Kentucky's transgender youth are caught in the middle as Beshear, Cameron and political allies spar over trans health care

Students protested at the state Capitol against a law that banned gender-
affirming care for minors. (Kentucky Lantern photo by McKenna Horsley)

By McKenna Horsley
Kentucky Lantern

Ysa Leon is questioning their future in Kentucky. The outcome of the state's gubernatorial election this November will be a deciding factor.

“I’ve told my family: Be prepared in November, because that might change where I’m staying after I graduate in May,” said Leon, a 20-year-old nonbinary student at Transylvania University, where they are president of the Student Government Association.

Leon and other transgender Kentuckians have been concerned for much of the year as Kentucky politics filled with heated discourse on the rights of trans people, specifically over what gender-affirming medical care for youth should be permitted in the state.

After the General Assembly passed one of the strongest anti-trans bills in the country, Senate Bill 150, Ray Loux, 17, decided to enroll in Fayette County Public Schools’ Middle College program for his senior year. He did not want to worry about which bathroom he should use, what pronouns his teachers will use and “not being able to talk about who I am with my friends in school.”

Ray is considering going to a college out of state.

“I had a panic attack the other day because I wasn’t sure what my health-care situation would look like going forward,” Ray said, noting that he must taper off his hormones while he is underage.

Now, the issue of trans rights has reached the governor’s race.

Democratic Gov. Andy Beshear, who is seeking a second term in office, has released a 15-second ad called ‘Parents.” It focuses on claims made by Republicans, including his opponent Republican Attorney General Daniel Cameron, that the governor supports “sex change surgery and drugs” for kids.

Wearing basic dad attire — a blue button down under a red quarter-zip pullover — Beshear stares into the camera and says: “My faith guides me as a governor and as a dad.”

He then repeats a familiar line — “all children are children of God” — before saying Cameron’s attacks are not true, adding: “I’ve never supported gender reassignment surgery for kids – and those procedures don’t happen here in Kentucky.”

GOP backlash was swift, and rhetoric uplifting culture wars reached the annual Fancy Farm Picnic in West Kentucky earlier this month. Among his jokes for the day, Cameron riffed that come November Beshear’s pronouns will be “‘has’ and ‘been’,” and criticized the governor for protecting “transgender surgeries for kids.” (Those two words are not pronouns.)

In a press conference last week, Cameron highlighted a letter from a University of Kentucky health clinic, stating it had performed “a small number of non-genital gender reassignment surgeries on minors who are almost adult,” but stopped after the ban on gender-affirming medical care for youth took effect.

Hours later, Beshear said in his press conference that the letter was new to him, and said that if a bill that only banned gender-reassignment surgeries for minors made its way to his desk, he would have signed it.

“Daniel Cameron’s taken this race to the gutter in a way that I’ve never seen,” Beshear said. “I mean, right now, I think if you ask him about climate change, he’ll say it’s caused by children and gender reassignment surgeries.”

As politicians put a spotlight on gender-affirming medical care, advocates say the lives of transgender Kentuckians — especially those of the commonwealth’s trans youth — are on the line.

 
‘It’s hard to be a trans child anywhere’

Transgender youth are already vulnerable, and the way politicians talk about trans people in general is “really dehumanizing,” said Oliver Hall, trans-health director at the Kentucky Health Justice Network. They work directly with transgender youth, a demographic that Hall said is being used as a “political football.”

“It’s hard to be a kid. It’s hard to be a teenager in general,” Hall said. “And then it’s additionally hard to be a trans teenager. It’s hard to be a trans child anywhere.”

Leon, who came out as queer in 2020 and then as trans and nonbinary in 2021, said it took a lot of therapy to find themselves. At first, only their roommates and close friends referred to them with they/them pronouns in private.

“When I heard it the first time, I felt like I took the biggest breath ever — this exhale that I’d been holding in for so long. All of this pent up anxiety was gone and I felt so good,” Leon said. “And it’s not that that fixed everything for me, but accepting yourself and having other people accept you changed my life. It changes everything for some people.”

SB 150 took effect in July despite a legal challenge brought by the American Civil Liberties Union of Kentucky. Cameron's office is defending the law, which bans gender-affirming medical care for anyone under 18, including forcing those already taking puberty blockers to stop. It allows teachers to ignore trans kids' choices of names and pronouns, regulates which school bathrooms kids can use, and limits the sex education students can receive.

Beshear vetoed the legislation, but the Republican supermajority in the General Assembly easily overrode it. In his rejection of the bill, Beshear wrote that he was doing so based on the rights of parents to make decisions about how their child is treated and that the law would allow government interference in medical care.

“Improving access to gender-affirming care is an important means of improving health outcomes for the transgender population,” the governor wrote in his veto message.

Leon said gender-affirming care is different for each transgender person. They did not use puberty blockers because they came out as an adult, but socially transitioned with support from their friends and family. Gender-affirming medical care is also not always covered by health-insurance companies.

Having such laws on Kentucky’s books mixed with support from politicians running for the highest state office in the Commonwealth has “a detrimental effect on the physical and mental health of trans people,” said Hall, of the Kentucky Health Justice Network.

