The Psychiatrist Who Discovered RSD: "RSD Dies When You Do THIS!" | Dr. William (Bill) Dodson

1. 0:00 – 0:54

   Intro

   1. APAlex Partridge0:00

      This for me is very surreal. It's not every day I get to speak to somebody who coined one of the most used, recognizable, yet I think painful acronyms in ADHD history. ADHD royalty, I truly believe you are.

   2. WDDr. William Dodson0:18

      [laughs]

   3. APAlex Partridge0:19

      [laughs] I was saying, um, just before we started, I got my diagnosis two and a half years ago, and, and your work was, was, was one of the first I dived into. So on a personal note, thank you ever so much.

   4. WDDr. William Dodson0:30

      Ah, my pleasure. Thank you.

   5. APAlex Partridge0:33

      Let's start off, Bill, with a simple but probably not an easy question about rejection sensitivity dysphoria, and I'll refer to it as RSD from this point on. Um, and then perhaps we'll build up to some more advanced and specific details about RSD.

   6. WDDr. William Dodson0:52

      Sure.

   7. APAlex Partridge0:52

      But to start with,

2. 0:54 – 7:11

   What is RSD and how people experience it

   1. APAlex Partridge0:54

      what is RSD and how is it experienced?

   2. WDDr. William Dodson0:59

      RSD is a phenomenon that I first noticed because I'm a practitioner, I'm not a researcher. And so when you sit with 1,000 people, and you hear the same thing coming from every single one of them, you may not know that it's important-- I mean, what it is, but you know that it's important. And so, um, I, I have to give all the credit to my patients because they were the ones who described it to me. And what RSD is, is an exquisite sensitivity to the perception, doesn't have to be real, the perception that someone has withdrawn their love, approval, or respect. And I mean, nobody likes being criticized. Nobody likes being rejected. But for people who have an ADHD-style nervous system, it is catastrophic. In fact, that's why the, the name of it includes the word dysphoria, which is literally Greek for unbearable. And so it's, it's like sort of, uh, other people's experience of rejection, only it is suddenly hit. It goes from zero to 100 in the blink of an eye. It's incredibly painful. It's physically painful. You'll see people clutch their chest or hunch over or grimace because it, it's not just emotionally painful, uh, it's physically painful as well. Uh, one of the other odd features of it is that people cannot describe what the pain is like. Uh, it's, it's wordless. I always think of it as having been so primitive it came before there were words. But people can describe the intensity of it. That's why they use words like it's awful, it's terrible, unbearable, catastrophic, overwhelming. Uh, and the person can't just keep going. It knocks them to their knees instantaneously. And so that's one of the problems is that it hits so suddenly, so completely that most people can't see it happening in advance and bring up all the stuff that they learned in cognitive behavioral treatment or dialectical behavioral treatment. You just get slammed with it. Um, people report feeling totally cut off from their surroundings, totally cut off from everybody else, just a profound loneliness. Uh, and it's that they've been cast out from everybody, every place that they know. They feel totally bereft. I mean, it's an awful, awful feeling. Uh, it then will continue an unknown period of time. It can be minutes, it can be days. Uh, but during that time, uh, there's really nothing much that you can do. You just have to let it run its course. Uh, one of the most important things I've found that people need to know up front is that it will end. Most people, when they're in an episode of RSD, uh, have the conscious fear, "This is never going to end. I'm going to be in torment forever." So letting people know that every time it does come to an end, you will survive it. It's just extremely unpleasant. Uh, whether or not it's only seen in ADHD is unknown. Now, we did some research last year. We're turning the numbers on to try and answer that question. So talk to me in six months, I'll be able to give you at least the preliminary of the results. Um, but for right now, in my own practice, uh, when I ask sort of a screening question for RSD, somewhere around 90% to 95% of people say, "Oh my God, yes. You've been following me around my entire life." It's not, "Well, I don't know." It's, "Wow." Um, and about half of the people who say no come back later and say, "Well, yeah, I sort of lied to you. I-- It just caught me by surprise, and I panicked and masked it," and all that. The screening question that I use in my practice for the last 15 years is look back over your entire life. Judge up all the memories you can. Have you always been much more sensitive than other people you know to rejection, teasing, criticism, or your own perception that you've failed or fallen short? The vast majority of people with ADHD identify with that strongly.Uh, and I was actually surprised just how strongly, um, after the first time I actually put something on the internet, um, there were within six months more than 100 sites on Instagram talking about it. Uh, there were chat groups on Reddit. Uh, in fact, uh, the one on Reddit received more involvement and comments and things like that than any other topic in ADHD in their history. So I was-- I, even I was surprised at how many people identified with it, uh, worldwide. I mean, I get-

   3. APAlex Partridge6:41

      I mean-

   4. WDDr. William Dodson6:41

      ... literally from around the world.

   5. APAlex Partridge6:44

      You've perfectly described the debilitating feeling that comes with RSD, and I think everyone listening or watching will relate to that. Um, I, when I see someone who has dedicated so much of their career towards a particular topic, I always question and wonder where that passion and motivation comes from. So why

3. 7:11 – 12:55

   Why did you coin the phrase ‘RSD’

   1. APAlex Partridge7:11

      did you coin the phrase RSD? Where, where did that interest start for you?

   2. WDDr. William Dodson7:16

      Well, at the very beginning, uh, when I was listening to people, uh, I recognized that what they were describing was something from way back in my own training, um, that was called rejection sensitivity dysphoria, and at the time, it was a part of the very first research on treatment-resistant depression. In fact, it was the hallmark symptom of treatment-resistant depression. And the treatment of choice then and now were the monoamine oxidase inhibitor antidepressants, anti-anxiety medications, which by the way, work beautifully for ADHD as well. Uh, and so as I said a minute, that's what Paul Wender was describing. Uh, and because, um, the current state of affairs in ADHD, uh, had been allowed to languish for so long, and they lacked so much, um, back, you know, fifteen, twenty years ago, I went back and started over again from the beginning, and that's the work of Paul Wender and Frederick Reimer, who originally described, uh, the syndrome. And they described it very much the same way I approach RSD. Uh, they were psychiatrists in Salt Lake City, Utah, who sat with thousands of hyperactive children and write, wrote down the patterns that they saw. And that's how we got our first diagnostic criteria. They w- it was called the Wender-Reimer criteria, then the Utah criteria, and finally it, um, went into the DSM-II, uh, and it replaced, uh, minimal brain dysfunction.

   3. APAlex Partridge9:05

      Bill, do you think that following on from that, are people with ADHD, are they born more sensitive to rejection, or is it a consequence of exposure to nasty comments?

   4. WDDr. William Dodson9:19

      The answer is yes. [chuckles] It's both. Um, A- ADHD itself is a genetic, biologic, neurologic condition. You're born with it. You'll die with it. It's lifelong. It's how you're wired. And that, that statement is always one of the big disappointments for most of my patients who hope that someday it's gonna go away, and they're going to be neurotypical. Doesn't happen. Uh, on your 18th birthday, they don't give you a nice wrapped-up present. "Oh, goodie. Just what I always wanted, a new nervous system." It doesn't happen.

