So for a neurotypical person, the more

important

something is, the more it sinks in. But

for ADHD, if we don't ever hear it in

the first place, it doesn't matter how

important it is because we never heard

it. That when we are relaxed, something

can go wrong. When we are relaxed,

something will go wrong. And so, how do

we correct against this? Being relaxed

doesn't work for us. So, we start to

become paranoid. You cannot rely on your

mind to remember. ADHD feels like

waiting for an email that says you're in

big trouble and everyone's mad at you.

Hello, Dr. K. I really enjoy what you do

and I've watched many of your videos,

particularly those about ADHD. Is an

autistic man with an a lot of

overlapping symptoms. I saw an Instagram

post that read, "Add feels like waiting

for an email that says, "You're in big

trouble and everyone is mad at you."

That line hit me harder than I expected.

It captures this constant low-level

tension I carry, especially in

professional settings. It rarely shows

up in my personal life. Thankfully, I

feel secure with the people that I care

about. But in contexts where composure

matters more than content, I'm always

waiting for a mistake with my name on it

to surface. Um, no matter how organized

I try to be, there's this quiet dread

that something slipped through the

cracks, a form I missed, an unanswered

email, and one day it'll all come

crashing down. Part of me thinks this is

just adulthood. Nobody points out small

errors anymore. They just accumulate

until they become something big. So I

overcorrect with perfectionism. Not

because I need perfection, but because I

can't tell what actually matters. Okay.

So let's talk a little bit about this.

So often times people with ADHD grow up

with this sense of constant dread. this

kind of like baseline paranoia that

something is going to pop up and it's

going to screw me over and I'm going to

be in big trouble and everyone's going

to be disappointed in me. So where does

this feeling come from and how do we

protect against it? So the first is that

we have to understand if we think this

way there's a good reason for it. Okay.

Now I want y'all to understand what it's

like to grow up with ADHD. So this was

my constant state when I still have

nightmares about it's it's hilarious.

Like I had a nightmare about 2 years ago

that I forgot to turn in an assignment

in high school. And since I forgot to

turn in an assignment in high school, I

didn't pass the class. And someone found

out that I didn't pass the class, which

means that I never graduated from high

school. And since I never graduated from

high school, that invalidated my college

degree because I never finished high

school. So college is invalid. Since I

never went to college, that invalidated

my medical degree, which invalidated my

residency, which means that I'm no

longer a psychiatrist. So this is like

some weird like what what is this? Like

what is going on? So here's what we got

to understand. If you have ADHD, you

grow up in a situation where you cannot

rely on your mind. You cannot rely on

your mind to remember. Now technically

it's not me remembering. Technically it

never goes in in the first place. So

let's remember that memory is stuff

getting stored to the hard drive and

being recalled to the hard drive.

there's an intentional component where

whether it ever gets written to the hard

drive in the first place and then it has

to be pulled out. So, a lot of people

with ADHD think they have memory

problems. They don't have memory

problems. Memory is actually perfectly

intact. It never gets written down in

the hard drive in the first place. You

weren't paying attention, so it didn't

sink in. It's not that you forgot, it's

that you never knew. Now, the practical

result of this is that if you've got

ADHD, you walk into school one day and

you're not worried about anything. And

then you discover that you forgot an

assignment. So, I was not worried and

I'm in trouble. A week later, I walk

into school not worried. Get in trouble.

Oh my god, I forgot I had a test. So,

over time, what happens with ADHD is we

learn that when we are relaxed,

something can go wrong. When we are

relaxed, something will go wrong. And

so, how do we correct against this?

Being relaxed doesn't work for us. So,

we start to become paranoid. We start to

have this low level of dread always at

the back of our mind because we have

learned time and time and time again

when we are relaxed, things go wrong.

Now, there are a couple of things that

are different about people who don't

have ADHD, people who are neurotypical.

They too forget things. The problem is

that they don't forget things nearly as

much and oftentimes the consequences

aren't so severe. And I want y'all to

really think about this for a second. So

the problem with ADHD is it is a sensory

attentional disorder. So for a

neurotypical person, the more important

something is, the more it sinks in. But

for ADHD, if we don't ever hear it in

the first place, it doesn't matter how

important it is because we never heard

it. So people who are neurotypical will

also forget things. They won't pay

attention 100% of the time, but they

don't forget exams. They don't forget

projects. They don't forget weddings,

right? They don't forget like the big

stuff. So some of that stuff is intact

in neurotypical people. So everyone will

forget, but it doesn't happen as often

and the consequences are not as severe.

