Episode 56: “What is ADHD?” (Part 2): Unpacking ADHD-Inattentive Traits
May 30, 2024
Show Notes
ADHD has many nuances and is often misunderstood and stereotyped. 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, talk about the DSM-5 criteria for the inattentive subtype of ADHD, as well as share their personal experiences.
Top 3 reasons to listen to the entire episode:
- Understand the DSM-5 criteria for ADHD, offering a deeper understanding of the inattentive, combined, and hyperactive subtypes.
- Hear about Dr. Neff and Patrick’s struggles with inattentive traits of ADHD, including household chores, daily activities, the overwhelming feeling of decision fatigue, and the resulting “ADHD Tax.”
- Discover some ways that Patrick and Dr. Neff cope with the day-to-day struggles of ADHD, from managing time and prioritizing tasks to overcoming the hurdles of incomplete projects and decision fatigue.
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
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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.
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PATRICK CASALE: So, Megan and I are going to talk about our own experiences of ADHD, our own kind of zoom-out perspectives of what it was like as children, adults, teenagers, for ourselves. And then we're going to get into DSM criteria, and kind of go through the three different types of ADHD.
So, where are we starting in terms of-
MEGAN NEFF: Like, yeah. I mean, let's go through, like, the criteria. And yeah, again, I think we're doing this partly because it gives structure to the conversation, but also just transparency, if someone is pursuing a diagnosis, like these are the criteria. At least in the States, this is what's used. In Europe it might be slightly different. But a lot of these would still be included in what's used in Europe.
So, okay, first of all, when we're talking about ADHD, yeah, there's three subtypes. You already mentioned that. So, it used to be, right, like people can be sometimes confused because like, well, I was diagnosed with ADD. So, it used to be that and then they put all of it under ADHD, but with different subtypes. So, like inattentive subtype, combined subtype, or hyperactive subtype.
And I have a Venn diagram that shows us, maybe we could link it because it's probably helpful to see it visually. So, if you have, you know, six criteria of inattention and six criteria of hyperactive then you've got the combined type. Or for an adult, actually, it's just five. So, those are the three subtypes.
And then, also, the subtypes ebb and flow throughout the lifespan. Like, it's interesting, you'll look at prevalence rates. And so, like, hyperactive subtype tends to be more common around, like, young childhood age. And then, the inattentive type is more commonly diagnosed in adulthood.
So, I think, like, we don't want to think about these as static boxes, but it's a bit more dynamic in that at one time you might go to a clinician, and they might diagnose you with ADHD inattentive type. Possible you would go at another point in life, and it would be combined type. So, there's some ebb and flow to these.
Okay, but yeah, I think, when we're looking at the DSM, you know, the first bucket is inattention. And there are nine different symptoms that are highlighted and to meet criteria. Yeah, six if you're a child or five if you're 17 or older.
So, let's just go through these. This is going to be fun or like, really sobering.
PATRICK CASALE: Right.
MEGAN NEFF: So, the first one, often fails to give close attention to details or make careless mistakes in schoolwork, at work, or during other activities. So, misses details, work is inaccurate. Do you meet this criteria, Patrick?
PATRICK CASALE: I think it depends. Like, I would not say all the time. But I think that there's also a flip side for me where I am having to work so hard not to miss the details, or to overlook something, or to drop something, drop a ball while I'm juggling. So, I would say for me, not as much. What about for you?
MEGAN NEFF: I'm kind of a mixed bag in that I definitely miss details and my spouse would agree. But I also have OCD. So, there is a lot of checking behavior that, like, is kind of a safety net for this. And yeah, there's a lot of compulsive checking.
But no, I like, oh, my gosh, I have so many expensive stories for this year. So, like yeah, this is a great example. And it was one of those moments of like, okay, maybe I can stop doubting my ADHD now that I don't doubt it that much. But experiences like this are very reinforcing.
So, I took a trip with one of my children to California recently. And I've been doing that a lot because I have learned I really need sunshine in the winter. And I was being so careful. Like, right, we were booking airplane, we were booking Airbnb, and were booking a car rental. So, I was doing my obsessive checking. And I, like, made sure okay, like, all the dates are aligned, yes, we're flying on the date of the Airbnb.
And then the night before I go to check in for my flight and I don't see my child's ticket. And I'm like, "Oh, my gosh, I only bought one airplane ticket." I like just did not buy my child an airplane ticket. And I was being so careful. So, then, thankfully, there was another ticket left. But it was a very expensive ticket.
So, that would be an example of missing details. And yeah, so I do actually have a lot of examples like that.
Paperwork, like DSM paperwork, not DSM, what's the drivers place? The DMV. Like, any kind of paperwork is so laborious for me, partly, because I'm like struggling to understand, but also, I typically miss details. Like, even when I'm doing contracts with people for, like, public speaking, I feel like I end up going back and forth because they're like, "Actually, can you also fill out this section of the paperwork?" So yeah, this causes me quite a bit of stress.
