5 Newly Discovered Physical Signs Of Autism & ADHD

1. 0:00 – 0:47

   Intro

   1. APAlex Partridge0:00

      Right. Ah. I heard that a sign of autism and ADHD was you could be extra bendy, so I'm just trying to do the splits. Is that a good test?

   2. NPNick Potter0:13

      It's a [laughs] a very good question. It is, believe it or not, dancers who are all pretty much hypermobile-

   3. APAlex Partridge0:18

      Okay

   4. NPNick Potter0:18

      ... which is their extra flexi. Yes, can do the splits probably without even, even practicing. So it, uh, it's not in the Beighton score of hypermobility, but, uh, maybe 'cause if they're a bit older it might be a bit unreasonable to pull their groins when they-

   5. APAlex Partridge0:30

      [laughs]

   6. NPNick Potter0:31

      ... when you test them. But yeah, it... You could, you could use it as a test, but it also relies on hip shape, and-

   7. APAlex Partridge0:36

      Mm

   8. NPNick Potter0:36

      ... so it's too variable.

   9. APAlex Partridge0:38

      So if, if I'm not able to do the splits, that doesn't mean... That, that means that I'm not hypermobile?

   10. NPNick Potter0:45

       No, it just doesn't mean that you're not.

   11. APAlex Partridge0:46

       Right.

2. 0:47 – 7:38

   The Hypermobility Test: Are You Hypermobile Without Knowing?

   1. APAlex Partridge0:47

      Then the Beighton score, what is in that? What, what is the test?

   2. NPNick Potter0:50

      The Beighton score was a score for hypermobility, which was based on certain joints being over-flexible, beyond the normative range, so in the population, whether peop- And it is another spectrum, so you can be mildly hypermobile right through to what we call Ehlers-Danlos syndrome or Marfan syndrome, which is sort of really uber flexy. Um, which also comes with other problems, unfortunately. That's why we categorize them, because it comes with vision problems and heart problems and so on. But you can be hyperflexible like me, and... But it tends to mean things like hy- hyperextending knees, so when you do that they get the banana knees. Um, and there is a, the main score is that you can take your thumb to your wrist relatively easily. I actually can't do that. Flexing your little finger to 90 degrees easily without really any f- effort. Hyperextending knees past about 10 degrees, so if you lie them flat, their knees go upwards. You can see it when they're standing, they just go into a bow leg. And, uh, elbows will extend further than normal. And then that you can relatively easily, probably even in the morning when you feel stiff, you can pretty much easily touch your toes.

   3. APAlex Partridge1:48

      Right. You said you're hyper-

   4. NPNick Potter1:50

      I am actually hypermobile, yeah

   5. APAlex Partridge1:51

      ... Is there anything you can show us today? [laughs]

   6. NPNick Potter1:53

      Um, my flexi knees.

   7. APAlex Partridge1:55

      Yeah. [laughs]

   8. NPNick Potter1:56

      Which is if I do that, they go up-

   9. APAlex Partridge1:58

      Oh, yeah

   10. NPNick Potter1:58

       ... and backwards.

   11. APAlex Partridge1:59

       Yes.

   12. NPNick Potter1:59

       And if I'm standing on them they go even further.

   13. APAlex Partridge2:01

       Right, okay.

   14. NPNick Potter2:01

       And this one's even worse, 'cause unfortunately I did my ACL ligament, so now they go-

   15. APAlex Partridge2:04

       Mm

   16. NPNick Potter2:04

       ... really hyperextending.

   17. APAlex Partridge2:06

       What about someone's childhood? Is there any early signs? Does it, does it show up in a similar way, or?

   18. NPNick Potter2:10

       Yeah. Um, in fact, one of the big signs of hypermobility is actually clumsiness. Uh, that's more about where I'm positioning myself in the world, because if you're hypermobile, your soft tissues are... It's, it's collagen deficiency, basically. So collagen is your stiffening agent, and it sits in all your connective tissues, so it potentially can affect everything. It's just a question of degree. Um, and in those soft tissues, you have special receptors, and they feed back to where you are in space, and if they're sitting in, uh, soft tissues that are flexier, they're in marshmallow rather than in chewing gum, if that makes sense. So you don't... You get this less high resolution feedback from the body, and you correlate that with your vision. So where am I in space? So when, the classic thing is they go down to reach for their glasses when talking to something, and they'll just miss them. Um, you drop your phone regularly. You just, you know, you're just... It's a, it's a clumsiness. Um, and you see that in child behavior quite early. It's actually different from dyspraxia, um, which is a completely... You go to hit a tennis ball and you'll just never hit it. In hypermobility, they'll hit it, but they'll look a bit gawky doing it. So it's joint position sense and that sort of thing. But it's, it's... It creates a nervous system response, which also-

   19. APAlex Partridge3:17

       Mm

   20. NPNick Potter3:17

       ... is very similar to ADHD. That's why it's been highly correlated.

   21. APAlex Partridge3:21

       I often walk into doorframes. Like, it's just always-

   22. NPNick Potter3:23

       Yeah

   23. APAlex Partridge3:23

       ... something that I've always done. Um, often I'm not sure if it's because I wasn't aware that the door was there, or because I'm looking at my phone or I'm focused on something else.

   24. NPNick Potter3:32

       It's that, mainly. So the fact that you can walk means that you've got some coordination, et cetera, whatever-

   25. APAlex Partridge3:38

       Right. [laughs]

   26. NPNick Potter3:38

       ... and that you can orientate yourself roughly. What you've done is you've probably noticed the door in your peripheral vision, but because you were looking at your phone or because the ADHD-ness means that you're scoping the periphery-

   27. APAlex Partridge3:48

       Mm

   28. NPNick Potter3:48

       ... you're distracted to look at something else. And so you plot it, but your positional awareness is a little bit off, and so as you look down, you go and smack into it instead. So it's like having a target, a, a, a sight on a gun that's two inches to the right. You're just constantly having to adjust for it.

   29. APAlex Partridge4:03

       Can you still be hypermobile and not show any obvious signs of bendiness?

   30. NPNick Potter4:10

       Very good question. I have... I've discovered in my own practice life that if you see kids who've grown up very sporty, um, and of course private school kids are a good example because they do, part of their curriculum is they do a lot of sport. What is interesting is that you can't change collagen, but by loading the tissues over time, the fascia, particularly in the connective tissue, will thicken and strengthen. So they tend to come in and they, you lie them on the table and they are very flexible, but when their muscles are active and there, there's tension in their system, they, they, they're much, they're much more be- They, they have better posture, they're better able to stand up, and their coordination is better. So they can get on a surfboard and feel fine, whereas a hypermobile person will find that balance very difficult if they're not integrated in the same way.
3. 7:38 – 11:39

   Why So Many ADHD and Autistic Women Were Missed

   1. NPNick Potter7:38

      Yeah. Yeah.

   2. APAlex Partridge7:38

      So could the conversation around hypermobility and the connection to neurodiversity, could that have played a part in why so many women have been missed?

