7 Newly Discovered Signs of ADHD | Dr Daniel Amen

Alex Partridge 0:00 You've recently discovered 7 different types of ADHD. Why do you think it's important that people understand the 7 types?

Dr. Daniel Amen 0:08 So I'm a psychiatrist by training.

Alex Partridge 0:11 Mm.

Dr. Daniel Amen 0:11 I'm also a child psychiatrist, and half the patients you see as a child psychiatrist have ADD or ADHD of one type or another. Um, when I started looking at the brain, I, I sorta thought ADD was one thing. And I like the term ADD way more than I like ADHD. Um, DSM-III came out in 1980 from the American Psychiatric Association. It's called Attention Deficit Disorder With or Without Hyperactivity. 1987, they revised the DSM, DSM-III, and they changed the name, and I'm like, "Well, why'd you do that?" They changed it to Attention Deficit Hyperactivity Disorder, which just threw out half the people who had it. And I'm like, "No, I hate that." Um, 1994, they changed the name again to AD/HD. They put the slash in to make up for the mistake they made as opposed to just saying, "Sorry, we made a mistake." Anyways, uh, that's why one of my books is called Healing ADD because I'm still on strike-

Alex Partridge 1:25 [laughs]

Dr. Daniel Amen 1:26 ... for the ADHD name because so, especially females, don't-- are never hyperactive, so they don't bring the attention to themselves, and so they're misdiagnosed as, "You're not that interested. You're not that smart. Uh, you're depressed. You're anxious," when, in fact, the problem is they have ADD. Um, so when I first started looking at the brain, I thought it would be one thing. Um, 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, um, are over-focused. Some people have too much activity. Some people, it's from trauma, and it's clearly not one thing.

Alex Partridge 2:24 It's interesting that you say that women sometimes aren't hyperactive. What do you say to people who say that women or girls w- were hyperactive at one point in their life, but perhaps because of messaging and conditioning that they had from the world, they, they learnt to suppress that, and the hyperactivity ends up in their head?

Dr. Daniel Amen 2:47 No. It, it wouldn't correlate with my experience. Um, and I'm blessed to have two girls who have ADD, one of 'em hyperactive from before birth. She was so active inside her mother's womb, we thought she was gonna be a boy 'cause the lore is the more active a baby is, the more likely they are to be a boy. Well, she wasn't. Trying to hold her at a year old was like trying to hold a live salmon. I'm like, "Where are you going?" Um, she would've been one of those children on little yellow leashes in the mall-

Alex Partridge 3:23 [laughs]

Dr. Daniel Amen 3:24 ... 'cause she was so active.

Alex Partridge 3:26 Mm.

Dr. Daniel Amen 3:26 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. It's like, no. So I used to put her in her stroller and tie her shoes together [laughs] so she couldn't get out. She had the H. Her sister, never hyperactive, and, uh, I actually didn't figure it out until she was in 10th grade, where she was staying up every night until 1 or 2 o'clock in the morning studying just to get B's and C's. 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 inattentive ADHD type, straight A's for 10 straight years, and actually got into the University of Edinburgh's veterinarian school, one of the hardest schools in the world to get into.

Alex Partridge 4:34 So that is heartbreaking if she said that she wanted to be like the other girls. I mean, ADD or ADHD,

Alex Partridge 4:42 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?

Dr. Daniel Amen 5:00 Well, I think if a child who, who really has ADD, um, is not diagnosed until after 9, they already have negative chatter going on in their head. And if you're hyperactive, people are upset at 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, um, they often play this game of let's have a problem. Um, in my book, "Healing ADD," there's a whole chapter called "The Games ADD People Play." And, um, the hyperactive one used to run up to her brother, kick him as 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, um- Which meant she was in trouble a lot

Alex Partridge 6:04 And what does that do, like, to the developing brain? Because from, 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, their teachers, 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, 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, and this is the real quotes that I hear from, from girls with ADHD, what does that do to the brain chemistry as you t- enter adolescence?