PATRICK CASALE: I appreciate that perspective. And I think that makes me realize how much, like, accommodation I've had to build into my life so I don't miss details too. Because I do the obsessive checking, also OCD. But I also have, like, folders for things that are labeled specifically. I have certain, like, calendar reminders for me to do specific things. Because if I don't do all of the things, and it feels like sometimes you have to get the system just right, I know you've mentioned like the Goldilocks thing on here a million times. But that's how it feels. And if I don't do one of those things, then it's much more likely that something's going to fall through the cracks. And I'm going to miss the details. And then all of a sudden, it's going to snowball.
MEGAN NEFF: Yeah, absolutely. And one thing I do want to say while we're talking about OCD, so a person, especially, around this, missing details, an ADHDer might develop compulsive checking because they are prone to mistakes, which that in and of itself wouldn't be OCD, that would be compulsive checking. And then, a person, you know, we know a lot of us also have OCD. So, like for me, it's both. I do compulsive checking, which I think is compensation for the ADHD. And then I also legit have OCD. So, I just want to clarify that as listeners are hearing this, that you might have developed some, like, compulsive checking around this not necessarily OCD. And it could be both.
PATRICK CASALE: Sounds like another episode.
MEGAN NEFF: Yeah, we should definitely do an episode on OCD. I have a lot of avoidance around that. OCD, that's the hardest aspect of neurodivergence that I live with and for my children, as well. So, yeah, I have a lot of avoidance of talking about.
Actually, that's not true. I kind of like I have OCD. But, yeah, I have feelings for OCD. Okay, anything else about that? About attention to details or should we move on?
PATRICK CASALE: I think that makes sense to me. And I think that people listening are going to either like say, "Oh, that is really something I struggle with." Or it's going to be more of that gray area of like, "Well, sometimes." Or, "I have a mechanism in place to support myself."
And I think these are the things, those mechanisms, those accommodations, those adaptations are the things that a lot of people in society do not get to see because we've gotten so good at creating them because we've had to out of necessity.
MEGAN NEFF: Yeah, I mean, this reminds me of our autism series, how much we talked about you have to ask the deeper questions to get to the person's internal experience. So, like, you could ask this in a clinical interview. But then it's like, "Okay, well, like what do you do, you know, to avoid mistakes?" You want to be listening for those compensation strategies that take a lot of energy and time.
PATRICK CASALE: And that's why I'm so glad you mentioned what you mentioned about your child's ticket, etc., because when you first asked me that question, I'm like, "No, not an issue." Then I started thinking about it more and more I'm like, oh, yeah, there's [INDISCERNIBLE 00:10:12] like, in place to create, like a safety net."
So, I think that's a struggle for me a lot of the time is like, it is very much face value at the question. And I'm not thinking much deeper until I hear the details. And I'm like, "Oh, now I'm processing that, yeah."
MEGAN NEFF: Yeah, yeah. So, here's another example. And like, it still haunts me. So, in grad school, and this is when I was at Princeton there was one course that was like the hardest course in the seminary, everyone knew this. And I studied so hard for it. Partly, was a subject of interest.
And I was like, "I'm going to do so well on this test." It's a test that, like, they gave very few A's. And I got every question I answered right, but I got a 92. And it's because there was a part where you're supposed to answer six questions. And it was on the back, and I answered three.
And like, that's such a classic example of I spent hours and hours and hours studying. And then, like, when it came to taking the test, I just either misread that you're supposed to answer all of them, or I missed the back of it. And like, it haunted me because I was like, "I could have gotten 100 because I knew all of those answers. And I probably would have been the first person to like, ever get 100 on that test but I did it because I missed the back."
PATRICK CASALE: That would haunt me too.
MEGAN NEFF: Okay, so the second, it's interesting. For me, like, the language of the DSM is symptom, I guess, trait. These are worded so much like symptoms. Like, second symptom or second experience, how about experience?
PATRICK CASALE: Me too.
MEGAN NEFF: So, the second experience that is identified? So, this would be, yeah, is often has difficulty sustaining attention and tasks or play activities. Difficulty remaining focused, or in lectures, conversation, or lengthy reading.
This is one of the reasons I had a hard time seeing myself as ADHD is because I often am doing activities in my interest. And so, I was like, "Well, no, I can focus for long times." Or like, I used to be an avid reader. I don't retain what I read very well. But actually, even that, I would like reread paragraphs or pages over and over because I'd be like, "Oh, my gosh, I started daydreaming I have to go back five pages."
But yeah, this was a reason I had a hard time seeing it because I'm often doing things in my interest. And that's where the interest-based nervous system comes into play. I wish that the language on this would kind of qualify when it's outside of your interest because that's when we tend to have difficulty sustaining attention.
PATRICK CASALE: Yeah, I love that usage of that specific language. And I absolutely think we need to do an episode on that because that's such an important distinction. If I'm not interested in it, there's no chance in hell I'm paying attention.
And so many times, right? Like, how often do you or any of our listeners experience, like, "Well, you're not paying attention, you're being rude, you're being disrespectful." Like, if I'm in a lecture, if I'm in a training, if I'm in a talk, I'm probably on my phone or on my computer, and I'm doing other things because that's helping me pay attention.
If I have to sit and actually absorb, and it's not within that special interest or that zone for me, it feels almost impossible. And I just get so distracted so easily with that.