   3. NPNick Potter7:45

      100%. So going back to neural processing, if you can't find yourself in the world, okay, you make predictions about where you want to be and where you are, and then you match it with the incoming information, and if there's a mismatch, that's what we call prediction error. That's a stressful state. So in a sense, they're, they're, they're constantly in the highest level of arousal rather than stress, um, because, because they can't really orientate themselves in the world, and that can also then become an emotional response. So you've got that element. Then if you add in that part of that neurodevelopmental process, particularly as a child, we know that these, these patients have had this since they're young, um, it's a pl- it's where the brain is struggling to integrate itself with processing and to get a handle on the world, and then how it acts on the world. How do I interpret what I'm seeing and turn that into a response? Because also, if I ask you now, think of something other than secretion, right? So tears and snot and whatever. Think of the things that you do in your life that don't involve movement, including operating a computer. I see what's on the screen, I track it with my eyes, and I match it with clicking, keyboarding, et cetera. So the brain was designed to move, not to think, and we've got that kind of the wrong way around. And in fact, the prefrontal cortex, which is the part where you do the filtering and, and a lot of thinking, actually developed out of the motor cortex. So in our evolution, what we did was develop the respon- the ability to move and then to filter how we move and what we do. So actually, a lot of it's actually inhibitory, so, uh, and we see that in some of the diseases like Parkinson's, where they can't inhibit movement, and they will do all these movements all of the time, and it's very exhausting for them. So what you're looking at is a global change in the neurodevelopmental processes of a brain, but not because the brain is the problem, but because the input it's getting is not matching the predictions that we're making, and that mismatch we call precision error. Um, and then it gets weighted, so it's like, "This is really important." So if I've got a twisted ankle, very... A lot of hypermobile people will twist their ankles as kids, and they go, "Yeah, you're right. Yeah, I always used to twist my ankles." So what happens is now those ligaments that have been damaged are giving even more poor feedback, so then they get... Then they can't tell. They keep, they just keep twisting their ankle.

   4. APAlex Partridge9:51

      So interesting, Nick. That prediction error, that mismatch, what are some examples? Like day-to-day life, someone listening, they're thinking, "Is that me?"

   5. NPNick Potter9:59

      Clum- clumsiness. So you walk into the wall, was, was, was, "I'm walking, I'm walking straight. I've mapped everything in my environment. I need to avoid the door." You won't even know that you've thought that, but, uh, you know, they're deceptively solid. And, um, you've matched a pathway, a motor pathway that you're gonna move forward into. The problem was you got distracted from it, because most people will actually look at what they're doing in order to put their hand onto it. At that moment when you did, you just took your eyes off it. You actually see this in... I, I'm, I'm very anti digital displays in cars, for example, right? I used to like a knob, right? You used to put your hand down. You knew where the knob was. It was up or down.

   6. APAlex Partridge10:35

      Mm. Sure.

   7. NPNick Potter10:35

      Now you've gotta do a menu. Now, if you've got ADHD, you're much more likely to have an accident for that, because what you don't realize is that you're now having to spend more time going from one... 'Cause you can only attend to one thing at a time. That... Multitasking is a fallacy. It just means you're good at flipping between two tasks quite quickly, but what you're actually doing is attending, attending, attending, attending. So these are as much disorders of attention and how you're attending it, including pain in your body. You just start attending the body, over-attending it. So that's all you become, that you, you start to think about. So it's linking those neurodevelopmental processes-

   8. APAlex Partridge11:08

      Mm

   9. NPNick Potter11:09

      ... which are physical as well as cognitive and mental, and how the, the mismatch in the system forms these maps and orientations in the world that are slightly off, and that's very stressful to the brain and to you, and it manifests emotionally in agitation and in hyperactivity, wanting to move, grounding techniques-

   10. APAlex Partridge11:27

       Mm

   11. NPNick Potter11:28

       ... biting your nails, tapping your feet.

   12. APAlex Partridge11:29

       There's five physical signs of ADHD and autism that nobody speaks about, Nick, and that's what we're excited to speak about today and, and, and hypermobility is definitely one of them.

4. 11:39 – 15:37

   The Surprising Link Between ADHD, Autism and Chronic Pain

   1. NPNick Potter11:39

      Mm.

   2. APAlex Partridge11:39

      The second one is chronic pain.

   3. NPNick Potter11:41

      Yeah.

   4. APAlex Partridge11:41

      And I've heard a huge amount about fibo- fibromyalagia.

   5. NPNick Potter11:45

      That's right.

   6. APAlex Partridge11:46

      Why does that keep coming up in the conversation?

   7. NPNick Potter11:49

      Because it's much more common in that group. So, um, what I would do is just wind back a little bit, which is that pain, much as people don't grasp it as such, particularly if you feel it in your body, is an affect. It's a feeling. So it's actually no different to thirst or hunger. It's reputa- reputation of a need, and it's mostly need to move, okay? So we're sitting on these seats right now. In a minute, we'll probably just shift. We won't even think about it, but that's 'cause my buttock's going to sleep, the circulation's going out, and that feeds forward as discomfort. So I probably won't even register it. But if I made you sit still for a long time, that would ramp up as pain. It'd be like, it'd be saying, so it's like uncomfortable move. Really uncomfortable move. Move. Bloody move. Right? Bloody move is ugh. Okay? The problem is, if you have a hypermobile mob- mobile body, you're not processing because of all these prediction errors, et cetera, then what happens is you p- produce tension in your body, okay? 'Cause it's a preparation to action, particularly if you're having to sit-

   8. APAlex Partridge12:43

      Mm

   9. NPNick Potter12:43

      ... and you want to move all the time.

   10. APAlex Partridge12:44

       Yeah, I'm fidgeting now. [laughs]

   11. NPNick Potter12:45

       Exactly. Thinking about it.

   12. APAlex Partridge12:46

       Now I'm thinking about it.

   13. NPNick Potter12:47

       So we attend the body.

   14. APAlex Partridge12:48

       Sure.

   15. NPNick Potter12:49

       Fibromyalgia tends to occur when people have a constant level of tension. So are they stiff or are they tense? And you say, "Well, why are they tense? Why are they priming all the time? Why the arousal?" And that's what I tend to go after with my patients, is to say, "Look, what, what, what is the stress? Is it just, 'Shit boss'? Is it just you're working too long at the desk and not moving? Or is there something else that's constantly driving you to feel pain?" And in hypermobility, um, what tends to happen is we're very aware of our bodies because it lets us down so much, so we're attending it a lot more. What tends to happen is is that because of the prediction error, the brain attends the body 'cause that's the bit that's letting it down. So what it does is it allows much more gain, as we call it, so feedback from the periphery, to become much more important. So we give it much more awareness and attendance. But it also means we sensitize everything. So hypermobile people also tend to be sensitive. Hey ho, so do autistic people and, and hyper- hypermobile people. So it's not a disorder of the nervous system, it's just that if I can't trust the world, I need to turn up the sensitivity of my alarm system.

   16. APAlex Partridge13:48

       Mm.

   17. NPNick Potter13:49

       It also tends to happen in people who've been given what we call the, the wrong predictive prior, which is a belief mechanism. And unfortunately in medicine we do this quite a lot. Which is you see an MRI scan, they say you've got a black disc. And of course you think that means, "Oh, it's rotten, it's falling." But no, it's just the way the MRI picks up slightly less water. That could change next month. But then that's, that's logged in their brain. So then they actually change their movement, because, "If I have something wrong or broken, I've got to protect it." So again, the brain starts saying, "I need to protect you. What do I wanna do? Don't move." So this is also where brain fog tends to come in, so you get fibro fog. And what's happening is the fibro fog is not that you can't think, it's just that you're so busy attending your body, so busy attending what might cause the pain, that it's, it's, it's distracting you from what you actually need to be... So again, it's an attention issue, indirectly. It's just drawing you into a body and making you hyperaware of it. And once- if you've had that since childhood, that's become a program that you're... It's a habit you're very used to. And it's getting those people to change the prior, so what is really going on? Forget the black disc. You've just got a stiff back. You just got referred for an MRI unnecessarily. Also, once you let people see imaging, I try as often as possible to actually not show patients the image, I tell them what's going on. 'Cause once you see a bulging disc, once you see a small fracture, once you see a spur, very difficult to get that out of their head, you know, to d- to, to deprogram you.

   18. APAlex Partridge15:07

       Mm.

