This week I’m talking with Dr. Mel Houser, a family physician and founder of All Brains Belong, a nonprofit that brings together healthcare and community support for neurodivergent people. Dr. Houser is also Autistic and ADHD herself and the author of A Failure of Imagination: How the Healthcare System Fails Neurodivergent People—and What We’re Doing Instead.
In our conversation today, we get into some topics I don’t normally cover on the show, including how physical health conditions can overlap for neurodivergent people and what gets missed when we treat each issue as its own separate problem. We also talk about a resource you can bring to your doctor to help get that conversation started.
From there, we get into understanding our capacity, setting boundaries around what we can actually manage, and why rest doesn’t always have to mean lying down and doing nothing. And Dr. Houser shares a way of thinking about those moments when we can’t stop scrolling: if your foot is already on the gas, what could it look like to steer somewhere else?
If you'd life to follow along on the show notes page you can find that at HackingYourADHD.com/321
YouTube: https://tinyurl.com/y835cnrk
William Curb: I am so excited to have you here today because we're going to be talking about some topics that I don't normally cover that often because not that many people know about them—specifically, a lot of these chronic conditions that show up physically in people with autism, ADHD, and other neurodivergences. Everything is connected to everything. Can you tell me a little bit about that?
Dr. Mel Houser: Yeah, for sure. That concept really applies to lots of different things that we do here. Here at All Brains Belong, our nonprofit organization, we support neurodivergent folks who have struggled to get their needs met in lots of different broken systems: healthcare, school, workplaces, and the community at large.
I'm a family physician, mostly caring for neurodivergent kids and adults of all ages. When I worked in traditional primary care, I found that I was spending almost all of my time in the exam room problem-solving life outside the exam room. Because everything's connected to everything, right? The idea that the healthcare system treats medical care as separate from the rest of life never really made any sense to me.
So for the past five years, together with our community, we've been intentionally rethinking how we want healthcare to look. It's healthcare for neurodivergent people by neurodivergent people, co-created with our community. Some of the needs that have come up include support for employment, help making friends, and training employers on how to create workplaces where all people can do their best work.
That foundation of everything being connected means healthcare is more than medical care. In our medical practice, the folks who come to us are generally those who have medical problems for which they were unable to get adequate care from traditional healthcare. What we were seeing is a pattern—a constellation of intertwined medical conditions. Research links all of these conditions to autism, to ADHD, and to each other. We did not anticipate that this would represent the overwhelming majority of patients seeking care here.
Some examples of that cluster of intertwined medical conditions include hypermobility, mast cell dysfunction, irritable bowel syndrome, pain syndromes like fibromyalgia and migraines, endometriosis, post-infectious chronic illness (like long COVID), dysautonomia or POTS... the list goes on and on.
That's not an exhaustive list, but these conditions impact the nervous system and the immune system—the neuroimmune system—which is our first line of defense against threat. Living in a world that's not designed for you is threatening. On top of that, having a physiology that is different from the general population in a way that is not well understood or taught in medical education compounds the problem.
William Curb: Yeah, and it's shocking when you hear about all the physiological conditions that can accompany ADHD and autism, because that's not what people typically think about, nor is it what pops up in pop culture.
Dr. Mel Houser: Right. Some patients come to us because they either know or suspect they're neurodivergent. Sometimes their children receive diagnoses, which prompts them to learn about brains and seek to understand their own. That is one pathway.
Another pathway is someone in deep neurodivergent burnout struggling to function in their environment; they aren't necessarily thinking about neurodivergence, but they're struggling.
A third pathway is people who say, "I have all these medical conditions, something is wrong with me, and I keep being told my tests are normal and it's all in my head." It's not in your head—it's in your neuroimmune system. That's the pattern we see.
William Curb: Often you wouldn't even associate those things with neurodivergence. I've dislocated my shoulder so many times and just thought, "Oh, that's just how it is." It didn't occur to me that not everyone does that.
Dr. Mel Houser: Not everybody dislocates their shoulder once, let alone multiple times. Just as autism and ADHD run in families, so do these medical conditions, meaning a lot gets normalized intergenerationally. I was the six-year-old who needed allergy shots. Not all six-year-olds need allergy shots, but my mother did, so it was just, "Oh, allergies are bad in our family." In reality, my mast cells haven't worked properly for nearly 40 years.
William Curb: My son was at a doctor's appointment where they had him demonstrate hypermobility tricks. He's way more bendy than I am—I only have a couple of hypermobile joints—and watching him bend his fingers back is almost unpleasant to look at.
Dr. Mel Houser: I have a nine-year-old who is also bendy. The way we talk about it with kids is simply: "You have a bendy body." Then we figure out how to support them so they can do what they want to do. When we hike, we wear shoes with ankle support rather than flip-flops. We don't want to limit our activities because we're bendy; we just need appropriate support.