   5. APAlex Partridge9:55

      [laughs]

   6. WDDr. William Dodson9:57

      So it's, you know, you're there, deal with it. So, um, it, it is genetic, and you can also tell because it responds so well to two different classes of medication. Um, so in, in psychiatry, in the medications of psychiatry, we generally sort of lump them into two groups. Uh, one are the neurologic, biologic predispositions to certain conditions. These are all the big names in, uh, in the diagnostic criteria. But there's another large group that comes from what happened to you. You're just an average person, and you have adverse events, head injuries, uh, brain infections, uh, and of course, the big one, PTSD. Now, it's the average person's response to either a catas- one catastrophic emotional experience or thousands of them repeated for lifelong, and that, that really is what categorizes people with ADHD. Um, uh, Delane, uh, who was at the time the chairman of child psychiatry at Harvard, wrote a paper where he estimated that the average third-grader, so starting at eight to nine years old, has already heard twenty thousand additional negative or corrective messages by the third grade. I don't care who you are, but if you have twenty thousand messages saying, "Sit down. Stop that. Stop fidgeting. What's wrong with you? You're too intense." Basically just, just rapid fire, "You're not okay. You're not acceptable the way you are, and you better change in a hurry." Which of course they can't do. Set 'em up for failure. Uh, a guy named McConney, uh, has-- published extensively on the power, the necessity of having friendships, that you're not going through life alone.Being alone is traumatic, tremendously traumatic in and of itself. McConney published a study, again, on third graders with ADHD, and he found that 70% of these children did not have a friend, not a single friend. That's even more damaging. When mothers cry in my office, it's not because their kid's flunking math. They'll fix that. They cry because their child has never been asked to a birthday party, never been asked to a play date, and they live a life of being ostracized. Most of my patients, by the time they got to high school, had self-segregated into a group of other ADHD people where they keep themselves.

4. 12:55 – 19:05

   Is RSD a lonely experience

   1. APAlex Partridge12:55

      Can it be a lonely experience, Bill? Because if you're exposed to 20,000 extra negative comments, I suppose you quickly understand or realize that the problem to that solution, the solution to that problem is to change who you are-

   2. WDDr. William Dodson13:13

      Yeah

   3. APAlex Partridge13:13

      ... and to hide the version of you that is getting all of those negative criticisms.

   4. WDDr. William Dodson13:17

      Absolutely.

   5. APAlex Partridge13:18

      So if there is a disconnect over time, therefore, after perhaps years of masking between the version of you that is being presented to the world and the version of you that's hiding inside, can that make that inner version of you quite lonely?

   6. WDDr. William Dodson13:35

      Oh, exceedingly lonely. Okay, that's accurate. You are alone. And worse than that, people have demanded from you that you find a solution for something that has no solution. They basically say, "Be neurotypical." People with ADHD, let me tell you, try all day, every day, their entire lives, and never attain that. So they go through life with a false front out of a belief that what I actually genuinely, authentically am is unacceptable to anyone. And the big thing that comes out of that is massive shame, shame about who I am. And that's the source of a lot of the incredibly hostile self-talk that a lot of people have going on in their heads all day long.

   7. APAlex Partridge14:32

      When I speak to people who experience RSD, they have told me that in the past, heartbreakingly, people close to them have accused them of making mountains out of molehills.

   8. WDDr. William Dodson14:45

      Mm-hmm.

   9. APAlex Partridge14:46

      And when they've tried to explain that their intense emotional responses are RSD, it gets dismissed. Do you think this cycle of perhaps someone trying to open up about it and them getting met with a dismissal only perpetuates that shame?

   10. WDDr. William Dodson15:05

       Oh, absolutely. Multiplies it. The other place that that happens is at least as worse, if not worse, is when they go to their clinician, who probably has not read a word, had never heard the term, and they come in and said, and here's the thing that gets them in trouble, "I read on the internet about this condition. It's part of ADHD, and I've got it in spades." And they then describe RSD. As far as I can tell, most of the time, clinicians will go, "You're just exaggerating. Don't get anything from Dr. Google, and especially don't get anything from TikTok. Let's move on." And again, that's because a lot of physicians are clods. Here's a person who just walked in, told you that they have found something in their life that's deeply meaningful, and then for them immediately to discount it. You might as well just stab them in the chest and wave goodbye to that therapy ever being really an alliance. They have proven themselves are not worthy of being trusted with their own emotions. To go back to what you said, I don't really see it as that much of an exaggeration. I don't see it as a flaw. People with ADHD are very intense, passionate people. Now, if they don't care about something, it's just not in their lives. So everything that's left are things that they care deeply about. And so their highs are high, their lows are lower, and so they always go through life at a setting of about 10 out of 10. So that if something else major suddenly hits them out of the blue, they've got no reserve. And so it's layered on top of what a neurotypical person would describe as a really stressful day. People with ADHD have a really stressful day all day, every day. And so it's that layering on top. They don't have any capacity to deal with it. It just, boom, overwhelms them. They can't prepare for it because they don't see it coming. And even if they did, I haven't found anything in my patients other than medication that would prevent it. So yeah, people with ADHD go through wearing a mask to the world. And the bottom line is who and what I am is unwanted. And sometimes it goes beyond that. I'm bad. I'm terrible. I'm worthless. You can just really go down the rat hole.

   11. APAlex Partridge18:08

       I, I totally agree. People with ADHD certainly go through life wearing a mask, and sometimes when they are triggered by RSD, they can s- perhaps snap. It can come out as intense sadness or rage sometimes.

   12. WDDr. William Dodson18:25

       Mm-hmm.

   13. APAlex Partridge18:25

       And the people I've spoken to on my podcast have, have-- actually, many of them have said that they've been labeled as Dr. Jekyll and Mr. Hyde.

   14. WDDr. William Dodson18:33

       Yes.

   15. APAlex Partridge18:33

       Because the version that their friends, family perhaps are used to, or their colleagues, is this masked version of themselves, and then someone says something, a tiny comment, or they're criticized-

   16. WDDr. William Dodson18:45

       Boom

   17. APAlex Partridge18:45

       ... and boom, this explosion and this new side comes, and this new side of them comes out that no one's seen before, and it can be quite shocking the difference in presentation between the triggered version versus their masked version. The, the, the triggered

5. 19:05 – 22:26

   Is RSD your inner child throwing a tantrum

   1. APAlex Partridge19:05

      version that perhaps could present as bursting into tears or internalizing it or externalizing it, perhaps in a huge row in the office or with your r- partner. Is that the inner child almost trying to scream out in frustration, almost annoyed that they've been seen, and the effort that they've put into masking has gone to waste in that moment?

