Rejection Sensitive Dysphoria: Dr. William Dodson brings new insight to Emotional Regulation
Today on the show, Dr. William Dodson joins Nikki Kinzer and Pete Wright to discuss Rejection Sensitive Dysphoria and provide new language to frame a state those living with ADHD know all too well.
There aren’t many practitioners writing about today’s topic. Unless, that is, you look up the collected works of Dr. Bill Dodson. Dr. Dodson is an award-winning board-certified psychiatrist and specialist in adult ADHD and his contributions to the study of Rejection Sensitive Dysphoria bring him to the show today. According to Dr. Dodson, nearly all those living with ADHD live with some level of rejection sensitivity, and thanks to the poor training on the ADHD connections to the condition, patients are going misdiagnosed and mistreated as a result.
Today on the show, Dr. Dodson joins Nikki Kinzer and Pete Wright to discuss Rejection Sensitive Dysphoria and provide new language to frame a state those living with ADHD know all too well.
About Dr. William Dodson
Dr. Bill Dodson is a award-winning board-certified psychiatrist and specialist in adult ADHD. While Dr. Dodson has been on the faculties of Georgetown University and the University of Colorado Health Sciences Center he is primarily a clinical practitioner who tries to combine evidence-based practice techniques with practice-based evidence. In addition to being named a Life Fellow of the American Psychiatric Association, and recipient of the national Maxwell J. Schleifer Award for Distinguished Service to Persons with Disabilities, Dr. Dodson is one of two experts from the US to the World Anti-Doping program for the development of guidelines for the use of ADHD stimulant medications in the world’s athletes.
Links & Notes
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Pete: Hello, everybody, and welcome to “Taking Control: The ADHD Podcast” on Rash Pixel.FM. I’m Pete Wright, and right over there is Nikki Kinzer.
Nikki: Hello, everyone. Hello Pete Wright.
Pete: Hi, Nikki Kinzer. Happy day. Oh, glorious day.
Nikki: It’s a great day.
Pete: It’s a great day. It’s fall. The weather is perfect, where I am. It’s so perfect that it makes me care less about where the weather is everywhere else. I’m in a bubble right now, and I wanna live there.
Nikki: Total bubble. It’s October. You know what October is.
Pete: It’s ADHD Awareness Month.
Nikki: Yes, and Breast Cancer Awareness. We’ve got two things, two big things going on.
Pete: Two things. You can be aware of a lot of things.
Nikki: A lot of different things, but yes…
Pete: So aware.
Nikki: …it’s October. I’m gonna focus on the ADHD Awareness piece of it all.
Pete: All right.
Nikki: In the month of October, we’ve got some great guests on our show.
Pete: We sure do, and we’re starting with one today who is fantastic. We’re talking about something that makes my brain light up, Nikki Kinzer.
Nikki: Oh oh.
Pete: It makes it light up. And as we’ve been talking about this, we find that so many people have been living with this experience, and only now find that they have words to put to it, they have a name to call it. As we all know, once you can name your pain, you can find a way to get through it. I’m very excited to talk about rejection-sensitive dysphoria today on the show with an unreal guest, so, so perfect to be talking about this with us. Before we get into that, head over to takecontroladhd.com to get to know us a little bit better. You can listen to the show right there on the website, or subscribe to the mailing list right there on the homepage, and we’ll send you an email with the latest episode each week. You can connect with us on Twitter or Facebook @takecontroladhd, and if this show has ever touched you, and I am almost sure 99.999% sure that this show today will touch you, then we invite you to consider becoming a supporter @patreon.com/theadhdpodcast.
