 Hello, Psych2Go viewers, this is Michelle Rivas and I'm the host of Psychology Roundtable. We have two amazing guests today for our expert panel. The first is licensed clinical social worker, childhood trauma specialist, and the host of his own amazing YouTube channel, Patrick Tian. The next is psychiatrist and host and founder of the popular YouTube channel, Healthy Gamer, Dr. K. Welcome to both of you. Thank you so much for being here. Thank you so much for having us. I think it's an honor to be here. Absolutely. It's an honor to have you. Yes. And so can you both tell us a little bit about yourselves and your expertise? Let's start with Dr. K. Sure. So I'm Dr. K. So I'm a psychiatrist by training, struggled a lot with technology addiction, growing up, failed out of college, went to India to find myself, decided to become a monk, but then met my wife, fell in love in the opposite order, actually. So decided to go to medical school. And then part of what I really loved about medicine was the mind. That was my favorite organ. So ended up training to become a psychiatrist and really incorporating a lot of like eastern principles of the mind and mental health. And then a couple of years ago, started focusing on technology addiction by streaming on Twitch and talking to gamers about the impact of technology on their brains and on their psychology. And so that's where Healthy Gamer was born. Amazing. Amazing. And then Patrick, I started off really as a client, you know, in my 20s, I started to do, I really hit the jackpot and started to do some trauma work with a really gifted therapist. And then there was some sobriety in there. And so it went like Dr. K story went from a lot of mess to doing a lot of work and then to kind of finding, finding yourself and kind of finding a passion and talking about this stuff and finding a bit of a purpose in it as well. And yeah. And then with, with YouTube, I was just putting up one video as a project. I didn't go into it. I don't know if this was your experience to Dr. K. Like I was just putting up a video just to kind of see what sticks and then didn't do much for a year. And then all of a sudden it got shared somewhere. And then here we are several years later. So yeah. Okay. Perfect. That's amazing. Thank you guys for that. And so Dr. K, I first wanted to touch on the science behind ADHD. First, for our viewers, what exactly is ADHD and how is someone clinically diagnosed with it? And what is the genetic component? Okay. That's a loaded question. So let's start by defining a couple of terms. So ADHD is attention deficit hyperactivity disorder. So the first thing to understand is that the attention deficit part is pretty uniform, but not everyone is hyperactive. So ADHD is a neurodevelopmental disorder, which means that for some reason, the way that our brain develops is a little bit different. And it's characterized by a couple of different things. So the first is disordered attention. And disordered attention can mean either having attention that's too distractible or too focused. So the key thing about ADHD is that when we should be shifting away, we have trouble shifting away. So I'm on my phone and I really need to get to work and I really can't get to work and I'm stuck on there. Or when I should be focusing, I'm getting distracted. So I'm sitting in class. I'm trying to pay attention and it's hard for me to focus. So that's a disorder of attention. And there are other subtypes, other aspects of it. So it can also have things like impulsivity. It can also have emotional dysregulation. So people with ADHD experience emotions more hotly and more intensely. And so there are a lot of different features to it. And one of the key things that we need to diagnose a disorder is that it should impair function in some way. So it causes some kind of problem in your life. And when we say sort of ADHD is diagnosed clinically, we've got two basic ways we diagnose it. One is through taking like a history. So we'll ask people, did you struggle in school? How did that go? What's your attention like? Are your emotions kind of like, do you have impulsive behavior? What's your emotional regulation like? So we'll take kind of a clinical history. And usually what we're looking for is the presence of symptoms starting pretty early, usually in childhood. And Patrick may be able to speak a little bit more on that. But also that it's present in multiple situations. So it's present at home and in school. That's a big part of the clinical diagnosis. And the cool thing now is that we have a lot of like neuropsychological testing. So there's actually like tests you can run to sort of see if someone has ADHD. And then I think the last question that you had was about genetics. Yeah, the genetic component. Absolutely. And ADHD does have a genetic component because it's something about the way that your brain develops, which is in some way determined by your genes. But I think that the tricky thing about the genetic component is not everyone who has a parent with ADHD is doomed or destined to have ADHD or vice versa. And that the other thing that we're sort of learning more and more, and I think this is really Patrick's area of expertise, is that even if you have a parent with ADHD, it's not just the genes that will sort of influence your ADHD. It is the adaptations that your parent has learned, the things that they don't know how to do because they're not neurotypical, that they can't teach you how to do. So there's absolutely a nurture component as well as well as a genetic component. Absolutely, and that's the perfect segue to this. Studies show that adults diagnosed with ADHD are more likely than those without ADHD to also have post-traumatic stress disorder or PTSD. That's a mood disorder that might develop after a traumatic event. People with PTSD can have ongoing trauma symptoms or ones that come and go. Patrick, what is the connection between trauma and ADHD? There's so much overlap. It's hard to sometimes differentiate between the two, but when I really think about the factors that kind of bind them two together, lack of focus, I have this theory that a lot of it is sort of dissociative. And I don't mean like a Hollywood version of dissociation of really being way outside of your body, seeing yourself in some kind of like movie, just really not being grounded, not being focused, not kind of being able to think and feel and communicate at the same time. So just really kind of, or in other words, when I think about dissociation, how I explain it, it's just simply maybe being in our head, being freaked out of what the barista might be thinking about us, even though that we didn't do anything wrong, as a version of being anxious and a little bit dissociative, just a little bit. So I see a lot of that in between the two. Sort of low frustration tolerance, disorganization, like that's what I mean about the overlap that in many ways, it's hard to tell the difference between the two. In a way, if it's just organic ADHD on its own, it may not have a lot of deep seated trauma beliefs. There can be low self-esteem beliefs, like, oh, I can't do anything