Alexithymia, ADHD, and the Feelings You Miss with Dr. Megan Anna Neff
This week I'm talking with Dr. Megan Anna Neff, an AuDHD clinical psychologist, author, and educator. She holds a doctorate in clinical psychology from George Fox University, which she completed the same year that she was diagnosed as autistic. Dr. Neff has moved away from traditional clinical practice to focus on creating research-informed, lived-experience-centered, and emotionally resonant resources and training through her platform Neurodivergent Insights.
In our conversation today, we discuss her diagnosis, how ADHD and Autism tend to run in families, and the ripple effects that can happen from there. We get into sensory processing and its role in burnout and self-regulation. We also hit on interoception, alexithymia, and self-care, and round things out with some frameworks and ideas on how we can work with our brains. It's a conversation of identity and self-attunement that I really enjoyed.
If you'd life to follow along on the show notes page you can find that at HackingYourADHD.com/311
YouTube: https://tinyurl.com/y835cnrk
William Curb: All right. I'm so excited to have you here today. I've been looking through your cards you sent over and the book, and it's been a lot of fun to kinda look at these self-care ideas. But I thought one of the ways that we could start today is maybe hearing a little bit about your own diagnosis journey, 'cause from what I understand, you got that like just right before you started graduating, right?
Dr. Neff: Yeah, it was the same year that I graduated with my doctorate in clinical psychology, which I think is partly what made it so poignant for me, as I had just gone through five years of clinical training, and that training hadn't prepared me to see my daughter or see myself as autistic. So when I discovered this about myself and then later got a diagnosis, it really lit a fire in me of "Oh my goodness, how is this not being taught in clinical trainings? How am I, a neuropsychologist, feeling really surprised by this?"
So we were discovering this around 2020 or 2021, around the pandemic, which interestingly is a time I think a lot of people began to discover this about themselves. For me, it was very kind of the classic pipeline story of one of my children was identified, and that's what got me curious about autism in girls. And within, I would say, a week of starting to read about this, I became obsessive with it. I was ferociously reading all the peer-reviewed research I could find. I did all of the screeners you could do online. I went and looked at my IQ results, which I had from when I was doing my doctoral degree.
So I was looking at all this data, and within a week of kind of opening this tab in my brain, I simply knew I was autistic, and all of a sudden it was like my whole life made sense in a way that frankly I thought I would never get to experience. As partly because I was training to become a psychologist, I'd been doing psychoanalytic depth therapy for about three years, and I'd been exploring all of the ways that my life felt disconnected. I felt dissociated from my experience, the ways I experienced social sadness and social isolation, and I was trying to find a narrative that made sense of it. And I was working through the grief of, I might never know why I am this way. And then it felt like the universe kind of gifted me this lens that all of a sudden all of these questions and angst and anxiety that I'd been holding clicked into place in a way that made a lot of sense for me once I discovered it.
And then, yes, later I went on to seek out an official diagnosis. And then it was about a year later that I discovered the ADHD, actually. So I have kind of the opposite story that a lot of AuDHDers have, which is I discovered the autism first and then the ADHD. ADHD was a little bit harder for me to see in myself because I'm so deeply monotropic. I'm so obsessive with my work that while school was hard for me, I was always able to do well because I would study my special interests, and I taught myself how to learn in ways that were visual and worked for my brain. So it was actually harder to see myself in the ADHD than in the autism.
So yeah, that's a bit about how I came to understand myself later in life.
William Curb: Yeah, I know exactly what you're talking about with this experience of realizing so much about your life once you get that diagnosis where it's just, oh, everything clicks into place. This makes sense, and this makes sense, and this makes sense. So with having the autism first and then the ADHD, did you have it twice over where you're like, "Oh, this is even more so"?
Dr. Neff: It made sense in different ways. And I've actually... It's interesting, I've been thinking more deeply about over the last year that I've actually had to work through more ableism when it comes to my ADHD. My ADHD is so wrapped up in things that I feel a lot of shame about.
