Episode 57: “What is ADHD?” (Part 3): Unpacking ADHD-Hyperactive Traits
Jun 06, 2024
Show Notes
ADHD hyperactive traits are often misunderstood and the DSM-5’s portrayal of this type is heavily geared toward children and adolescents, which can make it harder to understand and address in adulthood. In an attempt to better understand the ways ADHD can present in daily life, this episode uses the DSM-5 diagnostic criteria as a framework for discussion—this is not an endorsement of the DSM-5.
In this episode, Patrick Casale and Dr. Megan Anna Neff, two AuDHD mental health professionals, discuss the ADHD hyperactive type and share their personal experiences.
Top 3 reasons to listen to the entire episode:
- Learn about the DSM-5 criteria for ADHD hyperactive type and hear personal stories about managing these behaviors in social and professional settings.
- Gain insight into the concept of masking in ADHD, explore the internal struggle to self-monitor and achieve time equity in conversations, and understand its impact on relationships.
- Discover the challenges and strategies for being present in the moment, channeling hyperactive energy, and addressing the grief associated with limited movement as a result of aging or injuries.
As you listen, you might find parts of these criteria and stories that resonate with your own life, whether you have ADHD or simply face similar struggles. We encourage you to stay curious about your own experiences and continue exploring these important topics.
DISCLAIMER: We're using the DSM-5 criteria as a framework for this conversation, but this is not our endorsement of the DSM-5.
Resources:
- ADHD DSM In pictures series: Blog post: neurodivergentinsights.com/blog/dsm-5-criteria-for-adhd-explained-in-pictures
- PDF: neurodivergentinsights.com/neurodivergentstore/p/adhd-dsm-in-pictures
🎙️Listen to more episodes of the Divergent Conversations Podcast here
🎙️Spotify
🎙️Apple
🎙️YouTube Music
▶️ YouTube
💬 Join Divergent Conversations Underground
Divergent Conversations Underground is a space for messy conversations, real connection, and unfinished thoughts in a neurodivergent-affirming community. If you’d like to go deeper with us into more nuanced, searching conversations, join here: divergentconversations.substack.com
Transcript
PATRICK CASALE: Hey, everyone. You are listening to the Divergent Conversations podcast. We are two neurodivergent mental health professionals in a neurotypical world. I'm Patrick Casale.
MEGAN NEFF: And I'm Dr. Neff.
PATRICK CASALE: And during these episodes, we do talk about sensitive subjects, mental health, and there are some conversations that can certainly feel a bit overwhelming. So, we do just want to use that disclosure and disclaimer before jumping in. And thanks for listening.
PATRICK CASALE: Hey, everyone. Welcome back to our ADHD 101 series, our follow-up for our autism series.
And last episode, Megan and I talked about the inattentive type for ADHD. Today we're going to talk about hyperactivity and impulsivity. We might get into some other stuff for the next two episodes. But we want to wrap this up in the next two episodes as well.
And as always, just send us messages to our Instagram or Gmail if you have questions or topics you want us to cover.
So, I know it's been a couple of weeks since we recorded because I've been traveling and Megan, I don't know if you want to set the clinical stage for what we're about to talk about?
MEGAN NEFF: I don't know whether there's a lot of stage setting. We are going through the DSM criteria for ADHD, which is similar to the ICD criteria. And we have our big DSM disclaimer. This doesn't mean we love the way they word ADHD. We definitely don't.
But last time we talked through, goodness, is this like? I don't know, this feels like a parallel process. I can't really remember what we talked through and like did we talk through the three subtypes? I think we probably did. And so, we went through inattentive traits. And if a person might be diagnosed with inattentive type if they have five or six of those nine.
And then, now, we're looking, today, at hyperactivity and impulsivity traits. And then, if a person could either be diagnosed with ADHD-hyperactive type, that's more rare. That's common with like preschoolers, that's more commonly diagnosed in young children or more commonly the combined type.
I think both you and I are ADHD combined type, which is where you'd have, if you're an adult, at least five of the inattentive and five of the hyperactive-impulsive combined.
So, that's the stage. And then, I've got the criteria pulled up for us to get to talk about our fun experiences with these.
PATRICK CASALE: It's good.
MEGAN NEFF: Okay, I just want to… Okay, well, no, maybe that'll come up naturally. Okay. So, first off, hyperactivity. Often fidgets with or taps hands or feet or squirms in seats. That's the example.
And one of the critiques of the ADHD criteria for the DSM is it's written for children. And I think there's folks working on how do we kind of recontextualize these to be able to capture adults better. But you'll definitely see the kind of child suffocation of this when we go through how the DSM words this. But yes, fidgets, taps hand, squirms seat. What's your experience there?
