Think ADHD is just a genetic roll of the dice or a problem screens caused overnight?
Clinical social worker and attachment expert Erica Komisar reveals the overlooked stresses wiring kids into hyper-vigilant “fight-or-flight” mode, explains why diagnoses have soared, and shows Steven the practical fixes that calm young brains before medication ever enters the picture.
Discover The hidden early-life stress that’s fuelling a decade-long spike in ADHD and anxiety Why a child’s brain can mistake normal classrooms for danger zones—and how to spot the signs The real reason quick-fix meds often fail (and what to tackle first) Erica’s “30-second reset” parents can use anywhere to bring kids out of meltdown mode Simple lifestyle shifts that lower cortisol, improve focus, and protect mental health for life
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ADHD.
Yep, okay.
I don't feel like I don't even have to ask a question here,
but just to set the stage,
the reason why I'm so compelled by this is just this,
I have to say,
the shocking rise in diagnosis and prescriptions over the last 10 years.
Between 2000 and 2018,
ADHD diagnoses in the UK rose approximately 20-fold.
Yes.
Among boys aged 10 to 16,
diagnosis increased from 1% roughly to about 3.5% in 2018.
And in men aged 18 to 29,
there was a nearly 50-fold increase in ADHD prescriptions during the same period.
And the same applies to the United States,
where an estimated 15.5 million adults in the US have been diagnosed with ADHD.
Approximately one in nine US children have been diagnosed with ADHD at some point,
with 10.5% having a current diagnosis.
I don't know where ADHD was,
but the conversation around it, the prescriptions, the diagnosis,
seemed to have really surged into culture in a really, really big way.
What's going on?
So ADHD was one of the factors that drove me to write being there,
because I was seeing this huge uptick in ADHD diagnosis
and children being medicated so, so early.
Do you know what the fight-or-flight reaction is?
That's when the sympathetic nervous system starts to kick into action.
Yes, so well, it's basically our evolutionary response to a predatorial threat.
So if a sable-toothed tiger was chasing you,
you either stood and fought, fight, or you ran for your life, flight.
So when our children are under stress,
they go into fight or flight.
So one of the first signs that a child is under stress that they cannot manage
is when they become aggressive in school.
They hit, they bite, they throw chairs,
they have trouble, you know, socially in daycare or preschool or even in school.
Or they become distracted, which is the flight part of fight or flight.
So what's happening is their nervous systems,
the stress-regulating part of their brain is getting turned on.
So we say that the stress-regulating part of their brain has to do with
a little almond-shaped part of the brain called the amygdala.
It's a very primitive part of the brain, very old part of the brain.
And it regulates stress throughout our lives.
It helps us to manage it.
What we know is that part of the brain is supposed to remain
offline for the first year to three years,
which is why mothers wear babies on their bodies.
It's why babies stay close to their mothers in the first three years.
To keep the amygdala quiet and only incrementally,
incrementally expose children to stress and frustration that they can manage.
So imagine taking small bites of it so you can digest it, right?
And your mother's there to help you digest the stress.
What we're doing now by separating mothers and babies,
by putting babies into daycare with strangers,
is by sleep training babies,
all these weird things that we're doing to babies is we're turning the amygdala on.
We're making it active precociously too early.
What happens when the amygdala is activated too early
is it becomes very active and very large very quickly.
The problem is then it shrivels up and burns out also
because it cannot manage that kind of stress so early.
When it ceases to be functional, it ceases to be functional for a lifetime.
And so it's very important to protect,
you know, what's the expression?
The family jewels.
These are the family jewels in the brain of a baby.
This is the jewel, the amygdala.
You want to keep the stress to an absolute minimum in the first year,
which is why sleep training is dangerous.
It's why letting babies cry it out.
It's why putting babies into daycare.
It's why leaving babies for hours on end when they're so, so very fragile
is so bad for their brains because it gets the cortisol flowing,
which is the stress hormone, but it makes this part of the brain very active.
So it grows, grows, grows, and then ceases to be functional in the future.
Like a PTSD response.
So what we know is that these children are in hypervigilant states of stress.
ADHD children.
Hypervigilant states of stress.
If you stay in a hypervigilant state of stress long enough,
you go into a hypovigilant state of stress, which then causes depression.
So what we have now are not disorders.
So there was a whole movement to take the D off of ADHD because it's not a disorder.
It is a stress response.
And instead of asking the right questions, which are, okay, what's causing the stress?
How do we make sure that our children are not exposed to this kind of stress
because they're going into fight or flight?
So the nervous system, as you said, the brain has an on switch and an off switch.
The on switch to stress is the amygdala.
The hippocampus is the off switch.
And you'd say the stress response is in a negative feedback loop.
It's actually important.
Like in other words, if a sable-toothed tiger is chasing you,
very important that you can activate, right?
Run or fight.
So the stress response is supposed to be short term.
It's supposed to be not, it's supposed to be acute rather than chronic.
So we can kind of manifest it.
We can activate it.
But then it's supposed to be turned off by the turn off switch, the hippocampus.