And yes, they helped me make sense of my life in very different ways. And with the ADHD, I would say that one, partly it had a huge impact on my marriage, as you probably know from your experience of being in a relationship with ADHD is, I'm messy, and I lose things, and sometimes I lose expensive things, and I leave cabinets open.
And I think my spouse's narrative toward me completely shifted with the ADHD of it's not that Megan Anna doesn't care, it's, "Okay, yeah, food's left out on the counter again instead of in the fridge. That's ADHD." And he can kinda smile at it now rather than maybe it causing stress.
So it had a huge impact in my marriage relationship, but then also the shame I've had around ways that I was found unfortunate coping when I was younger or just a lot of the patterns that we can fall into when we're ADHD. And I'm still working through that. It's very much still a work in progress for me.
William Curb: Yeah, that's one of the things that I've found is, yeah, there's so many coping mechanisms that we came up with when we didn't know, and then it's this... I tell people like, yeah, for such a long time I was never late because I just relied so much on anxiety to make sure I was everywhere.
Dr. Neff: Oh my gosh. Okay, I love this topic because people who have co-occurring anxiety and ADHD often are diagnosed later, and it's 'cause the anxiety can hide a lot of that ADHD. And I'm the same way. I'd always show up early, and the anxiety would fuel kind of ADHD compensation, and yeah, absolutely.
So that was part of your experience. Was it also harder for you to see the ADHD because of that?
William Curb: So I got diagnosed after I realized I had three siblings that were diagnosed, and I was like, "Oh, I should probably go get this checked out." And they're like, "Yeah, all the testing shows this." I'm like, "Okay, that makes sense." But I would have never gone to check it out without having that one other step of "Oh yeah, I know a bunch of people in my life that have ADHD."
Dr. Neff: I think that's part of the powerful thing of this kind of wave of awakening that we're living through is when one person in a family gets identified or diagnosed, it can have a ripple effect on a family where siblings or parents or children are also getting identified. Of course, there can also be the opposite reaction with like resistance to the label or identity, but I see the ripple effect happening a lot in ways that are really powerful.
William Curb: Yeah. And I think one of the factors that would've kept me back is that my mom was also very the same way, where she just used anxiety for everything to really control all of her stuff. And she was very effective at using it, but very high-strung therefore. And so I was like, "That's the model I wanna go for," even though in reality it didn't work out that well.
Dr. Neff: Right. The struggle or the suffering gets turned inward more so than outward. Yeah, we take it on inward rather than the people around us being distressed by our ADHD.
William Curb: I think this is one of the things I feel like I talk about the most in my work is identity work, and this is why it feels like there's so much identity work that comes with... You know, even if someone's diagnosed in childhood, often they're revisiting it with more nuance in adulthood because of the ways we've learned to adapt, like "I don't want people around me to be displeased, so I'm gonna run on this really anxious engine and people-please and overcompensate and overwork."
Dr. Neff: And what that does to us as a self, no wonder so many of us end up in mental health care and in therapy. Like there's a lot there.
William Curb: Yeah, I was really interested when you were mentioning working through the internalized ableism part of it, 'cause I was like, "Oh yeah, that absolutely is one of the biggest things," where I'm like, "I should just be able to do all these things."
Dr. Neff: These narratives definitely were more sticky before I knew, but they're still there to some extent. But the "I should just be able to be an adult... why can't I be..." I used to talk about in my personal therapy the "shiny people," like I don't know why, but I just can't be like the shiny people, the people that are put together.
And then anytime someone was impressed with me, the metaphor I'd use is I feel like Oz in The Wizard of Oz, the little guy behind a curtain, and I'm just tricking everyone. And I think that's part of... So a lot of ADHDers, a lot of AuDHDers and autistic people, we have what's called a spiky cognitive profile.
So we might have a strength in one area, but a relative weakness in another. And I think there's a few complex things that happen with that around identity. On one hand, we can hold ourselves to the peaks of "I should be able to perform like this in all domains." But the other thing that can happen—and it's weird that both can happen, but both happen to me—is the peaks feel like, "Oh, I'm lying or tricking people into thinking I'm this talented person, but if they only knew, they would see how messy my bathroom is, or they would see all the things and that I'm actually not skilled, I'm just tricking people."