PATRICK CASALE: Well, I have something in my hand right now because I'm fidgeting, I'm tapping, squirming. Yeah, I mean, all of those things, right? Like, I feel like that's every second of every day for me. So, it feels pretty par for the course. You?
MEGAN NEFF: As I'm, like, swaying in my chair. It's so interesting, I wouldn't have thought this. Although, when I look back, I'm like, oh, yeah, I was always like tapping my foot or like was definitely always moving my body when I would be in class. I did a lot of repressing of that because like, I was aware of how people would interpret that around me. But yeah, I definitely am always fidgeting with something.
I think this is one of those where this overlaps with stimming. And so, this can be confusing for either if you're trying to tease out autism or ADHD, or someone has both. It's like, "Well, is it stimming, or is it fidgeting? And they do serve slightly different purposes.
But yeah, I'm definitely someone who needs to have something in my hands if my body… unless I'm under, like, a lot of weight, and like, have pressure on me, then my body needs to be moving in some way.
PATRICK CASALE: I'm glad you brought up the fact that there's that overlap and how they look so similar. And we talked about during our autism series what purpose stimming serves. Let's talk about what fidgeting serves. Like, there is a purpose for this stuff.
And, you know, I'm thinking about what you're saying too, like, how often I had to suppress whether it was in like school or in social settings. And a lot of the times it's like, bouncing my knees up and down. And I could feel myself, like, placing my hand on my knees so that I wasn't like rocking my desk up and down or like, rocking a table up and down. Because I can't even count how many times someone was like, "Can you stop?" Like, "Are you just really anxious? Are you really nervous?" And to me, it was like, it was not even conscious. It was just happening and [CROSSTALK 00:06:37]-
MEGAN NEFF: And it looks unprofessional. And I think that was one of the reasons I was always also trying to like, kind of keep it under wraps is I knew that it looked unprofessional to do this.
PATRICK CASALE: Yeah.
MEGAN NEFF: Yeah, yeah. And so, I think a lot of us do find those kind of quieter coping, I mean, this would be a form of ADHD masking, right? When we suppress that urge to release that energy and move our bodies.
PATRICK CASALE: Absolutely. And that's the thing is that energy releasing that I think is really important to highlight here, and yeah, the ADHD masking of suppression, trying to do so in ways that are less visible to the everyday human and the naked eye. Because I'm sure all of us who can identify this way have experienced situations where someone, a teacher, a parent, a friend, a colleague, has been like, "What's happening right now? Like, what are you doing? You're being very distracting?"
MEGAN NEFF: Yeah, yeah. One thing I've noticed, okay, do I confess this?
PATRICK CASALE: We can always take it out.
MEGAN NEFF: As a therapist and as a consultant, I don't often get bored. Because I think the stimulus, I've heard someone with ADHD talking about this, which I found so interesting. They became a therapist because it was enough stimulus to keep them engaged, because it's such deep, like intense conversations we're having.
So, I will say, it's rare for me, but it does happen occasionally, where I've been in a consult, and I'm like, finding myself struggling to stick with it. And I'm experiencing a lot of boredom or some boredom. And I notice myself move more.
And if I'd go back to, like, when I was in school, too, I noticed that when my boredom, like, when I'm experiencing less, like, understimulation in my mind, it's like my body needs more stimulation. And then if my mind is really engaged, I don't feel as much need in my body to move. That's just something I've noticed in myself. I have no idea I've not like looked into if that's a thing, but I've noticed that pattern for me.
PATRICK CASALE: Yeah, I mean, I think that feels okay to name. And I think I do the same thing. And that has been in coaching consults, therapy sessions, personal relationships. If I am bored, I'm probably moving more to kind of like, ramp it up to allow myself to get some of the energy out and to fidget it. Because it really is helpful to help me pay attention or at least get the energy going again. Otherwise, I'm just like, trying so hard to focus. And I'm just dissociating at times, if that's the case.
MEGAN NEFF: Yeah, yeah. I think that really speaks to like at this core, this experience of restlessness that a lot of us experience that I think can be very existential as well.
PATRICK CASALE: Totally.
MEGAN NEFF: And that, I think, if we're, like, in a conversation that we feel restless in and understimulated then, like, we're going to need more outlets to like, move that restlessness through.
PATRICK CASALE: Yep, absolutely. 100%.