or I can't get anything right. But in terms of like childhood trauma-based attachment beliefs that no one likes me or I mess everything up, I mean, even those are hard to suss out. So I think what I'm trying to say is where I find that in terms of figuring out, is it trauma? Is it ADHD? Is it both? They kind of really go hand in hand with each other. It really comes down to what happened to that individual growing up in that house at that time. So that's kind of how I see the connection. It's almost to talk about it's easier to figure out their similarities. It's harder to figure out their differences. Oh, wow, that's an interesting way of putting it. And would you say people with ADHD are more prone to depression and anxiety? Does it almost exist comorbidly? Is it like a package deal almost? Yeah, that's tricky in a way, because if we think about a fourth grader in public school, we're just organic ADHD. He or they or she are being potentially traumatized by the social interactions around them, depending on how sensitive the environment is to what their needs are. I think what Dr. Kay mentioned something earlier about the social component and then what's going on at home with the ADHD in context of childhood trauma. I don't know if that makes sense, but... Do you think the way that they might be treated in a public school setting, and as a child who has ADHD, you re-traumatize them in a way? Yeah, and it's funny, I think that I've had many clients come to me that when I start working with them, the first thing they start talking about is bullies in the school system. When they think about being traumatized, that's the first place that their brain goes to. And from what I do as a clinician, I'm thinking about how did your parents help you with that? Then I'm starting to poke around about the trauma at home with it. So absolutely, I also think about ASD and other neurodivergent kind of kids. It's just really a brutal disaster for them in a neurotypical world. So there's lots of trauma that comes from that. And I think where if the family, it's healthy enough and psych-minded enough and sort of good enough parenting and knowing what's going on with the kids, they can really soften that blow of what's going on in the social component at school. Thank you for that, Patrick. And Dr. Kay, what do you think is the connection between trauma and ADHD and what is the impact when these exist comorbidly? That's a great question. So I'm gonna kind of build a little bit on what Patrick said, because I think he hit all the high points. So a couple of things, and I'm gonna start with this, which I thought he did a great job of describing. So I think we need to all understand that generally speaking, it is traumatic for a neurodivergent kid to be raised in the neurotypical world. And there's plenty of evidence. It's a bold statement, but there's plenty of evidence. So one study, for example, found that by the second grade, a child with ADHD will get invited to zero birthday parties. So if we sort of think a little bit about, even kids that are six and seven will be able to tell the difference in terms of neurodivergence. So if we kind of think about how do you get invited to a birthday party? Well, at school, on the playground, we all wanna use the slide and we get in line. And so what oftentimes happens with kids with ADHD is they don't know how to wait their turn in line. So they cut in front of other kids. There are social impacts that leads to isolation. And once we start, once isolation enters the picture, that's when we open the door to things like PTSD or depression. So one study, for example, found that you asked about comorbidity, which is a great question, Michelle. So if we sort of think about, there was one study that looked at people who have ADHD and depression. And what they found is that 3% of kids who get diagnosed with depression will grow up to have ADHD. But 70% of kids who get diagnosed with ADHD first will end up with depression. So ADHD really does appear to have a causative impact in depression and later in life. And I think it's kind of what Patrick is sort of alluding to that these kids have harder experiences. And when I work with patients, what this kind of looks like is like, if you're a kid, let's say who's 10 years old, 11 years old, 12 years old, you know that you're just as smart as every other kid in the class. You know you're not smarter, you know you're not stupider, but for some reason, you can't do what your teacher is asking you to do. Everyone else can sit and study, but you're the one who gets in trouble. And so if you're a child, how do you understand that? So what these kids come away with is sort of this idea that I'm fundamentally busted in some way. Not sure what it is, but I'm just as smart. I can do, sometimes I can study just as well as anybody else. Sometimes I can pay attention. And so what happens is as they go through this upbringing with ADHD, and if there aren't enough people around them to support them, in terms of this is, by the way, this is how you need to wait your turn in line. So parents can kind of entrain that behavior. If a school system is supportive enough, they can give the child some degree of accommodation. And so it's kind of like the deck is stacked against the kid. And then as they grow up and they're not able to go to birthday parties, is they're not able to do well in school. If you kind of think about my identity, you know, what am I proud of? I'm proud of having friends. I'm proud of doing well in school. And so they sort of get deprived of that stuff. And then it develops into something like depression or trauma kind of later in life. And I think it's interesting that you bring that up because sometimes teachers will sort of exacerbate that. Like teachers will point out that the student isn't focusing in class. Like it's almost like the teacher kind of ostracized or marginalizes the child and that just makes it worse. And then the other kids kind of pick up on that. And how do you feel like teachers and mental health professionals need to, you know, approach children in a more empathetic way? How can they do that? Yeah, that's a great question. And, you know, it's kind of weird because there's definitely some things. Was that from me or Patrick? I'm sorry. It's for you and then for Patrick. Okay. So I think the first thing we've got to understand is that the rate, so there's one study that shows that the rate of ADHD diagnosis depends on the teacher to student ratio. Wow. So the more students there are in the class, the more likely they are to get diagnosed with ADHD. So the first thing I think we've got to understand is that oftentimes our teachers are already like overworked and then disadvantageous situations. So oftentimes what happens is that when there's more attention to be given to a child with ADHD, they act out less. It's not that they're acting out less. It's that there's more kind of accommodation given. I think in my experience, so the biggest thing that teachers can do is to ask the question why, right? So if there's one child who's constantly disruptive, if we think about our teaching