So the spiky skills, the spiky cognitive profile, that too feeds a lot of the internalized ableism and the kind of identity wounds that we form.
William Curb: Yeah, that really resonates 'cause I know the exact same feeling of being like, "You don't know how little time or how much time I spent on this project." 'Cause yeah, sometimes I'll spend five minutes on something and people are like, "That's amazing," and I'm like, "Mm, you don't know."
Dr. Neff: Do you find it easier to relate to your peaks or your valleys as your true self? Do you find yourself identifying with either holding yourself to that standard of "I should always be able to perform like this"?
William Curb: I hear what you're saying, and it's both, where I'm like, "That's who I should be and what I'm aiming for," and then, "This is who I am." It really kind of depends on my mental state, 'cause I have some history of depression, and that can easily be like, "Yeah, you're that guy." I know it's not true, but it is very hard to fight through.
Dr. Neff: Yeah. I'm so glad you... I also have a history of depression, and I think the way we hold the stories about ourselves is so influenced by that. Absolutely. When I'm depressed, the narrative I tell myself is all the lows, and the highs are just flukes and luck and not true.
That is one of the brutalities of a depressed mind, how it convinces us that we are just garbage. And then when you're already ADHD with internalized ableism, it's just gonna feed off of all of those neurodivergent woundings that are already there.
William Curb: Yeah. And I also think it very much plays into this idea of burnout too, where you hit that wall and it's just, "Oh, I just can't."
I was really interested in reading one of the definitions you had of autistic burnout where it talked about this need to drop sensory input as well, because everything feels like too much. I hadn't thought about it that way, but absolutely.
Dr. Neff: Yeah. A new metastudy just came out confirming—for years ADHDers have been saying, "We have sensory stuff too," but it's not in the DSM—that yes, ADHD is associated with sensory processing differences too.
It is a little bit more complex when we're AuDHD or ADHD 'cause we also can be seeking sensory input to wake us up and feel alive. But sensory input is such a big part of our regulation experience and our experience of our bodies when we're autistic, ADHD, or AuDHD. And for burnout, sensory input, sensory transitions, unpredictable sensory input—all of that can activate that fight-or-flight and threat mode in the nervous system so much more quickly 'cause the nervous system's already on edge.
So that's definitely the first thing I go to when I'm starting to feel burnout or burnout-adjacent: How do I create more sensory predictability and increase soothing sensory inputs? That's a big part of it too. Even now, I've got weight on my lap. I'm thinking through what are the sensory inputs that soothe me.
William Curb: Oh yeah. Once I went the route of a weighted blanket for bed, it was like, okay, I don't like traveling 'cause it's hard to travel with a weighted blanket.
Dr. Neff: It's a quarter of your weight in your bag if you're checking bags. Yeah. I have yet to travel with a weighted blanket. But you're right. My sleep accommodations are so intensive that that makes traveling hard.
William Curb: Yeah. I was talking with some friends recently about how what we would like most in a travel site is a rating of their beds and rooms with lidar and sound. If we could have just that, that would be the biggest factor in how we decide where we stay.
Dr. Neff: If any of your listeners are entrepreneurs, I've been saying this for years. In an ADHD moment, I started a second website and then closed it—I was like, "I don't have capacity for this"—but it was a neurodivergent traveling website. This absolutely needs to exist as almost like a travel guide, but with a sensory lens on top of it, where it's like, go to this hotel, go find this quiet park in this city.
I think that resource would be so well-utilized, especially 'cause a lot of us do enjoy the stimulus of new places and travel, but accommodating our sensory needs when we don't know what we're walking into is really hard. So yeah, that resource is just asking to be built by someone.
William Curb: Yeah, so listeners, I will support you any way I can if you email me that you're gonna do it.
