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What Everyone Gets Wrong About ADHD — Transcript

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0:00So this is an ADHD assessment, okay? I'm
0:02going to take some notes. Then we're
0:03going to understand what is going on
0:05here and what to do about it.
0:06>> Uh 45 minutes late.
0:08>> Yeah, sorry. There was like a ton of
0:09traffic. I forgot it was today.
0:10>> That's okay. Let's review your answers
0:12to the questionnaire I sent over.
0:14>> Didn't do it.
0:14>> Mhm.
0:15>> [clears throat]
0:15>> Okay, let's just dive in then. Uh
0:16question one, where are your sunglasses?
0:19>> I don't know.
0:19>> And when was the last time you did know?
0:21>> 2017.
0:22>> Okay. Are you thirsty?
0:24>> Yes.
0:24>> Do you have water?
0:25>> Got it.
0:26>> Will you drink it?
0:27>> Nope.
0:27>> What was that noise?
0:28>> A reminder.
0:29>> For you to
0:30>> Wish my best friend a happy birthday.
0:31>> Today?
0:32>> Two months ago.
0:32>> And you
0:33>> Forgot.
0:33>> For the
0:34>> Seventh year in a row.
0:35>> And how many times have they forgotten
0:36yours?
0:37>> Zero.
0:37>> Which makes you feel like
0:38>> friend.
0:39>> Even though you're
0:40>> Friends are super important to me.
0:41>> And when was the last time you started a
0:42new hobby?
0:43>> This morning.
0:43>> Pottery or pizza making?
0:44>> Pottery.
0:45>> Say more.
0:46>> So that I can make custom plates on
0:47which to put my homemade pizza.
0:48>> And your pizza oven has been
0:50>> Outside.
0:50>> For
0:50>> Three years.
0:51>> Filled with
0:51>> Cobwebs.
0:52>> And you are
0:53>> Too afraid to clean it.
0:53>> Have you ever kept a plant alive?
0:55>> No.
0:55>> How many amazing ideas do you have on a
0:57given day?
0:57>> Uh between one and 300,000.
1:00>> And how many of them do you execute?
1:02>> Pass.
1:02>> And finally, if you were the star of an
1:03action movie where the fate of humanity
1:05hinged on your ability to send a thank
1:07you card, it would end with
1:09>> Perfect score.
1:09>> So what we're going to do is go through
1:12each of these things that they describe
1:14and talk about how they connect to ADHD,
1:17okay? So first thing is that he's late.
1:19So we know that ADHD has time blindness.
1:22Second thing is the questionnaire. Did
1:24you fill out the questionnaire? No, I
1:25forgot. This is executive function and
1:28or disorganization. The water thing I'm
1:31not quite sure about. Do you have water?
1:33Are you thirsty? I was kind of confused
1:35about that one. You forget to eat or
1:37drink. Okay, that's helpful.
1:38>> We can talk about that.
1:39>> Thank you, Chad.
1:40>> Bodily signals.
1:41>> Next thing is birthday. This is a big
1:43one, okay? So forgot birthday, set
1:45reminder, reminder is old. This is the
1:48other interesting thing, right? Like the
1:50reminder was from a while ago, but they
1:51still haven't turned it off. They
1:53forgotten for seven years. Friends are
1:55important to me, and this makes me feel
1:57bad. This one is really interesting.
1:59We're going to dig into this one some.
2:00So, adopting new hobbies, impulsivity,
2:03and then they have cobwebs, which is
2:05lack of follow-through, right? So,
2:06discipline, also executive function.
2:08Plant is dead. This I think is also
2:10impulsivity. This is kind of the same as
2:12number five. How many ideas do you have?
2:14Hyper association. And then the last
2:16thing is this thing where he says, "If
2:19you had to write a thank you card,
2:20otherwise humanity would die, what would
2:22happen?" And he's like, "Everyone would
2:23die." So, we're going to talk about high
2:25stakes and how high stakes impedes
2:28action. There was an interesting paper.
