7 Newly Discovered Types Of ADHD (After 300,000 brain scans!)

you've recently discovered seven different types of ADHD, why do you think it's important that people understand the seven types? So I'm a psychiatrist by training, I'm also a child's psychiatrist, and half the patients you see as a child's psychiatrist have ADD or ADHD of one type or another. When I started looking at the brain, I sort of thought ADD was one thing, and I like the term ADD way more than I like ADHD. DSM-3 came out in 1980 from the American Psychiatrics Association, it's called Attention Duff, it's a disorder with or without hyperactivity, 1987. They revised the DSM, DSM-3, and they changed the name, and I'm like, well, why'd you do that? They changed it to Attention Duff said hyperactivity disorder, which just threw out half the people who have it, and I'm like, no, I hate that. 1994, they changed the name again to AD/HD, they put the slashing to make up for the mistake they made as opposed to just saying sorry, we made the mistake. Anyways, that's why one of my books is called Healing ADD because I'm still on strike for the ADHD name, because so especially females don't are never hyperactive, so they don't bring the attention to themselves, and so their misdiagnosed is you're not that interested, you're not that smart, you're depressed, you're anxious, when, in fact, the problem is they have ADD. So when I first started looking at the brain, I thought it would be one thing, healthy brain at rest, but when you try to concentrate, you get decreased activity in the front part of your brain, and indeed that happens, but not for everybody. Some people are over-focused, some people have too much activity, some people it's from drama, and it's clearly not one thing. It's interesting that you say that women sometimes aren't hyperactive. What do you say to people who say that women or girls were hyperactive at one point in their life, but perhaps because of messaging and conditioning that they had from the world, they learnt to suppress that, and their hyperactivity ends up in their head? No, I wouldn't correlate with my experience, and I'm blessed to have two girls who have ADD, one of them hyperactive from before birth. She was so active inside her mother's womb, we thought she was going to be a boy, because the law is the more active a baby is, the more likely they are to be a boy, well she wasn't trying to hold her a year old, was like trying to hold a live salmon. I'm like where are you going? She would have been one of those children on little yellow leashes in the mall, because she was so active, but I wrote a column in the local newspaper, so when I would go to the mall people would recognize me so I couldn't have my child on a little yellow leash. No, so I used to put her in her stroller and tie her shoes together so she couldn't get out. She had the age, her sister, never hyperactive, and I actually didn't figure it out until she was in 10th grade where she would stand up every night until one or two o'clock in the morning studying, just to get bees and seas, and she came to me one night and she was crying and she said, "Dad, I don't think I'll ever be as smart as my friends," and at that point I'm like, "I need to look at your brain," and so when I scanned her she had that low activity in the front part of her brain, and on medicine for the, in a ten of ADHD type straight A's for ten straight years and actually got into the University of Edinburgh's veterinarian school, one of the hardest schools in the world to get into. So that is heart breaking if she said that she wanted to be like the other girls. I mean, ADD or ADHD, right, you're gonna get exposed to a ton of comments from the world that make you feel different. What does that do to the developing brain? If you are exposed to this tsunami of comments that make you feel fundamentally different? Well, I think of a child who really has ADD is not diagnosed until after nine. They already have negative chatter going on in their head, and if you're hyperactive, people who have said it to you almost every day sit down, pay attention, stop, because many people who have ADD have low cortisol, level cortisol is a stress hormone, and they often play this game of let's have a problem. In my book, Healing ADD, there's a whole chapter called the games ADD people play, and the hyperactive one used to run up to her brother, kick him, is hard as she could and run away laughing. And if he didn't chase her, she'd go kick him again. You could just see the sort of conflict-seeking nature, which mentions trouble. And what does that do? Like to the developing brain, because from the thousands of women that I've spoken to who have ADHD, they purport to receive an absolute tsunami of comments from the world that teaches their parents, sometimes even like a non-verbal rejection, like an eye roll, or a sigh, or even putting an idea forward at the dinner table and just having it dismissed, because they feel that who they are is not adequate, and not designed