The Chris Voss Show - The Chris Voss Show Podcast – Psychology Within the Context of Psychiatry: Closing the Translational Gap by Amy Twilegar

Episode Date: June 16, 2025

Psychology Within the Context of Psychiatry: Closing the Translational Gap by Amy Twilegar Amazon.com Psychology and Psychiatry are fields grounded in the assessment and treatment of clinical disorders and mental health. As such, the two professions aim to identify and treat specific psychological and physiological abnormalities within the context of psychological dysfunction; however, this convergence proves disparate when considering the divergent analytical confluence with regard to rigid structure compounds for labeling certain disorders. The criteria-based assessment variables for classifying ADHD remains fundamentally based in childhood for symptom expressions in the diagnosis across age groups; however, the etiological significance to latent trait expression remains to be obscured. This work aims to re-evaluate such emergent properties, emphasizing the role of trait-based consequences leading up to, and sustainability of, the development of adult ADHD. In efforts to exploit the necessity for reappraisal of ADHD constructs, this work aims to reorganize the structural criteria measures when considering existential variables in the classification limitations in labeling ADHD; specific to adult diagnoses, particularly with regard to etiology as well as onset, pervasive developmental effects emerge which may help to explain the adverse consequential influences of parental maltreatment in the form of neglect and/or abuse. Through a series of research and literature reviews, the manifestations of ADHD symptoms, particularly within adult populations, are carefully reviewed and analyzed to highlight etiological significance of parental maltreatment and early relationship influences to explain the developmental constructs in re-assessing adult ADHD. Such clarification efforts may serve to better understand the neurobiological constraints in light of psychological dysfunction, rendering the need to re-classify the variables in the acquisition and precursor properties leading to the development of adult ADHD. In re-conceptualizing the rigid structural criteria measures to diagnose ADHD in adulthood, this lends credence to considering developmental factors when assessing trait-based characteristics as fundamental precursors to adult-onset proclivity in the development of ADHD. Taken together, these measures call for the mapping of theoretical frameworks onto biological measures, constituting a revisionary view for a Translational Developmental Psychobiology perspective in re-classifying ADHD.

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and maximize their book's success. We've got another wonderful young lady on the show with us today. We're gonna get into her insights and some of the stuff that she's going to learn, talk about my favorite subject, not by my choice, ADHD. Squirrel! Anyway, we're going to get into it with her. Her latest book came out June 20th, 2024, called Psychology Within the Context. Let me, let me recut that cause I kind of flood the word context. Psychology within the context of psychiatry, closing the translational gap.

Amy Twilligar joins us on the show today. We're going to get into it with her and find out all this great stuff to know about ADHD and why, uh, why they call it the CEO disease. Maybe we'll get some of that from her, uh, or just how much fun it is to have it. Cause I love mine kind of sometimes she's a postgraduate student dedicated to raising awareness for and furthering her educational pursuits and identifying confounding variables, often overlooked in the assessment procedure protocols for classifying mental disorders such as adult ADHD

or the poster child for Chris Voss. Welcome to the show. How are you, Amy? Amy- Great, thank you. How are you? Pete- I am excellent. I am excellent. So, give us your dot coms. Where can people find you on the interwebs? Amy- Are you talking about my websites? Pete- Yes. Amy- Okay. Translational Developmental Psychobiology.com, that's a mouthful right now, and at author amytwilger.com.

So, give us a 30,000 over you, what's inside your book? Well, there's a newfound perspective on redefining the constricting variables to measure ADHD in adults. Research has been extensive with, as we know, it is a childhood disorder, as we all know. They have linked very significantly PTSD in childhood with adult ADHD, as well as severity of trauma experienced in the home environment in childhood with ADHD and adulthood. But they're missing something.

Pete Slauson Oh, what are we missing? Debra Larson They're missing the developmental construct. Pete Slauson Okay. So, give us a breakdown as to what that means, if you could, a foundation for it. So the DSM-5 currently says it has to be present in childhood. You cannot get the diagnosis without it being present before 12 years of age and cannot be comorbid with anxiety disorder, both of which I counter that actually with my research book. Okay.