Some in the trans community fear that, eventually, gender-affirming care for adults could be banned as well, said Ray’s mother, Shavahn Loux. While her son is in a “better situation than a lot of kids” because he will be an adult in a few months and could regain access to health care, she said “it’s scary” to think Ray’s access to hormone treatment in general could end completely.

“I know a number of people who were thinking about coming here and are now no longer considering it because of this,” she said. “That’s true for trans individuals and non-trans individuals.”

Cameron, asked recently if he thought gender-affirming medical care for adults should be banned in Kentucky, told reporters that he supported “what our legislature did in protecting our children.”

“Adults can make different decisions but this is about protecting kids and making sure that we don’t rob them of youth and innocence,” Cameron said.

‘The right buzzwords’

After a federal judge reversed a temporary block on the health-care part of the new law, Cameron issued a statement calling the treatments “experimental” and vowed that his office would continue to “stand up for the right of children to be children, free from the influences of leftist activists and radical gender ideology.”

Rebecca Blankenship, the executive director of Ban Conversion Therapy Kentucky and the first openly transgender person ever elected to public office in the state, noted that Cameron’s defense was initially “rebuked” by the judge in the injunction, who noted that the drugs “have a long history of safe use in minors for various conditions.”

This shows, she said, that “Attorney General Cameron is willing not only to lie to voters, but even to the courts to advance these political talking points.”

Alexander Griggs, the community outreach coordinator for the Fairness Campaign, said such messaging argues that “Trans people shouldn’t have autonomy over the decisions they make over their bodies” and that their medical needs are “wrong.” With that constant messaging, transgender youth may internalize it, Griggs said: “The more of that language that’s used, the more damage is being done.”

Leon agreed, saying “People think they can say whatever they want, and not realize the harm that it does.”

As a teenager, Leon said they tried their best to fit in with their cisgender peers. They turned to their church, but were presented with the option of conversion therapy, which seeks to change a person’s sexual or gender identity. They rejected the offer, which leading medical and mental-health organizations have criticized.

Leon said, “My mental health and my self-love improved more than I could have ever imagined after I came out as nonbinary.”

Beshear has taken a more moderate stance on gender-affirming medical care. Bobbie Glass, a transgender woman who testified before lawmakers against Senate Bill 150, said Beshear’s recent ad used “very specific” language to discuss his position, pointing out that he did not discuss his position on puberty blockers.

Beshear is using “the right buzzwords” that people in the transgender community will understand, she said, adding that people who don’t understand the terms could interpret the ad to mean “he believes the same thing” they do.

“But then, Daniel Cameron’s going to turn around and try to exploit that stuff with the language he used in his veto,” Glass said. “And so it’s still going to have the effect of just making life miserable.”

Blankenship appreciates Beshear’s ad for “advancing the conversation, in that he’s lowering the temperature of it, and focusing on the truth.” Ban Conversion Therapy Kentucky does not endorse or oppose political candidates.

“He has been unwilling to bow to pressure from radicals to hurt us,” Blankenship said of the governor. “But at the same time, it’s difficult to point to anything that he’s done since maybe 2020, that was clearly designed to help LGBT people.”

Members of the LGBTQ+ community have asked the governor’s administration to direct the state Cabinet for Health and Family Services to track suicides within the community or where conversion therapy is happening in the state, Blankenship added.

The Trevor Project, which aims to prevent suicide among LGBTQ+ youth, reported in 2022 that 59% of Kentucky’s transgender and non-binary kids considered suicide, and 24% tried to take their own lives.

At least 15 laws banning gender-affirming care for transgender youth have been enacted across the country, according to the Human Rights Campaign, along with at least seven laws that require or allow the misgendering of transgender students. HRC also found that more than 220 bills specifically targeting transgender and non-binary people were introduced in state legislatures this year.

If Beshear is re-elected, Hall hopes the governor “will acknowledge the support that trans Kentuckians have given him” and enact executive orders to ensure policies like anti-discrimination protections for transgender people statewide.

Ray called Beshear’s first term “empowering” for trans Kentuckians: “It was really nice to be able to see somebody in a position of power in Kentucky who was accepting of people like me and welcoming of us and embracing us to live in this state.”

A February Mason-Dixon poll released by the Fairness Campaign showed 71% of Kentucky registered voters don’t want lawmakers making the decisions about transgender youths' health care. 

Nevertheless, the Trevor Project’s 2023 U.S. National Survey on the Mental Health of LGBTQ Young People found that 27% of transgender and nonbinary touth reported being physically threatened or harmed in the previous year because of their gender identity.

But the politicization of the issue “is radicalizing people, and people are treating trans people even worse than we have been treated historically,” Hall said.

Leon and Ray say the outcome of the November election will impact their future in Kentucky. Ray is prepared to leave the state for college if he has to. “If Beshear loses, I think Kentucky is going to become a lot less welcoming of a place,” he said.

Leon hasn’t decided: “I’m kind of weighing: Do I stay here and fight for people like me and make it a better state for people like me or do I protect myself and go somewhere where I am safe?”