Dr. Daniel Amen 6:55 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, measures 17 areas of cognitive, emotional function, and one of them is, uh, face recognition. You know, 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.

Alex Partridge 7:56 Do you know a, a psychiatrist called William Dodson?

Dr. Daniel Amen 8:00 No.

Alex Partridge 8:01 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, 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. Like, 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?

Dr. Daniel Amen 9:27 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 when they probably should've taken an hour [chuckles] and, and then it's, 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-

Alex Partridge 10:13 Can you give me-

Dr. Daniel Amen 10:13 ... about that rejection. And-

Alex Partridge 10:16 Is there an example of, of how that could actually play out in someone's life, uh, uh, that presentation?

Dr. Daniel Amen 10:20 Well, if you're, and I see it especially in children and grandchildren of alcoholics, so I think there's a genetic-environmental interaction with it. Um, so practically, they have the ADHD symptoms. Hyperactive, maybe, maybe not. But short attention span, distractibility, um, organizational issues, procrastination, impulse control. So I think of those as sort of the five hallmarks of ADD. And, 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, uh, 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.

Alex Partridge 11:36 How do you-

Dr. Daniel Amen 11:36 And, 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-

Alex Partridge 11:54 It's a nightmare. The oversensitive type, being super sensitive to rejection or, or criticism, uh, 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, to latch on and, and you can't let go of what that person said. Like, how could that practically manifest in someone's romantic life?

Dr. Daniel Amen 12:23 Well, you push the other person away. I mean, the other person feels like they can't do anything right, and it, it wears your self-esteem, but it also wears your partner's self-esteem. And for whatever reason, I only love ADD women. I don't know what that's about, and my, my first wife taught me so much [chuckles] about ADD. And Tana, my wife, uh, you know, my love of 21 years, uh, she and I did a show together, uh, Healing ADD, where we talked about it. Um, but she doesn't do that to my nervous system, I think because she's a lot more conscious. She gets it treated to, um... But, you know, just speaking from the partner standpoint, it's chronically stressful, um, when you d- when you can't do most things right. And I, and I often would say to my first wife, "Please don't read my mind."

Alex Partridge 13:31 [chuckles]

Dr. Daniel Amen 13:31 "I have enough trouble reading it myself." [chuckles] 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 18, 40, 60 rule that says when you're 18, you worry, but everybody's thinking of you.

Alex Partridge 13:49 Sure.

Dr. Daniel Amen 13:49 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.

Alex Partridge 14:10 Sure. I guess it helps to pay attention to the patterns. If it's just one event, then they might be constipated. [chuckles] If it's a, if it's a pattern of, of 10 in a row in one week, then there might be something there to dig for.

Dr. Daniel Amen 14:21 I was talking to one of my patients yesterday about projective identification, uh, which is this interesting psychodynamic or psychoanalytic term that means you can make other people feel, you can project onto them what you're thinking and feeling. So if you're sensitive to rejection, you can project that onto the other person so that they can't do anything right, and that will push people away.

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Alex Partridge 15:56 Have you heard 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's a, she was an alcoholic. She, she is 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, uh, 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 home, bottle of wine, and 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, and RSD was triggered and she felt physical pain. Is that something you have heard of before?

Dr. Daniel Amen 17:36 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 in 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, write down what you're thinking. And she would've written down the trail of-- 'Cause ANTs, um, 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 gonna get fired." Um, so you write these things down, and then you go, "Is that true?" And you absolutely know 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 100 times, and then your brain starts doing it on its own. Um, 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. [chuckles] And I'm like, "No, 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.

Alex Partridge 19:37 What's your stance on RSD, Rejection Sensitive Dysphoria? There's a ton of literature and, and information on it on- online. But do you subscribe to it being a, a real thing that should be in the assessment process for ADHD?

