ADHD, Trauma, and Developmental Healing

ADHD, Trauma, and Developmental Healing. Jonathan Murphy, PMHNP-BC, tells the origin story of Developmental Reinforcement Theory and the survival modalities, tracing the clinical, personal, and intellectual journey from failed behavioral instruction to the framework that now anchors the Focus Path YouTube channel.

This episode covers:

• Ten years specializing in adult ADHD treatment and what the work turned out to be versus what was expected
• The behavioral instruction approach from the first book Cheat Codes and why teaching habit formation worked for the author but failed with many patients
• The personal habit formation story: athletic transformation from age 35, guitar, personal finances, writing, YouTube channel
• The structural emptiness of the ADHD diagnostic criteria as transition, forgetfulness, losing things, sustaining attention, initiating tasks, without specifying content
• Why building a tribal identity around a structural pattern produces a loose, amorphous conglomeration of people that share the pattern but share nothing else
• The silent majority of adults with ADHD who are doing the individual treatment work without participating in the online identity space
• The realization triggered when the author's daughter reached an age that activated memories
• The encounter with complex PTSD as a framework that explained what behavioral instruction couldn't reach
• The bio change that added trauma to the practice description and the immediate shift in clinical presentations
• The defense mechanisms emerging more visibly than attachment theory predicted
• The intellectual lineage informing the framework: Skinner, CBT, attachment theory, Gustave Le Bon on group psychology, Edward Bernays and Walter Lippmann on media and propaganda, internal family systems, Body Keeps the Score
• The flip phone decision and the underlying dopamine-loop research
• The 2024 burnout point and the delegation that opened up writing time
• AI as analyzer rather than creator: talk-to-text brain dumps, ChatGPT then Claude, the mirroring back of accumulated material
• The development of the screener through four axes, refined to six, that identified specific pathologies and produced the eight survival modalities
• The 70-75% comorbidity observation: most adult ADHD patients appear to have some form of complex PTSD
• The universal applicability of Developmental Reinforcement Theory beyond ADHD because the framework is about survival adaptation patterns that everyone has

This is the ninth episode of Actually ADHD. The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4T

Find the YouTube channel Focus Path | PMHNP-BC for the full Survival Modality season one catalog and the Developmental Reinforcement Theory framework.

For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

What is Actually ADHD | Medication Strategies & Clinical Wisdom?

Adult ADHD from the board-certified PMHNP behind the YouTube channel Focus Path and the book The Process. Clinical perspective on medication, frameworks, and the conversations the internet hasn't been having.

This is Actually ADHD.

I'm your host, Jonathan Murphy,
psychiatric nurse practitioner.

I've been treating adults
with ADHD for 10 years.

When I started in this work, it wasn't
what I thought it would be I've talked

about that before, but I wanted to talk
about something differently this time.

after I had a realization about my
own ADHD and diving deep into the

behavioralism, which is the strategies
that you use, essentially therapy,

behavior therapy, to implement change.

And with the medication,
the game has changed.

So I really went in deep on this, and yes,
I hacked my ADHD brain, as I've talked

about in my first book, " Cheat Codes: How
I Hacked My ADHD Brain and You Can Too".

And that book was really informed by this
long history I had of trying to teach what

helped me to other patients with ADHD.

I have to say, I fell flat on my face

And the thing right
away that I noticed was

Not everyone could handle
taking this advice.

Some people would just brush it off.

Other people would shut down.

That was a noticeable thing
And I learned quickly that

It's very boring to talk
about ADHD behavior training.

So to change one's habits
is a basic process.

To train yourself to do anything,
like I talk about on the Focus

Path YouTube channel, the process
of habit formation, it works.

I know it works because I was
uncoordinated up until 35, and now

I'm athletic which is the biggest
transformation that I can experience,

which was physical transformation,
being the uncoordinated kid.

And that's the biggest game change for
your ADHD brain if you don't exercise.

Though many people with ADHD do exercise
because it's a source of stimulation.

But I also did a bunch of other
stuff, like learned how to play

the guitar, a lifelong goal of mine

Got my personal finances together, wrote a
book, and the list goes on and on and on,

and then eventually the YouTube channel

And my big thing was, and why it
clicked with me, was like, "Oh,

I'm not so stupid after all.

It had nothing to do with me.

This had nothing to do with me why
I d- I didn't know these things."

There's a million reasons why.

I get it now.

You have to understand the systems.

You have to understand
what we're set up for.

Why don't they teach this in school?

They teach you with it in school.

They don't teach you about it in school.

