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Thriving With ADHD

Updated: Jan 25

Undiagnosed adult ADHD (Attention Deficit Hyperactivity Disorder) can really screw up your life. Dr James Kustow is a leading psychiatrist and specialist in ADHD. He received his ADHD diagnosis as an adult, like myself (four months ago). He has written a brilliant book that explains how to thrive with ADHD rather than simply survive called ‘How to Thrive with Adult ADHD’, which is in my ‘Suggested Reading List.’ Here it is in summary.


Like him, I went through life working ultra hard to compensate for my ADHD, knowing I was different, but not knowing why I could do some things really well, and how else it was holding me back.


Kustow eventually received an ADHD diagnosis aged 34. He has spent the past decade and a half unpicking the complex nature of the condition, gleaning insights from his own personal experience while studying and contributing to emerging research on the causes and associations of adult ADHD, many of which are misunderstood and rarely acknowledged.  


Awareness about the condition, particularly in adults, is growing. Some say ADHD is being over-diagnosed, a premise Kustow rejects citing The National Institute for Health and Care who estimate, based on research studies, that 3-4 per cent of adults have ADHD in the UK – yet well under a fifth have actually been diagnosed, according to the data. “It’s most definitely not over-diagnosed – we are in catch-up presently as more adults are realising that ADHD explains their difficulties,” he surmises. So this is the tip of the iceberg, as eighty percent of adults with ADHD haven’t even been diagnosed yet.  It is not an abnormality, it is neurodiversity. The good news is that it can be an advantage.


ADHD needn’t mess up your life. Dr Kustow passionately believes that the goal should not be to just ‘manage’ ADHD, but to thrive with it.


How to thrive with ADHD


ADHD as a superpower

In his new book, ‘How to Thrive with Adult ADHD’, which is in my 'Suggested Reading List,' Kustow lays out a tested practical framework for not only managing the symptoms of adult ADHD, but excelling with a disorder many attribute to depleted levels of the brain chemicals dopamine and noradrenaline. Kustow argues that reducing ADHD to the child-centric criteria used to diagnose it has done those with the condition a disservice. It isn’t the entire picture, and doesn’t wholly capture ADHD in adulthood, particularly adult women (historically research has been carried out on pre-adolescent boys) who are much more likely to hide and mask their symptoms to fit into societal expectations. 


Adult ADHD can be your superpower. If you have, or suspect you have, ADHD, or you simply feel stuck – drowning in half-finished tasks, unhelpful or destructive habits, and a perpetual feeling that you can’t seem to ‘get it together’ – then his book is for you. In small, manageable steps, you can transform the chaos into focus, productivity, success, and balance – for life. He delivers easy-to-implement strategies and tools to streamline your life. He delivers simple techniques to calm your mind, reduce the catastrophising ‘noise’ and achieve your goals, underpinned by a growth-oriented mindset.


It can take up to eight years to receive your first appointment for ADHD in the NHS, so you may well need these strategies to keep you going until then, when you might be given medication, and after that, lifelong. It’s about harnessing the power of your unique ADHD brain requires ways of using it to your advantage. Take from this what you need. Drip feed this buzz of excitement. This is not a linear trajectory: It’s a lifelong agile expedition. It’s time to thrive rather than simply survive.


Harnessing the potential power of your unique ADHD brain requires you to discover ways of using it to your advantage shifting outcomes away from adverse and towards adaptive. There is so much you can do; but it's going to take the right mental attitude, a structured approach, and an investment of energy. Such an undertaking requires a multifaceted approach: One that recognises and nurtures your brilliance, that proactively engages with others for support, and the reflects the complexity of you and your individual journey. Whether you are pre- or post-assessment, on or off medication, a family member or friend; material included in this section should add tangible value to your self-development journey or your ability to support the journey of a loved one. Remember not every suggestion will apply to you at the stage you're at; please extract only what you need, engage with it more as a menu of options than a prescriptive ‘must do’. There is no one-size-fits-all when it comes to adult ADHD so try some stuff out and see if it works. Finally, when attempting to make changes in your life it is important that they are integrated actively and consciously with an upbeat welcoming and positive attitude. When you resort to a high effort, low joy strategy, interventions have a high chance of losing steam and ultimately failing. Try to drip-feed mini shifts progressively and incrementally rather than attempting to do everything all in one go.


