Isabelle & David welcome Isabelle’s husband, Bobby, and their friends, Christina, AJ, and Gabe, to continue to listen and learn from David’s tried and tested presentation on ADHD, which he normally gives to fellow clinicians (for the first, second, and third parts of this talk, please see episode 4, All About ADHD Part I; episode 6, All About ADHD Part II; episode 9, All About ADHD Part III). David describes how deep self esteem injuries go for folx with ADHD. That and a lack of response cost (see definition below) and how frequently you fail—means that folx with ADHD will jump on a grenade to save someone they care about. There is a sacrifice aspect — “It’s my fault.” Self esteem is so injured that people don’t even realize it’s injured: you think you’re wrong asking for an accommodation, regardless-it’s your fault. One example is when Isabelle was on a conference call where she couldn’t hear what anybody else was saying, she didn’t speak up the whole time, thinking it was her fault. But if a friend were to say “hey, I’m having trouble hearing you,” she would stand up for them in that meeting, no problem. As soon as people find an accommodation or medication or something that helps them: they feel like they’re cheating (“I should be able to do this without that thing!”). David judged himself for needing medication to read a book, but he also wears glasses to see—yet he judges the accommodations only he needs for ADHD, rather than the accommodations everyone (neurotypical and not) uses. ADHD best marked by an increase in stimulation, using emotions like anger, excitement, sexual arousal, and fear-the emotions you will use to stimulate yourself in the absence of medication. When people ruminate at night after not using up your energy, its stimulating with emotions. These are neurological habits, they are hard to notice and even harder to interrupt without finding something else to stimulate yourself with. So, make your externals go as fast as your internals: fueled up by anger, go for a run, go move. Therapy will often be biased toward calming, cleansing breaths, grounding activities, etc. David talks about Wim Hof breathing techniques (or other energizing breathing techniques-see below for more). Another intervention is jumping up and down and allowing your feet to land hard on the ground (which creates joint compression). What does it feel like to not fit in and not be normalized by your peers: either you have to make choices to fit in or stick with who you are and be ostracized, which happens to a lot of folx with ADHD. There is a +/- 3-5 year maturation delay with ADHD—which means a ten year old can act like a 13 year old or a 7 year old, depending on the environment they’re in. The big way this impacts self esteem. People with ADHD can take more hits than most people, but feel the hits differently than most people, and that doesn’t get validated. Could be as an accommodation you need a lot of structure—but also not. Folx with ADHD can do well in school, but then flounder when the structure/accomodations change and they hit big life transitions (like leaving school, starting work, starting major relationships/coupling up, starting a family). Adult onset ADHD does not happen: it’s about how your environment has changed and your accommodations have changed. It’s not just major life transitions, it’s all transitions, that are hard and handled differently. Don’t know what to do, forget things, get angry/anxious/self-stimulate (same with getting married, having kids, etc.). Things get lost in transition. The second you don’t remember that, is the second you blame yourself for it (instead of realizing that without structure, transitions are hard). How do you want to restructure your life: that’s the accommodation. It’s not just typical therapy; “that sounds awful,” it’s “that sounds awful, what are you going to do with your time?” Some people with ADHD will avoid transitions because the entire time you are transition can make you uncomfortable. If you’re on time, if you’re not running late, if you have all your stuff, etc. it will be more uncomfortable (absent structure because you haven’t gotten your needed dopamine to manage all that change). Typical scenario: one parent with ADHD screaming the whole way getting the whole family out of the house and then you get to the place and suddenly all is well. As Bobby mentions, when he does set up a structure, and it works, it sets up a win/lose condition so that when he does it well without the stress, he feels like he’s winning. The parent (or person) is screaming: they’re the ones who need the accommodation. If you outsource the structure (another cue, another person, a written note, something). It’s not a control issue: it feels good to set up a win/lose. People with ADHD will think they’re are “controlling” but actually it’s giving yourself something to do, which helps, and creates structure. Giving yourself something to do helps. 

Wim Hof: Also known as the Ice Man, developed a breathing method to endure cold temperatures and holding his breath a long time. It’s a breathing method that can help you stimulate yourself and ground yourself using a cold shower, for example. 

+/- 3-5 year maturation delay: While data suggests there is a delay in development for those with ADHD, clinically I see this as a plus or minus in maturity. Some places people will have more maturity in some places than other places. Maturity is not a fixed number or age. It's dependent on behavior in context.  "In children with ADHD, the brain matures in a normal pattern but is delayed by three years in some regions, when compared to children without the disorder," said the study's lead investigator, Dr. Philip Shaw, a child psychiatrist at the National Institute of Mental Health.Feb 27, 2008

Four emotions we self-stimulate with (in the absence of medication): Arousal, Excitement, Anxiety, and Anger. To tell someone to calm down doesn’t help—because you still need the stimulation. 

-----

Cover Art by: Sol Vázquez

Technical Support by: Bobby Richards