The Neuroanatomy of ADHD and thus how to treat ADHD – CADDAC – Dr Russel Barkley part 3ALL

The Neuroanatomy of ADHD and thus how to treat ADHD – CADDAC – Dr Russel Barkley part 3ALL

So let me show you how we can build a
model of ADHD from the neuroanatomy and
neuropsychology of ADHD to understand ADHD we have to
understand how normal self control develops and then we’ll show were ADHD affects it
there are three concepts that we need to build this model One inhiibtion you have to stop and build a pause in your behavior as
your mother said stop and think before you act in the stopping comes first or as Rabalais said everything comes to
those who can wait but whoever said the fact is that what
distinguishes human cognition from all other species is we wait
weekend decouple and avenge stimulus from our response to
that event other species cannot do that and bite decoupling them we can do things in the delay that others cannot do but
the first thing we have to do is stop now in addition can be defined
as three separate capacities all of which are
impaired in patients with ADHD the first is the ability to inhibit the
urge to respond on the moment to the event this is the
impulsiveness the dish in addition the second however
is the ability to interrupt in ongoing behavior when it’s time to do
something else that’s two percent variation and that is
also an inhibitory failure you can’t stop what you were doing
particularly if it was interested if it was rewarding
to shift to something more important but where the consequences might be
delayed finally there is the ability to protect your frontal lobes you’re working memory
your what and went systems from destruction from
interference from being perverted disrupted and
distorted by events around you that have nothing to do with the goal you’re
pursuing you must be able to suppress those
unwanted reactions notice that the distractibility in ADHD
is not a perceptual issue it isn’t inhibition problem people with
ADHD don’t perceive distractors any more than others the difference is they respond to them
they get up and they react to the irrelevant event
another of task and once they’re off past they can’t
retain the goal so now they will return to the task so it’s simply a series of responding to
irrelevant events in life which is why it is so
hard to accomplish your goals all three of these are failures up the
innovation system and people with ADHD as we well know have trouble with all three now the next
concept we need to build up our model is not just in addition but self-regulation what
isn’t self-regulation is very simply defined
as it was forty years ago by Skinner and others as involving three steps the four-step we’ve already talked about you don’t stop but having stopped you
will now direct a behavior back at yourself you will
engage in some action that is aimed you not the world not others back it yourself you doing
something what are you doing you trying to change your behavior from what it
would have been had you simply responded on impulse so
there’s a form of shelf change going on here I’m acting on
myself to change my next response why would I
want to do that to change a distant consequence I am trying to alter the future I’m not
trying to change the now in fact I may use this as an opportunity
to turn away from the seduction zav the moment from
the immediate rewards the feel-good aspect of life I may turn away from that and subject
myself to adversity and poverty for years to change that future call going to college you you’ve given up the job the money the
car the close the babes in everything right and you can live in poverty for at
least four years because if you can get that degree
you’re gonna earn ten to fifteen thousand dollars more a year than people
who didn’t at a distant consequence all deferred gratification requires
self-regulation action to the self that’s changing
yourself that altering your future okay now the third concept we have to
discuss is what then is an executive function
we’ve been talking about the executive system but we haven’t defined now this is
interesting because if you look anywhere in a row psychology there is no definition I’ve looked
actually wrote a review paper seven years ago on the amorphous nature up the concept no one defines it they will give you a
list of testing think that measured like Wisconsin card sort or they will
give you a list love what they think are the functions
themselves in addition non verbal working memory
verbal working memory the central executive and so on but just a list right it’s not a
definition so that operationally define a in my
theory Ave tht we define an executive function as what you doing to yourself the action
to the self that first step in our definition of
self-regulation that is an executive function and action
to the self designed to change you so as to change
your future and there are five actions that humans will direct it themselves which means
there are five executive abilities may be more but we know of at least five so self control isn’t one thing its five
things and each of them can be called an executive action put them all together you got the
executive system and by adulthood you should be using all five of these to get to the future so we can now link all of these together in addition links
up with self control because you can’t direct connection it yourself if you don’t stop responding to the
world you can’t do both at once you can’t react when event and control
yourself at the same time you have to stop doing this one to come
back and change urself and self-regulation the jump with
executive function obviously because self-regulation is comprised a5 types of self control each and
executive function these are going to develop one at a time they’re going to take thirty years to
develop and each of them is going to need the one before it to
develop before it consumption so it’s a hierarchy think
it is a pyramid the first began to three months of age
and right along with it comes the second not is in addition and the nonverbal system now
neuropsychologist have labeled the used by these useless terms that you see here non verbal working memory what the hell
is a verbal working memory emotional in
addition that’s a little more obvious planning and problem solving what is
that so what I did in 1994 was after reading papers by by god’s key
Jacob renounce key lauria and others my specialty is
neuropsychology hence the reading I began to see an idea that was taking
shape that could be used to help us understand and redefine each of these executive functions
because she forgot he had already developed a model of how language goes from being
a public action to others to the voice in your
head so I stole my God he’s idea and I simply
said this must be how all the executive functions develop actions to others turn back on the shelf and slowly made internal private can we redefine each executive function
as an action to the self absolutely and by doing so
we get a much clearer picture up what we’re doing with this executive
system also just as an aside we also get a much better picture of how
they evolved how do you get from a primate brain to human brain this model can explain it the earlier neuropsychological terms
cannot so what action are you doing to yourself
in terms of non verbal working memory you are seen to yourself it is the
visual imagery system and humans have the best
system for holding images in their mind any
species on this planet and check by 12 months of age you exceed
all other primates and from there you will have 10 more
years to let the system develop you have a theater in your mind a DVD
player up the past which you can activate
on-demand to see which you have previously done if
it would be useful to do so the layman’s term for this is hindsight
you activate images have the relevant cashed and you hold them in mind and that’s the
non verbal working memory system but you can also use the other centers
to yourself you can hear yourself you can taste yourself you can feel to yourself I can describe
the wine I had with dinner last night over at the Delta hotel by just visualizing the dinner Henry
tasting the Cabernet if I didn’t do that I
couldn’t describe it to you so the image comes first and then the
description by the way this is how you can tell
people about all the yesterday’s have your life but wasn’t for the images you couldn’t
say anything the words require the images but it
isn’t just the images I can re sense everything I can really
hear the conversation with my waiter and I can really feel the texture of the
napkin for the food or whatever I can replay the whole event right
appear in this theater simply put this is the
mind’s eye the ability to hold images in mind and
