Born to Be Free PodcastEpisode 2 with Bowen Marshall

[Introductory music; child singing]Kids are born to be free. When you grow up, still wild and still free.

[Introduction note]Welcome to Born to Be Free, a podcast from Learn Play Thrive Continuing Education. On this podcast, we explore how to support the deepest wellbeing of our neurodivergent clients. I'm Meg Ferrell, and our show intro was recorded by my six-year-old daughter. You can find show notes at learnplaythrive.com for all of our episodes, as well as options for in-person and live-streamed continuing education trainings for OTs, SLPs, and mental health providers supporting Autistic kids. If you like the show and want to go even deeper into what it looks like to truly put neurodiversity-affirming practices into action in real life with all of the complexities of our work settings and our clients' needs, don't miss our Patreon series at patreon.com/learnplaythrive. Thanks for being part of the Learn Play Thrive community. 

Meg: This episode is a deep and nuanced exploration into the seemingly competing needs of being Autistic and being ADHD. We call these folks AuDHD-ers, and they're often faced with both the need for routines that comes with being Autistic and the craving for novelty that comes with ADHD. 

In this episode, AuDHD psychotherapist, Dr. Bowen Marshall, helps us explore all of the complexities around AuDHD, including how ADHD and autism can be complementary and how that may change when one condition is medicated. We talk about what's tricky and what helps, and we look in every corner of this to explore the complexities of this topic, like dopamine, executive function, routines, estrogen, testosterone, gender identity, race, and more.

My hope is that you'll leave this conversation with a much more nuanced lens to help you explore the challenges AuDHD-ers face in daily life and with some new tools in your toolbox for how to support them. Here's the conversation with Dr. Bowen Marshall. 

Hi, Bowen. Welcome to the podcast. 

Bowen: Thanks for having me, Meg.

Meg: I'm really excited to sit down and chat with you, and I wanna start with you. Before we dive in, can you share with us a little bit about your personal story and how you came to do the work that you do? 

Bowen: So, when I graduated with my master's degree in counseling in 2011, it just felt like the field was not ready for me — a queer, neurodivergent person of color. Didn't know I was non-binary at the time, but that came out. And so, I went and did a couple other things. I went to higher ed, and I went into private philanthropic consulting. Because in 2017, I just finished my PhD in higher ed and counseling, and I was a DACA liaison for Ohio State. So, 68,000 students all terrified that the Trump administration at that time was gonna do what it did in its second administration. And I thought, "This is not why I got into higher ed, to terrorize students." 

So, did philanthropic consulting. During the pandemic, we had a huge reduction in clientele. And so, 2020, middle of the pandemic, talking with a former grad student buddy, and she said, "Bowen, did you keep your counseling license active? Because I always thought you'd be a great therapist." And I said, "Oh, yeah. Totally. I just have always been wondering when would be the right time to come back." And as soon as I said it, I thought, "Oh, now. Now it's time." So, I ended up working at a private practice specializing in queer folk, 'cause I like to rep people that I'm in community with.

And because I have a PhD, I was able to write a lot of gender-affirming letters for bottom surgeries. And I would have people come to me and say, "People don't like me because I'm trans." And I thought we were definitely experiencing some discrimination, some gender dis — but that's not why people don't, why you're not connecting with people. Came to find out that in clinical settings, 75% of female-to-male trans persons who come to therapy also have autism. And so, I thought, "Oh, my gosh, if I'm gonna be competent in this, I need to upskill on autism." So, I did a lot of trainings, readings, just really digging into it. 

Then you learn that if you have autism, at least Level 1 support autism, there's an 80% — you have an 80% chance you have ADHD. And I was — I thought, "Gosh, I gotta learn how to do that now." And in the course of that, and I should have known that action precedes identity, that's what I found, like, the most surprising finding in my dissertation is not that we say, "I wanna be — I am neurodivergent." You start to realize you're doing all these things, and you go, "Wait a minute. I'm neurodivergent." 