McConnell announces another multi-million-dollar grant to former Gov. Fletcher's firm to help build housing for drug treatment

Former Gov. Ernie Fletcher

Kentucky Health News

Senate Minority Leader Mitch McConnell announced that he helped get $3.3 million for the Fletcher Group, a nonprofit founded by former Gov. Ernie Fletcher, to build housing for rural people in drug recovery.

“With the help of the Fletcher Group’s targeted prevention, treatment and enforcement programs, Kentucky’s rural communities can take a stand against addiction and save lives,” McConnell said in a news release.

However, Andrew Howard, a former McConnell aide who is the Fletcher Group’s policy director, told John Cheves of the Lexington Herald-Leader that the firm doesn't provide care or own facilities. 

“Rural communities often have capacity challenges,” Howard said. “You’ll have one kind of spark plug in the community that’s wearing multiple hats, and they don’t have that capacity to understand or to figure out or to find information about new best practices or recovery housing programs. So that’s where we come in — to be boots on the ground and walk with those community stakeholders.” 

Howard told Cheves that this latest round of funding will help the Fletcher Group and its partners to accomplish several specific projects in Kentucky, including the opening of a recovery home in Bell County for pregnant women and new mothers that will offer holistic treatment and job training and a pilot project at Southeast Kentucky Community and Technical College in Cumberland to help recruit and train certified peer support specialists. 

The Fletcher Group is one of three “rural centers of excellence” that have shared in many millions of dollars in drug-abuse grants in recent years from the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

"We serve any HRSA-designated rural community in the U.S.; however, we have had a significant focus on Kentucky's rural communities," Fletcher Group CEO Dave Johnson told Kentucky Health News. "There are 103 HRSA-designated rural counties in Kentucky, of the 120 Kentucky counties. Over the past four years we have provided consultation, training, education, and research in 47." 

Cheves reports, "The Fletcher Group, founded in 2017, has locations in London and at the home of Ernie Fletcher and his wife, Glenna, near Sarasota, Fla. It employs more than 30 people working out of 13 states. From 2018 to 2021, it collected nearly $8.8 million in public funds, with steadily rising revenues, according to its most recently available tax returns."

Howard told Cheves that McConnell announced previous HHS grants for The Fletcher Group of $6.66 million in 2019, $3.33 million in 2021, and $1.68 million from the Appalachian Regional Commission in 2019. Cheves reports that the firm "has paid the Washington lobbying firm of Akin Gump Strauss Hauer & Feld at least $120,000 a year since 2018 to lobby congressional spending committees on its behalf, according to federal lobbying disclosures."

Cheves adds, "Ernie and Glenna Fletcher together collected $850,345 in compensation from The Fletcher Group during the three years from 2019 to 2021, according to the nonprofit’s tax filings. Each of them is identified as co-chair and co-founder of The Fletcher Group. Additionally, Ernie Fletcher is listed as chief medical officer." 

During his tenure as governor, in 2003-07, the Republican established a recovery housing program called "Recovery Kentucky" that continued under Steve Beshear, the Democrat who ousted him in the 2007 election. The firm's website says the program inspired Fletcher to extend this recovery model nationwide.

National poll finds online patient portals for children are underused

University of Michigan illustration

By Melissa Patrick
Kentucky Health News

A national survey found that only 43% of parents have set up an online patient portal for their child and 41% said they had not been educated on when to use it.

"Given all the conveniences portals offer, it's surprising that over half of parents have not set one up for their child, most commonly because they don't see a need for it," Sarah J. Clark, co-director of the polling team, told HealthDay. "This report suggests many parents may not be aware of all the potential benefits of using a patient portal for children."

Patient portals are computer applications to facilitate communication between patients, parents and health-care providers.

The poll was taken by the C. S. Mott Children's Hospital at the University of Michigan. It was administered in February to a randomly selected, stratified group of 2,000 adults who were parents of at least one child living in their household. The poll's overall margin of error is plus or minus 1 percentage points, and up to 6 poimts for its subsamples.

The poll found that 59% of parents said their child's health-care provider gave them instructions or guidance on when to use the portal. Of that group, three-fourths said they felt "very satisfied" with their ability to communicate with their child's provider, compared to just over half of those who said they received no instruction. 

Of those who did not have a portal, 31% said they did not need one, 25% said they did not know it needed to be set up, 21% said it was not an option with their provider, 16% said they prefer other ways to communicate, 6% had privacy concerns and 3% had technical problems in getting it set up. 

Of those who had a portal, the top three uses were for scheduling appointments (57%), completing pre-visit forms (68%) and looking at their child's test results (65%). Other uses included telehealth visits, requesting records and forms for school, sports or camp, getting a prescription refilled and referrals. And, 34% of the parents used the portal to get advice about their child's illness, injury or symptoms.

One concern among parents reported in the poll was losing access to their child's health information as they age, with 74% of them wishing they had access to their child's health records until they turned 18. 

The poll found that 31% of parents of teens saw changes in their patient portal access, including the information and messages from their child that they could see.