All right. So I wanted to touch on this too, which we kinda skipped past, but the diagnostic process. We talked a little bit about it, but I was just interested... It seems so mysterious for a lot of listeners 'cause they don't understand how it works. Since you have both sides of this experience, I thought maybe you could talk a little bit more about that.
Dr. Neff: Yes. First of all, absolutely. It's kind of this black box experience, and I think that's one of the places where the mental health field has really let people down. Just in general in the mental health field, it's hard to know what you're walking into, partly 'cause there are so many different kinds of therapists out there. It's historically been treated as this opaque thing.
But especially when we start talking about ADHD and autistic assessments, it's even more cloudy, partly 'cause there are so many different kinds of assessments. It's also because we really are living through this wave of cultural changes and diagnostic changes that have happened in the DSM or the ICD.
We've seen a lot of waves of shifts over the years about the parameters of what is autism and what is ADHD. But back to my experience, there's peer-reviewed research out there around, for example, masking. However, much of it has not yet trickled down to training programs.
So the same person could walk into two assessors: one assessor would diagnose autism, and the other one wouldn't. Partly it depends on what their training is and what their awareness is around non-stereotypical presentations and masking.
And then there are also a lot of different kinds of assessments. Someone might do a full neuropsych assessment, which would include an IQ test, as part of an ADHD and autism evaluation, but not always. So yes, there is reason people feel confused by this.
William Curb: Yeah. Well, and I think it's helpful for people to know if they are feeling confused that it's not just them. The myths are still out there. I do clinical trainings, and I'll give a stump speech about how there are still clinicians who say, "You can't be autistic 'cause you made eye contact," or, "They can't have ADHD 'cause they're successful."
Dr. Neff: Clinicians are not immune to these cultural stereotypes. Unfortunately, those are still present in some clinicians.
William Curb: Yeah, I know. It's really funny too 'cause I remember looking at some very early report card things I had where it said, "fails to make eye contact" and all that kind of stuff, and it was never flagged as maybe I have autism. But at this point in my life, I am incredibly good at faking eye contact.
Dr. Neff: Do you look here?
William Curb: Yeah. Well, especially for these kinds of things, I'm just like, "I'm not really looking at you. I'm looking at the camera here to make sure it looks like I'm looking at you." But looking directly at someone isn't always comfortable.
Dr. Neff: Can you describe what eye contact feels like to you?
William Curb: It feels very intense oftentimes, and it can feel like someone is doing it because they are trying to make a power move over me, like, "I'm the one in charge here. You need to look at me."
Which now I realize is probably some childhood trauma there.
Dr. Neff: Well, I was thinking you probably actually were told that in childhood if it was flagged that you struggled with eye contact. I bet you had adults say, "Look at me when I'm talking," because in neuronormative culture, we assume to listen means to look, whereas for most of us, I'm actually gonna be listening a lot better if I'm doodling and not looking at you.
William Curb: Yeah. With my kids, I always try to say, "Just acknowledge that I'm talking," because otherwise, with ADHD stuff, I'm like, "I don't know if you heard me at all." So I need to make sure you heard me, but I don't necessarily need you to look at me to tell me that.
Dr. Neff: I love that you've been able to get underneath what matters here. Especially with ADHD, it's: Are we connected? Then we can do the social talking thing. It's not about the symbol of eye contact; it's about what we are actually trying to accomplish here. That you've found language for that in your family is great.
William Curb: Well, it's also 'cause I will do things where I'm driving and my wife will be talking, and then five minutes in I'll be like, "Oh no, I didn't realize she's been talking this whole time." We're now at a point where I'm like, "Hey, I'm sorry, I didn't realize that you started talking and I have not been paying attention."
Dr. Neff: That's another nice thing about ADHD discovery for me. I used to mask when I would lose the conversation and frantically try to catch up. Now I'll just say, "I'm so sorry, I spaced out. Can you repeat that?" I feel more comfortable asking for that now when it happens versus trying to hide the fact that I have no idea what conversation I'm in.
William Curb: Yeah, it is always that fun game of: Do I really need to tell someone that I wasn't listening, or can I pick this up?