And so, I'm working with all these clients. That's how I figured out I was non-binary, 'cause I was like, "Oh, I experience that, too." That's how I figured out I was neuro — I had ADHD, because I thought, "Why am I so good at this?" And then, I got a diagnosis. So, I kind of feel like I back-ended into it, and then the autism stuff came out because I would sit and talk with people who had ADHD and thought, "This doesn't just quite align. What's going on?" My biological father at 74 got diagnosed with AuDHD, and I thought, "Oh, there's the sensory issue. There's the fear of crowds. There's the kind of duality between rigidity and flexibility." So, that's how I got to this work. 

Meg: Wow, that was such an interesting journey to follow both professionally and personally, and then with your dad there at the end. Thank you so much for sharing that. I wanna talk more about AuDHD, that's our Autistic folks who also have ADHD, which I think you gave the statistic of 80% of Autistic people also have ADHD. Give us all of the details. Let's do a deep dive. What does ADHD look like together with being Autistic? 

Bowen: So, I tell people that if the core executive dysfunction of autism is rigidity; and the core executive dysfunction of ADHD is forgetfulness, flexibility, disorganization. It's a cold winter's day. You walk out of the house. Autism: You see your coat crumpled on the floor. You go, "Oh, my gosh, my coat's crumpled on the floor. I can't go vote, go to the doctor, go take my mail. I can't move forward." ADHD is: "Oh, my gosh, where's my coat?" AuDHD is some blend. It's like, "Okay, I don't know where that coat is, but I have five others that I've set aside. Okay, I can still go out — except this one has dog hair on it; this one has cat hair on it. Ugh, ugh, ugh." 

It's trying to put together two disorders that I actually think are adaptive to one another. And I see that a lot when I work with clients who have one diagnosis. So, last year there were two large scale genetic studies, one out of Princeton and one out of Europe. And I thought the most interesting one was that about a third — 34% — of people who are diagnosed with autism get diagnosed in late adolescence or adulthood.

And that for those people, they're unlikely to be caught in childhood because they're not exhibiting typical symptoms. They don't have verbal or intellectual delays, and they hit all developmental milestones on pace with their neurotypical peers. But as they hit the complexity of adolescence and then adulthood, symptoms around rigidity, around disorganization start to appear.

And in one study that looked at childhood presentations/diagnoses and adulthood presentations/diagnoses, they found that the later you are diagnosed with autism in this kind of adult presentation, the more likely you are to have ADHD, and PTSD, and depression, and anxiety. So, ADHD is something that clinicians used to say we all just grew out of, but we've found out that's not true. 

I think the single greatest growth in ADHD diagnosis is people who are older than 25 because we just thought, "Oh, you're an adult, you can't have ADHD. What are you talking about?" Women weren't included in these studies, so until the late '90s, early aughts, autism and ADHD were both thought to be male disorders. And so, you have this huge confluence of people who are starting to understand that they're neurodivergent. 

And so, your question was, what does AuDHD and ADHD look like? The other thing that I look at is the understimulation/overstimulation problem. So, right, like, in ADHD, it's almost painful for the nervous system not to be doing something; versus in autism it's like there's just too much happening. So, the core executive dysfunction or core sensory issue, right, so you've got the executive dysfunction, which is autism, rigidity, overstimulation sensory issues. In ADHD, it's understimulation and then hyperflexibility. And so, someone will, you know, come in with an ADHD diagnosis and they'll start ADHD meds. And all of a sudden, all of the noise, the physical noise, that misfiring neurons cause in their brain, quiets.

But about two or three days in — because stimulants, unlike other classes of medication, act instantaneously. And people know day one if they've got a high enough dose if their brain kind of quiets and if it's gonna work for them. But about two to three days in, they start to get hyperfixated on things. They start to get angry. And so, what I see a lot in my practice is ADHD can be an adaptive response to OCD. So, the inability to not turn away from your resistance compulsions. Well, ADHD is like, "Ugh, let it go." And then, with autism, what happens is that rigidity, that inability to — I often say that in practice, rigidity for autism looks like analysis paralysis.

So, we're gonna sit down. You want me to make a decision on my meal? Let me go through all the reasons why. How is it sourced? Is it ethically sourced? Is it unethically sourced? Is it local? What's the carbon footprint? Do I like this? Is it gonna give me an upset stomach? Do I support this business model, right? You start, as opposed to kind of being able to quickly click through all of those decision points, you get paralyzed by that. While when your ADHD is untreated, your ADHD goes, "Oh, my gosh, just make a decision." You're like, "Yeah, I can't hold that information anyway," and you make a decision. 