   2. WDDr. William Dodson19:33

      Yeah, I mean, it's, it's experienced as a rejection. I have tried so hard, so long, with everything I have, only to be told it's wrong, it's unacceptable. It just-- it's immediately cast aside without any appreciation of how hard people with ADHD work, um, just to get through life. Um, so again, the, uh, I would draw a distinction between this approach, where you see people with ADHD as being good, normal, intact people who are dealing with something that's just extraordinarily strong, and the way that people who are devotees of executive function deficit view it. Um, I think one of the reasons why executive function deficit theory has failed so completely is that its basic premise is wrong. Uh, executive function folks, uh, view people with ADHD as really just being neurotypical people, but they're damaged, they're deficit, they're broken, and they need to be fixed. And they seem to have absolutely no awareness at all of how hostile [chuckles] and off-putting that is to people with ADHD. And the fact that, um, again, in al- in all their studies, less than fifty percent of people have an executive function deficit, and yet they want to explain ADHD strictly in terms of executive function deficits. Can't do that if more than half don't have them. The other thing is, all the therapies that they've tried have failed to show, and here's the standard, any detectable lasting benefit to the core features of ADHD. It just hasn't worked at all. So that's why over, again, I'm a therapist. I work with people. Uh, I tend to see them as good people who are dealing with something that nobody's given them any instruction at all about how to deal with it. Uh, if, if you get any ideas, it's from other people with ADHD who have written books, written articles about what the experience is. If you look at all the useful stuff that you've probably looked at, it wasn't scientific papers. It was other people who got it, who really understood, uh, who really understood what you were going through and accepted you just as you are. You're not broken. You're not deficit. You're a hardworking person doing the best they can.

   3. APAlex Partridge22:17

      I think it's such a, an emotional condition, so much more so than the medical community, I still think, give credit for. Um,

6. 22:26 – 28:22

   The link between emotional dysregulation and RSD

   1. APAlex Partridge22:26

      is emotional dysregulation, is that part of the RSD conversation?

   2. WDDr. William Dodson22:31

      Oh, yeah. Um, again, I have to go back and lay a little historical groundwork. When you're doing, uh, research that you hope has a chance of being published because your job depends on it being published, you can only use things which you can see, count, which are always there, and that you can do statistical analysis on so you can get your paper published. ADHD has none of those things. Um, after the hyperactivity dims in early adolescence and goes inside as hyperarousal, it's almost entirely an internal experience that indeed people can and do mask. It also isn't consistent. Now, just about everybody with ADHD, when the situation's just right, can flip and become totally engaged with what they're doing, hyperfocus, flow state, whatever you want to call it. And when they do, they don't have any, uh, problems. They have no deficits. Um, so again, ADHD is not a damaged brain. It's just what matters is the situation that the person's in. That's what determines whether or not they're off in la-la land or in a hyperfocus. So again, it's not the people, like with people, uh, people with ADHD have bad brains. It's that they have a different brain, a second nervous system. Works perfectly well.Just by a totally different set of rules, techniques, methods, et cetera. Again, one of the questions I ask every patient is, "Look back over your entire life, dredge up all the memories you can, because this has to be lifelong. If you've been able to get engaged and stay engaged with literally any task of your life, have you ever found anything you couldn't do?" I like the listeners sort of jawing now, think back over their lives. Thus far, everybody I've asked that question to who has an ADHD nervous system will say, "You know what? No, I, if, if I can ever get engaged and stick with it, I've never found anything I couldn't do." Now, that shoots executive function deficit theory right out the window. People with ADHD are not deficit. They can do anything if, if the situation's right. And that's what rejection sensitivity is, is, is something outside. Now, something they perceive as being a threat, a trigger, now that somebody's going to withdraw their love or approval or respect, they have a catastro- they're hardwired, in my belief, to have a catastrophic reaction, which is the groundwork is already laid from having hundreds of thousands of rejections, corrections, demands that you change. "I don't want you the way you are." Uh, and also, you know, despite having very high IQs, struggling with school, struggling with jobs, knowing from those times when you do get engaged that your brain is capable of remarkable things if you can get access to them. That's the problem with ADHD, is the traditional ways that everybody's taught that neurotypical people get engaged and get motivated don't work at all for people with ADHD. You know, neurotypical people use importance and rewards. What do I get out of this? You know, ask somebody with ADHD, look back over your entire life, dredge up all the memories you can. Can you remember a single time, even once, in which the importance of the task all by itself ever once helped you? Helped you get engaged, overcome procrastination, get access to your ability, stick with it all the way to the payoff? Or has importance been nothing but a nag? Just about everybody will go, "Oh God, it's nothing but a nag. I just hate it. I know it's important, but I can't get started." So again, that's, that's the background on which RSD is layered. Um, good people, incredibly bright people. The average IQ of a person with ADHD is 123. That's all the IQ you need to do anything. You can get a doctoral degree without breaking a sweat. Trouble is they don't have acce- access to it on demand. And so it's that lifetime of frustration, knowing that you can do better and not being able to do it. And you layer on top of that a neurologic, catastrophic emotional response, and it's a witch's brew. Um, you know, it just really gets ugly and heartbreaking.

   3. APAlex Partridge27:45

      It's fascinating. I, I truly s- agree with you. ADHD is not a deficit of attention. I think when someone with ADHD finds something that truly aligns with who they really are and what they actually-

   4. WDDr. William Dodson27:59

      Mm-hmm

   5. APAlex Partridge27:59

      ... care about, they don't have a deficit of attention, despite what the name wants you to believe.

   6. WDDr. William Dodson28:05

      Um-

   7. APAlex Partridge28:05

      They have an abundance of attention. Um, RSD often stops people, I feel, from starting stuff though, from, from sort of opening that door and putting a foot forward th- because of this horrible fear of-

   8. WDDr. William Dodson28:21

      Absolutely

   9. APAlex Partridge28:21

      ... criticism.

7. 28:22 – 34:59

   The darkest side of RSD

   1. APAlex Partridge28:22

      From your experience, Bill, at its absolute worst, what can RSD look like in a person with ADHD?

   2. WDDr. William Dodson28:32

      Since RSD is usually not there, other people don't understand it. They don't know what's happening inside you. And even when you explain it, they don't listen. They compare it to their own experience, and it doesn't match, and they discard it. Uh, ADHD is always there, unabated, and so people do everything they can to avoid the occasion of either disapproval or another-- This is where the s- last feature comes in. Your own perception that you've failed or fallen short because ADHD sets you up to do that pretty much all the time. So, uh, the pattern that I've seen is it has a profound effect upon the development of personality. Personality is that set of problem-solving abilities that a person has that when they're presented with stress or a task in life, it's what do they have to do to contend with that, solve it, master it, et cetera. And everybody has a different set, and that's how we know who they are. You know, somebody who's mild-mannered and very thoughtful y- has an externalization of RSD and a rage at the person or situation that wounded them so severely. People said, "Oh, Fred, I, I didn't-- It, it wasn't you. I didn't recognize you." So personality is who we are. It's t- technical terms in, in literary is, it's the mark of the man or mark of the woman, mark of the child, whatever.And so people deal with it in three ways. Some people just decide to quit. Um, they're not going to start anything new, anything challenging, unless they're absolutely assured upfront of quick, easy, complete success. If they don't have that, they don't start. And so I have dozens and dozens of people that I've worked with who have never asked somebody on a date, never applied for a job. Uh, they're grossly underemployed. Uh, and it's because just the imagination of asking somebody and being rejected, being turned down, just the thought of it is so devastating. They say, "No, thanks. I want no part of that. You can go on yourself. I'm gonna stay here." And so they basically live pretty much meaningless lives and lonely lives 'cause they can't ask somebody out for a date. Another, probably the most frequent one, is what I call people, people pleaser. Um, people learn to scan the room. They can read the room faster and better than anybody else. A stranger can walk in, and in a matter of seconds, they can tell you what that person likes, approves of, praises, rewards, and that's what they give them. They're constantly anticipating the needs of everybody else around them and fulfilling that need before the person's even aware of it. And this gets so pervasive that they lose track of what they wanted in their lives. It's, it's just not fair to ask them, "What do you want?" They, you know, "I, I want everybody to be happy." I don't... It always is, "I want other people to be happy so that they don't get unhappy with me." Um, and when somebody gets on medication for RSD, and it's essentially gone, all of a sudden they don't have to do this anymore. And when they say, "When is it my turn [chuckles] for other people to meet my needs?" And they don't, oh, the rage from that is six months in therapy. Um, the other very common one is perfectionism. Um, "I'm gonna be so good, an overachiever. I'm gonna do the very best. Nobody's better. And most of all, I'm going to be above reproach. Nobody can find anything wrong with me." It's a trap because you have to keep doing it all the time. Today's audience does not applaud yesterday's performance, and it's that your acceptance, they believe, is entirely conditional. You slip up once, you're out. Um, and so, um, it, it's a very, very hard life, and you thought it was somebody with a mask. Perfectionists live in a mask.