as William James said a hundred years ago it is the secret to the human will to
understand the human will one only needs to hold an image in mind
because from that image everything else flows as a consequence so the first executive function besides
stopping is to re image the relevant past hindsight will say more about that in a
moment the next executive function his speech
to the self the bike got skin model I’ll teach you that one those three are
going to lead to the next one you can remote to yourself you literally can create emotions de novo in yourself there was no other species it can do
that finally you internalize your manual play and it
becomes the source of the highest executive function which is planning problem-solving and
simulating multiple possible responses and you can
do it all appear and it’s situated at the foremost
frontal pole it has the capacity to manipulate what
you are holding in mind and not display the nice thing about
this model is it tells you why childrens play is so crucial to adult planning and
problem solving because manual play moves to symbolic and mental play and that’s the source of
all human Planet as I said he to the use develops in a
stepwise sequence creating a hierarchy up the executive
system now this is the bike got skin model so
let me explain it to you because what i’m arguing is that each of these executive abilities
follows the same sequence so let’s take speech between 0 and three
years of age according to my God he’s turned out to be correct young children emit language to others
there is no cell speech and there certainly is no voice in his
head but between 5 sees me three in five
years of age you’re going to see this young child
talk to themselves and apt is measurable you can video tape 3- to 5-year-olds
engaging in a lot of self-directed outward speech they are just little
chatty Kathys effect if you put two 4-year-olds together it’s not a
conversation its parallels of speech and if you put this kid to bed at night
you’re going to hear them talking in the room even though nobody’s there right you are witnessing by got peace
theory in action between five and seven you’re gonna start to see the face being
suppressed along with the larynx and the utterances you’ll see children do this the mouth still moving but you don’t get
to hear the utterance now speech at this point is going to
change in three fundamental ways when you get quieter as I just
illustrated and it’s going to be telegraphic once in a
while a word slips out that is perceptible but the most
important changes going to be going from description young children described
their world to self instruction they start to tell
themselves what to do and at this point it starts to work
below five years of age anything a young child tested themselves has no function it doesn’t work so they could
be sitting there saying stop stop stop stop and I’ll keep playing video games
language has not yet captured the motor system but by five to seven it has what you say starts to control what you do and that
is why it’s there between nine and twelve years of age
this voice is entirely in the mind but we know that it still
based on shelf speech because the research done in the last decade let me give you an example I can put
electrode all over your face and I can ask you disliked to shake your not say Canadian Pledge of
Allegiance in your mind used in with your face the muscle
movements are so small but the imperceptible to you and two
others but they’re measurable the human face is moving anytime you
engage in verbal fight social lyrics by the way but you can’t
see it I can’t see it but we can now measure it all verbal thinking his speech to the
self with the face suppressed but you can suppress an
entirely little electrical pulses are coming out and their activating the muscles around
the face in very Jerry subtle ways you can ask an athlete to
engage in a visual image up in action let’s
take a diver or how about just somebody picking up
something and throwing it across the room you know that when you
imagine that we can measure your right are moving it
it really moving but the muscle potentials are all
changing in the exact sequence that would be needed to throw that ball this is why you can
use visual imagery to improve athletic performance because you’re using the same system
there is no separate system you’ve just kept the actual brain
activity from going down the spinal cord but
using the same part of the brain when you talk to yourself you use the
speech system but the only thing different between talking to you in
talking to me the to suppress your motor strip still
the same speech system which is why you can’t talk yourself and
talk to other simultaneously because it’s the same damn system right
but you just keeping it in your head attorney trip so it helps us to
understand what I got he was talking about here really shouldn’t be called
internalization should be called privatization because you’re developing the capacity
to inhibit public actions and to keep them in the brain and that gives you a sense
of something mental cognitive but it still action to
the self no matter what now the first executive function
therefore that’s going to appear three months of age is the innovation system and it is going
to shut down that motor system because right along side it is going to
come the visual imagery system and it needs you to stop what you’re
doing to hold images in mind too that those images can start to take over your
behavior so the first two executive functions Co
develop simultaneously and by about 12 to 14 years a page
they’ve reached their adult level of development you get no more after that they are
early arising by the way there’s a rule in biology
that the earlier a function emerges the more important was to the survival that
species telling us that as humans visual imagery
in in addition played a very crucial role in human
survival by three years of age you get that I got
game system and now you have to mean to controlling your behavior images and words those are going to lead
to the third system you are now going to use those images
and words to create your own emotional state you are no longer depending on the
environment around you for your emotions and then finally you will internalize
your play and it becomes a source of planning creativity innovation and
problem-solving by the way that’s goal-directed
creativity not just artistic musical there’s a goal to be attained you can
count on an obstacle can you solve the obstacle can you
invent multiple possible ways around the obstacle to accomplish that
goal and that’s based on human play by thirty
years of age you have this entire system functioning unless you have ADHD and then you have a
thirty to forty percent lag in this entire sequence the five executive abilities I just
described are going to shift your behavior from the left to the right as a
three-year-old you’re being managed by external events
around you as a 30-year-old you better be being regulated by your
thoughts by what you are anticipating by the things you hold in mind but to
ship from external to internal control that is going to lead you away from
being controlled by Others which three-year-olds art to
self-management you no longer need other people to wake you up in the morning for
instance that is going to lead to a third shift you’re going to go from being
preoccupied entirely with the now to increasingly being concerned about
the future and the older you get the further out
you anticipate this is gonna go from being a matter of a few hours in early elementary school to about
eight to 12 hours by age 7 rate to about two to three days by
adolescents to 12 weeks by the time you’re an adult by age 30 the average decision made by
the average adult on the average day is eight to 12 weeks that’s how far out
the average adult anticipates the future or they can
anticipate it further out if that’s necessary but on average our window on time is two to three months just look at your
calendars you’ll see when you start to rate things
in them that is going to change your behavior
from being concerned only with immediate consequences to being concerned with delayed
consequences deferred gratification so to summarize this executive system is there to help him self regulate and
organize your behavior across time to anticipate the future and the future
you anticipating is the social future the frontal lobe is
a social organ as diamond argued it is the sheet
of our social intelligence it is where we regulate our social
behavior and it probably emerged initially as a
basis for social cooperation because we do something very few species
do we live with other members of our