When you join us there, you’re invited to join the discord online community and the Facebook private member community where you can share your ADHD story and get support, tips, tactics, strategies, and just that feeling of family that we all love and cherish. I know I absolutely do. At the higher levels, you could access to the monthly live stream. I should say weekly live stream, the weekly live stream of this very podcast. You get access to the show without any of this messaging. No ads, no sponsorship talk. You get the show in your own private feed over on Patreon. There’s a lot you get access to, including at the higher level, a monthly workshop with Nikki Kinzer and access to the Hangout, The Happy Hour Hangout with Nikki and Pete, which is always an incredibly fun and experience with us on video. There’s a lot you get used to over there @patreon.com/theadhdpodcast. We hope you’ll consider becoming a supporter there. It is thanks to the support of patrons that we’ve been able to bring transcripts, full transcripts of every episode of the show that are available on the website, and continued growth of guests just like the one we have today. Shall we get going?
Nikki: Sounds good to me. Let’s go.
Pete: Dr. Bill Dodson is an award-winning, board-certified psychiatrist and specialist in adult ADHD. Well, Dr. Dodson has been on the faculties of Georgetown University and the University of Colorado Health Sciences Center. He is primarily a clinical practitioner who tries to combine evidence-based practice techniques with practice-based evidence. In addition to being named the Life Fellow of the American Psychiatric Association and a recipient of the National Maxwell J. Schleifer Award for Distinguished Service to persons with disabilities, Dr. Dodson is one of two experts from the US to the World Anti-Doping Program for the development of guidelines for the use of ADHD stimulant medications in the world’s athletes. Most important. Dr. Dodson hails from Greenwood Village, Colorado, my very own homeland, which, before he even opens his mouth to speak, makes him a quality individual. Dr. Dodson, welcome to the ADHD podcast.
Dr. Dodson: Good to be here. Thank you for inviting me.
Nikki: Welcome. It is great to have you here. One of the things that really strikes me about your work is, one, I know you do a lot of different subjects, you talk about a lot of different things. But this rejection-sensitive dysphoria has really hit home in a lot of different ways with my clients, with our listeners. If you were to actually google rejection-sensitive dysphoria in Google, you are going to come up with your name in some way. One of the things I really wanna start with is just the definition of what this means. What is rejection-sensitive dysphoria?
Dr. Dodson: The term is really quite old. It comes from the late 1950s, early 1960s, back before anybody was really talking about ADHD. It was the hallmark symptom of what was then called atypical depression or non-typical depression. The reason that it wasn’t a typical depression was that it had nothing to do with a mood disorder. It was ADHD. The original term never got associated with ADHD at the time, so that’s why you can’t find anything. Anything before in about 1984, ’85, just isn’t cataloged. It isn’t findable in a internet search or something like that. When Paul Wender, the guy who did the original writing on it, wrote about it, he never used the term rejection-sensitive dysphoria, like, he didn’t call it anything. But he did use the medications to treat ADHD. In fact, there are a couple of studies that compare the monoamine oxidase inhibitors to riddle. And that’s where the association first came from. Wender was impressed with the fact that emotional dysregulation was probably the most impairing form or the most impairing aspect of ADHD for children, adolescents, and adults. In my practice, when I ask people, “What about ADHD is most apparent, most disturbing, most disruptive to your life?” About a third of people will say, “Rejection-sensitivity.” About a fourth of people will list sleep-disorder. So what you have is more than half of adolescents and adults listing things that are not diagnostic criteria of ADHD. The diagnostic criteria are strictly behavioral. They’re written by, designed for researchers, not people like the three of us. It’s all things that you can see, count, measure, do statistical analysis on, and they purposely ignore the really important things like emotions, like sleep, like how people with ADHD think.