2:31We're going to talk about all these
2:31mechanisms, okay? We're going to speed
2:33run them. There was an interesting paper
2:35that came out maybe about a year and a
2:37half to two years ago that did an
2:38analysis of ADHD short-form content, I
2:43think specifically on TikTok, and found
2:45that something like 90% of it was like
2:48wrong in some way. So, there's a lot of
2:50bad information about ADHD on the
2:53internet. I actually think this one is
2:54pretty good because each of these things
2:56we can describe, we can characterize and
2:59describe in a particular way. The first
3:01problem with this is that when
3:03oftentimes when we see a piece of
3:05content like this, we're like, "Oh,
3:06yeah, this is me. I have ADHD. This is
3:08me." What I don't like about this is the
3:10finality of it, right? So, this is our
3:13experience, and when we hear that a
3:15million other people have our
3:17experience, what we don't hear is the
3:19million people who were able to change
3:21it, right? So, if you have an ADHD, if
3:23you have a 60-second clip about all the
3:25problems that ADHD causes, that will way
3:28outperform what actually works because
3:31that requires depth and nuance, right?
3:34This clip I think has something like
3:35800,000 views. There's no way that my
3:37reaction to it will get that, even
3:39though I too have clips in the 800,000
3:41million whatever multi-million views.
3:44And so, that's the challenge. So, let's
3:45start with time blindness. Clinical
3:48implications of perception of time and
3:49attention deficit hyperactivity
3:51disorder, a review. time perception in
3:53children with attention deficit
3:55disorder, why don't you go to bed on
3:56time, a daily diary study of the
3:58relationship between chronotype,
3:59self-control resources, and the
4:01phenomenon of bedtime procrastination.
4:03There's a lot of papers about this. So,
4:04I'm going to give you guys a quick
4:06overview of this stuff, okay? So, what
4:08causes time blindness in ADHD and how do
4:11we fix it? So, the first thing is we
4:13have an internal biological clock that
4:16measures how long things take. In people
4:19with ADHD, that basic capability is
4:22impaired, which frustrates the
4:24neurotypical people around us a lot
4:27because they're like, "I told you what
4:29time to be here. Why are you always
4:31late? How long does it take you? It
4:32takes you 45 minutes to get here. Why
4:34don't you just leave at 5:15 so you can
4:36be here by 6:00?" So, the reason this is
4:38so confusing for them is they will lay
4:40it out for you so easily, right? And
4:42that makes sense cognitively. The
4:44problem is that that theoretical thing
4:47does not translate to your frontal lobes
4:51to actually plan action. This is kind of
4:53like telling someone, "Okay, how do you
4:55not recognize a tree has branches and
4:58leaves and flowers? If the flowers are
5:00red, that means it's a rose. How do you
5:02not understand that this is a rose
5:03bush?" And it's because you're blind.
5:05Like, that's that middle step of, "Oh,
5:08this makes sense into my head," which
5:10neurotypical people have no idea that
5:13there is a process between make sense in
5:16my head, therefore I do it. That
5:19fundamental gap has to be translated by
5:22your brain. And time blindness is a good
5:24example of this. There's another really
5:26interesting thing about time blindness,
5:28which is that, you know how people with
5:29ADHD don't know how long something
5:32takes, right? So, it's hard to plan your
5:34day. Why is it hard to plan your day?
5:36Well, because I have 15 minutes of I
5:37have to fill out this application. How
5:39long will it take? Between 15 minutes
5:41and 15 hours. That's why it's hard to
5:43plan because you have no idea how long
5:44something will take. The other
5:45interesting reason why it's hard to plan
5:47for your day is because when you do a
5:49task, if you have no internal biological
5:52clock, your brain gets no data about how
5:56long that takes. Does that kind of make
5:57sense? When I sit down to do something,
5:59a neurotypical person is like, I sat
6:01down around this time. Oh, how long did
6:02that take? It'll take you about half an
6:03hour. How long were you in line at the
6:05DMV? I was in line for about half an
6:07hour. You have an internal biological
6:09clock that is measuring things. When it
6:10measures how long something it takes,
6:12subconsciously and without your
6:14knowledge, you can also plan because now
6:16your brain knows, oh, go to the DMV,
6:18that is a 30-minute errand. That is
6:20missing in ADHD. So, a big part of what
6:23we like teach in Dr. K's Guide to ADHD
6:25and Doing Stuff, About Doing Stuff, is
6:28what are the tools that you can use to
6:31overcome that. So, as a simple example,
6:33people with ADHD, their sensory input is
6:36very, very robust. So, if you see
6:38something, if you hear something, you
6:40get distracted, you start paying
6:41attention to it. What you see and what
6:43you hear sinks in, which is why the
6:45utilization of like an organized planner
6:47or something where you measure your time
6:50in some way. I like measure things. I'm
6:53working on, I started at this time on
6:55this day, and I worked for this many
6:57minutes. And I just happen to have what
6:59games I chose not to play, which was
7:01Monster Hunter Stories and Warhammer and
7:03Unicorn Overlord recently. So, literally
7:05externally measuring things, writing
7:08things down, will help your brain.