model, what do we do to disruptive children? We punish them in some way, right? That's how we get behavior in line. We show them, hey, this is wrong, this is right and you're spot on that other kids pick up on that. So ADHD kids also wind up as the class clown because that's how they end up socially sort of getting some respect. Or actually, I've heard this a lot, or the bad kid quote unquote, which is really sad to be labeled that. Absolutely, right? So they develop some kind of identity about how I fit in with things. And so I think the tricky thing that I think a lot of teachers don't have the bandwidth for, so I don't really blame them for this. But I think the most important thing is to ask why is this child behaving this way, right? To really dig into, as opposed to thinking, okay, this child is a pain, right? Which they may be objectively in class, they're very disruptive. But the question is why? What's going on at home? Because there could be trauma, there could be abuse, there could be ADHD. And I think the patients that I've worked with and the teachers that I've worked with, the best outcomes come when teachers sort of ask the question, what's going on here, as opposed to let's try to fix it. So good diagnosis precedes good treatment. Exactly, thank you for that, Dr. Kay. And then Patrick, what is your take on that and how teachers and mental health professionals need to approach it or approach it with more empathy? I love the conversation, because I was thinking almost like in a parental attachment with the teacher, because we're so every day in public school with this one person from September to May, like they're like a parental figure. And I think about like almost like goodness of fit. I had some teachers that could recognize, some teachers could not be triggered by my attention seeking behaviors, because I was that class clown. Some teachers could work with me on it. Other teachers would really be triggered by it. So I think it kind of depends, and I'm not trying to demonize teachers at all, they were just trying to get through their day. But at the same time too, they can, I really think about it in my mindset of like growing up in the 80s or the 90s, where it really wasn't a discussion about what kids, it wasn't even, we didn't even know what these things were. So I just think about it in terms of that way. I think it really depends on the teacher to be able to connect with a kid outside of what they're struggling with. Or the teacher tends to just kind of be really bootstrappy, get it together, you know what I mean? You're not gonna amount to anything. We are like, there's so much trauma happens in those school settings, you know? Exactly, especially teachers who tell children that like you're not gonna amount to anything or you're lazy. I feel like there should be some sort of penalty for that or some sort of training to help teachers approach it differently because that could actually re-traumatize a child. Yes, I think it's more, I think progress is slow, but I think a lot of school systems are becoming way more educated on this. But the other piece too is I've had a lot of clients that are able to tell me that they did have one soft, gentle teacher that really went to bat for them, that could really meet them and give them connection that they weren't getting at home about a problem. Like when a teacher says like, I know this isn't the real you or something like that. Do you know what I mean? Or I know that, you know, like I could see you. I could see what's going on for you. I think that's what I'm trying to say. Thank you for that, Patrick, and I agree. And I just wanna know what suggestions do you have for someone who's struggling with ADHD and maybe substance abuse disorder or PTSD and what are some effective coping mechanisms or treatment options? And I'll start with Dr. K. Okay. So the question was about ADHD, like how do you approach ADHD, substance use, and trauma as a bundle? Yeah, well, yeah, I mean, since sometimes they exist comorbidly. Oh, absolutely. They exist comorbidly a lot. Yeah, I mean, as a bundle, I guess we're talking about this because a lot of people, they deal with so many issues comorbidly and they don't know what to do. They're emotionally exhausted and drained. And I know Dr. K. That you did a video on this on how draining and depressing ADHD can be for people. Yeah, no, I mean, I think the real sad thing, Michelle, is that they do exist comorbidly. It's a great question because I think these are the people, so like the problem is that, right? So the problem is that if you've got one of these things, there's an answer. But the more of these things that you have, the more complicated the answer becomes. So where do you start, right? So do you deal with the addiction first? Do you deal with the trauma first? Do you deal with the ADHD first? You know, what's going on here? And so I think let's understand, I think there are a couple of common pathways that we can sort of understand the development of that will give us some insight on where to start. So the first is that let's start with like emotional regulation because I think this is a key, key common pathway to all three of these things. So sometimes people think, okay, I have three problems to solve but the cool thing is sometimes there's one thing that you can do that can improve all three. So we know that kids with ADHD, their brain is wired different to where they're amygdala in their limbic system, which is our emotional circuitry of the brain is kind of hyperactive, it's fidgety. So a small thing can really upset kids a lot and they can get really, really kind of angry or hyper-focused very easily. So there's a subgroup of researchers who are hypothesizing that there's a different variant of ADHD that is specifically emotional dysregulation. These people have powerful emotions that they can't control. Now, if we look at something like addictions, when I have powerful emotions that I can't control, what do I do with those emotions? Well, it turns out there are substances that I can physiologically ingest and will biologically alter the emotions that I feel. So having ADHD makes you more prone to addiction due to a combination of impulsivity, which leads to addiction and a lack of emotional regulation because you can't regulate your own emotions. So you're gonna reach for a substance and that's what your brain learns is gonna help it. Next thing to understand is if we look at something like trauma. So what happens in trauma, I'm generalizing here, is if you look at the brains of people with trauma, there's this part of our brain called the corpus callosum which connects our emotional brain to our logical brain. We've got a right hemisphere and a left hemisphere. The corpus callosum is what allows them to talk. Now what happens in trauma is when people dissociate, their emotions get disconnected from the rest of their brain. So activity across that corpus callosum actually stops or doesn't stop, it reduces. And so what happens in trauma is when I feel a ton of emotion, it's overwhelming for my brain, so I dissociate. And then I'm looking at things kind of