But suffice to say, it doesn't
matter, and I even found not

everybody needed to do this with ADHD.

When your ADHD is treated,
you don't necessarily need to

build a bunch of habits, but

… I needed to do that because I
had that inferiority complex.

Even though I was a nurse practitioner,
I felt bad about myself 'cause I couldn't

remain consistent in things that I wanted
to, People don't need to learn habits.

Some people just need to show up and
communicate or just, you know, like

be able to manage impulse control.

I mean, there's a variety
of different things.

There's no, there's no
path that's the same.

It's the only sameness is ADHD and
then you treat the symptoms and then

that life comes in But I started
thinking because I was very stuck in

this idea of ADHD because I was like,
"Oh man, ADHD is most soulless thing."

It's the boring stuff about life.

It's not the interesting stuff.

It's your executive function, how you
transition from one thing to the next.

Not what you're transitioning to
and from, just the transition.

Forgetfulness, not what you're
forgetting just the fact that

you're forgetting something.

Could be anything.

Losing things, not what you're losing,
just the fact that you lost it.

Difficulty sustaining attention,
not what you're having difficulty

sustaining attention on, but
just the fact that you're having

difficulty sustaining attention.

Difficulty initiating tasks, not
what tasks you're initiating,

just the fact that you're having
difficulty initiating them.

And you get where I'm going with this.

It's soulless.

And yet there's a whole identity
on the internet built around it.

You couldn't have, probably at the end
of the day, a more loose, amorphous

conglomeration of people that are
grouped together for a single purpose.

It's a little absurd and hilarious
and ironic all at the same time.

But nonetheless, this…

there is some sameness.

The fact…

Those struggles are all real struggles.

But where someone's life goes
after they get their brain online,

that's where it's different.

Nonetheless, people with ADHD, they
do probably, um, need to develop some

skills that they haven't, and there's
different levels of functioning.

You have people that have trouble
brushing their teeth to people that

are very high-functioning and have
already developed sophisticated systems.

So, you have to be able to capture a
wide net or cast a wide net, and that's

the needle I've been trying to thread
on the Focus Path YouTube channel.

And this is treatment that is actually
productive, not a complaining sort

of, um, woe is me tribal situation.

This is individual treatment, and
that individual treatment that is

gonna help someone, that individual
is whoever it is There's no one

size fits all even on belief system.

So again, it's a very misrepresented
silent majority of people.

So you are the silent majority,
whether you believe it or not.

And I know the silent majority exists
out there 'cause my patients tell me.

And As time goes on the first
child was hitting about two or

three, long story made short.

And I just suddenly realized once she got
to the age two or three, where I could

kind of have memories, I didn't have
memories of a baby, obviously, right?

But I have some memories that maybe
aren't great of age three or four.

And then it goes, "Oh,
whoa," like, that is insane.

It's like, I would
never do that to my kid.

So likely story, I suppose,
in this generation.

But I realized that I was traumatized, and
I learned about complex PTSD or CPTSD, and

that was a really interesting situation
'cause I went into work, I had already

been working in ADHD treatment for several
years, and I went through a huge sort

of personal transformation, um, my own
therapy, my own, um, Pandora's box opened,

and I was ripe for all this self-help,
self-help material that I'd never needed

or thought of needing, I just devoured.

And I go in to work on Monday, and
suddenly I just changed one word on

my online bio for my private practice,
added trauma to ADHD, and the exact

opposite happened right away with the
patients that I saw that I was trying

to teach the behavioral tools to.

Instead of those habit formation skills
that failed, I was seeing the connections

to, \ interpersonal stress and struggle
and difficult relationships and those ties

that bind among so many of my patients.

And that's when I started to see
the differences in the defense

mechanisms really come forward in a
way that was much bigger and louder,

let's say, than attachment theory.

So I've learned a lot on my
own, and I've enhanced that

learning through just reading.

The behavioralism, I
had to learn about B.F.

Skinner.

There's the stuff you learn
in school, which is great.

Uh, CBT is an important
tool, uh, in the…

to have in a toolbox to sort of navigate
the mind Attachment theory is solid.

But I also learned about the history
of advertising and marketing, was

very, uh, stuck in the dopamine loops,
and I didn't wanna be, especially

when I was trying to build habits.

So I got a flip phone, and part of that
was learning about the dopamine-activating

technology and the algorithms.

But that led me to Gustave Le Bon
and Edward Bernays and, uh, Lippmann,

And these, uh, thinkers and philosophers
that talk about media and spreading

information, so on and so forth.

