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ADHD Chatter Podcast

5 Simple Tricks to HACK Your ADHD - Dr James Kustow

Dr James Kustow is a leading London-based Consultant Psychiatrist and a trained integrative psychotherapist, working in one of the few specialist NHS Adult ADHD services in the capital.

Dr. James KustowguestAlex Partridgehost

Oct 29, 20241h 17mWatch on YouTube

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CHAPTERS

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Chapter summaries

Energy Dysregulation and the Ten Domains Model
After the sponsor read and the reveal of the night owl item, Alex asks whether people with ADHD spend energy differently. Dr Kustow introduces his 'ten domains of dysregulation' model and describes the boom and bust energy pattern.
- •His model frames ADHD as dysregulation across ten domains
- •Energy expenditure and arousal is one of those domains
- •Many people with ADHD show a boom and bust pattern
- •Alex relates the pattern to abandoned projects and the shame that follows
Masking, Energy Cost and Unmasking
Dr Kustow explains how undiagnosed ADHD shows up as impairment and co-occurring mental health problems, and how masking uses up energy. Alex describes his own shape-shifting and asks how to begin unmasking, and Kustow offers an orange-segments analogy.
- •ADHD implies significant impairment and often comes with depression and anxiety
- •Masking and staying up late to keep pace use a lot of energy
- •The strain tends to show in the late 30s and 40s
- •Kustow prefers thinking of segments of the self rather than layers
Rejection Sensitivity and Its Three Personality Shifts
Dr Kustow describes rejection sensitive dysphoria and the three personality shifts he sees: people pleasing, avoidance and perfectionism. He explains how avoidance feeds fear and how recognizing RSD helps people catch it early.
- •RSD is a concept that has not yet been formally studied
- •Shifts include people pleasing, avoidance and perfectionism
- •Avoiding a fear makes the fear grow
- •Emotional dysregulation is not in the diagnostic criteria
The Solution: Growth Mindset and Dropping Self-Criticism
Asked for a solution, Dr Kustow points to knowledge, supportive people and a growth-oriented mindset, the first of his seven pillars. He says he allows no self-deprecation and does not use ADHD as an excuse, though he will explain a mistake.
- •Knowledge, supportive people and mindset are the starting points
- •Expect to trip up and respond without self-punishment
- •Explain a mistake without excusing it
- •Cutting out self-deprecating remarks lets you carry yourself with more pride
Handling RSD Triggers in Relationships
Alex describes RSD as debilitating and asks what to do in the moment of being triggered. Dr Kustow suggests a code word, a state change and tapping, and explains how anger can be an unconscious way of self-treating ADHD with adrenaline.
- •Partners should discuss RSD beforehand and agree a code word
- •Take time out and change state, such as going outside or having water
- •Tapping is the quickest regulation tool in his experience
- •Adrenaline from arguments can feel calming afterwards, which is why it gets repeated
Saying No and Ending People Pleasing
Alex asks how to set boundaries and say no. Dr Kustow says people say yes to make up for past inadequacies, which invites being walked over, and recommends respecting yourself and sleeping on decisions.
- •People please hoping to compensate for past mistakes
- •Saying yes to everything signals that boundaries are weak
- •Pause and sleep on a request instead of agreeing impulsively
- •Mindset and self-love matter more than trying to repair old mistakes
Why Adults Seek Diagnosis: Scaffolding, Structure and Habits
Dr Kustow says many people come to him after their first year at university, when the loss of structure causes things to unravel. He then discusses external regulation, habit stacking, and structure that includes variation.
- •First-year university removes the scaffolding of home and school
- •Those with ADHD need to build external structure and stability
- •Habit stacking attaches a new habit to an existing one
- •Structure needs some variation to avoid boredom
Surviving University Undiagnosed
Alex describes being kicked out of university and asks what Dr Kustow did differently. Kustow says he worked extremely hard with many study strategies, relied on caffeine tablets and used rugby to release energy. Alex notes the myth that people with ADHD just need to work harder.
- •Kustow worked far harder than peers without knowing he had ADHD
- •He used highlighters, recordings, songs and mnemonics
- •He used rugby to release energy and masked in weaker areas
- •The toll became clearer later and led him to treat his ADHD
Why ADHD Is Hard to Prove and Whether It Exists
Asked why ADHD is hard to prove to cynics, Dr Kustow says it is a matter of degree and severity, like blood pressure. He argues that a dysregulation model explains both attention deficit and hyperfocus, and says he does not see ADHD as a discrete entity.