Dr. Daniel Amen 19:51 I think it's a real thing, and I think it, it's, uh, causes a great deal of suffering and pain.

Alex Partridge 19:58 Is it measurable? Like, can you see it on a brain scan?

Dr. Daniel Amen 20:00 You know, I don't know. I'm sure there are questionnaires that'll help, uh, 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. Um, and your-- the 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 zero to 10, how many bad things happened to you-

Alex Partridge 20:47 Mm-hmm

Dr. Daniel Amen 20:48 ... growing up? Because if you had ADHD, my experience, your mom or dad had it. It, it's highly heritable. And with my hyperactive child, um, so 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, um, 'cause she was so busy, so noisy. Um, I'm like, "Okay, she's only three." On her fourth birthday week, I'm like, "We're going for an evaluation." [chuckles] And the doctor basically looked at me and looked at my ex-wife, and was 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, "Oh, I can never study at home. I get way too distracted. I have to go, um, inside my car under a streetlamp. No kids, no noise, nothing. There I can study." And I went, "You have ADD."

Alex Partridge 21:58 [laughs] Sometimes you just need to sit in a car for five or 10 minutes-

Dr. Daniel Amen 22:03 Yeah

Alex Partridge 22:03 ... before you pull up to a, 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, I think Rejection Sensitive Dysphoria is, 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 s- 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.

Alex Partridge 23:26 Do you hear stories of loneliness when people come into your clinic?

Dr. Daniel Amen 23:30 You know, again, if we go back to the types, I think three and four. Three is the over-focused ADD. Four is limbic ADD, where their emotional centers are busy. Um, those are the two that are most vulnerable. Um, type one classic ADHD, they're often the life of the party. They often have lots of friends. Um, they often run companies. Uh, 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 [chuckles] in life. So I think it depends- On what's going on in their emotional brain, not just their focused brain, if that makes sense.

Alex Partridge 24:30 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, 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. I mean, do you think ultimately there is a cost, a, a huge difference between perhaps the successful person with ADHD and actually what's going on in their life behind the scenes?

Dr. Daniel Amen 25:12 You know, again, I think it depends on the type. You know, I've seen tens of thousands of people have ADD of one form or another, and some of them not really suffering that much, and, um, but not really getting near their potential, and others being deeply lonely and sensitive. So I think it depends on their brain.

Alex Partridge 25:43 I think, I think I saw you say that loneliness is more dangerous than smoking 20 cigarettes a day, or something along those lines.

Dr. Daniel Amen 25:49 Has the same negative health effects of smoking 15 cigarettes a day.

Alex Partridge 25:54 Why?

Dr. Daniel Amen 25:54 And it's a crisis. There's actually one study from the UK. 58% of young people report being persistently lonely, and I think that has to do with our devices, and social media, and dating apps [chuckles] 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 gonna make the wrong choice. There's actually this 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? Um, I was, 52% of girls reported being, 57% of girls reported being persistently sad. 32% have thought of killing themselves, 24% planned, and 13% have tried. And I'm just completely blown away with these statistics 'cause they don't compute to my experience as a child when I grew up in the '60s. It doesn't compute to my experience as a child psychiatrist until the last decade.

Alex Partridge 27:28 Well, I think it's all connected. I mean, I think the, the early years being criticized, the masking, the, 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 were a kid. Perhaps addiction as well. You know, with the loneliness, it can compound to create, I think, somebody who, who is very miserable and very lonely. Uh, d- c- can lonely-

Dr. Daniel Amen 27:52 So it'd be interesting what percentage of those 57% of girls also had ADD, and perhaps 10%. So there's something wider in society. But having untreated ADD will accelerate whatever emotional

Dr. Daniel Amen 28:16 issue you have.

Alex Partridge 28:17 You mentioned, uh, suicide. I wanted to touch on that. Is, uh, it, it is a, a depressing reality of the ADHD experience. We know that the chances of, of thinking that way is considerably higher than in the neurotypical population. Is suicide ideation, that way of thinking, is that measurable? Is that observable on a scan?