They don’t wanna talk about that because it doesn’t make nice clean research. When I was listening to my patient, and so when you hear the same thing from a thousand people in a row, you may not understand it, but you know it’s important. The definition I use on my checklist is literally out of an old psychiatric textbook from back in the ’60s. It asks for your entire life, “Have you always been much more sensitive than other people you know to rejection, teasing, criticism, or your own perception that you failed or fallen short?” About 99% of my adolescent or adult patients not only check that, they underline it, they put stars by it. My personal favorite was the guy who wrote, “This was the cause of my first three divorces.” It’s tremendously disruptive. Now, nobody, whether they have ADHD or not, likes being rejected or criticized. We’re talking about something that’s in a whole different league. Now, this goes beyond not liking it, to it being catastrophic. A person can’t continue to function. It takes over their lives for hours to days, and it’s an overwhelming emotional experience that people can’t describe. That’s another aspect of it is that, in fact, that’s where the word dysphoria originally came from, is that it’s literally grief, or unbearable. The people who did the original work wanted to get how severe this emotional reaction was right up there in the neck. Of course, it was harder when they put it in Greek, so we’re pretty much lost on everything. But that’s what happened over and over again. The researchers were pestering the research subjects, “What does it feel like? What does it feel like?” And finally, over and over again, people will say, “Look, man, back off. I can’t find the words to tell you what this feels like. I want you to know, I can hardly stand it.” It was this unbearable nature that got really the name, rejection-sensitive dysphoria, difficult to bear.
Pete: So, as long as you’ve been working with folks, and I should say that in my mind right now, “I’m the one living with ADHD on our show, and mind is fireworks right now.” You’ve just explained much of my summer that I felt like I couldn’t really put words to. So this is both exhilarating and eye-opening. As you’re listening to, you know, your clients or your patients, the folks that you’re working with who are starting to talk about this, what are some consistent threads of their experience, right? I mean, we have to have been able to build more of a tapestry of kind of shared experience in the last 25 years.
Dr. Dodson: Well, over interpretation. People, they usually go through their life easily wounded by things which may or may not be real, and it’s somebody’s perception. It doesn’t have to be real, but your perception is your reality. What you perceive to be real is real to you. For people with ADHD, it can be you’re walking down the hall, and somebody didn’t say hello. They obviously may have been elsewhere or whatever, but a person with ADHD, they immediately catastrophize it and say, “That person hates me. They didn’t say hello. They don’t wanna be around me,” that sort of thing. It’s this catastrophic reaction, overinterpretation. Some people will end up being diagnosed as being borderline because they’re constantly seeing rejection in everything, because it is so painful, so agonizing when it happens, people become vigilant for it. They wanna make sure that they’re prepared for the next time they go into one of this tailspins. So what you’re looking for, you tend to find. So that they’re constantly having these emotional storms when they perceive that someone has withdrawn their love, approval or respect, which indeed does sound very borderline. And it takes a while. As you know, it takes 8 or 10 hours of sitting with somebody to really, you know, look at their egos, strengths and saying in things like that. We find that these people are not borderline at all. They’ve got good relationships. They’re loving, caring people, they’re not abusing drugs and alcohol. It’s, got rejection-sensitive. So it can, and again, most mental health professionals are trained to see the borderline character organization and not ADHD.
Pete: Well, that is actually the fascinating thing that you’re calling out here. I wonder what you see in terms of trends of mental health professionals who are adopting rejection-sensitivity as something in their conversation to have about ADHD? Why are you an outlier?
Dr. Dodson: Medicine is not a rational field. It doesn’t perceive, and people don’t make decisions according to what makes sense or to what they see over and over out in the real world. Medicine is an authority-based field. You do something because you’re attending and your training told you, that’s the way to do it. You do something because that’s what is sanctioned in the scientific literature. It’s authority-based. If there, if somebody hasn’t heard of this before, as far as they’re concerned, not only does it not exist, it is suspect as well. They haven’t heard about it, therefore, there’s something wrong with it. There’s no authority behind it. Rejection-sensitive dysphoria, one of the reasons why it was actively avoided back in the ’60s is that you can’t research it. One, it’s not always there. It comes and it goes usually with the suddenness of lightning. When one instance the person is fine, and the next they’re in a catastrophic emotional state. People tend to hide it. They’re embarrassed by it. They don’t like being thought of as head cases. The biggest one for researchers is even when it does happen, happens right in front of you, you can’t measure it. And measurability is necessary for publishability. It’s truly published or perish. So they’re not gonna waste their time on something they can’t get published. Simple as that. I mean, I’ve tried to get other people interested in this just to validate that, “Yeah, people with ADHD do identify with this,” and I’ve not been able to get anybody willing to even go that far, because it’s not publishable.