Once the consequences are severe and it

happens often enough, we turn on this

dread mode, this paranoia mode, because

we can't trust ourselves when we are

relaxed. When we are relaxed, we make

mistakes. So, let's constantly be in a

state of dread. There are a couple of

other features here that are really

important to understand. Two other

neurodedevelopmental aspects that are

important. The first is emotional

regulation. So people with ADHD

experience emotions more rapidly and

more intensely and have difficulty

regulating their emotions. So a

neurotypical person when they feel a

little bit of worry or paranoia, their

ability to calm themselves down is

naturally more robust than someone with

ADHD. So some people have even

hypothesized that there is an emotional

disregulation

subtype of ADHD. So we think about

attention deficit disorder, attention

deficit hyperactivity disorder. There's

a subtype that has that's the H right

that has hyperactivity or not. And then

there's a third subt type of ADHD

attention deficit disorder with

emotional dysregulation as a primary

feature. So this is not so much about

the dread being justified but your

ability to control the dread is going to

be impaired. The last thing is

impulsivity. So I don't know if this

makes sense but the idea that you forgot

something is actually an impulse. So,

you're going about your day d

and then there's an impulse. Oh, oh my

god, you forgot something. And you're

like, wait, what did I forget? I didn't

forget anything. Let me think. I can't

think of anything. Goes away. Oh my god,

you forgot something. So, I I don't know

if this makes sense. It's not just that

you learned that you can't trust

yourself. It is that your brain is more

vulnerable to repeated impulses of dread

and has more difficulty regulating those

repeated impulses of dread. So, how do

we fix this? This is where the reason I

talk about these other

neurodedevelopmental aspects is if you

go to treatment for ADHD, then hopefully

they will help you with some of these

things. So when I made the ADHD guide, I

tried to list out a bunch of stuff that

you can do. Everything from organization

and planning to make sure that things

don't fall through the cracks to

emotional regulation stuff. Okay? So all

that stuff is laid out there. So the

most important thing that I do with my

patients is teaching them damage

control. And what I'll do with them is

we'll say they're worried about

something going wrong. And so what we'll

actually do is utilize a couple parts of

the brain that are actually quite robust

in ADHD. Number one is your sensory

circuits. So often times people with

ADHD will have diff difficulty with like

being overstimulated. We'll have

difficulty with like you know arid like

symptoms where certain textures really

bother them, stuff like that. So sensory

sensitivity is very high. We can use

that to our advantage by giving

ourselves sensory inputs. So literally

what I'll tell my patients to do and I

think this works better on pen and paper

than on a on a electronic device.

There's certain neuroscience mechanisms

for that as well. Anytime we write

something, it slows down our thought

process. We have to concentrate on that

a little bit longer which means it sinks

in a little bit deeper and the act of

writing somehow commits things to memory

a little bit better. There's just some

connections there which just the way

that our our brain works. Okay. speaking

by the way. So anytime we generate

something from our mind, that thing gets

locked into our head a little bit more.

So if you have ideas in your head, but

you speak them out loud, you're more

likely to remember them. Okay? So what

we'll do is I'll I'll tell my patients,

look, just grab a piece of paper and at

the end of every day, write down what

you forgot. Just write down what you

forgot. You're going to forget stuff.

Oh, you're dreading this stuff. You're

going to forget things all the time,

right? Just write it down. So we

discover a couple of really important

things. First is that sometimes they

forget things, which is totally fine.

often times their fear of forgetting

things is actually far greater than the

actual amount of stuff that they forget.

Right? Once you're paranoid about

something, the likelihood of it

happening is lower than what you think

it is. That's very common. Okay, so this

does a couple of things. It actually is

quite reassuring because now you're

getting sensory input. Okay, I'm not

screwing things up every day. That in

and of itself is so soothing for your

mind. But you will say, "But Dr. K, what

about the days that I forget something?"

Great. When you forget something, write

down what you did to handle it. And this

is what's really cool. You know,

sometimes I'll have patients come into

my office with ADHD and they say, "Oh my

god, my life is so chaotic. Everything

is chaotic and I hate it. I can never

rest. I can never relax." And what I

find when I talk to these people is that

they do really well in chaos. If you

take a chaotic environment, you drop a

neurotypical person into it, you drop an

ADHD person into it, the ADHD person

will outperform the neurotypical person.