Dr. Daniel Amen 28:39 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, um, we have a HOPE questionnaire, um, so zero 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, um, much more likely to kill themselves.

Alex Partridge 29:28 What are some of the questions on that HOPE questionnaire? I was interested to see how we're defining the word.

Dr. Daniel Amen 29:33 It's about agency, can you make tomorrow better, and pathways, do you have different ways to get what you want? Um, when I decided I wanted to go to medical school, I was not a good student in high school. I was a really good student in college. Um, but I had 35 different ways to go to medical school. Like [chuckles] I was going to the Philippines if I had to. Um, but that's hope. It's, you know, it's, if I get into Harvard, I'll go to medical school, if I don't, I'll do something else. It's like, no When you, when you have a goal, develop pathways to get it.

Alex Partridge 30:22 We know ADHD is, is very heritable. I mean, could the same be said for, uh, hopelessness, and therefore suicide ideation? Like, can you literally be born at-

Dr. Daniel Amen 30:32 Interesting-

Alex Partridge 30:32 ... a higher risk of, for-

Dr. Daniel Amen 30:33 ... question. I talked to one of my patients today. Suicide is rampant on both sides of her family. Um, so yes, I think there is a, a heritableness to it, but if there's also modeling, then that's sort of that gene environmental interaction.

Alex Partridge 30:59 What can't be seen on a brain scan?

Dr. Daniel Amen 31:02 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 be a male or a 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 enough? It's not likely to say, "You're depressed, you're anxious." Uh, it, it doesn't give you sort of the name. It gives you the underlying biology.

Alex Partridge 31:40 So if I came into your clinic, and we were trying to figure out what type of ADHD I had, like, what, what would be the first step? How would that process work?

Dr. Daniel Amen 31:47 Well, we'd talk to you. I mean, that's always the first thing we do. We'd have you fill out, you know, lots of questions, and do total brain or cognitive assessment. We'd scan you twice, once at rest, 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." Um, so it's not just the scan. It's the scan plus a lot of other data. And, you know, A- ADD is not a disorder of the moment. You know, all of us have ADD days. Like, we didn't sleep well, um, 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.

Alex Partridge 32:44 Can you think of someone who-- [stammers] how many brains have you scanned? Around 300,000?

Dr. Daniel Amen 32:49 Around 300,000.

Alex Partridge 32:50 Is there one patient that stands out, one particular story that really made you double take and go, "You're doing good stuff"?

Dr. Daniel Amen 32:56 So many. [laughs] So many stories. Um, I mean, my hero story, 'cause I got no end of grief when I first started scanning people. Like, it was bad. Um, you shouldn't do this. It's not what psychiatrists do. Um, my nephew attacked a little girl on the baseball field for no reason, out of the blue, and 999 child psychiatrists out of 1,000 would've put him on medicine and put him in therapy. Um, I'm like, "I wonder what his brain's doing." He had a cyst the size of a golf ball occupying the space of his left temporal lobe, and when the neurosurgeon drained the cyst, his behavior completely went back to normal. If you don't look, you don't know.

Alex Partridge 33:45 What's the part of ADHD that you think is the most misunderstood, uh, within the general population? Like, someone who has ADHD, and they struggle the most with it, this part because their family, friends perhaps just don't get it.

Dr. Daniel Amen 33:58 Y- you know, two answers come to mind. Uh, 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 who have A- ADD are not dumb, crazy, or stupid. Um, their frontal lobes don't turn on, um, and the medicine sort of works like glasses. Um, m- medicine's 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 10 improve significantly. And so getting your diet right is absolutely essential, I think, and hard because of the society we live in. Um, your gadgets can make you look like you have ADHD 'cause they destroy dopamine. I mean, they're purposeful to keep you hooked, and dopamine is a neurotransmitter that they wear out. Um, but when the medicine is effective, it's so effective, uh, 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- um, -perform for their ability, which just ruins their self-esteem.