   19. NPNick Potter15:07

       So there's this constant conversation between the brain and the body, and if one of those w- areas becomes too sensitive... Just as if you've broken a forearm six years ago, people say, "Oh, when the, when it's cold weather I get pain in my arm." Well, it's healed. Why are you still getting pain? Because the programming says, "When my mood drops when I look at the bad weather, I g- I give, I release the peri- the information from the periphery. And I'll go straight to the sign of where I've got a memory around a previous injury." And that's why you get this repetitive pain. And we call it chronic pain, but we don't like that word, 'cause chronic tends to mean really bad to most people. But it just

5. 15:37 – 24:23

   What Fibromyalgia REALLY Feels Like

   1. NPNick Potter15:37

      means time.

   2. APAlex Partridge15:38

      If, if someone's listening, Nick, and, and they have heard fibromyalgia but they don't know if they experience it, what does it feel like? Like, how do you describe the pain?

   3. NPNick Potter15:47

      It's much more global. So they're saying, "My legs hurt, my arms hurt, and my, my neck... Just everything. And it hurts to move." Okay? So one of the little strap lines I give them is that chronic pain patients or persistent pain patients are locked between pain's call to action, that's what it's telling you to do, but perception's fear of harm. It's like a little equation. So what's the answer? Change the perception. Okay? The prior, as we call it.

   4. APAlex Partridge16:11

      What's an example of that?

   5. NPNick Potter16:12

      So, um, long COVID was a good example. Um, we saw a lot of patients who come in that they, they have all the dizziness and all those things, but a lot of it is fatigue and a lot of it is body pain. "Oh, just everything aches." And the perception is in a lot of them that actually they had an infection and that it's kind of still there, the long COVID. You've still got a bug eating you. You know, it's a very powerful image for them. And sometimes I say to them, "Well, look, did you get COVID really badly?" And they said, "No, I didn't actually. It seemed to be quite mild." "Tell me about lockdown." "Oh, well, I was locked up with my crap husband," or, you know, "I was at the top of a, on the A40 at the top of a 70-story building with my only kids and the lift was broken. It was pretty bloody str- " Okay, so we had a prolonged period of stress, right? So you're neurally processing at a very high rate, and you got neurally exhausted. Then you got an infection, and you're blaming it on the infection, the bug. What it actually is is an immune response. Okay? So it could've been anything. It could've been a cold. But COVID, don't forget, also carried, "You're gonna die." Right? So the, all these priors, as we call it, all these belief mechanisms were getting ramped up. "Christ, I've had COVID. It's a really bad condition." It ended up being a cold. But now it's been labeled. Epstein-Barr was another one. You know, we blame glandular fever on a lot of things, but the antibodies to it are in 60% of the population who are not symptomatic. It's just a correlation thing. But what I would say to them is, "So tell me, tell me about this." We did to patients in lockdown what the human brain most hates, which is uncertainty, what's happening? Isolation, we couldn't go anywhere. And the worst of all is agency. I can't change my circumstances. And if you do that to rats in a lab, they get cancer. I mean, that, you know, that's how much you can stress them. Put 'em in a cage with a cat hair, they get really unwell. They lose their hair, they get overweight, et cetera. So we did horrible things to human beings. Like, that's why we do it in isolation cells, right? I can't get out of here and I'm on my own. So that produces a whole set of physiological responses, okay? Including inflammatory, uh, molecules, because my perception is if I'm being... This is, this is an evolutionary response, which is if I'm being perceived that my threat is I might be attacked. It's the, it's actually underpins placebo. What happens is my perception is this is necessary- I'm going to produ- my body will produce all of the horm- all of the hormones and the cells and the j- and the proteins and code for genes that m- I may need in case I get eaten, injured, or infected. And that's exactly what happens in humans. We're no different.

   6. APAlex Partridge18:35

      Is, is this-

   7. NPNick Potter18:35

      So that's why we got inflamed. I saw more frozen shoulder during lockdown-

   8. APAlex Partridge18:39

      Hmm

   9. NPNick Potter18:39

      ... than I've ever seen before in males and females. And they came, and they were just inflamed. And interestingly, if you, if you test that inflammation, it's usually two things, interleukin 1B and 6, and interestingly, those are the hormones you produce, uh, in inflammatory responses in joint disease. So it's the chronic stress blamed on a mega infection, which is also very energetically expensive. So you're ... if you've expended all this neural energy on being stressed, and then you get an infection, the only other thing that uses more energy in the body is your immune system, and then they just get locked into that because they just ... th- the perception is, "I'm, I'm ill. I'm not diseased. I'm ill." And that's what these... And it responds by autonomic responses, so they hyperventilate, they breath hold, they tense their muscles. And so everything just gets sore and painful, and they get all ... And of course, in the medical world, you can take advantage of that, and that's definitely what happened.

   10. APAlex Partridge19:27

       [laughs] You know, so-

   11. NPNick Potter19:29

       Here's, here's endless supplements.

   12. APAlex Partridge19:31

       Yeah.

   13. NPNick Potter19:31

       Do you think, okay?

   14. APAlex Partridge19:32

       So fibromyalgia, i- is it more common, with the ADHD and autistic community?

   15. NPNick Potter19:38

       Yeah. Because, because they tend to be, uh, particularly if you add in the hypermobility, they tend to be very body-centered and orientated, particularly if, you know, they go and strain something, and then it's, it's broken. It needs attention. But, and the pain, the pain that you get is justified, but that heals. So why are you still getting pain?

   16. APAlex Partridge19:55

       Hmm.

   17. NPNick Potter19:56

       Because the brain's saying, "Don't move it, because that will harm it." So what we kind of do in therapy is, even just do with manual therapy at the basic element, what I'll do is I'll just take them and say, "Look, you can move this. Look, yeah? And it's fine. I'm giving you permission, so do it." And they go, "Okay. Oh, yeah, it's not that bad." "Breathe."

   18. APAlex Partridge20:12

       [laughs]

   19. NPNick Potter20:13

       "Calm down." You can see them, they're holding their breath. The brain subliminally is going, "Don't do that. Don't do that." Okay? And then suddenly they go... "No, just breathe. Just let it go. It's fine." And they go, "Okay." And sometimes they just walk out with, without a stiff knee. But why they get fibromyalgia is because all the muscles all the time become sensitive. They're contracted from stress, and so they produce lactic acid. They produce all sorts of irritants to the nerves and the muscles, so they ... And it seems to spread like a creeping death. It's not. It's just the nervous system's firing everything all of the time. And the diagnosis of it is if you take 16 pre-de- determined points, which is things like the tennis elbow point, uh, back of the neck, bu- buttock, leg, etc., and you press 11 of those 16, then you have fibromyalgia. It's just not a diagnosis. It's a symptom. But we call it an entity. Anything that you call a syndrome means we don't really know what it is. It's just they just seem to be correlated.

   20. APAlex Partridge21:00

       Just going back to the example of me walking into the door, and that's proprioception-

   21. NPNick Potter21:05

       Yeah

   22. APAlex Partridge21:05

       ... me not knowing my place in the world-

   23. NPNick Potter21:07

       Mm

   24. APAlex Partridge21:07

       ... and being clumsy, walking into the doorframe-

   25. NPNick Potter21:09

       Yeah

   26. APAlex Partridge21:09

       ... walking into a stall, whatever it is, and hurting myself. Is that connected to me not being able to see where a source of pain is coming from? I.e., I might think the pain in my body is long COVID because I can't see, because of, again, proprioception, the true source.

   27. NPNick Potter21:27

       Wind it back a little bit. If you can't propriocept properly, okay, then the world's a dangerous place to me, because I can step off a cliff. I can go ... It might not have been the door. It might have been a sharp spike.