7:10Second thing, the questionnaire. Did you
7:12forget to do the questionnaire? So,
7:13neurotypical people can remember to do
7:16things. Now, remembering to do something
7:18is actually really strange if you think
7:20about it. This is one of the weirdest
7:21things in the brain is remembering
7:23things. I'll give you all an example.
7:24I'm on my way home from work, and I'm
7:26about to take the exit off the highway
7:28to return to my home when I remember I
7:31need to pick up some milk. So, I'm like,
7:32oh, I was about to take the exit, I
7:34don't take the exit, I move one more
7:36exit down the highway, and then I go
7:37pick up the milk. I want you all to
7:39think about how weird that is. I forgot
7:41something, and then I remembered. Do I
7:43control the remembering? Absolutely not.
7:46My brain I forgot. My brain My brain
7:49remembers, and my brain floats up to the
7:51surface of my conscious thinking that I
7:53did I need to do this thing. So, a
7:55neurotypical person takes this for
7:57granted. The fact that you can remember
7:59is bizarre. To remember means that you
8:01forgot. And if you forgot, you don't
8:03control whether you remember or not,
8:05right? That is the experience of
8:06remembering. Oh, sometimes I remember,
8:09and sometimes I forget.
8:10>> Hey all, if you're interested in
8:11applying some of the principles that we
8:12share to actually create change in your
8:14life, check out Dr. K's Guide to Mental
8:16[music] Health. And so, we start by
8:17understanding what literally is
8:20meditation. How does experience shape us
8:22as human [music] beings? How do we
8:24strengthen the mind itself as an organ?
8:27And so, by understanding our mind, we
8:28understand a very, very simple tool, a
8:31crucial tool [music]
8:32that we have to learn how to use if we
8:34want to build the life that we want to.
8:36So, check out the link in the bio and
8:38start your journey today.
8:39>> So, what we know about people with ADHD
8:41is that their executive function and
8:43their inability to remember things makes
8:45it so that organization becomes really
8:48important, and particularly sensory
8:51input becomes really important. I will
8:53never remember where I put my keys. So,
8:58I always put them in the same place. I
9:00know where the keys belong, but I won't
9:04remember where they are, which brings us
9:07to another really interesting thing
9:08about ADHD, which is that a lot of the
9:10problems with ADHD, the reason we don't
9:12solve them is because we try to use a
9:14neurotypical strategy. And a
9:16neurotypical strategy won't work, right?
9:19So, if we're blind, we can't navigate
9:21with sight, we need a stick. But if you
9:24have a stick, you can manage. So, this
9:25is where like with ADHD, this is where
9:27you won't remember where you put it.
9:30That's why there must be one place where
9:32it goes. I love this phrase, don't put
9:35it down, put it away. Put it where it
9:37belongs. So, what I found working with
9:39patients, and this is going to be a big
9:40theme that we're going to focus on, is
9:42half the problems that you have are way
9:45easier to solve than you realize if you
9:48do them in a particular way. Now,
9:50building up the habit to do them in that
9:51way is not simple, but it's way easier.