Alex Partridge 36:04 So w- w- there's seven different types, you claim, of ADHD, and the same diagnosis but very different brains, and yet we prescribe ADHD-

Dr. Daniel Amen 36:14 The same thing

Alex Partridge 36:14 ... medication. Now, you, 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 after medication?

Dr. Daniel Amen 36:26 Very common And, you know, those are the people who tend to come see us.

Dr. Daniel Amen 36:31 Um, so just quickly, classic ADHD, hyperactive, restless, impulsive with the hallmark symptoms, 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 ADD 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 [laughs] because they're off looking for something else. So short attention span, distractibility, they hear too much, see too much, sense too much, um, often disorganization. They organize by the pile system, pile here, pile there, pile, pile everywhere. Um, put things off until they're stressed to do it. Remember, they have low cortisol levels, low stress hormone levels. Um, and then poor impulse control. They say things that they shouldn't say. They do things that maybe are not in their best interest. So now, classic, they're hyperactive. Type 2 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. Bulimia is the perfect example. Compulsively make themselves throw up, but impulsive as well, so impulsive. Compulsive disorders, gambling, is like that. Limbic ADD, sort of chronically dysthymic or sad, uh, more common with rejection sensitivity syndrome. Temporal lobe ADD, where one or both of their temporal lobes is low, and activity may be from a head injury, not uncommon, but they often have learning problems, especially dyslexia. Um, the ring of fire, that was the one, um, I think is my contribution, is they don't have low activity, they have high activity. I published a study, 80% of the time, give them a stimulant, you will make them worse, 'cause the problem is not low activity, it's too much, and it's like pouring gasoline on a fire. Um, and type 7 is anxious ADD, where anxiety and, uh, 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, but 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 can rebound into depression. Uh, type 5 can actually make you hallucinate. I had one of my patients who had type 5 hallucinate on stimulants. Type 6 almost always makes you worse, and type

Dr. Daniel Amen 39:47 7 makes you more anxious.

Alex Partridge 39:48 Today’s episode is sponsored by Neuralis by HealthRestore. I wasn’t diagnosed with ADHD until I was 36, and one thing I’ve learnt is just how differently ADHD affects everyone. For example, I can spend three hours researching a guest 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 personalised 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 HealthRestore and explore your own ADHD operating system profile. It could be a useful first step towards

Alex Partridge 40:40 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?

Dr. Daniel Amen 40:50 Yes. No, I think, uh, women have more type 2 and type 3. Uh, men have more type 6 and type 1, women with more type 7.

Alex Partridge 41:03 And the type that you have, that's like you for life, or can you, can your type change?

Dr. Daniel Amen 41:08 No, I think with, um, interventions, you can change your types over time. You can become certainly less obsessive, less anxious.

Alex Partridge 41:17 What type do you think is most likely to be missed, that goes under the radar?

Dr. Daniel Amen 41:22 Six, 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.

Alex Partridge 41:33 So what two types-- Like, tell me how you would treat one type and how you would treat another type.

Dr. Daniel Amen 41:39 Well, if we take 1 and 6, uh, so one, both the types, I'm gonna change their diet. I'm gonna get them to exercise. I'm gonna get them more sun. I'm gonna decrease their devices if I can, right? It's hard. Um, and type 1, I'm gonna start with L-tyrosine, um, as a supplement or a stimulant. If it's a child, I'll use a methylphenidate-based medicine. If it's a teenager or an adult, I'll generally use, uh, one of the amphetamine-based medicines like Adderall or Vyvanse here in the US. Um- 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, 'cause you asked me about cases. My niece, Jennifer, love her, seven years old. My sister's calling me three 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 three times a week, and I tried this medicine, it didn't work. Stimulants made her awful. Um, finally scan her. She has the ring of fire. Um, I put her on a supplement called, uh, Neuralink, GABA, 5-HTP, L-tyrosine. Um, my sister doesn't call me anymore. Like, four months later, I haven't heard from my sister. I'm like, "Don't you love me anymore?" She goes, "Don't be stupid. Jennifer's doing so much better. She has straight As. We're not fighting anymore." And I love that story. And now she's an attorney, and-