for the world that they're living in. So if you go through your childhood and you have had so many messages that reinforce this internal narrative that you are fundamentally flawed as a human being, this is the real quotes that I hear from from girls with ADHD. What does that do to the brain chemistry as you enter out an essence? So it heightens their emotional brain and makes them much more sensitive to rejection. And for our patients have 11 clinics, we not only do we do the imaging work we do, we also give them a cognitive psychological test called total brain, measure 17 areas of cognitive emotional function, and one of them is a face recognition. Are you good at recognizing faces and most of them are? And do you recognize positive faces or negative faces faster? And they recognize negative faces faster. And so it's almost like their brain is looking for what's wrong because it's been trained to do that. Do you know a psychiatrist called William Dodson? No. He's a ADHD specialist. He estimates that ADHD children are exposed to 20,000 extra micro-rejections in their formative years from birth until 13 years old. 20,000 extra little emotional cuts simply for being them. Comments like you're too dramatic, stop fidgeting, you're so lazy, you're so sensitive, stop biting your fingernails, sit still, why are you doing it like that? That's not how it's always been done. Again, just an eye roll can count and the 20,000 extra comments they compound to create an adult that is super sensitive to rejection and criticism. Even something benign like a friend saying I'm too busy to see you tonight having previously made plans can feel like your nervous system is under attack. And it makes them super sensitive to criticism to the point where they can't do anything unless it's perfect. But they'll stay in the office four hours later than everyone else simply because the thought of their boss making a tiny correction to a piece of work is too emotionally painful. They might fear disappointing people which can turn them into a people pleaser. He encompasses this whole manifestation and presentation into something he called RSD, rejection sensitivity dysphoria. Is that something you've heard of? Yes, but I would say certain types are more prone to that, especially the over-focused subtype because there's a lot of people who have ADHD that they get it done in five minutes. They probably should have taken an hour. And then they're off to the next thing. The one that obsesses about it has what I call type three. over-focused ADD, where they have low dopamine and low serotonin and they can't stop thinking about that rejection. Is there an example of how that could actually play out in someone's life? Well, I see it especially in children and grandchildren of alcoholics, so I think there's a genetic environmental interaction with it. So, practically, they have the ADHD symptoms, hyperactive maybe, maybe not, but short attention span, distractability, organizational issues, procrastination, impulse control. So I think of those as sort of the five hallmarks of ADD, but in addition, that type has trouble shifting attention. It's like their gear shifter gets stuck, worried, rigid, inflexible, things don't go their way, they get upset, they tend to be argumentative and oppositional. And they get that negative comment and it spins in their head. So they don't hear it once, might have only been said once, in their head they hear it dozens of times or more. And giving them a stimulant to treat the ADD makes them spin more. And so that's why Ritalin has a bad reputation because for some kids it's miraculous for other kids to nightmare. The oversensitive type being super sensitive to rejection or criticism, how do you think that can play out in relationships? If you're someone who latches on to something that someone said and you take it exquisitely, personally, and it causes a catastrophic emotional response in you, plus you have a tendency to latch on and you can't let go of what that person said. Like, how could that practically manifest in someone's romantic life? Will you push the other person away? I mean, the other person feels like they can't do anything right. And it wears your self-esteem, but it also wears your partners self-esteem. And for whatever reason, I only love ADD women. I don't know what that's about. My first wife taught me so much about ADD and Tanah, my wife, you know, my love of 21 years. She and I did a show together, healing ADD, where we talked about it. But she doesn't do that to my nervous system, I think, because she's a lot more conscious. She gets it treated. But, you know, just speaking from the partner standpoint, it's chronically stressful when you can't do most things, right? And I often would say to my first wife, please don't read my mind. I have enough trouble breathing it myself. And a negative look from someone else may mean nothing more than they're constipated. It might not have anything to do with you, which is also why I teach all of my patients, the 