Everything You Get Wrong About ADHD ft. Dr.Micaela

Dr. Micaela, a licensed clinical psychologist specializing in young people, but with broad experience across age groups, introduces herself as a substitute host for Dr. K. She clarifies that the information shared is for informational and entertainment purposes only, not medical or therapeutic advice. Her career has often focused on individuals with complex mental health conditions, leading her to work extensively with neurodivergent people. She emphasizes that many of the insights discussed are relevant to all individuals, regardless of neurodivergent identification, making the content broadly applicable and helpful.

The discussion begins with a post from an individual who feels more alert and functional after only 5-6 hours of sleep, contrasting this with feeling tired and experiencing brain fog after 8 hours. Dr. Micaela acknowledges this as a common, albeit triggering, topic, highlighting that healthy sleep is arguably the single most important factor for protecting mental health. She notes the paradox where a slightly attenuated night of sleep can sometimes lead to improved experiences or performance for both neurodivergent and neurotypical individuals.

When sleep is slightly reduced (e.g., 5-6 hours), the brain may enter a 'super mode' or 'hyperthreat mode' to compensate for low energy, pushing through to maintain optimal functioning. However, this compensatory mechanism is not sustainable. Chronic sleep deprivation, lasting four to five days or more, can begin to mimic clinically significant signs of ADHD. This is because the brain, lacking sufficient energy, triages its systems, reducing functioning to the most basic levels and significantly impairing executive functions such as prioritizing, planning, organizing, and impulse control. Emotion regulation, a critical function of the frontal lobe, also suffers, leading to increased emotional reactivity.

While eight hours of sleep is often cited as ideal, individual sleep needs vary greatly. Some may require nine hours, while others might thrive on seven or even 5-6 hours combined with naps. Dr. Micaela shares her personal aversion to naps, illustrating that what works for one person, like her sister who can feel refreshed after a five-minute nap, may not work for another. She emphasizes that no one can definitively say what is best for an individual other than themselves, necessitating a personal journey of discovery.

Sleep is a constantly moving target influenced by factors such as brain maturation (typically between ages 23 and 25), life phases, circadian rhythms, sunlight exposure, physical activity, and stress levels. This variability makes it challenging to pinpoint consistent optimal sleep patterns. Furthermore, both oversleeping and undersleeping can lead to similar problems, creating confusing feedback, much like overwatering or underwatering a plant. Individuals often attempt to compensate for poor weekday sleep by oversleeping on weekends, only to wake up feeling worse, perpetuating a cycle of misunderstanding their body's needs.

Sleep does not exist in isolation but is part of a constellation of wellness behaviors. Dr. Micaela, who has struggled with sleep her entire life, points out that for some, the experience of falling asleep is not calm or rewarding, which reduces motivation to prioritize it. Research indicates that the inability to manage sleep is the single biggest vulnerability to relapse in any mental health condition. This highlights its critical role in maintaining mental well-being and recovery. Therefore, addressing sleep issues is paramount, even if challenging.

If sleep is a highly fraught area, individuals can pick one or two other wellness areas to focus on. These might include reducing screen time, increasing physical activity (e.g., walking, taking stairs, exercising, jumping on a trampoline), or improving nutrition. The benefit is that positive changes in one or two areas of physical wellness often align to optimize overall functioning, potentially leading to indirect improvements in sleep and mental health.

The next post reveals a profound realization: a lifetime believed to be severe social anxiety was largely related to ADHD. The individual lists various struggles, such as overthinking sentences, rephrasing things repeatedly, preemptively explaining actions, difficulty with eye contact, trouble recalling conversations, preferring to work alone, panicking under observation, and interrupting others. This newfound understanding provided immense catharsis and highlighted how deeply ADHD contributed to their social challenges.

The frontal lobe, which regulates the brain's emotion center, is less active in individuals with ADHD, making them neurobiologically less skilled at regulating emotions. This can lead to more reactive and intense emotional responses, often characterized by a slow return to baseline. In social situations, misinterpretations (e.g., someone giggling being perceived as mocking) can trigger intense anxiety or other emotions. Subsequent reactions or further social interactions can then create a cascading effect, constantly reactivating emotional responses and leading to a reputation for being overly sensitive.