What we're seeing in children's brains is that the amygdala is growing very precociously large
and the hippocampus, which is the off switch is very small.
So we have this problem.
As we say, Houston, we have a problem.
We have an on switch going full speed, gas, no brakes, and no off switch.
And that's causing ADHD, behavioral problems that are hugely rising in children in school,
a lot of aggression and violence.
And so that's what's happening.
This is a stress response.
And again, instead of asking the right questions, like,
where is this coming from?
What's causing the stress?
Instead, we silence the children's pain.
We tell parents, we'll medicate it and we'll just relieve the symptoms.
For me, that's malpractice.
The way we treat ADHD is malpractice.
A child develops, goes into fight or flight when they are under stress.
It could be psychosocial stressors at home, in the family.
It could be at school.
It could be with their friends.
It could be a learning disability.
There's so many things that can cause kids stress.
So instead of medicating them, why don't we figure out what's happening to that child
deeply that's causing them to go into fight or flight?
Isn't that point of view?
I've got two questions here.
The first is, how do you know that it's stress?
And the second is, if it is stress, then the problem, or at least the inconvenient truth
that that then creates is that the parent is responsible.
Yes, there's the inconvenient truth.
For their child's ADHD.
Yes, that's the inconvenient truth.
It's not so simple.
Sometimes it's the family.
Usually it's the family, particularly with small children.
But when children get to school, it could be social.
As I said, you can't control whether your children are exposed to social issues or bullying,
or there's many things that can cause stress in children.
But when they're very little, you are their environment.
So the inconvenient truth is that when your child gets an ADHD diagnosis,
the first thing you should do is go to a therapist who will do parent guidance with you.
Don't rush that child to a psychiatrist to medicate them.
You go with your partner or spouse and talk to a parent guidance expert about
what could be causing this child to feel such stress.
And look at the psychosocial stressors.
Look at the influences and the dynamics in this child's life.
That would be causing them to go into a state of stress like this.
Give me some examples of the type of stresses,
the everyday stresses that we're now exposing children to that are
leading to ADHD in your opinion.
Well, again, let's start at home.
At home, the stresses might be that they were handed over to a daycare center at an early age,
which turned that amygdala response on,
which turned the stress regulating part of their brain on too early.
Now you have that hypervigilant reaction and they can't turn it off, right?
It could be a divorce situation.
50% of couples divorce, which means that divorce is an adversity.
I have a book coming out in a year about how to divorce and mitigate
the impact of the divorce on the child.
But no matter what, a divorce is an adversity on a child and a stress.
When parents fight dramatically in the home,
if there's a tremendous sibling rivalry issues in the home,
if there's the birth of another child, it's stressful, right?
If you have a sibling, believe it or not, that's a very stressful thing.
If parents are sensitive about that, then it can be mitigated.
But if parents are insensitive about the birth of a second child
and the feelings that your first child may have, that can cause stress.
Moving can cause stress.
Illness or mental illness in a parent can cause stress.
Alcoholism, any kind of addiction can cause stress.
A grandparent or uncle or aunt or even a parent getting sick and dying can cause stress.
I mean, there are so many things that can cause stress.
But the point is that stress can be regulated, but it can only be regulated
if parents are introspective and self-aware and willing to look at their part in it.
If parents hand a child over to a psychiatrist and say,
of course psychiatrists will cooperate with you and silence your child's pain.
But is that really what you want to be doing?
Because in the end, you're just putting your finger in a dike,
you're putting your finger in a dam, and eventually that dam is going to burst.
What do you say to some of the evidence around
there being a link to a hereditary component?
In twin studies, they found that ADHD is about 74% to 80% heritable,
making it one of the most genetically influenced psychiatric conditions.
Let me tell you a different study that will help you to understand that study,
which is that we know that there is no genetic precursor to mental illness.
There is no genetic precursor to ADHD.
There is no genetic precursor to depression and no genetic precursor to anxiety.
What do you mean by precursor?
Meaning there's no genetic connection.
You don't get it in your genes.
If your father or your mother were depressed,
you get it by something called the inheritance of acquired characteristics.
If you're raised by a depressed parent, you're more likely to become depressed.
It's the nature-nurture argument.
Okay, but what they did find...
Now, schizophrenia has a genetic connection, bipolar disorder, those have genetics,
but the rest do not.
Anxiety, depression, ADHD, no genetics.
What they did find is a genetic tie to something called the sensitivity gene.
It's a short allele on the serotonin receptor,
and serotonin, as we know, is used to regulate happy emotions, to regulate emotions, right?
So when you have a short allele, it means that you have a harder time picking up the serotonin,
but it also means that you are more sensitive to stress.
Now, those children who are born with this gene,
this short allele on the serotonin receptor gene,
they are more prone to mental illness later on because of that sensitivity to stress.
What the study shows is if those children who are born with that gene for sensitivity
are provided with emotionally and physically present attachment security in the first year,
neutralizes the expression of that gene.
So epigenetics means that we're born with genes,
like you might have a gene for rheumatoid arthritis,
or you might have a gene for cancer, but it never gets expressed.