1840 60 world. It says when you're 18, you worry, but everybody's thinking of you. So when you're 40, you don't give a damn what anybody thinks about you. And when you're 60, you realize nobody has been thinking about you at all. People spend their days worrying and thinking about themselves, not you. But when you have the RSD, you're thinking everybody doesn't like you. Sure. I guess it helps to pay attention to the patterns. If it's just one event, then they might be constipated. If it's a pattern of 10 in a row, one week, then there might be something there to dig for. Let's talk about my patients yesterday about projective identification, which is this interesting psychodynamic or psychoanalytic term that means you can make other people feel you can project on to them what you're thinking and feeling. So if you're sensitive to rejection, you can project that on to the other person so that they can't do anything right. And that will push people away. Just a quick hyper focus interruption from our sponsor, Timo. 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And remember, ADHD chatter listeners get a whopping 30% off the annual subscription. Back to the episode. Have you had stories of rejection being physically painful inside someone's body? Because I know of a lady and I'll change her name for confidentiality, but she told me that she, she said she was an alcoholic. She, she has an alcoholic and she said that she was in a meeting and she said my name is Bethany. I'm an alcoholic. I had been sober for seven years, but last weekend I relapsed. And she said last weekend, she was sat in the office at work ready to clock off. It was Friday for the weekend. And her email pinged and it was from her boss. And the boss, the email simply said Bethany, have a lovely weekend. Can we have a chat on Monday morning? And that's all it said. Nothing to add context to it. And she said that she instantly filled with catastrophic thoughts such as everyone in the office hates me. Everyone in the office has tolerated me all of these years. And I'm definitely going to get fired on Monday morning. And she said she physically felt pain in her body. And the only thing she said was to go and get a bottle of wine. And she drove her in bottle of wine. It got absolutely drunk on Friday night. She drank again. Saturday and she didn't sleep on Sunday night. And she went into work Monday morning, trembling. And she sat down in her boss's office and the boss said Bethany, I would like to offer you a promotion. Now, I think she said it was the absence of context and clarity that made her catastrophize and jump to the worst case scenario. But that sensation of experiencing rejection in the body, like a physical pain. She said she really felt it when she read that email and RSD was triggered and she felt physical pain. Is that something you have heard of before? A lot. I published a book last December called Change Your Brain, Change Your Pain. And talk about what triggers physical or emotional pain, which then activate the suffering pathways in the brain. And so the email triggered a flood of catastrophic thinking. So no one and all of her getting sober had taught her to manage her mind. So here we call it killing the ants, the automatic negative thoughts that steal your happiness. And the exercise is super simple. Whenever you feel sad or mad or nervous or out of control, so that's how she was feeling right down what you're thinking. And she would have written down the trail of because ants link and then stack and then they attack you. And so that's what they did. They link the catastrophic thinking. Everybody hates me. I'm going to get fired. So you write these things down and then you go, is that true? No, absolutely no. That that's true. We have five questions. We teach people to kill the ants. And you have to do it, like maybe 30 to a hundred times. And then your brain starts doing it on it. So so unfortunately she didn't have that training. And then she had to drink to shut up the ants. So she had to get the ants drunk. And I'm like, there's a better way to do it. And if she's my patient and she relapsed, I'm like, that's so awesome. Let's learn. So walk me through the whole process so that we can learn from it, right? Every day you win or you learn. What's your stance on RSD? Rejection sensitivity dysphoria. There's a ton of literature and and information on it online. But you subscribe to it being a real thing that should be in the assessment process for ADHD. I think it's a real thing and I think it it causes a great deal of suffering and pain. Is it measurable? I can you see it? And I don't know, I'm sure there are questionnaires that will help discover it. It would be interesting to look at our database and does it track with adverse childhood experiences. So we published a study on 7,500 patients. It's the largest imaging study ever of childhood trauma. And your emotional centers of the brain tended to be much more active in people who had high scores versus people who had low