species with whom we may not be related and we share we cooperate reciprocate but most importantly we keep score you don’t think so just stopped repaying
your favors and see how many friends you have on test your friendships real quick if
you stop reciprocity so let’s take a look at these executive
functions very quickly because we’re getting a very good idea what they do the visual imagery system the ability to
sense to yourself which comes very early is probably the basis for all human
social exchange we use images to keep track of who we
owe and who owes us and we can usually keep track of about
200 250 people in that frontal lobe you have a giant Excel spreadsheet in
your frontal lobe and it is for bookkeeping you use images I’ve the
past in order to understand who you paid who
owes you how much when and what it’s worth but if
you can hold images in mind even if it originated for this kind of reciprocity
in cooperation you can now copy the behavior of other
people because all imitation and bike here is learning is based on holding an image of what
other people do in your head and if you can do that you can use other
people’s behavior as your own you don’t need to learn
things anymore you could just watch people and by watching what they do and what
happens you can use what you saw to change yourself by the way is a go
through this list each of these as a deficit created by ADHD there’s an interesting prediction
children with ADHD can not use the behavior of others to change their own behavior they can’t
use the experiences they witness to all to themselves oh they sought it
just doesn’t matter other kids can be punished for fighting
on the playground this job loss of light they will have to
experience life first hint so they’re going to hit the
Hard Knocks a lot more often than other people this
is the system that let you look back to look ahead to get ready hindsight foresight and anticipation a future
events ADHD children are not going to be doing
that very well and if you look back to look ahead you
get a sense of time and now you know why ADHD destroys the
sense of time adult ADHD is the consummate disorder of time management and that’s because
people with ADHD cannot use percent of time which part of
the frontal lobe deficit the second executive functions of speeches where we
talk to ourselves this is where we reasoned with ourselves
we self question we saw of direct rules to ourselves
where we internalize the instructions given to us by others
were the ones we create ourselves and they work they serve to guide our
behavior in a rule governs fashion people with ADHD will find language to
be very weak at influencing their behavior until
adulthood they will be delayed in the ability to
use words language and instructions as a form of guidance which is why they
don’t do what you tell them to do not willful disobedience it’s a failure language to control the motor system but
this is also the source of reading comprehension because if you can talk to yourself in
your head you can hold the word you reading in mind and that leads to a deeper comprehension
what you’ve read heard were seen so we should find it
adult ADHD is associated with a progressive deficit in comprehending what we read see and here and then of course internal
rules are the basis for morality so we should find some delay in the
ability to morally govern our behavior we’ve talked about
the emotion motivational system so I won’t go any further into that this is
where we modify our emotions and create our motivational states which is the
basis for persistence self-discipline willpower finally the ability to internalize are playing
gives rise to the ability to generate multiple options when we are faced with the
problem and if this system isn’t working very well people tend to fall back on over learned outdated ineffective
behavior by the way the system also involves
putting behavior together to solve the problem stringing a sequence of actions together so we
should see that people with ADHD have a lot of trouble with problem solving in
their mind with generating multiple possibilities
for getting things done and then with following the one that
most effective in doing so but we should also see that they have
trouble stringing behavior together in a proper sequence and we will see there’s no better than
in their speech ask a high school student with ADHD to
stand up and tell you what they read in history last night and you will get massive dis fluency this is what it will look like history I think I read that yeah I did I know I
did okay um it in Boston I’m sure that and there’s a guy with the
horse yeah there’s a person there something about a church in some
lanterns give me a moment gotta love horseback riding us-led
forces we go to charlottesville virginia every
summer man is at a cool place cuz we have our storm down there and you know when you’re there if you go
there they’re searching casting barbecue place right at the corner of the
downtown and what did you ask me you’re laughing because what you have
just seen are two executives share yours I couldn’t hold
the goal in mind that’s working memory and I could not
assembled the behavior to attain it and that’s this module so what do you
get you get the correct statements the
concrete superficial out of sequence and finally the goal is
lost and the conversation has wondered so you will see a lot of certainly
Putian in verbal wondering in ADHD adults because they lose the
goal they were talking about and then they
can sequence the information very well either by the way you’ll see this in writing
you’ll see this in speech in to see this and behave what does this mean for ADHD in didn’t
ADHD is not an attention disorder it’s a blind as to the future it is a
myopia to the impending future events you are
nearsighted in time which means that the child and
adult with ADHD are going to wait until the future is
imminent and then they will try to deal with it
but as long as the future stays out there I don’t have to deal with that
the closer it gets the more I’m going to organize toward it but I can’t really do
much about it until it’s the 11th our and I will race around try to slap
things together in a happy dash manner to get it done
ADHD creates an nearsightedness two-time so that the person with the disorder can
not organize to the delayed future but only
to the imminent future and so everything in
life becomes a crisis but the crisis was avoidable and no one
has any patients with us because they see this as a moral failing you could have chosen to get ready but you didn’t it is phrased as a former
the laziness this layabout near do well carefree care less attitude did you could change
if you wanted to me but we know it as the executive share
your it really is this disorder precludes you from
organizing across time so you live in the moment and you cannot organized Jerry large hierarchically
sequenced behavior across time it means that
future direct behavior is intentional behavior which means ADD is actually ID’d intention deficit disorder I don’t
seem to be able to accomplish most to the things I intended to do you can call that a short attention span
but I think intention deficit disorder captures that much better now the
Frontalot the executive system is where you take what you know and you apply it in your daily life it
is not where you know something it is where you
use what you know the back part of the brain
acquires knowledge the front front part of the brain put it
in play ADHD has separated these two like a meat cleaver so it
really doesn’t matter what you know you can’t use it as effectively as other
people can ADHD is a performance disorder you can’t perform the things you know
how to do it is not a knowledge disorder most
people with ADHD know about as much as anybody else from their neighborhood
with their education at school at that age but they can’t use it not to anywhere
near the degree of effectiveness of others so people with ADHD know what to do but
they can’t do what they know one of the things we have known in
neuropsychology is if you wish to treat an executive
disorder a performance disorder the only way to treated is to change the
pointer performance the point performance is the place out
there in life we are you should be using this
knowledge and for some reason you can’t seem to do it so all treatment
must be at the point performance and if it’s not it won’t work no amount
of treatment done away from that place will solve that problem only changing that place will solve that
problem you have to restructure the environment
to help them show what they know so what does this mean it means a
teaching skills as a waste of time because they will be used skills or
knowledge and these people already have motor