- •Everyone experiences distraction, so the difference is degree and impairment
- •Dysregulation of sleep, immunity, senses, reward and attention can all explain ADHD features
- •The problem with hyperfocus is the inability to detach
- •ADHD is compared to blood pressure and is also a systemic, bodily problem
Myths and the Impact of Diagnosis and Medication
Dr Kustow debunks myths such as ADHD being invented for pharma or caused by poor parenting, citing its high heritability. He then describes the stages after diagnosis, including the light bulb moment, validation, the medication honeymoon and why more work is needed beyond medication.
- •ADHD is highly heritable, in the 70s percent
- •Genes may also relate to traits like hypermobility
- •Diagnosis validates that it is not your fault
- •Medication helps but a big gap remains to thriving
- •His group program offers a resource-light way to do the additional work
The Night Owl: Sleep, Stress and Trauma
Dr Kustow explains why he chose a night owl: circadian rhythms in ADHD are shifted later, causing sleep deficit. He also links the owl's wide-eyed scanning to autonomic imbalance, dysautonomia and trauma overlap, and to flightiness.
- •The sleep-wake cycle is often shifted later by about an hour
- •Late nights plus 9am starts build a sleep deficit
- •Autonomic imbalance and dysautonomia are more common in ADHD
- •Trauma and ADHD overlap through hypervigilance
Agony Aunt: Emotional Partner and Owning Mistakes
In the Washing Machine of Woes segment, a listener asks how to tell a partner that his passionate arguments feel intimidating. Dr Kustow links this to rejection sensitivity, advises agreed signals and says the person with ADHD should do the work, listen, own mistakes, apologize and discharge resentment.
- •Anger is often tied to perceived rejection
- •A quiet prior discussion and a sign can stop escalation
- •The person with ADHD needs to work on it and take feedback
- •Owning and apologizing defuses conflict
- •Unresolved micro traumas can contribute to illness and addiction
Executive Dysfunction Explained
Dr Kustow defines executive function as the brain capacities needed to achieve goals over time. He says the core problem in ADHD is inhibition, or the lack of brakes, which makes it hard to delay gratification and explains the symptoms.
- •Executive function covers capacities used to reach future goals
- •ADHD brains are often very in the moment
- •Disinhibition makes it hard to resist rewards now
- •Impulsivity and distraction follow from missing brakes
The Seven Pillars for Thriving with ADHD
Asked how to thrive, Dr Kustow describes mindset, trauma clearing through body-based methods and his seven pillars. He outlines sleep, time and task management, nutrition and movement, and environment as the next steps.
- •Mindset and commitment to growth are the foundation
- •Body-based approaches like tapping, eye movements and walking help clear trauma
- •Pillar two is sleep, developed with a sleep specialist
- •Next come time and task management, nutrition and environment
- •Things need to be visible for those with ADHD
Emotional Dysregulation and Solo Soma
Dr Kustow explains emotional dysregulation as hotter emotions that shift more often and describes two strategies: calming down in the moment and raising the stress threshold. He introduces Solo Soma, a movement-based meditation he created from several techniques.
- •Emotions cycle more often with a short fuse and low frustration tolerance
- •Two strategies: calm yourself in the moment and prevent triggers day to day
- •Regulating emotions is the seventh and largest pillar
- •Solo Soma combines elements of EMDR, tapping, yoga and other approaches
- •He uses it as a proactive daily practice
ADHD Hacks and Productivity
Asked about hacking ADHD for productivity, Dr Kustow describes point-of-action reminders, an early alarm with medication, and a lifestyle-first approach before medication. Alex shares his bracelet task system and they discuss gamifying tasks.
- •Place reminders where the action happens
- •Clean up lifestyle before jumping to medication; it can reduce dose needs
- •The book is practical, built on a platform of understanding ADHD
- •Alex uses five bracelets and a reward for tasks
- •Games and fun add dopamine to mundane tasks
Closing Letter and Rapid-Fire Questions
Dr Kustow reads the previous guest's three life rules, then answers light questions about ADHD characters, social media, unread emails, his clothes mountain and an impulsive decision that led to an unfinished book.
- •The letter's rules include loving yourself and being your unique self
- •He names Robin Williams and Maria from The Sound of Music as ADHD examples
- •He avoids social media and lost hours to Shorts
- •He has thousands of unread emails and a clothes mountain
- •An impulsive book project taught him to contact a publisher first

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