HealthyGamerGG - Obscure Symptoms you didn't know were ADHD ft. Dr.Micaela

Episode Date: September 15, 2025

Dr. K and Dr. Micaela dive into the side of ADHD most people don’t hear about. The everyday quirks, emotional struggles, and hidden habits that go far beyond “not paying attention.” They explore how ADHD shows up in piles of clutter (“doom piles”), impulse-driven conversations, and difficulty filtering what really matters. The discussion digs into: Why focus often collapses before big deadlines or events The link between ADHD and social anxiety, rejection sensitivity, and “ADHD guilt” How emotional regulation and chronic boredom fuel cycles of shame Why masking drains energy and damages relationships Practical coping strategies from timers and structured breaks to unmasking safely with trusted people This episode reframes ADHD as more than distraction—it’s about emotions, identity, and the way your brain interacts with the world. Dr. Micaela's ADHD Adulting Workshop: https://bit.ly/4mI2bGG HG Coaching : ⁠https://bit.ly/46bIkdo⁠ Dr. K's Guide to Mental Health: ⁠https://bit.ly/44z3Szt⁠ HG Memberships : ⁠https://bit.ly/3TNoMVf⁠ Products & Services : ⁠https://bit.ly/44kz7x0⁠ HealthyGamer.GG: ⁠https://bit.ly/3ZOopgQ⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

We heard you nine years of bring back the snack wrap and you've won. But maybe you should have asked for more. Say hello to the hot honey snack wrap. Now you've really won. Go to McDonald's and get it while you can. Jackson Hewitt handles your taxes and your stress. Inhale on no surprise price of 149 or less. Exhale.

Paying more for complicated taxes. You won't. Inhale, new tax law knowledge. Exhale. Missing out on your biggest refund? Certainly not. Don't miss paying 149 or less. Rest easy. Jackson Hewitt's culture taxes. Guaranteed. Limitory time offer for new clients on federal returns. Participating locations in the next terms at Jacksonu.com slash 149. Hey, chat. Welcome to the Healthy Gigi podcast. I'm Dr. Alokinoja, but you can call me Dr. K. I'm a psychiatrist gamer and co-founder of Healthy Gamer. On this podcast, we explore mental health and life in the digital age,

breaking down big ideas to help you better understand yourself and the world around you. So let's dive right in. Let's get started. Welcome to another Healthy Gamer Gigi stream. My name is Dr. Alok Kanoja. Just a reminder that although I'm a psychiatrist, nothing we discussed on stream today is intended to be taken as medical advice. Everything is for educational or entertainment purposes only.

If you all have a medical concern or question, please go see a licensed professional. So welcome, everybody. Today we have a couple of awesome things in store for y'all. we've got Dr. Michaela with us, an expert in ADHD. We're going to be talking about uncommon signs or symptoms of ADHD, explaining a little bit about what causes them, explaining a little bit about hopefully what to do about it. We've had Dr. Michaela on the channel a couple of times before. She's run a workshop for us.

That was awesome. So she is fantastic and awesome and everyone loves her, which is why she keeps coming back. But without further ado, we're going to. hop in with Dr. Michaela. Hello. Hello. How are you? I am mildly chaotic this morning, but feeling great.

Me and you both, dude. I got a late start this morning. I have some family in town. My kids went to see a movie. And so I've got a little bit of time for this. But it's great to see you again. And I realize that I'm looking in. It's weird to say that I missed you?

Um, it, uh, I think it is weird. And I missed you too. And I'm glad you said that. Right. So I think you just, it's something interesting, right? We, we, we're like, oh, is it weird to do this? But like, when did weird become not okay to do? Yeah. Right. So, so, so I, I, I think it's, it's absolutely unusual, given that we've only met a handful of times in our life. And, and, you know, we were on Zoom and stuff all the time. But I genuinely do really enjoy hanging out with you. And I think you're, and I think you're, a lot of fun and I love how emotive your faces. And I miss you too. See, that's what I mean. Thank you. Yeah. I live in a world where people's faces are not emotive. Yeah.

I have learned that it will get me in trouble if I show it in the wrong place. So I just keep my face. Yeah. Apparently on screens. Yeah. So it gets me in trouble too. But I found that oftentimes the kind of trouble it gets me into is actually pretty good. Like it will create.

conflict, but then we will address issues at hand. Right. And, yeah, facial expressions are great. I love them. Awesome. I think we're, I know you have a hard out in about 45 minutes, so let's get into it. Okay. So we're going to look at a couple of things.

Let me see if I can find the right. Here we go. All right. So we're going to watch some TikToks and Instagram reels, and then we're going to get your thoughts on them. Yeah. Does your house look like this? The only doom pile I haven't conquered is the paper one.

Okay. Yeah. I do have, I didn't make it. Yeah, I have a closet full of various backpacks. I think what's really funny about that is how, yeah, I have so many bags and they're each for a specific thing. Yes. Yeah. So what's going on with the doom piles, Michaela?

I mean, so it's funny because. this is the way that, so I will also say, like, there is this, like, kind of joy in seeing, like, a reel like this because you're like, oh, my God, wow, yeah, this is, I share this. This isn't, like, I'm alone in this, this, like, bane of my existence of all of these piles in my life. But also seeing it, especially when she opened the closet and, like, tried to close it and had to, like, kick the shoe in. I did notice, like, that sense of, like, overwhelmed. and like a hint of dread, like kind of creeping, because that's what these, I mean, it's what I call them doom piles, right? It really kind of goes back into the whole like ADHD. It's not an

attention deficit. It's a deficit of filtering, right? And so this is just like one of those, like, what does a deficit in the ability to filter look like in real life? And so it looks like we accumulate all of these things and we can't determine kind of right like which one well in some of these cases we can't like backpacks or water bottles um we need one for all of the different situations and we can't actually kind of like filter out it's like of course we need all of them for all of the things um or sometimes we just don't understand things or the um the expectation of the effort that we have to put into weed like dishes, right? Nobody needs to decide what to do on dishes, but like the expectation of how long it's going to take me to do dishes is so overwhelming that like

I just am not even going to start. Yeah. So can we can we tunnel down into this idea of a filtering deficit? What does that mean? Yeah. So part of our like a frontal lobe, that executive functioning part of our brain is being able to discriminate, like, what is the most important thing at any given point in time? So in this exact moment, every person who's experiencing us, their brain is taking in, like, a wide array of information, right? So we're wearing clothes. There are lights. There are maybe things moving or, like, colors and, like, physical things in our environments, right? So a neurotypical brain can say, oh, I'm watching a video that I'm interested in, hopefully, and I'm going to focus on that video and maybe a couple things about the video or whatever, right? An ADHD brain is taking in the seams of my clothing, the sound, the light is making.

And instead of saying, oh, I know I want to watch this video, it's like, in some of the sound. ways it's ping ponging, but really it's being assaulted by all of that information because I'm not like that filter isn't present to be able to say, here's the one or two things that I want to be kind of focused on in this moment. And so that's just, then it manifests, right? How does that result in a doom pile? Right. So when we're thinking about like, oh, shoes, okay, shoes, we need them. they go on our feet. In general, we have to use them most of the day, every day. Sometimes we want new ones, especially if we like shoes. We end up buying a lot of shoes. Another perfect example of how you build an ADHD doom pile of shoes is you go to the shoe store for one pair of shoes and you walk out with five pairs of shoes, but not the pair that you were looking for. You know what I love about this conversation. Sorry to interrupt. No, please interrupt me all the time. This is literally how I talk to my children.

So you know how we like shoes and we need to wear shoes most of the day. And you know how when we go to the store because you need a new pair of shoes and you walk out with five pairs of shoes? And the funny thing is I don't feel condescended to at all. But I like how you're like, okay, like let's start with like the basics. So please keep going. I just love that. I'm probably going to think about that a lot later if I remember. Okay, so we get home.

Yeah, we have too many shoes. We get home with our five new pairs of shoes and we're like, oh, but I don't have room in the closet for these in like the perfect little shoe rack that I bought to get organized. Got it. And then trying to decide which shoes I need, right, especially because I might have five pairs of black high heels, but each one has a different function. Those are the boring work black heels. These are the nicer work black heels. Those are the work black heels that have a heel that's a little bit too tall, so I don't walk as well, but sometimes that's helpful. Right?

Like, then you end up being like, well, I can't get rid of any of the shoes. Oh, those tennis shoes have a hole in the toe. But they're my favorite tennis shoes and they feel the best on my feet. And so you end up with no filter, which means all of the shoes. And then every time you realize, like, now they don't fit in the rack, now they are literally falling out of the closet. Now I'm afraid to open the closet because more things are going to, like, jump out and maybe bite me or something. but I still can't figure out which ones I want to or need to get rid of because of that discriminative filter, right?

Yeah. So it sounds like this is an issue of, I guess, prioritization. Would you say that as well? Like that the inability of filter is how we rank things in our frontal lobes are the things that will basically weigh stuff against other things. Like, do we want to do this first or this first? that's how we sequence. So I'm hearing filtering is sort of related to sequencing.

Yes. And so you said that you have one pile left, which is your papers. How did you deal with the other piles? Right. And I, sorry, one last thing. I love how you said, you know, we buy this rack to get organized. Yes. So I sort of feel like I'm constantly catching up, but never planning.

ahead, right? So I'm like, okay, I need like two bookshelves. Really, I should have gotten three because I've filled up the two. But then the other thing that I sometimes worry about, I don't know if this has ever happened to you, but do you ever worry that if you buy extra space, like if you get like a big closet, you're just going to fill it up with junk? Uh-huh. Yeah, that's the purse problem. What's the purse problem? You need the purse to fit all the things. But then like, well, sometimes I need a little bit extra. So should I just get the bigger purse that I can fit it when I'm carrying my laptop and my water bottle all at once? But then am I just going to make that the new norm of capacity, right?

So now I just have 10 pounds I carry. So how do you deal with that? Yeah. How did you get down to just one pile of papers? It's so much love for yourself. Yeah, it starts with, um, I'm setting. Wait, that was actually hilarious.

It's so much love for yourself. Like, I love that that is not the answer. And that's what we say to ourselves. And that doesn't help us at all. It helps in the sense of like, it frees up. It allows you to actually do things. Like,

I feel like when we are so angry and mean to ourselves, we get really paralyzed. Right? So that like perfectionism of like, I'm never going to be exactly what I need. be because I'm so messed up is like, then I'm not going to try. Right. So like I do, I mean, tongue and cheek. That that's actually, I was. I wasn't. Yeah. And I don't think you can start there. Yeah. Because that that is an incredible, that's an incredibly challenging life journey is to learn to

love yourself and to keep loving yourself. Um, and, uh, the fact that I do love myself, um, is, is why I have learned to be free enough to say, is it weird to say that I missed you? Like, if I really thought it was that weird and I really hated myself for having that thought, like maybe I wouldn't have said it out loud. And you said you missed me too. So, you know, bonus reward for being a little weird. Yeah. But how do you actually?

Yeah. So, but that's really great because I think, I think this is what's interesting because I know this is going to sound weird. So I recognize that we are both therapists and, you know, we are both doctors. but there's a part of me that like when I hear like you know love yourself I'm like that's not going to fix the problem but what I'm hearing from you is actually a very clear mechanistic oh yeah if your head is full of self-hatred how are you going to have the cognitive bandwidth to actually organize and so I thought you were being sarcastic but it turns out that you were being not sarcastic

no and so you should love yourself for anyone who's watching great And it frees up your cognitive bandwidth, right? So then you have the space. And then what do you do? And then you impose limits, right? So that's the other thing is like when we think about any doom pile is we obviously have to conquer the entire thing all at once in one sitting, which, no thank you. So working on those limits.

And so that might be go, I mean, I'm going to start with dishes because that has like, at least for me, less emotional, like, value, which means it's easier to tackle, right? Like, I love shoes. And so trying to get rid of one of my pairs of shoes is, like, a little bit asking me to cut off a toe. So I'm not going to start there if I have not established, like, a practice where I've been successful at winnowing down my pile, right? So dishes, I am going to set a five-minute timer or actually it was on a break for something I was doing with Healthy Gamer. I had a stack of dishes and I was like, okay, I have five minutes. I've eaten.