William Curb: My daughter has poor interoception and doesn't register thirst signals, so we got her a water bottle that blinks every half hour to remind her to drink. It's about modifying things so we can participate rather than saying, "You can't do that."
Dr. Mel Houser: Exactly.
William Curb: A lot of people live with these conditions without realizing what they are.
Dr. Mel Houser: Related to that is not knowing one's risks. For example, autistic and ADHD individuals have higher rates of long COVID. We also know that reinfections increase the risk of long COVID, and hypermobility is an independent risk factor.
If you don't know you have these conditions, you don't know you're at elevated risk. In 2026, people are frequently forced to choose between health and safety versus full, meaningful participation in life. That's a serious dilemma. It's one thing to take informed risks, but without this information, it's just uncalculated risk.
William Curb: That's compounded by the impulsivity that comes with ADHD, where you just jump into things.
Dr. Mel Houser: Right. "I'm just going to do it, trusting the air is safe to breathe." When you can't trust that, it impacts everything.
William Curb: I could see that driving anxiety or OCD patterns, where you train yourself not to trust your surroundings.
Dr. Mel Houser: You become hypervigilant because the systems meant to protect you aren't reliable.
William Curb: Mhm.
Dr. Mel Houser: The stakes are high with neuroimmune conditions. Even if an acute infection like COVID is mild, the downstream consequences on the neuroimmune system can be profound. About a third of my medical practice has long COVID. Their acute infections were largely mild, but now they can't work, can't play with their kids, or are homebound or bedbound, having had no idea they were at higher risk.
William Curb: What can be done for long COVID at this point?
Dr. Mel Houser: In 2023, we co-created a project with 100 autistic and ADHD patients called Everything's Connected to Everything: Improving the Healthcare of Autistic and ADHD Adults. It's a toolkit designed for patients and primary care clinicians to navigate these issues together.
It includes a 16-page evidence-based clinician guide addressing long COVID and related conditions. There's also a printable patient letter to bring to primary care visits. It introduces the project in standard clinical language, relieving patients of the burden of translating their experiences during a short 15-minute appointment.
Most primary care doctors receive minimal training on the physical health profiles of autistic and ADHD adults, so having an accessible, vetted resource is often welcomed. Feedback shows this letter helps patients facilitate constructive clinical conversations where they previously struggled.
William Curb: When I visit a doctor, I'm conscious of describing symptoms with precision to get proper care—and as a white male, I recognize I start with an advantage there. A tool like that must be invaluable.
Dr. Mel Houser: It lets the letter do the heavy lifting. The clinical terminology doctors listen for often doesn't match how patients describe their symptoms. A patient might describe "tingling" or "buzzing," while the clinician is screening for "pain."
This matters because these conditions interact. If a patient presents with chronic pain and muscle tightness, a doctor might prescribe a muscle relaxant. However, if that patient has hypermobility or hypermobile Ehlers-Danlos syndrome, relaxing the connective tissue can worsen laxity in the airway, exacerbating undiagnosed sleep apnea. Poor sleep worsens autonomic dysfunction (dysautonomia), which in turn amplifies pain.
The treatment intended to help actually worsens the entire cluster. Our toolkit outlines interventions, medications, and strategies that support the primary issues without destabilizing others. We screen for the whole cluster because it's rarely just one isolated issue.
William Curb: Having taken muscle relaxants that wrecked my sleep, that makes total sense. My mind is blown.
Dr. Mel Houser: Most people don't know, so clinicians rely on standard protocols. The healthcare system itself is the issue here—it thwarts clinicians and patients alike. Holistically evaluating an interconnected system in a 10-minute slot is nearly impossible.
William Curb: There's so much ground to cover. While my primary care doctor is fairly knowledgeable about ADHD, medicine is so specialized that expecting every doctor to know everything is unrealistic.
Dr. Mel Houser: It should be normalized for clinicians to say, "I don't know," rather than dismissing a symptom because they aren't familiar with it. Dismissal leads to distressing patient experiences.
William Curb: The power dynamic is strange, considering providers are technically there to serve the patient.
Dr. Mel Houser: At All Brains Belong, our community healthcare model focuses on peer connection, collaborative learning, and redistributing power to the community, because effective solutions come from those closest to the lived experience.
William Curb: Absolutely. Having this knowledge gives people a real advantage.
Dr. Mel Houser: There are layers of understanding. First, understanding your brain and your access needs for participation. Second, understanding your physical vulnerability so you can approach care with the right lens. Third, addressing internalized ableism and shifting shame narratives, especially for late-identified adults.
Hearing your experiences mirrored in a community normalizes your struggles. It accelerates the process of unlearning shame: you realize you aren't alone, and that you are fundamentally okay.