   28. APAlex Partridge21:37

       Mm.

   29. NPNick Potter21:37

       Then you're dead, right? So the hyperarousal that you get makes you tense because you have a stress response. You're constantly, "What's going on? What's going on?" I'm attending the world at a much higher rate. Now, the problem is, if you're attending the world, it makes it very difficult to concentrate, and that's really what ADHD is, right? It's not the inability to, to con- to, to concentrate. It's the inability to take two types of perception and separate them. So we have default mode tracking, which is I walk into, I've walked into the studio. I've mapped it with my multiple mi- With it ... By the way, even within eye vision, we feel the world. We feel the landscape. It's a rather nice concept, just as you feel a surface, okay? If you put your hands on your ch- on your jeans now and shut your eyes.

   30. APAlex Partridge22:13

       Mm.
6. 24:23 – 26:12

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   1. APAlex Partridge24:23

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7. 26:12 – 33:05

   Why You're Always Exhausted (Even After Resting)

   1. APAlex Partridge26:12

      that is being exhausted all the time- Yeah ... and having a, a, a brain fog even when they haven't done anything necessarily physically demanding. Mm, exactly. Is that connected to what you were saying? Yeah, because it's, because it's neural stimulation, and you, and you, and you have so much of that budget. You're about a 60-watt light bulb all the time, right? So it is... And we're not talking woo wah energy. Mm. We're talking real, physical, physics energy. It's chemistry. The human brain. It's chemistry. You're, you're, you're literally producing an electrical charge. The human body. Yeah. Wow, okay. In fact, if you use a certain type of camera, you can actually see the aura around you, which is electromagnetic. So you are a, you are a humming, buzzing electrical creature. You're a bag of enormous amounts of chemistry ruled by a set of laws of physics which run the universe, and that's all gotta work together. We're an internal system navigating an external world that's full of chaos, okay? Things that can hurt me, things that I've got to navigate. And then we developed hands, right? The, the, the, the one structure that's most represented on our brains is actually our hands because it gave us the planet. We got an opposable thumb, so it meant that instead of just clubbing somebody to death, I could now actually use tools and I go... And that gave us power, right? So now we've got to orientate not just about what is important to me, but what is useful to me, tools, okay? So that's, that's what we learn to navigate, but I've also got to orientate myself towards it. Now if you're a little bit clumsy, and it's embarrassing to be clumsy, right? And if you look at these girls I speak to particularly, 'cause there's many more of them, is that when they're teenagers, were you always the pots at dinner? Yeah, I mean, Dad. Mm. "Oh, darling, you've knocked over the salt again." The glass of wine. Because as she's going to pick it up, she makes an assumption that her prediction's right where her hand is, but it's not, so she just misses it. She just clumps it. But that's shaming. You're always the, you're always the pots. And the same with exercise and sport. Again, you should often see girls, or my kids who are at school, they were both playing tennis on the same courts, you know? And what you found was the girls, the moment they couldn't get it, because of that clumsiness ratio, they'd go, "Oh, I'm just, I'm crap at this," they just, you know, throw it away. So then they don't do the exercise. They don't get involved. But actually, if you say to them, "You just need to do probably 10 times what somebody does five, just iteration- Mm ... you'll get it." But they're much quicker to give up on it because of the shame element, and if that's been your track history, then it runs into everything. "Oh, I'm just crap. I'm crap at everything. I drop everything. You know, I'm, I'm buzzy. I'm," I mean, neurospicy, the new word. Yeah. [laughs] Okay? But, um, but it's, you know... But actually, if you explain it to them, and I have lovely moments where a lot of people cry in my room and go, "Somebody has finally explained why I'm like I am, brought it together. Otherwise, it's just a number of symptoms and madness that I can't get a handle on." And I had one patient said to me, "Do you know what? Having no diagnosis was worse than a cancer diagnosis, because at least I know what I'm dealing with." We all have to have a grasp on the world, and, as we do with ideas. And if they can't, if somebody can't bring it together for them... Now does that help them? Yeah, because you're grounded. Now you know what you're dealing with. Okay, what are the little hacks I can do? Make life a bit more bearable. Mm. If you do have a grasp on the world- And by the way, just quick, a lot of that's body, not just how are you with people? Mm. How do I focus on the computer? You centrate your body, and your focus and your concentration ramps up. For example, I give a lot of compression garments to people to use when they're working out, okay? And also say to them, "Look, just wear these tight leggings or wear these tight tights." And they say, "It's really weird. I feel calmer." Exactly, because the second layer on your skin is giving you greater feedback, and that's proprioceptors. Your skin's highly proprioceptive. That's why a lot of people like wearing legging. Look at the Lululemons everybody's wearing, et cetera. And e- and if you look at hypermobile, when I was in the gym the other day, and I noticed they all wear the high-waisted ones, right? 'Cause they're very aware that their skin rolls over their top. Not 'cause of fat, but because their skin's more elastic. So what's that actually doing? If you're wearing tight leggings, y- so it's pressing against the skin, and is that connected to hypermobility? Great question. Your skin is the most unbelievable organ, and we take it for granted. We put it in the sun and we don't, you know, we abuse it all the time. It is the outer surface of your skin, which is the contact between the internal homeostatic world of chemistry inside me and the external world. That's a big thing. And buried in the skin are unbelievable amounts of receptors, mostly mechanoreceptors, so fine touch, vibration, warmth. You take it f- for granted that you'd not, you can then just feel the leg and feel it's w- it's got, it's on a warm leg, it's not a dead leg, okay? So we're taking all of that information all the time, and that comes through our skin. Now if you have looser skin-

   2. NPNick Potter30:21

      Again, you have le- less resolution on the feedback. So if you give them a tight surface, it not only holds the skin against the body more, so you can get a better high-resolution reference, but it also gives you a second layer of feeling. So you kind of extend your awareness through, through the tight garments. And th- this is why all these, th- this leisure wear is so popular. And also they feel it holds everything in, you know? But actually for the hypermobile, it, it stops their skin folding, and their perception... And this is why it can lead into eating disorder. This is q- highly correlated, 'cause they feel that their skin rolls, "I'm fat." No, it's just the way.

   3. APAlex Partridge30:55

      Yeah.

   4. NPNick Potter30:55

      So you can be as skinny as you like, but your skin will still roll.

   5. APAlex Partridge30:58

      I- is there only so much of that that someone can do until it starts having the opposite effect? 'Cause I'm thinking of people that I speak to who have an autism diagnosis-

   6. NPNick Potter31:08

      Yep

   7. APAlex Partridge31:08

      ... and they, they can't wait to get home at the end of the day and take off-

   8. NPNick Potter31:10

      And get their clothes off

   9. APAlex Partridge31:10

      ... the tight clothes-

   10. NPNick Potter31:11

       Yeah

   11. APAlex Partridge31:11

       ... and get into the loose PJs, because it's overstimulating.

   12. NPNick Potter31:14

       Yeah. I think you're right. I mean, that is, that's a, a unique group of people who have, ha- have almost... It's a bit like, as we were talking about before, ADHD is, is, has an impulsivity associated with, so they like risk, and they take it, but they won't check first, so it tends to go wrong. The autistic spectrum p- patient, p- people tend on the whole to not like uncertainty. Okay? So containment, constriction is sort of associated with, "I can't breathe, I can't be free, I can't move." So that's, that, it's a, it's a, it's a different end of it.

   13. APAlex Partridge31:43

       Mm.

   14. NPNick Potter31:43

       But yeah, no, there are some people who just don't want... And also people with eating disorders and body dysmorphia, they often don't like, like it. But that's because they're just too interoceptive in what they're feeling. So if there's a, there's a midsection who will really benefit, and then there are the people who just need something else, and they want to wear loose garments, and that's fine. 'Cause they don't really wanna feel.

