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ADHD Chatter PodcastNo.1 ADHD Psychologist Shares 2 Proven Ways to STOP Overthinking + People Pleasing - Dr Mark Rackley
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How Dr. Rackley Assesses a New Patient for ADHD
Alex asks where Dr. Rackley would begin with a new patient who may have ADHD. He describes reviewing existing diagnoses, taking full childhood and current histories, and listening for developmental patterns.
- •Some patients arrive already diagnosed by a psychiatrist; others get a full assessment
- •He takes childhood history and looks for depression, anxiety, or developmental causes
- •He describes having 'spidey senses' for ADHD patterns
- •Parents are in the room for young patients and supply history
- •He only raises undiagnosed ADHD when about 95% sure
The Cost of Repressed Emotion and ADHD Shame
Alex raises shame and reluctance to share inadequacies, and asks about the cost of repressed emotion. Dr. Rackley explains that it can show up as physical symptoms and that shame makes patients feel unsafe, so he treads carefully.
- •Repressed emotion can emerge as migraines, skin problems, or gut issues
- •Shame is an all-encompassing negative emotion about how one sees oneself
- •Shame can lead to hopelessness and feeling suicidal
- •Combined with rejection sensitivity, shame makes opening up very hard
- •Patients need to be reassured they are safe
Rejection Sensitivity (RSD) in the Brain and Daily Life
Dr. Rackley explains RSD as a chronic sense of being different in a negative way, leading people to overcompensate. Alex describes how intense it can be for his community, even stopping people leaving the house.
- •RSD is a chronic sense that being different is negative
- •People protect against rejection by being careful or by becoming the 'Jack the Lad'
- •It is linked to shame and plays out in relationships
- •Alex says fear of rejection can stop people going for promotions or going to the shop
Gender Differences in Feeling Inadequate at School
Dr. Rackley generalizes from research that boys tend to externalize and girls tend to internalize difficulties at school. He cautions that individual experience varies.
- •Boys tend toward disruptive, behavioral problems
- •Girls more often internalize, which may show as anxiety linked to ADHD
- •These are generalizations from research, not rules for individuals
Emotional Dysregulation: How It Appears and How to Manage It
Using homeostasis as a frame, Dr. Rackley describes dysregulation as meltdowns, shutting down, or positive surges like never wanting the party to end. He then covers managing it through learning triggers, reading physical cues, and using interventions, and names common triggers.
- •Dysregulation can be big overreactions, shutdown, or positive overexcitement
- •Understanding triggering environments, even specific teachers, helps
- •Heartbeat, breathing, and loss of focus can serve as bodily cues
- •Interventions include a five-minute break or music with headphones
- •Common triggers include injustice, not being listened to, and bullying
ADHD Struggles in Girls and Boys From Childhood to Adulthood
Dr. Rackley explains the roughly three-year prefrontal cortex development gap and what it means for teenagers. He then compares typical struggles for girls and boys through adolescence and into adulthood.
- •The ADHD prefrontal cortex develops about three years slower
- •Girls may struggle with disorganization, friendship groups, perfectionism, and body image
- •Adult women more often face job stress, life management, and dating
- •Boys may behave badly to be liked, become highly competitive, or develop depression and anxiety
Why an ADHD Diagnosis Matters and Reactions to Late Diagnosis
Dr. Rackley strongly supports seeking a diagnosis because it gives a framework and causality, and he often frames it as neurodiversity. He says late diagnosis commonly brings anger and sadness about what could have been.
- •A diagnosis explains why life has unfolded as it has and reduces feeling misunderstood
- •He often uses 'neurodiversity' rather than the ADHD label
- •Anger is the main reaction to a late diagnosis, since no one picked it up
- •Sadness arises because core memories are negative
- •Alex notes lost relationships and jobs that might have gone differently
Overthinking: Advantages, Modern Causes, and Managing It
Dr. Rackley says overthinking can help creativity and holistic problem-solving but also feeds anxiety, and that modern habits like worrying about texts and followers make it unhealthy. He suggests managing rather than controlling it by checking the evidence and using distraction.
- •Overthinking can fuel a creative, different view of the world
- •People now overthink the wrong things, like unanswered texts and social media
- •The goal is to manage it, not control it
- •Replaying social events adds stories without evidence
- •A distraction technique can pull the brain away, which ADHD brains respond to well
Three Tips for Sleep and Avoiding Bedtime Mistakes
Dr. Rackley explains that some ADHD brains look for stimulation in the quiet of night. He recommends a calm pre-sleep hour off devices, a relaxing bedroom, and white noise, and names devices as the biggest mistake.
- •Not everyone with ADHD has sleep problems
- •Calm, device-free hour before bed
- •Bedroom should be comfortable and not chaotic
- •White noise relaxes and distracts without stimulating
- •Devices, especially social media, are the biggest pre-bed mistake
- •Oxytocin is discussed briefly as a possible aid
Understanding and Managing Intrusive Thoughts
Responding to Alex's question about thoughts that flood in at bedtime, Dr. Rackley says intrusive thoughts are normal and come from the unconscious. He recommends mindfulness, active approaches, and professional help if they are frequent or distressing.
