Defining Features of ADHD That Everyone Overlooks: RSD, Hyperarousal, More (w/ Dr. William Dodson)

240,844
0
Published 2022-03-17
The textbook symptoms of attention deficit hyperactivity disorder (ADHD or ADD) — inattention, hyperactivity, and impulsivity — are inadequate; they fail to reflect the complexity of the condition, and several of its most prevalent and powerful attributes.

Patients and clinicians who rely on the DSM-5 alone tend to overlook these defining features of ADHD:
1. an interest-based nervous system
2. rejection sensitive dysphoria
3. intense emotional responsiveness

In this hour-long webinar replay, leading ADHD expert William Dodson, M.D., explains how these core features affect the daily life of individuals with ADHD, and how they often complicate diagnoses and treatment plans.

3:00 The Criteria Are Made for Researchers - Not for Patients or Clinicians
5:07 DSM-5 and ICD-10 Diagnostic Criteria
6:20 Why does this matter?
7:00 Multimodal Therapy is No Longer the Standard of Care
8:43 Attention "Deficit"
10:25 Required Elements
10:55 Interest-Based Nervous System (Cognitive Component)
11:03 Functional/Experimental Definition of ADHD
11:53 Genetic and Neurological
12:56 Difficulty with Engagement on Demand
13:19 Performance, Mood, and Energy
14:44 Interest, Challenge, Novelty, and Urgency (and perhaps Passion)
17:09 Contrasted to Importance-Based Nervous Systems
18:12 An Interest-Based Nervous System is One of Two Things That Defines ADHD
19:04 A Second Type of Nervous System
19:07 Implications
20:54 We now talk in terms of managing ADHD rather than treating it
21:48 You need to have both pieces
22:05 The ADHD Owner's Manual
22:26 Two Types of Emotional Problems
22:55 What is a Mood Disorder?
23:00 Moods in ADHD
23:08 Shame: The Master Emotion
23:12 Self-Esteem?
24:02 The Need for Cheerleaders
25:09 RSD: Rejection Sensitive Dysphoria
26:16 Features of RSD
26:59 Emotional Wounds
28:04 RSD is Genetic and Neurologically Hardwired
29:38 Common Coping Mechanisms for the Vulnerability of RSD
30:38 What Treatments Help?

Download the slides associated with this webinar here:
www.additudemag.com/webinar/adhd-symptoms-emotions…

Related Resources
1. Read: 3 Defining Features of ADHD That Everyone Overlooks
www.additudemag.com/symptoms-of-add-hyperarousal-r…

2. Quiz: Self-Test: Could You Have Rejection Sensitive Dysphoria?
www.additudemag.com/rejection-sensitive-dysphoria-…

3. Download: Rein in Intense ADHD Emotions
www.additudemag.com/download/understanding-adhd-em…

Subscribe to the ADDitude YouTube Channel:    / @additudemag  

Visit the ADDitude web site: www.additudemag.com/

Follow ADDitude on Facebook: www.facebook.com/additudemag/
Follow ADDitude on Instagram: www.instagram.com/additudemag/
Follow ADDitude on Twitter: www.twitter.com/ADDitudeMag/

