Episode 94: FLASHBACK — “What is ADHD?” (Part 1): Personal Stories and Professional Insights

Show Notes 

Navigating the identification, assessment, and diagnosis of ADHD as an adult can be confusing and overwhelming. This mini-series on ADHD focuses on demystifying the diagnostic criteria and making the process clearer and more understandable.

In this flashback episode, Patrick Casale and Dr. Megan Anna Neff, two AuDHD mental health professionals, dive into ADHD, breaking down what it means. This episode lays the groundwork for their series focused on ADHD.

Top 3 reasons to listen to the entire episode:

1. Get an overview of the often misunderstood and oversimplified traits of ADHD, from executive functioning challenges to emotional hyperarousal.
2. Hear personal stories from Patrick and Dr. Neff as they reflect on their own ADHD experiences and how misdiagnoses and societal stereotypes can cloud self-understanding.
3. Discover the interconnectedness and overlapping traits between ADHD and autism, helping to clarify common misconceptions and pave the way for more nuanced discussions.

This episode sets the stage for our mini-series on ADHD. 

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

***This episode is the 4th of 10 episodes that Divergent Conversations is re-releasing for 2025. Please enjoy, and we'll be back with new content, resources, and guests in a couple of months.

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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.

Hey, everyone. Welcome back to Divergent Conversations. 

MEGAN NEFF: We're taking a pause from recording new episodes for a while, and we're going to re-release some old ones. We've both talked about feeling like this podcast has been like flying by the seat of our pants and we want to be a little bit more intentional with it. 

PATRICK CASALE: We're going to re-release 10 episodes. See you all in like 10 weeks. Just know that these episodes coming out are all thematic. And we selected ones that we think are really, really good. Hope that you catch things that maybe you missed the first time around, or maybe you didn't listen to the first time around. 

DR. MEGAN NEFF: Maybe it'll give people a breather to, like, catch up.

PATRICK CASALE: So, this episode is just going to be a short overview on our own thoughts on ADHD before we dive into a series like we did for our autism series, specifically, catering to ADHD, going through all of the criteria, sharing our personal experiences, and just kind of highlighting the overlapping differences between autism, ADHD, as well.

Hey everyone. So, we just wrapped up our What is Autism series, our four-part series. And now we are moving into our What is ADHD series. We're going to go through the DSM-5. You kind of have heard our thoughts on the DSM-5 already, so we're not going to jump back into that.

We do want to just use the disclaimer, though, that we're going off of the DSM-5 and our own experiences. That does not mean this is going to encapsulate everyone else's experiences who are listening to this. That doesn't mean that if you don't check every single box of what we're talking about, that you know this is not a part of your reality. So, we're just trying to be as general as we can right now.

And we understand there's a lot of nuance here, too, and a lot of overlap, hell a lot of misdiagnosis. And that's why you should definitely check out Megan's Misdiagnosis Monday series for her Neurodivergent Insights website because those things will really help clear things up as well.

With that being said, Megan ADHD 101, here we go. I'm really glad we waited to episode 46 through 54 to do this series. So, feels pretty much like us.

MEGAN NEFF: I know. I feel like… So, yeah, my website is about, I don't know, two or three years old. And I realized, like, I don't even have, like, basics like, this is what autism is, this is what ADHD is, this is what a sensory meltdown is. Like, all that basic stuff. My goal for this year is to go through and, like, make that foundational stuff.

Yeah, so I'm glad we're doing this. And it is funny that it took us 50 episodes to get here.

PATRICK CASALE: Here we are. So, I had mentioned to you before we started recording that your mic looks different. It's white. You bought some new stuff, some new software, and you were like, "Well, I wish I was recording because this would be very ADHD of me."

MEGAN NEFF: Yes, it was like, so I often talk about how If You Give a Mouse a Cookie, that children's book that feels like my brain. It's a book where it's like, if you give a mouse a cookie, and then the cookie wants a glass of milk, and then the mouse, like, sees the crayons and it wants to draw, that was this project of this mic, was I wanted it to be white, so I bought it. And then I realized it wouldn't work with my computer.

So, well, first of all, I accidentally bought two of the, like, bars, which was an obvious ADHD, what's the first criteria in attention? Doesn't give close attention to details. And then it wouldn't work with a computer. So, then I had to buy, like, a whole fancy setup to get the mic to work, to work with my computer. And I had a big talk I was doing this week, which is partly what was inspiring all this.