Alex Partridge 43:34 On the other end of it, Daniel, what do you think people who are, like, trying to figure it out on their own, they haven't perhaps gone to see a professional

Alex Partridge 43:43 to get treatment, what are the biggest mistakes somebody might be making in managing their ADHD?

Dr. Daniel Amen 43:49 Um, that they're managing it with alcohol, or they're managing it with marijuana, or they're managing it with video games, uh, 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, um, because they ran 10 miles every day. And intense exercise helps balance the neurotransmitters in your brain. It raises both serotonin and dopamine. And when they get injured, then they get depressed, uh, which I think is really interesting. Um, so I think exercise is an excellent way, uh, to manage it, but it's hard on your joints if you have to do that. [laughs]

Alex Partridge 45:07 You must have seen a lot of emotions over the years when you finally give an explanation to someone that ADHD m- it has explained perhaps decades

Alex Partridge 45:14 of struggle. What do you think the biggest thing people grieve after a diagnosis is?

Dr. Daniel Amen 45:20 So I think that's a great question, and I, I think, uh, 'cause 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. Um, so yeah, grief is a-- And I warn people 'cause initially they feel it's like, oh, I have an answer, and I'm doing so much better. And, uh, I'm like, "It 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, you know, 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 this, they try the child's medication, and they're like, "Oh my God, this was so helpful." [laughs] Yeah, don't do that. Talk to the doctor.

Alex Partridge 46:37 What about forgiveness? Do you-- 'Cause I, I've spoken to a lot of people who give themselves a, 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," but 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?

Dr. Daniel Amen 47:02 Well, they didn't have all the data, and, you know, likely they're like me, and they make the best decision they can with the information they have. And all of us w- would make thousands of other decisions, but then, of course, we wouldn't be us. Um, I teach all of my patients the REACH model of forgiveness, uh, Everett Worthington's work out of Virginia Commonwealth University. It's okay. 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. Uh, 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, ooh, it's sort

Dr. Daniel Amen 48:00 of intense.

Alex Partridge 48:01 And 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, uh, loss of identity, low self-worth. What would you say to that person?

Dr. Daniel Amen 48:14 You know, the, the first thing is to start loving your brain. I know it sounds crazy, but it's not. Uh, your brain controls everything you do, how you think, how you feel, how you act, how you get along with other people. Um, 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, um, 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. Um, I'm working, um, on a program with the 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? 'Cause too often when the world is all about you, when you're seeing the negativity and it's y- it's all self-referential, you're gonna be lonelier. 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. Is what I'm doing now good for my brain or bad for it, and does it make the world better? Um, and if you just think of having ADD sort of like, oh, you needed glasses and no one saw that. Now I can get it, I can see clearer, um, I c- can be better. It's not just medicine, although medicine 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, and one of my professors said, "Teach your patients not to believe every stupid thing they think." And I'm like, "Really? You can do that?" [laughs]

Alex Partridge 50:21 I've actually got a surprise for you, Daniel, before we, before we end. Uh, in tradition for ADHD Chatter, every guest writes a letter to their younger self, and I deliver the previous guest's letter to my current guest, and if you could kindly read that out for us. [paper rustling]

Alex Partridge 50:39 There we go, Daniel.

Dr. Daniel Amen 50:39 "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 to ADD 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. That afternoon where you didn't need, where you didn't have to pretend, where nobody made you feel like something was wrong with you. I'd hold you until you stopped 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 leaving you. Love, the woman you became." Wow.

Alex Partridge 53:38 Thank you, Daniel.