like what Patrick was describing, that's sort of the more Hollywood version of I'm looking down at myself, I don't feel anything I feel numb even though I'm going through a bad situation. So if we look at these things, emotional dysregulation triggers dissociation, which causes all kinds of problems. Emotional dysregulation causes us to reach for substances as a coping skill. And emotional dysregulation is part of the wiring of ADHD. So if we look at where should we start, I would start with emotional regulation. So whether that is learning mindfulness techniques, whether that's processing your emotions on kind of a daily basis through journaling or seeing someone like a therapist or psychiatrist, but really leveling up your emotional coping skills is like the one thing that benefits all three of those. And when I'm working with someone, that's really what I start with. And you can even use coping mechanisms like one thing that I'll teach people is exercising as hard as you can for 60 seconds. And what I'm talking about is like pretend that you're being chased by a monster in a horror movie. So when you have just absolute maximal exercise for a 60 second period, it activates a very powerful calming response, which will really calm down your emotions after that. So it's something that's weird. You can't do this at work, but really what I'll tell people to do is like, we'll go out of my office, we'll cross the street and you'll run as hard as you can 30 seconds that way and 30 seconds back in the park, like outside of my office. And if you can do that, it really calms you down. So it really starts with whatever emotional regulation works for you. Thank you, Dr. K. And then Patrick, what coping suggestions would you recommend? That was really well said because that bundle is super, or any bundle. Any bundle of problems. I think about it where someone's struggling with alcohol or drugs, ADHD and childhood trauma, they come in and they wanna work on their childhood trauma because they know what happened to them growing up or what they went through is driving the two other things. But when we start to do some childhood trauma, I'm now dysregulating them more so. So it's sort of like with the trauma piece of being really the last piece after some long-term sobriety that's good enough for them. So all of that treatment that Dr. K recommended, like learning how to regulate your system is one thing. So that's what I wanna say that is usually it's the last part for someone to be prepared to willingly wanna dysregulate themselves by talking about what happened to them. That takes a lot of kind of footwork. That takes a lot of a little bit of time, a little more sort of pre-stuff to happen. But also when I think about the substance abuse and ADHD and trauma, so much shame. There's so much shame around calling in sick to work. I just mean the really the cluster of the whole lifestyle of relationships, tanking or a lot of it isolation. But in a way, for those, when I'm processing, say with a client and they started smoking cigarettes and doing drugs around 12 or 13 years old, I might kind of address the shame piece and say, good for you for coming up with a way to reset your system or deal with the pain on some level because you weren't getting that help at home. So in a way like when they come in, it's just like it can be really, I don't know if Dr. K has had this experience where it might feel a little bit humbled if we're asking them to do mindfulness exercises when they have such big problems. So speaking to that, it's kind of, you really have to have a really good dialogue and conversation about first things first, but also really kind of say, I get it why you came up with this stuff. You know what I mean? I really get that and almost like good for you that you came up with this stuff because it was like a pressure release to reset, you know? It's like when I used to be a smoker, my mindset used to be, I'm gonna have this cigarette, then I'll go back into work and do these things. It was a way for me to reset the moment, to reset my emotions and sort of next steps. And I think that makes me think about that with substance abuse. I mean, it's a lot more messy than smoking and going back into work, but... I love that you brought that up because you talk about resetting the moment, which in a way, do you think that could be something healthy if you do it without smoking? Like maybe with a cup of coffee or with, yeah. Yeah, just like, well, in what Dr. Kay is suggesting is we are trying to give them comfort and help them be seen while replacing the coping strategy that's gonna take them out and be really bad for them with a new coping strategy, a new way to regulate your system, running for a solid minute, learning how to meditate, learning how to put stuff away and just get something done for just a few minutes and just how to like, and I'm not an ADHD sort of like expert, but just sort of for those therapists that are able to kind of help them just do things differently, is a replacement. But at the same time too, if someone is addicted to a hardcore, if someone is a physical dependency to alcohol, they need to be in a facility that's safe for them to titrate down and all, you know what I mean? We're not gonna be given the mindfulness and hope for the best kind of a thing. Depending on how much substance abuse is going on. Exactly. Well, thank you for that, Patrick. And now we're going to switch over to our audience segment where we answer your viewer questions, our experts answer the viewer questions. So let's begin. So this first question is for Dr. K. Ethan asks, is my ADHD causing me to have porn addiction? I'm really struggling. What advice can you give me? That's a loaded question. Yeah, so is your ADHD causing porn addiction? So this is, I'm sorry to say, Ethan, you can't get a pass on that. You've got some personal responsibility. Here's what we need to understand. There's a lot of stuff to understand though. The first is that your ADHD is absolutely making you more vulnerable to pornography addiction. So this is where, you know, I think it's interesting because what's the relationship between the two? And I found, so I do primarily addiction psychiatry work and I find that when I have a patient who says, is my depression the cause of my addiction? I find that that's a little bit tricky because it implies that if you fix the root problem, the addiction will go away. Whereas the addiction has its own life at this point. So I think that your ADHD absolutely enhances the vulnerability and makes your brain more likely to be addicted to pornography, whereas a neurotypical brain may have it easier. Now, what we know about the brains of people with ADHD is that they have a lot of difficulty with impulse control and emotional regulation. And if you look at FMRI studies, so these are brain scan studies which look at the brains of people who are addicted to pornography. What you actually find is that the primary thing that pornography addiction does is emotional regulation. So literally what happens is when people are feeling more emotion, but they're not oftentimes aware