ADHD needs a rebrand

“According to our current way of describing it, ADHD is a disorder characterised particularly by persistent and impairing features of inattention (including distractibility, disorganisation and forgetfulness), hyperactivity (of both body and mind) or impulsivity (of actions and words), or aspects of all three. Most of those affected also experience emotional dysregulation, or mood instability, in addition to the features listed above,” Kustow writes in the book. 


He adds: “Personally, I find it most helpful to think of ADHD simply as a disorder of regulation (or a ‘dysregulation disorder’). This aptly describes my personal experience, and that of the many patients I have worked with, where pretty much all difficulties experienced relate back to an issue with one’s ability to regulate something.”


Are you suffering from too much histamine?

Kustow calls this “the somatic super syndrome,” and has developed a model to visualise the link between hypermobility disorders (EDS or HSD), autonomic nervous system dysfunction and mast cell activation syndrome (MCAS) and neuropsychiatric conditions like ADHD. A 2015 study published in the Journal of Allergy and Clinical Immunology found that 65 per cent of people with hypermobility disorder also had MCAS. Kustow believes this is a key piece of the puzzle that deserves further study.


Mast cells are white blood cells that play an important ‘first responder’ role in the immune system. These cells store histamine which is released when the body is exposed to toxins, allergens or infections. In some people (often those with a hypermobility disorder), this normal immune reaction can become dysregulated resulting in the mast cells getting stuck in a chronic and excessive release of histamine which manifests in allergic reactions such as itching, rashes, hives, pain, fatigue. 


One way to ease the symptoms of excess histamine is to take an antihistamine daily, something Kustow does himself, while observing a moderately low-histamine diet which limits foods like aged meats, cheese and fermented foods that are high in histamine. “It’s not as simple as taking an antihistamine but it’s an easy, inexpensive thing to try and see if there’s any improvements,” says Kustow. 


The theory builds on the premise that if your whole system is bathed in inflammatory chemicals, even in small doses, for years and years, these chemicals are no doubt affecting not only the body (causing joint pain, fatigue, dizziness, irritable bowel syndrome [IBS]) they are also negatively impacting brain function. “Neuroinflammation occurs when inflammatory chemicals gain entry into the brain,” says Kustow adding: “When the brain is inflamed, or there isn’t enough blood flow, you essentially get brain failure. What does brain failure look like? Anxiety, mood disorders and ADHD.”


Mast cell activation syndrome is difficult to test for accurately and is often provisionally diagnosed on clinical grounds, whereas hypermobility is determined, usually by a rheumatologist using the Beighton scoring system which tests joint flexibility in nine key places. If you’re experiencing a number of inflammatory symptoms from pain to fatigue and allergies, a good functional medical doctor will often be able to connect the dots and treat the body systemically, possibly alleviating the need to visit several medical specialists, something many with this cluster of difficulties, including some of those with ADHD, find frustrating. 


Medication only works so far

Kustow is not against medication. Stimulants, says Kustow, are among the most effective mental health medications there are and shouldn’t be overlooked as numerous studies show the negative outcomes of ADHD (74 per cent of those with ADHD are more likely to be involved in road traffic accidents, for example) are reduced dramatically with medication. “So long as blood pressure is monitored regularly, and controlled, ADHD medication is for the most part a net benefit,” he stresses. 


Some people can’t or don’t want to take medication, thus the pillars Kustow prescribes have been part of a personal quest to deliver a holistic treatment protocol. “I’m very sensitive to stimulants so I take a small dose and combine it with the body-based strategies I’ve honed over the years on myself and my patients,” he tells me, insisting that despite its proven track record, medication will only get you so far. In addition, you need to deploy lifestyle changes to reduce inflammation and other strategies to manage your environment.


The 10 domains of dysregulation

In order to understand how disordered regulation plays out in those with adult ADHD, Kustow has presented 10 key domains based on current and emerging research.  