9:54So, like a big problem with ADHD is
9:55preventing certain steps of this
9:58process, which is really where the
10:00problem lies. So, if I always put things
10:02where they belong, I will never lose
10:04them. Right? Which a neurotypical person
10:06can afford to be lazy, we cannot. And if
10:09you really think about it, how hard is
10:11it to, in my case, you know, in our
10:13house we have a nice little key rack
10:15thing right by the door, and that's
10:17where the keys go. And what's
10:18infuriating to me is, since I lose my
10:20keys a lot, I always put my keys in the
10:22same place. My wife does not have ADHD,
10:25she does not put her keys where they
10:27belong all the time. However, so then
10:29what happens is she misplaces her copy
10:31of the key, and then she takes my copy
10:32of the key. And then I go to drive the
10:34car and I can't find my keys. Now she's
10:37lost two sets of keys because my keys
10:39are reliably in one spot, and her keys
10:41are who the hell knows where. So then I
10:43end up looking for keys anyway. And then
10:45what I have to do, and by the way, I
10:46This is really interesting. I'm curious
10:48about this. If you have ADHD, are you
10:50better at finding the things that your
10:52partner misplaces than what you
10:54misplace? I would bet money that the
10:56answer to that question is true yes for
10:58y'all, too. Now I figured out where to
11:00find the keys that she misplaces because
11:02there's a pattern or order to them.
11:04Whereas, when I misplace them, it's
11:05absolute chaos. Okay? So, this is where
11:08if you forget to do questionnaires, if
11:10you forget to do things, you need to
11:12create a system where you are prompted
11:14in a sensory way. So, like
11:16questionnaires or paperwork goes in a
11:18particular place that you check on a
11:20daily basis. You don't rely on, "Oh, do
11:23I need to do something? Do I not?" No,
11:24you just go there and mechanically you
11:25look through what you need to do. Right?
11:27So, a good example of this is when I'm
11:28using an electronic health record and
11:30and things like that. When I go to the
11:32office, the first thing that I do is I
11:33log into my EHR and I see what what what
11:36my tasks for the day are. What I do the
11:38the night before I go to bed is check my
11:40calendar, when I wake up in the morning,
11:41I check my calendar. And then it goes
11:43into the calendar and it goes out of the
11:44mind. We can talk about bodily signals.
11:46So, this happens a lot. This is kind of
11:48with like
11:49hyperfocus. So, often times with ADHD,
11:52we get so hyperfocused on something.
11:54This isn't just ADHD. This is going to
11:56be neurotypical people with video games,
11:57for example. When we get really
11:59hyperfocused on something, we will often
12:01times suppress our bodily signals. And
12:03then when we have a break of some kind,
12:05we realize, "Oh my god, I'm so thirsty."
12:08And so, often times the right move there
12:10is to once again structure the way that
12:13you consume food and the way that you,
12:15you know, drink water or whatever. So,
12:16this is where often times what I try to
12:18do is have lunch ready when I'm done
12:21streaming. This I have a lot of help
12:23with. Thankfully, somebody else
12:24basically takes care of this for me. But
12:26when I'm done, lunch is usually ready.
12:28And if it's not ready, then I'm going to
12:29eat like crap. Right? Cuz I'm so hungry.
12:31And the really strange thing about being
12:34really hungry, which is true people with
12:36ADHD, I think it's maybe more intense,
12:38but true of regular people as well,
12:39neurotypical people as well. When you
12:41are really hungry, you want unhealthy
12:43food way more than you want healthy
12:45food. But healthy food will satisfy you
12:49way more than it will if you're not
12:51starving. The food that you want, you
12:53want a hamburger so much, but you will
12:56be way more satisfied with a salad when
12:59you are starving. And when you are not
13:01starving, a salad will satisfy you less.