skills anyway but even if you teach the new into the likelihood that they will
get implemented is pretty slim I can hand any adult
Alicia time management recommendations and I can guarantee you the most to them
will never get used in fact the paper will be lost on the way home because it will blow up under the front
seat of the car and then you’ll forget that it’s there or if you do remember that if they are
not able to the refrigerator but you won’t look at it and if you do you say
you know I really should be doing those things these are really cool things this is
what I really need help with and then I’ll just go about behaving impossibly
anyway you know come back and say you know
doctor partly those were great ideas did you do the Welsh I’m working on it point and find that
hard to DC Entertainment this is not a knowledge disorder it never once it’s
a problem with using what you know and no shita paper correct her
performance December you have to design the point performance around the
individual the phrase we like to use is designing prosthetic environments we’re going to use
prostheses little artificial things around the patient in order to help them I’ll give you some
suggestions in a moment but let’s remember that the most effective
treatment is done with the problem occurs not away from the problem this means
that medication is going to be needed for most cases have ADHD because we now
know how medications altered genes in the brain to change these neural networks so the
drugs like the stimulant in at a March 13 are actually forms of genetic therapy they literally Armada Armada fine the
neuro genetic impacted the disorder in the brain unfortunately like insulin they only do
it temporarily only while they’re in the bloodstream in
the brain and once they wash out the brain goes back to being the
executive deficit brain that it was previously but this gives a very clear rationale
for why medications are essential for this disorder this is not a socially created construct
that we’re using medication is a band aid to paper over as if we were putting mental straight
jackets on people with ADHD medication can now be rephrased as near
a genetic intervention now I just made a case for being excused
from the consequences of your actions but I really haven’t because you see in this theory the most
important thing is not the consequences it was the delay to the consequence what hurts people with ADHD is that most
natural consequences have any importance or delayed and the longer they’re delayed the more
disabled you become so the way to do with ADHD is not to
dismiss consequences that would make it worse it is to tighten up the accountability
to bring those consequences closer in time more frequent for immediate more serious
accountability over time that’s what we’re going to
talk about in my next lecture so the point here isn’t to dismiss
accountability is to take that up individuals with ADHD need more not less
accountability so we’re gonna need to modify point to
perform in turn create little prosthetic devices and behavior modification
becomes one means I’m doing so so you now know why we have
to do behavior modification because it creates artificial environments that
weren’t previously there in order to compensate for these
executive deficits but because we have to change the
natural environment the success in any treatment is
contingent on the compassion other people in that environment how
willing are they to help you modified appointed
performance and if they’re not on board and if
they’re not willing or compassionate can be very difficult not impossible but
quite difficult so we come to view ADHD there for like
diabetes on long-term chronic disorder they can be successfully managed but it
requires modifying environments lifestyles behaviors up the
individual so a chronic disability viewers ADHD as
a much better view then the attention deficit view I V DHT so to summarize we can think about ADHD
as a disorder in addition that disrupts the executive
system and leads to failures and
self-regulation and since the purpose of the executive system is to organize
overtime and get ready for the futures in life that is what ADHD is robbing the
individual of a capacity to do organized across time to the future now
how can we change that point a performance well if you can’t hold things in mind
put them outside a few you need to externalize key pieces of
information at these crucial point in life this is
where sticky notes charge list card reminders PDA’s computers anything
you can think about okay you’re the issue here is not what you do its
why you have to do it ADHD has destroyed the working memory
system you can’t hold things in mind so don’t right them down 10 most effective things
an adult with a DG can do is carry a journal that is changing your body if
necessary and in it you will write what you agree
to do and what others tell you to do and Zach is your working member you are going to
use an external resource to compensate for an internal working
memory problem so whether it’s digital memory recorders
whether it’s a journal whether it’s card whether it’s notes you
need to do it I remember being picked up once at the airport in Cedar Falls Iowa
by a drug rep who was adult ADHD a friend of mine and I got in
the car ni pick me up and I looked at the dashboard and I was stunned you know what was on the dashboard sixty
sticky notes sixty rate spread all over the dashboard
now I understood that he had always noted the pointer
performance and they were in the right sequence in which he had to call on
these various doc and get things done what concerned me to know when is he
covered the speedometer damn a I knew I was in trouble and rent as we will see in my next recent Asian
driving is a major problem but the point is this the more
externally represented the information is the more compelling it is and the
more likely it is to elicit the action you need to do you need to be using external props and
choose however you do it now you have no
internal clock that you can reliably call upon you have a distortion in the internal
sense of time so you’re going to need external
temporal references young children will need cooking timers older adults may
need watches that vibrate and go of it varies hours you
may need computers with outlook that signals you 20 to 30 minutes before a deadline but
you’re gonna need to use external temporal guidance devices things like
week at a glance calendars PDA’s and other means organizing your
life but time must be represented externally and not just rely on your internal some
tough time you cannot anticipate that future and
deal with it across time so the best thing to do is to break the future into
pieces into a piece today and other people can help you do this so
take the long term goals break them into their baby steps go back to those little
many behavioral structures I showed you but the frontal lobe is supposed to be
organizing the higher-level structures and do step a day a sequin today and
then you can have baby steps across time and when the future gets here you’re
ready all of that will be for nothing if you
don’t have some external means of motivating you to do these
things so you need to arrange for consequences
around you for getting things done when the best
way to do that is to make yourself accountable to others got social consequences can be very
motivating but you may also need to arrange other privileges other rewards that you
find interesting valuable in ordered for you to get your
goals done and these things need to be soon
immediate don’t tell yourself that if I work for a month I’m gonna allow myself
to one by some new clothes or get some iPhone or iPod or download a
musical whenever this need to be something within the day
not outside today near you bring the consequence more
motivating it will be you also need to use manual
problem-solving so if you have things that need to get done instead of just doing them in your head
try to do them with your hands as much as you can as well take mental arithmetic instead of
striving to do would appear you could be doing it with physical things you could
have marbles a number line in tobacco so hit calculator or the calculator in the laptop you’re
going to need some external means a representing and manipulating the
problem so however best you were able to do that
try to do so but this is how you solve the five
executive difficulties by going backward in their development
they were want external they have become internal we need to make them external
once again if we do that along with medication you
should be able to compensate for these executive problems but if you
persist in viewing ADHD as an attention disorder you will
learn nothing thank you very much