of it because we're so numbed out from the pornography, we're not even aware of it. But what you'll find is throughout the day, you'll have these impulses to watch. And if you track those impulses back to their root, what you'll oftentimes find is that there's some kind of emotion at play. Because if we look at what pornography does, there are very powerful circuits in our brain that are geared towards procreation because that's like the purpose of the species. And so these are things that will really suppress your negative emotions, will really activate certain parts of your nervous system, will trigger things like dopamine, which can feel good. And so when we're feeling bad, we reach for the pornography. The real challenge here is that pornography is getting more addictive. So it's not just that you have a vulnerability to it, it's that there's actually an industry which is trying to figure out how to get you to watch more pornography. And so it's super challenging and the two absolutely intersect. But I think one thing to understand is that treating either one will help the other, but fixing one won't necessarily fix the other. So you kind of got to fight a war on two fronts there. Thank you, Dr. Cain Patrick. Do you have any thoughts on that question or your take on it? Well said. Where also just to, probably with every one of these questions, I'm just going to be having everyone be thoughtful about, was there childhood trauma at play that might cause this kind of stress? You know what I mean? Where someone like that would come into my office is my ADHD causing my porn addiction. The first thing I want to flush out was how did the family of origin deal with issues around sex? Yes, 100%. Was the household sensualized? Was its household super repressed? You know, like the tale of the classic American sort of boy my age, we all find magazines at way too much of a young age. You know, I'm always thinking about we all needed healthy parents to have conversations with us around that time. And I think that those are the things that I think would confactor to developing the coping strategy of porn addiction. Just another thing to kind of reset our system or to get a little hit of something, you know? Thank you, Patrick. And I wanted to throw this next question to you. It's, Hamani asked, is my ADHD causing me to practice escapism? Which I would say is, I think they're asking like, is it the same as like dissociating? Maybe that's what they're referring to. Can we, are we doing the ability to ask them? Cause escapism is that like you're going into a little bit of fantasy in your mind or daydreaming or are you talking about like dropping everything and living in a van for 10 months cause you want to, you know what I mean? And that's not like maybe like a well thought out kind of kind of thing. Escapism, like... Living in a van for 10 months sounds very well thought out and a great idea to me. Let's see. So in terms of dissociation? Yeah, so like, I think that that's what they mean. They're escaping like their problems or they're practicing escapism such as dissociating to deal with the ADHD. Yeah, and it could be again, I'm thinking about, is it something that was developed as a child to just kind of go a little bit blank or go into a little bit of fantasy or to go, cause it's just, is it one of the traditional trauma responses of just kind of freezing a little bit? But I think it's more of a question, not so much an answer for me, but just to kind of get you to think about like in a way, if children are not growing up in safety, they're going to have an overactive limbic system, amygdala, trauma brain, they're going to have difficulty keeping their prefrontal cortex online. I couch that conversation depending on what people like. Some people have an aversion to inner child semantics, but our trauma brain is a lot like our inner child and our prefrontal cortex is a lot like our inner adult who can kind of be more focused in the moment. So I'm not really probably giving a good answer here, but it can like, the last question, ADHD can contribute to the dissociation that can kind of go hand in hand. I think my answer would be to just make sure to flush out and not like to figure out if it's coming from a place of trauma as well. Thank you so much, Patrick. And then I have a question for both of you. I'll start with Dr. K. Joel Demetrius Johnson asked, is my inattentive ADHD and depression linked or are they separate from each other? I also developed PTSD from my mother's passing in 2009. My condolences Joel. If I can actually just chime in on the last one for a second, just a slightly different perspective and then I'm going to punt this one to Patrick because I'd love to hear his answer to this one. So just a quick point. So one thing that I thought was really interesting. So maladaptive daydreaming is on the rise. And so it's really interesting. And I was looking into it because like, we were kind of wondering what does this person mean by escapism and I think dissociation is a completely fair interpretation of the question. But what we've been seeing a lot in our community is maladaptive daydreaming. So it's not quite dissociation, but they'll really get lost in like fantasies for extended periods of time. And there are actually some studies that really suggest that this is another subtype of ADHD. That when we sort of emotionally, once again, when we're, we'll sort of enter this daydream to help manage our emotions. And there's something about the attention component there as well because instead of focusing on the real day, we get kind of lost in this fantasy. So it's kind of like this perfect storm of like distraction and getting lost in this fantasy, which happens with the attentional deficits combined with something else that kind of results in this sort of escapism or daydreaming or something like that. So it's just something that's definitely on the rise. And I think we'll be hearing more about because I think that many people have Himani's experience of kind of getting lost in this world when they have ADHD and they're not quite sure, is it dissociation, what's going on? And I'd love to hear Patrick's kind of take on this question if that's okay, because I really appreciate his really attachment perspective. And I'd love to hear, I think he's just a really robust thinker on this. How would you approach someone who kind of combines this inattentive ADHD and depression and development stuff? I'm gonna ask a question on top of the question for you. I'm glad you said that last piece, Dr. Kay. Is it, could any of that maladaptive daydreaming be related to social media or screens or the change in the last 10 or 15 years about where our culture has gone there? I think it could, but there is, the studies really look at maladaptive daydreaming. And I think what social media really does is it creates spaces for us to get lost in. So whereas before your brain had to do all the work to construct a fantasy, whereas now if we want to escape, it's really easy, right? Because all I have to do is open up a little bit of social media and then I am boarding the dopamine