13:04A burger will be more enjoyable because
13:06it's fatty and it's delicious and it's
13:08got protein in there and it's got that
13:09umami and we're going to put that
13:11pickles and mayo and mustard or
13:12whatever. So, this is what's also really
13:14hard is often times when we're really
13:16hungry, right? Like we want to eat that
13:18really unhealthy thing, but you'll
13:19notice something interesting. If you
13:20want a cookie when you're starving and
13:22you eat a piece of fruit, you will love
13:24the fruit way more as well. So, usually
13:26when I work with people with ADHD or who
13:28are just trying to eat healthy, we try
13:30to lean into this principle. Next thing,
13:32this is one that I want to spend a
13:33little bit of time with, the birthday
13:35card, okay? This is a reminder to do a
13:37birthday card for my friend, okay? We
13:39talked about executive function, we
13:40talked about forgetting things, we've
13:42talked about sensory input. The biggest
13:43challenges in ADHD, in my opinion, are
13:46not the first level challenges, they're
13:48the challenges that we layer on top,
13:51okay? So, so this is how this goes. I
13:53forgot my birthday card. That is a
13:54problem in of itself, that could be
13:56fixed. Then our mind does something kind
13:58of interesting. I've forgotten 7 years
14:00in a row. So interesting that it
14:02remembers that. Have you guys ever
14:03noticed that? That my mind is really
14:05good. Oh, yeah, I may have forgotten
14:07where my keys are, but it's really good
14:09at keeping track of how many years I've
14:11forgotten this kind of thing. So, not
14:13only do I forget my friend's birthday
14:15card, now my mind is keeping track of it
14:17and it is making me feel worse because I
14:20am I have a very good resolution into
14:24how bad I'm doing. And then it does
14:26something even more interesting, which
14:28is it says, "Oh, do you care about your
14:30friends?" Yes, I value my friendship so
14:34much. And then it does something kind of
14:36interesting. I value my friendships a
14:38lot and I failed. And since I value my
14:41friendships a lot, I feel so much worse
14:44about myself. You guys see how that
14:46works? And it happens so quickly. Forgot
14:48a birthday card, forgot a birthday card
14:49for 7 years, but I care about my friends
14:51and they got me one. And so you kind of
14:53like beat yourself up very, very
14:55quickly. So, this is where there's also
14:58emotional reactivity in ADHD. There's an
15:01emotional dysregulation subtype, which
15:03some people are advocating to be its own
15:05classification. So, there's attention
15:07deficit disorder, there's attention
15:08deficit hyperactivity disorder, right?
15:10Those are two subtypes. Inattention
15:12predominant, hyperactivity predominant,
15:14or a mix of the two, the combo meal. And
15:16then they're like, "Okay, let's do
15:18emotional dysregulation subtype." If you
15:20really look at what this is, this is
15:22dysregulation of your emotions. And
15:24here's how this works. Every day when
15:26you get the reminder, you are reminded
15:28that you forgot the birthday card. That
15:30reminder that you forgot the birthday
15:32card activates the emotional circuits
15:34that give you guilt. And once my guilt
15:37emotional circuitry gets hyperactivated,
15:40right? Let's think about what's
15:40precisely happening here. I hear a
15:42reminder,
15:44guilt pops to 100. Literally, the action
15:46is an alarm went off on my phone.
15:48Response is guilt goes to 100. We're not
15:50even aware that it's guilt. Then what
15:51happens is when the guilt circuitry
15:53activates, it manifests as thoughts.
15:56It's been 7 years. You care about your
15:59friends. Look at you caring about your
16:01friends. How pathetic. You care about
16:03your friends and you've forgotten 7
16:05years in a row. It's like bludgeoning
16:07you with these thoughts. And then there
16:09is an identification with it. I am a bad
16:13friend. So, I love to cite this this
16:15paper. Really interesting. If you look
16:17at the comorbidity between people with
16:19ADHD and depression, 3% of people who
16:22are diagnosed with depression will grow
16:24up to have ADHD. 70% of people with ADHD
16:27will grow up to have depression. A
16:29Treating ADHD is not just about time
16:32blindness, suppression of bodily
16:33sensations, executive function deficit,
16:36emotional dysregulation. It is also
16:39about the consequences
16:41of living with those things. I'm an
16:44idiot. I'm unreliable. I'm this. I'm
16:46that. Right? We have the first layer of
16:49primary symptoms. And then we layer on
16:51top of that things that are harder to
16:53beat. And here's the tricky thing. If I
16:55start someone on stimulant medication,
16:57it only works on layer one. Doesn't
16:59really work on layer two. Works on layer
17:01two maybe a little bit because it
17:02regulates the amount of guilt that I
17:03feel. Reduces the activity of my my
17:06guilt circuit in the brain. But it
17:07doesn't change my sense of identity,
17:09which is why I really love, and this is
17:10what really confuses people,
17:12psychotherapy is equally effective to
17:14medication. Works the same. Effect size
17:16is the same. And when I when I work with
17:18patients with ADHD, I like to do
17:20psychotherapy with them as well because
17:21we have to do this identity component.