I don't need to use the restroom. I have a beverage. So I'm going to use that five minutes. I'm going to run. I'm going to do as many dishes as I can and I'm going to come back before the break is up. But I'm only going to get through a few of the dishes. Well, I did actually knock out all of the dishes. because it turns out it didn't require as much of an investment as I needed to.

And so it's like, okay, I'm just going to do five minutes. So I conquered one pile that time. But that's also because I'm historically better at conquering the dishes pile. And that's with, even with all the people that I work with, they're thinking, like, how could I ever organize any closet or anything because it's so overwhelming and I'm never going to get it all in one day and I have to do something later? So it's like, no, that's not the expectation.

Let's start with literally five minutes set a timer and then when my timer has a duck quack at the end. So when the duck quacks, stop. And of course, that requires a little bit of impulse control because once you started, you're kind of like, but I must. And so there's also practicing of that letting go, which is so freeing and then helps us learn, you don't have to do all of the things all at once. Why do you think it is that we're so attached to doing all of the things all at once? I mean, I think part of it is the filter, right? But I think part of it is also the messaging that, so ADHD is a developmental disorder.

You were born with it. So from the day you started being, you know, in this world until today, you've probably been getting messages that, like, you're not doing it right. You're not working hard enough. You don't care. You're lazy. You know, are you stupid? Are you just like you don't understand things? And so there's also the like, obviously I have to finish everything and do it.

Otherwise, I'm not good enough, which I kind of already believe because that's what everybody says, even though they're silly and wrong. Yeah, I think so sometimes when I work with people, what I sort of notice is in my own life, when we look at a doom pile, we want that to be gone. Right. We look at the doom pile. It overwhelms us. We feel ashamed. We know it's a problem. We know we should fix it.

we shouldn't have bought five shoes, we should just bought one shoe, I should have gotten a bigger rack. There's all this kind of thing and you want the problem to go away. And if you chip away at it, the problem is still going to be there tomorrow. And it's going to create all of those problems in your head. And you just want it to be done, right? You want it to be gone. You want it to not be there because it won't affect you. And interestingly enough, it's so interesting.

I love how you said that start with something that isn't important, right? Start with something that doesn't emotionally activate you. because when you're emotionally activated, restraining your behavior, controlling your behavior is going to be so much harder. But when you start with something that's like small stakes, then you're just dealing with the distractibility, impulsivity, a little bit of attention control. There's no emotional component. And I think this is what I love so much about how you approach things is you bake in a lot of like skills, training background. Right? So you want to start, like you don't want to learn how to swim in the ocean.

you want to learn how to swim in a kitty pool and then work your way up. But that conflicts so much with our sense of like, I want this to be done. I want to be good at this. Yeah. Yeah, absolutely. I mean, even like, so dishes for me is not emotionally evocative. But like when I've worked with people where it's, how many pens do you have in your house? Me?

Dr. K. Yeah. I have, I have a fair number of pens. I have a couple of boxes. pens. Yeah. Or like pads of paper. I know you get pet, if you ever go to a conference, right?

Like you probably get like a bazillion pens and like different pads of paper, like the marketing things. So like those would be another thing. Like let's just like start with pens. Nobody needs 10,000 pens. So just pick one cup of pens and then get rid of the rest of them. That's so hard. So you know there's, I don't know if you've seen this, but there's an overlap between ADHD and

hoarding disorder. I did. Yeah. Yes. Yeah. Okay. Of course you've seen that. Yeah.

Well, I actually, the first time I used the pens example was with a hoarding case. And then I was like, wow, it worked really well with this person, although it was arduous. So I do also want to point out that I'm saying like, oh, yeah, start with the least emotionally evocative thing. And even the concept of I am only going to keep one cup of pens can fee, to be honest, I have three cups, including an entire cup of highlighters, that I don't think I even used much in grad school because very quickly I transitioned into electronic papers. So you can't use an actual highlighter. Have I gotten rid of them?

No. Do I know if they work? Also no. Do I care? Not right now. Yeah, cool. So it sounds like dealing with doom piles. We want to really start with things that are small.

Yes. Right? So small, start with it. It's a filtering deficit. that and, you know, I like this idea of, like, set a timer, chip away at it. So that's a big thing that I found works for me too is the sort of like concept of, okay, like, I'm going to chip away at this. One thing that I find helps is, which is the problem?

What is the status of this problem that I want to inherit tomorrow? That's kind of like what I tell myself, right? So it's like, okay, like, I don't want to inherit this problem. but I'm okay inheriting and my wife, this drives her insane, but I will do one or the other. Either I will empty the dishwasher or I will load the dishwasher and run the dishwasher, but I will never do both.

That makes complete sense. Yeah. And so I just think like, okay, like I don't want to do both. I never want to do both. So like let me do it half asked. Let me do it halfway, which is infuriating for her, but works really great for me because I'm not like doing it all all the time. Yes. Yeah. But that's a great approach. I will say because I do, I mentioned, I have one, like all caps doom pile. Sometimes the doom piles might be related to something that you don't actually know what to do with it. And so instead of doing anything, even five minutes, you're like, but I don't even know what I would do in those five minutes. Yeah. Yeah.

And so then your first step is actually how do you find out what to do? But to address that doom pile, I actually need to spend five minutes on a podcast or a YouTube video or something to start to learn or call a friend or I don't know, right, so that I can learn what to do to actually approach that doom pile. If you're super, super, super stuck and the five minutes start is just not a thing that has worked at all or can work. Yeah, so I remember, I don't remember where I saw this, but there was a great statement I saw in a therapy guide or something about the right question to ask is, what do you need to learn to get started on this problem? Because everyone's focused on how do I get started? What do you need to learn to get started? It changes the focus quite a bit. And I love that you went into that.

So we move on? Yeah. Okay. Let me go ahead and let's do this. We're going to watch a TikTok, okay? You know you need fiber for a healthy gut, but do you actually know how to get it? Quaker's been serving up fiber since 1877,

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That was really fast and really short too. It was really fast and really short, which I so appreciate it. You know, I don't know that I'll remember all the five things that she covers. But I think to me, like one of the unique things that really jumped out from this one was the mind reading and like finishing people's sentences as they're talking. which like interpersonally can be like profoundly annoying to other people who like don't understand like why is this happening what are you doing um and yet uh stopping yourself from like saying the thing right that impulse control to like oh my god like I know what you're going to say I agree kind of like it's a I think the intent um is like oh I want to connect with you and I can

show you how aligned we are. And that is definitely rarely the impact of how that behavior feels. I do that quite a bit and I noticed that my mom does that quite a bit too where she'll like we kind of know

where you're going. We don't need you to keep talking about it. Right? Yeah. I kind of like so there's also that so for me it's a lot of it is like yeah next. Yeah. Like let's advance the conversation. We don't need to spend 90 seconds talking about something that you can explain in 15. And I am excited about what you're talking about. Let's just, let's just fast forward past

the commercials. You know what I'm saying? Like, let's add free. Let's go. Four times speed. Absolutely. So I think it's just, I mean, people, I sometimes feel like people just move like they're lagging in real life when I'm sitting to talk to them. Yes. Yes. Yes. I think that the, the, The paired part about that is the like, so you like have part of the conversation in your head. And then you just like jump to the next thing. And so the other person is like, what? Yeah. So, so I mean, you know, I had to train myself out of that in the whole psychiatrist thing. Yes. And what I discovered was something insane that the first three words of their sentence don't actually dictate their point. That they have a lot more to say.

and that what I was doing, you know, they had a bunch of weird context or preamble or whatever like prologue. And then there's like act one, act two, act three and then there's the epilogue. And I've discovered, I know this may sound crazy, but actually a lot of what they say like in the latter half, like that stuff is really important.

There's actually, oftentimes that's the main thing that they're trying to say. Yeah. And they just waste a lot of time at the beginning. That's really what I think is going on. Yeah. They need a little warm up, right? Yeah. I kind of got to like get going, get go. Okay. I got to work myself up to the actual point. Or sometimes you find your point as you're talking. Yeah. Um, right? Like you start talking and then like, oh, so what I really am actually trying to say. Um, yeah. It's funny how you said you had to train yourself out of that as a psychiatrist. As a psychologist, I have, I had the habit of, um, I would start the whole conversation in my head and then eventually my marriage. Um, as a psychologist. I have, I had the habit of, um, I would start the whole conversation in my head. And then eventually my marriage. And then eventually my marriage. Um,

would start, would like share the conversation. But people would be like, I, what? And so I had a friend actually who would say, I need you, I need you to leave and come back and start at the beginning. And I was like, oh, excuse me, oh, that, that is what I'm doing. And so it was that feedback from a friend that was like, you are starting like in the middle of a thought, stop that. because as a baby therapist, like my patients would, you know, patients are so kind to us sometimes, right?

And they're like, hmm, yeah, that's interesting. I will try that. But nobody actually tells you you didn't make any sense. But thankfully, we had videotapes where I could be like, oh, what was I doing there? Yeah, that's, that's hilarious. So, and if people are running into this, I saw that there was like the jumping ahead, people, you know, we understand this, we experience this. What is going on? How is this related to ADHD? I mean, this is one of those things that like, because these are, like, we're talking, when we're talking about like, oh, these uncommon or unknown or untalked about symptoms of ADHD, I think that what the disconnect is is like our science or like the DSM has everything boiled down

into these like fundamental symptoms. Like these are the things that drive all the other stuff that happens. But we live life as whole humans. And so we don't start with a book. We're like, look at what is happening in my life around me. And so these are the manifestations of those symptoms. But we don't have the science that ties what are these core pieces to all of the different ways that they manifest. So when we get into like something like this like talking and and

whatnot, uh, are like idiosyncratic speech habits, if you will, it's like we're like hypothesizing, right? Like we have, we understand the science and we understand the manifestation, but we're kind of like, we're a little bit guessing like how are these things connected. Sometimes it's a really obvious connection, but, um, I mean, I think for me, a big piece of this is impulse control. Like, I think neurotiv- I mean, think about like interrupting, right? Like, we can't not say the thing if

it, like, is in our minds and we just have this urge and it needs to like, bubble out. So I think this is probably related to that, that like, impulse control piece, but also the, like, the boredom, the impatience, right? So, like, some of, like, the emotion

regulation, if you will, of the, like, I'm ready for the next thing. I'm ready for the next thing. I want this, like, new stimulation. or I want this connection or I already had a new thought. Can we go to the next topic, please? I don't know. What do you think? Yeah, so I think that has a lot to do with it.

I think sometimes we forget that symptoms of ADHD can happen internally. So even when we talk about distractibility, we usually think about distractibility as like, I am doing this external thing, like I'm trying to read a book, and I'm getting distracted by that. external thing. What I, what I, what I think a lot of the manifestations are is actually in your mind. So this person is saying this thing and my distraction is literally a thought. That your thought, thoughts can be distractions. Like it's so simple to say, but we don't think of them that way,

right? That the distractibility, the inability to maintain my attention, impulse control, I think filtering deficit, all of those kinds of things, the ability to stick on something, that you will produce distractions. So I think this is another really, really scary thing to really think about. This is where we understand the basic science. And I think we have a hypothesis. So I remember seeing that, you know, there's a really famous video of, you know, a kid watching a movie or something with ADHD and he's like sitting still in the chair

and he's like engaged in the movie. And if his mind is engaged enough, he doesn't, he's fine. But then if he's like listening to a lecture on math, he's like spinning it in a circle in a chair. And so one of the key things that I sort of learned is there's a certain amount of mental stimulation that you need if you have ADHD. And if the environment doesn't give it to you, then you will give it to yourself. And this is where I've started to realize that, you know, if someone is like boring in a conversation because they're working with their way up to a point, like your mind is like this is not doing it for me. So your mind starts spinning around in circles.

you start thinking about something else. You start with something that you're engaging in. And then the last piece of emotional regulation that I think you talked about, I think sometimes what we, you know, the emotions that actually get my patience in the most trouble are not the negative emotions. It's like the positive emotions. Oh, yeah. You know, curiosity.