Physician-in-chief at Kentucky Children's Hospital says state can do better by its kids; it ranks 40th in well-being of children

Dr. Scottie B. Day (UK photo)

By Dr. Scottie B. Day

University of Kentucky

A recent report by the 2023 Kids Count Data Book studied how economic well-being, education, health and family support impacts a child’s overall well-being, and how those impacts vary from state to state. So how does Kentucky rank? Are parents able to find secure employment, with wages that keep pace with inflation and cost of living? Are the kids doing well in school, meeting education benchmarks and graduating on time? Do they have access to health care, especially mental health resources? How do we fare compared to other states?

Kentucky ranks 40th in children’s overall well-being. This is unacceptable, and we can do better.

Our kids are in crisis. 22% of Kentucky’s kids live in poverty. Without access to affordable, quality childcare and preschool programs, those kids fall behind their peers in developmental and educational benchmarks. More than 41% of children between the ages of 10-17 are overweight or obese. Children who struggle with their weight are at higher risk for heart disease, diabetes and cancer later in life. Sixty percent of children and adolescents with major depression receive no mental health care. Since 2019, suicide deaths in individuals ages 10 to 19 increased by almost 70%.

The pattern is clear; how we provide kids now informs their futures, as well as the future of the entire commonwealth.

This is not to suggest that as children transition to adulthood, they aren’t capable of change and have the knowledge to make better decisions for themselves and their children. But shouldn’t they have the best possible start to begin with? Shouldn’t we utilize every resource to ensure that every child in Kentucky grows up to be a healthy adult?

We need to help families offset the cost of child care and support child-care workers. Strengthen preschool programs accessibility so kids can build the skills they need to be successful in school. But most importantly, we must invest in kids’ physical and mental health. The stress of poverty, exposure to violence, substance abuse and lack of access to primary care, preventive screenings and proper nutrition are just a few of the factors that adversely affect a child’s physical, mental, and emotional well-being. Adversity doesn’t “build character;” it influences every aspect of a child’s life and continues to inform patterns of behavior for generations.

If we only do what we can do, we will never be more than we are now. Let’s plant the tree now and let the roots take hold to build a stable foundation. Even though we may not see the fruit for years, we can take comfort in knowing that future generations of Kentuckians will be strong and well-nourished.

Scottie B. Day, M.D., is physician-in-chief at Kentucky Children’s Hospital and chair of the University of Kentucky College of Medicine’s Department of Pediatrics.

Kentucky Homeplace trains 11 more community health workers

Kentucky Homeplace is the University of Kentucky's
program to train community health workers.

By Melissa Patrick

Kentucky Health News

Community health workers fill a vital role in meeting the health-care needs of Kentuckians. Now the state now has 11 more of them.

CHWs aren't trained medically, but as patient advocates who come from the communities they serve. They help their clients coordinate care, provide access to medical, social and environmental services, work to improve health literacy, and deliver education on prevention and disease self-management.

The graduates from the University of Kentucky Center of Excellence in Rural Health's CHW program, called Kentucky Homeplace, were recently honored by the center and health insurer UnitedHealthcare Community Plan of Kentucky at a ceremony held in Hazard where the center is located.

Through this initiative, funded with $35,000 from UnitedHealthcare's Community Plan of Kentucky, the 11 students from Hazard and Perry County high schools completed the training with Kentucky Homeplace and can now apply for CHW certification.

Once completed, they will be able to serve as health-care advocates providing education and guidance to help Eastern Kentuckians connect with health-care resources.

CHWs serve in their own communities, which helps ensure cultural sensitivity to their client's health disparities and special needs. Ten more CHWs will graduate in 2024.

The federal Bureau of Labor Statistics says Kentucky had 1,540 CHWs in May 2022, with an average wage of $54,530. 

Kentucky Association of Health Plans is offering free rides at Kentucky State Fair to people who get vaccinated at its site there

The Kentucky Association of Health Plans is hosting its third annual vaccination pop-up clinic at the Kentucky State Fair and while supplies last, will give away free, unlimited ride wristbands to those who get vaccinated, as well as the opportunity for other incentives. 

KAHP is the trade association representing commercial health insurers and Medicaid managed-care organizations in the commonwealth. 

From Aug. 17 to 27, KAHP is giving away a free unlimited ride wristband (while supplies last) when State Fair attendees go to the Health Horizons Pavilion in South Wing B to receive a vaccination. Hours are 10 a.m. to 5 p.m. daily.

In addition, those receiving a vaccine will be able to spin the wheel for a chance to win prizes like a bonus ride pass, food voucher, or $25 gift card. Medicaid members may also be eligible to receive an incentive offered by their health plan in addition to the KAHP giveaway. KAHP also has a kid-friendly zone with coloring books and life-size “Max the Vax” and “Maxine the Vaccine” cut-outs.

Vaccines offered include measles-mumps-rubella (MMR), tetanus-diphtheria-pertussis (Tdap) and influenza.