But when your ADHD is treated, there's nothing to derail that thought process. You go, you sit there and you click through first decision point, second decision point, third decision point, fourth decision point. And you're at this place where all of a sudden, with the ADHD treated, the autism is revealed. 

Meg: That is fascinating. Would you say there's folks that would disagree with that from their lived experience? To say, "No, actually my experience of ADHD makes my preferences as an Autistic person harder"? 

Bowen: Yes. I think, 'cause when we look at AuDHD, I often ask people, "Do you feel you're more ADHD forward, or do you feel you're more Autistic forward?" And I think that there are situations where it can feel like autism and ADHD present an impossible choice.

I'll give you an example. So, I went to WorldPride in DC last year or the year before, and I really wanted to see Troye Sivan. Like, I love him. I think he — yeah, I just love him as a performer. The night before, he was the last act on Saturday. And then, Sunday there was, like, a day festival. And then, Friday night they also had some major acts.

And so, Friday night they didn't have as big an act. Well, okay, if you love Jennifer Lopez more than you love Troye Sivan, then we had a huge act. I love Jennifer Lopez, so we waited till Jennifer Lopez's set was over. And trying to get out of those fairgrounds, I think it was the RFK Fairgrounds — first RFK, not second RFK — was a nightmare for me. There was just, like, this crush of bodies, the subway system was too packed. You couldn't get an Uber. It's too far to walk.

I mean, for me, it was a sensory nightmare. I was so dysregulated by the time we got back to our area with the hotel. We were supposed to meet up with friends, I just went home and went to bed 'cause it was just, it's just too much. And mind you, this is before I knew about the autism stuff. Which is why I couldn't figure out why everyone else was okay. I was like, "What? I guess it's me, but I don't know what's going on." 

So, the next night, we watched — my husband really wanted to see Kim Petras. Loved it. And then, I just started thinking about how awful it was to get home the night before. And we had spent maybe $200 or $300 on these passes just to get the Kim Petras Choice One experience, and I said, "As much as I want the stimulation, I wanna be here, I love this artist, I impulsively bought these tickets — I would rather go home and miss this person I've been waiting to see for months than deal with it."

And I think those are the types of things that sometimes make it feel like an impossible choice. Like, the you that's refreshed and ready makes an impulsive decision. You spend $600 on a pair of tickets, you're super excited, then you get all the way there and you just can't do it. 

Meg: Yeah. That really highlights the importance of something that comes up over and over and over on the podcast, is just knowing how your brain works, knowing your neurotype. 'Cause you were able to turn to yourself and kind of say, "I understand this part of my brain that likes routine and predictability, and I'm going to honor it." Or, as you described, you kind of said, "What's wrong with me? Like, why am I not — why do I not want to do this thing other people wanna do?" And it's so much better to be able to say, like, "I understand this about myself."

We recently had Vanessa Castañeda Gill on the podcast who is also an AuDHD-er, and she said she talks about teaching her clients to learn, like, "Okay, am I having an ADHD moment or am I having an Autistic moment? Do I need some sort of stimulation, some novelty? Do I need to get myself a treat to get through this moment, or do I need to reduce stimulation? Do I need to create more predictability?" It sounds like a lot of mental and emotional work, just listening to you describe all of the things that a person might be navigating to figure out how to get through a moment. Is it — would you describe this as a process that uses a lot of a person's energy and capacity?

Bowen: At the beginning, yes. I think because you — I don't think that autism or ADHD are disabilities. I think that in a neurotypical context, in a world that's not built for neurodivergence, absolutely, right? There are disabling things about lights that are fluorescent and then cause you pain, right? I often think we live not in environments that are built for human thriving, but are the lowest cost build to funnel profits to a billionaire's yacht.

Meg: That's right. Yeah. 

Bowen: Right? So, if every office was built with, like, sound pods, sound barriers, appropriate lighting, neutral scents, we could — I mean, we have the technology, we have the wealth to do it, it's just not distributed. 