17:23You're not a bad friend. You're not a
17:24bad person. You have this problem. We're
17:26going to actually jump to this, high
17:29stakes. There's one thing that is very,
17:31very, very annoying about ADHD. Can
17:34happen in neurotypical typical people,
17:36too. So, if you look at motivation and
17:39action, as something called salience
17:42increases, salience is importance. As
17:44the importance of an action increases,
17:47your motivation increases with it,
17:49right? So, oh, it's not like, do I need
17:50to pick up milk? Uh, not that big of a
17:52deal. Oh my god, I've got a hot date
17:55tonight. I really got to pick up that
17:56bottle of wine on my way home. As
17:58something becomes more important to you,
18:01your motivation towards that thing will
18:03increase. It's why it's hard to get
18:04patients to take blood pressure
18:05medicine. Cuz if you take blood pressure
18:07medicine, you don't really feel a
18:08difference. You feel the side effects,
18:09but you don't feel the difference. It
18:11doesn't feel important. So, we really
18:12have to help people understand how
18:13important it is. Cuz high blood pressure
18:15usually doesn't have any symptoms unless
18:17it's catastrophically high. You can run
18:18it like 160 doing damage to your body
18:20for 20 years and not feel a thing. But
18:22I've noticed in my patients with ADHD
18:24that high stakes is paralyzing, not
18:28motivating. For most people, as the
18:29stakes increase, our motivation
18:32increases. ADHD, it seems to have the
18:34opposite effect. And even in
18:35neurotypical people, there comes a point
18:37where if the stakes elevate to a certain
18:39point, we become overwhelmed and we
18:41become paralyzed. Now, one of the
18:43mechanisms for this is when we have a
18:45sympathetic nervous system response, so
18:47when our body gets turned on, I don't
18:50mean like sexually, well, sexually, too,
18:52but so, when our body is facing stress,
18:55tiger in the jungle, I'm taking my final
18:57exam, my body's like, we need to be
18:59active. So, adrenaline increases,
19:01cortisol increases. And when our
19:03sympathetic nervous system activates,
19:05uh, fight or flight is what we think
19:07about with the sympathetic nervous
19:08system. There's a third element, which
19:09is freeze. Fight, flight, or freeze. So,
19:12what we know is that, you know, when a
19:13when an animal is being hunted, it'll
19:16run away, it'll fight, or it'll play
19:18dead. And so, there's a a point where
19:20even like with trauma, right? Like
19:22there's a moment where we try to run,
19:24but then we freeze. When I work with
19:26patients who have been sexually
19:27assaulted, they will sometimes resist,
19:29they'll sometimes fight back, but
19:31sometimes what they'll do is dissociate
19:32and lock down and freeze. And that lock
19:34down is triggered by a high level of
19:37sympathetic activity. We feel
19:38overwhelmed, stuck, frozen. This seems
19:41to happen more often in patients with
19:43ADHD. And the reason for that is,
19:45remember there's a emotional
19:46dysregulation subtype, right? So,
19:48emotions skyrocket, and when emotions
19:51are very, very, very high, that is what
19:53can trigger the freeze response. I'm
19:55going to throw down with you when I'm
19:57not mildly angry, when I'm absolutely
20:00pissed. Oh my god, I'm so angry. Er.
20:02I'm not going to dead ass run away if
20:04I'm like a little bit anxious. The more
20:06fearful I am, I'm terrified, I'm just
20:09going to run. I'm going to stop
20:10thinking, I'm going to run. And when I
20:11feel overwhelmed, I'm going to lock
20:12down. This is what makes it so hard for
20:15my patients is because the more
20:16important things are, the harder it is
20:20for them to actually act. So, when they
20:22want to act the most, it becomes the
20:24hardest to act, right? So, this is it's
20:26it's such a beautiful example because
20:27he's like, "Can you write a thank you
20:29card if it's not that big of a deal?"