“The recent outbreak of whooping cough (pertussis) in Lexington is something that should concern us all,” Tom Stephens, KAHP president and CEO, said in a news release. “Children, pregnant women, newborns, and those around other medically vulnerable people are most at risk. It is vaccine-preventable, so we are urging folks to stay up to date on their shots. We have seen an alarming trend with fewer Kentucky children receiving Tdap vaccines, which protect against tetanus, diphtheria and pertussis." 

Breaking the stigma: ADHD can make rejection feel even worse

Joshua Claytor lives with ADHD. (Photo via Kentucky Lantern)

By Sarah Ladd
Kentucky Lantern

Sitting in high school classes was “always a struggle” for a young Joshua Claytor. He filled his papers with “doodles.” Certain math concepts eluded his understanding.

Despite these early signs, it took the Vine Grove man decades to learn he had attention deficit hyperactivity disorder, or ADHD.

When he was diagnosed last year at the age of 42, some things about his life started to make sense.

He realized that “quirky” things about his character were actually part of his ADHD: Fixating on a hobby for a few months, then never touching it again. Taking rejections hyper-personally. Getting ready for work one moment, and realizing the next that too much time had passed and he was already late.

All these symptoms, from time blindness to rejection sensitive dysphoria (RSD) are common but often-ignored parts of ADHD, therapists who treat it said.

 
What is ADHD? Where does it come from?

The Centers for Disease Control and Prevention says ADHD is among the most common neurodevelopmental disorders, and almost always appears by the age of 7, with elementary school helping to reveal inattentiveness, according to Johns Hopkins University.

Often characterized by forgetfulness, daydreaming and carelessness, among other symptoms, the disorder affects millions around the country. Time blindness, too, is common in the ADHD brain, experts said, often making people who have it late to events.

“It’s really hard to manage time, to have an accurate sense of time, to have a good kind of internal guess of how long something is going to take or how long it’s been that you’ve been working at something,” Brenda Arellano, who specializes in treating ADHD, said. “That’s a really difficult thing for a person with ADHD to keep track of.”

Therapy can help people with ADHD become more aware of time and resolve other symptoms of the disorder. But ADHD’s causes are unknown, and the CDC says scientists want to find out if things like brain injury, low birthweight and exposure to alcohol or tobacco in utero can lead to it.

Like many other mental health conditions, people often misunderstand and stigmatize ADHD. For example, there’s this idea that ADHD is “caused by bad parenting,” said Arellano, who works at Well Kentucky.

But it’s just not that simple.

“Certainly, environment plays a factor,” Arellano said. “But it’s not something that’s going to be caused by bad parenting or eating too much sugar or watching too much TV or anything like that. Certainly those things might not help with your ADHD, but it’s not like that’s the reason why you have it.”

 
Different types of ADHD

A person with ADHD may be predominantly inattentive, predominantly hyperactive/impulsive – or have both presentations, Arellano said.

ADHD on television usually looks hyperactive or impulsive, Arellano said. “We often see it as … a little boy that’s just bouncing off the walls. Super, super energetic. Can’t sit still for a second. … And it certainly can be that way, but it also can be much more than that.”

People with hyperactive ADHD can struggle with impulse control, regulating frustration and balancing long and short-term goals, Arellano said. They may end up with more broken bones and traffic tickets than other people, or appear to talk more than average.

Inattentive folks may get distracted easily and struggle with time management. These challenges have “big impacts” on school and meeting deadlines at work.

Males are more likely to be hyperactive/impulsive or both, while females are more likely to be inattentive, Arellano said, though anyone can have any sort of presentation.

Males also are more likely to get diagnosed, she said. That may be because it’s easier for teachers and parents to spot disruption than daydreaming as an issue.

But there is a misconception that people with ADHD lack the ability to pay attention. That’s just not true, according to licensed clinical social worker Sarita E. Trawick.

“The people that have ADHD often can actually hyper-focus on something that they’re interested in,” said Trawick, who sees clients in Kentucky and Oregon.

Pairing an activity or area of interest with the boring or difficult task can help, she said.

Calling ADHD “dopamine deficit” may be more accurate, she said. That’s because “Boredom is like death to someone who has ADHD.”

Dopamine serves as a “reward center,” according to the Cleveland Clinic, and is also called the “feel-good hormone.” People with ADHD may not have enough dopamine — or too much.

 
Is ADHD ‘curable’?

Talk therapy and medications like Adderall can help manage ADHD symptoms.

And while it’s not clear if it’s curable, people can learn to manage symptoms with these treatments.

Some people do appear to “grow out” of ADHD as they get older, according to Arellano, who primarily works with youth.

But the “jury’s out” still on why that happens — and it’s not true for everyone. ADHD may also appear to fade with age for those who look for careers that play to their strengths and not their weaknesses.

“If you’re somebody who has a really hard time staying in their seat, it doesn’t make sense that you’re going to grow up and get an office job where you have to sit in a chair still for eight hours,” Arellano said. “You might do something that has a little bit more interaction or where you can move.”

In that case, she explained, it’s not that ADHD went away. The person is simply playing to their strengths.

The condition “is manageable,” Arellano said. “We can learn to work with the way that a person’s brain is wired and we can seek out situations and environments and supports that … (don’t) hold the person back from showing their intelligence and their other talents.”