train, which will occupy me for the next four hours of doom scrolling and suppress all of my negative emotions, especially through things like video games and stuff like that. So I think we're absolutely seeing a link and I'd love to kind of hear your perspective on this too, around the rise of technology and kind of as technology gets more sophisticated and it's impacting our attention span for sure. Right, right. Thank you for that. Can I see the question that I was up on deck for? Yeah, actually I'll just summarize it. So Demetrius asked, he asks, is my depression and ADHD linked and also my PTSD from my mother's passing? I don't really know how to answer this question. I can't say yes or no, but where my brain goes with it is, I think it's interesting then the way that we wanna think about causation and separate these issues, depression and ADHD and the trauma is, I just think that, I'll answer it with this, that I think with good psychotherapy and processing, I'm very sorry for the loss of your mom, processing mom's passing, I think that with good psychotherapy comes good energetic shifts in space. So in a way, things might get better with the depression and the anxiety, but I think what the questioners are sort of asking is like, is this causing that and what do I address first or whatever? And I think if you're just able to kind of talk with somebody who you like, who is effective with you is, it may not be so much about what causes what or separating the two things, more so about, it would be beautiful for all of us just to have more headspace and some more calmness. So that's maybe the best way that I can kind of like address that kind of question. Thank you, Patrick. And then Jar asked, and this one's for Dr. K, what is ADHD doom scrolling and how do I escape from it? Thank you for answering questions. Since you mentioned technology. Yeah, so, I wish I had a better answer for this, but because this is a evolving problem. So the first thing to understand is that technology companies are competing for your attention because the more of your attention they get, the more money they make. And so we have a battle between these tech giants, right? Things like YouTube and Amazon and TikTok and Meta. And they're all fighting for your attention. The key thing is no matter which of them wins, the one person who always loses is you because now you are spending more time on the device. As all of these platforms become more and more engaging, and I don't think that they're nefarious about it, by the way, I don't think they're evil or anything like that. I think they just have a job to do, which is to serve people the best content that they find the most engaging, right? So that's their goal is to keep you clicking. The next thing to understand is that if you have ADHD, you have particular vulnerabilities that make it easier for them to kind of engage you. So I'll give you just very simple examples. So people say ADHD doom scrolling is tough. I completely agree, but I've seen the most benefit not in terms of stopping the doom scrolling but preventing it in the first place. So just to give you a very simple trick that I give to people with ADHD, our phone makes it easier and easier for us to access distracting things. So once you start scrolling, you're gonna doom scroll and then it's hard to stop. So the question is, what can you do to slow down the engagement of the doom scrolling? So now we have things like face ID where I just pick up my phone and I'm not even intending to look at anything. And the phone sees my face, it unlocks and it opens up Reddit or Twitter or whatever I have there. And then now like we're off to the races, right? Because now there's some engaging piece of content that kind of sucks you in. So the tricky thing is with ADHD, we are more impulsive. And so what we really wanna do if you wanna bypass doom scrolling is you need to increase the time between an impulse and the gratification of that impulse. So what I would say is disable phone lock or like finger lock, disable phone ID, make it as much of a pain in the ass as possible to engage with technology. So uninstall native apps and use a browser to browse something like Twitter or whatever. So I recently uninstalled the Reddit app from my phone and I use a web browser to access Reddit because it adds an additional step. So the key thing about ADHD is you have an impulse. And if you can satisfy that impulse and you board the doom scrolling train within one second, which by the way is how long it takes now because they're getting better and better at like making it easy for you to get to your content. Stretch it out to five seconds, 10 seconds, 15 seconds. And then the impulse just as quickly as it arises, it'll disappear too. That's one of the advantages of ADHD. So all you have to do is ride out the impulse. Yeah, so I think that's really the, that's what I found to be more effective than stopping doom scrolling is preventing doom scrolling in the first place. Because it leads you down a rabbit hole. Absolutely, right? So when I look at one Reddit post, I lose 30 minutes. So the big change that's happened with technology is back when I was like studying in high school, I would be at a library and I have a textbook. If I get distracted, I get distracted for 30 seconds and there's nothing else to do. So I go back to reading the textbook. Now the problem is we carry our phones around. So getting distracted, a five second distraction now costs you 30 minutes. So try to increase the barriers of access as much as you can. Thank you, Dr. Kay. And then this question is for Patrick and it's from Devil Blues. She asks, maybe ADHD is a sign of not feeling safe in the body due to frozen trauma from the past. This is an interesting question. What do you think, Patrick? I just love the conversation. This is, you know, I could die all day. Maybe ADHD is a sign of not feeling safe in the body due to a frozen trauma. I love the question because I think that for childhood trauma survivors, there are just beliefs, situations, family dynamics that kind of run us in the background, like a refrigerator buzz. You don't really know what's there until you kind of pick up on it. For example, you're in the fifth grade and your parents go through like a really horrific divorce and you get forgotten in that. It's really, really nasty. And I think until we kind of get the chance to process that with somebody and really kind of talk it through and do some work around that, I think it kind of runs us in the background. And I think if you have organic ADHD, it's not even a thing. Dr. Kay, is that a fair two words that you put together, organic ADHD, to say that it's not caused by childhood trauma? I mean, yes and no. So, so... What's a better term? So, I mean, I think that... So what's the opposite of organic? That's kind of my question. Yeah, that's a good... Right, so because when I think organic, I sort of think biological and I sort of think the opposite of that, at least in our field is like psychological. Yeah. So, but I think the two go hand in hand. So, I think there's absolutely a genetic neurodevelopmental aspect to