Pod Insights The Diary Of A CEO with Steven Bartlett Most Replayed Moment: Is Modern Parenting Causing ADHD? Your Decisions Shape Your Child’s Mind! About this episode Erica Komisar is a psychoanalyst renowned for her work on parenting, early childhood development, and the root causes of behavioural issues. In today’s moment, Erica discusses the rise in ADHD diagnoses and reveals which modern parenting practices may be significantly contributing to this trend, and to stress in early childhood.
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Independent research (this clip comes from a longer episode. The accompanying research covers that full episode): https://stevenbartlett.com/wp-content/uploads/2025/03/DOAC-Erica-Komisar-Independent-research-further-reading.pdf
Erica Komisar: https://www.ericakomisar.com/
Transcript Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.
0:03 Steven Bartlett? ADHD.
0:04 Speaker 01 Yeah, okay.
0:06 Steven Bartlett? A bit. 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 it, the shocking rise in diagnosis and prescriptions over the last 10 years. Between 2018, ADHD diagnoses in the UK rose approximately 20-fold.
0:28 Speaker 01 Yes.
0:29 Steven Bartlett? 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 1 in 9 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?
1:10 Speaker 01 So ADHD was one of the factors that drove me to right 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?
1:24 Steven Bartlett? That's when the sympathetic nervous system starts to kick into action and...
1:31 Speaker 01 Yes, so well, it's basically our evolutionary response to a predatory 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...
2:16 Speaker 01 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.
2:57 Speaker 01 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.
3:40 Speaker 01 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. It's very, 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.
4:24 Speaker 01 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 And ceases to be functional in the future, like a PTSD response. So what we know is that these children are in hyper vigilant states of stress.
4:55 Steven Bartlett? ADHD children.
4:56 Speaker 01 ADHD children, hyper vigilant states of stress. If you stay in a hyper vigilant state of stress long enough, you go into a hypo vigilant 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.
5:36 Speaker 01 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, it's, it's actually important. Like in other words, if a sable tooth tiger is chasing you, very important that you can activate, right, and 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.
6:16 Speaker 01 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
6:43 Speaker 01 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, 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 are so many things that can cause kids stress.
7:27 Speaker 01 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?
7:36 Steven Bartlett? 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 that, the problem, or at least the inconvenient truth that that then creates is that the parent is responsible.
7:51 Speaker 01 Yes, that's the, there's the inconvenient truth.
7:53 Steven Bartlett? For their child's ADHD.
7:54 Speaker 01 Yes, yes, that's the inconvenient truth. It's not so simple. Sometimes it's the families. Usually it's the family, particularly with small children. But when children get to school, it could be social. As I said, you know, 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.
8:34 Speaker 01 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.
8:54 Steven Bartlett? 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?
9:01 Speaker 01 Well, again, let's start at home. At home, the stresses might be that they were. Hand it 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 hyper vigilant 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. You know, 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.
9:41 Speaker 01 When parents fight dramatically in the home, if there's 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... I mean, there are so many things that can cause stress, but the point is that stress
10:26 Speaker 01 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, "Fix my child," 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.
10:57 Steven Bartlett? What'd 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% inheritable, making one of the most genetically influenced psychiatric conditions.
11:11 Speaker 01 Let me tell you a different study that will help you to understand that study.
11:16 Speaker 01 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.
11:29 Steven Bartlett? What do you mean by precursor?
11:30 Speaker 01 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.
12:07 Speaker 01 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.
12:30 Speaker 01 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, it 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.
13:15 Speaker 01 It means the environment has to turn on the gene to make it, let's rock and roll, right?
13:22 Speaker 01 What it showed in this study is that the children who were born with this genetic precursor, this 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.
13:44 Speaker 01 If, however, children born with that sensitivity gene were neglected, you know, abandoned, not provided with sensitive empathic present nurturing, it exacerbated that gene. So we know that that sensitivity gene is tied and correlated to mental illness later on, unless the sensitive empathic nurturing mitigates that gene.
14:07 Steven Bartlett? And what do you say to people that point to MRI scans?
14:11 Speaker 01 FMRI's and yeah, there's, 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.
14:28 Steven Bartlett? But 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.
14:38 Speaker 01 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, were you more, 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.
15:12 Steven Bartlett? But if they say no, and they still have an ADHD diagnosis?
15:15 Speaker 01 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, "Okay, everybody here, who has a sensitive child?" And I describe, "Okay, 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
15:57 Speaker 01 on their own, is sensitive to things like noise and smells and touch."
16:03 Steven Bartlett? 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.
16:20 Speaker 01 Yeah.
16:21 Steven Bartlett? You're offered medication. You take the medication. The medication makes you much more functional in your career, in your relationships, in your life.
16:29 Speaker 01 It's a stimulant. And so what stimulants do is 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. So...
17:02 Steven Bartlett? They're quite life-saving. They're quite life-saving for some people in terms of having a...
17:06 Speaker 01 They can be. 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, you know, I'm sixty and we didn't have this kind
17:47 Speaker 01 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 so, 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
18:31 Speaker 01 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
19:15 Speaker 01 with future losses that may never occur. What do they have in common?
19:21 Steven Bartlett? It's all about losses.
