The Psychiatrist’s Take on Vulnerabilities in ADHD Entrepreneurship

H: You are an expert in the intersection of ADHD and entrepreneurship for many years now, but you yourself do not have ADHD. What was the attraction?

G: The attraction was rather, secondary, actually. I am a serial entrepreneur myself as well as an academic research oriented psychiatrist. And my focus within the world of psychiatry has always been bipolar disorder. And when I began studying bipolar disorder among entrepreneurs, it became clear that about forty percent of people in the bipolar spectrum also have ADHD. And about forty percent of people in the ADHD spectrum also have bipolar conditions. And so I basically had to learn about ADHD in order to comprehensively address the needs of the entrepreneurs that I was working with. So I didn't set out to become a ADHD specialist, but it was impossible to avoid. And along the way, I learned quite a bit about it.

That was maybe fifteen years ago. And, since then, I've spent thousands of hours working with entrepreneurs who do have ADHD and, as well as other mental health conditions. And while we're on that subject, it's really worth noting that most people who have ADHD do have one or more co-occurring mental health issues. The most common ones being anxiety, substance use, bipolar spectrum conditions. And so when we think about what package of solutions is gonna be most effective for people who are trying to overcome the limitations related to those symptoms, you know, I kind of think about it broad spectrum. What's the entire set of issues that is either leading to superpowers and strengths or causing vulnerabilities and disabilities?

H: It's really, really fascinating. I have three adult children. I passed on my ADHD to all three of them by two different marriages so I'm the common denominator. We have all three different subtypes represented, and my oldest is also bipolar. So I've learned the hard way about the co-occurring disorders and have definitely seen many, many entrepreneurs who are either bipolar one or two as well as ADHD, or they think they only have bipolar, but they also have ADHD. There's a lot of research out there, including some of your own, about why so many people with these particular conditions are intrinsically drawn to entrepreneurship. I know we're gonna talk a little bit more about why there's so much hype around that and why so many of us are attracted to it.

really began to emerge in the: 1990

The second thing about the, appeal of entrepreneurship and self employment is that, as you know, the underlying neurological difference that is kind of shapes the experience of people with ADHD has to do with dopamine processing. And people who are in emergency situations, chaotic situations, crises tend to not do very well except if they have ADHD. And the people within the ADHD world really are hit their stride in this chaotic crisis driven, circumstances. That's why people with ADHD make very good first responders, firefighters, police officers, military, and the same applies to entrepreneurs. Entrepreneurs I think of as our economic first responders. They see opportunities and they rush in there and come up with new concepts in new businesses.

And as a result, 80% of net new jobs are created by businesses that are less than five years old. So the entrepreneurs are really doing a huge service to our economy. And they don't get overwhelmed, they can get into flow states. So I think entrepreneur what we found in our studies, we've done a number of studies now. I'm referring to my colleagues at UC San Francisco, UC Berkeley, the Gallup organization, and Stanford University and other academic centers around the world. What we find is that the entrepreneurs who get the best business outcomes tend to also have ADHD hyperactive impulsive subtype plus or minus by some kind of bipolar spectrum condition so it's a good match. But, you know, too much of a good thing can be a bad thing. And people with ADHD have plenty of experience wiping out, and business, is no different than the rest of life in that regard.

H: I'm thinking about the serial entrepreneurs that I've known and worked with. And I'm quite certain, Michael, a hundred percent of them are ADHD and probably at least bipolar too because they it's almost like they treat each new business as a project that they only have to focus on for a certain amount of time, for certain goals, and they're never going to have to do it long enough to reach boredom or burnout.

G: Exactly.

H: They use their creativity and then move on.

G: That's right. That's exactly right. And, founders typically exit their own companies once the companies are big enough to have about three layers, once you get to three or four layers, in a company, the amount of accountability that's required no matter what your job is, including CEO, is such that it begins to go against the grain of what's fun for the entrepreneur. So in many cases, entrepreneur ADD founders will exit their company and start something new, once they kind of get to that milestone.

H: And if we don't have the understanding that we're gonna build this with the exit strategy baked in from the jump, they become reckless and destructive. And that's not a you can't always come back from that. And so I love the ideas like, okay, what kind of entrepreneur are you? Are you a founder? Is this a legacy project? Are you building this to sell? What is the exit strategy? We have to talk about that from day one because if they have ADHD, they're going to need to get out one way or the other. I think the harder thing to do is build an organization, a business, that you don't think you're gonna get bored of and you're not going to want to escape from. That is a much trickier thing, and I don't know what your thoughts are about that.