MEGAN NEFF: I just had a flashback to grad school for my PsyD of like, I would spend so much time. I'd always like try to kind of sit in the back so other people couldn't see my computer. Because, yeah, that was the first time I was in school where we had, like, internet access and like, you're multitasking often. And I would do that. And it would often help me focus sometimes not on that.
PATRICK CASALE: Sure.
MEGAN NEFF: But like the experience of boredom for me just like it hurts all over my body. Like, I just want out. So, yeah, I was always multitasking. And some multitasking helped me focus whereas some was just, I was trying to escape boredom. But even before that, like, I'd always be doodling. Yeah, I mean, school is just so boring.
PATRICK CASALE: It really is. It really is. And if anyone's gifted and just able to learn differently or absorb differently, and retain differently, like, I told you this before, I didn't go to class and I could get A's all the time. I just absorbed things very quickly. And-
MEGAN NEFF: Yeah, I'm jealous. And my brain's not like that.
PATRICK CASALE: … sitting in a lecture or sitting in, like, an hour, a two-hour class I was just like, did I ever tell you that I had to take Intro to Canada when I was in undergrad, which is the most boring lecture experience.
MEGAN NEFF: Be careful. We've got Canadian listeners.
PATRICK CASALE: Maybe it was just the professor, maybe it was the material, I don't know. But I would just get up and leave that class every single day until I eventually had to drop it because of like, I can't keep missing these classes, found some strange elective that was a much better fit.
But those are real examples of like, it feels, like you said, it's so uncomfortable in my body when I'm bored, or when I can't pay attention, or when I can't focus. And then I will start moving, then I will start, like, fidgeting, then I will start, like, shifting over and over and over again. And I have to get out of it. I can't just sit there.
MEGAN NEFF: Yeah, absolutely, absolutely. I think the worst combo for me is when I'm in a conversation that is boring, that I'm trapped in. Because it's both, like, the sensory demand of being in a conversation plus the boredom. That to me, like my body just, like I'm having a visceral response just talking about it. Like, the combination of that is just-
PATRICK CASALE: Absolutely, 100%.
MEGAN NEFF: One thing, this is where I think my autism kind of helped out my ADHD is I've always been pretty good at associative thinking. And so, for the most part, if I was, especially, this got a lot easier in college and grad school than K12. But I could typically, for most courses, find a way that it linked to something of interest. And if I could make that association in my head, then I could be engaged in the class. And I think I did all kinds of tricks like that, I think. Like, okay, this is kind of like this thing, which was an area of special interest. And that was one workaround I did to get myself interested.
PATRICK CASALE: Yeah. I think you mentioned that in one of our episodes, yeah. One of your special interests, I can't remember what it was. You kind of [CROSSTALK 00:17:21]-
MEGAN NEFF: Oh, yeah, sex trafficking. And then, like, I would study that, and yeah, yeah.
But even in lectures, if it's like, okay, they're talking about this, but I can make a few jumps and connect it to this idea I am interested in, okay, now, this is interesting.
PATRICK CASALE: Right, absolutely. But if you can't do that, then it's kind of like vacancy.
MEGAN NEFF: Then it's multitasking on the computer, yeah.
PATRICK CASALE: Yeah, yeah.
MEGAN NEFF: For real. So, yeah, that's hard. And this one is socially hard. Because like, there's times I wish, you know, that people can tell when we shut off. And like, I think that is hard when it's, like, when you're socializing, but the thing the person is talking about is just so boring.
PATRICK CASALE: Here's a real meta experience, when you are in those conversations, and you shut off, and you know you're shutting off. But then you start to realize that the other person realizes that you're shutting off, then you have this really meta experience, like, looking at the conversation from a different lens, like outside of your body. Like, how do I get out of this, but I also understand that this person knows that I'm not interested in this? And it's such a strange dynamic. And I don't know how to navigate those things. I just know that my face and my body betray me most of the time. And then, I ultimately like end up backing, sometimes, like moonwalking backwards out of conversation sometimes just to get the hell out of there.
MEGAN NEFF: Okay, so this is interesting. I could see this. So, one thing we talked about with autism is the tendency to bring conversations back to our special interests. I could see this also been through in ADHD. Like, I feel like I definitely do this of if I'm wanting to continue the conversation, but I'm bored out of my mind, then I will either try to, like, emotionally increase the emotional charge, either through, like, increasing, like vulnerability, and emotional intensity of the conversation, or bring it back to a topic of interest. Like, I will try to do something to get me back engaged.
And so, I could also see how this could look like, "Oh, well, you're always bringing it back to your passions or your interests." But it would be a way of like, well, I'm trying to get my body engaged and my mind engaged in this conversation so I can be here for it.
PATRICK CASALE: Yeah, and we've talked about the autistic perspective of some of these social experiences and struggle areas. ADHD, same way, right? Like, the other person in this dynamic can oftentimes say like, "You're really rude or you're being really kind of self-absorbed or self-centered because you only want to talk about the things that you're interested in." And I just imagine that it can be hard to be friends with us sometimes.
MEGAN NEFF: Yeah, I mean, I think in a, like, healthy dynamic there's space for both people's subjectivity. And if every time the person we're talking to brings something that they're of interest in, they feel shut down, or they are shut down. Like, that's not a healthy dynamic.