Meg: Yeah. 

Bowen: I will say part of it is starting to learn patterns, right? So, like, some basic patterns that I think make it easier to understand what you're going through. It's that the neurodivergent brain goes through a boom-and-bust cycle. So, you're gonna have those highly productive days where you do — and I don't know, did you see that — oh gosh, he runs Palantir. Peter Thiel released slide decks that showed — and I guess he collects psychometrics on his employees, I don't know how else he would know this — but that his neurodivergent employees produce 8 to 12 times more, are 8 to 12 times more productive than his neurotypical employees. 

And I'm just like, "Wow, you're saying the quiet part out loud." Like, yeah. But the yeah, that idea that oftentimes the neurodivergent brain gets stuck in that boom-bust cycle, not wanting to admit the bust, so they commit to things on their super productive days, and then there's this expectation that every day will be that super productive day.

Meg: Yeah. Yeah, that makes a lot of sense. And I appreciate that you highlighted that it's harder at the beginning, and that it is often the world and the environment that's disabling. We do hear from Autistic folks whose Autistic brain creates a motor disconnect. Those folks are more likely to say, like, "No, I do find being Autistic to be disabling because my mouth will not make the words that I want it to make, and my hands won't move in the way."

And there are other folks, you know, who might have the experience you're describing of being Autistic is neutral, being ADHD is neutral, and the environment is disabling. I think it's really exciting to be raising a generation of kids, or at least some of them, with that sort of neutral, compassionate curiosity about their brains.

My own neurodivergent nine-year-old was describing something about something that was hard for him or helpful for him in the car, and I said, "You're really curious about your brain." And he said, "Oh, yes, I wanna learn everything I can about my brain." And I just thought, what a gift, right, to grow up with that sort of neutral curiosity, and to have it not be so exhausting to try and play catch-up and figure out, "Why is this so hard for me?".

Bowen: Yeah. I think — so, one thing, I don't wanna miss a point, you know, I'm medicated today. And I just had a medication adjustment, so I'm feeling a lot better. And I think sometimes when we're talking about changing our neural chemistry that much, you know, last week — and this happens to me when the seasons change, probably three months a year, I wake up with passive suicidal ideation, like, passive death wish. And the thought that goes through my head is, "Thank God this life does not last forever. Thank God," you know, that line from Game of Thrones, "My watch will end, and this will be over." And then, I have to talk myself through it and go, "But is today that day? No." 

So, even though your ADHD, hyperactive, self-critical part is online to try and — so, things about dopamine. We think of it as a pleasure chemical. It's not. It's a focusing neurotransmitter. So, most ADHD medications work on norepinephrine and dopamine. Norepinephrine is global awakeness. So, like, it just kind of raises your energy level, because one of the most common symptoms of ADHD is tiredness. When I'm not medicated, I'm tired five days a week at least. When I am medicated, I'm tired one day a week. 

After you get a certain level of awakeness — and we know this from recent studies that ADHD meds make people feel more awake, which then allows them to be able to better direct their attention — dopamine is a focusing. Of all these things that I could pay attention to, you're the most important right now. Not the camera in the background, not my bag on the floor — you. And we tend to focus on things that give us pleasure, right? Food and sex, important to keep us alive. 

We also focus on really dangerous things like fights and physical threats. And so, what a lot of ADHD-ers learn to do when they can't get dopamine from medication, they're not drinking a lot, caffeine doesn't give them enough dopamine, they can't get enough sugar, they will switch into what I call a dirty dopamine response where they will mine for dopamine by being very self-critical. "If I don't do this, you will hate me. If I don't do this, I am a failure." And we used to call it perfectionism, and it is, but it's actually a specific biological process. 

What they're trying to do is put themself in enough panic that their brain dumps adrenaline, and then that dumps dopamine and norepinephrine. And so — I have hyperactive ADHD — and so, before my medication kicks in, as soon as my feet hit the floor, it's 30 minutes of sheer terror. It's like, "You're gonna fail today. You're gonna, you're gonna — You misdiagnosed that person yesterday. You sent the wrong email." And that's the thing that I hate so much, that exhausts me, that gives me that think of, "Thank God I don't have to go through this forever." Luckily, now I'm medicated, so I take my now 20 milligrams of Adderall, and 30 minutes later it's like that self-doubt goes away because I have enough dopamine now that I'm not having to mine for it.