All Comments (21)
  • @dj_n8_films521
    I have no words to say, this is me and my brother completely. My parents don't get us, and neither does society. I am a people pleaser, and my brother is the one that doesn't try. It makes me completely SAD for him, myself and everyone else. We are the ones misunderstood and left in the dark. Nobody seems to really care about us. I am completely overwhelmed and paralyzed mentally with so many emotions right now. FINALLY, IN MY LIFE someone is explaining something that I have lived with for all my life but could never find the words to explain. It made me feel so alone, I wanted to end it all so many times. I need to show my parents this, and I want to stick up for my brother and help others. Life is super tough.... luckily I found ADDitude Magazine and hope in a higher power, but there are days where it is not enough. I could go on and on because I am in the moment. My brain is buzzing mad right now. Thank you ADDitude for everyone you all do! It means the world to me, and I am sure countless others!!! I just cannot thank you all enough. I REALLY hope someone important reads this comment.
  • @bluejedi723
    I have ADHD, and it's so sad that so many of us fall through the cracks because of how different we are from the rest of the world. For me, ADHD has always made me just slightly out of sync with social norms, and it breaks my heart people don't understand sometimes I just really can't help the way I am. It's like punishing a fish for not being able to climb a tree no matter how hard they try.
  • @smileyginger1
    I hesitated to comment on a video this "old" but hopefully someone will see it. I have watched SO many videos from ADHD experts (real ones, Dr Barkley and Dr Hallowell, whose content I both like) and this content was exceptionally succinct and hit on so many points. Every mental health professional should have to watch it! 1) I thought the mention of Montessouri schools (which is the only time I've ever heard it talked about in conjunction with ADHD) was such an eye opener. I was extremely fortunate (despite not coming from a family of means) to attend a Montessouri preschool and kindergarten, where I was exceptionally happy. Attending mainstream schools, even as a "gifted" student was often torturous - the loneliness caused by poor personal interaction skills combined with low frustration tolerance/RSD (and I believe these are two sides of the same coin), discalculia and being terribly disorganized. 2) This is also the first I've heard of using both a stimulant AND the alpha agonist medication in concert (despite having worked with a medication manager that just zeroed in on depression and put me on such a high dose of bupropion that it felt like thorazine. I have suffered INTENSELY from RSD for most of my life and to learn that there is an additional medication that could help with the "zero to nuclear after burning dinner" pain could be so helpful. 3) After 50 years, I now have a word to describe my problem solving skills. "Saltatory." I went back and re-watched that part 3 times. It is SO difficult to explain to neurotypical people, especially in job interviews, how I work. How I solve problems. How I use pattern identification. and how, when I have come to someone with a solution, I KNOW I am right. They want my explanations or reasoning to fit in their box. Combine that with a disbelief from neurotypical people that don't understand how ADHD people can pick up skills VERY quickly when they find it engaging and stimulating.
  • @Ketsamo
    8:43 For example, I put off cleaning the apartment for months at first, but when I finally get it started, I can't stop, so I clean late at night even though I should wake up early in the morning. But again after a couple of weeks, when I try to start cleaning, I can't get started, even though I can remember how nice cleaning was last time. However, I have found two good ways. First I put on an interesting podcast like this one through my headphones, then I trick myself into picking up that one sock off the floor and into the laundry basket, and like magic I'm back in cleaning mode.
  • @sonja7halcyon
    I've never felt so seen and the comments made about having a cheerleader literally made me cry. It's all I've ever wanted was for someone to acknowledge how hard I try and how hard it is for me. For me this is the biggest factor in suicidal feelings, feeling so misunderstood with no help or support system whatsoever. Add chronic pain, depression and CPTSD on top, while being financially and physically dependent on people who continue to gaslight and shame you and life just feels impossible. Thank you for making this presentation!!! Feeling seen and understood is so important!!
  • @caroljoy839
    As far as ADHD people having motivation to do things they are interested in: I had a very bright roommate when in college, and she would have flunked out of HS if not for a system whereby she could cheat off the paperwork of her circle of friends. An uncle understood that somewhere along the line, she was atypical. She would only get involved if she wanted to do something. He took her on a private plane ride and let her handle the controls. The uncle could only let her "fly the plane" for a short period of time, but she was excellent at following the direction needed. She excelled at taking control of the plane for just the limited amount of time he could allow her. She was enrolled in flight lessons right after HS graduation and got her pilot's license and became a success story!
  • @lordcailx