   3. APAlex Partridge33:16

      I feel like though there's three consequences you've described there of RSD or going through life tiptoeing around the possibility of feeling the pain that comes with it. It's avoidance.

   4. WDDr. William Dodson33:28

      Yeah.

   5. APAlex Partridge33:29

      You just don't put yourself out there. It feels safer to stay indoors and not bother because there- therefore you can't experience any criticism. Perfectionism, how can anybody criticize me if I stay up all night or I stay in the office four hours later than everyone else and do the work to such a high standard that it's completely bulletproof from criticisms-

   6. WDDr. William Dodson33:51

      Right

   7. APAlex Partridge33:51

      ... or-

   8. WDDr. William Dodson33:51

      People don't see what it takes for people with ADHD to get by. You know the old saying, "People with ADHD have to work twice as hard for half as much."

   9. APAlex Partridge34:01

      Mm-hmm.

   10. WDDr. William Dodson34:02

       And they're willing to.

   11. APAlex Partridge34:04

       What do you think, Bill, the toll is on someone if they go through years of their life people-pleasing?

   12. WDDr. William Dodson34:13

       Um, they really don't know themselves. They can tell you all about other people. They're you- they can read other people better than they know themselves 'cause they're, that's what they do all day long. And so when they finally don't need to do that, um, there's a huge emptiness. You know, first of all, they mourn their life to that point. "What would my life have been like if I had only known, and if I'd, my parents had only done something back when I was eight?" And so there's a real mourning of that. Um, usually it lasts six to eight weeks, something like that, into a reactive grieving.

8. 34:59 – 37:01

   Dealing with regrets after an ADHD diagnosis

   1. WDDr. William Dodson35:00

      And then most people flip very suddenly, and again, people accuse them of being bipolar, to where they say, you know, "I regret my life to this point, and henceforth I'm going to lead a life without regret. I'm gonna do everything I want. Time's wasting. I'm going to lead the fullest life imaginable." And so with treatment, and you get rid of having to contend with RSD, um, it frees people up tremendously, um, to do what they always wanted to do. Now, most people, I'd say three out of four people, really don't know what they desire. They have no idea. They're forth to-do. And so for those folks, I flip it around and ask them, "What do you regret?" Um, have them do a guided affective imagery. Imagine yourself, you're 85 years old, sitting on the front porch in a rocking chair with a lifelong friend, and he starts the following sentence, "You know, knowing all that I know now at the end of my life-"If I were to have led my life without a single regret, I wish back in 2025 I had... And you finish the sentence. Most people don't know what they want, but everybody knows what they regret. And usually it's not something that they regret that they did, it's or regret that what they didn't do. That when the opportunity was there, they let it pass by. Uh, and that's, that's designed to help people to make that 180-degree turn and get in touch with themselves.

   2. APAlex Partridge36:54

      What do you think some of the biggest regrets are amongst the ADHD/RSD community, uh, if they were to have that conversation?

9. 37:01 – 42:59

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   1. APAlex Partridge37:01

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   2. WDDr. William Dodson38:04

      Probably the biggest one, and the one that's hardest to talk about, is that they never feel truly loved just as they are. They never feel truly chosen. You know, if, if they're married or something like that, they feel that their partner chose the mask because they never showed them the genuine person underneath. And so it means that they have to go back now that they have accepted themselves as having a second type of nervous system and dealing with all that that means. I mean, we are our nervous system. Neurology is destiny. They have to go back and reevaluate everything and re-understand their own lives with that important piece of information. Um, and so that's probably the biggest thing, is they're not sure if they've ever been loved. Now, they might have been, but they know that what the person saw was not truly them. I think that's probably the biggest.

   3. APAlex Partridge39:15

      It's the-- It certainly sounds like it, and it's heartbreaking. It's totally-

   4. WDDr. William Dodson39:19

      It is

   5. APAlex Partridge39:19

      ... heartbreaking. Um, I feel like-

   6. WDDr. William Dodson39:20

      And it's, it's one of the impoundments of ADHD that nobody talks about. Um, or it should. Nobody in science, medicine, you know, book writers and stuff like that, you know, they're sticking to the things that they can see and research and stuff like that, and not the stuff that's really important to people. Uh, not to, it's not important to people's lives.

   7. APAlex Partridge39:43

      Many people having that conversation when they are 85 with a lifelong friend, Bill, I'm sure many will have conversations saying similar of, "I was called too sensitive throughout my life."

   8. WDDr. William Dodson39:57

      Mm-hmm.

   9. APAlex Partridge39:57

      And I'm sure lots of the audience have been called that. Why do you think being too sensitive is seen as a negative thing?

   10. WDDr. William Dodson40:06

       Well, start with the flip. Um, think back to high school. Who are the popular people in high school? Uh, they weren't the smartest. Often they weren't the prettiest. They weren't the most accomplished. It was the kid who was confident. A, seemed like he, he or she looked like they knew all the answers to life problems, which of course in high school, nobody feels that way. But it's so attractive to find somebody. It gives them hope. You know, if you're around them, maybe it'll rub off on me. Um, again, it's that self-possessed confidence. So the flip side of being just totally knocked off your feet, helpless, not being able to even crawl out of it, um, um, being thought of as childish, immature, um, deficit, fractured, um, is the exact opposite. People avoid that. I mean, why do, um, third graders have no friends? One reason, because of their emotional explosions. Nobody, no other kid wants to be around that. They can put up with the impulsivity, blurting things out, um, you know, not being able to assist. They can, they can put up with that. If the emotional flooding, uh, that hits kids with ADHD, it ends up having them ostracized. Consequently, you know, whenever I have a parent that said, "Oh, I don't want to put my kid on medication," I say, "Look, [laughs] you know, your kid is already suffering. You just haven't talked to him about it. You didn't know to ask him." I say, "Now, one of you partners has ADHD. It has to, I mean, it's genetic. At least one parent has ADHD. Go and talk to them about what it was really like growing up, and then come back and tell me that you don't want to give your kid some protection from that." Um, you know, people say, "Oh, I don't want my kid labeled." Your kid is already labeled as that ADHD kid, that kid who's out of control, that kid who's obnoxious and disruptive. He's already labeled.You know, help them. And withholding treatment or withholding recognition of what's going on and withholding your educated help is what's damaging them. You know, there's nothing more damaging in the end than being given a lifetime problem that nobody's taught you how to handle, and somebody leaves you alone with it. That's where damage occurs. That's where despair occurs.