ADHD, but I think there's absolutely like all the issues that I, at least I come to you to learn for, you know, like attachment and development and that kind of stuff. And it gets so intertwined. I don't use the term organic ADHD. Got it, got it. Thank you for that. So for the, like a frozen trauma in the background, that can very much contribute to our symptoms of being in our head or dissociation or shame and anxiety. And again, I think that this stuff is like a big soup. So it's gonna be affecting probably some ADHD. And in a way to think about it like where, say you're going through a bad patch and you've been reflecting on your childhood trauma or you've been triggered by a relationship and you're just not your best and you go to a party. And so that trauma is in the background and the triggers are kind of in the background. And that might contribute to you being a little bit more in your ADHD symptoms because now you're at a social event at a party. You might be a little bit more impulsive and overshare for some reason because you're nervous. So that's what I mean about where my brain goes to that stuff. And I think again, if we can, if you have childhood trauma to find somebody and start to do some good work with somebody, I think a lot of stuff gets turned down in a really good way, creating some space. And most importantly, I'm a big advocate for changing the narrative about yourself in context of how we grow up. I love that. Oh, you were just kind of a dumb, goofy kid, class clown kind of a thing. That needs to be shifted to you weren't being safe at home, you were trying to get your own needs met. You know, none of it was your fault kind of stuff. I love that. Thank you, Patrick. And then Onigurl asks, how to combat ADHD burnout and depression? I'll throw this one to Dr. K and then Patrick. So I think first step is actually differentiating out the concepts because I think they're quite discreet. So let's start with that. So the first is burnout, oftentimes comes with the depression, but burnout usually comes from trying really hard in not seeing the result, right? So I'm gonna kind of focus on this, which is very common for people with ADHD. So what happens when you've got ADHD is you have a world that is designed for brains that are not yours. And so what you have to do is try extra hard or develop adaptations that are more costly, right? So other people can move through life relatively easier, but everything causes a lot of friction for you. It's hard to make friends. Even like socializing becomes something that you have to spend a lot of effort in because you know you shouldn't be interrupting people, you should be paying attention, you just introduced yourself and you forgot what this person's name is. And so if you look at sort of the experience of people with ADHD, they're very burnout prone because they expend a lot of effort and it requires twice as much effort to get what a neurotypical person may get. So then if we sort of look at, okay, what happens with people with ADHD and why does this happen and what can we do about it? A big part of it is if you look at willpower, the biggest cognitive drain that we have is exerting willpower. So if you are in a situation where you have to try really hard to keep your ADHD in check, that's gonna be incredibly draining and lead to burnout. The cool thing is there are some circuits in our brain in ADHD that are completely intact. So one example of this is the habit circuits of the brain and this is like the endocannabinoid system. So a lot of like ADHD is governed by like dopamine and the nucleus accumbens and stuff like that. But there's a different circuit in our brain which is how habits form and that's completely intact. And so a lot of times the situations that cause you to burn out, what are things that you can do to develop habits in those situations instead of exert willpower? And the more that you can do that, the less burnt out you will be. Just to give one example, so I worked with a ton of people who forget names, okay? So they'll introduce themselves and they'll forget names in social situations which makes socialization hard. So just simply practicing, I'm gonna repeat the name three times or I'm going to use the name in my response to them. Works wonders. So hi, Michelle, or like you'll introduce yourself as Michelle, I'll say hi, I'm All Oak. And then I'll say, it's nice to meet you, Michelle. And so when you practice some of these habits and you engage that habit circuitry, it removes the load because habits are automatic. And then that sort of increases the battery that you've got for other things and really helps with the burnout. Awesome, thank you for that Dr. Cannon. What advice would you give Patrick? For burnout where that was really well said, in my world for childhood trauma survivors. And again, I don't wanna sort of, not trying to say that every one of these like sort of those contributing to questions have childhood trauma, but just though it's like a different way to kind of think about things is if a client comes in as it is talking about burnout and ADHD, again, my world would be thinking about are they trying too hard in their world from a place of childhood trauma? Are they people-pleasing? Or did they grow up in poverty and they're just a juggernaut just trying to make a salary even though they don't really need to make that much because the salary keeps them safe on some level and they're not kind of addressing that kind of pain. So the burnout is just to also consider like what might be childhood beliefs if you have childhood trauma, that's running that like, I love the way Dr. Kay said it, it's just like willpower or will like so much cognitive energy goes into sort of doing that that's our engine going through life. And there's our engine coming from a place of perfectionism, competition, shame, those kinds of ideas that might, it may not cure the burnout, it doesn't immediately solve being either workaholic or having to work several jobs because of capitalism or something like that, but it does help the emotions. Thank you for that, Patrick. And that concludes our audience segment. I have one last question for both of you. Why do you guys believe that more and more people are coming forward with their ADHD struggles? And we talked about how people are ostracized by having ADHD, but in this day and age and the age of social media, do you believe it's actually becoming trendy? Dr. Kay. Sure. Well, for the record, Patrick, I think it's totally fine to take a childhood trauma lens for all these questions because I think it's, I actually really appreciate that perspective that you have and I think it's something that our childhood shapes so much of what we have as adults and for everyone listening out there, I think the number of patients I've been able to help by gaining sight of that perspective is astronomical. And I think a lot of the stuff that Patrick is talking about, I think is really transformative once you really get into it. And I love the way that he kind of reframes things, so to understand that an addiction that you developed was your survival mechanism