    24:57 "The worst part of being ashamed is being alone with it... What the [support person] needs to be able to say is: 'I know you. You're a good person. If anybody could have overcome these problems by hard work and sheer ability it would have been you." -- Oof.. This hits home HARD. I feel like this could literally mean the difference between life and death for so many people..
  • I am an old dude. I have been struggling with this kind of issues whole my life. Never thought it could be ADHD, because that is this guy that changes his job every half year and cannot sit still. I have been holding on to the same job, where I could work around my irregular working (a lot of procrastination and some late night work and creative new ideas to compensate for it) without anybody noticing. But often the shame and self-hate are unbearable. It would be such a relief to get an official diagnose and to know I am not just a lazy person.
  • @cbeshorern
    I'm 46 and sobbed the entire presentation. I work in mental health every issue that has plagued my existence you just articulated my existence. My 2nd grade teacher put me in a refrigerator box so "I'd pay attention and not day dream" and I've been in that box since. I'm grateful younger kids may have a chance now thanks to this work.
  • @lambs5258
    This is the best. The bit on the DSM-V was soooo validating. 5:53 "it requires an adult to be functioning on the level of an untreated elementary school-aged child in order to meet diagnostic criteria" that was EXACTLY my problem. wasn't diagnosed in childhood, a fate shared by so many adhd girls. And getting diagnosed as an adult was an uphill battle. Had to visit 3 different evaluators before one finally listened to me. First one said I couldn't have ADHD, because I have a job and college degree, and because I'm not "hyperactive" (even though I am lol). But because I wasn't running around the room or jumping on the couch, I "wasn't hyperactive." Because I completed school (nevermind how difficult it was), I "couldn't" have ADHD, because you're expected to be functioning like an elementary school chlid. Nevermind you could not possibly survive adult life if you were like that, and have to adapt one way or another. Super jaded by the DSM-V and its narrow definition of ADHD. It only measures how difficult you are for others, and how much you match stereotypes (that were formed looong ago, based on the presentation in one gender and age group). Not how much you're actually struggling just to live. Going undiagnosed for so long is a hell i can't even describe.
  • @ExkupidsMom
    This is extraordinary. I'm 63 and found out 2 years ago that I have ADD. Medication has made my life-long treatment resistant depression and anxiety virtually disappear. I'm still struggling, but not for the reasons that I always thought. In fact, I see my life as heroic, because I overcame so many things by myself, without the support I shoud have had.
  • "Help the person write their personal owner's manual for their ADHD nervous system" This is absolutely revelatory and contains so much wisdom that it can be unpacked into a whole therapeutic modality. Thank you from a recently diagnosed 42-year old.
  • @HinrikS
    I'd read or heard some of it before, but damn! Now i'm irrefutably certain. I'm not a colossal piece of shit, simply afflicted with every fucking thing ADHD has to offer. There is hope.
  • @papabear1714
    "This shifting of mood and energy is often misinterpreted as Bipolar Disorder"... The relief I feel from this revelation is immeasurable, as is my gratefulness to the beautiful people that made this video.
  • I can't believe it. You've made sense of my 44yrs of that perceived emotional rejection. Thank you so much.
  • Psychedelics are just an exceptional mental health breakthrough. It's quite fascinating how effective they are against depression and anxiety. Saved my life.
  • The craziest thing about this is the part where the adult ADHD person goes through an average of 6 doctors before finding one who can satisfactorily treat ADHD. Setting up an appointment with a doctor is absurdly mentally taxing for me, and that doesn't even take into account the significant risk of subsequently forgetting/missing the appointment because i'm late, or double-booking and being forced to cancel. but yeah TBH this is all consistent with my experience. It took me nearly a decade after developing suspicions that I had ADHD to finally get medicated because I would repeatedly drop the ball while seeking help. I remember a therapist in college ending treatment after I missed a few appointments, saying "If you can't put in the effort to show up then how am I supposed to treat you?" Literally that is what I was asking to be treated for. But no, they just put me on a series antidepressants that all did nothing but cause side effects because anyone seeking treatment for ADHD in college must be malingering.
  • I think avoiding RSD was my motivator in youth. I loved being seen at school, being praised. Because I didn't receive that from parents. Just my teachers. But, when I experienced rejection, it could be crippling.
  • @SN-sz7kw
    Wow. I was one of the “lost generation” of girls who were never diagnosed or diagnosed very late. I was in my 50’s before I received help with this. My daughters are much more fortunate. This is so very helpful. Thank you!
  • @IDiveInFirst
    I have learned so much about my adhd, but to hear it as a second type nervous system!? Wow. I am in tears. I wish all educators and parents would watch this, and share with their kids. I was at a point in my 50s where I thought I was sociopathic because I just dont care about so many things. Im just not interested!