20:31Yes. If the fate of humanity depends on
20:33it, that pressure activates us
20:35emotionally. I don't know if it
20:36activates really that dissociation
20:38mechanism, that's a different mechanism
20:39in the brain, but it really causes us to
20:41shut down, for sure. To feel locked
20:44down, to feel paralyzed. I'd say lock
20:46down is a better subjective description
20:48from the patients that I've worked with,
20:50right? They feel like they're stuck,
20:51they're paralyzed. They're like they
20:52can't do it, okay? And so, then what
20:54happens is this aspect of high stakes,
20:57how important are friendships to you?
20:59The more important they are, the more
21:01that stakes increase, the more that you
21:03lock down, which then makes you feel
21:05even worse and leads to low self-esteem,
21:07leads to low things like depression,
21:09okay? So, this is what's really scary
21:11about it. Now, this is where there's an
21:13element of work that oftentimes people
21:15with ADHD miss, which is like, how do I
21:18deal with this? Actually, the way to
21:19deal with this is to deal with the
21:21association, right? There's a chain,
21:23forgot card, forgot 7 years,
21:26relationships are important, I am bad.
21:30And so, people will come in and they
21:31say, "How do I have self-esteem, Dr. K?"
21:34And they try to work on this problem,
21:36confidence, in isolation. Whereas,
21:38actually what we need to do is this is
21:40caused by this, this is caused by this,
21:42and this is caused by this. If we can
21:43break the chain, this melts on its own.
21:46So, notice the associations, notice the
21:49way that your mind jumps from one thing
21:51to another thing to another thing. And
21:52you will say, "But, Dr. K, all of those
21:54things are true." I'm not saying they're
21:55not true. What I'm saying is that as you
21:57lose attentional control of your mind,
22:01this is why mindfulness and meditation
22:03helps so much in ADHD. Because I want
22:05y'all to think about what is really
22:07happening in this scenario. The event is
22:10an alarm goes off, and the result is I
22:13am bad. I'm not disputing the logic of
22:15any of these. What I'm encouraging y'all
22:17to notice is just see how when an alarm
22:20goes off, I feel like crap. Like, what?
22:23It's this daisy chain, this is where we
22:24have to stop the attentional We have to
22:26shift our attention away from this
22:28process, restrain the mind. And then
22:30when we restrain the mind, direct the
22:32mind, make a card. Then, get excited
22:35about it, make six more. Then, mail one
22:39overnight. Just go to the post office.
22:41But instead, we do this. We do this
22:43every day when the alarm goes off,
22:44instead of actually fixing the problem.
22:46And this is like, this is what's so cool
22:48about working with situations like this.
22:50All of these things can get better. Now,
22:52this too is something that I think is
22:53really important. Let's talk about
22:54number five, new hobbies. I love this
22:57example, pottery or pizza. Pottery so I
22:59can make a plate for my homemade pizza.
23:01So good. So, new hobbies. We're
23:03impulsive. There's a lot of excitement.
23:06Oh, I want to do this. I want to do
23:07this. It would be so cool if we did
23:08this. So cool if we did this. But, then
23:09we have a problem with follow-through.
23:11So, one of the biggest things that I I
23:12try to help people do is what people
23:15will come to me and they'll say, "How do
23:16I follow through? How do I follow
23:17through? How do I follow through? How do
23:19I develop discipline?" That's not what
23:21you need to do. The circuit in your
23:23brain that acts impulsively turns on and
23:26then turns off. When it's on, you're
23:28motivated. When it's off, you're
23:30demotivated. So, order pizza oven
23:32cobwebs for 3 years. Really good, right?
23:34That's the scenario. So, actually what
23:36we need to control is not the discipline
23:39to follow through. What we need to
23:41control is starting in the first place.
23:43If we start to separate action from
23:46impulsivity. If we act impulsively and
23:49impulsiveness is what gets us to act.