William Curb: I still catch myself thinking, "I should just be able to do this." Reframing that to, "Regardless of what I 'should' do, what can I realistically manage right now?" is much more useful.
Dr. Mel Houser: I received my diagnoses of ADHD, autism, dyslexia, dyspraxia, and dyscalculia just over five years ago. Founding All Brains Belong shortly thereafter meant I didn't have to unpack that alone. Being immersed in a community that understands has been invaluable.
William Curb: Hyper-individualism just doesn't work for managing these conditions. Community is essential.
Dr. Mel Houser: We have to unlearn the myth of total independence; interdependence is healthy. In A Failure of Imagination, we explore community care, interdependence, and how to implement or advocate for structural changes.
A core principle across our free virtual community programs is universal design: providing multiple, flexible ways to engage so people have autonomy. Universal design applies to healthcare, community events, and workplaces alike.
William Curb: Accommodations built on universal design help everyone, including neurotypicals.
Dr. Mel Houser: Just like curb cuts: originally designed for wheelchair users, they benefit people with strollers, carts, and luggage. Multiple modes of participation benefit everyone. When workplace cultures meet everyone's access needs, resentment disappears.
William Curb: Producing transcripts for this podcast is a clear example: it's vital for hard-of-hearing listeners, but it's equally valuable for anyone who prefers reading or searching text.
Dr. Mel Houser: On September 22nd, we're releasing a free Universal Design Toolkit with specific versions for healthcare, community events, and workplaces, providing actionable language for both employers and employees.
William Curb: Perfect. By the time this episode airs, it will already be live. Time management and dates can feel completely abstract with ADHD.
Dr. Mel Houser: I don't experience time linearly either. I tend to assume everything will get done until I hit the wall of my own finite capacity.
William Curb: Capacity is tricky. We often keep pushing, borrowing energy from tomorrow to get through today.
Dr. Mel Houser: In chronic illness spaces, people use Christine Miserandino's Spoon Theory or a bandwidth budget to illustrate finite daily energy. When you exhaust your reserves, you must recharge before spending more.
Persistently masking, coping with unsupportive environments, and lacking safety drains your battery faster than it charges, leading to neurodivergent burnout. That's the most common catalyst for late diagnosis in our practice—skills regress to the point where clinical stereotypes finally register. Self-identification remains completely valid; people are the experts in their own lives.
William Curb: An interesting extension of Spoon Theory I encountered is "knife theory."
Dr. Mel Houser: How does that work?
William Curb: When you run out of spoons, you start reaching for knives—meaning you get through tasks by running on adrenaline or anger, ultimately hurting yourself or others.
Dr. Mel Houser: That's spot on. As someone who uses butter knives to eat yogurt when clean spoons run out, I relate.
William Curb: You push through using anger or tomorrow's energy, which is essentially grabbing knives from the drawer.
Dr. Mel Houser: Exactly.
William Curb: ADHD makes it hard to see capacity as a fluctuating continuum rather than just existing in the immediate present.
Dr. Mel Houser: Capacity changes daily based on sleep, nutrition, hydration, and co-occurring energy conditions like ME/CFS or long COVID. Community helps normalize saying, "I am beyond capacity for this, so I cannot participate."
In the book, I distinguish between preference-based and capacity-based boundaries. A preference is: "I don't want to answer the phone because I dislike phone calls." A capacity-based boundary is: "I cannot have phones ringing while seeing patients because sensory overload prevents me from doing my job."
We also have conflicting access needs between people—and even within ourselves. My child needs to discharge energy loudly after school, while I need silence. Within myself, my autistic and ADHD traits simultaneously crave routine and novelty. These needs are morally neutral.
William Curb: I'll catch myself vocal stimming to the point of annoyance, yet I can't seem to stop.
Dr. Mel Houser: That's the "foot on the gas" phenomenon.
William Curb: Kids experience restraint collapse after school, and adults do too after masking through a workday.
Dr. Mel Houser: The nervous system will inevitably find a way to discharge energy and regulate.
William Curb: If you suppress it entirely, you crash into burnout.
Dr. Mel Houser: We default to deeply ingrained neural pathways, like staying up until 3:00 AM to finish tasks delayed by daytime distractions. You can choose to say, "I am beyond capacity today." Making that choice is much easier when supported by a culture of interdependence.
William Curb: It functions like body doubling for mental health. When my wife is home, I stick to a regular bedtime routine; when she's away, that structure falls apart.
Dr. Mel Houser: Co-regulation with a safe nervous system is a powerful form of body doubling.
William Curb: It comes back to not having to do everything alone.
Dr. Mel Houser: You aren't the only one experiencing this.
William Curb: Giving yourself grace when things don't work out on the first attempt is essential, especially on days when chronic illness limits what you can do.