Nikki: It’s just amazing to me, because as an ADHD coach, I mean, that is the first thing I hear is the shame, the embarrassment, the, “I’m less than, why do this? Every single time I do this, it doesn’t work out.” They’re always referring to their past, and it is so emotionally charged. I am so thankful that you’re bringing this to light, and you’ve been bringing this to light for many, many years. I mean, we’re just now having you on the show, but I know you talk about this and bringing it to the attention of our listeners, it gives them…I believe it will give them some…I don’t know if it’s a reason, but just some explanation of what’s happening.
Dr. Dodson: People who have ADHD identify wrongly with this concept. About a year and a half ago, somebody took one of the articles that I wrote and posted it on that august Journal, Reddit, in their sub-Reddit on ADHD. Within the next month, it got more comment, more positive comment than any other topic they’ve ever had.
Dr. Dodson: It was just a tremendous outpouring of people, things after that It’s, “This is real? I’m not alone?” So it really touches a lot of people.
Pete: I find it’s interesting, too, that I feel like I’ve manufactured… I’m not gonna say manufactured. That’s not fair. It’s a thing, another thing that we talked about. But for me, it seems to manifest and coming as a podcaster, somebody who needs that sort of external validatio, you know, both personally but also professionally, right, to grow a business. And I find that when I don’t see feedback, if I don’t see somebody commenting, saying, “Hey, that was a great show, or that was a good idea or that was something I relate to,” that can send me into what I’ve, for a long time, been calling imposter syndrome. Well, clearly, I am an imposter. That I catalog in my head as that explicit rejection, and that can send me into a spiral, a complete spiral. Just the act of not receiving any feedback is the same as somebody actively rejecting me.
Dr. Dodson: Well, you fill in the gaps with the greatest fear.
Pete: That’s right.
Dr. Dodson: That’s what you… Everybody does that. People with ADHD do it very, very strongly, and it can take over their lives. It’s really kind of what in the introduction when we’re talking about evidence-based practice. I mean, that’s the gold standard. You wanna do what you’d be doing in medicine because there’s strong evidence that that’s the right thing to do. But, you also need practice based-evidence that you have to respond to what you’re seeing and hearing in front of you patient after patient after patient. There’s a great deal in the cannon of ADHD that’s wrong. It’s just nonsense. But nobody will confront it. There’s a lot of stuff that I was taught, and indeed, if any of that is taught is just plain wrong, but nobody confronts it. Again, ADHD has been in a bunker mentality since its inception. It’s a concept that has been attacked. I can’t think of another topic, whether in medicine or elsewhere or otherwise that has as much disinformation, outright nonsense, fake news. It’s just attack after attack after attack. And so, the field does have sort of a self-protective bunker mentality. There are a lot of things that may change, and new ideas that are even the slightest bit controversial, hard for people to accept.
Pete: Well, you just outlined another show. I’m sure we would like to have you back to talk about.
Nikki: I bet. Yup.
Pete: Back on RSD, can you talk a little bit about differences you might see between men and women and their relationship with rejection?