So, now you mentioned the DSA-5 or there was something about a five that you mentioned. Yes, the current Diagnostic Manual for Mental Disorders. So we want to make sure we lay a foundation for people that are just the laymen out there in the world trying to figure all this good stuff out. So what made you want to write this book? What was the proponent behind that that inspired you? Well, there's a lot of adults out there that have ADHD and they can't get the treatment that they need because they can't receive the diagnosis without childhood records of having ADHD as a child. That is at the heart of what stemmed my inspiration

to write this book because if you look at the developmental constructs, if you have an abused child that goes up in fear, they are susceptible to developing ADHD in adulthood if in the next set of intimate relationships, 20 to 22 years old, typically, there's a problem there, because they're going to be more susceptible and prone to develop ADHD in adulthood. And the diagnostic manual to diagnose ADHD in adulthood states that it must be present in childhood and that anxiety cannot be a comorbid condition. But my argument to that is that it can be predisposed by anxiety related to trauma experienced in childhood and more vulnerable to developing ADHD in adulthood at that critical phase of development of young adulthood years when that next set of intimate relationships, romantic partnerships for instance, they experience the abuse again

then their attention spirals out of control and they're in real Well then because their dendritic cells in the brain are crystallizing for emotion Self-regulation patterns and if you're internalizing at the focusing on the internal distress experience inside those patterns Set the stage for a lifetime of attentional problems Wow, wow now that I mean that makes sense because you know patterns set the stage for a lifetime of attentional problems. Wow. Wow. Now that, I mean, that makes sense because, you know, sometimes when we have trauma in childhood and we have these blueprints and I'm not a psychologist, so correct me if I'm wrong, but we talk about this a lot on the show, it seems

these days is, you know, I suppose when it rears its head in, in older ages, you know, it's kind of a fight or flight symptom we have where we're like, oh, I know what this danger is and now I'm seeing it again and here's how I'm going to react. Is that a good assessment? Kirsten Absolutely, because the hypervigilance constantly looking over your shoulder out of fear, for instance, that really translates into hyperactivity, which is an H component in ADHD.

So if you experience trauma in childhood in an abusive home environment, you can become resilient all you want as an adolescent. But if you enter your next set of close intimate relationships at that critical phase of development for young adulthood years, you're going to be re-experiencing it. And research shows that you're in trouble. It comes back threefold, the experiences to you. And so then they can't get diagnosed because they don't have childhood records. They were a scared child. And so therefore, now that they're

in adulthood, and they have a voice of their own, and they are able to depict that this something is wrong. They can't get diagnosed in starting too late. They said irreversible at that point because the emotional self-regulation patterns are already set in stone for the rest of their lives. And that, that kind of leads to if they can't get diagnosed, then they can't get help. Is that, is that correct? Yes. As a matter of fact, they often get misdiagnosed. They get anti-depressants for instance and

when they say anxiety cannot be a comorbid condition that's an interesting one because anxiety and depression are one and the same on a spectral level because it's hype or arousal nervous system activity versus hype oh arousal nervous system activity versus hype-o arousal nervous system activity. So it all has to do with emotion self-figuration and there's only one neurobiological connection between the prefrontal cortex for higher order cognitive processing such as problem solving skills and reasoning abilities and the limbic system which ironically is aggression and fear based. And so there's only so much attention that you can allocate in, it's called the right frontal striatal

cilibar network in the brain or right food domain is what they're called too. And there's, and it shows in the metabolic pathways as I show in my book even that the ADHD brain, this is for control subjects and for adult ADHD subjects, there's a stark difference obviously in the metabolic pathways for oxygen that occur in the controlled lab setting and it's evident. So I have more to say about that. Okay. So, you know, one of the things that happened to me as a child is I experienced trauma as a child and then the home life wasn't great.

Let's put it that way. And so my ADHD and my brother's ADHD became instantly recognizable. I would check the door 20 times a night as a teen. I was, you know, there, I think there were other obsessive compulsives that I had. My brother had the obsessive compulsive where he would wash his hands. He needed to be on Ritalin, you know, things like that. So our stuff showed up right away. It became a response, I think, right away. What percentage of people do you think does it show up in right away as opposed to what you're talking about where sometimes

it may not show up until later in life? Probably about 8%. 8%? No, 8% that it shows up later in life? Or the other? About 1% are going to be diagnosed because it's virtually impossible to get diagnosed without having it present in childhood. And those are the rules that they go by to diagnose

and their hands are tied. I mean, what they put on the paper, the psychiatrist has to go off of that. And if they can't diagnose based on those measures that should be changed, they're in trouble. They'll get misdiagnosed or just suffer. Pete Slauson Now with my ADHD, they did prescribe me for depression. But they, you know, my psychiatrist or psychologist, I forget which one gives you the medication, which one just gives you counseling, whichever one gives you medicine. But you know, he did hear about my childhood and he was like, my God, you had two narcissistic parents at the same time, most people just have one.