   11. APAlex Partridge42:56

       At that young age or any age with

10. 42:59 – 45:16

    RSD is women VS men

    1. APAlex Partridge42:59

       RSD, do you notice a difference in how it presents th-throughout the two sexes?

    2. WDDr. William Dodson43:06

       If, if there is a difference, um, all these guys will not talk about it. Uh, but if they internalize it, they see it as a ma-failure of masculinity. What they can tell you about is when they externalize, and males tend to externalize much more than internalize the way women do. And it's ex- it's basically they get slammed, no warning at all, in a white rage at the person or situation that wounded them so severely. Uh, they're, um, loosely associated with a, a business, uh, where the courts m-mandated people for anger management treatment, from domestic violence, from road rage, that sort of thing. And I just asked them, "Do a screening checklist for adult ADHD." And 50%, or almost exactly 50%, had previously unrecognized ADHD and RSD. I mean, that's the impact it's having. 50% of domestic violence, 50% of road rage, um, could have been prevented with proper treat- recognition and proper treatment. So y- these things have their fingers everywhere in life. Uh, no-nothing remains un-unchecked. So again, it's, it's the domestic couple where one of them, when they perceive disapproval in the other person's face, just either collapse or explode. And it passes. They're humiliated by it. They apologize for it. "I'll never let that happen again." And of course, the first time they imagine they see disapproval in the other's face, bam, it happens again because they don't have control of it. It's not a matter of willpower. And other-- And the other thing is people don't see it coming. They can't prepare for it. They can't pull together all the things that they've learned to deal with strong emotions. Boom, they're overwhelmed. They're done for.

11. 45:16 – 47:18

    How long an RSD trigger lasts

    1. APAlex Partridge45:17

       How long do you think an episode of RSD lasts within a person? Uh, from that point of unpredictable trigger, explosive rage, sadness, from that point, how long do you think it takes until they're completely over it?

    2. WDDr. William Dodson45:29

       Well, if you're really lucky, 20 minutes is what, what I hear from my patients. More typical is a couple of hours, and usually what the person does is if they can, they find solitude somewhere. I have people just go into the, the broom closet just to get out of people's sight and let it run its course. For some people, it lasts until they go to sleep, and they wake up the next morning, and it's gone. Um, some people it'll last into the next day. I have had people that never came out. I had one woman who, uh, was rejected, uh, on the day that she thought she was going to be married. And when I saw her two years later, she was still in an RSD episode. I mean, she had just suffered agony for two years because, I mean, it's, it's one of these things where she had a clear onset. It's not something gradual over time. Bam, it hits. And with her, every time she'd think of what happened, she was back there. Well, again, it's almost like, uh, a flashback in PTSD. Um, I, I in fact, when it happened, I personally saw on the outside, I can't tell the difference. But again, you have to talk to the person. You know, "I don't know what's going on, but you do. Tell me. You know, take that instant and expand it and tell me exactly how it happened." And that's usually very clear. Uh, well, I saw a friend, or I thought of him. I thought of what happened, uh, and just boom, it hit me, and, you know, the pain was just as fresh as it was two years ago.

12. 47:18 – 49:16

    Can RSD be comparable to PTSD

    1. APAlex Partridge47:19

       Can RSD be comparable to PTSD? Can the effect of those 20,000 horrible extra comments in your early years, can they compound and, and to create a similar effect to PTSD?

    2. WDDr. William Dodson47:31

       Absolutely. Yeah. Um, again, just a real splitting of hairs. In my experience, uh, thousands of traumas through your life don't cause ADHD. They make it much worse. Um, again, the two of them together are just dreadful. But again, it's, uh, uh, when you get nothing but that type of feedback, and it hurts. I mean, it'll hurt anybody, but it really hurts you if you have rejection sensitivity. Um, damaging. It can't help but change the person and how they view themselves. Um, and yeah, so this multiple, you know, death by a thousand cuts type of thing, uh, makes it much worse, and people become vigilant.Um, for the possibility that somebody is going to hurt them. And so they tend to over-interpret, over re-respond very benign statements, very constructive criticism, uh, as being devastating. Now, your boss asks, you know, "Can I talk to you in private?" And you don't know the context or anything like that. Everybody with ADHD says, "I'm in deep trouble. I have no idea why," or, "I'm in deep trouble and he's telling me he's firing me. He's again casting me out." And so, you know, it's unpleasant to go through that, but people with ADHD go through it in their head dozens and dozens and dozens of times.

    3. APAlex Partridge49:13

       It sounds totally exhausting.

    4. WDDr. William Dodson49:15

       It-

    5. APAlex Partridge49:15

       And I imagine,

13. 49:16 – 1:04:50

    RSD in romantic relationships

    1. APAlex Partridge49:16

       do you think RSD plays a big part in the breakdown of romantic relationships? And if so-

    2. WDDr. William Dodson49:22

       [laughs]

    3. APAlex Partridge49:22

       ... what might be a good remedy, if there is one, for managing RSD as a romantic couple?

    4. WDDr. William Dodson49:31

       Um, one, nobody likes walking on eggshells constantly, um, because the, the responses can be, "You wounded me with what you said." It's comes back to them as an accusation of your bad. Um, that's not hea- good for any healthy relationship. Um, that means that the other partner all of a sudden has to wear a mask. They can't be authentic. They have to be checking every word, every tone of voice. Uh, and yeah, it loses all the spontaneity, all the gentleness. Um, and again, especially if that person, e- either one of them, has not been told what the hell's going on. Lord knows, you know, this is my crazy ex-girlfriend type of thing. Um, so yeah, it's disruptive. Um, and amazingly, it's also disruptive between the ADHD parent and their children. You know, all, all they've seen in terms of parenting is what happened to them. And so they respond to their kids in exactly the same way, and then hate themselves for it later. Um, so in, in an ideal world, the parent would get the diagnosis, but beyond diagnosis, find out what it really means, 'cause our diagnostic criteria suck. They don't tell you anything about what it's like to live that way. Learn all the implications for their own lives. Get on some medication that helps the majority of people put on what I call emotional armor, and you still see all the potential rejections and things like that going on that went on last week, but now they bounce off without wounding you. And that's tremendously freeing. So then they can turn around and be the parent to their child that they wish they had when they were growing up. It stops that generational pattern of destruction.

    5. APAlex Partridge51:45

       This is really interesting, Bill. I wanna talk about the medication that can potentially help RSD in, in a little bit. You, you said ADHD, you're born with it, you die with it. Is RSD potentially though a concoction of ADHD and some form of PTSD that comes from all of those criticisms?