And, like, this is where I could see one argument be like, "Well, this is how our brain works so this is how we are."
But it's like, well, I think, yes, like, this is how our brain works. And I think we can stretch. Like, I work hard to learn to like… like my spouse is really into European soccer. And like, that is very uninteresting to me. But I try to remember to, like, ask questions about it and to be engaged because I know that that's a point of connection and I value him. So, I think it is important to also, like, stretch ourselves, like, you know, to be there for the people we care about.
PATRICK CASALE: Yeah, absolutely, 100%. I agree, absolutely.
MEGAN NEFF: Okay, so the next one up is often does not seem to listen when spoken to directly, mind seems elsewhere even in the absence of an obvious distraction. So, that kind of, like, daydreaming or just not there. Have you gotten that feedback from folks?
PATRICK CASALE: Absolutely. Yeah, it happens a lot, especially, I think if… So, distraction. It could be executive functioning-related, sometimes. Like my mind is just kind of slowly shutting down. So, it becomes so much harder to sustain attention, and focus, and conversation. It could be the conversation's not interesting. There's a lot of reasons for that. But I've gotten that many, many times.
MEGAN NEFF: Yeah, yeah.
PATRICK CASALE: What about you?
MEGAN NEFF: You know, I think my hyper-arousal and masking was so high that when I was in conversations I didn't necessarily get it a lot. I get it a lot, you know, my kids are really good at calling me out. They'll be like, "Oh, you're not actually here." Or sometimes they'll ask a question, I'll give the answer and they'll be like, "Is that a real answer or is that, like, your fake answer which is like autopilot answer?" So, my kids will do a great job calling me out on this and I'll catch myself.
The one thing that I got a lot in college, and also, like, in adulthood is people will be like, "Oh, I saw you like walking to class, and I said hi, and you just walked right past." Or like, people will call my name and I didn't hear it. So, like, I've gotten a lot of feedback around that of people trying to get my attention or call my name, and me not hearing it.
But when I'm one-on-one with someone, I think it'd be interesting now, but back in the day, I think my masking and hypervigilance was so high that this was not a super common feedback that I got.
PATRICK CASALE: Yeah.
MEGAN NEFF: Okay, often doesn't follow through on instructions and fails to finish school works, chores, or duties in the workplace, starts tasks, but quickly loses focus, and is easily sidetracked.
PATRICK CASALE: Yeah. I can give personal examples to this because it happens all the time. But I just know that this is one of the experiences for me, in addition to the ADHD tax that we're talking about, especially, that financial piece or whatever. That brings up a lot of like shamefulness because it's that, like, stereotypical lack of follow-through of like, you can really get into this internal narration of, I just can't follow through on things like…
And this as an entrepreneur happens all the time. I have all these ideas. I start them. I get like six steps in, and then they no longer interest me. And that's my reframe now is like, well, it no longer interests me. It's not that I can't follow through on things because I certainly can. But that is a constant where if it's not interesting to me, it's so challenging to follow through on completion of any task.
So, that's why we see, like, all the videos of people posting like, "Here's my laundry in big piles in my laundry room." Or, "Here are the dishes building up in the sink." Or, you know, all of the things that a lot of ADHDers tend to experience because that stuff feels laborious, that stuff feels meticulous, it feels boring. So, where's the incentivization to getting it done?
MEGAN NEFF: Yeah, yeah. So, I've so many half-finished projects and I think I've five half-finished eBooks or digital workbooks right now. Like, oh my goodness. Yeah, I call it tree branch projects. And actually, I think I've created kind of a work ecosystem where this works.
But like last week, I was going to go schedule my, like, social media posts. But it led to like a two-hour long tree branch project of like, "Oh, actually, I should add this resource to my newsletter resource vault. And then, I need to make a landing page for it. And then, I need to make like a sequence for it."
And I was, so, I have things in place where I can do these tree branch projects. And the more I've been able to create a lifestyle where I can just follow these tree branch projects, it's been helpful, but it also is stressful to know there's, like, a lot of half-finished projects out there.
For me, I never really struggled with getting assignments in on time. And again, this was why ADHD was hard for me to see. For me with school, as soon as I would get a project on my plate I would do it. And it's like this anxiety, actually, I think this might be, like, partly demand avoidance stuff. But like, I would feel so anxious knowing something's on my plate. So, like, as soon as I would get a syllabus, I will try to do all the homework assignments. And it's just this myth of like, once I get all the tasks done then I will be free.
PATRICK CASALE: Right.
MEGAN NEFF: So, I like would do the opposite where, like, I would start projects early, which would sometimes backfire because I didn't have all the information I needed. So, that is one of the reasons that ADHD felt really hard to see. But it's this, like, need to get demands off my plate because I just feel like the pressure of them as long as they exist.
So, for school, unless I just missed it because like I missed a detail I tended not to struggle with getting assignments in.
PATRICK CASALE: I didn't struggle to get the assignments in but I definitely always waited until the last minute. And like, it didn't matter how easy it was, it didn't matter how long it was going to take me, I needed that pressure in order to propel into that. And I think we look at that so often as like a negative. But I mean, it has been working for me my entire life. So, I just started embracing that as well.
