ticket might be helping mom make chocolate chip cookies or dad go do something in the garage, but they don't have to be things that cost money. So.

Host: Even a hug is nice.

Tiffini Toliver, ARNP: Absolutely. Yeah. Yeah. A hug. Right. Computer time. We really try to limit screen time. American Academy of Pediatrics recommends two hours or less of screen time.

Host: Daily.

Tiffini Toliver, ARNP: Daily. Yep. which my young adults really don't like me when I say that out loud, but then I explain the why, one is it can cause some vision issues. When you're staring at a screen all day, you can get dry eye syndrome because you're not blinking.

Your brain needs to rest. Our brain is going all the time. We need to rest it. And you're not doing kid things. I want you to be outside. I want you to playing and I want you running. I want you riding that bike.

Yeah brain is

 Exactly. Go do that. So, maybe screen time can be a reward, like maybe they get 10 minutes extra. But praise, you know you can't praise enough, you really can't praise enough. The other thing is just helping with, the days going well. One of the suggestions that I have, and I often hear this, probably more with my middle aged school kids, when the homework is starting to get harder, and then what happens is, they just don't do it.

So they're coming in, and they're frustrated with themselves, the parents are frustrated, the teachers are frustrated, because assignments aren't getting turned in. So, I like analogies, and for my patients that, come see me, they know I like analogies. So I often will talk about, eat the green frog, eat the big green frog.

So,

Host: I just told my husband this the other day and he goes, what? Yeah, he didn't know the green frog.

Tiffini Toliver, ARNP: And I even have one kid who put it like on his locker like he picked the ugliest green frog he could find pasted in his locker and one of the other parents told me that their son had gotten like a beanie baby ugly frog and stuck it like on his computer desk so for those that you don't know about the ugly green frog is I tell my patients to think about the biggest, ugliest green frog that they could possibly think of, and it's staring at you, and it's going to look at you all day long. And you know, at the end of the day, you have to eat the frog.

Right? So would you rather just eat the frog in the morning and get it done, right? Because I would. And then do the things that are the hardest first, because what do we tend to do? The things that are the easiest first are the things that we like first, and then we don't have the attention or the desire to do the things that are harder.

And I feel like that really has helped a lot of kids to focus on that and break it down, break down assignments and write them down, list them out, cross them off, sometimes the visual is crossing things off, right? And I feel like that, that's helped a lot.

I will often equate it to like my laundry room where I, so I'll go down and I'll see like this huge pile of laundry. You can only imagine the laundry in my house, right? And, but if

And you're the Nazi.

I know, right? Like, OCD extreme, right? And so, I tell them, when I break down my laundry and I have like, my colors, my towels, my more delicate wash, et cetera, towels, I might have five smaller loads.

It's still the same amount of laundry, but it looks more doable, right? It looks more doable. I'm like, oh, one pile is done. And I feel like that has helped it a lot of people just to know that, yes, it can be overwhelming, but break it down because it's doable. You just have to break it down because then when you start falling behind and you're getting behind in homework, it feels impossible to get caught back up.

So, baby step it and get caught back up.

Host: I will tell you that this analogy has worked very well for me the last week and a half because I started a regular workout routine and I'm working with Phil Beadle who I did a podcast with.

And we meet every Monday morning at 6:30 here in Clarion. And I just thought this is never going to work because I'm a morning person. And I said are you serious? Like we're really doing this? He goes, let's get it done. Let's let's just get it done, and then you're done, and then you don't have to stress about it or worry about it the rest of the day, you're free.

I have taken that mindset, and so far so good. That's my big green frog.

Tiffini Toliver, ARNP: My husband I will that occasionally too. Like if we're dreading doing something, we're like, just go eat the frog. it done. So I use that analogy a lot because I think it works and you can use it, as you said, for many things, not just homework. So,

So, yeah.

Host: Okay. Well, let's just summarize a little bit. If you are listening to this podcast and you suspect that you have a child or a partner or somebody in your family, maybe who you care about that might have ADHD and they haven't had official diagnosis, it's just, we're suspecting it, what should they do?