    6. WDDr. William Dodson52:06

       Uh, a- as I was talking about before, I think it's both. Um, the, that group of conditions in mental health that come from what happens to you, not how you're genetically predisposed, none of those things respond to medication. They've never found a single medication that makes PTSD better. Not a one. They searched, believe me, they searched. The military has been probably foremost in that 'cause they have the most traumatized people. And basically we have nothing. Um, one thing we know is giving benzodiazepines makes it worse. There are a lot of things that make it worse. Now what works for PTSD is trauma-informed psychotherapy, you know, where somebody really gets what it's like to have had multiple repetitive traumas when you're a defenseless child especially. Um, in an ideal world, that trauma-informed therapist would also be ADHD informed as well. Um, because people, uh, I think the, the prevalence of PTSD in the general population is 6%, something like that. Um, in people with ADHD, it's, depending on which study you read, somewhere between 60 and 70%. And for women, very commonly it's intimate partner violence that is so damaging. Again, going back to what effect does this have, um, on a couple. And so it's having to have somebody that really understands you, accepts you just as you are so you can take off that mask, relax, be yourself. What a luxury that is after a lifetime of being on guard. Um, and so, uh, the other things that help, um, um, PTSD in particular are some of the somatic therapies. Um, EMDR is particularly good. Um, so again, it's not medication that helps that. Now, medication has a profound benefit for the majority, not everyone, but the majority of people with ADHD. So to me it's two, it's-Two ingredients in a witch's brew, um, that people with ADHD have to deal with without an instruction book.

    7. APAlex Partridge54:44

       Is there a medication that can help with RSD specifically?

    8. WDDr. William Dodson54:47

       Yes. Um, the-- again, um, uh, I stumbled onto it. Um, and that is there's a, um, second group of medications besides the stimulants. Uh, in fact, it's-- they're called non-stimulants, uh, but really don't have a name to most people. The medical name is they're alpha-2A agonists. Again, a real tongue twister. ADHD seems to attract them. But in the United States and in the United Kingdom, uh, these medications are approved by our, you know, government re-regulatory agencies for the treatment of ADHD. So, I mean, they're well-known, and they came on the market as blood pressure medications in the nineteen sixties. So we've got sixty-five years' worth of experience with these medications, and nothing new is gonna come up and bite us at this late date. Um, they're extremely safe, well-tolerated in blood pressure medications. They've been replaced because we-- better things have come along. Um, and so now, almost exclusively, they're used for the treatment of children and adults with ADHD. And what they do is they, uh, address the hyperactive impulsive components of ADHD. The stimulants handle performance. They, they're really good for distractibility and not so good for, uh, impulsivity, not so good for hyperactivity. And for that, we add in the alpha agonist. Um, again, when I'm thinking about using an alpha agonist, I ask four questions. I-I'm big on questions. You know, first thing I ask is the definition of RSD. And if they have that, that, that's plain. Or I continue. I ask them, "What's your sleep like?" About seventy-five to eighty percent of people say, "Doc, I'm a night owl. When the sun goes down and everyone gets fully dark, everybody's getting ready for bed, I get a burst of energy, and it's the best time of the day. My mood's best, my energy's best, my attention's best, and everybody else is gone, so I'm not being distracted. I can do what I want. And I know that if I get into bed at a reasonable hour, I can't turn my brain and body off to go to sleep. Thoughts that turn my mind jumps from one thing to another. I replay all the humiliations of my life into Technicolor." And that goes on till somewhere between two and four in the morning when they finally do go to sleep or when they try to wake up in the morning, it's out of the sleep of the dead. It's really hard for people with ADHD to wake up, be fully alert, and engage with things until about noon. So the technical term for that is chronic delayed sleep-wake syndrome. You know, anything that takes a whole breath to say is usually a fairly simple concept. Um, and that is people with ADHD want to sleep a nice normal eight-hour sleep phase is they wanna do it from four AM till noon. Trouble is there are very few schools, jobs, or relationships tolerate that. And, again, the paradoxical thing is it goes away when you treat the ADHD. And it also prevents people from going to other things to treat their insomnia, marijuana, alcohol, barbiturates, that sort of thing. S- a third question I ask is, "Look at how you think. How many simultaneous, simultaneous, but completely separate thoughts do you have going on in your head at any one time?" Most people go, "Oh, at least a dozen." I-I've never heard anything less than three. Um, and again, it's not they're jumping one thing to another. They have three things they're thinking about at the same time. Again, it's like being in a room and having, you know, three to five people talking to you on different subjects at the same time, demanding that you listen to them and to respond. It's maddening. Um, the alpha agonists when they work reduce that to one thought, and it's the thought that you want. Last question I ask is, "Can you remember a period of time, anytime in your life, longer than about five minutes, and not drug-induced back in your wild and wooly youth, in which you have been both mentally and physically at peace?" Now, peace is not a very scientific word, but it's the right one. Uh, most people say, "No, my brain is always going. It never lets up." Um, some people do report that when they're alone in nature, then their mind shuts down. They have one thought at a time. They are peaceful. But otherwise, peace is a w- fairly rare experience for most people with ADHD. So those four things get much better. In fact, almost cured it with the alpha agonist. Uh, the problem with the alpha agonist, um, is that most docs, even in mental health, don't even know they're there, uh, much less how to use them. Second thing is, is the individual response rate to any one of those medications is disappointingly low at about thirty percent. So if you took a hundred people, you started them on whichever alpha agonist I was feeling lucky with that day, thirty percent of people would have a life-changing experience. But seventy percent, the majority would go, "What was that?" At that point, you stop the first one, you try the other one, and there's another different thirty percent of people who will get that, "Oh, wow, where have you been all my life? This is, this is what I should be doing. I get more benefit out of this than I do the stimulant."Unfortunately, that's still at least 40% who try most medications sequentially, um, and unfortunately don't get much benefit. Uh, if a person is really, really impaired by their rejection sensitivity, I mean, they're not getting on with their life, uh, I will try the, um, the old medications from back in the '60s, uh, the monoamine oxidase inhibitors. Uh, they work great. In fact, work better than the alpha agonists. They're just a royal pain to use, and you have to be as old as I am to have ever been trained on them. Um, but they're still the very best antidepressants, very best anti-anxiety medications that have ever come on the market. It's just they're a pain. They're difficult. And-

    9. APAlex Partridge1:01:31

       Why, why are they difficult?