   15. APAlex Partridge32:00

       Mm.

   16. NPNick Potter32:00

       To a certain extent, I'd argue they don't wanna feel the outside world. I really do. I mean, 'cause they're really struggling to navigate their internal world, so why the hell... And that's why they will go home, and they'll stay in their man- man cave and not really-

   17. APAlex Partridge32:10

       [laughs]

   18. NPNick Potter32:10

       ... wanna interact with... 'Cause the most chaotic thing you can throw at a human nervous system is another human.

   19. APAlex Partridge32:15

       Mm.

   20. NPNick Potter32:16

       Right? You know about inani- this chair's never gonna affect you. All these inanimate objects won't do, but the one thing is I might. I might just get out of this chair and attack you. It's unlikely, the probability's low. I could. So in this, in the sub-narrative of your brain, Nick could be a violent psychopath, amongst he probably isn't.

   21. APAlex Partridge32:31

       [laughs]

   22. NPNick Potter32:31

       And that's what the brain does, it makes these, these Bayesian decisions on probability and hierarchy. If I suddenly keep doing this, and that's why Tourette's is so distracting for people.

   23. APAlex Partridge32:40

       Mm.

   24. NPNick Potter32:40

       Because it's just so unexpected. But if you know him really well, you know that the tic is... That's why you need to get to know, know people. But also they just need to be educated that sometimes people do funny movements, and it's fine. But to a nervous system, that suddenly raising your head or calling them something abusive is potentially aggressive.

   25. APAlex Partridge32:55

       It's why I have security just off camera.

   26. NPNick Potter32:57

       [laughs]

   27. APAlex Partridge32:57

       It's only a matter of time doing an ADHD podcast-

   28. NPNick Potter32:59

       You have no idea the inner tiger-

   29. APAlex Partridge33:00

       ... one of, one of my guests-

   30. NPNick Potter33:00

       ... that's trying to tear your eyes out
8. 33:05 – 36:07

   Why Do You Bruise So Easily?

   1. APAlex Partridge33:05

      What about people who bruise really easily? 'Cause again, I'm thinking of a c- couple of people that I know, and it, it got to the point where they were worried that their partner, that people would think their partner-

   2. NPNick Potter33:14

      Had been beating them up

   3. APAlex Partridge33:14

      ... was hitting them.

   4. NPNick Potter33:15

      Yeah.

   5. APAlex Partridge33:15

      Uh, it, it-

   6. NPNick Potter33:16

      It's a great case. So remember, connective tissue is everywhere. Collagen's everywhere. Unfortunately, it's also in your blood cell, blood tis- um, blood vessels.

   7. APAlex Partridge33:22

      Mm.

   8. NPNick Potter33:22

      Now, in your skin, you've got these little micro blood vessels, and in most of the population, they can be stretched and pulled quite hard or, or hit. In us, they, uh, they will, they will rupture. Uh, which sounds really dramatic. It's not. But they, so they tend to get a much more high, much higher propensity to bruise, and of course, if you're clumsy, then you have more bruises. So it, part of it's an attention problem, which is I just keep kicking my s- my knee on the same coffee table every day, even though I know it's there, but I'm just not attent... In fact, the more, more likely it is there, the more make, I'll make an assumption about where it is and get it wrong. Um, and then obviously because of my blood, my blood, uh, vessel weakness, then I'm more likely to tear things. And at the far end of the spectrum in things like Ehlers-Danlos, where that, where the c- the connective tissue is so poor, then they do actually get blood vessels rupture. I mean, big blood vessels can rupture-

   9. APAlex Partridge34:07

      Mm

   10. NPNick Potter34:07

       ... and that sort of, so it's a bit, and retinas and that sort of thing. So, but for m- to make it very clear, for the vast majority of hypermobile people, that's never going to be a problem. But of course, if you go and read up on it, and you get AI to do it, and it hierarchalizes a whole set of symptoms, you're gonna rush to the very worst one, 'cause that's human nature.

   11. APAlex Partridge34:22

       I brought a toy with me from home, Nick. I thought it might make you laugh a little bit.

   12. NPNick Potter34:25

       Oh, my word. That's Stretch Armstrong, isn't it?

   13. APAlex Partridge34:27

       Stretch Armstrong. Y- you familiar with Stretch Armstrong?

   14. NPNick Potter34:28

       I sadly grew up with Stretch Armstrong. A, a probably a very old version, but as I... Uh, the rubber used to perish, and the goo came out.

   15. APAlex Partridge34:34

       [laughs]

   16. NPNick Potter34:35

       [laughs] He secreted his entire being.

   17. APAlex Partridge34:37

       Yeah, I'm scared to pull it too hard in case I get absolutely soaked in it.

   18. NPNick Potter34:40

       Good God.

   19. APAlex Partridge34:40

       Is this a accurate representation of hypermobility, or is Stretch Armstrong-

   20. NPNick Potter34:44

       [laughs]

   21. APAlex Partridge34:44

       ... taking it a bit far? [laughs]

   22. NPNick Potter34:45

       Very good, great. Yeah, it's, it's not a too bad, uh, representation, actually, in the sense that, yes, I mean, it, if you stretch him out right, he can't tell where he is. You know, I mean, he's got very wide arms. The world becomes bigger if he's got very long leg-

   23. APAlex Partridge34:55

       Mm.

   24. NPNick Potter34:55

       You know, so, so yeah. What you'll... If you had a hypothetical, his brain would be going, "Wah, okay, big world, small world."

   25. APAlex Partridge35:01

       Yeah. [laughs]

   26. NPNick Potter35:01

       "You know, I can reach, and I can't reach." So he'd have to be navigating an awful lot of data.

   27. APAlex Partridge35:05

       Mm.

   28. NPNick Potter35:06

       Which would make his ADHD go through the roof.

   29. APAlex Partridge35:08

       His leg bends a little bit like yours.

   30. NPNick Potter35:10

       Th- uh, uh, perfect.
9. 36:07 – 51:04

   Interoception: Why You Might Not Notice Your Body's Signals

   1. APAlex Partridge36:07

      one talks about, really interesting one, interoception. So in basic terms to start with, what, what is that?

