I take short, 10–20 minute, walks throughout the day. I never sit at my desk for more than 40 minutes at a time. I will get up, walk through the neighborhood for just 10–15 minutes, and then get back to work. I find that as long as I am disciplined and don’t get distracted, I get more done and enjoy it more if my “saw is sharpened.”
As a part of our series about Mental Health Champions helping to promote mental wellness, I had the pleasure to interview Dr. Walt Karniski.
Walt Karniski is a Developmental Pediatrician who trained at Boston Children’s Hospital and was Director of the Division of Developmental Pediatrics at the University of South Florida for 15 years before opening a private practice. His focus for the past 20 years has been children with ADHD, Autism, Anxiety, Learning Disabilities and other developmental difficulties. He has developed and operated three private schools for children with ADHD, Anxiety and Learning Disabilities and during the 40 years he has been practicing, has evaluated and treated close to 10,000 children. Dr. Karniski approaches each child as a unique individual, with distinctive strengths and weaknesses, where the diagnosis is not as important as understanding the specific needs of each child.
Thank you so much for doing this with us! Before we dig in, our readers would like to get to know you a bit. Can you tell us a bit about how you grew up?
I grew up in Prairie Village, Kansas, a suburb of Kansas City. My mother was very nurturing and my father had high expectations for my brother and me. One time I brought home a report card with all As and one B. He looked at the report card, then at me, and then said, “Are you proud of that B?” I feel that my mother kept us feeling secure and my father kept us motivated so that we could achieve “Our Big Plans.”
You are currently leading a social impact organization that is helping to promote mental wellness. Can you tell us a bit about what you or your organization are trying to address?
The Florida Children’ s Center grew out of a concern that children with learning problems, with ADHD or anxiety or autism, often see multiple therapists and providers who work independently. We knew that we could provide more productive intervention if the therapists were working collaboratively. The Florida Children’s Center initially was my developmental pediatrics practice. However, a year after opening the practice, we acquired a small school that was teaching children with learning disabilities. In addition, we added a group of 15 speech and language therapists and since their interest was autism and related disorders, this partnership expanded the population to children on the autistic spectrum, as well. Finally, we added two psychologists, one of whom conducted parenting classes and the other who ran social skills groups and counseling services. When we decided to add a tutoring program, we realized we needed more space. We built a brand new and much larger campus for Tampa Day School, and moved all of these services, including my medical practice, into the school building. Children who need therapy will often see a therapist once or twice a week, for an hour at a time. Now, instead of a child getting speech and language services a few hours a week, the speech and language therapist works closely with the teacher to provide those same therapies in the classroom, six hours a day, 5 days a week. Now it is possible to offer truly integrated therapy for children with ADHD, learning disabilities, anxiety, and autism.
Can you tell us the backstory about what inspired you to originally feel passionate about this cause?
My fellowship training in Developmental Pediatrics was obtained at Boston Children’s Hospital, affiliated with Harvard Medical School. All of the outpatient services were delivered in an 11-story building filled with the most expert, passionate and caring health care providers. Developmental Pediatrics was on the 6th floor, neurology on the 7th floor, speech and language therapy and audiology on the 8th, physical therapy on the 9th, and social work on the 10th. We used to joke that when a family got on the elevator and the child pushed a random button, the diagnosis was dependent upon which floor they entered. I realized that each child with developmental or educational or behavioral concerns should first be evaluated by a team of clinicians and therapists and that team should develop a comprehensive treatment plan that is made clear to the parents.
Many of us have ideas, dreams, and passions, but never manifest them. They don’t get up and just do it. But you did. Was there an “Aha Moment” that made you decide that you were actually going to step up and do it? What was that final trigger?
There was no single “Aha Moment” for me. I started my medical practice with a list of clinicians and therapists to whom I intended to refer my patients for specialized treatment. Three months after starting my practice, I was in the process of setting up some of the programs that would be available for my patients when I received a call from Joan Schabacker, the developer and owner of Tampa Day School, a small, specialized school of about 30 students. She was retiring and wanted to know if I knew anyone who might be interested in purchasing the school from her. I thought for a while, then said, “No, Joan, I don’t know anyone who might be interested, but I will keep my ears open.” Then I said goodbye and put the phone down. As I turned to begin responding to other phone calls, it suddenly occurred to me that my medical evaluation was important, but a school was a much more logical place to act as the center of both a diagnostic and treatment program for children with learning and behavioral difficulties. Three months later, we purchased the school (in 1997) and three years later, built a new building. The school has now grown to over 160 children.
Can you share the most interesting story that happened to you since you began leading your company or organization?