Dr. Mel Houser: ADHD and autistic brains run on dopamine to initiate and terminate actions. Inertia and dopamine deficits feel awful. Sometimes our conflicting needs compete: dopamine-enhancing medications can cause vasoconstriction, which compromises blood flow for conditions like long COVID. Choosing blood flow over dopamine requires recognizing needs neutrally: "I need dopamine, and I need blood flow."
Similarly, reframe "I am procrastinating" into neutral language: "I am having difficulty initiating."
William Curb: Pausing to assess what you actually need in that moment is challenging when moving on autopilot.
Dr. Mel Houser: I schedule explicit breaks on my calendar. I don't always protect them, but having them visible helps.
We also host Brain Club, a free virtual community education series on Tuesday nights. We discuss rest, workplace navigation, and practical access needs to help participants build new habits and feel less isolated.
William Curb: The concept of rest is counterintuitive for me. Simply lying down feels intolerable; I'm up within minutes because it doesn't feel restful.
Dr. Mel Houser: Rest doesn't have to mean stillness. It can mean reducing sensory demands. In our all-neurodivergent workplace, we sometimes hold silent meetings where communication happens entirely in the Zoom chat to avoid auditory and expressive fatigue.
William Curb: Reducing input rather than halting activity entirely.
Dr. Mel Houser: Autism Level UP! offers fantastic resources for nervous system regulation at autismlevelup.com. They provide practical tools for exploring regulation and customized forms of rest.
William Curb: Remembering to pause and check internal cues is difficult when you're caught in momentum.
Dr. Mel Houser: Many of us lack standard interoceptive cues, meaning we don't realize we're exhausted until we collapse, or hungry until we're irritable. Relying on scheduled cues—like eating at designated times rather than waiting for hunger—is often necessary.
William Curb: When internal signals are unreliable, what helps establish routines?
Dr. Mel Houser: Revenge bedtime procrastination often stems from seeking dopamine that was unavailable during the day. Integrating genuine dopamine-rich breaks throughout the day reduces the urge to stay awake until 2:00 AM chasing stimulation.
William Curb: Mindless late-night scrolling isn't even enjoyable; it's pure momentum.
Dr. Mel Houser: Dopamine deficiency presents in two ways: "foot on the brake" (struggling to start showers, chores, or work) and "foot on the gas" (starting an activity and being unable to stop).
Scrolling social media provides poor-quality dopamine, shifting you from foot on the brake directly to foot on the gas. Identifying authentic sources of dopamine—such as learning something new, listening to a podcast, or watching an engaging video—gives you better alternatives when you need stimulation.
William Curb: Social media delivers just enough micro-doses of dopamine to keep you trapped in the loop.
Dr. Mel Houser: When your foot is stuck on the gas, slamming on the brake doesn't work; telling yourself to "just stop scrolling" fails. Instead, steer the momentum. Keep looking at the phone, but stand up. The physical shift often breaks the loop.
William Curb: I'll toss my phone across the bed so I have to get up to retrieve it.
Dr. Mel Houser: Physical movement generates genuine dopamine.
William Curb: Don't slam the brakes—steer somewhere else. That's a great metaphor.
As we wrap up, where can listeners find your work?
Dr. Mel Houser: You can connect with our programs, including Brain Club and Kid Connections, at allbrainsbelong.org/get-connected.
To learn more about our book, A Failure of Imagination: How the Healthcare System Fails Neurodivergent People and What We're Doing Instead, visit allbrainsbelong.org/book. It is available in print, e-book, and audiobook on November 6th.
William Curb: Thank you so much for taking the time, Mel.
Dr. Mel Houser: Thank you for having me.
This episode's Top Tips:
Our boundaries need to account for our capacity. There’s a difference between not wanting to do something and not having the capacity to do it, even if those can look the same from the outside. We can still want to answer the phone, go to an event, or help someone and still need to say, “I can’t do that right now.”
It's important to pay attention to what drains you and what helps you recharge. Whether you think about that in terms of spoons or a battery, the point is to recognize that your energy has limits and those limits can change. Being able to push through something doesn’t necessarily mean you have the capacity to keep doing it, especially if you’re borrowing from what you’ll need later.
When you’re having trouble stopping, try changing direction. Dr. Houser describes this as having your foot stuck on the gas: instead of trying to slam on the brakes while the gas is still going, see if you can steer somewhere else. If you’re stuck scrolling, getting up while you’re still holding your phone might be a first step toward a transition. You don’t have to make the entire change at once.
Rest can mean reducing demands, not just stopping everything. A meeting where you can use the chat instead of speaking is one example where you're making participation less demanding. When you’re looking for ways to rest, consider which demands you can remove or reduce, even if you can’t step away from everything.