   2. NPNick Potter36:14

      Interoception is awareness of your internal world or state. It's the one that's been least researched at the moment. Uh, funnily enough, my work at, at hedge fund, we actually did that to a certain extent, which is that we looked at, we stressed our traders by giving them volatility, which is unpredictable ... uh, changes in the market, which is stressful 'cause you can't predict it. So again, we're going back to prediction stuff. And then what we did, we took their, we took their cortisol levels, and we measured various things, and what was fascinating was that the cortisol levels exactly matched the market. And more worryingly, or interestingly, we noticed that a cytokine, one called 1B and 6, which are inflammatory cytokines, also matched the market. And when they said, "What does that mean?" I said, "Your immune sys- your immune system is tracking volatility." I mean, that was massive. So inflammation was, was being varied, but also responding to a stressful state. Mm. But if you asked them how they felt, they said, "We're fine." So interoception is awareness of cer- those... For example, in POTS, patients who gets POTS is a good example, where they get, where they suddenly get dizzy when they get up too quickly. What a lot of them will say is, "I'm dizzy," but they'll also say, "I suddenly feel my... I get palpitations." There actually tend to not be palpitations, it's just a re- a very quick increase in their rapid pulse rate, and it tends to be very thumpy. So it's like, "Oh, God, I'm having a heart attack." So, you know, so then, then of course you get the escalation in anxiety, which then becomes a vicious cycle, and so everything's anxious. And if you're anxious, you get tense, and if you get tense, you start getting pain, right? So you get this vicious cycle of mind and body interoception and so on. Mm. Gut feeling. Yes. So, uh, and is highly, highly related to emotion. So somatic therapists, for example, will say, "Oh, I noticed I touched you there about your dad. You know, where'd you feel that?" "Well, it's kind of here. It's tense." I say, "Okay." And that tends to be anger, sadness, et cetera. Okay? And then they say, "Well, it's kind of here. I feel a bit nauseous. I feel, like, in my gut." You know, again, that's very much sadness. Well, let's take the two apart. Tell me about this one. Why are you angry? Tell me about this one. Why are you sad? So that's interoception feeding back into therapy, and what they're trying to do is take a bodily response. So just to explain, when you perceive a situation, if it's emotional or otherwise, or frightening or frightening, then what a- wait, what happens is it's actually perceived through your, your nervous system in the periphery. So vision, hearing, sound, all these, the, the multidimensional appreciation of a situation is fed back, but it actually comes up mainly through the spinal cord into the most primitive centers of the brain, which is call to action, wake up, arousal, at its basic term. Then it filters up to, "What do I need?" Okay? Now, that could be hunger, right? I'm working at the computer, and a little bit of a gurgle in my tummy. So then, and then suddenly this thing called hunger. You couldn't describe hunger to me, you just know what it is. What do you do? You seek food. An apple, you cut it, you da da, and then you put it, and then suddenly that's gratified. That uncomfortable sensation, feeling, affect goes back down the holes. Exactly the same with thirst. You can't tell me what thirst is. You can be thirsty before you get a dry mouth, right? You just know what it is. Horniness is an affect. You gratify it [chuckles] or you don't, and if you don't, oh. Okay? But if you do, ah. Okay? So it's, it's gratified. So with almost every affect, there is a motor element. If you're upset, you cry. There's no reason to cry fro- from a, from a biological point of view, other than to show the group that I'm upset. Okay? So these all have reason. They're what we call the social emotions. And then you've got the survival ones, which is horniness, uh, things. But you feel them, and you feel them in your body first. Okay? And then what happens is they filter up through, into, into your brain, and you say, "Why am... What is it that I'm feeling?" Hunger, thirst, whatever, or sadness, despondency, rejection. Why am I doing that? Okay. And then you think it through, and it gets discharged. It's like energy. The energy comes through the sy- through these systems, and then you discharge it. And very often, you know, I'm angry, I'll punch something. So my traders in the old days, they would be screaming at each other on a trading floor, manifesting. Whether they were losing or winning, they just were physical, and then it, bell stopped at 3:00, they all went for a pint, and you left it there. Now they have to sit at a computer, lose 200 million pounds, and go, "Hm." And you can see their body's tense as shit, right? So they can't manifest. So they would like to go and hit the mannequin in the b- in the gym, and they often do. Mm. They'll just disappear or throw the keyboard at somebody, you know. But you are much more aware of your internal state. For example, if I said to you right now, "Would you, could you do a wee?" And you go, "Yeah, I could, actually." You haven't thought about it for 20 minutes, until it becomes imminently needy. So we- need to wee is affect. I go and do it. If I don't, I'm getting an infection or I'll die. And of course, that ramps up. So if I stop you weeing, it's, becomes really agitatory, and painful eventually, which is call to action. So you see, so these things are all linked, and the interoception is, what do I feel bodily internally that is manifesting as affect, which is something I can tick, and then it comes out as an action or a response, et cetera. So people who have high interoception and can manifest what it is do well, 'cause they can discharge it. If you are autistic, for example, there is a condition that I am more excited by than I've ever been in terms of sort of, uh, professional interest I don't think gets nearly enough attention, I think is beginning to get to, and it's called alexithymia. Alexithymia literally means in Greek, no words for feeling. And I d- realized that in a lot of my patients I was seeing who said, you know, "Your temp's not stiff," I realized that they were unable to tell me as to why they were tense, and we'd sort of ask for some emotional reasons, but most importantly, they couldn't name it. So your parents teach you how to emotionally respond to the world. Okay? So, uh, you, you're in the playground, you get rejected by a friend, you run to your mother, she hugs you. In an ideal world, your mother hugs you, and she says, "Oh, darling, you must feel sad, rejected, despondent." You subliminally go, "Ah, that thing that I'm feeling," tummy, chest, whatever, could be both, "is rejection, despondency, sadness. Thanks, Mom." Tick. You just do it subliminally, and then over time and iteration, you learn all of those feelings, mainly through Mom, and sometimes through Dad, et cetera. If he's, he's an empathic dad, he'll do it too. He tends to regulate your emotions, actually. He says, "Yeah, you're sad, but suck it up," you know. Um, now the problem is, if you can't, if you have, if you've had emotionally, uh, unavailable parents, and they don't... This is why I think some of Gabor Maté's stuff is great, but it's always about trauma. You know, you have to be raped or beaten or something, you know. Um, they're just not available. So I had a, got a chap in yesterday. His mom, it turned out, had quite a lot of mental health. She wasn't really available to him. She was very depressed, and he was good about it, but he never had anybody to go to. And you ask him, "Who did you emotionally go to?" And they say, "Yeah, I didn't really," and Dad was away a lot. So what they can't do, they've never ticked those boxes- So they feel, they're not psychopaths, but they cannot discharge it, and that gets stored as energy because it's not discharged, and it, it, you've got to put it somewhere. So you put it into your muscles, and you prepare. So there's a lot of anger and ra- When I trained with John, wonderful John Sarno in America, he said, "You can't find the pain, find the rage." You know, why isn't it just getting better with a rub or a stretch or whatever, an injection? Ask the question, and 90% of the time you just went straight, and you do it in childhood and school, and you can just pick up those. And they're very often people that say, "If I asked you, your wife, your husband, would they say possibly that it's quite difficult to get an emotional response out of you? You're very calm." And of course, they do well in the corporate world because they don't-- they're very unresponsive, and they just seem to be very calm. But internally, they're burning up, and their muscles are like this, and you see them, and they tend to drink too much, you know? And so that's a good example of where interoception goes wrong, and it's very highly correlated with, with, with autism and it's-- and they are, and they are... We know that they are actually independent. So you can be autistic and not alexithymic, which is un-unusual, but, um... But you can also be alexithymic and not autistic, but they are very correlated. And we think that actually if you're going to help an autistic person, see if they're alexithymic, treat that. It's not the social interactional stuff that's so important. It's their inability to, to integrate and not feel overwhelmed and it's 'cause they're not manifesting. So they get overwhelmed, they withdraw. They go back to the man cave and, and game too much. You know, the world just doesn't understand them. It's like, well, it's actually that you can't vent what it is that you're feeling, and you can be helped with that.

   3. APAlex Partridge44:09

      So interesting, Nick. I hear a lot of autistic people and ADHD people say they often don't even realize that they're thirsty, that they're hungry-

   4. NPNick Potter44:17

      Mm

   5. APAlex Partridge44:17

      ... that they're exhausted, they're stressed, until suddenly they're completely overwhelmed by it-

   6. NPNick Potter44:21

      Yeah

   7. APAlex Partridge44:21

      ... and they have to run and get a drink, or they, they go and eat really quickly. So you're saying that that struggle to feel what you're actually wanting in that moment could be related to emotionally neglectful parents?

   8. NPNick Potter44:35

      [laughs] That's, that's a big-

   9. APAlex Partridge44:37

      Big leap. [laughs]

   10. NPNick Potter44:38

       ... miscorrelate, yeah. You've got to be really careful there 'cause that's where I get canceled. But no, what I would say, so if you take the autistic brain, okay? What they're doing is they're trying so busy to navigate the external world and its imposition on them and their orientation in it, okay? Which is high attention to the external world, that they haven't, it's n- they're just not attending to their internal state. Now, you've got to separate. Let's say this is a non-alexithymic, okay? 'Cause that's, that's a complicator.