MEGAN NEFF: Yeah. So, let's see, I could imagine this question coming up. So, the difference between stimming and fidgeting, stimming often, so it's repetitive sensory input. And part of what that does is because we're controlling it and it's repetitive, it helps block out the sensory information around us. And it also releases neurotransmitters that supports us. So, that's the function of stimming is it's just like sensory regulation.
When I think about fidgeting and squirming, I think more about what we've been talking about about like releasing that restless kind of angst. And of course, then a person can both stim and fidget. But they're not a one-to-one. Like, they're not functioning exactly the same.
PATRICK CASALE: Thanks for that clarification because I'm sure that definitely comes up, especially, for those who are like, is it autism? Is it ADHD? And then all the overlap, so…
MEGAN NEFF: Mm-hmm (affirmative). Okay, so the next one is similar. Often leaves seat in situations when remaining seated is expected, leaves their place in the classroom, in the office, workplace, or in situations that require remaining in place.
Again, I'm just going to offer my critique. If someone has ADHD with anxiety, so actually, anxiety is one of the things that makes it harder to identify ADHD because folks with anxiety, they'll often mask their ADHD more. Like, if you're anxious and ADHD, it would take a lot to leave your seat. Or if you have a marginalized identity where leaving the seat is like, you're going to have harsher repercussions around that. So, this is another one of those criteria I'm like, I really wish they would reward it.
So, one thing back when I was doing assessments, so I'd follow it up with like, did you take extra water breaks when you didn't need water breaks? Did you like find like "legitimate" excuses to get up and leave your seat? Because there's a lot of people who'll be like, like, "Well, no, I wouldn't just bring that attention to myself and leave my seat."
But yeah, it sounded like you had a big nod when I read this off. Was this you in childhood?
PATRICK CASALE: It's me now. Yeah, I mean, it was me then it's me now. But I was up all the time in class. And whether it was for water breaks, whether I just had to get up and like, literally move around the classroom, and then get told to sit back down. Or I was like, "Oh, can I use the bathroom?" Maybe five, six times in an hour. So, yeah, all of those things, and still to this day, all those things.
MEGAN NEFF: So, I was not this way in childhood. I remember hating school. I remember, like, feeling, again, like physically sick being there sitting there. But I was a very shy child. I was very like rule-oriented. So, it never would have occurred to me to just get up out of my chair.
Definitely in graduate school when I got more comfortable, and there were more people doing this people, especially, on like long symposium days, like stand up, and be in the back or do extra bathroom breaks. So, I have more memories of the discomfort of sitting for long periods. But I was not someone who was that like, hyperactive child that someone would have been like, "Look at little Megan Anna. She's so hyperactive." Like, that wasn't me.
At home, it was a different story. But in school and in settings I was uncomfortable and sitting.
PATRICK CASALE: Yeah, I can definitely remember moments being very uncomfortable and feeling like I have to suppress this urge to get up. I think it's always been easier for me in both classroom settings, work settings, etc. When you're not like all facing each other in like those blocks of desks, but if you can sit in the back, I would always sit in the back, I would always sit on the aisle, so that it's a lot easier to get up and maybe have less attention on me if that was the case.
But that was very strategic and still remains that way to this day. And I think that it's just a matter of, like, me acknowledging if I keep getting up, I'm going to interrupt people. So, if I stay in the back, I can take care of my needs, and maybe not as many people have their eyes on me.
MEGAN NEFF: I think that's a great example of being like neurodivergent affirming and also like, being mindful of how your actions intersect with other people's. Like, if you're thinking of the speaker of like, if you're in the front row, and you're getting up constantly, like how will they read that? How is that going to impact them? I really love that example of, yeah, yeah.
And I think, I guess, I haven't thought, but I do something similar in that I just don't put myself in situations very often where I have to sit for a long time. Like, if I'm going to go to a conference, I typically do it virtually, and then I'm listening in, and I'm walking around while I'm listening. So, it's been a long time since I've, and like I don't go to movie theaters. Like, I just don't do things that require me, other than work. And again, when I'm working and my mind is very engaged I will sit for a long time and work.
PATRICK CASALE: And I want to kind of piggyback off what you're saying about if you're at a conference, right? And you're walking around, and you're listening, especially, virtually or however, if you're doing that in person, the speaker could get rattled a bit, right? Like, by saying, "Maybe this person is just not interested in what I'm saying." Or whatever their perception is. But for you, that's actually helping you pay attention to what the speaker is saying.
So, it is like that intersection of when these neurotypes can clash a bit in terms of how people pay attention, how we receive information, how we process information.