And Gustave Le Bon, it's group
psychology, and it's , late 1800s,

and he's describing the psychology of
crowds, groups, and as I say, tribes.

And that's when it really hit me.

Wow, like you really need
to understand the group.

And this is, uh, also internal family
systems, or you could say family therapy.

But once we un- once we look at things
from that perspective, then suddenly

I was seeing something even deeper.

And I'd finally, at this point in
my career, 2024, was burning out

and I found ways to slowly delegate
because I'd always wanted to write.

My brain was full, I remember saying,
and I just dumped my brain out.

As soon as I had the time, I
no longer had to deal with the

friction of writing notes, and I
wrote as much as I could by hand.

But then I was like, "How
else am I gonna get all this

stuff out, this material out?"

'Cause I had to think about it.

And AI was brand new, and I hadn't really
thought to use it besides like just

playing around with the silliness of it.

But then I realized, whoa,
I can just put it all in AI.

And that's when I started using AI in
terms of talking to text, just talking.

I'm telling you like 20 pages of
talking and then upload it to,

I think, ChatGPT at the time.

I've long since been on Claude.

But that's when I had these mind-blowing
sort of revelations about what I

was learning because I was able
to have it mirrored back to me.

But to be clear, AI is terrible
as a creator, but it's very,

very good as an analyzer.

So to analyze your thoughts,
it can be very powerful.

And I developed my own modality, and
it's very been fascinating for me 'cause

I realized my nervous system changed so
much just when I developed boundaries

and I learned how to communicate.

And, um, certainly, you know, those
habits that I built, they gave me the

self-confidence to continue to heal.

But it wasn't until, um, a certain
point, you know, when I had this

sort of realization with my daughter
that I learned how to actually feel.

And I felt like, you know, a word that
I will not say I felt-- I realized,

like, how horrible I felt in it.

I never realized it before.

But by setting boundaries and, and
realizing and coming to, um Coming face

to face with the fact of my trauma and
the difficult people that I just so

unfortunately happened to be related
to, I did what I needed to do, and I set

those boundaries, and it took a while.

But, um, this was before
I did the, the brain dump.

So I'd already had, uh, this healing to
inform the observations because I knew

I felt one way and then I felt another.

So now having the calm, the neutrality,
I no longer was like needy and insecure

and vulnerable, so I was able to
see other people's vulnerability.

It-- But it was different.

Some people do this, some people do that.

And I really started to see how
people's distress can be tied to

other people and how people react
automatic, involuntarily, depending on,

uh, what they've been through and…

But the specific factors are relational,
what people do in response and reaction

to these groups that they're in.

' Cause I very much understood, , the
toxicity of what I had been around.

So those differences I
could really appreciate.

I developed a screener, and I
took all these different axes.

I used,, Body Keeps the Score, bottom up.

You get your personal individual
dimensions, your mind, what you think,

your body, what you feel, and your
emotions, what your emotions tell you,

and your body, what you physically feel.

But then you get the group, and you
got, like, what you experience and

feel in relation to other people.

And I was able to come up
with four different axes,

and I made this screener,
and it worked really well.

And then I broke it down and came up
with six, and I made the screener again,

and it worked crazy well, to the point
where I was able to identify specific

pathologies downstream from the screener,
which ultimately created the survival

modality, these eight survival modes.

Um, and on the Focus Path YouTube channel,
I broke it down all eight, 'cause I

started the channel, I didn't know if
that there would be interest in that.

Well, it turns out there was.

So I'm excited to be, uh, writing
and recording season two now.

But I want people to understand
the individual differences between

themselves and other people, understand,
how to trust what their body's

telling them, and what boundaries or
the path to healing means to them.

And that's the biggest piece of
the Focus Path YouTube channel.

It's all been leading up to
this developmental reinforcement

theory, which ultimately most of
my patients with ADHD are gonna

benefit from in some way or another.

' Cause I would argue 70 to 75% of
my patients with ADHD appear to

have some form of a complex PTSD.

So that's gonna do it for today.

But I wanted to bring up developmental
reinforcement theory because

it is a part of this channel.

It's a part of me as a
provider having ADHD.

So actually ADHD will include what
started out as a way to understand

how to teach ADHD behavioral skills.

But developmental reinforcement theory
applies to everybody, whether or not

you have ADHD , because it is about
survival, and everyone's done that.

So on that note, and until next
time This is actually ADHD.

My name is Jonathan Murphy,
psychiatric nurse practitioner.

I'll talk to you later