23:52And then when the impulsiveness goes
23:53away, we won't follow through. The
23:54secret to follow through is not aha.
23:57Aha. The secret to follow through is to
23:59not start.
24:03You cannot quit or abandon if you never
24:06start.
24:07>> [laughter]
24:08>> Look at the wisdom. But, literally. So,
24:10here's the cool thing, okay? This is
24:12going to be some weird neuroscience, but
24:14I'm like it's it's legit, y'all. Action
24:17is motivated by all kinds of things.
24:19Nucleus accumbens. This is dopamine,
24:21emotions, impulsivity, okay? So, like
24:24all of these things can result in
24:25action. So, when I restrain my
24:29impulsivity, this is my frontal lobe
24:31blocking this and preventing that
24:34action. This is also the same part of my
24:37brain that gives me discipline. That
24:39gives me follow-through. The ability to
24:40plan and execute tasks over a long
24:44period of time is done by the frontal
24:46lobes, okay? So, literally the same part
24:48of your brain that does follow-through
24:50is the same part of your brain that does
24:53not behave impulsively. That restrains
24:55your impulses. It's the same part of the
24:56brain. It is to act deliberately. Does
24:58that make sense? Act deliberately means
25:01act with follow-through. Deliberate, one
25:03after the other. It's the same circuit.
25:04Stopping the impulse is the
25:07follow-through, literally. Same circuit
25:09in the brain, same function. And the way
25:10that that works, another way to kind of
25:12understand is what I said earlier, which
25:14is to disassociate impulsivity from
25:17action. To be able to train yourself to
25:20act out of things that are not
25:22impulsive. But as long as you are acting
25:24out of impulsivity, that circuit will
25:26not grow, right? We are stopping one
25:28circuit, we are pruning some neurons,
25:31and we're strengthening other synaptic
25:33connections. So this one is huge, right?
25:35And while I'm learning lots of things, I
25:38also have this scheduled on my calendar,
25:41right? So like I'm using organization to
25:43be able to do it all. Where you guys saw
25:45saw my excel excel spreadsheet with the
25:47various words that I wrote, the times
25:49that I wrote them. So I'm not just
25:50buying books on fiction, I'm actually
25:52writing. And I have a scheduled time
25:54that I go to an art class for 2 hours a
25:56week. And so if you schedule it, you'll
25:58do it. If you get prompted by it, you'll
26:00do it. If you have to show up, you will
26:01show up, right? You may show up late,
26:03unless you set a a timer and you know
26:05where your keys are. Do you all see what
26:06what I'm saying? Keys are in one place.
26:08I have my bag ready to go. I put
26:10everything in in in its place, and then
26:12I'm out the door on time. And I'm
26:13checking my calendar obsessively four
26:15times a day, okay? The impulsivity is
26:18also the the the ideas. How many ideas
26:21do you have? One to 300,000 a day. How
26:23many of them do you do? None. This is
26:25also impulsivity. Why do you do none of
26:27them? Because you're impulsive. If you
26:29are relying on your impulse, you'll
26:31start on a dozen and you'll finish none.
26:33If you disassociate impulsivity from
26:36action, if you start to act without
26:38impulse impulsiveness, and you restrain
26:41yourself from acting when you get
26:43excited. And I mean literally restrain
26:44yourself, like sit and like I'm not
26:46going to order this book on Amazon. I
26:48feel like ordering it, I'm not going to
26:50do it. And then another impulse will
26:52will come up. You check your calendar,
26:53you look at what you need to do next.
26:55It's amazing. A ADHD when I work with
26:58people, it feels like a set of dominoes.
27:00But the first one is like Stonehenge.
27:03But once one thing gets better, what's
27:05really scary about is scary about it is
27:06all of these deficits cascade. A
27:09snowball becomes an avalanche. And now
27:12suddenly I am a fundamentally bad person
27:16because each of these statements is
27:18logically true. But it is the process
27:20that my brain literally what happened
27:22today? My alarm went off. And then I
27:24feel like crap for the rest of the day.
27:26It can get better.
27:39>> [music]
27:52[music]

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