And so, I guess I would say I don't know what existing in a non-neurotypical world looks like, but I will say, and I've said this to people, that when RFK was threatening to take away ADHD meds, I thought people were saying, "Over my dead body," and I was like, "Oh, I'll be dead." Because that was torture. Every day of my life for 37 years before I was diagnosed, it was awful. There were some bright spots, but fighting that every day was terrible. And so, I do, although I do not think it's a disability, I don't want to diminish the suffering inherent in these disorders.

Meg: Thank you. Yeah. Thank you for sharing. And I know it can be really difficult to distinguish trauma from ADHD, that a person might have trauma that is showing up presenting like ADHD even though that person doesn't have ADHD, right? And then, you know, so many neurodivergent folks have trauma from existing in this world. Do you see what you just described for folks who are not ADHD but might be moving through similar processes because of trauma?

Bowen: So, severely traumatized people look like they have ADHD, and people who have severe ADHD look like they have trauma, because trauma and ADHD impact the same parts of the brain. So, there's the default mode network, which is made up between, people say, seven to nine different interrelated regions. They're all about meaning making, identity construction, how you think about yourself in relationship to the world. Trauma damages those regions, which means that — people don't like it when I say this, I don't know why — but ADHD is not genetic, it's epigenetic. So, it is a genetic potentiation.

Is there a genetic component to ADHD? Yes. But I do see things where extreme stress and — we already know this — trauma can actually exacerbate and make ADHD symptoms worse. Because if those regions of the brain, the default mode network, are already struggling because of ADHD genetically and you add trauma to it, you're affecting the same systems, so you're gonna make ADHD worse. It's gonna be louder; it's gonna be harder. And so, treating trauma does treat ADHD, but it's not gonna cure it. 

Meg: Yeah. Thank you. Thank you. That's so interesting. I appreciate you sharing all that. One of the things I wanted to circle back to is we talked a little bit about what AuDHD looks like, and you briefly mentioned that a lot of the earlier studies excluded girls and women, non-binary folks, people who were assigned female at birth just in general.

How might AuDHD look — people of color, yeah. I mean, it centers, they center cis, white European boys, right? So, can we talk about how AuDHD might look different for folks who are assigned female at birth? 

Bowen: I really look at it in terms of estrogen-led and testosterone-led presentations. Because we know that postnatally, estrogen moderates and reduces the severity of autism symptoms and seems to improve ADHD symptoms, specifically estradiol. And we know this because so many Autistic women and AuDHD women report that when they hit perimenopause and you have all the spikes and fluctuations in the amount of estrogen available to the body, their autism explodes.

And it's because estrogen helps with, I believe, it's norepinephrine, dopamine, and glutamate signaling. Glutamate is just kind of this neurochemical that we don't talk a lot about that's just about overall maintenance and basically helping the brain to function and signal itself. This is why Autistic women and AFAB folks who are on estrogen tend to have worse postpartum. So, right when you need to bond with your newborn, the screaming, the lack of sleep, you actually have huge sensory issues because your brain, you don't have the right amount of estrogen in your body to help with those things. Autistic and ADHD women are more likely to have severe premenstrual dysphoric disorder.

And so, all of that's happening while women specifically, and people who are raised as girls, are also socialized not to complain. They're socialized to take care of themselves only after they've taken care of everyone else first. And so, I've found that — so, I use the DSM-5 screener, screening tool for adult diagnoses, and it asks questions like, "Do you interrupt people's — do you finish people's sentences for them?" Who does that? What woman, what adult woman do you know in a workplace, would ever get away with being able to interrupt a male colleague? 

Meg: Right. Yeah. 

Bowen: And so, you have autism, right? And so, I'm asking you this question, and you say, "No." Well, of course you say no because you're taking the question literally, and you've also been trained not to. So, what I say is, "Okay, do you finish their sentences out loud, and/or do you finish them in your head?" And they'll go, "Oh, yeah, I finish them in my head all the time." That's what I mean in terms of — and I shared my specific piece because I think that I'm non-binary, and this comes to the estrogen piece.