Dr. Dodson: I don’t see that much difference. Men are much more likely to hide and stuff their emotions than women, whether they have ADHD or not. As far as I can tell with my patients, men are just as deeply wounded by rejection-sensitivity, as women are. It is an equal opportunity destroyer. And so it , since most people don’t see it coming, they can’t prepare for it. Even when they do, it still can take over. What people try and do is protect themselves from it ever happening in the first place, and you’re seeing what actually ends up to be almost personality type arising out of this. Some people try to perfectionists, above reproach, always the most admired, accomplished person in the room, but it’s a trap. They have to keep on producing all the time, and they’re constantly running scared lest somebody discovered them. It’s sort of the imposter syndrome. Some people become people pleaser. They have the ability that within two seconds of meeting somebody new, they can tell you exactly what that person likes, approves of, will praise, and that’s what they do. So much so, that very commonly they lose track of what they wanted for their own lives. You’ll see, this is one of the places where women, I think, are different. A lot of my female patients will get out into their ’40s, their kids are moving on with their lives, and the mother has literally given her life to the family, to the kids. And she says, “Okay, when is it my turn? When is somebody going to do this for me?” The thing is the family is very happy with being constantly catered to and taken care of by mom. And there’s a tremendous amount of resentment that comes out because how they chose to protect themselves from rejection-sensitivity, again, backfires on them.
Nikki: Well, I was gonna say because now they feel more rejected, you know, right and more unappreciated, or appreciated. Right. Yeah.
Dr. Dodson: I’m not important, not important enough. Some people give up trying. There are slackers of where completely capable people, likable people, but the whole notion of going out there in front of everybody else, and crying and failing, is terrifying. They’ve done it, it hurts too much. “I’ll sit this one out. Thank you.” I’ve got dozens and dozens of people in my practice who have never been on a date. The notion of asking somebody on a date, or just getting that close to somebody would end, the relationship could end unhappily or whatever. It’s terrifying. I’ve met people who have never been able to apply for a job because just the possibility of not getting the job is so daunting. I get a lot of people who literally can get to the door of the business and have a panic attack. That’s what happens is they get diagnosed with panic or phobias or something like that when what’s underneath it is this fear of being rejected. There’s a lot of different ways that people try and protect themselves from this storm of emotions.
Pete: We have a timely question I wanna insert here from, because we’re having sort of a gendered conversation, I think. We have somebody who asked how this shakes out with trans folks. Any experience working with trans individuals?
Dr. Dodson: If there’s a group of people that has to deal with rejection, it’s trans folks. They deal with, “You’re not what we had in mind,” all the time. But I don’t have any personal experience with it.
Nikki: So these things, the people-pleasers that stop trying overachievers, those are all things that are happening when it’s untreated, or is it still happening even when we’re treating this? Or, do you still find those things happening with folks?
Dr. Dodson: The earlier you can intervene, the less fixed these ways of approaching the world are. That’s what I was talking earlier, that it, if a person’s been this way their entire life, it almost is character logic. It is part of who they are, of how they view their relationships with other people, what’s possible versus what’s not possible. That’s where they…it is a fundamental part of themselves that they sort of, “Well, that’s me,” rather than get something that’s part of ADHD, it has a name, it has a treatment. It’s, as my patients say, “It’s a thing, and I’m not alone with it. This is not my fault.” So that helps to know that I’m not alone with it.
Nikki: I have a feeling many; many listeners are nodding their heads. “This is me. I get this. I feel it.” We know it, right, if you have ADHD. I think I read somewhere in one of your articles. It’s almost 100% of people with ADHD experience rejection- sensitivity. I mean this…
Dr. Dodson: It’s around 99%.
Nikki: Yeah. I mean, it is part of it. What can we do to help?
Dr. Dodson: When I first started thinking about this and noticing the patterns 15, 20 years ago, and went back and found that Paul Wender, the guy who defined the ADHD syndrome back in the ’60s, that he’d already thought about it, written about it, and had used medications called monoamine oxidase inhibitors to treat ADHD. They were our very first anti-depressant medications long before, 20 years before Prozac or something like that. If you look at one called Parnate, it’s only one chemical bond different from amphetamine. You have to sort of look at it for a while to see how the two molecules are different. And he knows that probably the biggest benefit that people got was not so much in their ability to pay attention, but in their emotional dysregulatio, that their emotions would just completely and suddenly wanna mock among them, that didn’t happen either. The problem with monoamine oxidase inhibitors is that they’re difficult to use. You have to avoid certain foods. You have to avoid practically every anti-depressant medication under the sun, over-the-counter cold sinus and hay fever medications, cough syrups.There’s a whole list of medications you have to avoid. You also have to avoid foods that are aged rather than cooked. This is aged cheeses, aged sausages, pickled herring, that sort of thing. But they are excellent antidepressants and excellent anti-anxiety medications and the treatment of choice for rejection-sensitive dysphoria.