  1. Attention and executive functioning (procrastination, hyperfocus, forgetfulness, distraction) 

  2. Activity (difficulty staying still, talking excessively, physical and mental exhaustion, apathy, social withdrawal, overexcitement, sexual issues) 

  3. Impulse (problems delaying gratification, disordered eating, self-harming, careless driving, interpersonal conflicts, substance abuse or addictive tendencies, spending money impulsively)

  4. Emotion (anxiety, rapid mood shifts, quick to anger, excitability, difficulty relaxing, heightened sensitivity to rejection or criticism)

  5. Reward or pleasure seeking (risk taking, boredom, difficulty inhibiting drives, being in the moment)

  6. Sensory processing (sensory over-reactivity, sensory under-reactivity, sensation-seeking behaviours, frequent sense of overwhelm)

  7. Time appraisal (time blindness, time management issues) 

  8. Sleep-wake rhythm (delayed bedtimes, sleep deficient, daytime tiredness, sleep disorders such as sleep apnoea and restless leg syndrome) 

  9. Immune function (heightened sensitivity, increased pain or pain syndromes, fatigue syndrome, more susceptible to infections, allergies, a theme of mast cell activation abnormalities with more asthma, allergy and autoimmunity)

  10. Arousal and energy expenditure (a “boom-bust” pattern of energy expenditure, physical and mental exhaustion, blood sugar problems, perfectionism, motivation issues)


How to thrive with ADHD

While the book goes into more detail the following tips are drawn from Kustow’s “how to thrive” method. 


  1. Adopt a growth mindset – catch negative thoughts early and think of more accurate and balanced alternative explanations. This is known as “reframing.” The first pillar is nurturing a growth oriented mindset, which may well also apply to many who don’t have ADHD. Identify some targets for change in relation to your ADHD. You can use the following problems as a starting point:

    ·      What is healthy and positive about your life at present?

    ·      Where do you feel you are not living up to your expectations of yourself?

    ·      Can you identify key problem areas and think about what may be holding you back?

    ·      Which areas do you want to focus on initially?

    ·      You possibly have a wish to slow down, pull back, or shed some of your current responsibilities that are wearing you down?

    ·      Perhaps a desire to better regulate your emotional world?

    ·      Change the way you communicate and relate to yourself and others?

    ·      Or addressing or overcoming a block or barrier that stands in your way such as a limiting belief or a festering addiction; it's really up to you…

    ·      Before you fire up the engines, an important caveat: If things don't work out with your first attempt try not to despair; take some time to stop and reflect on what didn't go to plan as well as what went well and then redirect your efforts and try something new, adapting your approach based on what you learned and get something clear in your mind from the very start: This change business is not a linear trajectory, it's a lifelong expedition that will present unpredictable twists and turns - it's just the way it is. Do your very best to enjoy the ride. The more I have experienced and observed in both my personal and professional wanderings the more I realise how important mindset is when it comes to managing ADHD. In the context of ADHD mindset encompasses the following themes:

    ·      How you understand and make sense of your ADHD and associated difficulties

    ·      How you negotiate ADHD related adversity

    ·      How much toxic emotions such as anger, guilt, or shame do you harbour and carry with you?

    Kustow finds that adults who have struggled during their life with undiagnosed ADHD and a fair number of those diagnosed in childhood too often have a tainted view of themselves and their ability to affect change. A resigned acceptance that they are in some way flawed or inferior.

    He doesn’t know a single person with the condition who doesn't struggle more than the average with some form of shame-related intrusion.

    From the frustrating and embarrassing executive function mess ups and impulsive “I can't believe I said that” screw ups, to the slowness and the absent-mindedness and the “Oh no not again” - you just can't get away from it. Shame is just one block or psychological barrier that risks impeding your progress. Barriers that may lead to a degree of resistance to you fully accepting yourself and embracing your ADHD. In my experience the most common sources of resistance broadly align with the following themes:

    ·      A concern that ADHD is not a real thing and that you are just making it up

    ·      A worry that there are far more needy people out there, that is not so bad and that you're making an unnecessary fuss

    ·      Fear of being judged and stigmatised by others

    ·      A confusion about the boundaries between you and your ADHD

    ·      A self-pitying “Why me?” preoccupation

    ·      Unhelpful limiting thoughts such as I'm a failure, I'm flawed, I'm unworthy, or it’s just hopeless and futile

  2. Get enough high-quality sleep. Sixty per cent of people with ADHD report feeling sleepy during the day and have a tendency to stay up late. Lack of sleep exacerbates inflammation.

  3. ADHD can lead to “time blindness”. If you struggle with lateness add 30-50 per cent to your initial estimation of how long things will take.

  4. Always losing or misplacing things?  Have a set place for key items like keys, phone or work security pass.

  5. Regular decluttering once a week will help reduce feelings of being overwhelmed.

  6. Eat more anti-inflammatory foods such as green vegetables and cut back on red and processed meat, both of which increase inflammation.