100 thoughts on “The Neuroanatomy of ADHD and thus how to treat ADHD – CADDAC – Dr Russel Barkley part 3ALL”

  1. Doctor, you're very insightful. Some of your blanket conclusions (regarding the psychology) are not correct though. I've lived with ADHD my whole life. I naturally used a notepad for short term memory. I would ask you to focus on the EMOTIONAL aspect of ADHD. That is, MORE susceptible to external (parental and societal abuses in youth) psychological abuse as 'Hyper Focus' [which is activated by emotion] can be used negatively, focusing on perceived abusive behavior. For example, even 'silent treatment' from loved ones hits an ADHD person very hard because they HYPER FOCUS on the event. I could go on, but you are an educated person, and one for whom I consider THE TOP EXPERT in ADHD as it pertains to Neuropsychology. Period.

    [I wrote this as it flowed, with no editing, so please pardon grammatical issues]

    I would ask you to re-evaluate, in light of the relatively recent (discovery) affirmation as to the 5 areas of the brain that are delayed, in utero ADHD. As you know, almost all (all?) major inventions were by ADHD individuals using the 'disorder' (obsessive focus on passion for one) to their advantage.

    I am not convinced ADHD is caused in utero. I know this was a commonly accepted/believed theory for a long time, but it wouldn't account for the ADHD we see hundreds of years ago. I would just ask you re-examine this. My belief is that 95% (plus?) are hereditary.

    I would also ask you think about ADD. The 'H' could be suppressed by early sociological conditioning, (what is acceptable for boys, i.e. 'rambo', 'gunslinger', 'Indiana Jones', etc, etc. vs accepted female norms as required to 'fit in') .. as well as a few other factors (such as lower testosterone for example) so that we would see ADD more commonly in females, but in actuality, is ALL ADHD. In other words, there is only ADHD, not ADD and ADHD. And one or more parents of an ADHD child ALWAYS has ADHD.

    .. Just something for you to consider.

  2. omg the 'impersonation' he did at 24:20 had me laughing my ass off but truth be told i found it a bit embarrassing too.. waaaay too true! 😮

  3. I don't know what college you went to but going to college does not mean giving up the babes in fact it means getting more babes

  4. He had me until minute 26 when he finally grossly oversimplifias things. But by minute 27 he's right back on message. Full disclosure I was diagnosed with ADHD in my late 20s

  5. Am I the only one who sees the irony of giving a lecture to a crowd on a subject of Attention Deficit disorder? Stress on the word ATTENTION.

  6. ''Images on the head define the human will'', but there are people who no have imaginative capacity.

  7. damn! as someone with ADHD hearing about normal memory is amazing! it's like you guys have superpowers! my memory is like a notebook with a couple sentences describing things I noticed and a few snippets of images and sound. I always thought memories in movies were poorly done because it's way too accurate but if that's what normal people experience I'm really missing out.

  8. So what you're saying is that our ability to formulate and articulate words reflects our own intellectual abilities. This explains why we evolved for the ability to feel annoyance. It reflects the breeding "qualities" of a partner and thus our offspring.

  9. we are all a big joke to you you look like niles from crammer only his jokes are funny and your more of pompass ass than he is

  10. people with adhd/add arnt affected at the same level so to say he will never do it when somtimes he does or giving axact ages that they all develop at is crap

  11. I can’t stay focused! So I can’t watch this whole video! I keep thinking “get to the point, get to the point, give me what I need to hear, what I need to do, short and sweet! “ trying to read what’s in the background and then keep seeing his lips moving then I’m like “oh shit what did I miss?”

  12. I might have ADHD , at least I have ALL symptoms. I’m 72 years old male and living in a nursing home because of a spinal cord injury, I understand now why my life.was so disastrous, I still have symptoms which affects my life now. I came up with a theory of common sense where I step back and think of what are all the consequences if I do this. It took a year to learn it and use itI had to make it a habit and training learning on a iPad and the internet. I had to learn it step by step and slowly learn one thing at a time. This helped greatly, and excersizeing was very important even with a c5 c6 injury. I’m hoping to find out if I actually have ADHD and get what ever I need to settle my brain down. I was diagnosed with depression and on a antidepressant witch doesn’t do much if on it or off it.thanks to DR. Russell Barkley I understand a lot more about ADHD and how it controlled my life,

  13. The captioning needs to be edited. "Inhibition" is written as "in addition" just before 1:13. Also "we can" is printed as "weekend". Great work otherwise.

  14. i have not come across anyone who could explain complicated matters of adhd in layman terms as Dr. russell barkeley. i have watched many of his videos. it shows his dedication and passion on this particular disorder. this is a great video that provides insights for adhders who are looking out for improving themselves.

  15. Or if you have it bad enough, then you could always try and increase the brain cortex. Eating things high in protein will help to increase the cortex size. Or you could increase the neurotransmitter levels by eating foods like chicken, duck, almonds, oatmeal, sea weed, mustard greens, and certain cheeses.

  16. I am still convinced that there's something else that is the root cause of ADHD besides genetics (chronic inflammation, environmental toxins etc.) and it can be resolved easily instead of being medicated for the rest of your life.

  17. This is incredibly interesting but I wonder if he could explain why some people with ADHD are actually excellent problem solvers – I'm one of them. Perhaps ADHD can be expressed as singular or more isolated executive functions misfiring while others work well, or even better than average. I do notice that as a higher executive function, problem-solving relies on previously learned information, so perhaps because ADHD children are so easily distracted by stimulating or peripheral information, some of them develop "out of the box" problem solving skills, effectively circumventing the standard path of executive function development and in fact applying their base level dysfunction to their higher functions. Again I have excellent planning skills, I just have trouble following through on those plans if they are remotely long-term. That again implies developed "advanced" executive functions but a deficit in basic ones. Perhaps the advanced functions develop semi-independently with a base level of basic functions. Perhaps it's more nurture than nature though too and because some ADHD people encounter problem-solving or planning requirements they kinda stack their points into those skills to the detriment of their basic ones.

  18. Here's two questions for you Barkley. You have never had the guts to answer them but you are ready to give amphetamines to children.

    Why did you get Gretchen Le Fever Watson fired because she said too many kids were being diagnosed with ADHD and drugged?

    Why do you take Big Pharma money when your salary will be high enough to live on?

    This is how it works. Big Pharma stuff Barkley's wallets with money and pay for his speaking fees and vacations etc. Big Pharma give speakers plenty of money. They are paying for their vacations. They are paying their speaking fees at conferences. The big pharma whores like Barkley and Biederman push their drugs, and develop their often far fetched theories. They exaggerate the the benefits of drugs and downplay their side effects. They then get to speak at more conferences and make a name for themselves. Both big pharma and psychiatrists are laughing all the way to the bank. The people who are hurt are kids who are put on anti-psychotics and amphetamines.