19:22 Speaker 01 All about loss. And you could say the generations now are very preoccupied with loss.
19:32 Steven Bartlett? Loss of status, achievement, but because we're also very preoccupied with gain.
19:42 Speaker 01 Well, we're preoccupied with what I say, the, 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, right? You would say objectively, family. These are the important things in life. But we've become very preoccupied with material success, money, career achievements, 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.
20:25 Speaker 01 And so we're preoccupied with the wrong things.
20:29 Steven Bartlett? On this point of stress and the link with ADHD, looking at some research from the Injury.com Research Education Group. It says that children with an ACE score, which is the trauma-based score, where I think it goes up to 10 different sort of questions, with an ACE score of four or more, so four experiences of trauma or more, have nearly four times, which is 400% more chance of having parent-reported ADHD compared to children with no ACEs.
20:57 Speaker 01 Yep.
20:58 Steven Bartlett? And some of the factors that have big impact is socio-economic hardship increases your probability of having ADHD by 40%, parental divorce by 35%, familial mental illness, or a parent having a mental illness increases it up to almost 60%, 55%, I believe, and neighborhood violence, almost 50%, familial incarceration. So if a parent goes to prison, then that increases your probability of ADHD by about 40% as well. And that's published by the, I think it's the New England.
21:28 Speaker 01 Yeah.
21:29 Steven Bartlett? What is it? Oh, the National Library of Medicine, National Center of Biological Information.
21:32 Speaker 01 Yeah, so remember what I said, that you can't control everything that happens to your child. Divorces do happen and adversities happen to children, health, health issues happen to children. What you can control is you can control the first three years and be as present as possible for your child.
21:51 Steven Bartlett? So if my kids start screaming in a supermarket. One of the prevailing pieces of advice says, just walk off or start screaming yourself as the parent to show them. Am I supposed to just ignore my child when it's screaming and throwing a tantrum? Am I meant to drop what I'm doing and go and cater to them? What am I meant to do in these situations?
22:10 Speaker 01 You can have me on speed dial, Stephen.
22:11 Steven Bartlett? You be careful, because if you make a promise like that-
22:14 Speaker 01 Yes, I promise, I promise. I'll be on speed dial.
22:16 Steven Bartlett? You only want to drop your career and focus on raising my children.
22:19 Speaker 01 No, but you can call me. You can have me on speed dial.
22:22 Steven Bartlett? I've got this on video. That's legally binding.
22:23 Speaker 01 No, you can have me on speed dial.
22:25 Steven Bartlett? How much?
22:26 Speaker 01 You can, as much as you want. So, the deal is, you don't yell at your children. An emotionally regulated parent, a healthy parent produces a healthy child. So, what is a healthy parent? A healthy parent is a parent who feels good about themselves, who has authentically good self-esteem, not grandiosity, but really feels good about themselves, knows their strengths and limitations, and overall as a whole person feels good about themselves. They have the capacity to regulate their emotions, to keep their emotions from going too high and too low. Remember sailing in the Caribbean, meaning they can stay calm in a storm? Is sensitive and empathic as a nurturer. These are signs of health in a parent.
23:11 Steven Bartlett? So if my kid says, "I want that pack of sweets," and I go, "You can't have that pack of sweets."
23:17 Speaker 01 Well, first you have to, so before you discipline, you always want to be empathic first. So I always say that if you are going to discipline a child, first you have to recognize how they feel. I mean, recognizing how children feel is important anyway, meaning when you recognize a child's feelings, if they're sad, you mirror their sadness. If they're angry, you say, "I can see you're angry." If they're happy, you look happy with them. That kind of reflection- Is the way that your child knows that you acknowledge them, that they're a person to you, that they're a separate person to you. It's how they feel valuable. So when you acknowledge their feelings, that's the first critical,
24:02 Speaker 01 you'd say parenting 101. Acknowledge your child's feelings.
24:05 Steven Bartlett? So I would tend to my child and say, you want sweets or you hungry?
24:08 Speaker 01 Yeah, you can say, I can see that you really want that packet of sweets. I can see how hard it is because you really want it. But you know, you can't have it before dinner. You know, that's the rule.
24:18 Steven Bartlett? And then they stop screaming and crying.
24:20 Speaker 01 And then they start screaming and you say, a broken record is a communication style where you say, oh, I can see it's really hard for you, but you still can't have the sweets. And you stay with them and you keep empathizing and then setting structure, empathizing, structure, empathizing, structure. The mistake that parents make is that they go right into the no word. They don't use empathy. They don't bring empathy in. And the truth is that even as an adult, if somebody just says no, without first recognizing how you feel, you feel very unsatisfied. Right? For a child, it's critical. It's critical that even when you have to say no, and particularly if you have to say no, that you first recognize how they feel.
25:05 Steven Bartlett? I mean, that's what all the relationship experts on the show tell me. They say, if you want to be successful in a romantic relationship, then you first must make your partner feel heard and understood.
25:14 Speaker 01 That's right.
25:14 Steven Bartlett? Even if you disagree in an argument, first acknowledge what they said, maybe repeat it back to them. And then they'll feel heard and understood and it kind of stops the broken record. What you just listened to was a most replayed moment from a previous episode. If you want to listen to that full episode, I've linked it down below. Check the description. Thank you.
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