Nikki: Would it help with other ADHD symptoms?
Dr. Dodson: It does help with focus distractibility, lowers impulsivity, that sort of thing, but not as dramatically as the standard stimulants, or alpha-agonists do, that really does end up treating… So this is the type of medication that if somebody came in and the only thing that was impairing about their ADHD was their rejection-sensitivity, it would be a drug I would consider using much earlier in the process. About six or seven years ago, I just stumbled on to the fact that there’s another category of FDA approved ADHD medication called alpha-agonists. The full name is Alpha–2 Specific Adrenergic Agonists.
Dr. Dodson: You got a real tongue twister. But this in two native [inaudible 00:28:04] being clonidine, guanfacine. There have been FDA approved for the treatment of the hyperactive component of ADHD for 35, 40 years. And a significant percentage of people can have their rejection-sensitivity almost completely removed by an alpha-agonist, which is much easier to use. The actual robust response rate is disappointingly low. In the United States, we have two alpha-agonist clonidine in one guanfacine, and the response rate to either one is about 30%. So if I chose to put somebody on clonidine, 30% of them are gonna go, “Wow, this is life-changing,” but 70% are gonna go, “What’s the big whoop?” So, the much higher failure rate than success rate. But the people who respond to each molecule is a different group. So if the first one doesn’t work, you can try the other one, and you’ll still have another 30% chance of very robust response. So if you end up trying both of them sequentially, not together, you get about a 55% to 60% robust success rate. To put that in perspective, that’s better than any antidepressant hatch. It’s better than any antipsychotic. It’s better than any anti-anxiety medication hatch. When you add them up, it’s a pretty good response for psychiatry. But what people talk about is that when the medication works the way it’s…I think the best description I’ve heard from several patients, is that it’s like putting on emotional armor, that you still see the same events, the same facial expressions and things like that that last week, would have triggered the rejection-sensitivity and a catastrophic emotional experience, but this week, it just sort of bounces off, or you watch it fly past, and it doesn’t wound you. That’s one of the few common descriptive words is that people experience the pain of rejection-sensitivity as if it was a physical wound. You’ll see people clutch their chests, or like somebody just punched them in the chests. One of my patients says, like being hit in the chest with a cannonball.
Pete: That’s just what it is. It takes your breath away. That’s the experience.
Dr. Dodson: And that, that now they are wounded, and how tremendously freeing that is to be able to get on with your life. Now somebody who has never been able to apply for a job, in fact, I just had to refill this guy’s prescription. Now he has been with the same company two years. He’s gotten two promotions. He’s getting a degree at night. I mean, his life has just blossomed because he doesn’t close days to weeks to these catastrophic, rejection-sensitive dysphoria episodes. He is not afraid to ask a girl out on a date, which he was terrified to do it before. It basically frees up the person to be who they are. They’re not always playing defense. So it makes a huge difference. Medication alone, though, is usually not completely adequate. Where, people have been like this, they’ve had these attitudes and responses every day, all day, their entire lives, their habitual, their logic. So they do need some behavioral management, so some cognitive behavioral treatment to understand that these weren’t errors to begin with. That they were an internal perception, it wasn’t that somebody hated them or rejected them or whatever. If, they have to own it as, “This was a distorted perception on my part,” and they have to rework their whole relationship with other human beings that to them was all that they’d ever known before. They never questioned it. “That’s me. That’s the way the world is,” and now they have to come back and go, “Well, maybe not.” I found that unless you give them the protection from those catastrophic emotional experiences, cognitive behavioral therapy goes nowhere. I had two people in my practice, each one had been in psychoanalysis for more than 10 years each. Did try and to deal with their rejection-sensitivity. They were the first ones to admit they had made zero progress in 10 years. And within two weeks, the medications gave them a new life. But they still had to come back and redo their whole perception of what human relationships is all about. It’s a big deal, because that all that somebody has ever known. They need somebody else to tell them, to guide them through what…
Nikki: Sass through it.