scores. And if you have ADHD, you know, I think any discussion of ADHD we should talk about adverse childhood experiences, which is, you know, on a scale of 0 to 10, how many bad things happen to you growing up? Because if you had ADHD, my experience, your mom or dad had it. It's highly heritable. And with my hyperactive child, what is it, 30% of three-year-olds look hyperactive, only about 5 to 10% of four-year-olds look hyper. So I took my child who got me thrown out of church because she was so busy, so noisy. I'm like, okay, she's only three. And her fourth birthday week, I'm like, we're going for an evaluation. And the doctor basically looked at me and looked at my ex-wife and it's like, so who has it? And of course, both of us denied it. But she then asked my ex who was in college for like the 12th year, she's like, how do you study? She goes, I can never study at home. I go way too distracted, I have to go inside my car, under a street lamp. No kids, no noise, nothing, there I can study. Maybe. Sometimes you just need to sit in a car for five or ten minutes before you pull up to a new event just for that transitional period to give yourself time to ease into it. But that's so interesting. I think it does get really interesting. I think rejection sensitivity to dysphoria is like the first step on a road that leads to loneliness, like severe intellectual loneliness. Because I think you experience so many negative messages about yourself from the world that you learn to change the question you ask yourself. I think from a young age, many of us ask the question, what do I need to do in order to make myself happy? But then the flood of horrible criticisms come in and over time, it transitions into what do I need to do in order to make other people happy. So you begin to suppress who you really are, and you put on this character that you learn is more accepted by the world around you. There is this huge gap, therefore, between the version that the world sees of yourself and who you really are deep inside. And I think when you're connecting with the world through this thick mask, you can be in a busy room at a party, at a work conference, and it's not actually you that's getting all of the conversation or any of the connection, so you can get incredibly lonely, intellectually, because you don't have anyone to think with. You can have people to be with, but not to really share an intellectual moment with. Do you hear stories of loneliness when people come into your clinic? You know, again, if we go back to the types, I think 3 and 4, 3 is the over-focus, maybe the 4 is limbic ADV, where their emotional centers are busy. Those are the two that are most vulnerable. Type 1 classic ADHD, they're often the life of the party, they often have lots of friends, they often run companies, yeah, they don't do that great in school, but there's actually some literature to suggest if you didn't do that great in school, you might end up doing something truly awesome in life. So I think it depends on what's going on in their emotional brain, not just their focused brain. That makes sense. I think so. I think many people with ADHD who have done successful things through the metrics of what the world defines as success, but many might call them high achieving, but they would define themselves as high masking, and the cost of selling that business for X million or getting that promotion or running the marathon or whatever it is that they're being praised for is falling apart behind the scenes and getting home after a long day and crumbling and arguing with their partner. Do you think ultimately there is a cost, a huge difference between perhaps the successful person with ADHD and actually what's going on in their life behind the scenes? Again, I think it depends on the type, you know, I've seen tens of thousands of people have a review of one form or another, and some of them not really suffering that much, not really getting near their potential and others being deeply lonely and sensitive. So I think it depends on their brain. I think that's what you say that loneliness is more dangerous than smoking 20 cigarettes a day or something. It has the same negative health effects if smoking 15 cigarettes a day. It's a crisis. There's actually one study from the UK, 58% of young people report being persistently lonely. I think that has to do with our devices and social media dating apps. In the sense that when you have too many choices, it's like you don't make any because you're just afraid you're going to make the wrong choice. It's actually the study where they gave people six choices of jam and another group, 24 choices of jam. The six choice, they sold 10 times the amount of jam than people who, and today we just, there's so many choices. It's a mess when 50, what was it? I was 52% of girls reported being 57% of girls reported being persistently sad, 32% of thought of killing themselves, 24% planned, 13% of tried. And I've just completely blown away with these statistics because they don't