Love. Oh, my God. Love damages more lives than hate does. IMO. Yeah. And maybe that's not, that's just selection bias for who I end up seeing. But,

right. Falling in love with the wrong person or at the wrong time is a really great way to ruin your entire life. Inability to kind of like, I love them, but they're terrible. And like, but I'm going to keep going back, keep going back, keep going back. Yeah. So do you have any thoughts about if people are jumping ahead in conversations if they're having difficulty attending to a conversation? How do you work with those people? Yeah.

I mean, I think kind of tying that into the stimulation piece of, of if you, first of all, sometimes it's, that's okay, right? And get yourself some neurodivergent friends if it's not okay for the people in your life. Like, I think it's really important to have a space or have a couple relationships where you can just be 100%. I don't want to filter. I don't want to be skillful. I don't want to do, I don't want to have to control my impulses. And I think what that allows is like I can channel the intensity of some of this into a completely free and wild

environment so that I then have the resources to like, so I can control my facial expressions like one percent of the time. And so if I just don't even try ever, except for when it really, really, really, really, really matters, I'm decent at it. And so I think that it's the same kind of concept in like, have the weird speech stuff, have the idiosyncratic, like, I'm going to finish your sentence. I'm going to, I'm going to jump ahead. I'm going to interrupt you and completely change the topic. I'm going to say, next, right? Like, do those things. And then in the places that you really can't do that, or that it has been punishing for you to do that, having some kind of usually external

stimulation, and I say external because if you do your own internal distraction and just sit there quietly and kind of nod your head, that can also sometimes get us into trouble because like we actually need to hear what our bosses are saying or friends, you know, like, oh, I do need to listen a little bit. So that's where. like, I'm going to use the word fidgets, but that's where doing something with your hands, whether that's like maybe wear a little bit more jewelry, wear shirts with cuffs that have buttons on them, so that you can kind of like pick at them or fiddle with them.

Any amount of like, let me do something with my hands, taking notes, if it's, if it's appropriate to the setting. Like, don't go to coffee with a friend and like take notes with the conversation. but some kind of little bit of stimulation that you can add into the moment to help you kind of with that antsiness, if you will. Yeah, I know you're a therapist who works with neurodivergent people when you say, don't take notes when you go to coffee with a friend. And that's where sometimes, so I know it sounds kind of weird, but I actually sometimes

do take notes when I go to coffee with a friend. And I find that it. is not always, but sometimes it's an indicator of like how much you value what they're saying. Like I'm, I'm write this shit down. Yeah. So let me just understand what's going on. And then I'll start taking notes. But yeah.

So I'm totally with you on the fidget too. What I found is that when I'm doing psychotherapy with patients with ADHD and we're not, when we're doing the more psychodynamic style, so when we're like talking about your past and talking about your feelings and stuff like that, as opposed to like, let's learn certain skills. Right. What I found is that I would take walks with them and that works great. Yes. So you usually like proprioception and I'm sure you're familiar with like sensory swings and stuff like that for children on the spectrum.

Yeah. Using your body and kids will spin around and they'll start fidgeting and they'll start wiggling and like whatever. So I think giving them some opportunity to really use their body I think goes a long way with conversations especially. So when I have patients who are struggling because they're having like relationship problems or whatever and they've got ADHD or if their partner has ADHD and they're coming into the office, one of the best, you know, tips that I will give them is like go for a walk when you're talking about something important and you'll be amazed at how easier, how much easier it is to pay attention. Yeah, totally. Also things like doing dishes together unpleasant. We don't want to do it. It's a mildly distracting activity. but it does facilitate the conversation. I think there's another piece of it too of the like,

when I don't have the intensity of the eye contact sometimes, it kind of frees up. I don't know if it's like emotional bandwidth or cognitive bandwidth, but there is something that really facilitates certain, like maybe harder conversations when you don't have that like directness. Yeah, that was something. I don't know if you got this in your training, but like, you know, I remember getting a lot of stuff.

specific training about how to set up the chairs in my office. Oh, yeah. You know, like, don't sit across from someone because you sit across from, like, people that you are trying to sign a peace treaty with, right? There's a lot of opposition to, yeah. So I was thinking, because I primarily work with younger folks. And so, like, if you are sitting across from an adult as a child, it's usually because you're in trouble.

Yeah. So signing a peace treaty conflict, right? Yeah, that is, there is this kind of, and I guess, inherent social structure or social norm of like face to face can sometimes be you know combative in a way. Yeah. So I think one thing that helped me a lot in my marriage was when I started having conversations with my wife that were a little bit difficult, I would sit next to her and then also hold hands or something like that because then like if you're in a relationship, you'll start, you know, doing things like that. Yeah. And it really helped a lot. Like I think it completely changes the feel of the conversation.

whereas like we need to talk and like let's go and like go to dinner and and stuff like that. Right. Right. And this is completely off topic, but I love how you said like I will even like, I'm going to have a more challenging conversation and like hold her hand while I'm doing it or sit next to her or I'll like lay my head on my boyfriend's shoulder. Right. And so like not only are we taking away the kind of like face to face combative, conflactual potential message, but your brain is actually getting messages of like safety or comfort. Like this is good when we have that physical affection while we're engaging in a more challenging conversation that could be evoking other emotions, right?

Like, I'm going to tell you that I'm really, really angry at you, but I'm going to do it while we're holding, I mean, gently holding hands, while my head is resting on you while I'm saying, like, this was really hard for me. And so that communication has the blend of the affection safety that your brain is getting in addition to the content, it like it softens that communication, and it makes things so much more helpful. Yeah, that's great. So I think the challenge is that, you know,

if you're trying to pay attention into a conversation and it's not your romantic partner, then, you know, holding hands. Yeah. But I'm sure. Or maybe do. I don't know. I'm sure you'll address that in your workshop that's coming up.

So if you all don't know, There's Dr. Michaela's holding a workshop at the end of the month where she's teaching y'all how to adult and stuff. I know you've got to go soon. Do we have time to take a look at one more? Yeah, let's do it. This one is a little bit longer. Oh yeah, this one is a lot longer. Okay.

That I had no idea where ADHD until I was diagnosed with ADHD at 30 years old. Number one is the feeling that everyone hates you. They're secretly talking behind your back, that you're not good enough. This is actually called regenerative. rejection-sensitive dysphoria. Rejection-sensitive dysphoria or RSD is when you find extreme emotional distress by being criticized or even a perception of being criticized. RSD is no joke. It can take over someone's life and destroy their self-esteem. Number two is not understanding who I am at the core of my being.

It has a lot to do with chronic boredom. People with ADHD experience chronic boredom. This is why I'm always searching for dopamine and we're looking for and we're looking for ourselves in different activities, and it's hard to even know who you are or what you like because you're bouncing from idea to idea, from project to project, job to job. It's hard to know who you are when what you love and like

is constantly changing as well. Number three is people pleasing. Can I just pause here? Does this sound like ADHD to you? Uh... Can we try, again? game? Yeah. Okay, let's play a game. So I want you to think about what you think this person's diagnosis is. I'm going to do the same. And then when you have your answer, I want to count to three

and then we say it at the same time. Does that work? Can we try that? Not like this person's diagnosis, but if someone has rejection sensitive. Yeah, there's a lot of these things often come together with, yeah. This diagnosis, right? So this is not, we don't know what this person. You know, but like, like, because when I hear this symptom cluster, I do not think ADHD. What I think of is a particular diagnosis where there's a lot of TikToks about ADHD. Yes. Yeah. And then they're, okay, so do you want to play this game or no?

Yeah, yeah, yeah, yeah. I'm ready. Okay, you got it? Okay. One, two, three, BPD. I was going to say Porterland Personality disorder. Yeah. You see what I did there.

I jumped ahead. Right? Yeah, yeah. I love it. This sounds like BPD. Yes, it does. And it's what's fascinating is working with like adolescents and young adults, there are a lot of, and you probably get this in your caseload of the young adults who

were diagnosed ADHD and now are diagnosed BPD, right? And there is such questionable diagnostic practicing out there sometimes, right? So I think, who knows? But yeah, these, like, there are kernels in here that I can connect with that are like, oh, yeah, that I think relates to ADHD. But when you put those three things in particular together, you are actually talking about a very different mental health condition. Yeah. I think. So I think it's great that we, I feel better.

that you, we came to the same conclusion. How do you think it is that someone who, so, because so many people will experience things like this and they'll think, okay, I have ADHD. These are ADHD symptoms. How do you think this happens? How is it that someone describes a lot of BPD symptoms and ends up thinking they have ADHD?

Like, how do we get here? What is going on with this? Well, there are a lot of zoomed out, like similarities, right? So instability in relationships is a hallmark feature of BPD and is something that can definitely happen with people with ADHD for really different mechanisms, right, of how we understand how that's happening, typically. And so I think that right there, right? So labile emotions, like really intense mood swings, right?

Also happens in ADHD. I don't know that the mechanisms are super different, but the development of those mechanisms, right? We understand as different, like how a BPD person develops that like really intense labile affect versus what a person with ADHD like born with the core deficits in the frontal lobe that then is what is regulating. emotions, right? So I think that there are these kind of like on the surface. And that's why there's so much value in the information that's out there on the internet or that anybody can access. And I love the free access to so much information. But I think sometimes then the like professional component gets discounted of no, but look, I, I check these boxes. Therefore, I have

these things. And there's not the like, oh, but let me help. you understand those things and how it doesn't necessarily check those boxes or how the better boxes to check, but a different thing. Yeah. So that's that's so I completely agree. I think what the internet has a lot of access to good diagnostic information, but what no one on the internet does is a differential diagnosis. I have literally never seen a single TikTok where someone discusses the concept of a differential. Right. And for people who aren't familiar with this, what we're trained to do is, okay, you check

those boxes, there's a good chance you have the flu, but there's also a chance that you have an immunodeficiency. There's also a chance that you have an autoimmune disease like lupus, right? So I think this is where the internet falls short, which is like, and I love the way that you described this, kind of my understanding of it is like, okay, rejection, sensitivity, dysphoria is some combination of, you know, self-esteem issues because if you're a kid and you don't wait your turn, you do interrupt everybody. People get mad at you a lot. So people, I saw the fascinating study that if you look at people between the ages of 60 and 94

and they have ADHD, right? So we think of ADHD as like, oh, all these kids have ADHD nowadays. But if you look at people between the ages of 60 and 94, they are 300 percent, more likely to be divorced or never married, that it makes it really hard to engage in relationships. And that your partner, you know, has to deal with a lot. It's really hard for you. And so if you're sort of like not getting invited to birthday parties, if you're having difficulty like making friendships or relationships,

then you can sort of develop this hypersensitivity to rejection. And even in your own head, where if you have difficulty regulating what thoughts pop up, you can sort of start to spiral very easily. So I can see the overlap. You know, I think this person was saying, the second thing is like a chronic sense of not knowing who you are, which I get excited about this.

I'm super curious about this. Now I'm super curious about this. Now I'm super curious about this. Right. So I can sort of see how that overlap is there too, but I think you pointed out that there's a big mechanistic difference in BPD usually ADHD, where that really, that chronic sense of emptiness

and not knowing who I am and adopting identities from outside me, I think feels a lot more like VPD. And what I find in my neurodivergent patients is when they find other kids who are ADHD, you still have this sense of, okay, these are my people. Yes, exactly, exactly. And so I think that for a lot, she's kind of saying it's because you're constantly switching interests and you're, you know, you start a project and don't finish it until you move on to the next project and seeing got all these projects. But I think there's also the component for ADHD

is like the masking of the, I might actually know who I, but I'm trying not to be that person. I'm trying to be a different person so that I can be normal and I can like do the things I'm supposed to do like work in a cubicle from nine to five and fill out Excel spreadsheets. Right? Like I think and but it feels wrong. And so therefore, I don't feel like I have a core identity, but it's not at all in the same way as when we're working with a person who has that borderline personality disorder experience, which is very just qualitative and experientially very different. Like you said, like that hollowness, that emptiness versus the like, I'm confused or like I don't want to be. Who I am. I want to be like someone else.