Dr. Neff: Yes! Sometimes we can just pick it up, and sometimes it's like, "Oh, I think I really need to know what you were just saying."
William Curb: Yeah, that's usually with my wife's stories. I'm like, "I've not been listening way too long for me to know what's going on here."
And I think it's really interesting how you don't really realize what's going on until it happens. A lot of times with both autism and ADHD, we have trouble feeling ourselves so much.
Dr. Neff: Interoceptive awareness and alexithymia. Because I wrote Self-Care for Autistic People and now the card deck, I get the question a lot of how self-care actually differs for us. The thing I often go back to is that it's hard for us to know what we need in any moment. Self-care starts with self-attunement: the ability to know what's happening here and what I need in this moment.
That might sound simple, but that's actually really complex work for a lot of us, both because of interoception and masking. A lot of us have trained out the ability to listen to our bodies. For example, as a child with eye contact, it was uncomfortable for you, but paying attention to that discomfort might have gotten trained out of you if you received a lot of corrective feedback to look. Over time, you might have trained out that tendency to look away, which would have been regulating for you.
For me, fidgeting and moving really soothes me, especially in long meetings that are boring, 'cause I need the stimulus to wake me up. But in professional spaces, I trained out listening to my body's need for movement. Relearning that our body actually has helpful information for us is important, because if our body's signals got us in trouble in childhood or adulthood—like avoiding eye contact or fidgeting—we learn that it's dangerous to listen to our body.
So then something as "simple" as self-care becomes quite complex for us.
William Curb: Ooh, yeah. I'm just thinking about how important fidgeting is for me to pay attention. I have fidgets all over my office to make sure that when I'm doing these kinds of things, I can pay attention. Or else I'm doing stuff like rubbing my fingers together to get that little bit of extra tactile feel. I also want to make sure I'm not clicking pens when I'm on interviews.
Dr. Neff: Yes. When I do podcasts or recordings like this, I'm like, "Okay, what quiet fidgets do I have?"
William Curb: Yeah, 'cause it's so easy to do something that sounds terrible on audio. But yeah, so much of that idea that we got trained not to listen to ourselves because it gets us in trouble... and with ADHD and autism, we're so good at pattern recognition.
Dr. Neff: Even unconsciously, we're building those structures. If I did something five times and it got me in trouble, I used to have a working doc in my brain tracking rules: don't do this, do do this. We pull from that pattern finding. This is where masking is such a complex topic because it does help keep us safe, but it's also a huge energetic drain, and it's connected with burnout and depression.
William Curb: Yeah, it's really interesting to start examining that and ask, "How can I unlearn this?" It takes a lot of work to be okay with doing things differently.
Dr. Neff: Yeah. There are cognitive elements, but a lot of it is about how we relate to a body we've learned to mistrust. That's not something we can learn quickly or snap out of, or learn fully through our brain. It's a process.
William Curb: Especially when you have weak interoception, or alexithymia where you're like, "I don't know what these emotions are that I'm feeling. I'm mad, but that's not really what I am—I'm frustrated," or whatever it is.
Dr. Neff: For me, that's where I recruit a lot of my pattern finding. I'm alexithymic and very ideas-oriented or intellectual in how I make sense of myself. If I'm feeling a free-floating unease, I'll do detective work around, "Why do I feel this way? What happened?" It's probably why I became a therapist—I've always used pattern finding to make sense of my experience. I've recruited my head to make sense of my body because my body has felt so disorienting and disconnected for so much of my life.
William Curb: Yeah. Some people listening might think, "Of course you know how you feel," but we've all had the experience of suddenly realizing, "Oh, I really need to use the bathroom right now," because we weren't getting those signals earlier.
Dr. Neff: Yes! I did a training on alexithymia years ago, and this is one reason folks with alexithymia can actually get misdiagnosed with things like borderline personality disorder—though of course they can co-occur.