A number of years ago, I met Danny for the first time. His mother sat in front of my desk, with Danny to her right. He was not at all interested in our conversation, but he was in a good mood and smiled occasionally. While his mother was talking, he was fidgeting, looking out the window, moving around in his seat, and occasionally interrupting.
When I asked her what was her biggest concern, she responded, “Well, Danny is highly intelligent, but he has a tough time staying focused and quiet in school. As a result, he has a difficult time learning. He is very scattered.”
So, I began asking my usual questions. When did this start, how is he doing in school, how are his grades, how does he get along with other kids? She tried to answer each question, but she was clearly getting frustrated. I could hear a quiver in her voice, and I thought she was going to start crying. But then she stopped talking, reached into the bag sitting on the chair next to her, and pulled out a brightly-colored, very ragged spiral notebook and handed it to me.
“Danny’s teacher uses this calendar notebook to communicate with her students’ parents. Each day the teacher will write a short note about how Danny did that day. I then can write a response or a question, and this notebook goes back and forth each day, from home to the school and back again.”
I told her that I could not read the whole notebook at this time, but I would like to glance through the notebook now, and I would review it in more depth later. I then opened the notebook and began reading.
By the time I got to the third page, I began to feel tears in my eyes. I already knew what was in the rest of the notebook, and I knew that I could not read any further without breaking into tears. I was so used to treating children with learning and behavioral problems like a detective, objectively analyzing the facts, that I had forgotten what it felt like to the child and his or her parents. Suddenly, reading this notebook, I could tell exactly how Danny and his mother must feel.
So, if someone asks me, “What is ADHD?,” I can answer by showing them a list of hyperactive, impulsive and attention behaviors. The American Psychiatric Association indicates that the diagnosis of ADHD can be made by identifying six of nine behaviors in each category. Or I could show them Danny’s notebook. That notebook served as a reminder to me of what is important in conducting an evaluation of each child, and it has also served as the focus of a book that I just completed, ADHD Medication: Does It Work and Is It Safe? Many of the pages from Danny’s notebook are reproduced in that book, and they clarify and magnify the importance of listening closely to the child, the parents and the teacher
None of us can be successful without some help along the way. Did you have mentors or cheerleaders who helped you to succeed? Can you tell us a story about their influence?
My wife, Teresa Burgess has had the greatest impact on my professional career. She is a speech and language therapist, a teacher, a mother, and the director of Bowman Academy, a preschool that we have owned and operated together for 23 years. I consult with her at least 10 times a day, sometimes over minor details, sometimes over major decisions that will affect one of the school programs for years to come. She has read and re-read the book that I just completed (ADHD Medication: Does It Work and Is It Safe?) at least 4 times and her input is embedded in every page. When I feel stuck and unable to make a decision, I tend to be very restless in my sleep and will often move around or thrash about. She is always there to calm me back to sleep. Some people might feel that they want to keep their work life out of their personal life, but we have learned that they are not easily separated. We rarely argue and she always has a smile or a hug ready when it is most needed.
According to Mental Health America’s report, over 44 million Americans have a mental health condition. Yet there’s still a stigma about mental illness. Can you share a few reasons you think this is so?
The most frequent mental health disorder that I work with is Attention Deficit Hyperactivity Disorder. It occurs in 7% of children. Yet most people have concerns that ADHD is over diagnosed. A few years ago, I visited my dermatologist for my annual check-up. He was not in the office that day, so I saw another dermatologist in the same practice. She came into the exam room, introduced herself, and then began to look at my chart.
“Oh, I see here that you are a physician. What kind of medicine do you practice?”
“I’m a developmental pediatrician. I see children with ADHD, autism, cerebral palsy, learning disabilities, that kind of thing.”
“ADHD, huh? That’s kind of over diagnosed, isn’t it?”
I hesitated for a second, then said, “Uh, let me answer that question by asking you a question. What is the prevalence of skin cancer in people over the age of sixty?”
“Well, about 40 percent of people over the age of sixty will get skin cancer at some point.”
“Oh, that’s really high. Skin cancer must be over diagnosed then, isn’t it?”
“No, those are accurate numbers. The rate of occurrence is high because people don’t take care of their skin. They go out to the beach without sunscreen, don’t moisturize their skin….“Oh, wait a minute, I see what you are trying to do.”
No one questions the physical and medical basis of leukemia, a stroke or a heart attack. In each case, we have medical tests that clearly identify the physical abnormalities. But for ADHD and other mental health diagnoses, such as depression, anxiety and post-traumatic stress disorder, there are no such tests. For ADHD, every one of the behaviors occurs in every person, at one time or another (trouble paying attention, fidgets, forgets things). It is only when these behaviors interfere with a child’s ability to learn or to develop strong social relations that it is necessary to intervene
We do know that ADHD occurs at the level of the neuron, and that the neurons in three different parts of the brain have a chemical imbalance that produces the “symptoms” of ADHD. Unfortunately, we do not have tests yet that will identify those dysfunctional areas of the brain. Hopefully, in the near future, we will find the test that clearly identifies the mental health diagnosis and attempts to “blame the victim” will hopefully disappear.