So, during my keynote last week, in Alaska, I just told people, like, if you need to get up and walk around or move around while I'm talking please do that. I will not feel like you're not paying attention. I won't feel like you're not, like, accessing this information because I know I would need to do that too.
But I know for a lot of speakers who are neurotypical or maybe they're struggling with the distraction element that could be perceived in a way that does come across as rude, disrespectful, unprofessional, all the labels that come along with that?
MEGAN NEFF: Absolutely, yeah. And that's where I think, like, I really love the framework of intent versus impact, that our intent and the impact we have can have a disconnect. And then, especially, in cross-neurotype interactions, there's a lot of intent impact clashes where, like, for example, yeah, if I'm in a meeting my intention is this is actually going to help me listen if I'm folding laundry, or I'm doing something.
But being mindful that yes, when we're in those spaces, and we're visible, the impact that will have on the speaker, right? Might be like, "Wow, I'm really boring my audience." And like the impact it's having on them is going to be probably one that you don't desire to have on that person.
PATRICK CASALE: Absolutely.
MEGAN NEFF: And I think that framework moves us away from like, the idea of finding fault, or it's just is like, yeah, we're going to have intent versus impact. Ideally, we're in relationships where we can talk about it, and clear it up, and work through it. In situations like that, it's not like you're going to go up to the speaker. And so, I think finding ways to support ourselves will also be mindful of the impact we have. Yeah.
Okay, so the next one is kind of similar, often runs about or climbs in situations where it isn't appropriate. Okay, this is obviously written for children. But they do make a nice note. They say in adolescents or adults may be limited to feeling restless.
And this is one of the reasons. So, ADHD inattentive type is more often diagnosed in adults. And one of the ideas out there is partly it's because that restlessness gets internalized. And sometimes the way it gets internalized can feel like or show up similar to anxiety.
So, anyways, as it's written, runs about or climbs in situations where it's inappropriate. Was that you as a child?
PATRICK CASALE: I'm trying to think back. I mean, I don't remember myself climbing in situations. I know a lot of folks that did. But I definitely think maybe more like running about Yeah, that probably makes more sense. And then turning into adolescence of the restlessness component, for sure. What about you? I think you mentioned like, that was not something that you experienced, right?
MEGAN NEFF: No, I mean, similar to what like how I wouldn't have gotten up from my seat, I wouldn't have, like, yeah. We grew up in kind of rural mountain area in Oregon. And I definitely, like, explored the woods a lot. At home, I think I had a lot of physical energy. But I definitely would not have done this in situations where I would have been kind of reprimanded for this. I do relate to the experience of restlessness.
Also, like, I think one of the reasons it was harder for me to see myself as ADHD is because I've had chronic fatigue for the last 10 years. So, it's this weird mix of my body will at times feel restless, but also, I feel so much physical fatigue pretty chronically that I'm like, I don't relate to hyperactivity. It's a really weird mix because the fatigue is pretty pervasive. And I feel it most of my body. So, that also kind of throws things off, at least, for the last decade when I look at things, which is, that's how long I've had chronic fatigue for.
PATRICK CASALE: It makes a lot of sense, yeah. I also think that criteria, right? Running, climbing, it can be so often overlooked for kiddos in classrooms and settings because a lot of teachers are just like, "It's just a kid, being a kid. Like, a kid just being restless." And I think that can kind of dismiss the actual reason for the experience and the behavior, too.
MEGAN NEFF: Yeah, I mean, and well, that's part of why ADHD is also tricky to diagnosis because a lot of these are really normal behaviors and children to like, explore and some have more physical energy. And like, so I think that is part of what is tricky.
And for parents, also, it's like, well, what's normal climbing, right? What's abnormal climbing? Like, these things can be really tricky and subjective to be like, yes. Yeah, yeah.
Also, the other thought I had is like how this often can get channeled into sports. Like, I am thinking back to, like, I did cross country, I did track, I did basketball. When I stopped doing sports, I'd go on like to our rollerblade rides after school. So, I think there's also some, like, channeling of this that can sometimes happen.
And this is also, like, something I really consistently hear among ADHDers is that when we get that physical exercise in every day, or like, managing the harder ADHD aspects gets a lot easier for a lot of us. So, I also think the channeling of this into, you know, socially desired behavior is part of it.
PATRICK CASALE: Yep, I would agree. I think most of that energy for me went into soccer. I've been playing since I was four. So, it just felt like a very natural release and outlet in a way where you know, especially, as like a kid, and in junior high, in high school, being like a JV and varsity player, you're playing every day. And you're playing at a high level. So, there's so much energy expenditure. And it really did help kind of even things out for me and balance out my energy levels, too.