So, yes, it felt like a very ADHD project which turned into a very expensive project, which the ADHD tax is real.

PATRICK CASALE: Yeah, yeah, yeah. Super real. I do like the look of it. I like the aesthetic, but yeah, super real. Cannot tell you how many times I've purchased something and when I'm, like, really excited about it, and I feel really stimulated by it, and then only to have to return it, cancel it, regret it, feel shame about the decision, and then there's a financial fallout or loss. So, I know we're going to talk about that as we go through this series, but [CROSSTALK 00:06:38]-

MEGAN NEFF: Yeah, I think the financial impact of ADHD, like, oh my goodness. Like, I kind of want to add it up, but I also don't want to add it up, like, subscriptions. Like, oh goodness, between, yeah, purchases to subscriptions to just all the things I lose. Yeah, someone in my community said this, so I'm not taking credit for it. They're actually on my autism [INDISCERNIBLE 00:07:07] the same thing for ADHD of like, this is an expensive neurotype to have.

PATRICK CASALE: Yeah, fair. I know this is just on my mind because I just got back from doing that Spain retreat, and when I'm traveling the ADHD tax is really expensive because I'll, like, commit to things, either it's emotionally or financially, and then immediately have a reaction to it, or, like, very shortly after have a reaction, and then have to cancel plans, or I have to cancel something that I can't get a refund. Oh, I booked this hotel because I was really excited about it, but now it's not in the right part of town. And all the things. And it's chaos.

MEGAN NEFF: Yes, I relate, I relate. Yep, yep. Okay, so what is ADHD? We started our autism series with what is autism? What is ADHD?

PATRICK CASALE: Is that rhetorical? Or are you just saying that?

MEGAN NEFF: I'm like, well, I am asking you, but if you're like, "uh" you can punt it back. But I am asking.

PATRICK CASALE: I mean, okay, I just wanted to make sure I'm following.

So, yeah, ADHD, we're talking about another neurotype, right? You just mentioned expensive neurotypes. We are talking about three different types. We're going to go into detail about all three types. I think that we still as society have some like stigma around what ADHD looks like.

I think if we were to, like, pull 100 random humans, and ask them, like, "What is ADHD?" They'd probably describe like a young, probably, white boy who was unruly, disruptive, like, got up a lot in class, interrupted a lot in class, really struggled with their attention.

I think we would also hear like, oh, you know, like squirrel, and then all of a sudden that's like, where my brain goes.

So, those are two things I hear so often from just random human beings when we're talking about ADHD. But I'm thinking about how we're going to talk about, like, social struggles, attention struggles, the struggles with memory, with executive functioning, with the way that we organize information, the way that we really struggle to follow through on certain things when we get overloaded or overstimulated. The ADHD tax that we talk about, where there is fallout, and there is shame, and there is some spiraling that happens.

So, I think there's so much here, and there's so much that looks and overlaps with autism as well. Now I'm punting back to you.

MEGAN NEFF: Yeah, absolutely. So much overlap. So much overlap. And, yeah, I mean, there's so much that you even listed there that's not part of the DSM criteria. Like, it's really interesting.

And I know Europe, I think, has expanded their criteria that they use for ADHD, but there's so much that clusters with the ADHD experience. I mean, that's true for autism too, but that's just not even mentioned. Like, and I think that's part of what's unfortunate, is it really gets the stereotype. It's like, it's distractibility and hyperactivity. But it's so much more than that, right? It's like, when I think about like, it's time perception that's, you know, not even mentioned in the DSM.

When I think about ADHD and a lot of this comes from Dr. Dodson's work, but I think about kind of, so I have an image in my head. Let's see if I can translate it towards like if I think about the kind of clustering of experiences that are core aspects of ADHD, I think, by the interest-based nervous system, which we should do an episode like just on that. But that idea that when it's in an area of interest, like our nervous system can more easily engage because we actually have more dopamine when it's a area of interest, and dopamine means the neurons in our brain talk to each other faster. But things outside of our interest are really, really hard and painful for many of us to do. So, like, I think about that as a core feature of ADHD.

Emotional hyperarousal, and that's Dr. Dodson's language, but I really like it. And both that refers to like, the kind of sensitivity to emotional experiences, but also the restlessness of like, why it can be hard to sit through a movie. And this can be both, right? Like a more profound experience of joy, and delight, and also more profound experience of the harder emotions, rejection sensitivity or rejection sensitive dysphoria, which we've done a whole episode on, that definitely feels like a core feature of ADHD. And then I would add executive functioning disabilities.