    10. WDDr. William Dodson1:01:33

        Um, two, two reasons. Uh, one is that, um, originally, um, foods that were aged rather than cooked had an amino acid called tyramine that came from the aging process that usually the body destroys as soon as it's absorbed in the gut, and it's destroyed by an enzyme called monoamine oxidase. Well, as you inhibit that enzyme, it gets in. First thing the body does with it is turns it into adrenaline, and all of a sudden you have these huge blood pressure, um, spikes. And several people in Europe, uh, there's a reason why just in Europe, um, had strokes and died. Scared the bejesus out of people 'cause they didn't know why it was happening. Um, now we know that it's tyramine, and that if a person eats a balanced diet, they don't excessively eat, you know, really expensive cheese or something like that, they don't have to make a difference in change in their diet. Um, perfectly safe. Uh, the other one is that, um, the MAOIs, uh, are fairly strongly serotonergic. They really boost the serotonin side. That's part of why they work as, as well as antidepressants. But if you add that in on other drugs that are really boosting serotonin, such as the SSRIs, SNRIs, um, dextromethorphan, which is the most common cough syrup, th- there's a list, um, you risk getting into what's called serotonin syndrome, where basically your muscles just lock up. You're stiff as a board, disoriented, sweating, blood pressure bounces all over the place, and again, there have been deaths reported. Well, usually when you tell people there have been deaths reported, that's the end of it, and they go, "I don't want this." Um, but, um, when you use them, um, m- most of that 40% gets an even better response, and ultimately you can get close to everybody having some sort of, um, uh, relief from RSD. The group of m- medications that really then become a problem is you can't take any of the stimulants with it. Um, so, but luckily one of them, a drug called tranylcypromine, is only one atom different from amphetamine, uh, and it works very well for the treatment of, uh, of ADHD. In fact, there was a study way back by a guy named Alan Zametkin, who was a really big name back when I was in my residency, where he looked at monoamine oxidase inhibitors versus amphetamine and found that they worked equally well. So, but again, you have to find somebody who's really deep into treating ADHD well, and I can name those people on the fingers of one hand.

    11. APAlex Partridge1:04:35

        I want to expand on something fascinating you said earlier, Bill. You said that RSD can cause people to avoid other people or avoid putting themselves forward because of that fear of criticism.

    12. WDDr. William Dodson1:04:49

        Mm-hmm.

14. 1:04:50 – 1:07:25

    Can RSD cause agoraphobia or OCD

    1. APAlex Partridge1:04:50

       And the expansion is can that avoidance associated with RSD, can that cause things like agoraphobia or OCD?

    2. WDDr. William Dodson1:04:58

       It can be missed for that. Uh, not so much OCD, but certainly agoraphobia and especially social anxiety disorder. Um, social anxiety disorder is an intense anticipatory... So much for turning off my phone. [chuckles] Um, social anxiety disorder is an intense anticipatory fear before the event that I'm either going to say or do something that's going to humiliate me in front of other people. And even if I perform perfectly, everybody's gonna be scrutinizing me, just waiting for me to make a mistake, and then they'll jump me. Now, when they get into the situation, most of that anxiety goes away. It's always before the event. So you can see how that fear of rejection, fear of humiliation, et cetera, could be mistaken for RSD. The difference is that RSD is triggered, so that's the event, and everything comes afterwards. So they look like the timing is totally different, and that's a very fine point, but it's how you tell the difference because they each have, um, different treatments. Interesting enough, the very best treatment for s- uh, social anxiety disorder is back to the MAOIs. [chuckles] They, they, they just take it away 95% of the time. But again, most docs younger than me have never, ever prescribed it, never been trained on it. They're afraid of it. I mean, they have these irrational fears. You have to find an old codger like me-Uh, who has experience with it. Um, the other place is, you know, if you have a DSM or c- you know, just get online, look under the axis III personality disorders and find avoidant personality disorder, and you will see an exact description of ADHD. So again, it m- gets mistaken as personality disorder.

    3. APAlex Partridge1:07:17

       How can-

    4. WDDr. William Dodson1:07:17

       As it has been forever

    5. APAlex Partridge1:07:18

       ... A- and be- before medications, if someone i- isn't quite able to get those,

15. 1:07:25 – 1:11:40

    Tools to stop RSD

    1. APAlex Partridge1:07:25

       do you have any tools to stop RSD or at least perhaps mitigate the reaction or overreaction that might come with that overwhelming sense and feeling of rejection?

    2. WDDr. William Dodson1:07:36

       Absolutely. Now, just generally speaking, the therapeutic response to RSD is prevention, prevention, and more prevention. 'Cause once it's happening, you're done, you just have to wait for it to, to run its course. So, uh, if you're running on 10 out of 10 all the time, that's gonna be exhausting, debilitating. Um, learn to lead a life in balance. Take good care of yourself. And part of that, of course, is getting adequate sleep. Everything is better when you've had a good night's sleep. Um, also, you know, take time away. Uh, when you're feeling stressed, leave it with somebody else. You know, get back to yourself, get relaxed before you go back in. Uh, again, it's basically just leading a life in balance. No excesses and things like that. Uh, no, um, self-medication. Um, a lot of the, um, drug misuse by people with ADHD is their attempt to medicate ADHD on their own, e- especially the hyperactive component. Uh, again, if, this is a digression, if you ask somebody who has a substance use disorder, "What do you like about your substance? When you use it, what are you sure it's gonna do for you?" Um, people who are just, you know, not ADHD, just addicted to drugs, are after the high. You know, you know, I get, get high. Me and my buddies feel great. We go out and get rowdy. We're having a great time. You know, and that, that, that person's not what we're talking about. People with ADHD will tell you, "Well, I blow a bowl of dope so I can slow down my brain to study. So I can slow down my brain and body, uh, to fall asleep." They're using it for adaptive purposes. They're using it to lead life better and in more balance by subduing, um, the impulsive-hyperactive component of ADHD. Uh, which is yet a whole 'nother presentation. But, uh, anyway, take good care of yourself. Don't get pushed to the edge. Don't try so hard. Um, I have a magnet on my refrigerator that has Mount Everest on it, and it says, "Remember that all the corpses on Mount Everest was once a highly motivated person." So it made me think about calming down a little bit. [laughs]

    3. APAlex Partridge1:10:12

       [laughs] It's incredible advice. So that's really interesting, Bill, about the non-ADHD addict chasing the high and the ADHD person perhaps chasing the low. Um, I've spoken to many alcoholics who have ADHD, and alcohol is the only thing that quietens the mind.

    4. WDDr. William Dodson1:10:32

       Yeah.

    5. APAlex Partridge1:10:32

       They're not drinking to go out and party. They're drinking to turn the volume down.

    6. WDDr. William Dodson1:10:37

       They're treating their ADHD. And again, it-- but again, a distinction. It is always better to treat the cause of a symptom rather than merely suppress the symptom. And so that's what other medications do, is they suppress what's going on and actually impairing you more than a bit. But the trade-off is worth it to most people. And so that's why, again, going back to the tried and true ADHD medications that treat the cause. Now-- and that's why you don't develop tolerance to them. They're treating the cause of ADHD. They're not pushing your nervous system in any direction. It's a return to your best functioning. It's not an artificial state. So again, just a digression, because that's an important distinction.

    7. APAlex Partridge1:11:29

       Bill, this has been absolutely insightful and truly surreal. I mentioned at the beginning, and people know you coined the phrase RSD, and I'm, I'm genuinely curious, at that point in

16. 1:11:40 – 1:14:01

    Other names for RSD

    1. APAlex Partridge1:11:40

       time, were you toying with any o- any other acronyms? Like what else could you have perhaps called it?