In your experience, what should a) individuals b) society, and c) the government do to better support people suffering from mental illness?
The United States has a very cruel approach to people with mental health concerns. If someone is having a hard time finding a job, they are accused of being lazy. If someone is anxious, we tell them to “Relax. It will be OK.” If someone is depressed and unmotivated, we tell them to “Get over it and pull yourself up by your bootsraps.” We blame those who are unfortunate to have a physical disease. We arrest them instead of helping them. We criticize them for being angry or unsocial, with no attempt to understand the medical and physical basis of their difficulties. Portugal and Norway have decriminalized the same drugs for which the United States drops people in jail. In both those countries, money that was spent to imprison drug offenders has been diverted to treatment facilities. And the prevalence of substance abuse has since declined dramatically in both countries.
We are supposed to be a compassionate country, yet we fail our most vulnerable.
What are your 5 strategies you use to promote your own wellbeing and mental wellness? Can you please give a story or example for each?
For the most part, I just don’t have or I am not aware of such strategies.
I take short, 10–20 minute, walks throughout the day. I never sit at my desk for more than 40 minutes at a time. I will get up, walk through the neighborhood for just 10–15 minutes, and then get back to work. I find that as long as I am disciplined and don’t get distracted, I get more done and enjoy it more if my “saw is sharpened.”
Two lumberjacks were the finalists in a tree cutting competition. One of the lumberjacks would persist at the back and forth movements without stopping, without interruption, working up a major sweat. The other lumberjack would saw for 20 minutes, then go off into the woods for 5 minutes and return to resume sawing. The second lumberjack finished before the first and took first prize. Later the losing lumberjack asked him, “How did you beat me? I am bigger and stronger than you, and I never stopped. You took frequent breaks. How did you beat me?
“Every once in a while, it helps if I sharpen my saw.”
Another thing that promotes my own wellbeing and mental wellness is that because ADHD medication works almost immediately, I see people’s behavior and self-esteem improve almost as quickly. This rapid and dramatic improvement is highly rewarding and keeps me motivated throughout the day.
What are your favorite books, podcasts, or resources that inspire you to be a mental health champion?
My patients inspire me. Too many people have told them that they are lazy or spacey or angry. Would you blame someone for developing leukemia? My patients inspire me.
If you could tell other people one thing about why they should consider making a positive impact on our environment or society, like you, what would you tell them?
From my sophomore year in college, until I was over 40, I kept a journal, a diary. It contained trivial information about my day, about people that I don’t even remember now. But every once in a while, I would write about my goals and my dreams. And I would begin to map out a strategy for obtaining those goals. But I would frequently make a comment, such as “I wonder how I will feel about this 50 years from now?” Now, 50 years later, I decided to read what I had written when I was in my 20s and 30s. I read the journal, cover to cover, almost like a novel. However, the re-reading served as an answer to the question, “So, how did I do?” It turns out that there are many things that I have done in my life that I am very proud of. I have also made some mistakes. But when I am lying on the proverbial deathbed, I want to be able to say, “I made a difference”
Of course, there are religious and moral and ethical reasons why we should do well beyond our own interests and consider our obligations to the rest of our society. Some people give their lives for others, either in war or in a selfless act that surrenders one person’s life to protect another.
In 2017, the New York Times published an article about Pope Francis’ feelings about giving money to a panhandler. “But what if someone uses the money for, say, a glass of wine? The Pope’s answer: If “a glass of wine is the only happiness he has in life, that’s O.K. Instead, ask yourself, what do you do on the sly? What ‘happiness’ do you seek in secret?” Another way to look at it, he said, is to recognize how you are the “luckier” one, with a home, a spouse and children, and then ask why your responsibility to help should be pushed onto someone else.
Then he posed a greater challenge. He said the way of giving is as important as the gift. You should not simply drop a bill into a cup and walk away. You must stop, look the person in the eyes, and touch his or her hands.
The reason is to preserve dignity, to see another person not as a pathology or a social condition, but as a human, with a life whose value is equal to your own.”
How can our readers follow you online?
https://adhdmedicationbook.com/
This was very meaningful, thank you so much. We wish you only continued success on your great work!
Mental Health Champions: Why & How Walt Karniski Is Helping To Champion Mental Wellness was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.