  7. ADHD predisposes people towards disordered eating, so stick to regular mealtimes.

  8. Reduce the toxins in your environment. Swap plastic water bottles for metal, invest in a water filter and switch to organic cleaning and personal care products.

  9. Practise diaphragmatic breathing exercises to manage your emotions. 


Emotions and emotional dysregulation in ADHD

Emotional dysregulation is inherent to ADHD and should therefore be considered a core feature of the disorder.


In adult ADHD emotions tend to be hot: Although not generally listed as a symptom, anxiety in all its manifestations is really common in ADHD and often highly impairing. The mood characteristically shifts around more frequently than usual in a slightly chaotic and dysregulated manner. Quick to anger, easily frustrated, excitable, low, changeable, and a little unstable. The actual emotions themselves are no different but the intensity at which they are felt is heightened. The highs are a bit higher and the lows a bit lower. And the frequency of the fluctuations is increased; all taking place within what is considered a normal range. Although there are more frequent shifts between different emotional states with multiple changes during a single day the mood instability or mood lability as it is sometimes called doesn't reach the threshold of mania or hypomania as experienced in bipolar disorder or manic depression. Unless of course bipolar is also in the mix.


Those with ADHD often feel restless inside leaving them on edge and unable to settle and relax. Words commonly used to describe adults with ADHD often laden with emotional intensity; too passionate; overexcited; short-fused; bouncy; wired; intense; full on. If an individual with ADHD perceives even subtle rejection or negativity from others they may have a disproportionate emotional response: Something that is referred to as rejection sensitive dysphoria (RSD). So, with emotional over reactivity and mood instability often overlying a background state of heightened arousal, the emotional volume turned up, paired with an inability to easily shut down and switch off, and an endlessly active mind that struggles to feel at peace, to quieten, and to fall asleep, you can see how easy it could be to become overwhelmed. An experience I'm sure many of you are very familiar with.

Developing a heightened awareness of your mind-body system and being able to recognise early indicators of emotional dysregulation is key; as it allows you to put in place effective strategies to avert or manage distress. As well as learning how to better regulate emotions it is also important to consider their meaning; to listen to what they may be trying to communicate to you.


When turmoil becomes mental illness it can sometimes be challenging to differentiate between the normal stresses and strains of modern living with ADHD, and an independent co-occurring mental disorder. Normally, however you will know if something is not right. And in these cases you need to take some form of action. As emotional regulation work is unlikely to shift it alone. Having recurrent and inadequately treated mental illness episodes appears to have a kindling effect, worsening the prognosis over the long-term. If you suspect you may be suffering from some form of mental illness try to seek professional support, initially through your GP: I know it can feel scary but try not to ignore the presence of possible mental illness. Ask at your GP surgery which doctors are more interested in, and experienced in, mental health, and ask to see them specifically. If the dynamic is right it is good to establish a report and nurture the relationship: This may not be straightforward in the current health climate but it's certainly worth a go. Depending on the nature and severity of the issue your GP may signpost or refer you for psychotherapy, (you may have to wait well over a year for this in my experience), initiate a medication trial, or refer you to a psychiatrist. Your GP may potentially start an anti-anxiety or antidepressant drug. With the support of the professionals involved in your care, approach to the combined treatment of the ADHD and whatever else is going on in a structured and stepwise manner. Thinking about how the treatment of each could impact the other; if you're taking, or are about start taking ADHD medication, there will need to be some thought about the impact it may be having on the other condition and potential medication interactions, as not all medications are compatible. The goal is to find an optimal balance that addresses both conditions adequately.


Rejection sensitive dysphoria (RSD)

For your entire life have you always been much more sensitive than other people you know to rejection, teasing, criticism, or your own perception that you have failed or fallen short? RSD is a term coined by US based psychiatrist and ADHD specialist Doctor William Dodson who describes RSD as a central feature of ADHD.


From a purely anecdotal perspective RSD does indeed seem to be relatively specific to ADHD as Doctor Dodson argues. It also occurs in autism spectrum disorder (ASD) and that this may even be an important driver in those with ADHD who often have a few ASD traits if not the full diagnosis. ADHD patients resonate very strongly with the description of RSD often feeding back that it closely captures their inner experience. Few of us like being criticised or rejected but for adults with ADHD it is often registered as an unbearable, shame-ridden, and highly unpleasant experience. So much so that Dr James Kustow thinks that many patients organise their entire existence around a style of engagement with the world and others around them to actively reduce the chances of it happening. That gives you a flavour of the intensity of the experience.