But I think that for me, when you're talking about the pressure of getting those things done, a lot of that pressure for me comes with, like, responding to things. And that could be like emails that I need to respond to or messages. And I will respond to them immediately or schedule send a response because if I don't, I will forget them. And then they will disappear forever.
MEGAN NEFF: Yeah, I feel that of like, oh, this is in my mind now. Or even, like, I have energy to respond to this now or interest. Like, I'm interested in what this person is saying, so I've got to respond to it while the interest is hot.
PATRICK CASALE: [CROSSTALK 00:29:13] like you said, of like once I get all these responses done, man, I'm going to feel a lot of relief. That never comes, so…
MEGAN NEFF: Yeah, like more demands come that like we're chasing the end of the rainbow with like, once all these demands are done, but yeah, yeah.
Yeah, no, one of my children once said, like, I just can't wait till I retire. And this is a very young child. And it felt so much sadness for them. And I also totally got it of this idea that there's like, especially, I think if you're a PDA or have like intense demand avoidance, like it just feels so daunting, like facing demand after demand after demand.
PATRICK CASALE: I don't resonate with anything your child or you've ever said any more than that because that has been my fantasy since I was a kid where I've been like, "I can't wait to not have to do these things." Like, because I just can't tolerate the day-to-day demands, and the piling up, and the stress, and the energy that goes into it.
MEGAN NEFF: Yeah, yeah.
PATRICK CASALE: Yeah. Anyway, I'm going to sidetrack us or derail us so you can continue on.
MEGAN NEFF: Okay. So, often has difficulty organizing tasks and activities. So, difficulty managing sequential tasks. This is really like executive functioning stuff, right? Or messiness, keeping things in order, time management, meeting deadlines, disorganized work.
So, organizing tasks, which organization, right, there's a lot that goes into that. There's the, okay, I've been given a project, I've got to break it down into different tasks that tends to be harder for our brains. And then, there's time management of like, okay, I'll get this part done and then this part.
I think that's also kind of why I just jump right in because my brain's like I can't break this all down. So, I just need to, like, jump in and do it. I have a really hard time shifting. So, like, I just gave this big talk. And for the last three weeks, I feel like that's all I've been focused on because I can't… And I've got other projects that, like, I could have been like, "Okay, I'll work on this for a few hours, and then this." But like, I just have to be in a messy ecosystem of like, working on it all at once versus like breaking it down. I'm not sure if that's making sense but…
PATRICK CASALE: I mean, to me, it makes perfect sense. Like, when I see all the steps, all the different, like, processes for something, it's so overwhelming that I'd start to shut down kind of. And I can think, specifically, like cooking is a nightmare for me. So, if-
MEGAN NEFF: Oh, yeah, I don't cook. Yeah, absolutely.
PATRICK CASALE: Yeah, I try. I mean, if it's not like, put me on grill and grill me, okay, I can do. That feels like straightforward. But if I'm, like, following a recipe I get so-
MEGAN NEFF: Stressful.
PATRICK CASALE: …frustrated. It's so stressful.
MEGAN NEFF: Me too. And then, all the cleanup. And it's like, "Ooh."
PATRICK CASALE: Like, I can't do it at the same time. For those of you who do both, you're a magician. But like, Arielle, my wife will come home and be like, "I see that you cooked dinner and I appreciate that. But look at the kitchen. Like, you use every pan that we own." And I'm like, "Yeah." And it's so hard for me. Then I'll be like, "So, how do we cook this thing, and this thing at the same time, and have them done at the same time?" That feels like, that's wizardry to me. So, I can't do that. It has always been a struggle.
And again, like if I'm looking at a project for work that I really even want to create, so I get lost in that because it becomes too overwhelming. So, for right now I'm like, "We're going to create all these sales pages for these retreats for 2025." And I'm just looking at, like, blank documents right now knowing like, I have to do this thing, then this thing, then this thing, then this thing. And I'm like, "Can I just get to the place where it's finished?" Like, it's a really hard place to be mentally to like, just struggle with how to put things in order sequentially.
MEGAN NEFF: Totally, totally. I just had an aha moment of I've been saying probably for two years I want to build courses. So, like, I have all these workbooks. And any one of them could be turned into a course.
And I think the education component of me, like, yeah, I get that. Like, that could be module one, that could be module two. But even though I know, like, that would be such a smart business decision, and I actually have interest in it, that combination decision fatigue of like, well, what platform? And what kind of course? But also, there's the steps, there's so many steps in building a course that, like, I keep trying, and I keep running into blocks.
PATRICK CASALE: For sure. I was, you know, doing these, like, live coaching courses for so long. And my VA would be like, "You should really make this evergreen. And you should chop them up, and make modules, and then, do this in like sequential order."
And I'm like, "If I'm not going to show up live, I'm just not doing it." Because I get so overwhelmed. Would it be the smarter business decision? Absolutely. Do I feel like I can sit down and actually figure out the steps in order to like, piece everything together? No. And if I start doing that, I'm going to get distracted, going to start working on something else. And that thing is just never going to happen. And that is honestly really, really frustrating for me. And it's probably one of my most frustrating experiences within my ADHD experience is like that inability to sequentially do something or kind of like, zoom out, and be like, "Okay, now we're going to do this, now we're going to do this. This is how this goes together." It's like, "No, it's either going to happen organically or it's not going to happen at all."