I've been taught my whole life that who I am is bad. So let's try to be somebody else. Yeah. Yeah. Yeah. Right. Yeah. Yeah.

Totally. So, yeah. So thanks for coming, Michaela. I know you got to run. But this was incredibly helpful. Any, and if any kind of like any, I know we sort of talked about what is going on here. But if someone's going through this, do you have any suggestions for what to do about. it or how to approach this, like, more concretely.

And if you don't, because we didn't get that far, that's totally fine. Yeah, I mean, I'm going to, I'm going to go with the last kind of content area that I was, that we were referencing in a sense of like the masking piece of the like, uh, I think in, in so many of the things that I do with Healthy Gamer, I always, I feel like include, um, some component of unmasking. and of like learning to like root into the confidence in your own self. And that is that is also a lifelong journey. But it is so liberating to find the ways that you being the whole real you can actually

be profoundly successful and rewarding and fulfilling. And it is it's absolutely hard. and sometimes it means losing all of the friendships and relationships you currently have, which is devastating. And it is so utterly excruciating to continue to try to live your life and pretend in 99% of your interactions and daily activities that you are someone that you're not. and that there's beauty in being a little weird. And there are actually a large number of people out there who are going to appreciate you for the real you. I never finished this article,

but I was reading an article about a study. And there are current estimates out there that about 20% of the adult workforce is neurodivergent in some way. And so if 20% of people, that's one in five, our neurodivergent, we're actually not taking advantage of all of these unique abilities. And so there's this push on the employment side of things to like stop trying to make your neurodivergent folks fit into what the neurotypical experience of your work is and try to

try to actually like set them free to be themselves and to then harness those strengths. Because oftentimes a deficit is really just a deficit contextually and can be a strength in other situations. So, yeah, that was my very long answer because I'm also really good at saying things succinctly. Like, where can you say the weird thing today? Where can you do something that's a little unusual? That is like where can you just like liberate yourself in just a little bit? or say that you're having a hard time with something today. That's my, that's my takeaway.

Yeah, thank you so much for coming today. I think it's a beautiful takeaway, and I love talking to you about this stuff. I love being here with y'all, and I love this community. So have a fabulous rest of your Saturday. Yeah, it's Saturday. Yes, that is the day today. Okay.

All right, take care, Michaela. Bye. Bye, y'all. Okay. So, yeah. And so, Michaela's awesome. She's running a workshop this September 27th about adulting with ADHD. If you guys are interested in more stuff from her, definitely check that out.

I think she's great at doing stuff like this. So she's great at talking about things. But then I think one of the biggest questions that we get so often here at AG is like, okay, what do I do? What do I do? Like, sure, you can tell me, like, I should. should love myself, but how do I actually do that? How do I get started? That's what she sort of specializes in. That's what she's a real expert in. And I hope you guys kind of caught a piece of it. We hope that the stuff that we went over today was helpful. I can talk a little bit more.

I'm going to actually just check in with y'all. What do you all want to do? So I have a couple of thoughts about unspoken symptoms of ADHD. We can talk about those some more. I guess let's do that? I think there may be a video about RSD dysphoria. Let me see. Yeah, okay, here we go. We do have one. We made it two years ago. So, hey, I will, I'm going to go ahead and say this, chat. We did it before it was cool. And then we have another one about how to handle rejection. That's three years old. But yeah, we have good stuff about rejection sensitivity. I want to show you all a couple other posts, and let's talk about these, okay? So let's talk a little, it's on, it's on regular YouTube. Just search for Healthy Gamer Gigi rejection sensitivity, and it'll pop up. Yeah, so let's talk a

little bit about symptoms and traits of ADHD that people don't really appreciate or didn't realize. So what are some obscure symptoms you experienced that you didn't realize were ADHD until you were diagnosed and learned more about it? Coffee didn't do anything for me because of lack of stimulation in the brain. People feeling anxious due to coffee, always feeling like I was guilty as if I'll be in trouble and always feeling that whatever chore or activity I'm doing, it's wrong and I should be doing something else, never being able to stay in the moment. What are some ADHD signs you didn't realize were related? Executive dysfunction. The fact that I always needed some sort of body double to get chores done. Emotional dysregulation and random bouts of intense emotions and complete

inability to engage with a topic that I see no practical use for or have any interest in. Okay. If I hear just meditate one more time, I may lose my mind. Okay. So let's talk about this. There are a lot of things that happen in ADHD. And there's a lot of stuff that we're familiar with. Like we're familiar primarily with academics, right?

So if you think about the classic picture of who has ADHD, what you think about is something school related. a kid who doesn't sit still, having an inability to focus on your test, you know, using stimulant medication so you can focus and write a paper. These are the kinds of things that we think about. We also now think about ADHD is a professional thing too, right? So it's not just school. We'll now think a little bit about, okay, at my job, I have difficulty focusing, so I need stimulant medication or something like that. And that's sort of how we think about ADHD. But there's some really scary research about how ADHD will affect every part of our lives, basically.

So like I mentioned earlier, people between the ages of 60 and 94 are 300% more likely to have never been married or gotten divorced. 96% of people who are in relationships with people who have ADHD say that it affects their relationship. right? So it basically affects 96% of the relationships you will have. 92% of people say that they have to compensate for their partner's ADHD in some way. Women are way like, women with ADHD are way more likely to get divorced than men with ADHD. And ADHD seems to be a central factor in that. And here's the other really crazy thing. So if you ask what is the most important thing in a relationship,

people will say faithfulness is number one, something like connection is number two, and number three is, number three is actually like having a good support in terms of like organizational duties, household duties, things like that. So like helping out around the house is like the third most important thing to people in relationships. And these kinds of problems or these kinds of things are really hard to do if you have something like executive dysfunction. But what I think is the biggest unseen symptom of ADHD is that you can do everything that other people do.

It's just way harder. So as a psychiatrist, what I've come to appreciate is we talk about what can and can't be done with ADHD. Everyone's like, oh, yeah, I can't clean up my room. I can't study for a test. I can't write a paper. I can't stick with something. We think about things in terms of cans or canots. When I sit with my patients, one of the things that I've started to appreciate that no one ever talks about is that you can.

It just costs you a lot more. So a really great example of this is a lot of people with ADHD. So let's understand why this happens. What are the mechanisms and what are the neuroscience mechanisms in ADHD and how you can approach these things, okay? So first scenario we're going to talk about. I have, let's not call it an appointment, let's call it, I have a job interview at 4 p.m. Therefore, I can do nothing until then.

So for a neurotypical person, if you have something scheduled at a certain amount at a certain time, the time prior to that is available. for other things. You can be productive in other ways. But if you have ADHD, this is incredibly difficult to do. I have so many patients who will tell me if I have something later in the day, I can't do anything before then. I'm just waiting for that thing to happen. And once that happens, then maybe I can do something after that. But oftentimes waiting until 4 p.m. is actually exhausting. Takes up a lot of energy. And then they look at their lives and they're like, How on earth does this work?

This feels terrible. How am I ever supposed to succeed at anything in life if, if like I can only do one thing a day? And this kind of goes back to these chronic feelings of guilt and that'll always be in trouble. Always feeling like some chore or activity that I'm doing, I'm doing wrong and I should be doing something else. There's a lot of feelings that come with that. So let's understand this. People with ADHD tend to be environmentally oriented. The world moves fast.

Your work day, even faster. Pitching products, drafting reports, analyzing data. Microsoft 365 co-pilot is your AI assistant for work, built into Word, Excel, PowerPoint, and other Microsoft 365 apps you use, helping you quickly write, analyze, create, and summarize. So you can cut through clutter and clear a path to your best work. Learn more at Microsoft.com slash M365 copilot. Okay, this is sort of a simplification. But we know that. people are very sensitive to their environment. Okay? And there's a great quote, which I'll pull up later if I get a chance, about how, you know, if someone is prompting you to do something, you can do something. So when you get excited by something in your environment, it brings out a lot of like good energy.

You get super hyped about it. The relationship between what happens in your head and what is happening in the outside world is very close together. So neurotypical people can separate the outside world from the internal world. People with ADHD have a lot of trouble with this. And if we listen to Dr. Michaela, she's like, you know, these are variants and we should stop trying to make those people neurotypical. I completely agree it's a huge part of what I do.

I started preparing for this stream this morning. I just could not be bothered to deal with this until like basically this morning because I was doing something else before then. And if I start preparing for it two days from now, it's going to be really hard for me to focus on what I have to do two days ago. Or sorry, two days ago, not from now. If I start preparing for something two days from now, it'll like occupy my head and I won't be able to focus on what's going on today.

So the key thing here is that we're environmentally oriented. So the thing that you have to do at 4 p.m. fills up your brain. and there isn't space for anything else. Right? So you're thinking about that thing. You're thinking about that thing. We can't stop thinking about it and do something else. So this is what I found time and time and time again.

If there's something that you're, and this is why we respond so much to the environment, right? So like if there's a deadline, if there's a test that I have to study for tomorrow, I will study today. Whatever is coming down the line will fill up my head. Now, why is it that we can't do this? right? Why can't we empty our head and just focus on the job interview at 4 p.m.?

This is because we tend to have a lot of difficulty restraining our impulses, restraining our thoughts. We cannot shift our attention away from this. And part of the reason that we have difficulty with that is because this is the way that we have learned to survive. So if something is important, we don't want to forget. if something is important, it demands all of my attention. And so what we sort of learn with ADHD, and you all may have experienced this, right,

is once something is in your head, it's there for a long time. When I get really excited, or it's there until it isn't. So the ability to put things into your head or take things out of your head, that is the fundamental deficit in ADHD. We cannot switch. It's a problem.

Remember, it's an attention deficit. disorder, which means there are problems with attention. That goes both ways. It's not just that you can't focus. It's also that you can get into hyperfocus. So our brain says this is important. Let's not forget important things deserve to be thought about. Therefore, we're going to think about them. And so what this looks like, what is a huge amount of unproductivity, right? So people will say, like, what is a symptom of ADHD? Everyone's like, we procrastinate. Although why do we procrastinate? We look at this and we say, we're procrastinating, we're wasting time. It's that your mind is occupied. Your mind has to be occupied. It can't afford to do other things prior to 4 p.m.

Until we learn how to train ourselves in that direction, okay, which we'll get to in a second. Second thing that we're going to talk about is guilt. So this person says, always feeling like I'm guilty as if I'm in trouble, always feeling that whatever chore activity I'm doing, I'm doing it wrong and I should be doing something else. How does this happen? Always. doing things wrong. Now, when you look at something like this, you may say this looks like depression, and that's why the differential diagnosis is really important. You know, this is why jumping to this as a symptom of ADHD is you have to be careful.

Because there could be other things that can make you feel always guilty. You can have a history of trauma. You can have a mood disorder. You know, there's all, you can have abusive parents growing up. you can have something like dependent personality disorder. This subjective feeling doesn't necessarily, it's not a smoking gun for ADHD. Now let's talk about the mechanism of why this happens in ADHD.

So why does a human being think that they're always doing something wrong? Because they were taught they are always doing something wrong. It's not rocket science. So when you grow up with ADHD, you make all kinds of mistakes. Okay? So when I make a mistake and I like forget to do my homework, right? Or I did my homework, but I leave it at home. And then I get feedback.

They're like, hey, you were supposed to do your homework. You didn't do your homework. Bad you. But if we think about it for a second, everybody makes mistakes. Neutypical kids forget their homework too. They don't have this. Why? Here's the key thing.

When a neurotypical child usually makes a mistake, they usually have the executive function, the emotional regulation, the ability to regulate their attention to correct the mistake. Right. So I forgot it once. I won't forget it again. This type of feedback is useful in a neurotypical world. So when a neurotypical person says, hey, you forgot. don't do it again. And a neurotypical person hears that,

they're like, I forgot, I won't do it again. The big difference is not the mistake that you make, but that for one person, our society is designed to help them correct the mistake. It is sufficient to help them correct the mistake. But with an ADHD kid, the world that we live in does not support us in the right way

to not make that mistake again. So then what ends up happening is, if I make a mistake, and someone tells me to do it differently, I say to myself, I need to do this differently. But if I make the mistake again, then what happens? Then I'm still worried about it. I make the mistake again, and I make the mistake again.