You know, I guess he diagnosed me based on that. What is the main target audience that you're trying to send the message to that you want reading the book? Honestly, I think the criteria should be changed because there is a solution to this. Even though clinicians cannot yet diagnose ADHD in adulthood without the childhood records, they can certainly tell them to go with the brain scans and the neuroimaging scans on your brain from radiologists, for instance, and you know, map that theoretical framework onto that biological data.

And it's unmistakable that you, if you're taking that case history of that individual and you're seeing the brain scans are clearly different than that of a normal control subject brain, it's unmistakable. So it should be considered, and anxiety absolutely is a precursor. So those are two different things that I would like to get across with my book.

Pete Slauson Oh! So, with the book, I mean, that's the main reason you wrote it, I guess, right? Kirsten Yes. Pete Slauson Yeah. And what got you interested in this? What got you interested in the study of this? Was this your original intent when you went into psychology or did you find that this was a real issue during that time? Debra No. As I was doing research through my psychology classes, I kept seeing in all the research studies that it says that it has to be, is present in childhood. And it never mentioned adult development of it.

And so I thought there's something wrong here and I researched it more and low involved it's, it's a problem. How can psychologists redefine these constructs for diagnosing AHD, do they have to go through some board and a bunch of people have to write papers on or something or has it worked? I'm not really sure. Is it an extensive, extensive task? I'm sure. But, um, this is my contribution to get the word out there and raise awareness that it can

develop in adulthood. Absolutely. From a scared child. And then they have a next set of close intimate relationships and an abusive environment or relationship. Then, then they can a next set of close intimate relationships in an abusive environment or relationship, then they can't even get diagnosed.

Pete Slauson Yeah. And I mean, there are things that happen with children, we've talked about this on the show, where it seems, and I'm not a psychiatrist, folks, so, you know, don't start a cult or from whatever I say. But it seems like sometimes in childhood, we're so overwhelmed by a traumatic experience that the brain kind of blocks it away and makes us forget it. And then later in life, it seems to bring it forward when it thinks that maybe we're developed enough to handle what happened to us as a child. And I can imagine maybe a scenario of where that would apply to your thesis of, you know,

them not remembering their childhood issues and then suddenly having these issues are coming up and not realizing how they're connected maybe. Is that a possibility? Absolutely. But you just better hope you're not 20 to 22 years old in that critical phase of development when the brain matures in that emotional regulation patterns. And now you have dysfunction, emotional patterning and your intentions is going to inspire a lot of control focusing on the internalization distress inside rather than the salient cues in the environmental context. And by that, I. And by that I mean social environmental context.

Pete There you go. So, what changes do you foresee from publishing your work in the future? What do you, what do you, what do you, have you sent this to, I don't know, who oversees the psychiatry? Is there a psychiatry board or a bunch of people that oversee that sort of thing? It's not exactly a field yet. So it's, you're converging the two fields in a way that you're, you know, the medical and the clinical, I mean, it's, it's going to be a tough, tough one to get this. Are there boards for each of them?

Yes, they go to different, one goes to medical school, then, you know, philosophical school. So I mean, it's hard to converge them in an integral way to where the psychologist would be able to diagnose without those rigid structure criteria measures not being changed. Pete Slauson Yeah. Is there a way that you could get each of the individual boards to agree on this? Or does it take a lot of work? Or how does that, how does that work? Neva Everett I wish I knew. I just, I wrote this book

as you know, to help other people and get the ball rolling that say, hey, words should get out that this needs to at least just change a few things to say, have psychologists get those neuroimaging brain scans. And then if you map that theoretical framework, none of that biological data is unmistakable. That's in the research too, as well. Now, do you, do these brain scans, can you look at a person's brain, I guess, and determine that they have either trauma damage or they have ADHD? I imagine the frontal lobe cortex being overactive with high amount of activity on it. I'm no scientist folks.

