Dr. Micaela (Dr. Michaela)

So ADHD is a developmental disorder.

You were born with it.

So from the day you started being in this world until today, you've probably been getting messages that you're not doing it right, you're not working hard enough, you don't care, whatever.

uh, 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.

And I realized I'm looking in weird to say that I missed you.

Uh huh.

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?

Or like pads of paper.

I know you get, if you ever go to a conference, right?

Like you probably get like a bajillion 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.

I did.

Yeah.

Yes.

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 feel... 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...

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.

Yes.

Yeah.

But that's a great approach.

I will say, because 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.

And so then then your first step is actually how do you find out what to do?

So 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 to actually approach that doom pile.

If you're super, super, super stuck in the five minute start is just not a thing that has worked at all or can work.

Yeah.

oh yeah this is there's some good stuff in here what do you think yeah uh 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 like 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?

Yeah.

And yet, stopping yourself from saying the thing, that impulse control to like, oh my God, I know what you're going to say.

I agree.

I think the intent is like, oh, I want to connect with you and I can...

show you how aligned we are um and that is definitely rarely the impact um of how that behavior feels i i do that quite a bit and i i noticed that my mom does that quite a bit too where where she'll um

Four times speed, four times speed.

I think that 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?

I have learned that it will get me in trouble if I show it in the wrong place.

Yeah.

Yeah.

They need a little warm up.

I kind of got to like get going, get go.

OK, I got to work myself up to the actual point.

Or sometimes you find your point as you're talking.

Yeah.

Right.

Like you start talking and then like, oh, so what I really am actually trying to say is.

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 I would start the whole conversation in my head and then eventually my mouth would start would would like share the conversation.

So I just keep my face.

But people would be like, what?

And so I had a friend actually who would say, I need you to leave and come back and start at the beginning.

And I was like, oh, excuse me.

Oh, 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?

Apparently on screens.

And they're like, 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?

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,

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 something like this talking and whatnot, our idiosyncratic speech habits, if you will, it's like we're hypothesizing, right?

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 neurotypical, 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.

Um,

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 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?

Yes.

I don't know.

What do you think?

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, yeah.

Yeah, I mean, I think

kind of tying that into the stimulation piece of if you... First of all, sometimes that's okay, right?

And get yourself some neurodivergent friends if it's not okay for the people in your life.

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 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 1% 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.

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.

Uh, like, oh, I do need to listen a little bit.

Uh, so that's where like, I'm going to use the word fidgets, but that's where doing something with your hands.

Um, whether that's like maybe wear a little bit more jewelry, um, wear cuff, wear shirts with cuffs that have buttons on them.

Um, so that you can kind of like pick at them or fiddle with them, uh,

Any amount of like, let me do something with my hands, taking notes, 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, totally.

Also things like doing dishes together.

Unpleasant.

We don't want to do it.

It's a mildly distracting activity.

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.

Oh, yeah.

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.

So signing a peace treaty conflict, right?

Yeah, that is, there is this kind of, I guess, inherent social structure or social norm of like, face to face can sometimes be, you know, combative in a way.

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, conflictual 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 and

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 hands.

I mean, gently holding hands while my head is resting on you while I'm saying like, this was really hard for me.

And, and so that, that communication has the blend of the affection safety that your brain is getting.

In addition to the content, it gets softens that communication and it makes things so much more helpful.

Um, the only doom pile I haven't conquered is the paper one.

Or maybe you do.

I don't know.

This one is a lot longer.

Um, yeah.

A lot of these things often come together with, yeah.

Yes, it does.

And what's fascinating is working with 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.

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

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...

then the professional component gets discounted of, no, but look, 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.

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.

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're you start a project and don't finish it until you move on to the next project.

And so you've 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 am.

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, but it feels wrong.

And so therefore I don't feel like I have a core identity, but it's not in...

At all in the same way as when we're working with a person who has that borderline personality disorder experience, which is is very just qualitative and experientially very different that you like you said, like that hollowness, that emptiness versus the like.

But also seeing it, especially when she opened the closet and like tried to close it and had to like kick the shoe in.

uh, I'm confused or like, I don't want to be who I am.

I want to be like someone else.

Yeah, I mean, I'm going to go with the last kind of content area that we were referencing in the sense of, like, the masking piece of the, like... I think in so many of the things that I do with Healthy Gamer, I always, I feel like, include some component of unmasking and of, like...

I did notice like that sense of like overwhelm and like a hint of dread, like kind of creeping because that's what these...

learning to like root into the confidence in your own self.

Uh, and that is, that is also a lifelong journey.

Um, but it is so liberating, um, to find the ways that you being the whole real you can actually be profoundly successful and rewarding and fulfilling.

Um, and,

And 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 life.

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, are neurodivergent, we're actually not taking advantage of all of these unique abilities.

I mean, it's what I call doom piles, right?

And so there's this push on the employment side of things to 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.

I mean, it really kind of goes back into the whole like ADHD.

So, yeah, that was my very long answer because I'm also really good at saying things succinctly.

Yeah, you are.

like where can you say the weird thing today?

Where can you do something that's a little unusual that, 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?

Um, that's my, that's my takeaway.

I love being here with y'all and I love this community.

So have a fabulous rest of your Saturday.

Yes, that is the day today.

Bye.

Bye, y'all.

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 rate like which one.

Well, in some of these cases, we can't like backpacks or water bottles.

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 situations.

things.

Or sometimes we just don't understand things or the expectation of the effort that we have to put into dishes.

Nobody needs to decide what to do on dishes, but the expectation of how long it's going to take me to do dishes is so overwhelming that I just am not even going to

Yeah.

So part of our like 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 is

um, 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, and like physical things in our environments, right?

So 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.

Um,

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 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?

Right.

So when we're thinking about like, oh,

Shoes.

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.

No, please interrupt me all the time.

I'm probably going to think about that a lot later if I remember.

Okay.

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.

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?

Uh-huh.

Yeah, that'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.

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 to be because I'm so messed up is, like, then I'm not going to try.

Right?

So, like, I mean, tongue in cheek.

I wasn't.

And I don't think you can start there.

Because that's an incredibly challenging life journey is to learn to love yourself and to keep loving yourself.

And the fact that I do love myself 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.

Um, but how do you actually, yeah.

No, not sarcastic.

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.

I am mildly chaotic this morning, but feeling great.

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?

Um, 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.

I mean, I think part of it is the filter, right?

But I think part of it is also the messaging.