    2. WDDr. William Dodson1:11:45

       [laughs] Believe me, if I'd known just how tongue-twisting the name was going to be as far as people, I'd have searched for something else, anything else. Uh, I did try other things. Um, and I had the, the term reactive in the name. Um, uh, I would have used the word dysphoria, uh, but again, most people don't know the meaning of that. I mean, the guys back way be- way back when who were doing the, um, treatment-resistant depression work wanted to emphasize just how bad this was. It was not, you know, normal suffering. It was not normal depression or anxiety. It was unbearable. So they wanted to put it right up there in the name. And they did, in Greek. [laughs] You gotta love the guys at Harvard.

    3. APAlex Partridge1:12:41

       Yeah. [laughs]

    4. WDDr. William Dodson1:12:43

       But they, they wanted people to know that that was the real feature that mattered, was the intensity. These are normal emotions that most people have felt at some time. It's just the sudden overwhelming intensity of them.

    5. APAlex Partridge1:12:59

       It certain- it certainly is incredibly intense, and I'm, I've no doubt, Bill, that this conversation is gonna help so many people who will be watching or listening feel less alone and less crazy because, and I don't use that word lightly, sadly, I've spoken to lots of people, and that's what they have been called for many years-

    6. WDDr. William Dodson1:13:19

       No

    7. APAlex Partridge1:13:19

       ... sometimes even by their doctors, which is truly heartbreaking. Um-

    8. WDDr. William Dodson1:13:23

       And a misdiagnosis 'cause they don't even think of it.

    9. APAlex Partridge1:13:26

       Mm. Yeah.

    10. WDDr. William Dodson1:13:27

        And we, we renamed the book we're working on. It was Diagnosis and Treatment of ADHD. Dropped diagnosis because diagnosis is nonsense to begin with. It's now the recognition and treatment of ADHD. 'Cause that's the problem, is that for most clinicians and even most people, ADHD is just not on the radar screen. They don't know anything about it. They've heard the term, but they don't say, "Oh, that's me." They never show, you know, anything other than the name, and the fact that it's usually mentioned in a derogatory fashion. So, you know, sorry to interrupt

17. 1:14:01 – 1:21:14

    Audience questions

    1. WDDr. William Dodson1:14:01

       you.

    2. APAlex Partridge1:14:02

       No, not at all. I was going to move on, Bill, just finally to the audience questions. We have a section at the end of the show called The Washing Machine of Woes-

    3. WDDr. William Dodson1:14:10

       [laughs]

    4. APAlex Partridge1:14:10

       ... where a member of the audience... It's called The Washing Machine of Woes because t- typically we do an A- an ADHD item section, and my ADHD item, something that represents ADHD for me, is a washing machine because it perfectly summarizes my issues with memory, because I always leave my clothes in the machine after the cycle finishes.

    5. WDDr. William Dodson1:14:30

       Mm-hmm.

    6. APAlex Partridge1:14:30

       But I digress. Um, this week, Bill, someone has written in, and I'll read it from this card. "I have a 12-year-old with ADHD. Like any 12-year-old, she is prone to making mistakes, and as an overprotective mother, I'm terrified I'm going to give her RSD with my criticisms when she grows up. How can I avoid this?"

    7. WDDr. William Dodson1:14:53

       Okay. I always start with some basics, good grounding. Uh, and that is, um, accept the kid you've got. Um, don't have in your mind something you want to make the child into. Um, it's not gonna happen. Um, you know, one of the things that was, again, decided science is that parenting does not produce ADHD. Parenting does not produce emotional dysregulation. Your parenting style, as far as we know, has no effect on the development of RSD. Um, so parents are officially off the hook. I mean, that was one of the big productions of the MTA study back in the late 1990s. So parents, you know, now you can make matters worse, but you don't cause ADHD, you don't cause emotional dysregulation. So basically accept the child the way he or she is. Don't try and change them. Because let's face it, that's just hostile. You're saying, "I don't like you, and I'm gonna change you to suit me." Um, second thing is, be the parent that you wanted, you desperately needed when you were growing up. Rather than criticizing you, uh, when you're overwhelmed and all these ADHD things that you've been suppressing all day come out, and they get home and out of school, and they let down, and that's when parents see it. Um, rather than asking, "What's wrong with you?" Say, "How can I help? Now, I see you're a good person, and you're just dealing with more than you can handle right now. How can I help?" Again, you're not leaving the kid alone with it. You're not blaming them. You're saying, "This can get better." You know, and as a parent, I'm gonna read about ADHD, about what works and what doesn't, and a lot, and a lot doesn't. Um, again, all of a sudden that totally changes the dynamic on the child. You're actually, again, I use this word advisably, it's therapeutic. Somebody is gonna get better, or at least not worse, if you have that type of response. Now, I've always been interested in the people I don't see, people with ADHD, who have rip-roaring ADHD, but seem to be well-adjusted, happy, have good, solid marriages, raising good, healthy kids. I wanted to know what this person knew that I didn't. And the one thing that I've heard from everybody is that sometime in their life, us- usually in early years, they had somebody, and it could've been anyone. Blessedly, it was a parent or a grandparent, something like that, or it could be a special teacher, a coach, a neighbor. Doesn't matter who it is. But it was a person who gave a three-part message to the child. First one, "I know you. I watched you grow up. And if anybody could've overcome what you're dealing with through hard work and intellect, I know it would've been you." Saying, "You're a good person. I know you. I've known you for a long time, and I know you've thrown through. You're a good, hardworking person. This is not your fault. It's something you're dealing with," almost as if it was outside. Second thing is, "We don't know exactly what you're dealing with." Um-And so we will find out, we will master it. Third part, and I want you to know that until we overcome and master it, I will be with you. We'll go through this together. We'll talk with each other. We'll help each other find out what works and what doesn't until you overcome and master this. It's a message of hope in the future, but most of all, again, I've hit this several times in our discussion, you don't leave the child alone with an insolvable problem that everybody demands that they solve. That person keeps the child alive. That person acts as the vessel that keeps the memory of them as a good person who tries hard and is not the bad kid. And even when the kid forgets that, they know this person never forgets. They're also gonna have to be alone. Even if we don't figure it out, I'm not alone with it. That's what makes the difference, and that's why some people with ADHD are able to take that and internalize it and do it for themselves, and go on and lead a perfectly good life. I mean, it takes a huge amount of effort, don't get me wrong.

    8. APAlex Partridge1:20:27

       Mm-hmm.

    9. WDDr. William Dodson1:20:28

       But, you know, apparently they, they never had the need to try medication. So that's the parents to be.

    10. APAlex Partridge1:20:37

        Really, really, really powerful advice, Bill, and I've no doubt life-changing for many of the people watching and listening. Um, so truly thank you. As I said at the beginning, this has been a surreal experience for myself personally. I consider you to be one of the, the, the ADHD royalties.

    11. WDDr. William Dodson1:20:59

        [laughs]

    12. APAlex Partridge1:21:00

        Um, you, you truly are. So on behalf of everyone grappling to understand their brains, and from me personally, thank you very much.

    13. WDDr. William Dodson1:21:11

        Oh, it was truly my pleasure to be here. Thank you for inviting me

Episode duration: 1:21:15