MEGAN NEFF: Yeah, yeah, I am relating so much to what you're saying, yeah. And this is why and maybe this might be too much of a diverge than we want to go, but like, so, about six months ago, I noticed a lot of people were shifting from executive functioning disorder or disability to difference. I actually, like, it feels really invalidating to call it a difference. Like, for me it is very much a disability. And for a lot of the, like, ADHD folks I work with, it's like, "This is a disability." So, I don't know how you feel about the language, but to me, I think it's absolutely an executive functioning disability. And I think we really see it in this criteria.
But yeah, we should do an episode on that. There's a lot of like, a lot of people are shifting language away from disability in both autism and ADHD spaces, and I'm curious about that, and I am worried about that. Yeah, but that's another conversation.
PATRICK CASALE: So, if we're going to pin like four total conversations from today, I'm trying to keep a mental list of like, what did we say? [CROSSTALK 00:36:26]-
MEGAN NEFF: We're doing the ADHD tree branch thing. Like, okay, so we want to talk about interest-based nervous system, disability language in the neurodivergent space. Okay, I lost the other ones. There were more.
PATRICK CASALE: Yep. We want to talk about OCD.
MEGAN NEFF: Oh, OCD. See, I told you. I have so much avoidance around OCD. I blocked it.
PATRICK CASALE: [CROSSTALK 00:36:48] I don't remember what we said. Yeah, no. Okay, pinning it all for, yeah.
MEGAN NEFF: Okay.
PATRICK CASALE: Yeah, yeah.
MEGAN NEFF: You'll be our holder of the chaos. Okay, so we are getting close to getting through the inattentive criteria. I'm going to try and let's see if we can get through it in one episode.
Okay. So, yeah, difficulty organizing tasks. That's huge. I think this is where executive functioning coaching can be helpful, where systems can be helpful. Like, yeah, I feel so much stress around this. Like, my business, my goal for this next year is to, like, actually create processes and systems because my business is chaos because digitally I really struggle with organization. So, this is just-
PATRICK CASALE: For sure.
MEGAN NEFF: Yes, this is a hard one, okay. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort, schoolwork, homework, preparing reports, completing forms, reviewing lengthy papers.
PATRICK CASALE: Check.
MEGAN NEFF: For me, again, if it's outside of interest, and then the other thing that, like, made it hard to see this, again, it goes back to that demand, if it's like, I know I have an assessment report to write, typically, sometimes I would procrastinate, but typically it's like, I need to get it done.
PATRICK CASALE: Right.
MEGAN NEFF: Because then I have freedom. But like, for me, I feel this in like life, like activities of daily living, like scheduling medical appointments, going to the dentist, going to like, basically, things impacting my health, and like, daily living, this is where I really feel difficulty engaging in a lot of those tasks. If it's a demand that's been placed on me I will often, sometimes I'll procrastinate, but I'll often do it to get it done.
PATRICK CASALE: Right. Yeah, I can relate. And of course, we all have, I shouldn't say we all, so many of us have so many medical appointments, and like medical needs to take care of, and it can be so frustrating to try to have to, like, prioritize those things when you really simply just do not want to, and you don't have the space or energy to. So, I know you live in that life quite a bit.
MEGAN NEFF: Yep, yep. Yes, yes, that one, yeah. Oh, and then the other thing for this one is, again, it doesn't specify if it's outside of interest. So, that would be a nuance, I would add. Because we can often sustain our mental energy if it's within our interest.
Often losing things, I'm already laughing, often losing things necessary for tasks or activities. So, for kids like school materials, pencils, for adults, like phones, telephones, earbuds. I lose stuff all the time. And yeah, it'll and it'll be like my phone. I'll be all like, set it down. Like, I look for this thing like probably 10 times a day because it's like I put it down somewhere. I have no idea where but…
PATRICK CASALE: I don't experience that one as much. I try to think about, like, stuff like that. Like, more often than not, I'm throwing stuff out that I actually am going to need in the future or deleting something that I'm going to need in the future. And that's a real problem for me, but it's not the same thing.
One thing that I lose constantly is the TV remote when it's in my bed. I'll put it down next to my arm and I'm like, "I have no idea where I put it." Take the sheets off, take the blanket off. I'm like, "Oh, it's literally right there." But ultimately, not something that I struggle with very often.
MEGAN NEFF: Oh, that's so interesting. Yeah, this one's a big like, losing keys and losing, like I spend a lot of time stress, searching for things. Yeah, yeah.
And I think that is probably that, like, because those of us who struggle with it will like put things down and just like not register like where.
The whole launching pad idea is great. And when I remember to use it, it's great. That idea of like, you have a place where you put everything you need to launch in the morning. So, like wallet, keys. I keep trying to do that. But I'm just not consistent with keeping things where they're supposed to go.
PATRICK CASALE: So, when Jennifer and I were in Italy, looking at that village that we're having that summit at, the woman who was the host, who I identified as like ADHD immediately lost her cell phone five different times, in the two hours that she toured us around. We had to go back into her car, go back to different, like, houses that we were in or different like settings for her to go and be like, "I know that I left it in this room, in the setting, in this location because I do it all the time."