 
Stigma of seeing yourself as flawed

ADHD, to Claytor, often felt like a “punchline,” a “joke,” especially in high school.

“We didn’t really talk about ADHD being a real mental illness,” he said. That made it difficult to recognize and address symptoms.

Even now, he struggles when he reflects on past events and realizes how much his ADHD-related rejection sensitivity disorder (RSD) has affected his life. It even forced him to give up dating, he said.

For years he took rejection as a personal attack on his value, making him lash out at perceived attackers.

“To look and see that you didn’t have to defend yourself, that you overreacted, that you hurt people that you cared about. It’s hard to confront,” Claytor said. “It’s hard to face … because it’s embarrassing.”

You must “relive that hurt and having to learn to not only hope for forgiveness from the person that you’ve hurt, but also to forgive yourself,” he said.

RSD can happen to people with ADHD because, Arellano said, the brain may hyper-focus on one thing — something a person said or did — and may overanalyze it. The person with ADHD may even blame themselves for the real or perceived rejection.

“It can be really hard to move on from that,” she explained. “Folks with ADHD have a hard time with regulating emotions, so their feelings can be more intense and it can be hard to work through and cope with those feelings.”

Because ADHD can hinder a person’s ability to focus or cause them to hyper-focus, it can be difficult to separate symptoms from the individual who has them — both for that person and those around them, Arellano explained.

“You’re seeing yourself as, like, ‘I’m stupid’ or ‘I’m a bad student’ or ‘I don’t like school’ or ‘I’m a bad friend,’” she said. “All of those thoughts that really have more to do with your ADHD than with you are going to make it really difficult for you to show up as your full, true, authentic self.”

That negative messaging and feedback can start at a young age, Trawick said.

“Think about how, on a daily basis even, hour to hour, how much feedback you might get about yourself not being like everyone else,” she said. “If you carry that over time, you’re constantly waiting for you to get in trouble or waiting for you to do the wrong thing and then be rejected.”

Think of the child who’s kicked out of class, out of school. Who’s told they can’t come over to a friend’s house anymore because they’re too hyper.

That’s a “lot of rejection” for kids with ADHD to endure, Trawick said.

It impacts how they interact with the world.

“How do you … demonstrate that you’re a good friend if you forget appointments … you forget things, you forget to show up. You can’t pay attention. You forget what they told you because memory is an issue,” Trawick explained. But: “what, often, people forget is that: That’s the friend that if you call them, they’ll be right over. They’ll drop everything to do something for you.”

 
Changing the narrative

Arellano teaches her clients to change how they speak about their ADHD and separate it from their sense of self, which she said is a key part of therapy.

For example, her clients learn to say: “I’m a smart kid. I know what I’m doing. I’m very knowledgeable. I’m actually a pretty good student. And I have ADHD and I procrastinate sometimes and that really bites me in the butt.”

Or: “I’m a very considerate person, and my ADHD sometimes wants me to interrupt people, and that’s something I’m working on.”

The way movies and television sometime depict the disorder makes it easy to generalize and stigmatize the disorder too. There is this image, Arellano said, that people with ADHD are “dumb” or “airheaded.”

In fact, “The research that’s out there that looks at folks with ADHD and their intelligence shows that they’re either average or even above average intelligence,” she said. “So this potential idea that might be floating out there that folks with ADHD are dumb or lazy or unmotivated is just simply not true and not supported by the research.”

‘There’s definitely hope’

Claytor uses a technique called “body doubling” to help cope with his ADHD symptoms. He has an “ADHD buddy” who stays on the phone with him so they can complete things together like cleaning or dishes.

Sometimes just having someone around, even virtually, helps him focus. He knows he can’t go back in time to high school and get a do-over knowing that he has ADHD. He’s in therapy and strives to make his life better now and in the future.

He wishes he could tell his younger self: “Hey, it’s going to get better and there are tools that you can use” to make sure of it.

That, and: “There’s definitely hope.”

 
Could I have ADHD? Signs to look for:

Experts say people with ADHD may have trouble focusing on just one thing and may take rejection hyper personally, among other symptoms.

Other symptoms of ADHD include: 

• Distractedness
• Forgetfulness
• Excessive talking
• Deep connection with music
• Entrepreneurial leanings
• Storytelling skills

You can find Kentucky therapists who specialize in ADHD here.

University of Kentucky acupuncturists explain how their procedure can help relieve pain if medication and therapy don't

By Dennis Kim and Norah Charles
University of Kentucky

Acupuncture involves the insertion of needles on specific points of the body. In Eastern terminology, it helps stimulate the flow of chi, which is the life force, along the meridians of your body.

In Western terminology, it helps send nerve fibers to the spinal cord, brainstem, the hypothalamus and pituitary gland. These fibers help release neurotransmitters such as endorphins, the body's natural painkiller, along with enkephalins plus norepinephrine, which helps inhibit the nerve pain fibers to suppress pain.