Well, we all have genes for something, but they don't necessarily get expressed.
That's what epigenetics is.
It means the environment has to turn on the gene to make it, let's rock and roll, right?
What it showed in this study is that the children who are born with this genetic precursor,
the sensitivity to stress,
if they had sensitive empathic nurturing and present parents in the first year,
it neutralized the expression of that gene.
So those children could be as healthy as children born without that gene.
If, however, children born with that sensitivity gene were neglected,
you know, abandoned, not provided with sensitive empathic present nurturing,
it exacerbated that gene.
We know that that sensitivity gene is tied and correlated to mental illness later on,
unless the sensitive empathic nurturing mitigates that gene.
And what do you say to people that point to MRI scans?
fMRIs, and yeah, there's all kinds of neurological tests now
where we can see the brain in action, so it's not a static thing.
We can actually see the blood flow to the brain.
We can see the electrical activity in the brain.
It's amazing, actually.
Some people say that this proves that it's the way your brain is,
and lots of my friends that have ADHD,
when they talk about their ADHD or the way that they are,
they say, my brain works like this.
No, it's not correct.
Their brain is sensitive to stress.
Someone with ADHD is more sensitive to stress.
So you could ask them questions like this.
You could say, are you a more sensitive person?
Are you more sensitive to noise, to smells, to touch?
When you were a child, did you not like itchy things?
Did you cry more?
Were you more sensitive when your parents would go out for the night?
Were you more sensitive when your mom would go to work?
Or were you more sensitive when you were left at nursery school?
And they're probably going to say yes.
But if they say no and they still have an ADHD diagnosis?
I would guarantee, almost guarantee, they wouldn't say no,
because people with ADHD are people who are sensitive.
Sensitivity is an amazing strength if it's met with sensitivity.
If you have a sensitive child, so what does a sensitive child look like?
If you have multiple children, then you know,
because the first thing I'll do when I give a public talk is I'll say,
OK, everybody here, who has a sensitive child?
And I describe, OK, a sensitive child is a child who cries more,
is harder to soothe, is more clingy,
doesn't like you leaving them, has a harder time separating,
has a harder time going to sleep and being left to sleep on their own,
is sensitive to things like noise and smells and touch.
If you grew up in an environment that was stressful,
and again, you've identified that stress can come in many forms.
It could be arguing parents.
It could be a neighbor or whatever,
some environmental factor that caused that stress.
You were sensitive.
You developed ADHD.
You become an adult.
You get diagnosed at 30 years old as having ADHD.
You're offered medication.
You take the medication.
The medication makes you much more functional in your career,
in your relationships, in your life.
It's a stimulant.
And so what stimulants do is they cause,
they can cause great anxiety.
They can cause panic attacks.
In adolescence, they can cause growth issues.
So I have patients who come to me, young men who didn't grow
because they were put on stimulants when they were young.
So in terms of the consequences of using stimulants,
the jury is still out,
but we know that they cause growth issues.
They cause panic attacks.
They cause anxiety disorders.
They cause depression.
They're quite life-saving for some people in terms of having a...
They can be.
So what I would say is,
if you have tried everything to uncover what the stress is,
that's causing you to react this way,
and you still are feeling that way,
then sometimes medication can be a lifesaver.
The problem is that we turn to medication
in adolescence and children and young adults.
We turn to it as a performance drug
because there's so much stress in modern life
and there's such a need for people to perform
and be successful in their careers
and in school and get good grades.
There's so much pressure on kids.
So I'm 60 and we didn't have this kind of pressure growing up.
And so the generations that follow have so much pressure.
That pressure makes children literally go off the rails.
We could talk about the academic pressure,
the competitiveness, the perfectionism.
So ADHD is a bucket.
It's a bucket which you throw people in
who have anxiety that has never been treated.
And there's different ways of thinking about treatment too.
So we're a society that likes superficial quick fixes.
We like drugs, we like CBT therapy.
The truth is that this is not a quick fix.
Figuring out relationally,
dynamically what happened to you as a child,
what your losses were, what your traumas were,
what caused you to feel so anxious,
what's caused you to go into fight or flight is hard work.
It requires frustration.
It requires commitment.
It requires going to someone who can think very deeply with you.
You know, I want to define what anxiety is
because I think it's really important
because we rarely define depression and anxiety.
Depression is preoccupation with past losses.
Anxiety is preoccupation with future losses that may never occur.
What do they have in common?
It's all about losses.
All about loss.
And you could say the generations now are very preoccupied with loss.
Loss of status, achievement.
Because we're also very preoccupied with gain.
Well, we're preoccupied with what I say,
you know, I don't want to judge,
but I want to say the unimportant things in life.
What are the important things in life?
Relationships, love, connection, health.
You would say, objectively, family.
These are the important things in life.
But we've become very preoccupied with material success,
money, career achievement, fame.
I think there was a study that interviewed teenagers
and it was really discouraging because they said
that the thing they wanted more in life than anything was to be famous.
And so we're preoccupied with the wrong things.
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