I have what people would consider a more estrogen-leading presentation of ADHD because it's internal. Like, my eyes go [pause], and you think, like, "Is he dissociating? Is he having a seizure? Like, what's happening?" But, I'm so internally focused, and that's what happens with a lot of women and girls, that it — I had this one client once who they tested her for seizure disorder at six, but not ADHD, because she was so inattentive. 

Meg: So, I'll just say it, the way your eyes kinda went, like, wide and still when you were doing that demonstration. Like, almost like a freeze response. And so, they thought this child was having seizures. 

Bowen: And they tested and she wasn't, and so they didn't re-check until I think she was, like, 15. So, she spent from ages 6 to ages 15 struggling with inattentive ADHD, not doing well in school, and they were just like, "Oh, yeah, we tested her for seizures." 

Meg: Yeah. And what about — we also mentioned that Black, Brown, Indigenous folks, people of color are excluded from the research that's helped us define things like what is ADHD, what is autism. Can you speak to that a little bit as well?

Bowen: Well, if you're specifically a Black boy, you're more likely to be diagnosed, even if you're expressing the same symptoms, with oppositional defiant disorder than you are with ADHD. And what's problematic about that is, one, the stigma, right? Oppositional defiant disorder is often one of the precursors to antisocial personality disorder. You can't diagnose someone with personality disorder until adulthood. 

But also, if they engage in medication, the treatment protocol's different. So, if you have ADHD, it's to give someone a stimulant to help boost their dopamine. If someone has oppositional defiant disorder, often the treatment protocol, I believe, is still antipsychotics or mood stabilizers that actually limit and modulate the production of dopamine. So, you're putting somebody on some kind of chemical — they used to call it chemical castration — but a chemical modulator that makes them less oppositional, less defiant, less impulsive, but it also dampens their neural activity. 

So, I think we see that in terms of what's safe to express, right. In terms of impulsivity, Black and Brown bodies aren't able to be as impulsive and not have negative consequences, violent negative consequences. And I think the other thing is, you know, I posted a study out of Bristol where they took facial imaging maps of — a very small study. 25 Autistic people; 26 non-Autistic people. It's Bristol, England. I looked up the demographics of Bristol — or no, Birmingham. Birmingham, not Bristol. 

And they didn't provide the demographics of the participants, so I'm assuming it's mostly white. I can't tell you, though. But they kind of showed that typically what we see in the DSM, flat affect, less brow movement, less eye movement for happiness and anger, but I don't think sadness, that there is a actually consistent facial expression based on what we see. And in the comments, what I was really grateful, this is why I love doing this work and working with Autistic and ADHD-ers, is they're researchers. 

And one of the first things someone said was, "Black people, at least in my culture, are way more expressive than this. So, like, this whole flat affect thing, that's not going to translate if we're not working with white Eurocentric populations." And I think it's things like that, that you can still have the internal neuro-deficits, changes, issues. But because psychology is still a behaviorally diagnosed profession, you're gonna see a lot of misses. 

Meg: Yeah. I was interviewing Heather Clark recently, who's a Black Autistic consultant, and she was saying that in many parts of Black culture, there's such an emphasis on, like, the hugging and the warm greeting. And it was just yet another way that these Black Autistic kids weren't being identified 'cause folks were going, "Well, there's no way. You just walked in and smiled at my face and gave me a big hug." You just never know the cultural differences. Thank you for sharing. 

And I think, as providers, it's really important that we have this lens on how delayed diagnoses are, especially for our Black Autistic kids, the harm of them being misidentified, and the risk of providers, if we have police officers in schools especially, treating these kids differently and giving harsher punishments to Black and Brown students. We really have to have this at the front of our mind, so thank you for sharing that. 

I wanna get into the practical a little bit. What are the key things you wish providers like OTs, speech-language pathologists, mental health providers knew about how AuDHD-ers experience the world, and what kinds of supports they need?