ADHD significantly increases vulnerability to social anxiety due to frontal lobe deficits. The brain's tendency for 'neurons that fire together wire together' means repeated anxious reactions strengthen those neural pathways, creating well-trodden 'horse trails' of anxiety. Furthermore, neurodivergent individuals are inherently different from mainstream society, often leading to legitimate judgment and rejection. This combination of biological predisposition and social vulnerability makes them more susceptible to negative evaluation, intensifying social anxiety. Developmental stages, such as adolescence, where fitting in is a primary task, can further amplify these challenges, as can specific social contexts like faith communities where 'being different' might be actively shunned.

Mental health conditions and life circumstances can be conceptualized as a spiderweb. Instead of attempting to dismantle every single thread, which is exhausting and often leads to giving up, the goal is to identify one or two crucial threads that, if addressed, can cause the entire web to collapse. This frees the individual to rebuild the 'spiderweb' in a desired configuration. For the post's author, understanding that ADHD was at the core of their social anxiety allowed them to focus on that underlying condition, leading to a melting away of the broader social anxiety symptoms. This approach emphasizes gaining momentum and change through strategic intervention rather than exhaustive effort.

A diagnosis of ADHD does not instantly normalize behavior or eliminate challenges. Instead, it offers an opportunity to recognize and embrace weaknesses. For example, understanding a struggle with large group conversations due to interrupting or difficulty finding lulls allows for different choices. Individuals can choose to spend time with people who are not aggressively offended by interruptions, or focus their energy on unavoidable situations. This self-knowledge liberates individuals from constant anxiety and the need to seek external validation.

The journey of self-love, particularly for those who have spent a lifetime internalizing messages of being 'wrong' or 'not fitting in,' is excruciatingly difficult. It involves undoing years of conditioning while still navigating societal pressures to conform. However, by embracing one's unique traits (e.g., being 'the dinosaur person'), individuals can shed the burden of fitting in, allowing people who don't appreciate their authentic self to fade away. This shift leads to greater happiness and conserves energy previously spent on masking or self-control. This approach, though challenging, can be a more significant game-changer than even improving sleep habits.

A user expresses the unbearable ADHD guilt experienced after social hangouts. Despite loving deep conversations and feeling close to people, they consistently return home feeling like a horrible person, obsessing over every moment. Common worries include interrupting too much, oversharing, being too loud, dominating conversations, or making it too much about themselves. Forgetting to follow up on stories or details exacerbates the guilt, leading to avoidance and further embarrassment. This creates a dilemma: feeling like a burden when present or a bad friend when absent. Even with reassurance from friends that they had a good time, the guilt persists as a louder internal voice, preventing genuine self-acceptance in social interactions.

This post-social guilt is common for individuals with ADHD, social anxiety, or low self-esteem. During social interactions, engagement and stimulation can drown out critical inner voices, as the brain experiences a dopamine response from social reward. However, once alone, especially when trying to relax or fall asleep, these negative voices resurface with amplified intensity. For those with ADHD, the difficulty in regulating emotions further weakens the ability to dismiss irrational guilt, creating a spiraling effect where the brain struggles to process reassurance or positive social cues. Additionally, if ADHD medication has worn off, the frontal lobe's function is reduced, making emotional regulation even harder.

Individuals with ADHD may indeed forget to respond to comments or interrupt conversations, leading to genuine negative self-perception. Dr. Micaela, however, reframes these as 'differences' rather than 'deficits,' highlighting potential superpowers. For instance, while an individual with ADHD might interrupt a story, they may still remember the original story's tidbit, unlike neurotypical individuals who might struggle to pluck such specific details from a complex conversation. This is because ADHD involves a lack of selective attention, meaning the brain processes every piece of information simultaneously, without a filter. Recognizing and capitalizing on these unique strengths is crucial to counter societal negative messages and foster self-love.

Managing ADHD-related guilt and shame after social interactions requires intentional strategies. These involve hard work and repetition to build new neural pathways. It is important to acknowledge that there is no magic solution, and progress comes through consistent effort.