G: I think that's where coaching comes in. The inclination if you are navigating your way through life with a ADHD mindset, the inclination is to kind of be guided by the premise of ready, shoot, aim. And what you're talking about is ready, aim, shoot. And, I think coaching from people who don't have ADHD and who have been through that journey can be quite helpful for a lot of founders with ADHD. And that's just one strategy, but I would say if you are a founder or a cofounder of a growing company, there and you have ADHD, what's important to know is that you can build a toolkit of resources and strategies and solutions that are likely to help you play your strong cards, use your strengths, deploy your superpowers more often, and at the same time build safety nets and safeguards against, you know, some of the vulnerabilities. Like, you know, Diann, the, impulsivity and recklessness that you were just talking about.

H: We know the full toolkit can and often does, include medication, therapy, coaching, and safety structures, systems, behavior modifications, team members who are neurodivergent so that you can offload things that just frustrate you and doesn't make any sense for you to get good at. People who are really functioning at their optimum probably have some measure of all of those things. In your experience, what are the ones that most founders and entrepreneurs are more receptive to, and which ones do you find they're more likely to resist in that toolkit?

G: That's a good question. I think that, founders with ADHD are either in denial about that or they accept it. If they accept it, then they either accept it with a sense of shame and stigma or they accept it with a sense of equanimity and, you know, it's neither good nor bad. It's got it it's associated with strengths and vulnerabilities. So if you can accept reality, which is the goal of psychotherapy in case anybody ever asks you, then, you just have to look the cards in your sort of biological response style hand with a sense of equanimity and think through, how to improve your likelihood of winning the game.

So the strategies that are easiest for the founders I've worked with to understand and accept is to get backup, have executive assistance or operations leads or other people around who are very good at task initiation, execution, and completion, who are good at planning and scheduling, who are good at project management. The things that are not so easy if you have ADHD with respect to the cognitive lifting that requires your sustained concentration and attention if you're doing work that has, you know, a lot of detail and that may not be so interesting in and of itself. So backup having a backup team, and augmenting, your weaknesses with other people for whom those kinds of things are strengths.

I think a little bit lower down the list is communication skills. But, entrepreneur people with ADHD can have communication problems. Sometimes that's like, more likely to interrupt and blur things out and put people off that way. Sometimes they have some difficulty with regulating, emotions and particularly negative emotions like anger, and they can kinda, you know, be not so great to work with, if they don't learn how to handle that. And so I think focusing but people are open to that. So I think focusing on that. And I think, you know, the third layer is what, I guess, organizational and behavioral skills building. It's not really therapy. It's more like it's just, you know, skills, and it's they're pretty straightforward. And any ADHD therapist or coach will know how to help people with that, but that's important part of the toolkit. And then medication people have different opinions about it.

Some people are reluctant and resist. Some people can't get started soon enough, and we have definitely had people tell me that their parents wouldn't let them use medication. And now that they're in their twenties, their parents can't stop them so, like, let's give it a shot. So I think but that's another one as well. I think behavioral strategies are important. Sleep management, sleep regulation, sleep hygiene, critically important for entrepreneurs. And then, learning how to have nature exposure and exercise built into your routine as an entrepreneur is also very important. That's important for anyone with ADHD, and we can talk about the research on green space and ADHD later if you're interested. But it makes a big difference for entrepreneurs.

H: You know, I love so much about everything that you've said. When like, I probably got the biggest smile when you said that the actual goal of therapy is to accept reality. Because I think most people think of it as improving our functioning, improving our coping, managing our emotions. But dealing with reality, like, I'm a very direct person. I love just the simplicity and the directness of that because, yeah, I also happen to be Buddhist. And I noticed that you use the term equanimity, which is really the goal, for managing our dysregulated emotions and even dysregulated emotions where we may come on so strong at times because we're so excited, we're so passionate, we're so intense that even people who would otherwise be aligned and might wanna invest or collaborate or jump on board with our team might think, you're scary.