   11. APAlex Partridge45:04

       Mm.

   12. NPNick Potter45:05

       But what they're doing, they're so busy attending the external world and how it's imposing on them, that they, their, their, their thirst could be screaming at them. It's going, "Hello, go and have a drink." And the brain's kind of going, "Not now, I'm doing this." Right? So do, go back to when we were sitting and you're uncomfortable. The discomfort comes on, but they're so in flow, or they're so doing what they're doing, that it's got to be screaming at them. The buttock's got to actually hurt before they move.

   13. APAlex Partridge45:28

       Ah, right.

   14. NPNick Potter45:29

       Okay?

   15. APAlex Partridge45:29

       I see, yes.

   16. NPNick Potter45:29

       So I don't think they're not feeling it. I think it's just got to be sc-- it's screaming to be heard.

   17. APAlex Partridge45:33

       Mm.

   18. NPNick Potter45:34

       So that threshold now for outward looking is so intense that they can't feel that, that... So it's not what they do. If you took them out of the environment and then put them down and said, "Come away from the computer and sit down." "Oh, I'd quite like a drink now." Or, "I'd like some... I'm hungry." Or, "I'd like some company." Hungry, angry, lonely, tired, the great, great mix, right? Are they hungry? They probably haven't thought about it, but they are emotionally charged. They will start getting aggravated. What they're not just doing is linking it to, "Actually, I could just do with a burger."

   19. APAlex Partridge45:58

       Could this explain why somebody-- this is something I hear a lot anecdotally is that somebody might say to themselves, "I'm fine, I'm fine, I'm fine"-

   20. NPNick Potter46:08

       Mm

   21. APAlex Partridge46:08

       ... and then it's a sudden crash.

   22. NPNick Potter46:09

       Yeah. Well, it, it's, it's inherently the same thing. "I'm fine. I'm fine. I'm in the moment. I'm doing things. D-don't bother me." It's like when you're working. I should stop, but I'm in flow. It's sexy. I've got some dopamine, and my neck's hurting, but not because it's broken, but because I've been here for four hours, and it's just telling you, "Move," okay? But then what happens is then suddenly the noise, it could be multiple effects. I haven't drunk, and I haven't eaten. They're all screaming at you, and then suddenly it's like, "Oh my god," the attention gets grabbed and, "Oh, fuck. Yeah. No, I f- oh my god," you know, and it's, "Oh my god, I'm exhausted." Because your brain will be giving it some attention and the outside world, and that sh- and Ferrari brain, add it all in, right? That's bloody exhausting. You, you need nitro in the fuel tank, but you've only got so much reserve, 20%. So you're just burning it at a much faster rate, or you're using so many subsystems of the brain that it just says... And this is how it sabotages you. So if you look at the rat studies, right? You put a cat hair in their cage. They will gnaw the bars to get out for about 20 minutes, and then they don't. They go into learned helplessness. That's freeze, and that's exactly what these patients are experiencing. Brain fog, uh, fibromyalgia, pain. Pain activates, which is don't move, stop. Brain fog, which is stop thinking, okay? And then, um, they're the horsemen, as I call it, of, of freeze. Um, I'm trying to think of the third. I'm having a moment. Uh, so brain fro- brain fog, fatigue... Sorry, fatigue and pain. So those are the three ways that your internal brain really sabotages you.

   23. APAlex Partridge47:34

       Mm.

   24. NPNick Potter47:34

       Just says, and, uh, uh, if you're, if you're really unlucky, you get all three at the same time.

   25. APAlex Partridge47:38

       And the f-the fifth-

   26. NPNick Potter47:39

       And if they're really crashed, it takes a long time to recover.

   27. APAlex Partridge47:42

       What about chronic muscle tension? And I think that's-

   28. NPNick Potter47:45

       Mm

   29. APAlex Partridge47:45

       ... the fifth physical sign that-

   30. NPNick Potter47:46

       Yeah
10. 51:04 – 1:02:30

    ADHD and Autism: What If Your Brain Isn't the Problem?

    1. NPNick Potter51:04

       I think they're just different ways of being. You know, it's fundamental. Yeah. I mean, I think you're just, you're experiencing everything in a slightly variant way to the, to the, to the global population, you know? Um, I think it's always been there. I think we used to call them quirky. I think we should p- put a lot of autistics into Cambridge and Oxford 'cause a lot of them are quite bright as well, you know? And they like isolation, and if you have high IQ, you know, everybody bores you. So that's tough.

    2. APAlex Partridge51:27

       Yeah. [laughs]

    3. NPNick Potter51:27

       It's a difficult place to be, right? And it's difficult to mask that you're really boring me.

    4. APAlex Partridge51:31

       Yeah. [laughs]

    5. NPNick Potter51:31

       Um, and I think that, uh, yeah, and they did some amazing work. Um, but I think also that lack of socialization has its costs, so it's finding that balance. I think we've got a long way to go with lots of it. Uh, I think there's been this kind of ... It's kind of ironic in a neurodiverse world to say, "Everybody calm down," you know? And it's like the Channel 4 thing was an appalling program, um, made to be sensationalist and just to upset lots of people who don't understand a very subtly nuanced world. Um, and I think that, um, it's so multifac- it's, it's like lots of intersecting Venn diagrams all at the same time. Um, I liken it to climate science, which is that most of the climate science work that we do, we r- don't, we don't really know because we don't have enough data sets, enough knowledge. Secondly, you can't control for things. That's the problem. A human being is just like the cosmos. You can't control for the effect of volcanoes with clouds because the two sets of data don't talk to each other, and there's a lot of corruption in trying to overlay, you know. If two things seemed ... A wonderful teacher of mine said, "If you want to understand causation and correlation," he said, "just say to a patient, if you give somebody a gin and tonic, a whiskey and tonic, and a vodka and tonic, it doesn't mean tonic gets you pissed." Okay? Two things can just coexist, and then you make the false dichotomy that they're ... You know. And I think we've got to do lots more with that.

    6. APAlex Partridge52:51

       Mm.

    7. NPNick Potter52:52

       So that's like with the alexithymia and the autism and the, and the, and Jess Eckels is working for the hypermobility and the ADHD and, and, you know, and she really did the work, and you've got to find the people who are gonna do that work, and it takes time, and it's very easy for the intellectually lazy to make assumptions about things that actually can create havoc.

    8. APAlex Partridge53:07

       Mm.

    9. NPNick Potter53:08

       So I think it is frustrating how long things ... This is in lots of fields of medicine. There is good stuff out there in, in journals I think that we're not linking, and that's what I've tried to do, is to try and link being a, um, a, a clinician, front end facing, coal facing clinician. Um, how do I take what they're telling me, it's really great, but how do I turn it into therapy? How do I turn it into something I can genuinely help people with? And you see that in conferences. They drive you mad with great ideas, but then you go, "I haven't really learned anything because I can't help anybody more." So I think it's, um, I think it's great that this stuff is getting exposed and getting better understood. Um, but it's got to be subtly handled. You've got to be very eloquent about it and articulate because you can also upset people. By definition, we're a sensitive bunch. So, um, yeah, take it seriously, but equally staged, calm, you know, and diagno- of course people are gonna jump onto the bandwagon of something like ADHD 'cause you ca- 'cause you can't ma- you can't measure it, just like anxiety. But it's sad if they do that because it means that the people who really need it don't, and that is happening. There's no doubt about that. But also, as I said to you earlier before, in a world where cognitive ability, passing exams, doing well is a big predictor of outcome and success in life, then it's very hard for parents to not consider medicating their kids, et cetera, because they do perform better, and they get the results. Um, does it flat mood them in a lot of people? Yes. You know, there's always a payoff. It's, it's chemistry. It's just you put a drug in and it has effect in an infinite cosmos in a cell, and i- it's like the Chinese thing, you know, you put, you put, you pop a pebble into a, into a, uh, into a pond and you get ... It affects every molecule in the water. You know, that, that's what drugs do. And hopefully the side effects are better than not doing it. So it's an imperfect answer, but my God, it can change people's lives. And, um, so do we need to do it and can we make better drugs? Probably, but that takes time.