A user expresses feeling fake and bland when talking to people they are not close with, stating it feels physically impossible to be themselves. They believe this stems from not being naturally outgoing. Dr. Micaela validates this experience, acknowledging the immense pressure to perform or conform, which can lead to feeling inauthentic 90% of the time, especially when discussions are superficial and don't align with one's true interests. She asserts that it is perfectly acceptable for someone not to be a naturally talkative person.

The first step is to 'do you.' If complete authenticity isn't possible in certain situations (e.g., work, networking), then the goal becomes being 'the most you' possible while still masking or hiding idiosyncrasies. Dr. Micaela shares her personal example: in a professional hospital setting, she wears traditional attire like heels and blazers but refuses slacks and carries a brightly colored Spongebob backpack. This allows her to conform professionally while still expressing her unique self. For others, this might be a subtle pin, patch, or even fun socks or underwear, a concept known as 'alternative rebellion.'

Alternative rebellion involves subtly rebelling against social norms or expectations in ways that do not jeopardize professional or social standing. For instance, wearing a purple blazer instead of a traditional suit might lead to negative consequences, but fun socks hidden under professional attire can be a private act of rebellion. This strategy helps individuals feel more authentic without facing overt judgment or repercussions. It's crucial to also have designated 'safe spaces' where one can be fully liberated and utterly oneself, without any need to mask or conform. This could be a group chat where uninhibited conversations flow, or a specialized online community (like a subreddit for dinosaur enthusiasts) where unique interests are openly embraced. These spaces provide a vital balance to the energy expended in conforming.

A 27-year-old female with inattentive ADHD describes a significant problem with phone addiction, particularly doom scrolling for eight hours daily when anxious or avoiding thesis work. Despite deleting TikTok, she became addicted to Reddit. She's tried timers, disabling notifications, and even putting her phone in a different room, but consistently overrides these attempts. Her need for connection (texting 10+ people daily), essential apps like bank cards and Spotify, and two-factor authentication make a 'dumb phone' impractical. This addiction is affecting her insomnia, causing her to sleep at 7 AM. She seeks practical tips, even jokingly suggesting a phone jail, and notes she only takes her dexamphetamine medication when studying, not every day.

The user's selective use of dexamphetamine (only when studying) is addressed as a critical point. ADHD deficits encompass a broad range of symptoms beyond just focus, including impulse control and emotion regulation. Medications help strengthen frontal lobe activity, which improves these areas. For someone struggling with phone addiction driven by anxiety or avoidance, taking ADHD medication consistently, as prescribed, can help regulate urges and emotions. Dr. Micaela highlights that ADHD medication should be taken daily, not just for academic or work tasks, especially for activities like driving due to significantly higher accident rates for individuals with ADHD. Meds can also support managing daily life, even on vacation, preventing behaviors like excessive scrolling and enabling goal achievement.

A powerful strategy for addressing phone addiction is the 'pros and cons' analysis, which involves physically writing out a four-square grid. The first two columns list the pros and cons of the problematic behavior (e.g., scrolling on the phone for eight hours). This identifies the reinforcements maintaining the behavior (e.g., endless content, not thinking about thesis) and the punishments (e.g., not working on thesis, poor sleep). Behavior continues because reinforcement outweighs punishment. The goal is to either reduce reinforcements or increase punishments. For example, one could make a rule: "I'm not allowed to use my phone until I've done 30 minutes of thesis work." This breaks the inertia of avoiding the undesired task.

The remaining two columns focus on a 'replacement behavior.' It's crucial not to choose an overwhelming replacement (e.g., "work on my dissertation for eight hours"), as this will likely be filled with cons and perceived as impossible. Instead, choose a small, achievable replacement (e.g., "go to a coffee shop to work on my computer"). This reframes the choice from a vacuum ("scroll or not scroll") to a more balanced decision ("scroll or pack my bag for the coffee shop"). Breaking down tasks into micro goals, like outlining column headings for a spreadsheet, helps overcome inertia and build momentum, even if the initial steps seem insignificant. The brain's natural tendency is to fill vacuums, so providing a desirable alternative is key.

A common question raised is how to determine if one has autism, ADHD, or both, especially when experiencing social anxiety. Dr. Micaela's primary recommendation is to seek a professional diagnosis, but acknowledges that access to highly skilled mental health professionals is tragically limited. For those unable to access professional help, she suggests turning to reputable, 'boring websites' like the NIMH or the American Psychological Association for scientifically vetted information. When engaging with social media, cross-reference information with these credible sources to identify reliable content creators. Be wary of 'magic solutions' or supplements claiming to treat multiple conditions for a low price, as these are typically not reputable.