Often it's: I feel nothing, I feel nothing, and then suddenly I'm at a 10 in anger or stress and reacting. When we have alexithymia, it's exactly like, "I don't need to use the bathroom... oh my gosh, I'm gonna pee my pants if I don't go now," or, "I'm not stressed... I'm having a full-on meltdown and look very dysregulated to people around me because I'm at a 10." Once we're at a 10, it's so much harder to regulate and soothe our nervous system.
Alexithymia is interesting because it is something that can be worked on. When present with ADHD or autism, it exacerbates the hard parts. We see more hyperactivity, more struggles with impulsivity, and more anxiety around ADHD when the person is also alexithymic. With autism, it makes social communication harder.
If we target alexithymia in our mental health work, that can measurably improve our quality of life. I don't think it ever fully goes away for most of us, but we can make real improvements in understanding what we're feeling. We're not talking about changing the ADHD or autism; we're talking about addressing the alexithymia.
William Curb: Yeah, and it's great to think about this as something we can work on, because so many people with ADHD talk about going from zero to 10 in emotions as if it's just an unchangeable fact of life.
Dr. Neff: Right, because ADHD impulsivity and inhibition also make us likely to go from zero to 10, and alexithymia adds gasoline to that underlying struggle. If we work on the alexithymia, we won't magically become well-regulated people who never have big spikes, but it will definitely make managing emotions a lot easier.
In the neurodiversity space, when do we accidentally fall into limiting beliefs like, "Well, this is my wiring, I guess I'm always gonna have zero-or-10 emotions"? What's the balance between acceptance of "This is my neurology"—for me, accepting that I will always have sensory processing differences and struggle to decode context—versus recognizing where things can actually be improved to make life easier? It's hard to tease that out.
William Curb: Definitely. The executive function parts where you're like, "Yeah, this is how my life is," but then looking at it as, "Okay, that is how my life is, but there are things I can do so it's not such an issue."
Dr. Neff: Yeah. There are so many accommodations and ways we can build support in, even though there will always be a challenge there. The other area I see this come up a lot is Rejection Sensitive Dysphoria (RSD). Is this something we work with, or do we just accept, "Well, I'm always gonna have this intense reaction"? It's a tricky conversation.
William Curb: I think that's a good one where you can work on questioning your own thoughts, like asking, "Is this true?" If I slow down enough to say that or write it in a journal, especially getting it out of my head... If it's in my head, it's very easy to think, "Of course it's true." But when I say it to someone, say it to myself, or write it down, it's like, "Oh, okay, this does not feel so true when I actually put words to it."
Dr. Neff: RSD is something most of us will have a tendency toward, so I don't think that tendency goes away. But what we do with it when it comes—being able to pause and unhook from the thought—that's huge. Even asking, "Is this true?" is a form of cognitive defusion. You've taken something fused, like "This person hates me," and stepped outside it to ask, "Is that true? Is that helpful?" You've already done something to unhook from the RSD spiral. There are ways we can have agency in how we respond to these things when they show up.
William Curb: Yeah. I always try to remind myself that I don't have to believe everything that I think.
Dr. Neff: Yeah! A lot of my self-trust started to build once I realized that I don't have to always trust my mind, which sounds like an oxymoron. I trust myself more in realizing my mind is not always a trustworthy narrator, especially when you throw in depression, anxiety, or RSD.
Developing the ability to be skeptical of my mind has been one of the most helpful things for my mental health, and also learning to gauge when my mind is a solid narrator versus when to say, "Yeah, I'm just not gonna trust you today or this week." Especially with hormonal shifts—I know there's a week every month I'm not gonna trust my mind, and that really helps just to say, "I'm not listening to you this week. Go away."
William Curb: Yeah. I also find it helpful to think of those thoughts as maladaptive protectors. Extreme anxiety or hating this rejection feeling is just my brain being like, "Oh, this feels bad and I never want it to happen again, so I'm gonna make this the worst experience." That's not a good way for my brain to handle it, but it was trying to protect me.
Dr. Neff: I love that. Our brain does a lot of things that are hurtful to us, but it's trying to protect us, and being able to pause and name that is key. Even with internalized ableism, when we have narratives filled with shame, there's this underlying idea: "If I shame myself first before I behave in a way that causes other people to shame me, then I'm protecting myself."