So eventually what will happen is with a neurotypical kid, when you make a mistake, you correct your mistake, and then you can relax. You're not always doing something wrong. You made a mistake, you fixed it, now you can relax. But with ADHD, you can't correct your mistakes, which means the only way for you to not make a mistake. mistakes is to be paranoid, be in a constant state of hypervigilance, because you cannot count on yourself to correct your problems. Therefore, unless you are thinking in this moment,

I am making a mistake, I am doing it wrong, there must be a better way to do it, because you've said that to yourself all the time, and then you forgot about it, and then you ended up making the mistake again. So this paranoia of constant mistakes, this sense of overwhelming guilt, that you feel all the time is your adaptive mechanism. Because if I'm always worried that I could be doing something wrong, what is the likelihood that I will do something wrong? If I stop worrying that I'm making a mistake, what's going to happen? I'm going to make a mistake.

People tell me to pay attention. People tell me not to forget. People tell me to focus. And the way that I'm going to do that is by being paranoid. There are a couple of other mechanisms here. So in our ADHD guide and guide to doing stuff, we talk a lot about the comorbidity between ADHD and depression. There's another YouTube video about it. So kids with ADHD, there's a causal link with a mood disorder and low self-esteem because you can tell that your IQ is about it the same as everybody else's.

Kids are actually quite good at judging IQ. But you know that you can't perform the way that they can. You know you're just as smart as your classmates, but for some reason you get D's and they get A's. And so what you come away with is this idea there must be something broken within me because it's easy for everybody else. And people will say, just focus, just try harder, try harder, try harder.

And you're like, I am trying harder. And then it doesn't work. So then you think, okay, like, that must mean that there's something within me that's fundamentally broken. Right? I'm going through life with a flat tire, but I'm jamming my foot on the gas pedal

just like everybody else. There's something within me that is fundamentally broken. That will propagate the guilt. The third thing is there is an emotional regulation deficit. So people with ADHD will experience emotions more intensely, more quickly, and for a longer period. So this may be like a four out of ten guilt for a neurotypical person. That'll turn into an eight out of ten guilt.

It'll persist for way longer. So they sort of live with this constant feeling of I could be doing better. Maybe I'm doing things wrong. Maybe I feel guilty. Okay, really common. And if you look at it, right, so what I like about this is like an unrecognized symptom of ADHD is literally if we pull out the DSM, excessive guilt or paranoia that you're always doing something wrong is not going to be a diagnostic feature. That won't be part of the DSM criteria. Does that make sense?

So I think this kind of stuff can be good on the internet. I think people get a lot of things wrong, but this is pretty good. Okay, so this is a fun one. The complete inability to engage with a topic I see no practical use for or have any interest in. Okay? So this is an attention direction issue, but I want to pull up a paper real quick. I want to show you all. The primary brain-based challenge of self-regulation.

You can pay attention when you want to. That phrase painfully reverberates throughout the life trajectory of people with ADHD, but this is the quote that I really like. In a sense, then, there is a kernel of truths to the perception that ADHD adults can do something when they want to do it. As one middle-aged man with a late diagnosis of ADHD put it, I overdo what I want and I underdo what I need to do.

Love that quote. This is the core problem. It is a problem of attention regulation that when you want to do something, you overdo it. You can't stop yourself from doing it. Right? Because something happens where we get these signals from the outside

that fill up our mind with like, oh my God, I want to do this, I can't put this down, I need to do more, I need to do more, I need to do more. That's a text on ADHD and couples relationships, couples therapy for people with ADHD. It's specifically a text around, it's a treatment manual for, for therapists who are working with people with ADHD who have relationship issues. It's like couples therapy for ADHD. Okay?

That's what the text is called. It's a really great book. So this is where that's the core problem. Right? So you can overdo what you want to do, but you underdo what you need to do. And this is where, this is why I think that like the biggest thing here is it's not that you can't do. what you need to do. It's that the cost of it is way higher. So I think the most underappreciated symptom of ADHD is the energy it takes to do what everybody else is doing. It's kind of like playing

a game where you're on hard difficulty and everybody else is on normal difficulty. The game is roughly the same. The enemies are the same. You find the same loot. Leveling roughly works the same, but you take twice as much damage from all the hits and you do half as much damage to all of the enemies. It's just this flat quantifiable difficulty buff. Right? But buff in the sense that the game is harder. And so I think when you go through life,

you look around and you see all these people are like doing all this stuff and it's like you can do it but it just costs you so much more. And so I think this creates all kinds of problems with expectations. It creates all kinds of things with like the way that you act, right? So you like try to force yourself into doing things.

You should be able to do it. Other people are able to do it. What's wrong with me? How do I figure this out? Like, you know, what do I do? So we just end up pushing ourselves way harder. So even something is simple is like, you know, if you get into a fight with someone, the amount of exhaustion that your brain experiences is way higher.

And let me show you all another paper, actually, that touches on this. So here's another paper. So participants communicated that masking around neurotypical people was difficult and often required tremendous energy to maintain. When participants were no longer able to maintain this energy, they reported that their mask dropped, leading to extreme emotional instability. My emotions can go from like all, like nothing at all to all of a sudden I'm not able to maintain that mask anymore, and it's like a thousand miles an hour or all hitting me all

at one time, which turns me into a blubbering wreck. I had to learn the hard way that masking is not the benefit that I think it is. Participants felt different from neurotypical people and responded to this by masking their ADHD symptoms, sometimes to the point of apparently changing their symptoms, and masking was seen as emotionally difficult to maintain. And this is what the neuroscience supports as well. So if we look at what we look at, what drains your willpower, emotional regulation is one of our top willpower drains. Suppressing your emotions, right? So your emotions are much bigger, more intense. And so keeping those in check causes lots of problems, drains you more than anything else. And then you

have anything left in the tank for like other things. So in terms of these problems, you know, how do we approach this? I think this is where a lot of understanding goes a long way. Okay. And a lot adaptation becomes really important as well. So this is why, you know, Michaela's holding a workshop where she talks about adulting. Let me see if I can pull this up, right? So like, I love the title. AdD. Adalting, getting your shit together. Yay. That's what it's about. But we're going to share some of these principles with y'all, okay? There's a lot more skills-oriented stuff over there. But first thing is understand that you. you work differently.

If you are a ADHD person, if you're a neuroatypical person who tries to force yourself to live a neurotypical life, it's going to be really exhausting. So the amount of energy that you put in is not going to be commensurate with the yield that you get.

Now, the reason that we do this is because this is what we're told to do. We need to focus more. We need to try harder. Stick with one thing. So usually what I try to do is instead of forcing my ADHD patients to do things the way that everybody else does them, I think you should start with the question of

what brings you to your best, right? How do you do this in the best way possible? Like you doing it. So something is simple is if you can't focus on anything during the day, if you have an interview at 4 p.m., do your best not to schedule interviews at 4 p.m. And what I tend to find is most of my patients lack the executive function training to think that far ahead. They don't consider that, right? So you have to sit down and start to make rules for yourself. What are the rules for you? Because your brain ain't automatically going to do it.

So a big part of this is also formalizing the process of making change. So what are the rules that bring out the best in you and look at them on a piece of paper? Start following those rules when you structure your life. And if someone says, hey, we're sorry, the only time we can do is at 4 p.m. This is also really common where my patients with ADHD, you know, job interview calls me back and they say, hey, we'd love to bring you in for an interview. Does 4 p.m. next Tuesday work? And what does someone with ADHD say?

They say, yes. Without even thinking about it. Because we don't want to piss people off. We're lucky to get this job. We want this at all. We want this so much. We don't want to risk them not liking us. So instead of just creating that situation for yourself, take a step back and say, do you all have anything?

available in the morning? When's the first morning slot you have available? You just say that. So if you're someone who can't focus, if you've got something at 4 p.m. And someone, at some point that time is offered to you usually, right? If you have no choice, it's a different story. Like if you have an exam or something, that's scheduled for everybody. But I would say 80% of the time, people will ask you if 4 p.m. works.

Say, don't even make an excuse. This is where we get into excuses. don't make an excuse, don't provide a reason. Does 4 p.m. work with you. Do you have any availability in the morning? That is all you say. Really hard with ADHD because you want to say so much. There's so much in your head.

No, do you have anything available in the morning? Not on that day. When's your first morning availability? We don't have anything that week. Okay, fine. Then 4 p.m. will work. And you can say, look, if you guys don't have any morning availability, I really want to come to this interview.

I'd love to do 4 p.m. If you all have anything available that week in the a.m., like I would strong. We strongly prefer that. Right? You don't need to know reasons or anything like that. You don't have to explain or justify or whatever. Don't do things at 4 p.m.

Second thing is that a lot of the problems you have to solve are solved outside of the problem. This is such a huge mistake that people with ADHD make, my patients make. They come in, they say, oh, I'm having problems with my relationship. that is not a problem that you solve in your relationship. I know that sounds insane. This is where once we understand the mechanism of ADHD, there are root issues in the brain, that if we correct those root issues,

the downstream problems will get corrected. So this is why everyone's like, if someone tells me to meditate one more time, I'm done. Why do we tell people to meditate? Because meditate will strengthen your brain in the way that will help you with these problems, which then gets to the whole, it's hard for people with ADHD to meditate.

That's why we go into that in the guide and we have a bunch of stuff on our channel so you guys can take a look at that stuff if you want to, how to meditate with ADHD. We have this program specifically for training your impulse control and attention. Okay, so a lot of times this emotional regulation stuff, this attentional control stuff,

and this is the big mistake that people with ADHD make, we want to solve our problem and skill up at the same time. We want to skill up to. to solve our problem. We want to work on our problem and skill up. You can't work on your problem. I mean, you can. That's a terrible way to do it. You should skill up outside of the problem, right? So if I'm like preparing to play professional tennis, the practice happens outside of the match. In ADHD, you want to level up while you are solving the problem. The leveling up is outside of the problem. When I go into an instance and I try to take down a raid boss, if I wipe the

way to not wipe is to gear up outside of the raid boss. But we get so hyper-focused on this particular thing. We want to solve this thing. We want to solve this thing. We don't level up outside of it. So if you look at things like what does therapy for ADHD actually entail, it involves leveling up. It's kind of like training for a marathon and then there's the marathon.

Everyone with ADHD, what they do is they just show up at the marathon. They try to run it. They fail and they're like, I need to try way harder. I need to try way harder. They show up at the marathon again and then they fail again. And they say, I need to try way harder. They show up to the marathon a third time and they fail again. Now you've created another problem, which is that you failed at a marathon three times and what do you think about yourself?

You start to think, I'm never going to be able to run a marathon. You start to think to yourself, I'm not a marathon person. You start to feel hopeless. Therein comes the depression. Okay. So skills training is outside. And now why is this so common sense? doesn't everyone do it?

And that's where we go back to this. I overdo what I want and I underdo what I need to do. This is what's so devastating about it. Meditating is leveling up your brain so that you will be able to do these kinds of things in the future. But what do you think is the actual attraction to meditating in the here and now? When you have a circuitry that is externally oriented. When you have a circuitry that is environmentally oriented, when you have a circuitry that is environmentally oriented, when you have a task that yields you no immediate benefit,

like studying for an exam that you have at the end of the month, your brain does not want to do it. This is why it is such a crippling issue. Because the whole point is that you can't do it ahead of time. You need that external level of environment to motivate you in order to act. So training outside of doing the task, going and grinding gear so that you can down the raid boss is incredibly boring. It's not how your motivation system works.

So how do you address that? And that's where I suggest you start very concretely in doing things that are not important to do. So as you look around, you'll see there's all kinds of stuff that you should do, all kinds of things that you need to do, and all kinds of things that you want to do. What I encourage you to do is just practice doing, doing the task that you don't want to do.

And it's not even about should or need. It is recognizing that once your brain has a certain motivational system that is active, once I train my brain only to act in last minute panic, then what I require is last minute panic in order to act. Right? Neurons that fire together wire together. So we want to start unwiring those neurons. We want to take a small little thing.