compute to my experience as a child when I grew up in the 60s. It doesn't compute to my experiences as a child's psychiatrist until the last decade. Well, I think it's all connected. I mean, I think the early years being criticised, the masking, the loss of identity, the perhaps overworking in a field that you don't really enjoy, but you're doing it because someone said something to you on the playground when you're a kid. Perhaps addiction as well, you know, with the loneliness it can compound to create, I think somebody who is very miserable and very lonely. So be interested in what percentage of those 57% of girls also had ADD and perhaps 10%? So there's something wider in society. But having untreated AVV will accelerate whatever emotional issue you have. You mentioned suicide. I wanted to touch on that. It is a depressing reality of the ADHD experience. We know that the chances of thinking that way is considerably higher than in the neurotypical population is suicide ideation that way of thinking. Is that measurable? Observability, what a scan. Well, interesting, you said that. We have published a study on suicide and they tend to have lower function, especially in the front part of the brain, and they have low hope. And we ask everybody, we have a hope questionnaire, so 0 to 64, people with low hope have low frontal lobe function, they also have low function in an area called the insular cortex. It's a very interesting part of the brain, part of the brain that sort of helps you feel your body, but it gives you agency. And if that's low, common in people who have ADD, much more likely to kill themselves. What are some of the questions on that hope questionnaire? I was interested to see how we're defining the word. It's about agency, can you make tomorrow better? And pathways, do you have different ways to get what you want? When I decided I wanted to go to medical school, I was not a good student in high school. It was a really good student in college. But I had 35 different ways to go to medical school. school. I was going to the Philippines if I had to. But that's hope. If I get into Harvard or go to medical school, if I don't, I'll do something else. It's like, now, when you have a goal, develop pathways together. We know ADHD is very heritable. We could the same be said for hopelessness and therefore suicide ideation. Can you literally be born at a higher risk of depression? Question. I talked to one of my patients today. Suicide is rampant on both sides of her family. So, yes, I think there is a heritableness to bed. But if there's also modeling, then that sort of that gene environmental interaction, what can't be seen on a brain scan? Oh, so many things, right? I mean, what the scans do is they tell you the underlying biology of the person in front of you. They can say, actually, your brain more likely to be male or female, sort of have a sense of that. How old your brain looks? Has it had an injury? Is it toxic? Does it work too hard or not? Hard or not? It's not likely to say you're depressed, you're anxious. It doesn't give you sort of the name. It gives you the underlying biology. So if I came into your clinic and we were trying to figure out what type of ADHD I had, what would be the first step? How would that process work? Well, we talked to you. I mean, that's always the first thing we do. We'd have you fill out, you know, what's the questions? And do total brain, or cognitive assessment. We'd scan you twice, once it rast, once when you do a concentration task. And then our doctors will put all of that information together and go, here's what we think. The issue is, do we agree? Here's the plan. So it's not just the scan. It's the scan plus a lot of other data. And, you know, ADD is not a disorder of the moment. You know, all of us have ADD days. Like we didn't sleep well, or we're under a certain amount of stress. In order for you to get a diagnosis of ADD, it needs to sort of be the story of your life. Can you think of someone who, how many brains have you scanned? Around 300,000? Around 300,000. Is there one patient that stands out, one particular story that really made you double take and go, you're doing good stuff? So many stories. I mean, my hero story, because I got no end of grief when I first started scanning people. Like it was bad. You shouldn't do this. It's not what Skyatris do. My nephew attacked a low girl on the baseball field for no reason, out of the blue. And 999 child Skyatris out of 1,000 would have put him on medicine and put him in therapy. I'm like, I wonder what his brain is doing. He had a cysts the size of a golf ball occupying the space of his left temporal lobe. And when the neurosurgeon drained the cysts, his behavior completely went back to normal. If you don't look, you don't know. What's the part of ADHD that you think's the most misunderstood within the general population? Someone who has ADHD and they struggle the most with it, this part, because their family friends, perhaps, just don't get it? You know, two answers