Tiffini Toliver, ARNP: Make an appointment. Come and see us. We usually try to make those visits a little bit longer of a visit so when you call to schedule, make sure they know that you want to be assessed for possibly ADHD because we'll get a little bit more of a time slot so we can do more questioning and fill out some paperwork. Sometimes if we know that ahead of time, we might even try to give you the paperwork ahead of time. Just depends. But yeah, just come and see us. Let us evaluate it and there's a lot of things we can try and it's not always medicine. So I like to throw that out there. Medication can work really well, but sometimes, like you said, sleeping, cleaning up your diet there's some more homeopathic things.

GABA, which is a non medicine. It's more of a over the counter supplement can help with calming. GABA calms the neurotransmitters in your brain and can be calming. So if you have the child or even an adult, we have a lot of adults that use GABA too, it can calm your brain. And if your brain's a little bit calmer, sometimes you can think a little bit clearer, you can focus a little bit more.

So especially in the younger kids, we might say, if you haven't tried these things, try these things first. So medication isn't always the answer right away. Sometimes you need to see if other things might help, but medications can definitely be beneficial.

Host: So if I have a child who then I suspect that might have ADHD, and I call the clinic, make an appointment to see you. Am I fair in saying that this is something that's going to be followed up on? This isn't a one and done?

Tiffini Toliver, ARNP: No, yep. No. Yep. Like I said, usually it's like I said, it's a follow up. We want to see if you've tried these things, what makes it better? Sometimes it's even just structure or environment. Some kids do better in a smaller environment, like for a daycare versus a large daycare center. It's too overwhelming for them, which was the case of our children. The great daycare, it was just, too busy for them and they didn't do well. When we put them in a private daycare, they tended to do better because it wasn't quite as overwhelming for them.

Host: Mm-hmm.

Tiffini Toliver, ARNP: There was a lot going on. You look every direction, there was things going on.

Host: Yep. Okay. I appreciate you being on. This is great information.

Tiffini Toliver, ARNP: I'm passionate about this, I think, as you can tell.

Host: Yes, yes I can and then which makes it even better if you will when people come in to see you because you've lived through it. You've studied it. this. You've got this.

Tiffini Toliver, ARNP: When I hear these parents say, I don't want the school to call one more time, or I'm afraid they're going to get kicked out of daycare, I'm like, I've been there.

Host: Yeah, and I love the connection between the teachers and you as the caregiver, the parent, it's a team approach, really, and I that's fantastic and so wonderful for the children.

Tiffini Toliver, ARNP: And it's really not any kind of cookie cutter or recipe kind of medicine. What works for one may not work for the other. So we find what works for you. Sometimes it's trial and error. And that's what I tell my patients. There's no perfect algorithm that says, Oh, your child of this is this age and weighs this much. Oh, they need this medication. That would be amazing. It's really what we call in the medical world thumbs up, thumbs down. It worked. It didn't work. We try something else.

Host: Yeah, and so my analogy then going back to the personal training, that's why I hired Phil. Because if I pull up a YouTube video and decide to get fit, that might not be the program for me. He's tailoring this to my individual needs I want and keeping track of what I'm doing. Same concept. Personalized for the patient. Yeah, I love that, Tiff. Okay, if somebody wants to make an appointment to see you, I'm just going to throw out our toll free number is 888-258-0078. Again, that's 888-258-0078. Just tell them that you want to make appointment with Tiffini or Karn, yep.

Tiffini Toliver, ARNP: Dr. Aronson is

Host: He's in sabbatical

Tiffini Toliver, ARNP: for seven months, but yes, Karn is also excellent as

Host: Karn or Tiffini. Okay. I appreciate that. Also our website has information about all of these services plus you and Karn, on your provider profiles.

Tiffini Toliver, ARNP: MyChart is great, too. If you just have questions and you're not sure if this is the right avenue to go, don't hesitate to even send us a MyChart message and tell us what's going on. And maybe we could offer some suggestions or, help you get guided in that right direction. So if you have MyChart, use it. We love it.

Host: Perfect. Thank you so much.

Tiffini Toliver, ARNP: You're welcome. Thanks for having me.

Host: You bet. Thank you for listening to Iowa Specialty Hospitals and Clinics, ISH DISH Podcast. For more information on the topics we discussed today, visit us on the web at iowaspecialtyhospital.com. There you can read a transcript of today's episode or previously aired episodes, as well as get the latest news from Iowa Specialty Hospitals and Clinics and explore all of the services that we offer.

For the ISH DISH Podcast, I'm Gina. Thanks for tuning in.