So many things that fuel our depression or anxiety come from a place of trying to protect us. That's what makes it complex when people say, "Let's just unmask" or "Let's just deal with internalized ableism." We have to look at why that got there in the first place. Who and what is it protecting me from? A lot of times, that critical thinking or internal bully for ADHD and autistic people has been serving a purpose, so we have to address that fact.
William Curb: That's like what I was talking about earlier regarding using anxiety to get everywhere on time. A couple of years ago, I had a switch in my medication that reduced my anxiety quite a bit, and suddenly I was late to a bunch of things. It was very funny because I was like, "Oh, with this reduction in anxiety, which is great, I do have to use some of these other tools that I know about."
Dr. Neff: I hear this a lot, especially from ADHDers or AuDHDers: "I need my anger or my anxiety to get me to do stuff." When they work on those things, they feel like they can't do anything. It's a painful feeling of being stuck when things that aren't helpful for your mental health feel necessary to initiate tasks and get things done.
William Curb: Yeah, so many people really want to rely on these systems. For me, having done the podcast for years, I knew all the tools ahead of time and realized, "Oh, I already know how to do this. I just haven't been using them 'cause I haven't needed them." But for a lot of people, we all deal with these issues to certain levels and need to figure out how to motivate ourselves without anger, because anger's not always the best motivator.
Dr. Neff: Yeah. If someone's been drawing on anger or anxiety to turn their ignition on for years and years, and then that's worked through in therapy or with medicine, we have to dig deep into the ADHD toolkit: interest-based nervous system strategies, habit stacking, and so on.
William Curb: It's been hard for me to let go of some of the anxiety tools I've used for so many years, like thinking deadlines are the best thing in the world because I can always deliver. But I'm learning that it makes my sense of success go away, because instead of feeling, "Man, I did that, that's great," I just feel relief that the anxiety went away.
Dr. Neff: Absolutely. There's a psychiatrist I really like who talks about how we chip away at agency every time we rely on force-it techniques or urgency, because we don't give ourselves credit for doing the hard thing. We tell ourselves over and over, "I need the urgency" or "I need this force-it strategy to get myself to do things." Which gets back to identity—how we get ourselves in a space to engage ends up shaping how we see ourselves.
William Curb: Yeah. It's not an awful tool to use, but it shouldn't be the only tool you use all the time.
Dr. Neff: Right. This is where I really like the PINCH framework. Is this something you've covered on your podcast?
William Curb: I know of it, but I don't think I've covered it on the podcast.
Dr. Neff: It comes from the work of Dr. William Dodson. His initial acronym was NCUP, but it's the idea of ADHD having an interest-based nervous system, whereas the majority of non-ADHDers have an importance-based system. For them, if something is important—a school assignment, or important to a teacher or parent—they do it. That's just not the fuel our brains run off of. We run off of what is interesting, novel, challenging, or competitive.
PINCH stands for Passion, Interest, Novelty, Competition, and Hurry (urgency). Many of us, left to our own devices, will default to Hurry to get things done. Unfortunately, that's the hardest on our nervous system because it relies on cortisol and sympathetic mode.
The idea of the PINCH framework is to scaffold in Passion, Play, Interest, Competition, or Connection (like body doubling). Anything we can do to use one of those levers helps us build scaffolding so we're not always having to use Hurry. I've taught a course and written a workbook on this, and I still default to Hurry a lot, but I've gotten much better at incorporating the others so I'm not always relying on sympathetic mode.
William Curb: Yeah, it's hard to unlearn a lifetime of your brain going, "This works."
Dr. Neff: It's literally so much easier once the adrenaline is there because the hormones support the neurons communicating more efficiently. It's literally easier to do once our body chemistry is in that space, and Hurry does that so effectively.
William Curb: Absolutely. One thing we talked about before recording was processing speed, and I want to make sure we hit that before finishing up because it's not talked about a lot. With ADHD, a lot of people are very fast thinkers. Sometimes I am formulating a response before someone is finished saying the second word in their sentence, thinking I already know what they're gonna say. And then other times, it takes me such a long time to understand what they're saying.