come to mind. One, it's not one thing. It has multiple subtypes. And two, if you take medicine for it, you are not a failure. I think of ADD-like people who need glasses. People who need glasses aren't dumb crazy or stupid. Their eyeballs are shaped funny. And they wear glasses to focus. People have ADD or not dumb crazy or stupid. Their frontal lobes don't turn on. And the medicine sort of works like glasses. Medicines never the first thing I do. It's never the only thing I do. There's a replicated study from Holland. If you put kids with ADHD or ADD on an elimination diet, eliminate gluten, corn, soy, sugar, artificial dyes, and sweeteners, about seven out of ten improve significantly. And so getting your diet right is absolutely essential, I think. And hard because of the society we live in. Your gadgets can make you look like you have ADHD because they destroyed dopamine. I mean, they're purposeful to keep you hooked. And dopamine is a neurotransmitter that they wear out. But when the medicine is effective, it's so effective to just give you access to all of your brain. And so many people think, well, I'm evolved or I'm smarter if I don't give my child medicine. And the problem with that is if they really need it, they under perform for their ability, which just ruins their self-esteem. So there's seven different types. You claim of ADHD and the same diagnosis, but very different brains. And yet we prescribe ADHD medication. You alluded earlier. Like you can perhaps give the same medication to two different people because they both have ADHD. But one person could experience worse symptoms off of medication. Very common. And you know, those are the people who tend to come see us. So just quickly, classic ADHD, hyperactive restless impulsive with the hallmark symptom, short attention span, but not for everything. It's short attention span for regular routine everyday things, schoolwork, homework, paperwork, the things that make life work for things that are new, novel, highly stimulating, or frightening, people with ADHD can pay attention just fine. In fact, they love scary movies because it stimulates them. Love is a drug. So they fall in love. But after about three months, they're not that into you because they're off looking for something else. So short attention span to distractability. They hear too much, see too much, sense too much, often disorganization. They organize by the pile system, pile here, pile there, pile, pile everywhere, put things off until they're stressed to do it. Remember, they have low cortisol levels, low stress hormone levels. And then poor impulse control, they say things that they shouldn't say. They do things that maybe it's not in their best interests. So now, classic, they're hyperactive, type two is inattentive ADD. They're not hyperactive and not terribly impulsive, but they have the other ones over focus, sort of like a combination of being obsessive and ADD. Belimias, the perfect example, compulsively make themselves throw up, but impulsive as well. So, compulsive disorders gambling is like that limbic ADD, sort of chronically dysthemic or sad. More common with rejection sensitivity, syndrome, temporal lobe ADD, where one or both of their temporal lobes is low, and activity, maybe from a head injury, not uncommon, but they often have learning problems, especially dyslexia. The ring of fire, that was the one, I think is my contribution, is they don't have low activity, they have high activity, I publish to study 80% of the time, give them a stimulant, you will make them worse, because the problem is not low activity, it's too much, and it's like pouring gasoline on a fire. Type 7 is anxious ADD, wear anxiety, and ADHD come together. Now, some people will go, you're just describing the comorbidity that's common with ADD, and that's a fair criticism, and these are differences I see on their scan. Stimulants work really well for Type 1 and 2, Type 3, they make you more obsessive, Type 4, they rip rebound into depression, Type 5 can actually make you hallucinate, I had one of my patients who had Type 5 hallucinated on stimulants, Type 6 almost always makes you worse, and Type 7 makes you more anxious. Today's episode is sponsored by Nurellis, by HealthRustor. I also diagnosed with ADHD until I was 36, and one thing I've learned is just how differently ADHD affects everyone, for example, I can speak to you. spend three hours researching a guess for this podcast without even noticing the time, but replying to a two-minute email, sometimes that feels impossible. Understanding those patterns has really helped me make sense of myself, and that's what interests me about Neuralis. It's a personalized ADHD profiling tool. You complete a 10-minute questionnaire followed by a one-minute smartphone scan designed to help you explore your individual strengths and challenges. If you want to better understand how your ADHD works, click the link in the description to discover Neuralis by Health Restore and explore your own ADHD operating system