  19. I think he over generalizes when he said no other species can do that. I wish he would stick to adhd stuff and not keep harping on that. Otherwise a good speech.

  20. Oh my gosh I love yr brain. 🙂 I came across one of yr vids on adhd yesterday in a adhd group. And this stuff is really interesting. I did'nt get diagnosed until last year, but knew what I had after dating a guy with adhd. And it was the best thing ever, as now I understand myself; and understand why people have been calling my annoying and telling me to go away most of my life. You just said something here that spoke volumes to me. 36:44 rewards need to be in that day. WOW….. I have been trying to eat healthier and stop or limit my diet coke drinking and have previously said after 1 week I will buy ect. It never worked. Now I understand how to work this better. Also totally agree. I have paper signs in my room, mulipal alarms and big clocks (so I can see without glasses on). lol Thank you. It is interesting. Before seeing a doctor or teacher/ councillor ect I will study what I want to talk about and often find I know more than them. But sometimes it is like I am the alien inside my brain trying to say a simple comment and the mouth translates it into 4 different topics, sometimes not ever passing on the first intent message. I will be writing down the web links for teachers ect to watch. Thank you from the bottom of my heart. xx

  21. Peripheral attention getters helps if you’re trying to pay attention to the whole lecture. Knit, use a fidget toy, etc. It helps, trust me.

  22. This is a nice video for the psychological effects of ADD/ADHD , however, it begins as a physical disorder and CAN be cured in a relatively short time with a few alterations that are painless. My son had ADD from childhood, he is now 30 and has gone completely off his meds and is fine. I switched to a gluten free diet and A2 milk raw dairy, using only saturated fats (coconut oil, olive oil, avacado oil, grass fed butter, goat cheese, sheep cheese, and aged cheeses) along with going full organic non-gmo and adding Iodine supplements(lugol's 5% solution), selenium, D3, K2 w/Mk 4 &Mk 7, and zinc 30mg see Hakala
    Research Labs. Additionally, we take DHA and ALA supplements (fish oil). Problem solved, he's fine. You can look up the science of this to verify for yourselves. Dr. Axe, Dr. Flechas, Dr. Hyman , Dr.Whitcomb all have YT vids on Iodine, A2 milk, zinc,K2, ADD/ADHD. For those afraid of losing out on breads etc, YT has a ton of GF recipes, and America's Test Kitchen has put out 2 incredible books so far with wonderful recipes to help the transition. I did this change because of 18 surgeries and 2 cancers so far. I realized I was doing something wrong, and knew more about how to fix my car, than my body . Your body will heal itself, if given the right tools. Gluten , transfats and A1 dairy all block the body from absorbing DHA and ALA that your brain needs. Try it, stay on your meds, change your diet and see for yourself, brainfog that you didn't know you had may lift. Btw, none of these things will harm you.

  23. Notice how he didn't mention a SINGLE WORD about hyperactivity. I think that makes sense. ADD probably has nothing to do with energy and sitting still. Someone who can't control themself obviously isn't gonna be able to sit still in school.

  24. This guy is amazing! Thank God I was able to come across one of his videos. All of these things that he talks about, I don’t think it just applies to people diagnosed with ADHD. But applies to all who may be having trouble in self management and living their life as they intended to. So many insights provided in this 35 min talk. I have never watched a more eye openng video.

  25. His scientific information seems good however, his practical experience seems to be lacking. Some of his conclusions are simply off base from the reality of living with ADHD. As if it is a blanket pattern that affects everyone the same.

  26. ok totally lost but when i was learning how 2 do satellite internet there was something we called signal to noise and when the noise level was to high the pages/browsers had trouble opening and would even fail but when aiming dish properly background noise dropped signal went up and data transmitted smoothly. When I took adderall 1s and drove with my friend in the car and he was talking while on the drug He seemed quieter and i seemed to focus on the road better. "Signal to Noise" My mind has trouble filtering out the noise. Do you think i am adhd? I have to wait to 21st june to find out and thats bs

  27. If you're going to post his videos, please at least spell his name right in the title. It's Dr. Russell Barkley.

  28. I really should stop watching this video and do my assignments. But fuck that.
    At around 20 minutes all I'm thinking is what an asshole this guy is.

  29. This is fine except I'm overstimulated and sometimes can't respond the way he suggests.
    I guess it's the same fear a kid has when they refuse to get out of bed when they wet it….or rather get out of bed to use the toilet, when they wet it, they get it.
    When the possibility of failure starts to feel real, that's when your brain starts cramming information for the test eventhough it's too late.
    Sounds like a form of autism though?

  30. Thank you very much Dr.Russel Barkley. Finally, I understand my super ability ADHD brain, you explained each symptom and action of adhd mind very well.I always struggle with planning, study, low attention span, concentration, low self-esteem and so on.

  31. Thank you so much. It's taken me 50 years to find this gentleman's insight of ADHD offering up reason why i had to fall down, again and again, each time a struggle to get up, confused by my mind as it manifests, conditioned by it's unskilfull reaction to my external world. I acutely know what experience of the front-line of life is like. Simpy to be enlightened to this condition is such a gift. Knowing facilitates the opportunity for a new relationship to the self with compassion rather than a derogatory script repeatedly spun in the mind as suffering, forever present and bewildering by it's disproportionate level to the task, swiftly sapped my 'tank' leaving an evening phone call to a relative, impossible to carry out. The quote 'a 1000 journey begins with 1 step', lets me know where I am. Always at the beginning and the joy of a little less suffering.

  32. Dr Russell is a very important person for his work on ADHD and most importantly his delivery on the understanding of the condition. He is the light at the end of the tunnel. Thank you

  33. For those who are against him and medication – maybe you really don’t understand what ADHD is because you don’t have it, and I don’t blame you. But try really listen to his teaching – medication is just a tool to balance the brain chemicals and for many times he has taught many strategies and tools ppl with ADHD can use to manage the condition, and what parents/teachers to use to support children with ADHD. He never said medication only is the cure. If you stuff from ADHD and prefer not to take medication for any reason, that’s your choice and you are lucky to have a choice. For parents to are determined to NOT try medication for your children, you are basically depriving your children a choice and a chance. Imagine when you have a headache and you are not allowed paracetamol or cold/flu medication “because it is all in your head and pain killers don’t help you recover, it just reduces the pain”.
    Western medication a lot of the time relieves the symptoms and don’t cure the problem/causes – so that people can FUNCTION and COPE better. If anyone chooses to soldier on without medication, at their own will, it is absolutely fine. But don’t discourage or deprive others of a tool to help them function and cope better. I often choose not to take paracetamol until I am in absolute agony, that’s my choice; but not having paracetamol when I needed it – it is just unnecessary in 21st Century. If you are that against ADHD medication you might as well be anti vaccine and anti antibiotics as well.