Dr. Micaela expresses a personal bias towards focusing less on the specific name of a diagnosis and more on understanding what is bothering an individual and what changes they want to see in their life. Diagnoses can be subjective and vary between professionals, and even within a single diagnosis (like autism), individuals can be 100% unique. While a diagnosis can help one understand themselves better, the ultimate goal is to identify and address personal struggles. She encourages a deep dive into learning about conditions if suspected, but emphasizes that true progress comes from understanding one's unique brain and body, and taking steps towards desired changes, rather than solely relying on a label.

For those recovering from ADHD burnout, stress, or other forms of mental fatigue, extreme boredom and a pervasive 'meh' feeling are common and intensely uncomfortable experiences, especially for people with ADHD who often find boredom as distressing as physical pain. Recovery, whether emotional or physical, is a slow process that demands patience – a quality often lacking in those who push themselves to the brink of burnout. It's crucial to approach recovery with 'baby steps,' analogous to physical therapy for an injury. Avoid impulsively taking on ten new hobbies. Instead, focus on small, manageable activities. The challenge lies in overcoming the impulse to immediately return to high stimulation. If a relapse into burnout occurs, the key is self-compassion: avoid self-punishment and instead, view it as an opportunity to learn and rebuild wellness. Being kinder to oneself paradoxically accelerates recovery.

Individuals with co-occurring ADHD and autism often experience a push-pull dynamic: a desire for social interaction and stimulation contradicted by a need to avoid public settings and stress. While people with autism often appreciate systems and structure, and those with ADHD may rebel against them, the combination can create confusion. Creativity is key here. One must become attuned to personal needs and respect them, distinguishing between anxiety-driven avoidance and genuine depletion. For instance, if a week is already draining with stressful events, it might not be the time for a highly stimulating social outing. Instead, suggesting a low-key alternative (e.g., bowling instead of trivia) can meet the need for social connection without overwhelming. This requires self-awareness, learning to say 'no,' and understanding that societal messages often discourage self-prioritization.

The 'out of sight, out of mind' phenomenon is a common ADHD deficit, making it hard to remember to reach out to friends or recall significant events like birthdays. To counteract this, environmental shaping is crucial. Placing pictures of friends in immediate surroundings can serve as visual reminders, keeping them 'in sight' and 'in mind.' Additionally, utilizing technology by setting alarms or scheduling calendar check-ins to text specific people can build the habit of connecting. To prevent habituation, where notifications are tuned out, vary the reminder times, friends, or even the type of interaction (e.g., sending a funny TikTok). These 'love reminders' (pictures, mementos) can also help individuals with ADHD maintain emotional connection with loved ones even when physically apart.

Even with Adderall or other stimulant medications, following through with tasks on a to-do list and sticking to plans remains a challenge. ADHD medication makes it *possible* to learn and build habits, but it doesn't automatically create them. It's like a baby learning to walk: countless falls and persistent effort are required. Individuals must approach habit formation as learning a new skill, offering themselves the same patience and grace as one would a child learning to walk or ride a bike. Breaking down plans into tiny, manageable steps is essential. Celebrate small successes, even if only 10-20% of a plan is achieved initially. This process is inherently difficult, especially for those with ADHD who struggle with sustained motivation, but self-compassion and recognizing small progress are vital for long-term skill development.

Staring at a screen for hours before starting work is a common struggle. This often happens because the task ahead seems amorphous or overwhelming (e.g., "get work done" or "write a 10-page paper on Julius Caesar"). To overcome this, define the task specifically and create micro goals or 'baby steps.' Instead of thinking about the entire spreadsheet, focus on making column headings, then row headings, then formatting. This 'greases the wheels,' overcoming initial inertia. Your brain might argue these small steps don't matter, but they are crucial for building momentum. You don't need a 20-step path from the outset; just knowing the next few steps is enough. Validating and rewarding these baby steps, rather than fixating on a distant, perfect final product, is key to sustained progress and preventing paralysis.