Dr. Dodson: … through what relationships are all about.
Nikki: Right. Right.
Dr. Dodson: They really have a very little direct experience with. That’s when you guys come in.
Nikki: Well, I was gonna ask. Because, as a coach, you know, I’m not a therapist, I’m a coach. So I’m curious to know how can somebody like myself and other coaches out there help clients work through their RSD?
Dr. Dodson: Again, you span for what it’s like not to have to contend with the impairments of ADHD. I really like people with ADHD. They’re wonderful people, incredibly bright, incredibly creative, wonderful problem solvers, quick, zany sense of humor, tremendously loyal individuals. They’re your friends. They’re the most loyal friends you’ve ever had. People with ADHD have to expend so much of their life energy compensating for ADHD, then, even though they may be accomplished, you know, I look back and say, “What did it cost them to get that accomplishment?” The old saying that they have to work twice as hard for half as much. So what the treatment…I tend to use the word management of ADHD, it’s, you’re not gonna change the ADHD, you’re gonna help somebody manage it to their best ability so that it doesn’t suck the energy out of their lives the way it did before. So helping them manage their life frees up energy that was being lost to symptoms and contending with things so they can reinvest that in their lives. and that’s a lot of what a coach does. Pete, boy, this gets off into yet another program. One of the things that you’ll hear from people with ADHD is that on a fundamental level, they feel as if they are not from this planet. They are not like the other 90% of people who are neurotypical. They think differently, their cognitive style is totally different. They process emotions differently. They experience the world differently. That’s where they get into a lot of trouble is they tell themselves that they are wrong to be different because the world tells them they’re wrong to be different. They’re wrong too because they don’t learn like other people in school that’s with them.
Shame about who I am as a person is fundamental, I would say almost universal, to the experience of ADHD. Guilt is where you feel bad about something you did. Shame is when you feel bad about who you are, and as such, it’s much more profound. And so that really is really the two pieces of managing ADHD. You get somebody in the game on a level neurologic playing field with some medication. You have to find somebody who knows what they’re doing with the medications to get a good outcome, but look for that person. But medications alone are never enough, ever. The old slang is, “Pills don’t give skills.” You then have to learn not how to be neurotypical, but how to be the best person with ADHD that you can be. To learn how you’re different, how to manage that, how to actually take the advantage of that somehow. And that’s where coaches come in. You know, most therapists are not trained in ADHD. They’re going to offer the techniques that they were trained to do, again, it’s a priority-based field. And if they see it working for their depressives, they’re anxious patients, people like that, but they don’t work for people with ADHD. And so it basically, unless the person really is well-informed about ADHD, they’re setting the person up for yet another fail.
Nikki: It’s so true, because I can’t tell you how many times I’ve heard people say, “Well, I’ve gone to therapy, but it didn’t work. It’s not working. They don’t understand my ADHD, or they know very little of it.” It’s very true. I do hear that a lot with my clients.
Pete: Well, by the same token, the number of folks who come back and say, “Well, I’ve taken my medication, but now I don’t know what to do. Like, my doctor just prescribed, and now what? Like, there is no next after the prescription.” And that’s a sort of the other side of the same challenge.
Dr. Dodson: And that is sort of what a lot of people are working on who are not researchers. The researchers have lead us off into a blind alley. But, you know, there are a lot of people who are working on this. Dr. Wes Crenshaw in Kansas is working on it, Michael Manos of the Cleveland Clinic is working on it, about what do you do after the medication is over? You know, somebody who knows what they’re doing with the medications can get them perfect in a month. Then what? What do you do after that?