I thoroughly recommend reading the book. Here it is again: ‘How to Thrive with Adult ADHD.’


ADHD and entrepreneurship

When I began my new career, the second half of my life, I naturally slipped into being an entrepreneur and a startup person. It gave me the freedom to be who I was and not proceed with a “Traditional Career” thastyour loved ones had planned for you . The people around me were no different to me; they were all entrepreneurs and startup founders who exhibited the same traits I had. I felt at home. A strange and sometimes unhealthy “home environment”, yet still home.


The pace of the entrepreneurial and startup worlds, the diversity and variety of the work, the flexibility and control I have; all of this seemed tailor-made for me. Plus, I was surrounded by people similar to myself, who thought in the ways I did.


And indeed, although ADHD manifests in the general population at about 10–15% (depending on the country of the diagnosis), around 65% of entrepreneurs that were scored have ADHD. It seems, not only are we suited to entrepreneurship, but it is also suited to us.


That distractibility that drove your teachers mad? That becomes an aptitude for multitasking and the ability to switch between topics in the blink of an eye. The restlessness that led your parents to sign you up for multiple sports teams and other extracurricular activities? That becomes a desire to explore uncharted terrain, to pivot to new areas or new ways of doing things. That risk-taking and impulsiveness? With a little experience, that becomes intuition, allowing for swift action based on limited certainty (a certainty which is rare, as an entrepreneur). That hyperfocus: Who could not benfit from that? The ability to maintain super awareness for many hours at a time.


As you can see, I do not believe that ADHD is a hindrance, especially for entrepreneurs. I am not “suffering from ADHD”. It is simply the particular condition of how my brain is wired. Everyone’s brain is wired in a particular way; my way just has a name.


ADHD doesn’t come alone. As a renowned expert on trauma Gabor Maté has said, it needs both inherited brain physiology and environmental influence for one to become ADHD. Simply put — childhood trauma. Out of all my interviews, those who maximized on their ADHD traits had spent time untangling their childhood history through therapy, mindfulness, and bodywork and made their peace with it.


The same happened to me. In my adult life, I was exposed to therapy, coaching, mindfulness, etc, first as a client and then as a coaching professional. The label ADHD became even less critical or judgemental. I just accepted how I was and found my intuitive ways around it.


Spending time understanding the condition and also working with mental health professionals, mindfulness trainers, coaches etc. deepens the self-acceptance and self-awareness that lie at the core of maximising your ADHD superpowers.


It is like shifting the question from “what’s wrong with me” into the direction of “what works for me?” And really, it comes down to everything: your productivity habits and tricks, career choices, your relationships, your diet, even how much you sleep.


There are some remarkable examples of extremely successful entrepreneurs diagnosed with ADHD, but the connection between ADHD and entrepreneurship runs much deeper. By definition, entrepreneurs choose a field they love, explore unchartered terrains, take risks, and venture into the unknown-- the perfect antidote for boring.


When you look at ADHD traits through the entrepreneurial lens, distractibility becomes an aptitude for multitasking, restlessness becomes a desire to explore uncharted terrain, and risk-taking can be redefined as “functional impulsivity.” In other words, when you look more closely at what qualities make a successful entrepreneur, the so-called “symptoms” of ADHD emerge as distinct advantages. Suddenly, risk taking no longer seems reckless. Instead, it is an ability to operate well under conditions of uncertainty – to pull the trigger without overanalysing, before the opportunity is forever lost.



ADHD resources

Dr Gabor Maté on ADHD:


Dr Gabor Maté on ADHD


Dr Gabor Maté on ADHD: ADHD is not a disease - it's a response to the environment


Dr Gabor Maté on ADHD



Meditation = A break from stimuli. Time to focus on nothing and think about nothing. Think of it like your brain is a computer and you’re giving it a hard restart. Sometimes you need to shut it off for a while.


What is actually happening in the brain?: https://www.webmd.com/add-adhd/adhd-mindfulness-meditation-yoga


Namaste.


Sending you love, light, and blessings brothers.


Olly



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