The really interesting thing, what's

really scary is you may be dreading that

you make a mistake, but usually people

with ADHD are really fast at managing

them. So, they're actually quite good at

damage control. And why are you quite

good at damage control? Why are you good

at writing a paper really, really

quickly? Because you forgot about it

until 45 minutes before class, you sat

down, you started writing furiously. You

have so much more practice with chaos

because you're forgetting things all the

time and you're creating it all around

you. So, what I'll tell them to do is

even if you forget something, write down

what you did to fix it and what that was

like. And then we discover something

really important. And this is what

really gets the dread to disappear. The

moment that you realize that you can

handle things going wrong, you don't

need to be paranoid about it anymore.

You only need to be paranoid about

problems that cannot be handled. This is

why we have ICUs, intensive care units.

What's the purpose of an ICU? ICUs are

where we send the sickest patients. They

have the highest ability for something

to go wrong, but we have a better

nursing to patient ratio. We have

constant monitors. We have telemetry.

We're doing checks all the time. There's

a far larger team. There's a

specifically trained someone called an

intensivist, a pulmonary critical care

doctor who specializes in ICU care. The

only reason you need to be paranoid is

if your damage control capability is not

good enough. Not if things go wrong.

Things are absolutely going to go wrong.

You will not remember everything. You

will not pay attention to everything.

Things will go wrong. Now, this isn't

going to fix everything 100%. But if you

do these things, if you actually start

measuring how often you forget things,

and you start really paying attention to

how good you are at damage control,

hopefully these two things will help you

with this kind of paranoia. What

questions do you all have? Does this

ADHD dread that comes from g from

getting and punishment can stem from

trauma as well? Absolutely. So this is

what I want you all to understand. So

when a patient comes into my office with

ADHD, they have some degree of

depression or trauma until proven

otherwise. So if you look at the

causitive relationship between mood

disorders like major depressive disorder

and ADHD, what you find is that there's

a one-way street. If you have ADHD, the

likelihood that you will develop

depression is way higher compared to if

you have depression, the likelihood that

you develop ADHD is quite low. Okay. So,

what this means is that that original

thing, the original dynamic of you not

being able to trust yourself, the reason

you get programmed is because it's

traumatic. Let's understand what trauma

is. Trauma is not a disorder. This is

why trauma is so hard to treat. It's not

a disorder. PTSD is a disorder, but

generally speaking, a traumatic

experience against the body is not a

pathology. It's not something going

wrong. Getting sick is damage to our

body, but our body adapts. Our body's

immune system actually improves after an

infectious trauma. Does that make sense?

I don't know what the word infectious

trauma after an infection. Let's just

call it that. So, the reason trauma is

so hard to beat is because it is our

body's adaptation mechanism. It's what

it's wired to do. So, I want y'all to

think about this for a moment. If you

didn't think that you forgot something

and you forgot something, that's bad.

And your body's like, "hm, how do we

prevent this from happening again?" And

then you forget something again and then

you're you're like, "Oh my god, I didn't

realize I forgot this. Now I'm screwed."

So then our brain is sitting there and

it's like, "Well, this guy relaxes and

then forgets things." I've got an idea.

How about we never let him relax because

that's what the experience is. We're

constantly in the jungle. There could be

a tiger behind every tree and every

bush. So, we're going to be on a

constant low level of alert. This dread

in the back of the mind is absolutely

trauma-lated in the sense that we have

negative experiences that hurt us,

activate our negative emotional

circuitry. And anytime our negative

emotional circuitry activates, we're

talking about the amygdala and the lyic

system. What's sitting right on top of

it? The hippocampus where we learn. So,

learning and negative experiences are

very tightly tied together. Right? If I

meet an animal for the first time, if

you guys have ever seen like a rescue

dog or rescue cat that have has has had

negative experiences with with humans,

they are adapting. Trauma is an

adaptation, not a pathology in its most

basic sense. It can become pathologic

when the adaptation is maladaptive or

happens too much. But great question.

The tiger everywhere system. Well said.

Hey y'all, hope you enjoyed today's

video. We talk about a bunch of topics

like this on the channel, so be sure to

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