  34. This is totally fascinating stuff. I’m watching this probably the 3rd time. It is a great overview of what is all going on in all cognition, not just ADHD. It is an image of many parallel processes in time with branching and convergence on multiple scales of detail. I’my somehow trying to capture this all in my mind in one picture. But I’m far from such a complete view, it’s more using the “mind’s eye” to zoom around different views in a large complex dynamic landscape. A map would be good, and an idea to create a good functional hierarchy, and a reasonable schedule. That seems to be the problem for ADHD: as soon as you make a map it becomes obsolete, as soon as you try lists, they become a hindrance or are irrelevant because they note mostly trivia and tautologies.

  35. This guy is a dangerous caricature that willfully or ignorantly but most certainly egregiously leaves out the paradigm shift across the neuroscience, for example, the seminal breakthrough of Allan Schore, 1994, Affect regulation and the Neurobiology of Emotion; Dan Siegal, Bruce Perry, Ed Tronick and many others, not least of which transformed the entire field of neurophysiologically and neuroanatomy, Steven Porges Polvagal Theory; infant-childhood mental health, Developmental psychotherapy, etc.

    The fact is that EXECUTIVE FUNCTIONING is not as he describes it here at all, or what he describes is an extracted piece (and if you will grotesquely distorted piece) defined under the very narrow lens of 1950's antiquated Skinner stimulus-response control supported by the second part, a two-prong approach, psychotropics (but not addressed here).

    It is dyadic Emotional (affect) regulation that develops in the context of secure based attachment practices and deepening reciprocal affect attunement primarily during the first 1000 days of life beginning in the last trimester that determines what (many) gene sequences are triggered by epigenetic factors, namely the child/parent dyad. The parent's emotional attunement (i.e., the co-regulator or higher brain) for the child, helps foster (internal regulation, expressed literally in how that child's brain, prefrontal cortex actually begins to forge the neuronal pathways and synpatic connections between the cortical with the subcortical parts of the brain. The "self" as we now know to borrow a phrase is NOT a "skin-encapsulated ego" as our Dear Dr. Caricature would like to convey to the unsuspected! It is in fact back by 25 years of evidenced based research in the Developmental Affect Neurosciences and Polyvagal Theory inter-brain communication (read Interpersonal Neurobiology) specifically right hemisphere to right hemisphere dyadic child/parent affect regulation/communication where these connections form foundation or core-executive functioning!

    We are born with approximately 100 billion neurons, how these forms into neuronal pathway and synaptic connections (beginning from the emotional right to the linguistic and logical left) are entirely dependent upon health child/caregiver secure attachment practices. This determines how the prefrontal cortex (e.g., regulation, attention, motivation, sequencing) connects between the cortical and the subcortical (more important parts of the brain, LHPA, limbic hypothalamus, pituitary adrenal gland and most important running from the myelineated to unmyelineated vagus nerve) which is dependent upon healthy early emotional attachment and attunement, which in turn build a neural integrated foundation that allows for increased simple to increasingly complex ideation (e.g., symbolic play) and then the emergence of social pragmatic language. It is this that is the best predictor pf the child's outcome going forward. It is this that determines the child Social Emotional Intelligence!

  36. EXCELLENT presentation.
    It, at last, put words, and insight, to my dysfunction.
    Im going to listen to this, again, and again..
    I am going to need your next speach, too..About the external tools..or something.
    My life is at a CRUTIAL..VERY SEVERE, stage, right now..Does't got ANY TIME LEFT..but this moment..An hour..? A missed payment of a bill..Ten days..? I missed to buy the Christmas-presents for my children..And expensive last minute-buys, will spoil any Christmas…Brooke.
    Consequense, you said…That's my middle name…Alway late, alwats worn out, only of stressful thoughts…I hate myself, by now..I hate those, unnessecary consequences, I hate my life..if only zero result, of all my skills, and knowledge, keeps going down the drain..
    Im 54…And my life, did not even start. That's SUCKS!!!

    YOU-TUBE?? Better, than nothing
    I live in Gothenburg, Sweden.
    If there are any recommended names of psychatrist, or else..
    Any suggestions, any resource, you can present, would be HIGHLY APPRECIATED.
    Please, E-MAIL me…URGENT!
    [email protected]

    Thank you, God bless, for reading my SOS..

    Merry Christmas,


  37. Can we do a study researching the steps needed to obliterate your conscience? I know who the perfect subject would be…

  38. My dear intimidating want to be idiot extraordinaire! "…It is simply an inability not to respond to irrelevant events in life, and now they are off task and won't respond to the task."

    Let's breathe, pause, back up and let' s deconstruct, shall we? First and foremost by whose definition? That is, to say, how pray tell, are you defining your seemingly authoritative defined word of "task" and seemingly authoritative universal defined phrase, "irrelevant events in life." You dear Sir and so many like you in the field have much profits inversely proportional to zero shame!

    You are medically inducing a fictitious umbrella condition called, ADHD (along with much of the rest of DSM) and in proven long terms fMRIs criminally shrinking brain growth, pituitary diathesis, i.e. stunted bodily growth rates and organ affiliated diseases including increase potential for hypertension by administering your panacea of SSRIs and last but not least future strong risks for additional concurrent or future anitpsychotic drug addictions with very short term gains in some instances at the assured expense of robotizing children and adults with proven devastating long term outcomes! Congratulation! You should be imprisoned for such myths and medically induced conditions and dependency!

  39. "Action to self" is not an example of "self-regulation", i.e., an "executive function." That my dear Sir, is your definition, which smacks of a severe narcissistic disorder! It is not only contradiction to Developmental Affect Neuroscience, epigenetics, infant child mental health, developmental psychotherapy, psychoanalysis and Interpersonal Neurobiology, etc., c Rather, repeat after me, once again, it is again, "Self in Relationship to other," This is otherwise known in developmental neuroscience and integral part of executive functioning, or more specifically the inferior parietal lobe, the temporal parietal junction, supramarginal gyrus, superior temporal suclus and insular through the tenth cranial nerve (vagus) as Theory of Mind or shared-perspective taking, part of early attachment dyadic deepening affect reciprocal attachment and attunement. The latter is fundamental part of what we refer to as the roots of empathy and thus functional-emotional growth and development! You are distorting last 30 years! Bravo!