Nikki: Well, something I wanna highlight that you said that it is so important to me, and when I work with clients, and I think, Pete, you would say this when we’re talking about the show too. It is, the mission here is not to be a neurotypical. It’s not to be like everybody else, you know. We want to accept ourselves for who we are. We wanna accept the ADHD as it’s affecting us and seeing us, and you are who you are, be who you are. You’re not trying to fit a square into a circled world. It’s okay, you know, be that square, you know. Work with it, and get these resources and tools that you can have and support. I see connection with other people being a huge part of managing ADHD.
Dr. Dodson: That’s where it starts, especially dealing with shame, which is one of those things you have to do right upfront. Because, let’s say, somebody who’s full of shame, never asked for help to begin with. They don’t show up at any doctor or any coach’s office because they’re so old-trained. The only way of dealing with that is being with other people who accept you as you are. Now, that’s why Triad is so important, that’s why Nada is so important, why coaching is so important, is to help people start the process of accepting themselves as they are. One of the things I’ve always been impressed with was that medical school and residency did not teach me to ask the right questions. They taught me how to, you know, ask the questions necessary to do my paperwork, but not to really understand my patient. One of the questions that I’ve learned that I need to ask every patient is, “Look back over your entire life. Dredge up all the memories you can. If you’ve been able to get engaged and stay engaged with literally any facet of your life, have you ever found anything that you couldn’t do?”
Somebody with ADHD will sort of stop and think and say, “Now, you know, if I can get engaged with something, and stay in it, I can do anything. It’s one of the frustrations that I have with myself, that people have with me, is that I’m so inconsistent. Sometimes I’m a world-beater, and sometimes I’m off in la la land. But when I’m engaged, I’ve never found anything I couldn’t do.” That really sort of put fly to the notion of this as a disorder or a disease. Now I’m not gonna get off into this, you know, to give to the ADHD or what an explosion that would be. If you want to start a really dull argument, that’s the way to do it. But what it says is, there are times when people with ADHD do not have executive function deficits, or whatever, they can do anything, and then that’s what we ought to be focusing on. Let’s reproduce those times when people can do anything. If you look at all of the therapies up to this point, they have focused on what people with ADHD couldn’t do, and instead of we’re gonna teach you how to do what you can’t do, and ends up being a failure, yet another failure. That’s where the newer therapies are going is looking at those times when things go spectacularly right. And so it’s two pieces of management of ADHD. Your level of neurologic playing field with the medication, and most people will benefit from two, not one, a stimulant and an alpha-agonist, and then you’ve learned the rules of the game that you’re in. That part’s been left out until now.
Pete: And that is a, first of all, a fantastic message. That hits me just right. We sure appreciate your time today. I hope, I hope that this is not the last time we see you. Will you come back and talk to us about some of these other… I mean, you’re the one who planted the seed for these conversations, you’re sort of obligated.
Nikki: No pressure, though.
Pete: This has been wonderful. Is there a place online you would like to point folks who want to get to know a little bit more about your work?
Dr. Dodson: The place where I publish the most is a website called additudemag.com. It’s additudemag.com and just put my name in the search bar and it’ll bring up over 100 articles.
Dr. Dodson: I write an article for them every issue.
Pete: Outstanding. Well, I know that we have already some big fans of yours in our community and additudemag is, of course, a favorite of ours as well. Thank you so much, Dr. Dodson, for your time and attention today. We sure appreciate it.
Dr. Dodson: Thank you. Glad to be here.
Nikki: Thank you for being here.
Pete: Thank you, everybody, for downloading and listening to this show. On behalf of Dr. Bill Dodson and Nikki Kinzer, I’m Pete Wright. We’ll catch you next time right here on “Taking Control: The ADHD Podcast.”