And it was just like, constantly circling back, constantly circling back, constantly circling back. Am I surprised now when emails to her about our event aren't getting responded to? No, not a single ounce of surprise, so…
MEGAN NEFF: And that's a good point of like this experience or trait of ADHD. Like, this can be really stressful. Like, if you think about those acutely stressful moments, especially, during travel of like, I just lost my phone or my passport. Like, this is a huge cortisol burst of stress in some of these moments. So, this absolutely, I think is one of those things that just is so hard on the ADHD nervous system is-
PATRICK CASALE: Sure.
MEGAN NEFF: Yeah, I'm glad for you that this is one that you don't experience as much. Okay, we can do that, is often easily distracted by extraneous stimuli. So, for older adults and adolescents, this could also include thoughts. I'm really glad they included that. So, yeah, that could be just people around you talking, sounds, it could also be your own thoughts.
PATRICK CASALE: Yeah, that's a constant experience for me. And I noticed that like, those sounds will get louder at times, that become even more challenging to experience, the thoughts will become more overwhelming and intense. So, like, it's just a constant experience where there's like this distraction all around me and constantly having to, like, rein myself back in trying to like ground myself, trying to stim enough to focus. Like, it's really hard.
MEGAN NEFF: I think one thing I've talked about is, so I know I've used this metaphor before, like how, as a kid, I used to go under the pool and just sit there. And then when I bop up, it's like, I'd be so overwhelmed by all the stimuli. This is, I think, why I do so much with, like, hyper-focus or deep focus because when I'm not in deep focus it feels like I'm merged from the pool and my thoughts are all over the place.
And so, I'm often then, like, trying to find my next way back underwater. And by underwater, I mean, like, intense focus because it's so distracting and overwhelming to be in that bobby place which is why, like days like today, like, I have this, and then I have a community meeting, and then I have emails. Like, I have a lot of bobbing. And like, I've noticed, like, I feel more stress on days like this where I'm bobbing versus like, I have no, I mean, I guess like I kind of feel some hyper-focus in this conversation, but I don't have any, like, blocks of hyper-focus time. So, I feel more, like, kind of arousal in my body because it's like, I'm in the bobby place.
PATRICK CASALE: Makes sense. And that's a great metaphor, too. That's great imagery to think about, like, because when you're underwater, it's kind of that peaceful place, right? Like, everything's just, you can really hone in, or focus in, or just like, your mind is not going from one thing to the next. Or you're not juggling 2 million different sensations all around you.
Yeah, hyper-focus is definitely where I get most of my work done. And I think that's why I spend so much of my time, like, floating around away from it because I'm like, if I'm not in that place it feels like a moot point. Like, I'm not going to really accomplish much or get a lot done. That's why I take advantage of it too. Like, trying to get back into that place so that you can have large outputs or bursts of creation or energy, too.
MEGAN NEFF: Yeah, yeah. No, like it's interesting. I kind of attribute this to my ADHD. Like, I worry a lot about wasting time. And I think days like where I'm bobbing between things I feel really inefficient for one, but I feel like I'm working all day. And I it just feels like a wasted day, which I realized is not like the best way to think about existence or time.
But yeah, like, I do. I have a lot of stress about days and blocks of time spent in that kind of-
PATRICK CASALE: Yeah.
MEGAN NEFF: Yeah, yeah, yeah. The other, like, thing I'm thinking about, oh, no, okay, I'm thinking about a few things. Okay, reining in the thoughts. I would be curious other people's experience of like, being in a restaurant or a coffee shop. Like, I always used to feel guilty about this because I was like, "I know you're not supposed to eavesdrop, but like I can't. It's really hard not to listen to other people's conversations. Like, my brain is tracking these conversations."
So, I don't know if like, I feel like that would be part of this. Like, it's hard to just filter out other conversations. But I remember always feeling a lot of guilt about that because I was like, I feel like I'm just someone who like eavesdrops all the time. But I think unless I'm, like, putting on music my brain can't really filter out conversations happening around me. Like, and it's weird, like, do other brains actually do that? I'm asking the wrong brain, but…
PATRICK CASALE: Yeah, I was going to say, I bet if we asked, like, Jennifer, she'd be like, "Yeah, I selectively choose which conversations I participate in." And then I'd be like, "What the hell are you talking about?"
But the interesting thing, though, for me, is a lot of the times even though I'm hearing those conversations in a coffee shop, etc., that's where I get a lot of my work done. And it actually allows me to focus more while I'm in those environments opposed to the potential quiet and stillness of my home.
MEGAN NEFF: That's so interesting. Yeah, I guess it's kind of like body doubling.
PATRICK CASALE: Yeah.
MEGAN NEFF: Yeah, if I put on music I can. But I can't if I'm not putting on music. That's interesting.
Okay, we've got one more here. So, is often forgetful of daily activities. So, doing chores, running errands, returning calls, paying bills, keeping appointments. Oh, maybe I should have said all the medical stuff here. Yeah, this is I don't do activities of daily living, well, at all.