Bowen: I work with adults, right? I work with people who survived to adulthood. You know, one of the things that I think we don't know is how many people don't make it. When you have Level 2, Level 3 support autism, you know, this whole rhetoric around this explosion of autism, we're not seeing an explosion of autism because there are that many more people that have it. We're seeing an explosion of diagnoses, one, because we're more aware of it; but two, because we don't have the ugly laws. 

From, I think it was, like, 1865 in San Francisco to 1974 in Chicago, there were municipal laws across the country that if you were visibly disabled, indigent, I think homeless, that authorities could arrest you, jail you, prison you, put you in an asylum, and forcibly sterilize you against your will. And so, when you — that's what masking is. Masking is preventing detection of something that's different in you and then being taken away by the state. And so, I think we have to confront that legacy. 

But to your question around what do people, what do I wish people know? The way that I work with people who do make it to adulthood, predominantly Level 1 support autism, predominantly also having ADHD, is I go with what is the sequence of events that happened that makes this a perfectly reasonable behavior/solution/response in your mind?

That's it. I mean, like, if I could get people to do that, to go like, don't judge it. Don't go, "Oh, my gosh, I can't believe that happened." But just sit with it and go, like, "Okay, but if this is perfectly reasonable..." That's the thing that I wish every single mental health professional, speech and language pathologist, occupational therapist would do, is what if we got reasonable? Because if we start there — and so, it's something like, "I want you to do this homework assignment as opposed to playing on your iPad Angry Birds." And I hear stories of someone yanking an iPad out of someone's hand, and so then the child escalates. 

Thinking about — but like, so, like, I think that screens are going to be for this generation what ultra-processed foods were for millennials, right? Like, when the big tobacco companies started to get sued and realized they weren't gonna expand anymore in the American market, what did they do? They bought up all the major food companies, and they turned their food, their neuroscientists, from getting people addicted to cigarettes to getting people addicted to foods. They actually do EKGs and stuff — oh, God, I can't think of the thing. 

But they actually map energies to see what regions of the brain light up to make Cheetos, right? Like, Cheetos are infinite caloric density, right. So, you eat one, it hits all the pleasure centers of your brain. But then, it melts, so your body doesn't interpret it as nutrition. So, you can eat an entire bag of Cheetos and get this dopamine high, and people wonder why we have issues with obesity.

Same thing with screens, right? Like, when you see that people like Mark Zuckerberg or Steve Jobs don't let their children use screens. Playing Angry Birds, watching that video is such a huge dopamine fix for these kids who may be dysregulated for so many reasons. So, you're asking them, you're taking away what may be their only source of dopamine regulation in the day. You don't know what their home life's like. You're ripping that out of their hands, you're not giving them any tools, and then you're making them focus on this other thing. 

I think the real question is, okay, why are they so hardwired into that thing? That should be the question. What else is going wrong or right in their life that's making that happen? Now, I realize people don't always have time for that, but I really wish that's the approach people would take. 

Meg: I love this question. I love the simplicity and impact of it. And people say, "Well, you know, oh, real world. When they're a grown-up —" Okay, real world, and when they're a grown-up, they are going to have to navigate what is happening inside of them one way or another. And what we hope is for them to be able to be whole and untraumatized enough to look inside of them with compassion, inside of themselves, and say, "Hmm, what's going on inside of me right now that I wanna do this, or that I responded like that, or that I feel like I just can't do this?" To look with curiosity and compassion.

And what I hear you saying is even when they're young kids, we are modeling that, instead of just trying to shut off those parts of them. Like, "Just stop it, just do this." Well, whatever was inside of them is still there. Whatever skill they didn't have, whatever need was unmet, is still there. And all we've done is teach them that while it can't be here, it can't be here with me. There's not space. We're not gonna, we're not gonna grow right now. I think about my own kid, who I just understand so deeply, right. I just really, really get it.

And when I hear him describe another scenario where someone has wielded their power over him in a way that grown-up thinks is understandable, is fine, is justified, is a natural consequence, was effective. And then, if he self-advocates, which he's very, very good at saying, "Hey, when you give me a punishment like that, it doesn't help me learn. It just makes it harder for me to be at school, because now I'm missing this time when I could play, which is what I was looking forward to all morning, and now I'm gonna feel angry and things are gonna go worse."