But again, if you're looking at it from like that perspective, it's like, just a part of a soccer team. Like, of course, you're going to use all that energy there. And that makes a lot of sense.
MEGAN NEFF: Yeah, yeah. And I know we've talked about this briefly, but like, I'm seeing this more and more. And I think, oh, it'd be great to see like ADHD and aging. You know our bodies age, which is so unfortunate. And like I know you and I, like you've had a ton of injuries. I've had long stretches with chronic pain and chronic fatigue. Like, when we lose access to movement, the grief, and the… And I know, like, you just had another soccer injury. I know you're going through that right now of like the restlessness that comes up, and the grief, and like when we lose access to pleasurable movement it is so hard for us.
PATRICK CASALE: So well said. That's an episode for sure. Yeah, I mean it's so hard to think about all these injuries that I've been picking up that impact mobility and impact my ability to have that, like, sensation seeking, intensity seeking release that I so crave. And like it really can make you feel like the walls are closing in but the grief aspect is huge.
MEGAN NEFF: Yeah, yeah, yeah. That's kind of like the OCD episode, I want to do it and I don't want to do it. But it hits close.
PATRICK CASALE: Yep, yep.
MEGAN NEFF: Okay, often unable to play or take part in leisure activities quietly. I just like scratch that quietly. I just have a hard time taking part of leisurely activities or playing a game that requires you to wait your turn, just period.
My spouse, like this is something that I don't think they realized about me for a few years in. And he was just like, "You don't rest, do you?" Like, and yeah, I just don't. I mean, I think I… Okay, I'm going to reword that. I think I do rest, but it doesn't look like other people's forms of rest. That's not restful for me. That's actually very stressful.
PATRICK CASALE: You're talking about like stillness, laying down, quiet? Like, not a lot planned? Not a lot going on?
MEGAN NEFF: Mm-hmm (affirmative).
PATRICK CASALE: Yeah. Hard relate, yeah. And I think that's why we've talked about this before. But the whole concept of like Western mindfulness is not really useful for me.
MEGAN NEFF: It's terrible. That's so terrible.
PATRICK CASALE: It's pretty painful. Like, you know-
MEGAN NEFF: Yeah.
PATRICK CASALE: …sit for five minutes, 10, 30, 45. Like, I don't care about the duration. It's just the concept in general. So, I think that our overactive systems and this restlessness can cause quite a lot of confusion for people from the outside looking in who are a part of your life who are like, "You keep talking about how exhausted you are, yet look at you like doing A, B, C, D, E, F, G all the time."
And I think the restlessness feeling for me, and comparatively to some of the stuff we've talked about with autism, the restlessness from the ADHD side has been one of the most challenging experiences of my existence, both existentially and physiologically.
MEGAN NEFF: Can you say more about that? You've sparked my curiosity?
PATRICK CASALE: Yeah, I think it's just this constant inability to be still, to be restful, to not be thinking about the next thing, to not be daydreaming, to not constantly be comparing present-day situation to future tense, to always thinking grass is greener elsewhere, to being really unsettled, to feeling really unsettled in my body, like wanting to crawl out of my skin minute by minute, second by second.
I can think of so many instances where, like, I'd be home after school, in maybe elementary and junior high, and calling friends and be like, "What are you doing." And they're like, "It's Tuesday, I'm not doing anything." And I'd be like, "Can I come over because I cannot sit in my room any longer. Like, I have to get out of here." And I think that has felt that way my entire life.
MEGAN NEFF: I love how you capture that experience. And I was, like, nodding along enthusiastically. You know, there's a lot of things I was exploring in-depth therapy. So, I was working with a psychoanalyst for like a couple years leading up to autism and ADHD discovery.
And one of the things that I now see is like, oh, this was an ADHD thing I didn't understand. One of the things I was exploring is why can't I be present? Why can't I be present to my life? Because it kept being like, you know, I'm here with my kids, but I'm not present. Or I'm here with my spouse, but I'm not present. And like I want to be present. And I'm always looking for the next thing. I'm always planning ahead to, like, the new shiny thing. And, you know, we were exploring all kinds of potential childhood reasons for this.
And then with ADHD discovery it's like, "Oh, okay. Yeah, like, neurologically, it is a struggle for me to be present."
And this is something that, again, like I have grief around how hard it is to be present. And for me when I say that, I think I'm pairing presence and contentment. There's something about contentment that is also hard for me, which I think is very tied to this, it's so hard to be present to what is.