profile. It could be a useful first step towards understanding yourself better. So, do we see a rough split between these types, between the sexes, or do you see a higher concentration in men with some types than in women? Yes, no, I think women have more type 2 and type 3 men have more type 6 and type 1 women with more type 7. And the type that you have, that's like you for life, or can you type 10 with interventions, you can change your types over time, you can become certainly less obsessive, less anxious. What type do you think is most likely to be missed, that goes under the radar? Sex, because it's often diagnosed, they're worse, and then people don't know what to do, and they end up getting a bunch of different diagnoses. So, what two types, like tell me how you would treat one type and how you would treat another type? Like 1 and 6, so 1, both the types, I'm going to change their diet, I'm going to get them to exercise, I'm going to get them more sun, I'm going to decrease their devices if I can, right? It's hard. And type 1, I'm going to start with L-tyrosine as a supplement or a stimulant. If it's a child, I'll use a methylphenidate based medicine. If it's a teenager and adult, I'll generally use one of the emphetamine based medicines like Adderol or Bydance here in the U.S. I would never do that if they had type 6. I would, I'd like a combination of GABA and 5-HTP and tyrosine to help balance type 6 brains. I have this great story, so you ask me about cases. My niece, Jennifer, love her, 7 years old, my sister's calling me 3 times a week, she's a hellion, she's getting in trouble at school, they're fighting at home, it's awful. Like, she calls me 3 times a week and I tried this medicine, it didn't work, stimulants made her awful, finally scan her, she has a ring of fire. I put her on a supplement called Neuralink GABA, 5-HTP, L-tyrosine. My sister doesn't call me anymore. Like 4 months later, I haven't heard from my sister, I'm like, don't you love me anymore. Because don't be stupid, Jennifer's doing so much better, she has straight A's, we're not fighting anymore, I love that story, and now she's an attorney. On the other end of it, Daniel, what do you think, people who like trying to figure it out on their own, they haven't perhaps gotten to see a professional, to get treatment? What are the biggest mistakes somebody might be making in managing their ADHD? Um, that they're managing it with alcohol, or they're managing it with marijuana, or they're managing it with video games. That they're not thinking that ADHD is a brain that's not perhaps tuned right, so think of it like you have a Ferrari that's not properly tuned, and it can go really fast, but it makes a lot of noise, and working on brain health strategies will help so much. One of the treatments for ADHD is intense aerobic exercise. I know many people got themselves through medical school or law school, because they ran 10 miles every day, and intense exercise helps balance in our transmitters in your brain. It raises both serotonin and dopamine. And when they get injured, then they get depressed, which I think is really interesting. So exercise is an excellent way to manage it, but it's hard on your joints if you have to do that. You must have seen a lot of emotions over the years when you finally give an explanation to someone that ADHD has explained perhaps decades of struggle. What do you think the biggest thing people grieve after a diagnosis is? So I think that's a great question, because it surprised me initially. It's like they're so much better, and then they get sad because they're mourning the loss of what could have been if they had known earlier. So yeah, grief, and I warn people, because initially they feel it's like, oh, I have an answer, and I'm doing so much better, and I might come back to bite you. But just embrace it, and you can't change it. So be grateful you know for yourself, for your child, and for your future. And often how do many adults get diagnosed? They bring their children who are struggling in school, and they're like, I see myself in that child, and I don't want him or her to struggle like I struggled. And then as the child gets diagnosed, and they don't tell the doctor those, they try the child's medication, and they're like, oh my god, this was so helpful. Yeah, don't do that. Talk to the doctor. What about forgiveness, because I've spoken to a lot of people who give themselves a really hard time, and I always say to them like, you can't, you have to forgive yourself over decisions that you made before you had all of the answers, or you had all the pieces to the puzzle. Like you can't beat yourself up for taking that job that wasn't right for you, or getting into that relationship that perhaps wasn't a good fit for you. But what do you think people with ADHD should forgive themselves for the most? Well, they didn't have all the data, you know, likely they're like me, and they make the best decision they can with the information they have, and all of us would make