An acupuncture procedure (PeakStock/iStock/Getty Images Plus photo)

Acupuncture is non-medication. If a patient is having a condition that is not responding to medication, and they're not recovering fully with physical therapy or other kinds of therapy, we're sometimes able to make progress with acupuncture. We find that we get a lot of referrals from medical doctors who are trying to help patients, mostly with acute and chronic pain, find alternatives to medication.

The most common conditions that we treat with acupuncture in our clinic are musculoskeletal issues such as fibromyalgia, myofascial pain, carpal tunnel and arthritis. These, and other conditions that are treated here, involve neck pain, low back pain or any type of musculoskeletal issues.

The first session of acupuncture involves asking a lot of questions of the patient. Patients usually come in with a primary complaint and the acupuncturist needs details about what brought them into the clinic. The provider will usually go through questions involving other aspects of their health, such as health history, sleep, digestion and mood. This helps the provider develop a better diagnosis from the acupuncture perspective.

Another benefit of trying acupuncture is multiple conditions can be treated at once. If a patient presents with insomnia and also low back pain, those do not need to be separate treatments. We spend time talking with the patient at the beginning of the session to get an idea of what's going on with them in a whole health manner.

The acupuncture session lasts for about 20 to 30 minutes with the needles in, and follow-up sessions are scheduled as needed.

Acupuncture's benefits are cumulative. A patient who comes in with low back pain may notice relief after one session, but they will notice increased relief after more sessions. Everyone's body is different, and resukts depends on the condition, but we ask patients to give acupuncture three sessions to see if we can make any headway with their condition.

Dennis Kim and Norah Charles are licensed acupuncturists with UK HealthCare Integrative Medicine and Health.

Nominations are due by Aug. 31 for the Dan Martin Award recognizing lifetime contributions to rural health in Kentucky

Since 2003, the Kentucky Rural Health Association has presented an individual with an award for lifetime contributions to rural health in Kentucky. The award is named for its first recipient, Dr. Dan Martin of the Trover Foundation in Madisonville.

The Dan Martin Award is given to someone who has provided many years of service to rural health, whether in patient care, administration, health-professions education, health administration, health promotion or public advocacy.

The rural health association is seeking nominations for this year's award. To nominate someone, complete this form. Theis year's deadline for nominations is Thursday, Aug. 31.

Based on the responses and the criteria of the candidates received, the Dan Martin Award Committee makes recommendations to the KRHA Executive Committee, which will select the 2023 honoree. The award will be presented at the KRHA Annual Conference on Nov. 16-17 in Bowling Green. 

If you are a KRHA member and would like to serve on the award committee or have further questions, email Garrett Anspach at gban222@uky.edu.

Demon Copperhead author and Ky. native Barbara Kingsolver talks about the opioid epidemic and Appalachia's difficulty with it

Barbara Kingsolver (Facebook photo)

Barbara Kingsolver says she intended her Pulitzer Prize-winning novel Demon Copperhead to be her "great Appalachian novel" that told the story of how the opioid epidemic has ravaged the region, and its impact on children. 

Ezra Klein of The New York Times interviewed Kingsolver, who grew up in Nicholas County, for his podcast, "The Ezra Klein Show." The Times transcribed the interview. It is wide-ranging, but a big chunk has her telling Klein how the opioid epidemic has impacted a whole generation of children who have become orphans and are being raised by grandparents and the foster system — and getting the bulk of their social services at school.

 

"We have a generation of orphans coming up through our schools," Kingsolver said, adding later, "There’s so many more kids in need than there are social networks to catch them — but the caseworkers are so overloaded and so pathetically underpaid. . . . This is something that I think the world needs to know about, this country — voters — need to know about. We need to know how this epidemic has left a generation of innocents that nobody’s taking decent care of. . . . These kids have been left behind. Our burdened public school systems are being asked to raise these kids." 

Klein and Kingsolver also talked about how Central Appalachia was targeted by Purdue Pharma with a drug that was so addictive and with doctors who were told otherwise. "This was done to them," Kingsolver said of her neighbors in southwest Virginia and southeastern Kentucky. "Nobody wants to be addicted."

Winner of the 2023 Pulitzer for fiction

Kingsolver also talked about the stigma associated with addiction and how people have been brainwashed to think it is a moral failing, instead of the brain disease that it is. 

"We have been trained, culturally trained, to think of addiction in this way, as a personal failing that needs to be punished. Incarceration does not cure addiction any more than it cures cancer. Addiction is a disease," she said. "It’s impossible to describe how terrible this disease is, not just the dope sickness of it but the fact that your entire life has to become just a really difficult, hard work in process of, every morning, getting your means, getting your fix, getting through another day. And nobody wants to live like that." 

Kingsolver told Klein that she hopes her novel will help people have more compassion and think of people with addiction as having a disease and to get rid of the idea that you don't treat a person with addiction until they "hit bottom." 

"That’s how we treat the disease of addiction. And it’s incredibly inhumane. And effective treatment will only happen after we switch over from putting this in the hands of the police and the prisons to medical workers who can meet addicted people where they live and offer them the first steps of clean needles and fentanyl test strips so that they won’t die in the weeks that it will take for them logistically, physically, emotionally, to get to the beginnings of treatment," she said. 