And it's something I'm still working on. Like, I'm not adopting a defeatist, like this is impossible for me. But that has caused a lot of pain. Like, when I think about being older or like dying, whenever I die, I have this fear of looking back on my life and be like I was never in it. I was always thinking two steps ahead. And I never got to fully be in my experience. And that's really sad to me.
PATRICK CASALE: Yeah, I feel the exact same way. I feel a tremendous amount of grief around that even like present day, even as you name that I feel grief for you, I feel grief for me. Yeah, because I think it's constantly two, three, 20 steps ahead in all situations.
But then there's like, this process and I don't know if you experienced this, but like, while you're two, three, 20 steps ahead in whatever situation, there's this almost narration internally of like, you should be present. Like, you should be paying attention. You're not paying attention. You're not absorbing what's happening around you. You're not, like, accessing the love, and support, and camaraderie, and experience that's actually happening.
And I think that's why romanticism goes into this too, right? Like, we've talked so much about romanticism, and that's why. But all of this stuff, and I do think about dying a lot as well, as we both have talked about quite a bit on here. It's just like looking back and saying, like, "Did I ever really absorb what truly mattered? Or was I always so, you know, just struggling to just exist?"
And I think that it's really challenging to explain to people, it's really challenging to explain to partners, friend groups, like people that you care about because everyone, I think, on the outside would say, like, "Slow down. Like, just, life is so short." And I'm constantly like, just experiencing life in like, what feels like hyper lapse like 30 times the speed, it feels like.
PATRICK CASALE: Yeah, absolutely. I relate to all that. One practice, and this is where, you know, being more existentially oriented can be hard because we're constantly thinking about our death. But one practice, and I think having kids really helped with this, that has helped me about my existentialism is the awareness of the fact that I'm going to die, my children who I adore to no end, are going to die. Like, at some point our attachment does not get to continue, being so aware of that when I hold them, or when I cuddle them, like I'm holding on to that truth. And then there's a way, it's hard to describe, but it's like I anchor into a moment, typically, through the sensations. Like, I'm really focusing on like the way of holding them, maybe the smell of their hair. And it's this idea of I don't get this moment back.
And I actually have an image of like, I am encoding this memory into my, like, okay, this is a really weird imagery. I pretend to have like a spaceship I get to live in when I die that has like 20 memories that I've stored in my life that I get to replay. And so, I'm like, I am taking this memory and I'm storing it into my little spaceship I get to live in once I die with all my memories.
And there's something, like I take that, when I have that awareness, and then I'm pairing it with like anchoring into this sensory experience of that moment, whether I'm listening to my spouse's heartbeat, or I'm holding my child, I am able to be there. But it's only thanks to existential thinking that I'm able to really be there and capture that moment. And then encode it into my spaceship.
PATRICK CASALE: Yeah, I mean, I like that very unique-
MEGAN NEFF: [CROSSTALK 00:35:47] from Superman because you know how Superman was flying down in that spaceship and had, like, memories playing?
PATRICK CASALE: Yeah, yeah. Okay. I mean, I think if it works for you that's fantastic. Because so often we are trying all of these different things. And it can feel defeating when it's like, "Well, that didn't work. Well, that didn't work. All these things that other people are doing doesn't work." This experience is so hard to explain to other people. So, I think if you can find anything to allow you to be present for even 1% of it, it feels like a win to me, instead of feeling like I just can't do this, which so often defaulting into that mentality, so…
MEGAN NEFF: Well, folks should give it a try. Try to like encode a memory for your spaceship. And then tell us if it works.
PATRICK CASALE: Yeah. I'm actually fascinated by that. I think a lot of people are going to relate to this because this is the part of this existence that is so hard to sometimes articulate. Because I think it can be looked at in so many different ways, like, the restlessness, and this struggle to be present, and this moment by moment, like, thinking about the next thing can come across to people as like selfish or self-absorbed, or like, you know, you just don't care about what else is going on. And it's like, no, I care very deeply. I wish I could really be a part of it. You know, I wish I can be a part of the world that I've created. And that feels so weird to say.
MEGAN NEFF: Yeah, yeah. And again, back to like intent and impact, like this does impact the people around us because if, like, this experience, and I know this has been hard for my spouse, like, because, and again, this was pre-discovery. One thing he said to me once is like, "It feels like you struggle to be content." And like that's hard, right? It's hard to be in relationship with someone and to feel like no matter what they can't be content in the life you've built together. That is going to impact the people around us. And it's going to impact us. Yeah, yeah.
The other thing I'll just identify, to me, this feels very related to understimulation as well. And so, that need to escape into like three plans ahead. I think it's partly it's like, this is a way of getting more stimulation. So, that would be the other exception is in really stimulating but the right kind of stimulating moments. Those are the moments that it's easier for me to be present in.