And then, he, if he doesn't get listened to then, gets shut down or punished, now it's like there's no way to be. There is no way to be his whole self and be in that space, and I understand it so deeply. But if you just looked at the behavior, you miss all of that. You miss all of that kid's internal experience and all of the growth of being able to be like, "Hmm, what's going on? Oh, I don't know, my body acted faster than my brain, and now I feel so much shame because I wish I hadn't done that." There's so much to be learned. So, I actually really love, I love that framing of what happened that makes this make sense? 

Bowen: Well, in real world, so many people, you know, we were raised in a generation of shaming. The amount of people that died from alcohol consumption during the pandemic, right, because they were mainlining dopamine, 'cause they didn't have any other way to look at it. You know, when I got diagnosed with ADHD, I got diagnosed after I finished my PhD, and I would tell people what I was going through, which I was reporting ADHD symptoms, but people would just say, "Oh, getting a PhD is hard."

And it was actually my physician, not my counselor — I actually took this to my counselor, and that's what prompted the discussion. She knows, and maybe it's a literal thing. She goes, "Bowen, how many cups of coffee are you drinking a day?" I said, "Two." And she goes, "How many ounces are those cups?"

And I said, "Why would you ask me that?" And she goes, "Bowen, 'cause I know you. You, will answer a question based on what you think. How many ounces?" And I said, "32." And she goes, "You're drinking 64 ounces of coffee a day?" I said, "Well, they're free. Like, Starbucks just refills them." And I she goes, "That's why you're having, like, heart stuff." And I said, "Well, a lethal dose is a gram. I'm drinking 600 milligrams, and it's spread out throughout the day. What do you want from me?" Well, she goes, "Bowen, you have ADHD." 

And I said, "What?" And she goes, "People who don't have ADHD wouldn't tolerate those tachycardia symptoms, wouldn't feel drawn — like, you are desperate for dopamine. That's why you're doing it." Whereas everyone else around me was like, "Oh, my gosh, you drink too much caffeine. That's so unhealthy. Why would you do it?" And so, what happened? It drove the behavior underground. I would put it in — I'd be drinking Pepsi Max out of this cup. I would put it in a to-go water thing.

So, that's, for me, the adult examples of that same phenomenon, as opposed to saying, "That's unreasonable. That's outlandish. Why would you drink that much coffee? You're spending too much money," going, "Okay, but why do you think that's reasonable?" And I will say this other thing. I tried going, before that, I went off coffee cold turkey for two years, and it almost ended my marriage. Like, at the end of my dissertation, I was, like, sneaking coffee the last week thinking no one would notice, and I went to my husband and I said, "Hey, babe, how have I done?" And he goes, "Man, like, I thought you were gonna be a real B, but you've been, like, so pleasant." And I said, "I've been sneaking two cups of coffee a day. It's killing me. Thank you." Like... 

Meg: Yeah. Yeah, that's a great example. Thank you for sharing. We don't learn about ourselves, so we don't grow our skills through shame. Bowen, thank you so much for this really impactful conversation. For folks who wanna keep learning from you, where can we find you and your work online? 

Bowen: I just want to say thank you so much for having me. This has been delightful. You can find me on TikTok, Instagram, Facebook, or YouTube at @DrBoTyler. You can also find me on Substack at Bowen Marshall. I try and put out three videos a week and two thought pieces a week to help with ADHD, autism, AuDHD, and other neurodivergent concerns. 

Meg: Great. I'll link to all of that in the show notes. That's how I found you. I think I found you on Instagram, and your videos were so impactful and so meaningful, and I'm glad that we got to sit down and have this longer conversation. So, thank you. 

Bowen: Me too. Thanks. 

[Ending note]Thanks for listening to the Born to Be Free podcast from Learn Play Thrive Continuing Education. If you enjoyed the episode, please rate our show on your podcast player and share the episode on social media. For more in-depth episodes, visit patreon.com/learnplaythrive. 

[Ending music]Child: So, it's a C chord for, [singing] "Kids are born to be free." And then, the end part is D7, [singing] "Kids are born to be free." Which one are you gonna put on Mommy's? Person: We don't know. We're gonna figure it out.