because you were 13 years old and you didn't know any better, completely changes your narrative and shame and stuff like that. So strongly encourage y'all to really think about what Patrick is saying. Going back to the question at hand about ADHD and why it's on the rise, right? And what the connection between... Yeah. And those who argue that it's becoming not something that's ostracized anymore, but something that's more trendy, that's not my opinion, but what some people have been saying on the internet. So I think that there is a... There's a growing trend of a couple of things on the internet. The first is there's awareness about mental illness, which I think is good. I think the rates of ADHD diagnosis are increasing, which I think is probably good. I don't know if it's actually getting worse or we're just catching it more. I also think that technology is shortening our attention span and reducing our ability to regulate our own emotions because it does the regulation for us, right? If I'm feeling bad, let me watch a couple of cat videos. And then our brain has this very simple function of if you don't use it, you lose it. So you can study a language in high school and if you don't practice, you forget it. And in the same way, we won't develop emotional regulation skills if we outsource our emotional regulation to technology. Now, if we look at even things like YouTube content, right? So the more click baity you make it, the more engaging, brighter colors, zooming in and out a lot, that all engages your attention so that you don't have to focus it yourself. So I think all three of those things are happening and making ADHD kind of worse. On the flip side, what we're also starting to see is interestingly enough, a lot of compassion and understanding around ADHD, which I think is a good thing. But then now what's starting to happen, which I sometimes see, and sorry if this is like not the most PC answer, is that some people will start to use it as an excuse, right? So I've worked with a lot of people who have struggled with very serious mental illnesses and one of the most frustrating things is, you know, it's not your fault, but it is your responsibility. And what happens a lot of the time is that people will sort of say like, oh, I'm not responsible for this because I have ADHD. And so I do think that there's a lot of self-diagnosis. There's even like a fair number of studies now that are coming out that suggests that a lot of the self-diagnosis stuff is not very accurate. I think it's really harmful to the people who really are struggling when people kind of say, hey, I've got this problem too. But at the same time on the flip side, there are a lot of people who have gone through life not being diagnosed. And the reason that they really take it seriously is that they see someone else talking about it and they say, wow, this is like me too, right? I never realized that this is a feature of ADHD. And I'm even thinking about a beautiful video that Patrick made where he was talking about the overlap of trauma and ADHD and how one can really look like the other. And as we have that kind of content, people are realizing, oh, crap, I always thought I had ADHD, but I may have trauma. And vice versa. And so I do think people are kind of like, there's some unfortunate stuff kind of going on, but on the whole, I think we're moving in the right direction. Definitely. And then Patrick, what is your take on that and about maybe social media enabling more people to either misdiagnose or come out with their diagnosis? Well, I just wanna say what Dr. Kay was very well said there. I have mixed emotions about it, where we have this, it's like we have this internet. And we don't quite know all the pluses and minuses about it. But the pluses are, in the late 90s, when I started my own recovery journey, all you had was self-help books. And I absolutely love the amount of sea-shifting change that people can go on and kind of maybe figure out and get an answer about what they're struggling with. Whether that's about their family system, about some symptoms. And it's really such a powerful thing that is so helpful in the field of mental health. Where I get a lot of comments, it's just like they can't afford therapy or they're still living at home or stuff like that. And this is all that they have and it's actually really helping them. It's keeping them buoyant. It's keeping them informed. It's reducing some shame if they're able to name something or know that it's not about them. So that's the plus side. The downside is, this is gonna probably sound horrible, but it can sometimes become a hobby. It can sometimes become a default thing that even contributes to more ADHD kind of a thing. They're just kind of stewing in it because it's so available. But the piece where for those, in a way that I would love to see a lot more in-person old school interaction for people with mental health, then Reddit is amazing. But do you know what I mean? And there's very skilled experts in family stuff and narcissism and that kind of a thing. But the lack of human element, what would happen if they were all able to get into an actual room with a therapist and do some work in that way? I'm probably rambling or shaking my fists at a cloud like an old man. Then the last part of that question is around whether it's, so I don't think it's trendy. I think it's we're stewing in it too much. I think we're just becoming like a hobby. This is someone's gig. They go home and they spend hours on it, which they might have to just go do that for a period in their life. But I just want to say join a group, get into some kind of human interaction with people. Even I don't care what kind of group it is. Could be D&D or group therapy. Just do something where you're being more sort of social in that way. And the last piece about it is, I think the neurodivergent like education and I think it's always been there. I just think that now we're being much more sensitive to it, but I just think about all the kids I went into high school that I went to school with. The three of us on the call, how many kids did you know that were in a special needs class? What did that do to them? They're sensitive. So I think that it's always kind of been there. And I saw this hilarious TikTok where the woman was mimicking her grandmother. It was more about autism, about behaviors that someone on the autism spectrum does. And it's a grandmother kind of saying, no, don't touch my knickknacks. I want them this way. And she's knitting. And she's like, I don't know why you can't sit still. She's like, I think the stuff has always been there. We just are now to able kind of unpack it, I think. I think that's amazing that you bring that up too. Thank you, Patrick for that. And that concludes our expert panel. This was absolutely enlightening and amazing. And it's been an honor having both Patrick Tien and Dr. Kion. Thank you guys so much. And thank you to our amazing viewers. Thank you all very much. Thank you for having me. Love this conversation. Great meeting you. Awesome. Great meeting everyone today and everyone have a good day. Bye-bye.