I have this thing that has been sitting on my desk for six months. And this is something that my daughter 3D printed for me in 3D printing class. I've been sitting here. I didn't want to throw it away. I think it's a cat maybe. Can't tell. Yeah, maybe it's a cat, some kind of animal. And it's just been sitting here.

I also have a sanitizing wipe from United on my desk. And I have a pencil. These three objects have been sitting on my desk. for like a year. And I never dealt with them. So what am I going to do today when I'm done with stream? I'm going to take care of these three objects. Now, it's important to understand why I'm doing this.

I'm not doing it because I should do it. I'm not doing it because it needs to be clean. I'm doing this because I want to train myself to decouple action from environmental stimulus. I want to start acting when I do. don't need to. And this is where, like Dr. Michaela said, a big mistake that we make is that we try to start with things that are emotionally active for us. We start with things that are important. Huge mistake. Don't start with the things that are important. Start with the things that are unimportant. Because if something is important, it's going to trigger your emotional circuitry.

The moment that you trigger your emotional circuitry, remember, we have an emotional dysregulation problem with ADHD. So those emotions are going to hit you harder. They're going to hit you faster, and they're going to hit you for longer. You're actually making things hard for yourself. If I'm a level one character and I start aggrowing level 90 mobs and I keep wiping over and over and over again, I'm not actually leveling up. So start with tasks that are unimportant and focus on doing it just to train yourself to get into the habit of doing things without it being important. Great place to start.

Right? Yeah. So people are saying that's my life in a nutshell. Wiping against level. level 90 mobs and thinking we're leveling up doesn't work like that. But that's what our media shows us, right? Like, oh, I'm the, you know, there's, oh, actually, sometimes there's lots of training montages. But anyway, let's do questions.

And then we got a couple of other things that we can do. And while we're doing questions, so I'm going to do something apparently funsies. Do, do, okay, guys, give me a second. I'm now doing streaming things. Okay. And then we're going to go to YouTube. From Under Your Kitchen, you've done about 500 episodes now. Have you ever had an interview, NACA's planned?

Or I feel like you're so rehearsed. I mean, not rehearsed, but you do your homework. Oh, tell me, please. Yes, whatever you're about to say, say it. They've all got really well. Now, there was this one day where I had two interviews in the same day, and my research team blessed them, they sent me the research. So they send me the books, the research.

I click on the file, I start reading. I spend five hours reading the research. I'm ready to go. I've watched all the videos. I know everything about this person. I know their kids, their favorite music, everything. And then I walk into the studio to meet the guest. And I look up and I have no idea who this person is.

I've accidentally done the research for the other guests that was coming on in the evening. So I spent five hours and I didn't even know this person's name. So I walk up and I take their hand and we sit down and my producer, I think it's actually here tonight, says to me like, ready to go. And I don't know what this person's name is, let alone what they do.

So I said to the guy, I said, tell me how you spell your name. Which is what you do, right? And I'm hoping for like... That's such a good move. Of course. Tell me how you spell you. He's like, John. Yeah, this is the problem.

If you go for that strategy, it has to be like an Anastasia, a Malika. It has to be something. The guy said his name was K. The letter K. His name was K. He's called Dr. K, K. They called him K. So I was a K, okay, okay. K or K-A-Y?

He's like, no, K. I go, yeah, no. My first question to him, producer goes, ready to go. My first question to him is, for anybody watching at home, Kay, if they don't know who you are and what you do, please can you let them know and tell them why they should listen to this conversation. God bless him. That's kind of genius.

Yeah. And he said, amazing answer. And do you know what, we had one of the most downloaded conversations in the show's history for the next three hours. Is that right? Yeah. It was one of our, it was one of my favorite conversations ever, and it was one of the most downloaded that we've ever had. And it taught me to never do research. No, it taught me, it taught me that as to be a good interviewer, your job isn't to lead, it's to follow.

And if you listen, people will take you where they want to go with a conversation, because most people haven't had someone just listen to them really for like more than 10 minutes ever in their life. So true, dude. And it was, it was a beautiful conversation. So, oh my God. Yeah. So now I don't do any research. Yeah, right. That's beautiful, dude.

Yeah, so, so, you know, this is kind of, I remember. And he did, it's funny, Stephen did actually tell me, he told me that. So, you know, he had, he mentioned that something got messed up or something, but he's an amazing interviewer and really love the dude. He's, he's great. I didn't, I didn't know that side of the story, but yeah. And that's where it's kind of interesting, because people will ask, me like, you know, when we do interviews. So I actually try not to do research. Like I will try to

not, I try to go in blind. Because what I find is especially on the internet, like if you look at the internet, like everyone has all these judgments and opinions and all this stuff about, you know, like who this person is. And I think if you go in blind, like all that's going to do is bias you towards this person, right? If they're an, if they're an asshole, that'll show. And if if they're, but if they're not and you go in, like this is, it's so sad. Like, I see this all the time, especially with, you know, there was a couple of pretty bad shootings here in the U.S. over the last weekend. And, you know, people like approach these conversations and you start the conversation with like guns blazing. You start the conversation with like

so much negativity. There's, there's no sense of devoiding yourself, like voiding yourself. Like, voiding yourself of like all of your prior conceptions. And so what ends up happening is it's just like I'm coming into the conversation with all like fully armed, ready to throw down. I've already made my judgments. There are so many interviews that are like kind of like gotcha, right? There's like kind of gotcha journalism. I'm going to try to like, I already know what I'm going to say.

This conversation is actually me manipulating you into saying what I want you to say. And I see this all the time with like political TV shows where someone will like say something that's like somewhat moderate. And then what the interviewer will do is they'll polarize it. I don't know if you guys have seen this. They just polarize it. They're like, so are you saying that killing babies is good? They do this reflexive polarization.

You're not trying to understand what the other person is actually saying. conversation becomes like a form of like I don't know like just getting what you want out of the other person you're trying to extract something from the other person right so I think and I think this is why on occasion I make the mistake because I love it of watching LSF I will browse LSF I love LSF I think it's terrible

and I think it's great I love it. And what I see on there, anytime there's like beef between people, is that no one is trying to understand the other person. Right. So when you converse with someone, there's no attempt to understand. There's just, I'm going to try to prove you wrong. Here's my perspective. Here's my point. And I really think if you want to understand what's destroying the world, like number one reason the world is going to shit, it's that no one is trying to understand. it's just not considered important. Winning is important.

Being right is important. And why is being right? Right. Let's understand this. Right. Let's understand. This is really important. Being right is important because if I don't win and if we do it your way, the world is going to get worse.

Right? The world is going to get worse in a really, really noticeable way. You can talk about Gaza. you can talk about politics, you can talk about health care, you can talk about whatever. Like, there is so much on the line that we need to win. Because if we don't win, then everything will fall apart. Right? Like, if you take an issue like climate change, like if we're, if I, if we don't win, the world is going to end.

And if we don't win, the economy is going to go into the dumpster. the stakes are so high that understanding where someone else is coming from doesn't seem to be important at all. And if you look at why the world is getting worse, right? So this is where like when my patients come to me and, you know, sometimes I'll have like ideas for them

that they don't like. And I'll sort of ask them, okay, like, so here's your strategy in life, right? Do I understand this right? How's it working out for you? And if you are not happy with the way your life is going, then change your strategy. It's that simple. I don't care about why your strategy is right.

I don't care about why my strategy is wrong. That all becomes irrelevant. If you are not happy with the results, change your actions. It's that simple. So simple. In the East, we call this karma. In physics, we call it Newton's third law. If you act in a particular way, it will create certain results.

And as, and then oftentimes we think like, oh, I didn't do it hard enough. I need to do it more. I need to do it more. Right. And so if you don't like the way that things are going, then we need to change our, our angle. And this has been, maybe it's just top of mind for me right now because we had, like I said, a couple of bad shootings happen in the United States and everyone's kind of talking about it. And I see the same stuff that I see all the time, which is that no one is trying to understand. Right.

Everyone is just looking to blame. And the stakes are high. and we can't afford to lose. And so we look at the way the world is right now. The world is the way that it is right now because it's what we made. It's what we did. We made certain choices that create the world that we live in.

The world that we live in is a consequence of the choices that we make. If you have litter in your streets or your streets are clean, that is determined by the choices of the people that live there. Very simple. I'm not saying that A choice is right or A choice is wrong or left or right or whatever. I don't comment on that because I know this sounds insane. I don't know. And I don't know, not because I'm not trying to take responsibility or anything like that,

but this is a situation where I see a lot of people who are very, very convinced that they're right. And so if I want to understand what I think is right, I should start by understanding what they think is right. That's the only way that this is going to work. Right. And in terms of like what to do about this, like, I don't know if people have tried this or not. But if you have any persistent conflict in the world, take your hot-button political issue of choice, I wonder what would happen if you took everyone involved or you took a couple people involved

and you threw a psychiatrist in the mix to try to facilitate a conversation. That's literally what we do. We take people that are on the verge of divorce or in the process of divorce that hate each other, that are done with each other. And we use a certain skill set to increase understanding on both sides. Instead, what I see is negotiation. There's a great book called Don't Split the Difference, or Never Split the Difference, which is about negotiation.

It's written by this FBI, like, hostage negotiator, who's like, talks about how you can always get what you want. There's no spirit of cooperation anymore. And this is where, why isn't there a spirit of cooperation? Because it's their fault. They don't want to cooperate. And that's where it's like, let's take a step back, right? If you take someone who's in the process of divorce,

I've already done everything. They're the problem. They're making all the mistakes. I'm right. They're wrong. Other partner says, they're making all the mistakes. I'm right. They're wrong.

This is how it is. We're all sure that the other person is an idiot and I'm doing everything right and they're doing everything wrong. Sound like any political conflict that you know? Sound like any issue that sounds familiar? So the first thing that we got to do is understand. Not change, not win, not negotiate.

Right? And maybe this doesn't work. Maybe the reason that there are no psychiatrists helping out with this kind of thing is because people tried it before and it didn't work. And it made things worse. That's possibility. Right? We have to acknowledge that. But I really think like, there's a world where legends race across city skylines. Romance blossoms in glittering ballrooms. And there's magic around every. every corner. It's a world known to many as Great Britain. You've seen the action on screen. Now visit the real star of the show. Visit Great Britain. To discover more, go to TripAdvisor.com slash Great Britain. You know, like it's, I don't want to, you know, I have so many people in my head right now that I would like to talk about, but that's not something that we do here. Maybe you guys can piece together the, puzzle, put the puzzle pieces together.

But I mean, it's the kind of thing where it's like, you know, I could have a conversation with someone. And I think we should give it a shot. Like, try it, right? Try it. Let's try to take two people who really disagree about something and just see how far we can get. And I don't want to comment on particular people because I don't think that that's right. But, and I realize now I was like, oh, now you guys can maybe put the puzzle.

And that's shitty. I'm sorry for doing that. But really, a big ethos of this channel is that we don't talk about people. We really don't. We talk to people. And anyway, thus the rant endeth. So I apologize for doing that because now I created, stirred up more shit than before. But, okay.

How can I upskill things like learning a language when ADHD limits my ability to not self-motivate due to no deadlines, et cetera? Okay, this is great. So people with ADHD, how do you upskill when there's no deadline? right so I want to learn a language I want to learn an instrument I want to start exercising I should clean out my closet there's a lot of stuff that I really do want to do I want to do it but there's nothing externally motivating me and that's where the key thing is to decouple your action from external motivation and there's a great paper I'm going to pull up I got to say chat sometimes I feel like a Chad because it's like, okay.

Man, I read a lot. Okay. First, extrinsic reinforcers have elic amygdala, ACC, ventromedial, prefrontal cortex, orbidoprontal, blah, blah, blah, blah, blah, blah, blah, blah, blah, okay? Activity in healthy subjects that was associated with higher self-reported extrinsic motivation, but lower self-reported intrinsic motivation. So first thing to understand, there are all these regions of the brain.