PATRICK CASALE: I think this is one that I do well. But another example of one that takes an enormous amount of mental energy to do it well. And I think, again, it's like that fear of letting it fall through the cracks, wanting to check it off the list, not wanting to have to be over or like burdened by it. But I do those things pretty well.
MEGAN NEFF: So, this is kind of an embarrassing story. Kind of can't believe I'm sharing this. But in college, I don't know, and it's interesting. Maybe partly, I mean, I should have known, but I think it was just like, it's so hard for me to get myself to do this.
In college, probably, like halfway through the year, this is so gross, my roommate washed my sheets for me because I hadn't washed them, like, all year. I don't know that I would have washed them like the whole year if she hadn't washed them. And even now, still, like my spouse, like, will do the sheets. And if it was left to me, they would be done very, very infrequently.
Like, I'm kind of gross. And I realized, like, okay, I should probably unpack that narrative I have. But like when it comes to things that require effort around things like hygiene around like washing sheets, and doing daily activities, like these things are really, really hard for me.
PATRICK CASALE: Yeah, well, I appreciate you sharing that because I can guarantee you you're not the only person who's experiencing difficulty in these activities of daily living. So, I think for those who it's really hard for, and they have to get up, and go to work, if you don't work from home, or like you have to go out into the world a lot of the time, like, it can be super frustrating too to just be like, "I can't accomplish this, I can't do this thing. Or it's taking me all of my mental energy to do A, B, and C today." And that doesn't sound like an enjoyable way to go through every day either.
MEGAN NEFF: And it's interesting to me, like you struggle less with that one. And I struggle less with like, follow through on schoolwork. And like, I almost wonder if there's like a tradeoff. Like, in my mind even it's like, okay, I can't do things like clean the bathroom or laundry because I have to focus on like this talk, or I have to get this assessment report done. Like, those take precedence over activities of daily living and like things for health. And so, I almost wonder if for a lot of us, it's like, we can have one or the other, but not both.
PATRICK CASALE: Yeah, so that's a good question. I mean, I do laundry constantly, like three, four times a week. One of the things I struggle the most with is like hygiene. I want to feel like clean all the time. So, some of that could be OCD related. I often take two showers a day, like, and, yeah.
MEGAN NEFF: Showering to me is like my sensory reset. So, thankfully, I have like, and I can't, like, start my day without a shower. Just that feels like part of the routine. So, thankfully, I shower. But other things are a struggle.
PATRICK CASALE: Sure. Yeah. I mean, it's an interesting thought process to be like, is it this other priority or is it this priority for me? And how do you weigh those things out about which one takes precedence? That's an interesting dynamic.
MEGAN NEFF: Yeah, like, for me, the urgent demands of I've got something do like in school or professionally, those like almost always take precedent, which I don't like that. But that is how my brain works.
And then I'm always like, well, when I get done with that, you know, then I'll schedule my medical visits or then I'll… So, like, the only time I've really gone to the doctor last few years is like when it's urgent care because something that urgently needs attention has come up.
PATRICK CASALE: Right.
MEGAN NEFF: Yeah, not a role model to our listeners like-
PATRICK CASALE: In a lot of ways yes, in some ways, maybe not. And probably vice versa for me, too. So, yeah.
MEGAN NEFF: Okay, well, I think we've been recording for a while. So, those are the nine experiences, or traits, or symptoms of inattention. So, again, if a person experiences six of those under 16 or five or more of those.
And then, also, when ADHD has been diagnosed, and you're an adult, they will, it's interesting, the cutoff is 12. It's very, like, specific. But it's these experiences have to have been present before age 12 as well. And again, that's where you really need to look at, like, compensation. And also, you want to look at, like, stress or demands. Because for some kids in elementary school, like, because they're in one contained classroom, they can kind of hold it together. But then the wheels start to fall off, like in middle school when they're changing classes. So, you want to contextualize. But for an adult diagnosis, you do need to be able to show evidence that this was also present in childhood.
PATRICK CASALE: Yep, yep, yep. Good point.
MEGAN NEFF: Okay, so we get to talk about hyperactivity next time.
PATRICK CASALE: Okay.
MEGAN NEFF: Oh, and impulsivity. Oh, that'll be fun?
PATRICK CASALE: Yeah, that's all story of my life. So, now these are good. I like doing these series. I know you enjoy the collections.
MEGAN NEFF: I do.
PATRICK CASALE: Because they're super helpful. And I like being able to walk through it this way in terms of like, breaking it down step by step or piece by piece.
MEGAN NEFF: Yeah, I do, too. I do, too. Okay, we'll have to start thinking up what will our next collection be after ADHD.
PATRICK CASALE: Yeah. [CROSSTALK 00:54:41]-
MEGAN NEFF: Oh, we can do OCD collection.
PATRICK CASALE: We can do an OCD collection, for sure. We can do autistic ADHD collections of, yeah, there's lots. I'm trying to pin all this in my brain right now. We got all these ideas. Moving on-
MEGAN NEFF: Go write it down, go outsource.
PATRICK CASALE: All right, everyone, thanks for listening to the Divergent Conversations podcast. Episodes on Fridays on all major platforms and YouTube. Like, download, subscribe, and share. Goodbye.