PATRICK CASALE: Agreed, 100%.
MEGAN NEFF: The worst experience, and it took me being at a high school play for me to remember this. The worst experience is when I'm understimulated and overstimulated simultaneously. And that's a very, like, autistic ADHD. It's like that to me, yeah, that is the worst.
PATRICK CASALE: Agreed.
MEGAN NEFF: Okay, oh, and I think that is part because the thing is unable to play or take part in leisurely activities quietly. So, again, I think for like children, it's often they need more stimulation in the environment. Like, I was often picking fights with my siblings. I was the youngest, but this is a common way it can show up. It's like, if there's not enough stimulus, I'm going to pick a fight because that stimulus of a fight, even though it's negative is better than this dreadful feeling of nothingness. So, this is something that will show up a lot in kids is, and adults, too. Like, we might pick fights with our partners if we're understimulated or our friends.
Should we move on to the next one?
PATRICK CASALE: Mm-hmm (Affirmative).
MEGAN NEFF: Okay, so the next one is often on the go acting as if driven by a motor. And the example they give is unable to be or uncomfortable being still for extended time, as in restaurants, meetings, may be experienced by others as been restless or difficult to keep up with.
PATRICK CASALE: Yeah, I can think of a million examples of this. But yes, absolutely. And my friends, current day friends would be like, "When Patrick's ready to go, he's ready to go." And there's no stopping that once that moment happens, where I'm like, "Got to get up, got to leave." Like, it's got to happen.
And I think there's some overlap into like, the autistic parts of the social struggles in those environments of sensory overwhelmed too. But for me, the ADHD part of like, this is boring. I need new environment. Like, I need to get out of here. It's got to happen right now. Really fun in work settings.
MEGAN NEFF: I think we both talked about our hatred of meetings, which is why we work for ourselves. Yeah, yeah.
The worst to me is like when you're, I really dislike being in public, in a group of people. Like, I remember, like, my most recent ones has been like chaperoning, like, at the zoo with the kids or like, if you're in, like, at a family gathering, and you're going to a museum. And you're all like waiting to all gather to then go to the next thing. And I'm like, that drives me crazy. It's like, I just leave often, which I realize now is rude. But I can't. I just can't. But like [CROSSTALK 00:41:15]-
PATRICK CASALE: [INDISCERNIBLE 00:41:15].
MEGAN NEFF: What did you say?
PATRICK CASALE: You should see me when I host retreats when I'm like-
MEGAN NEFF: Oh, that would be… Yeah, how do that?
PATRICK CASALE: [INDISCERNIBLE 00:41:23] you're trying to get 30 people to do something within like a 10-minute window. And I'm just like-
MEGAN NEFF: Oh, my gosh. That sounds terrible. I would just be like, "I'll be here. Come find me."
PATRICK CASALE: Started to do that where I'm like, "Drop a pin into the WhatsApp. Like, can't do this anymore. Have to get out of this." So, yeah, it's quite challenging.
MEGAN NEFF: Yeah, that to me is also like, yeah, such an uncomfortable feeling, waiting on. And it's just so inefficient. Yeah, just like tell everyone where to meet and just, I mean, I get that doesn't always work. But yeah.
Okay, and then the last one here is often talks excessively.
PATRICK CASALE: Yep. For sure. I mean, I think this can also be misconstrued, or misdiagnosed, misidentified as pressured speech for folks who struggle with bipolar disorder. But if there's that excessive talking, filling that space, not able to, like, transition, to slow myself down.
I know, and I'm going to say this, and I know this could have some reaction, when I was working as a therapist, and even now in friend groups or social groups, like, I really do struggle with people who really struggle with often talks excessively, and being unable to transition or segue out of it.
MEGAN NEFF: Yeah, yeah. Well, and also this might get some reaction, we might choose to edit out, we get to decide. But like you and I, there's been some podcasts we haven't aired. And one thing we noticed once is that a lot of the ones we haven't aired have been with just ADHDers, not autistic ADHDers because we don't air episodes if it doesn't feel conversational.
And I remember a moment where you and I kind of looked at each other, and we're like, "Aren't we supposed to be the ones that can pick up social cues?"
PATRICK CASALE: Yep, yep, yep, yep. I remember the day and time.
MEGAN NEFF: And so, the… What did you say?
PATRICK CASALE: I said, I remember the day in time when that happened.