When we have activity, in these regions in the brain, we have higher extrinsic motivation, i.e. responding to deadlines, inner, lower self-reported motivation. Okay? Now, here's the cool thing. Others report that intrinsic motivation was associated with the deactivation

of the amygdala, dorsal ACC, ACC over here, ACC over here. Right, dorsom medial striatum, ventral striatum, not exactly the same, but in the same ballpark. And insula, this is another piece of evidence linking neural deactivation to intrinsic motivation. You all understand? This is what a lot of people don't realize. You can be externally motivated or internally motivated. You literally in your brain cannot do both.

There are some circuits in the brain. When those circuits are on, we are externally motivated. When those circuits are off, we are internally motivated. Literally, it's the same part of your brain, right? It's kind of like, I can be breathing or I can be swallowing. There's one space. Esophagus is collapsible, right? there's two tubes.

And when stuff goes down the neck, it either goes into the lungs or into the mouth. You can't do both at the same time. You have this one part of your brain. If it's on, you're externally motivated. If it's off, you're internally motivated. So basic problem in ADHD is that we are overly extrinsically motivated. So as long as that circuitry is active,

how can I do something without deadlines? As long as your brain is wired to respond to deadlines, you will never do anything on your own. So then the question becomes, how do we deactivate it? And that is where we have to literally stop being externally motivated. So this is what's confusing for people. They're like, how do I internally motivate? How do I force myself to do this thing?

That's not the right thing. What you want to do is shut off extrinsic motivation as best as you can. So start to do more tasks for no reason whatsoever. Start to do things. don't try to do this thing the thing that is important to you that you can't do without a deadline don't try to do that without a deadline

start to do anything without a deadline it doesn't matter what it is this is really confusing for people because they're like I'll give you all a simple example start brushing with your teeth that's when you know you've streamed too long

start brushing with your teeth start brushing with your teeth start brushing your teeth with your non-dominant hand. Okay? Just start brushing your teeth with your non-dominate hand. Start doing things for like no point whatsoever. Okay? That is one way to do it.

Second thing is where people get a little bit confused. But you need to start taking actions. I know this sounds weird. Based on your choices. So make choices. It doesn't matter what the choice is. It's not about don't think about what. what is the right choice or the wrong choice?

Okay, this is really important. So when I think about right choice or wrong choice, that is an external factor. Right means, okay, what should I major in in college? Which thing will make me the most money? How do I show up at what should I wear to work so I get promoted? All the time we're trying to make the right choice. Stop trying to make the right choice, make a choice.

Make the choice that you feel like. Not the choice that you want. It's not a desire. not the choice that you should do, just make a choice. Today I'm going to do this. Why? Because I feel like it. Make an intentional choice.

This is different with ADHD. Don't follow an impulse. Following an impulse is not making a choice. And according to this beautiful thing called self-determination theory, intrinsic motivation is going to come from making choices, not making right choices, just the part of your brain that chooses between two things. I don't know if this makes sense. Follow me here, okay?

When I should do something, that is my brain looking outside and saying like, okay, this is the right choice to make. This is what I should do. This is what I need to do. I'm not actually making the choice. I'm being forced to make a choice. Does that make sense? The moment right and wrong enter the picture, now you're forced into making a choice. It's not really your choice.

Practice your freedom. What are you going to do today? What I choose to do. Just do it is wrong. This is important to understand. You have to understand. It has to be an intentional choice that you make. Just Do It is usually, the reason, I mean, it's not wrong, but the reason is like a lot of people like, how do I get to work out?

Like, oh, you just do it. You just do it. What we're talking about is an internal process. It is not about the doing it. This is the thing. When you say just do it, it's the action. Remove all mental process. That's incorrect.

Doesn't work. You need to do something internally. Make a choice. Second thing that you need to do to activate your intrinsic motivation is stretch your capacity. This is the second thing that people who are extrinsically motivated never do. You want to know why everyone feels so directionless in life. It's because they never stretch their capacity. In fact, what they try to do is the minimum of their capacity.

How hard can I work to not get fired? We have all this like anti-work stuff going on. companies take advantage of people in a really shitty way, absolutely. And how do we respond to this? We respond to this by doing the bare minimum. And there's a lot of boomers out there who are like, you should work hard and you should do this and you should do this and you should do this. And my day we worked hard.

I'm not saying you should or shouldn't work hard from a work standpoint. What I'm saying is that from a neuroscientific standpoint, if you do the bare minimum, you will never be internally motivated. Because what is the bare minimum? Pay attention now, okay? What is the bare minimum? The minimum is decided by someone outside of you. How hard do I work to not get fired?

So your brain is literally thinking about the minimum amount of effort required for this external thing to happen. You're externally motivated again. Stretch your capacity. So whatever you are capable of doing, try to do more. And I'm not saying to do it to get promoted because if you do it to get promoted, it's still extrinsic motivation. We're trying to deactivate these circuits in the brain. Do you all understand? The why becomes the most important thing.

And everyone focuses on the how or the what or efficiency or productivity. That's all about output. They're not focusing on the internal. That's why we have a mental health crisis. That's why we have a burnout crisis. That's why we have a productivity crisis. That's why we have a motivational crisis. Because we started focusing on efficiency and productivity and getting more for doing less.

And in doing so, we literally shut off the circuits in our brain. that make us intrinsically motivated. We flipped that switch. So stretch your capacity. I love this because this is something that gamers know how to do all the time. I fucking play Dota with these people who are terrible at Dota. And the reason that they're terrible is because they throw all the time. They throw all the time.

And why do they throw all the time? because they're pushing their limits. We're ahead by like 10K, we're winning, and they're like, let's tower dive. Let's see if we can tower dive and survive. And why do those people play Dota? They're intrinsically motivated. No one is telling them you're going to play Dota

because it's going to help you on your resume. No one is telling them it's going to help you get late. It's going to help you do this. It is the stretching of your capacity. Let's see if we can do more. Another great example of intrinsic motivation. I went on a hike with my kids about a month ago. And they'd like see a rock.

They're like, let's see if we can climb it. That's it. And if you look at kids, they're so intrinsically motivated. Before your ass and my ass got beaten down by society and grades, and you got to do this, and you got to do this, and got to do this, we used to have zest in life. Right? We used to get excited to wake up every day. When I was growing up, like, we'd, like, go outside and we do, I don't even know what,

for 12 hours. What'd you do today? I played outside. What did you play? I don't even know how to describe it. But now what is going on? What we've done, so terrible, we've gamified everything. Oh, you want to meditate every day?

Let me give you points. And if we give you points, then you'll do it more. If you look at the world that we live in, it is so, it is shaping to be extrinsically motivated. We have lost, I don't know if you get this to making sense, we have lost so much intrinsic motivation that we've started to have to bribe people to do shit. And the more that we bribe people to do shit, the more that we activate their extrinsic motivation. Do this so many times and then you'll get, like, come to our place to get nine sandwiches and then you'll get a 10 sandwich for free. It's all about behavioral engagement, but it's behavioral engagement in one direction. And now we have all these punch cards and we have all these trophies and we have all those gamification over here,

gamification over there, work so that you get promoted, you should work extra hard so you do this. I'm going to pick you up from the airport. So now you owe me a blowjob. Everything that we do, nice guys, work stuff, meditation apps, extrinsically motivated, extrinsically motivated, extrinsically motivated, extrinsically motivated. And here's the really scary thing. This is what's so devastating. See, I want y'all to understand. and I've said this.

I don't know if you all really get it yet. Okay, and I'm not trying to be a dick. This is a part of your brain. You have one part of your brain. Okay? Wait, what happened? Does something clip? Did I miss something?

What happened? Oh, the blog job comment? Okay, sorry, I got... Okay, no, but I mean, come on. Like, how do I keep talking? Like, what the fuck, dude? Don't you all realize? it's the same thing. It's just another example in a series. We don't need to get all caught up about it just because it's sexual. Like, tell me I'm wrong. Right? Like, that's my point is we get all of this stuff. We're like, oh, we're so caught up and like all this shit. But it's like it's the same thing. We're extrinsically motivated. Whether you're working extra hard to get a promotion or you're picking up someone who friends owned you 10 years ago to get a blowjob. It's the same thing. I'm serious. Like, don't get thrown off.

Okay? I'm not trying to shame a good BJ. All I'm saying is if you are really good BJ, it shouldn't be externally motivated, not be something that you should be owed. It be something that is given with love. You feel me? Okay, let's go back to the key thing. Okay, no, don't fuck. Stop. I want to get, I was cooking there for a second. And then you guys got caught up with the sex. Okay, stop it. We go back. I return. Okay. Here's the key thing. thing. This is what I want you all understand. This is a part of your brain. Okay, part of your brain. So here's the really devastating thing. If your brain, your brain is turned on. If it is turned on, it is, you carry that with you wherever you go. You'll get that? Like that is in your brain. It's like, if I break a leg while I'm playing soccer, it causes me problems when I'm giving a blowjob. Right. Like, that injury carries forward to all of the things that I do. Okay. So, if your brain is extrinsically motivated, okay? If your brain, why do I stream? Do I stream for the money? Do I stream for the fame? No, baby. This right here, what you're seeing right here, this is intrinsic motivation. You all see it? Can you all tell the difference? Are we doing this for subs or likes or shit? No, this is for my pleasure, my benefit. Y'all, y'all get me, okay?

All right. So here's the thing. Your brain, if it's turned on oriented towards external motivation, that will carry with you wherever you go. So here's the really scary thing. Everyone's like, oh, my God, I'm so burnt out at work. I have to do this work. I have to do this work.

Like, I'm trying to get promoted. And then they go home and they're like, oh, I don't feel like I have an energy anymore. Oh my God, I have no energy. I have no energy. Oh my God. That's because you've turned on your extrinsic motivation. That circuit in the brain is activated, which means that the moment there's no external pressure, you will not act. The harder you work to get promoted, the less you will do for yourself in the rest of life. Y'all understand? Really simple. So this is what's so scary. I work with so many people who can force themselves into external motivation. I'm trying to get, and this is back when I was teaching at Harvard and all that stuff,

and all these medical students at Harvard Medical School and they're rotating with me and stuff. They're so externally motivated. A lot of them are really great people. I love it. It's a real privilege. But some of them are like really paranoid. And they're like, I got to get good grades. I got to get good grades.

I got to get good grades. They're so extrinsically motivated. And so all the dimensions of their life where they're absolutely crushing it are Extrinsically motivated. Half of them are like that. The other half are intrinsically motivated. It's amazing to see. Right? Two kinds of students at Harvard go in volunteer in a jail. One does it because they care about the people in the jail. One does it because they want it to look good on a resume. Those two are not the same. And the really scary thing about extrinsic motivation is if you have a life where you are forced into extrinsic motivation, that circuitry will carry over into the other parts of your life. That's why it's so hard to find motivation today.

So here's the really scary thing. You can't have it both ways. You can't be gunning for the promotion at work and then come home and be intrinsically motivated to do something else. It's one or the other. So interestingly enough, everyone's saying, how do I find motivation intrinsically? You need to let it go extrinsically. This is where you got to stop caring about the promotion.

And this is where people make a huge mistake. They say, stop caring about the promotion means, oh, that's easy. I can mentally check out. That's easy. I had to force myself to care about work anyway. I can mentally check out. It's easy. I can do that, bro.

Ain't no thing. Crucial mistake. I'm not telling you to stop caring about working. What I'm saying is that you should work twice as hard, but for no one but yourself. You should work for your own sake. You should go to work and you should say, I'm going to learn this shit as best as I can. I'm going to learn this shit because I want to be really good at this thing.

I want to acquire this skill set. I want to do right by my clients. I want to do right by my coworkers. I want to do right by my boss. Not to make them happy. Not to make money. I'm going to do it because I'm going to do it. And that's like, and it works so well.

It's what I did. Worked great for me. taught it to a bunch of people. I'm convinced this shit works. I go from a 2.5 GPA to like winning awards in medical school and not showing up to the award ceremony because you didn't even check your grades. I don't care about the grade. I went to learn medicine.

I went to learn everything I could about the body. Comes from in here. I didn't give a shit about anybody else or anything else. It's great. I highly, highly, highly recommend doing this in your life. If this sounds arrogant or this is another that influence it. I'm Dr. Kay. I'm so great at everything.