    10. APAlex Partridge54:59

        Mm.

    11. NPNick Potter55:00

        Um, so look, I think the answer is, I think it's a multifactorial, hugely intersectional world, and it's good that we have to separate things to understand them, to kind of put them back again. But, um, that will take time, and you've gotta have good people who know what they're talking about. Again, they're big bandwidth. Some people would say n- well-trained neurologists should see ADHD and autism rather than psychiatrists 'cause it's a, it's a processing disorder, not a psychiatric disorder. But it, it ends up in psychologies and it ends up in behavior patterns certainly, but that's not... That's the outcome. Understand the core value. And that's why I think Karl Friston's work, the, the, the free energy theory work, and it's all very complicated, but understanding that as a central model and that we are predictive machines that takes and then we have to process all this information and make a model of the world, which we start doing as a child, and if you have some sort of neurodevelopmental changes, quirks, like, like the insular and the parietal lobe, and all these things that we now know to be involved, they might be underdeveloped, not, not, uh, not a sort of disorder, because of input from your childhood, because of a number of traumatic experiences in life. Um, great, but don't tell him that until you can help him, you know, to a certain extent. And I think it's, um ... But we can do a lot more in childhood. I think recognize it early. Certainly the hypermobility is not recognized. It's a, it's a one-minute score on a child. I've done this in a prep school, and, uh, the parents were fascinated. I said, "No judgment, no stigma, but this is the likely outcome for him if he doesn't do this." And most of it was exercise. You know, spec- very specific exercise. You can exercise out of POTS-

    12. APAlex Partridge56:27

        Mm

    13. NPNick Potter56:27

        ... and you can make your hypermobility better. A lot of people think they know about hypermobility and don't. And also, um, it's about loading, it's about pacing, and it takes a while. But your tissues will respond. Stressing them makes them thicker. You can't change the collagen, but you can make them thicker and you can centrate better. You can knock out that error. And once that's more stable, so will your brain.

    14. APAlex Partridge56:49

        If you were a betting man, Nick, if you could place a prediction on the future-

    15. NPNick Potter56:53

        Mm

    16. APAlex Partridge56:54

        ... are there any physical signs of ADHD and autism do you think might come to the f- the front of the conversation that aren't being spoken about now?

    17. NPNick Potter57:04

        Something that I've noticed maybe in clinic that I don't think is always ... Little things like I've noticed, for example, that with, if you're mon- if you're monitoring somebody's breathing and talking about subjects, they don't, they, ADHD certainly, and probably autism, they tend to hold their breath for anything novel. So if you're, if they're intent on your listening 'cause they're g- they're earning something from it, they're getting novelty, they tend to hold their breath. It's the sort of bamboo. So they, so they're over, they're clearly oversensitive to new informa- novelty. And novelty is stressful to us if it's a rustle in the bushes, but to be sensitive to just what somebody's saying, but I think it's a representation of their, their intense effort to separate default mode tracking into focus tracking.

    18. APAlex Partridge57:43

        Mm.

    19. NPNick Potter57:43

        You know, you're working really hard to, to, to, to look at one and, and listen, and that's very exhausting because you're separating... It's like when we know that we look at TV screens, we actually look at the whole thing, and we subtract the lettering. Well, that's very exhausting. That's why screens exhaust you.

    20. APAlex Partridge57:55

        Mm.

    21. NPNick Potter57:55

        You're not just isolating the reading.

    22. APAlex Partridge57:57

        Could it be that-

    23. NPNick Potter57:58

        And that's what you're doing

    24. APAlex Partridge57:58

        ... any- anything new, anything novel is essentially a threat to their known pattern, their known source of safety that they're used to? Like they know how a particular situation that they're used to, they know what the outcome is-

    25. NPNick Potter58:11

        Yeah

    26. APAlex Partridge58:11

        ... and therefore they feel safe. Anything novel is almost a threat to their known safety.

    27. NPNick Potter58:14

        I, I'm a big one on desensitization. So I would ... So instead of saying, "I'm gonna avoid this situation because I know that it emotionally arouses me," we'll say, "Well, okay, why? Why does that situation arouse you? How can we work on that?" So it's like arachnophobia. You know, you go to the zoo, and by the end of it you're holding a tarantula. It's no different. If we're oversensitive, those are the things we should go after. And is it hard? Yes, but it's exactly the work that you should do. You know, so, do I get migraine in a bright light? Well, let, why don't we look at photosens- photosensitivity? Wear some glasses when you're working things. You look up blue light filters or whatever. But actually that's just a, that's a crutch. Why don't we just learn that, that you don't have to, you don't have to accept that high sensory input is stressful.

    28. APAlex Partridge58:54

        Mm. Well, I've, I'm terrified of flying to the point where it's, it's a really, really horrible experience, but I do fly a lot. Um, and I have flown a lot for, for many, many years, but I'm still terrified of flying.

    29. NPNick Potter59:05

        Mm. Mm.

    30. APAlex Partridge59:06

        So why doesn't that exposure make me less scared of flying?
11. 1:02:30 – 1:04:19

    A letter to my younger self

    1. NPNick Potter1:02:31

       "Dear little one, I wish I could come back and find you. Not to change you, just to sit beside you for a little while, because I know how tired you are, and I know nobody can see it. I know there are days when everything feels too loud, too uncomfortable, too much, and you look around at everybody else and wonder why they seem to be coping so much better than you. So you learn to say, 'I'm fine.' You say it when you're overwhelmed. You say it when you're exhausted. You say it when your body is screaming at you, and you don't even know what it's trying to say. And eventually, you get so good at saying, 'I'm fine,' that even you believe it. But I need you to know something. Your body has never betraying you. It was trying to talk to you. The exhaustion wasn't laziness. The overwhelm wasn't weakness. The things that hurt you weren't all in your head, and you weren't difficult for needing things that other people didn't seem to need. You were a child trying to understand a body and a brain nobody had given you the instructions for. I wish someone had told you that, because maybe you wouldn't have spent so many years fighting yourself. Maybe you wouldn't have believed you needed to, to become tougher, quieter, easier, less sensitive, less you. So please stop apologizing for the body you're growing up in. One day, you're going to understand it, and when you finally do, I hope you realize something that you deserved to know all along. You didn't need to try harder. You needed someone to listen. I'm listening now, and I'm sorry it took me so long. Love, your older self." Fantastic.

    2. APAlex Partridge1:04:06

       Wow. Thank you for reading it-

    3. NPNick Potter1:04:07

       That's big

    4. APAlex Partridge1:04:07

       ... so beautifully as well.

    5. NPNick Potter1:04:08

       I was choking up then.

    6. APAlex Partridge1:04:09

       Gosh. Nick, on behalf of everybody grappling to understand their brains-

    7. NPNick Potter1:04:12

       [laughs]

    8. APAlex Partridge1:04:13

       ... thank you so much.

    9. NPNick Potter1:04:14

       My absolute pleasure. Thank you for having me here. [upbeat music]

Episode duration: 1:04:19