  40. What Barkley doesn't tell you is how Adderall and Ritalin are banned in sport, have black box warnings, and skull warnings on the box.

    Can't upset his pharma paymasters can he?

  41. Exactly. There is no brain scan or blood test that confirms it. So one person might say you have ADHD. Another not. According to the DSM I've got ADHD, ODD, Major Depression and about 10 other disorders. As for as I am concerned there is no ADHD. It exists as a symptom rather than a condition alone, and children or adults should NOT be given Kiddie Cocaine or Speed for something that doesn't exist. Nadine Lamberts studies showed that children who were on Adderall or Ritalin became as adults Cocaine addicts, Speed freaks or Smokers. She was killed on her way to work in April 2006 when a truck ploughed into her car in California.

    How convenient.

    Don't be fooled by a drugs company salesman who uses big words and scholarly sounding language. He is no smarter than you or I.

  42. This is remarkable, I am sharing it with many people including doctors. I do hope the transcription is corrected, anyone who is hearing impaired is getting incorrect information.

  43. Wow here I was thinking hyperfocus was a unique benefit, now I find out it is a consequence of impaired set switching. Ugh. Depressing.

  44. As an ADHD adult which happens to also be a neuropsychologist meanwhile everyone is laughing at the ADHD jokes, I'm literally crying. I fucking KNOOOOWWWW exactly what I'm supposed to do but…well, I'm working on it (Where actually I put that sheets God Damn!) By now I'm supposed to be reviewing an ADHD paper from a student, but got curious about this class, and then class was so good, and now its almost midnight and I have to give the paper about tomorrow. And tomorrow I already got things to do, but I really want to finish this class, and why the heck Im even Commenting…that was not needed. But hey, here we are, thats life, who had never, isnt it?

  45. Im glad i found this. Though it was a little discouraging to be told the possibility of a normal life is a ways off. It was still really helpful. My ADHD has given me a lot of trouble when i try to connect with others. I have a few friends i made through hardships we shared, but ive had many others that simply walk away from me or even worse burn the bridge entirely. All the frustration i have about not being able to retain information well doesn't compare to my fear of not being able to maintain or build a real connection with people. I want nothing more than to have people i care about be able to rely on me one day and not worry i can't follow through. Like this man suggested in another video, I'm gonna get myself a watch today. Thatll be my first step i think.

  46. The things I should have known for years!!!! I wish this information had been available 25 years ago. I feel so wounded from living with ADD. So rejected and misunderstood. No wonder us ADDers suffer from anxiety, depression, and more. The world is a cruel place sometimes. I’ve been a round peg trying to fit into a square hole. Two surgeries and two traumas later, the ADD has only gotten worse. I’ve taken up transcendental meditation to assist with impulse control and I found that bupropion works great for focus and anxiety. The dopamine and norepinephrine re-uptake inhibitors work wonders for some ADD brains. All people with ADD should never smoke either. It really exasperated my symptoms and trashed my memory recall functionality.

  47. I'm trying so hard to pay attention, very reminiscent of my entire schooling just words,no grasp 🤣.

    Somehow I finished senior schooling and did my vet nursing successfully 🤷‍♀️

  48. Your knowledge, substantive presentation, thoroughness on Attention Deficit Disorder are amazing. Thank you for your work to develop all this. My husband is a psychiatrist, i am an LPC, (ABD! I am ADD). We have been disappointed for years at the dearth of information about add, the inevitable, invariable misinformation by even psychiatrists and psychologists who have spoken in the public arena. Even tho we are seeing this in 2019, your information is as relevant as the latest. We are so dismayed by the lack of information to the public and the resistance in our society to believe in add and realize how impairing it is! Again, thank you for your presentations.

  49. This is what pharma prostitute Barkley refuses to tell you.

  50. I can do that, but it not help if the outside stress and inside pain is to much to handle with my willpower. What should i do then, when my brain signals flee or fight and only painful tear venting helps if the sun or artificial light begins to make me really feel crazy with a 40h/4-8 h / sleepcycle, i know, i can keep that up with a good start for 6 weeks, at the moment the 2-3 weeks my sleepcycle is that way it is really time consuming to meditate) Did all of that with out medication, but my envirment always stresses me that they looking at my carreer stagnation and dont know what to do and treat me like crazy or stupid and just say: you living wrong, change -.-
    Why you can´t relax. You know all the pain is just ja imaginitiv response? ect. ect. and i felling they do not want to listen, they do not have time for this non sense and they do not understand, why my emotions sometimes sdtart to change and call me a lazy drug addiced. Fell really nice every day im my arrogant mindstate and ppl telling me ich am a lazy piece of … you can imagine the coulorful expression. And i really start to do not care anymore because i think nature-law is onb my side. Also the pain got for shorter and shorter priods relastivly immense, depandent on the sun … so it seems to me always like a light sensitivity, (serotonin / noradrenalin) inbalance. or because of the trouble to fall assleep it can be melatonin underproduction or something like that do. Triing to find information about the Funktion of the CAS 9 Gene.

  51. 1. Write down your goals whether its a journal or digital notes.
    2. Use calendars
    3. Break down your life into everyday tasks
    4. Social accountability
    5. Valuable Rewards that you get today not weeks or months later

  52. And this is were you get all the comorbidities, anxiety, worry, exacerbates the impulsiveness.

  53. This is a big problem for people/child with ADHD.
    The genetics of ADHD run threw the blood line, so the people responsible for the child have the same issues, exacerbating the ADHD in the child.

  54. And this is a problem for the Child with ADHD, cause the genetic predisposition, the parent responsible for the child has the same problems, exacerbating the problems for the child.

  55. He mentions compassion but there's nothing compassionate in his delivery. His audience laughs so he elaborates more on the description of painful details in the life of a person with ADHD, to make it funny for his crowd.
    I was diagnosed a few days ago and seeing this video caused me a break-down. This is the most hurtful source of "information" I've come across.

  56. Sooo true. I only face the future when the future and I are painfully face to face. So confusing. Im procrastinating as I write this. 😿

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