It would be an indication of that, right? Maybe? Absolutely. On page 48 of my book, I even, I even put it out there. So, yeah. Yeah. I was, uh, when I was, when I had my ADHD, I was trying to figure out, you know, what was going on with me and I remember reading, uh, it was a, I can't remember what it was, um, but it was a thing that talked about how basically

the theory of what my issue was is I had a, I had a over, I had an over abundance of activity in my frontal cortex. It's kind of where my front of my brain would hurt when I had my panic attacks. I thought I had brain cancer or something because it would just be just crazy. But yeah, so this is pretty interesting.

You know, we've talked about ADHD on the show, how it's kind of the CEO disease. A lot of CEOs tend to have it. And it actually kind of helps us be better entrepreneurs, which is kind of interesting. It's, I thought mine was under control from old age. And it actually kind of helps us be better entrepreneurs, which is kind of interesting. I thought mine was under control from old age and then a year and a half ago I went in for testosterone treatment and boy it came back like something else.

And I've been fighting with it ever since again. So I thought I finally got relief from it all my life. How do you believe this might implement a fundamental change in the industry and how can it be achieved? I suppose we've kind of been talking that and kicking away that around. I think getting the word out with this book, for instance, is step number one. Yeah, yeah. What are the reactions that you've had of the book so far in the scientific or social communities? 11 The reviews I've gotten are a array of reviews from the Fiend Dot. 12

Mm-hmm. 11 And nobody agrees with it, so it makes sense. 12 Yeah, yeah, it definitely does. So give us an idea of how you're raised. What got you into psychiatry, psychology, wanting to study this stuff and get to know it? What were some of the influences you had? Kirsten Well, my first interest was in my college

years actually. And after I started taking some psychology classes, I really, really enjoyed them. And I started seeing patterns through like with dichotomous viewpoints, you know, nominal labeling, such as, you know, saying it has to be present in childhood, or you do not, or you're not based on these rigid structural criteria measures. So when I started to notice that there was a lot of, a lot of constructs that were not being addressed, it got me interested in really diving into seeing why. And I kept coming running across all these literature articles that were saying that there's more research that needs to be conducted for the ideological

significance for instance, in order to deem an adult ADHD patient as actually having ADHD. And I just put, I just put it all together like a web and I just, I saw what was missing and I want to make a difference. Do you suffer from ADHD? Was that one of the reasons you kind of had like a, uh, firsthand knowledge of it and stuff? I'm, I'm familiar with ADHD a little bit. I'm too familiar with it myself.

I could use a break every now and then, but squirrel. But it really is helpful in business and stuff. I don't know. It is helpful, I think, and a lot of CEOs have it. It's amazing. It's high vigilance, I suppose, and paranoia, maybe. Anyway, the… So what have we discussed about your book that we want to tease out to people and entice them to pick it up?

It's going to allude into what the structural changes in the brain are, and that's at the very basic level for this book. Anyways, it's more of a research compilation to say all of these studies put together, you know, this is what is happening out there. There's people that suffer every day, really. And in my next book, my upcoming book, Translational Developmental Psychobiology is really at the forefront of making a change. Pete Slauson Well, making a change, making a difference is what we do in the world. We write books, we share ideas, we publish and convince others of our ways and lay out our arguments and stuff like that. So, as we go out, give people a final pitch out to order up your book and your dot coms

and all that good stuff. Well, it's on many platforms actually, Amazon, Barnes and Noble, Westbow Press, it's everywhere. Flipkart books, there are even textbooks, textbook sites, so if you just look up my name, for instance, or the title of the book, it's unmistakable that it's out there. All right. Sounds good then. Well, thank you very much for coming to the show.

We really appreciate it, Amy. Thank you. Thank you. Thanks so much for tuning in. Go to Goodreads.com, Forchess Crisvoss, or up her book where refined books are sold. It's called Psychology Within the Context of Psychiatry, Closing the Translational Gap by Amy Twilligar. Thanks for tuning in.

Go to youtube.com for Chess Chris Foss, facebook.com for Chess Chris Foss. Chris Foss one on the tick tock and Ian, all those crazy places in it. Be good to each other. Stay safe. We'll see you next time. And that should have us out.