I realize that's what it sounds like. But here's the thing. I don't care what you'll feel. think. I speak it because I think it's true. If you want to judge me for being another fucking soulless influencer, I don't think you're right, but hey, if it looks like a duck and quacks like a duck, maybe it's a duck. You know what I'm saying? Right? Like maybe all the right. Who knows? What, can I really make a defensible argument there? I don't think I can make a defensive argument.

Great question. And I love questions that get me on rants. All right, one more, chat. Oh, can you deal with shame in ADHD symptoms at the same time? Oh, my God. What a brilliant question. Love it. Okay.

So, when a patient comes into my office with ADHD, or do they have a diagnosis of ADHD? In my mind, they have a diagnosis of major depressive disorder or depressive episodes until proven otherwise. I default all of my patients in my mind to depression. Now, does that mean I diagnose it with that? No, what that means is that when someone grows up with ADHD, there's a really good chance that that creates a mood disorder. Unless I understand that, and unless I look for it, there's a really good chance I'm going to miss it.

So when I do therapy with people with ADHD, I do two kinds of therapy. One is, here are all of the skills that you need to learn to succeed in your life. Here's how you get organized. Here's how you find motivation. Here's how you pay attention in relationships. Here's how you pay attention at your job.

Here's a little bit of that stimulant to help you out. You know, I do all that stuff. But I also discover that I have to do another kind of thing, which is I need to fix or we need to repair all of the psychological hurt. of growing up with ADHD up until this point. All the things that you knew you were capable of that you got passed over for, this girl that you really liked or this guy that you really liked, that y'all went out on a day, but you couldn't pay attention to a fucking conversation.

So they ended up dumping you for someone else. You know, all these people that texted you and you, like, saw the text, but you wanted to say something really important. They sent you a really important text, but you didn't have time for a really important text right now. So you said to yourself, I'm going to do it later. And then what ends up happening is you forgot. And so someone sent you a really important text, and a month later, you realize, oh, shit, I got that text.

And I never responded to them. And then it feels really stupid to respond to it a month later. So then you don't know what to do. And so then you're just kind of like whatever. The consequences of growing up with ADHD is different from treating the ADHD itself. Do you all understand? So, to give you all an example, there's a great medication. called an ACE inhibitor.

Angiotensin converting enzyme inhibitor. When people have hypertension, hypertension means a high amount of pressure in the blood vessels. So my blood pressure is super high. So if the pressure in the vessels is really high, the heart has to pump really hard, right? So I have to overcome,

if I want a pressure gradient, which means I want blood to flow from here to hear, blood starts in the heart, and the pressure is high in the system, I got to squeeze really hard to overcome, to create that pressure gradient. So if my vascular has a systolic blood pressure of like 150, the heart has to pump higher than 150. So the heart starts pumping really, really, really, really hard. This is hypertension. Then the problem is if you go many years in your life having a high blood pressure, your heart will have to pump really hard. And if it pumps really hard, What happens when a muscle works really hard, chat?

Y'all know? Ah, beautiful. Someone said, heart becomes thick. Perfect. What happens when I lift a bunch of weights? Dr. K. gets swall. The heart becomes swell. The heart starts to swell.

But then we run into a really interesting problem. This is so scary. So the heart gets blood from two places. It gets blood from the inside because it's full of blood. And we have these things called coronary arteries, which are on the outside of the heart. So I've got some blood coming for arteries over here, and I've got blood inside the chamber. So I've got blood coming from both sides.

And the heart is happy. But if my heart expands because it's getting swall, now I have arteries over here, I've got blood over here. They don't reach this middle area. The heart becomes starved for blood, despite the fact that it is surrounded by blood. There is the hypertension which causes problems, and then the heart tries to adapt to those problems. that creates additional problems. When we give someone an angiotensin converting enzyme, we alter or we change the alterations in the heart themselves.

It doesn't just decrease the blood pressure. It alters the cardiac remodeling. Do you all understand how these are two different things? I can reduce the pressure directly, but that I can also prevent the adaptation that the heart makes in response to blood pressure. This we have to do in ADHD. There is the ADHD skills,

which is like the blood pressure, we've got to teach you these skills, but then we have to fix the adaptation that is also causing problems. The low self-esteem, the chronic feelings of guilt, the feeling like you're fundamentally broken. These are the things when you grow up

with undertreated or untreated ADHD, it shapes your psychology. So anytime I'm working with someone, how do you deal with shame and ADHD because the two spiral off of each other absolutely because not only do we have a lot of shame our sensitivity to negative emotion in ADHD is higher negative emotion controls us very powerfully

so we have to fix that that's completely independent so that's why what I usually do is I do it sequentially not at the same time don't fix ADHD and shame together not good. So usually we'll start with the ADHD stuff. So let's just like, bra, if you're feeling terrible about yourself, we can talk about how you feel sad about yourself and, but like, if you're on probation at work, like, let's fix that shit.

You know what I'm saying? Like, if your partner is really frustrated with you, like, let's rack up a couple of dubs before we like keep on racking up the else. So like let's like do this. And that's where things like stimulant medication can come. in, non-simulate medication can come in, like meditation can come in. Like, let's actually, like, let's start by just putting out the fires. Then we'll worry about rebuilding.

So I don't deal with them at the same time. I usually try to deal with them sequentially. So once you have some stability in your life, then let's ask this question. And this is usually the thrust of the question I ask. You've been here on this planet for 35 years, let's say. You've gone this whole life, you've been struggling so much. now you finally feel like things are under-controlling, you're doing better. This is a win, right?

This is good. No. What's it like to have to work this hard after all of this time just to get back to normal? What's it like to let everyone else just figured this stuff out and you've been suffering for 35 years? And you had to come to my ass and this office for six months just to get your shit like, basically like put out the fires, what's it like to have lived a life where working so hard just gets you to normal? And that's when the tears come.

And that's when we hug it out and they're like, all right, bra, let's talk about it. Now the real work begins. Now, practically, I try to do it sequentially, but practically that conversation shows up way faster. Like, it's not like they like do all that stuff, right? But they come in and they're like, my problem is like, I have difficulty focusing out. And I'm like, okay, let's talk about difficulty focusing at work. Here's some solutions you can try.

You should try meditating. Have you heard of meditation? Let me teach you how to meditate. That's got to regret. That's going to make great. That's going to make great. And then there's all this shame that's getting in the way of that. So it's like, oh, yeah, I screwed up.

I know you told me to meditate. I'm not meditating. I'm so sorry. I'm such a bad patient. I'm like, oh, my God. Love yourself. Practice some self-compassion. Grab a journal.

Let's talk about five things that you love about yourself. every morning and every evening. Doesn't that make you feel better? Oh, you forgot that too? Oh my God, let's do it now. It's great. Love yourself. Did you watch more TikToks?

Watch TikToks about loving yourself. That'll help. Okay? So practically it happens way earlier. But, yeah, so I think it's really hard to do them at the same time. So I think doing it at the same time is like, it's really hard to do.

Don't do it. do one and then the other. Like, come on, bra. Each of those is a problem that's too big to tackle and you want to do them both at once? Like, what is this? Like, Mantis Lord's Hollow Night? Like, I don't think so, bro.

I wiped on the first guy way too much. Okay? This episode is brought to you by Redfin. You're listening to a podcast, which means you're probably multitasking. Maybe even scrolling home listings on Redfin, saving homes without expecting to get them. But Redfin isn't just built.

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Okay, well, hopefully it moves you in the right direction. Cool. So someone did do a journal. Look, I'm not against journaling. I'm not against self-compassion. I'm not against any of those things. Those things are great. They're great.

Oh, my God. Have you tried that? But also, oh, ADHD paralysis. Why do I procrastinate on things that I want to do? Okay. It's a Saturday. ADHD paralysis and procrastination. I'm going to let you all go ahead.

I'm going to, I'll prepare lectures on that. Okay? I will do lectures on ADHD paralysis. Do I have a lecture? Have we already done? Let me look. Have I done this before? There's some good stuff about this, but I think I'm going to do, I'm a prep a lecture.

I'm a prep a lecture about paralysis, procrastination, and ADHD. I do that. I do that for you. So while I could just riff, I feel like I have riffed enough for today. And also, I think this is definitely something where while I could riff, I really think it's doing y'all a disservice. Because some of these things, like I want to make sure that the neuroscience is there and we've got like good stuff to say and things like that. Yeah, so this is the great thing.

So someone's asking ADHD paralysis and procrastination stems a lot from feeling overwhelmed. No. Yes. And there is a differential diagnosis. There are all kinds of mechanisms. Right? There's things like time blindness. There's like the reason that you procrastinate is because your internal biological clock doesn't work well in ADHD.

And if your internal biological clock doesn't work well, we have a video on time blindness. so you all should check that out. If your biological clock doesn't work well, it doesn't know how to measure how long things take. So imagine you were trying to measure how long something took, but you have no stopwatch. And then how are you supposed to plan your day?

Like, and if you have ADHD, you know what I'm talking about. Sign up for my health insurance on the HR portal at my job. How long does that take? 15 minutes or 15 days. There's literally no way of knowing. Oh, I have to write a paper. How long does that take? 15 days or 15 hours.

Can I do it in one night or two weeks? There's literally no way of knowing. And so if you think about it, imagine like there's an alien that has no concept of time. how would they plan their day? It becomes impossible. So then the strategy in ADHD becomes wait till shit is falling apart and then just start doing it until it's done.

And that's what we do. Just start and keep doing it until we're finished. And then we get back full circle to why we end up with so many things that we can't chip away at is because we have to do everything all at once because that's the only way we know how to do it because until we do it until it's done,

then it's going to keep being there, and we don't know how long it'll take, so I might as well keep doing it. Got to do it at some point, so might as well do it now, might as well do it until it's done. And it's all because our brain has no biological clock. So it's crazy.

This is what the problem with ADHD is like, the brain is supposed to have certain features that are like required to do things like plan. But how are you supposed to plan when you have no measurement of time? So that's why it's so interesting. But the solution is to use external sources of time tracking. Use a stopwatch. Because here's what's really cool.

When you use a stopwatch, it goes in through a different part of your brain. It goes in through your perception or sensory circuitry. Here's the really cool thing. The sensory or perception circuitry is really powerful with ADHD. We can detect all kinds of things. So instead of using, we need to turn our internal clock into a sensory perception. And the moment that you start doing that, planning will become easier. Procrastination will become easier.

Good luck, y'all. Be sure to check out. If y'all are interested in practical tips like this, definitely check out Dr. Michaela's workshop. It's on September 27th. People say her workshops are epic. She really focuses on a lot of skills training. So if y'all are like, what do I do about this problem? There's two things I'm going to say.

I can tell you what to do. But if you want to have the skill set done, like not done, but like if you have wanted to have leveled up, right, if you want to finish the tutorial, like at the end of four hours, like you show up, like I think it's on Saturday or something. You show up on a Saturday and at the end of the Saturday, you're like, you've made some significant progress. If you want to have progress behind you, that's why y'all should do a workshop. That's why we offer them. because I don't know if this makes sense. So I know I'm an influencer. And so we have like courses and workshops and stuff.

But you'll know why we do workshops? Because we've been making YouTube videos for five years. And for some of y'all, I've seen here, some of y'all, it's been transformative. But for some of y'all, it hasn't. So it's like, like I was saying earlier, if a strategy isn't working, what should you do? Should I just make a thousand more videos?

I am going to make a thousand more videos. but let's be clear. Those thousand videos will hopefully help a lot of people, but if you're someone who watches a lot of videos but never does anything about it, you need a different kind of push. Does that make sense?

We offered it because watching stuff on the internet, I know, that's insane. That's insane, y'all. Watching stuff on the internet doesn't equate to changing your life all the time. Now, I know we do good work here.

I know I'm Dr. Kay. If anyone can do it, I can do it, right? Check. But sometimes you need a little bit more. So go for it. And hopefully it'll help. And if that doesn't work, then we'll move on to something else. Okay?

Take care, everybody. Thanks for joining us today. We're here to help you understand your mind and live a better life. If you enjoy the conversation, be sure to subscribe. Until next time, take care of yourselves and each other. This episode is brought to you by CarMax. Want to buy a car the easy way? Start at CarMax.

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