thousands of other decisions, but then of course we wouldn't be us. I teach all of my patients the reach model of forgiveness, Everett Worthington's workout of Virginia Commonwealth University, remember what happened, empathize with the other person or with yourself, you didn't have all the data. Altruistically, give yourself the gift of forgiveness, commit to it, hold on to it. I have a new book coming out in February called The Neuroscience of the Lord's Prayer, and forgiveness is huge in the Lord's Prayer, forgive us as we forgive others. It's like, oh, it's sort of intense. At any closing advice, Daniel, for anyone listening who is perhaps in that dark place that we mentioned earlier, really struggling at the moment with loneliness, loss of identity, low self-worth, what would you say to that person? You know, the first thing is to start loving your brain. I know it sounds crazy, but it's not your brain controls everything you do, how you think, how you feel, how you act, how you get along with other people. It wasn't until I saw mine that I'm like, oh, I want that better, and when you love your brain, you start making better decisions for it, from what you eat, to how much you sleep. I'm like, I am not stuck with the brain, I have, I can make it better, which is totally hope, and there are lots of ways to make it better. I'm working on a program with a government called The Decade of Brain Health, and what I want everyone to ask themselves this one question, is what I'm doing now? Good for my brain or bad for it. And does it make the world better? Because too often when the world is all about you, when you're seeing the negativity and it's all self-referential, you're going to be lonelyer. It's like, how can you make the world better? What can you do to make someone else smile? It's so helpful. But it's that one question. What I'm doing now, good for my brain or bad for it, doesn't make the world better. And if you just think of having an ADD sort of like, oh, you needed glasses and no one saw that. Now I can get it, I can see clearer, I can be better. not just medicine, although medicine. and can be incredibly helpful. It's loving and caring for your brain, and not believing every stupid thing you think. It's like I was 28 years old in my psychiatric residency. One of my professors said, "Teacher patients not to believe every stupid thing they think." And I'm like, "Really? You can do that." I've actually got a surprise for you, Daniel, before we end. In tradition, for ADHD chatter, every guest writes a letter to their younger self. And I deliver the previous guest letter to my current guest, and if you could kindly read that out for us. There we go, Daniel. Dear little one, I wish I could reach back through time, find you in your bedroom, sit beside you, and hold you, because I know how much you're hurting. I know how desperately you're trying to be good, to understand why the things that seem so easy for everyone else feel so difficult for you. I know you've started believing that maybe everyone would be happier if you were somebody else, but sweetheart, there's something I need you to know. You were never a bad little girl. You were a little girl having a hard time, and nobody knew how to help you. I'm sorry that when you needed comfort, you were met with judgment. When you needed understanding, you were told to try harder. It's one of the things people always say that, "ADV people, try harder." Except the harder they try, the worse it gets. You must have felt so alone. One day, you'll grow up and meet people who believe they know everything about you. But here's the heartbreaking part. You'll spend years being loved by people who have never really met you. You'll create a version of yourself that nobody can hurt. You'll smile when you're breaking. You'll pretend you don't care when something has hurt you deeply. And sometimes, surrounded by hundreds of people, you'll feel just as lonely as that little girl who wanted somebody to understand her. One day, you'll discover that your brain works differently. And so many things you've spent your life blaming yourself for will finally make sense. You weren't stupid. You weren't lazy. You were never too much. One day, you'll learn how to give others the kindness and understanding. You so desperately needed growing up. And in doing so, you'll realize something heartbreaking. That little girl, you used to be, that little girl, you used to be deserved exactly the same love. So, sweetheart, if I could give you one thing, it wouldn't be success or any of the beautiful things waiting for you. I'd give you one ordinary childhood afternoon. Not afternoon, where you didn't have to pretend, where nobody made you feel like something was wrong with you. I'd hold you until you stop crying. I'd tell you the words you should have heard thousands of times. There's nothing wrong with you sweetheart. I'm so sorry, it took us so long to believe that. And this time, I'm not believing you. Love, the woman you became. Wow. Thank you Daniel.