So, in my mind when I think about ADHD, I'm thinking about kind of those four pillars. I think, and then there's more stuffed in there, but those four definitely stand out.

PATRICK CASALE: Yeah, I think those four feel really paramount to ADHD, and being able to put language to that in terms of what this experience is like. And it's so interesting because I reflect on this a lot in this podcast. Like you and I have talked about this. We're both autistic ADHDers. We talk so much about autism on this podcast, and we've talked openly about, like, why do we think that is? And, you know, in our diagnosis stories, episodes, in our conversations, in general.

And I think when I received my ADHD diagnosis, like, I was not surprised. I was just kind of like, this feels really fitting, right? Like, I felt like it was really accurate, and I think that getting diagnosed as autistic later in life was much more of a experience that I've had to really unpack for myself. And I don't know about how that has gone for you.

MEGAN NEFF: For me, it's flipped. I actually discovered the autism first. And I wasn't even thinking ADHD until I made my autism ADHD diagram. And then at that point, kind of both my kids have been diagnosed ADHD at that point. Or no, one had, but we were suspecting the other one.

And that was harder for me to see, and I think it probably speaks to the stereotypes of like, school has always been hard for me, but I have worked so, like, I always worked so ridiculously hard at school. And I think there was something about the fact that I worked so hard at school and could persist in working hard that made it hard to see my ADHD, or the fact that, for me, my strongest autistic trait is kind of interests and hyper fixation.

So, again, like, I can have long periods of time where I'm like, I'm not distractible. So, that actually made it a lot harder for me to see my ADHD. And I think at this point I have more impostor syndrome around my ADHD than my autism.

PATRICK CASALE: It's fascinating. So, when you were, and that makes a lot of sense when you say it that way. So, as you were, like, making this Venn diagram for ADHD and autism, were you just like, "Oh, yes, yes, yes."

MEGAN NEFF: Yeah, I realized because you know, whenever I make a Venn diagram, I'm reading a lot of the research articles. And what I realized is I was like, "Oh, the things I was thinking was my autism? Like, that's actually an ADHD trait."

PATRICK CASALE: Right.

MEGAN NEFF: And so, it was in doing that deep dive that I was realizing I was kind of overshadowing. My autism was overshadowing my ADHD traits. And so, that's what led me down the rabbit trail of discovering ADHD.

PATRICK CASALE: It's interesting to start looking at it this way. And yeah, when you're saying like, "Oh, these things certainly it would make me not think that I am ADHD because I could sustain focus, I could do this thing, I could follow through on this project or get good grades in school."

But I think again, going behind the mask or the curtain, it's like there's so much energy being used, right? To get good grades, to show up, to focus in class, to do all of the things that we probably had to do as kids and teenagers that we were just so not aware of at that time. And now looking back with that lens you're like, "Oh, wow, there was so much happening in order for A, B, and C to happen in secession.

MEGAN NEFF: Absolutely. Yeah, absolutely. Yeah. It is interesting, like looking back at school. I mean, I have a few learning differences. Like, I have surface-level dyslexia, which definitely impacted early learning. But if I look back, I think it really is more. I think I was even attributing my school struggles to autism, but I think actually a lot of them was ADHD.

But yeah, partly like I thought, and this is like, I think a lot of neurodivergent people say this or feel this, like I thought everyone was struggling as much as I was, and working as hard as I was. And then it was in like, forging close relationships and realized, like, what other people in college weren't just like going to class and studying all the time. They actually, like, socialized, and had lives, and did things, whereas for me, my process through school has pretty much always been like, you go to class, and then…

And even this, it's like, I would go to class and figure out what I needed to learn, and then I'd go home and learn it because I couldn't learn from class. So, it's like, okay, I think this is the big idea I need to learn. So, now I've got to go either find a video, or read some books, or, like, find a way to teach this idea to myself. So, I just spent a lot of time studying and learning.

PATRICK CASALE: Okay, so we just wanted to give a very brief introduction to our ADHD series. I know that episode was super quick with us just talking about our thoughts on ADHD and what was coming up. We are going to start the process of going through the DSM-5 next week, criteria by criteria, and giving our own personal experiences as well. And we will see you next Friday.