Dr. Neff: Yeah! I find this endlessly fascinating. Research is still limited on the ebb and flow, but anecdotally we see that processing speed can differ so much based on context and interest. When we're interested in something, we have more dopamine, and our neurons are more efficient at communicating. When we're in our interest, our processing speed is faster.
There isn't just one IQ profile for ADHD. We sometimes see lower processing speed or lower working memory, but there's no single specific profile. For me, both my processing speed and working memory are very average (around 100 on the pie chart), while my verbal intelligence is around 120. A 20-point gap on an IQ test is considered statistically significant, and you see those kinds of gaps more often in autistic, ADHD, and AuDHD humans.
William Curb: Yeah, totally. Caffeine definitely helps with getting from point A to point B in my brain faster.
Dr. Neff: Yeah. And also the environment. The ADHD attention can get pulled by things that are emotionally loud or sensory input. What the environment is like matters a whole lot.
The thing about processing speed that really interests me is I've seen ADHDers whose processing speed is in the 99th percentile IQ-wise, usually those with the hyperactive presentation. Then I've seen ADHD folks who struggle with processing speed on IQ tests, which is more common.
One profile that fascinates me is when someone's processing speed is really fast, but their working memory is lower. They're taking in so much information, but struggling to hold it in mind, which can create an overwhelming felt experience of, "I'm absorbing so much, but I can't hold it. It's slipping away."
William Curb: Yeah, absolutely. A lot of us have the experience where if there's too much sensory stuff going on, we can't focus on what we want to—like driving down the street and turning down the radio so you can see better.
Dr. Neff: Yes! As I'm working on my next book on AuDHD, I recently wrapped a chapter on the nervous system and found some newer research that was counterintuitive to what I expected. They found that at rest, for about 45% to 50% of people with ADHD, the nervous system tended to go more into hypoarousal—that sluggish feel—especially in between tasks or when doing a mundane task.
Part of that connects to processing speed: if our nervous system goes into low-throttle mode, we're not processing quickly. We're in shutdown mode until something wakes us up, interests us, or urgency grabs us. If your profile involves going foggy and shutting down, you're not going to process quickly in that state.
William Curb: Yeah, we have peaks and valleys, and if we're in a trough of interest, it's going to be hard to follow through. It's the same principle as the PINCH framework on the processing speed side.
Dr. Neff: Yeah, we often need support waking our systems up. Left to our own devices, we might shut down a little, which is another reason we fidget and move—to help wake ourselves up and keep us alert.
William Curb: We're coming up on time here, so I was wondering if you had any final thoughts you wanted to leave the audience with?
Dr. Neff: First, I just want to say thank you so much for having me on. I've really enjoyed this conversation. For folks out there interested in learning more about AuDHD, self-care, and how we relate to these bodies and work through identity, these are things I'm very passionate about. I do a lot of that work over at Neurodivergent Insights on our website and social media, so that's where you can find more.
William Curb: Awesome. Well, thank you so much for coming on the show. This was a great conversation, and I had so much fun.
Dr. Neff: Thanks for having me!
This Episode's Top Tips
Alexithymia, sometimes called emotional blindness, is a trait where you can have difficulties processing or describing your emotions and is often felt in ADHD with the experience of going from 0 to 100 with an emotion. While this can feel impossible to work on in the moment, learning to name your emotions and tracking how you feel through socio-emotional training can provide measurable improvements.
Self-care starts with figuring out where you're at, but most advice on self-care often assumes that you already know what you need. With ADHD and poor interoception that can be a hard read. When we're feeling dysregulated, often our first step needs to be checking in with ourselves, and as Dr. Neff suggests, creating more sensory predictability.
Masking can train you out of listening to your body because it is a learned way of suppressing yourself. While this insight won't necessarily fix what's going on here, it gives you a starting point to notice when you're not listening to your body because you're just not noticing, versus when you’ve trained yourself out of it.