- •Intrusive thoughts cannot be controlled and are a natural part of consciousness
- •Paying attention empowers them and wakes the brain up
- •Mindfulness helps let thoughts pass as brain processes
- •Being passive is not enough; talk to someone, use mindfulness or distraction
- •Thinking something does not mean it is real
Washing Machine of Woes: Coming Out With RSD
In Alex's recurring segment, a 17-year-old with severe RSD asks how to come out as gay. Dr. Rackley advises weighing the family's trust, love, and respect, and choosing one safe person to support them.
- •RSD focuses on negative outcomes and details, not the bigger picture
- •Consider whether the family shows trust, love, kindness, and respect
- •Feeling unsafe does not mean it is unsafe
- •Identify one safe family member to support you before telling others
Perfectionism and Fear of Failure
Dr. Rackley links ADHD perfectionism to fear of failure, which triggers avoidance. He gives tips on reining it in, stressing that perfect people don't exist and that perfectionism isn't a positive.
- •Fear is hardwired and easily triggered even when there's no real threat
- •Fear of failure produces flight, shown as avoidance of exams and study
- •These people care too much, not too little
- •Perfect people don't exist and nobody should expect it
- •Work with strengths and weaknesses instead of aiming for equal levels
People Pleasing and Setting Boundaries
Alex links RSD to people pleasing, and Dr. Rackley says you must accept that not everyone will like you without that meaning you are unlikable. He explains the costs of people pleasing and the value of assertive no's.
- •Not being liked by someone doesn't mean you're unlikable
- •Finding your tribe takes time
- •People pleasing is exhausting and loses agency
- •Being assertive means saying no and being okay with it
- •Boredom and impulsivity can lead to saying yes inappropriately
Biggest Problem Traits and the Long Effects of School Inadequacy
Asked for the three ADHD traits that cause the most trouble if unmanaged, Dr. Rackley names emotional dysregulation, impulsivity control, and sleep. He then describes how feeling inadequate at school can shrink a person's world later in life.
- •Emotional dysregulation, impulsivity control, and sleep are his three picks
- •Sleep deprivation is used to torture people because it wrecks you
- •Feeling inadequate at school lowers self-esteem and risk-taking
- •People may avoid jobs, dates, and challenges, limiting their opportunities
How Schools Handle ADHD and Whether School Is Designed Around It
Dr. Rackley, without naming schools, contrasts schools with dedicated learning support to those that don't invest and want to move on disruptive pupils. He says traditional school doesn't work for everyone and ADHD pupils thrive on praise and reward.
- •Some schools resource neurodiversity well with trained staff and learning support centers
- •Others label pupils as disruptive and want to move them along
- •Without embedded services, a doctor's letter may not be acted on
- •Traditional teaching suits some learners only
- •Lead with praise and reward, not punishment
Closing Advice on Anger After Late Diagnosis
Alex asks for closing words for late-diagnosed listeners in the grip of anger. Dr. Rackley says the anger is valid but should be channeled healthily, and that anger can mask other primary emotions that therapy can help identify.
- •Anger is valid but holds energy and hyperarouses the body
- •Healthy outlets include exercise, sport, and therapy
- •Alex describes late-diagnosis anger as grief, sadness, and anger together
- •Anger can be a secondary emotion covering disappointment, shame, or sadness
- •Identifying emotions starts with self-awareness; therapy can help
Publisher timestamps
- 0:00Trailer
- 1:26If a new patient were to come into your surgery, where would you start?Read this chapter
- 4:14ADHD shame can lead to not wanting to share inadequacies, what is the hidden cost of repressing emotion?
- 7:19What is happening in our brains when we experience RSD?Read this chapter
- 9:11Is there a difference between how men and women deal with feeling inadequate through the school years?
- 10:44How can emotional dysregulation manifest itself in a person who is undiagnosed?Read this chapter
- 16:34A girl with undiagnosed ADHD, what might her struggles be in pre-pubescence, vs adolescence and then young adulthood?
- 19:46And a boy with undiagnosed ADHD, what might his struggles be in pre-pubescence, vs adolescence and then young adulthood?Read this chapter
- 21:06Do you think it's beneficial to have an ADHD diagnosis if someone is exhibiting characteristics of ADHD?Read this chapter
- 23:18What reaction would you commonly see for someone who has had a diagnosis later in life?
- 25:47Do you think there's an evolutionary reason that we as ADHDers overthink?Read this chapter
- 27:22Is there a benefit to overthinking which no longer exists and otherthinking is a hangover of human nature?Read this chapter
- 30:473 tips to help a busy ADHD mind fall asleepRead this chapter
- 35:48How to manage your intrusive thoughtsRead this chapter
- 39:57Washing machine of woesRead this chapter
- 43:09The link between ADHD and perfectionismRead this chapter
- 46:32How to assert boundaries and stop people pleasingRead this chapter
- 51:17What are 3 major traits someone with ADHD has trouble controlling that negatively affect their lives?Read this chapter from 51:18
- 52:01How do you think feeling inadequate at school can affect people in their later life?
- 52:53We spoke previously and you mentioned how some schools are really well versed in ADHD and others aren't. Where are the schools who are not so good at dealing with ADHD going wrong?