And to those who maintain a moral objection to such "harm reduction" programs, she said, "It’s as if people feel that addicted people deserve to die. Imagine if we looked at any other disease that way."

The 'sandwich generation' still supports its children while caring for its parents, which is playing a toll on its health

Cornell Cooperative Extension graphic

Kentucky Health News

America has Generation X, Generation Z and more, but it also has "the sandwich generation," adults between 40 and 59 who care for their aging parents and help support their own children. Most family caregiving falls to this generation, and most of the caregivers are women.

Historically, when people reached this age group, they became empty nesters. But the Pew Research Center "found 54% of parents in their 40s are caring for seniors while also financially supporting their adult children," says a study report from the Seniorly Resource Center.

"The sandwich generation is bound by a unique set of social and demographic forces that include a record number of aging seniors and financial challenges that have stunted the economic stability of their adult children," the report says. "As the prevalence of Alzheimer’s disease and other conditions linked to old age continue to rise, and the financial stability of young adults remains stunted, America’s ‘sandwich generation’ is seeing substantial declines in their own physical, mental, and financial health."

In Kentucky, 45.8% of caregivers have two chronic health conditions, 15.5% are mentally distressed, Alzheimer’s disease is expected to increase 14.7% by 2025 and 3% of homes are multigenerational, according to a news release about the study.

In a report titled "Valuing the Invaluable: 2023 Update," the American Association of Retired Persons found that there are 610,000 caregivers in Kentucky who provide 570 million care hours, at an estimated economic value of $8.6 million. 

The Alzheimer's Association says in Kentucky, 75,000 people 65 and older are living with the disease and 157,000 family caregivers bear the burden of caring for them, while providing 302 million hours of unpaid care.

The report offers tips to prevent caregiver burnout, such as creating a financial strategy, prioritizing self-care, delegating tasks, utilizing available resources, staying organized and communicating openly with family about challenges. 

The release added three suggestions:  

Respite care provides short-term stays for seniors to give primary caretakers a break. It is also a great way to try out senior living and some organizations provide respite grants to help offset the cost.

Assistive technology: Caregivers should use new technology. Grandpad is a user-friendly tablet with 24-hour live support; Lively is a waterproof watch that replaces emergency pendants like Life Alert; and caregiving apps such as Medisafe are designed to keep track of tasks.

Ask for help and be specific: Most people want to help their friends and family but don’t know how. If you are overwhelmed, it is critical to ask for help. Determine what needs to be done and assign people specific tasks.

The report also offered information on some support groups, including: 

• National Alliance for Caregiving: The NAC is a non-profit organization dedicated to supporting caregivers. You can visit their website at www.caregiving.org.
• Caregiver Action Network: CAN is an organization that provides education, support, and resources for family caregivers. They offer a helpline, support groups, and an online community. You can contact them at 1-855-227-3640 or visit www.caregiveraction.org.
• Eldercare Locator: This is a public service of the U.S. Administration on Aging. They can help connect you with local resources and support services for caregivers. You can contact them at 1-800-677-1116 or visit their website at www.eldercare.acl.gov.

Using data from the Alzheimer’s Association and federal agencies, Seniorly did state-by-state estimates of likelihood of increasing caregiver burnout. Kentucky was at about the national average.

Health-care workers are more likely than law-enforcement officers to have injuries and illnesses that keep them away from work

Axios graphic

Kentucky Health News

"Health-care workers are increasingly being assaulted or shot on the job, making hospitals and clinics among the most dangerous workplaces in America," report Tina Reed and Jason Millman of Axios. 

They report that health-care workforce violence was a problem long before the pandemic, and then pandemic stressors such as backlash against public health measures and inadequate staffing have made matters worse.

In fact, "Data shows American health-care workers now suffer more nonfatal injuries from workplace violence than workers in any other profession, including law enforcement," according to  The Associated Press. And all of this can result in disrupted patient care and "alarming levels of burnout among the pandemic-fatigued health care workforce." 

"It used to be people had a respect for what was done in hospitals and the people who worked in those hospitals. That's not there anymore," National Nurses United Vice President Cokie Giles told Axios. 

Axios reports that "about three in four nonfatal workplace violence injuries involved workers in health care and social work in 2020, the most recent year for which statistics are available. And, "the frequency of injuries from workplace violence in health care has risen almost every year since 2011, reaching 10.4 per 10,000 full-time workers in 2018, up 62% from 6.4 per 10,000 in 2011, per the Bureau of Labor Statistics." 

Reed and Millman cite several examples that suggest that this trend has continued throughout the pandemic, with an increasing number of assaults involving guns. 

They also note a recent survey of health-care workers from Premier and the federal Agency for Healthcare Research and Quality that found 40% of health-care workers experienced workplace violence in the last two years.

Axios notes that hospitals are stepping up their efforts to "identify security risks, training staff on violence prevention and calling in counselors to de-escalate tense situations" and are beginning to invest in technology to help detect guns entering the building. Further, The authors write, there are ongoing efforts in Congress and statehouses to make health-care settings safer.