MEGAN NEFF: And so, I think this is an interesting, like, ADHDers also struggle socially. And this is one of them, is in that talking excessively. And then when there's not kind of that, like you and I both have pretty massive monitors because of our masking. So, I think we kind of will put the brakes on, and then like, do the dance back right to get the other person talking.
When an ADHDer doesn't have that monitor, it can make it feel like you're in monologues. Or we're like receiving a monologue. And that can be for an autistic person, that to me is very overstimulating because I absorb things so intensely. So, when someone's talking at me, and I do have some folks in my world where it feels more like that than a conversation, like my body will start to feel sick.
PATRICK CASALE: That's when I think our autistic parts don't help our facial expressions in those situations because I'm just like, how do I get out of this? Yeah, yeah. 100%.
MEGAN NEFF: So, this, I think this gets to a tricky question that I've also had is one of the interventions for children is to develop like a self-monitor, that's one of the things that helps them and it does help them to, like, get better responses from their peers because then they're not kind of talking over people in this excessive way. They're learning to, like, do some of that back and forth.
But technically, that is teaching ADHD masking. But also, I want to tease it apart, like, what's ADHD masking? And then what's having a monitor to be like, okay, I am taking up 80% of the conversation pie here. And I want to think about time equity. Like, what's the difference between masking and then kind of being thoughtful in how we share time equity?
PATRICK CASALE: It's a great, great point for discussion, for sure. Because I agree, I think that we've talked about this with like, masking, obviously, understanding the reason, the rationale, the benefit, and also having to think about, are there any sort of internal accommodations that I need to make to be able to participate in areas of my life that I need to participate in? And it becomes really challenging to tease apart.
MEGAN NEFF: Yeah, yeah.
PATRICK CASALE: Because I know there are people listening who are like, "You absolutely have to be unmasked to be as affirming as possible." And if other people can't handle that, then fuck them mentality. And then it's like, "Oh, I hear that, and I want to buy into that."
MEGAN NEFF: Yeah. No, I've seen an uptick of that mentality in the last year. And I want to find words to articulate why that unsettles me. I think there's something about, it takes it out of the relational field. And it's like, we still need to be considering our impact on people. And we are humans in relationship. And if our relationships aren't working, as soon as we say, well, our relationships are working because you're doing this, because there's a lot of words that get thrown out. And so, you just need to accept me. Like, the conversation collapses.
One thing I'm really interested in, I've always been interested in is how do you expand space? How do you expand conversation? But right now, there's ways that we're talking about being neurodivergent affirming that just collapse conversation because it's like, well, if you can't get on board with me being this way100% of the time, we can't be in relationship. I don't feel that is the affirming work, especially, if we're thinking from an, like, interdependence relational model of humaneness.
PATRICK CASALE: You've used the phrase intent versus impact several times today. And I think that's kind of what I would go back to is like intent and impact, too. And that doesn't, we're going to get way off course with this. We need to do an episode on like, neurodivergent affirming language, and identity work, and things that get messy, and things that are nuanced, and all those things because there's so many gray areas here. I don't want to go into like the black-and-white thinking patterns that we can fall into.
MEGAN NEFF: Yes, I want to talk about this more, too. It's been on my mind a lot, especially, this year. I feel like the conversation I'm seeing some shifts in it that are interesting to me. And-
PATRICK CASALE: For sure.
MEGAN NEFF: It's really easy to get kind of polarized in our thinking. And, yeah.
PATRICK CASALE: Absolutely.
MEGAN NEFF: We've gone through the hyperactive. So, there's one, two, three, four, there's five. And again, hyperactive and impulsivity traits are actually combined. But they're also, yeah. So, those are the five hyperactive traits. But they're very written for children, as you can see.
PATRICK CASALE: Right. Yeah, so I think with that being said, when you're hearing some of this stuff, I think really trying to expand on what are these symptoms or traits that are linked in this DSM-5? How can I, like, deep dive this with a different perspective? Acknowledging like, sure I'm not climbing bookshelves at 30 years old, but in reality, falling and defaulting back to the restlessness, falling back to the other things that we talked about today. And just acknowledging like, is this impactful for me? Am I experiencing this in different ways? Can I apply different contexts to this? And in a present-day setting, I think that's important, too.
MEGAN NEFF: Absolutely. Well, I think we're going to keep talking about impulsivity. But we're going to break here and break this up into a couple episodes. So, for listeners, we'll say goodbye here. And then we'll pick back up on impulsivity and more about ADHD next week.
PATRICK CASALE: Yep. So, to all of you listening to Divergent Conversations podcast, we have new episodes on Fridays on all major platforms and YouTube. You can like, download, subscribe, and share. Bye.