So I think just learning how we are perceived by others, to me, is also part of that. And that's where, you know, I'm glad that you brought up shame and stigma. If you have ADHD as an adult, as an entrepreneur, you've always had it. There's no such thing as adult onset. There may just be the adult discovery or awareness, or your or ADHD symptoms are more challenging because your life is simply more complex, and you've got a lot more things vying for your attention and taking you in different directions. But this notion that, you know, we've all internalized negative messages starting in childhood because our culture and probably every culture is not so kind to people who are different regardless of what that difference is.

G: Unless you live in a hunter gatherer culture, in which case, the people with ADHD were actually high status individuals. And, you know, that's why did God create ADHD it's because, the basic business model for humanity for about three hundred and fifty thousand years was hunting and gathering and guess who's good at hunting?

H: Absolutely. It's so true. And I really think that's one of the models even for people who are a little bit reluctant to be diagnosed and say, well, I don't really don't identify with the whole medical model. And I think it's stigmatizing and I don't like these labels and all that. Well, why don't we use a different metaphor, a different analogy that might be more accessible for you? Let's talk about hunters and gatherers. Because then they're like, oh, yeah, that's me right?

G: Yeah. Somebody asked me if I were to come up with a nonmedical model way of talking about ADHD, what would it be? And where I landed was, ADHD describes people who are uniquely gifted at living in the present. And you talked about the time horizon at the beginning that, you know, the other time horizon story is that people who are neurotypical tend to live in three time zones, past, present, and future. And people with ADHD tend to live in two time zones, now and not now. And so it's the gift of being able to be here now.

H: I even think it's one of the reasons why I like the company of canines so much. Because I think dogs have…

G: Live in the present.

H: Oh, my goodness. The unique quality of just, like, be here now. And you're right, I mean, I think when you're running an organization, when you're wherever you are in your entrepreneurial founder journey, the being present in the moment means, okay, well, there's now and there's not now. And literally, I think the expression out of sight, out of mind was made for people like us. Because unless we're obsessed with something, we literally couldn't care less. You can't only do the things that you're obsessed with and just forget about everything else if you wanna be successful.

In your experience, do you find most entrepreneurs are very willing to identify and recognize their zone of genius, their strengths, their superpowers, and the things that they struggle with, their vulnerabilities? They're barely competent, and then and then really allow other people to support them in those ways, or does that feel shameful for many of them?

G: So once I work with her, to do what you just said, but that's it's a biased sample because anybody who finds their way to me already knows I'm a psychiatrist and is already asking for help so that's a different breed. Out there, when we study, like, a thousand people, a thousand entrepreneurs at a time, where do they come down on that? I really I don't know. I think there's a lot that we don't know about this, but, what's of interest to me about what we don't know is the current the co-occurring conditions and the best ways to sort of support and optimize the entrepreneurial experience for people with this mindset. So that they can do what they do best, which is create jobs for people like, you know, me.

H: And me. Have you…

G: But you created your own job, so you're okay.

H: This is true. Have you, do you have any thoughts about what seems to be a growing group of people, at least growing in my awareness, is entrepreneurs who identify with both ADHD and autism?

G: Yes. They, I've definitely worked with a bunch of people who are in the autism spectrum as well as having ADHD. Whether it's growing or whether it's just being detected more is unclear. I think the autism people, the researchers believe that the incidence of autism actually is increasing. In our population, and it's unclear why that might be but, it's out there. And, again, in terms of supporting people with these, individual differences, the issue is what's great about, autism spectrum sensibilities that can help you and give you a competitive advantage. The people that I've met who the entrepreneurs that I've met who have, autism spectrum symptoms tend to be technical cofounders in companies, and they've been really good at it.

H: Yeah. And you're also in Northern California and associated with all the big universities and tech and all that so that makes complete sense. Do you have any thoughts, based on your experience or your research or collaborations about gender differences in entrepreneurs with ADHD?

G: I do not other than to say that so what I do for a living is I'm a psychiatrist. I'm an executive coach, I'm an academic researcher, and I run, like, projects related to entrepreneurship. So I have a lot of moving parts. And in my psychiatric practice, a lot of the entrepreneurs with ADHD that I've worked with have been women. And, you know, I think there are issues related to women in entrepreneurship as opposed to men in entrepreneurship, but the ADHD themes tend to be pretty similar, you know, across the board. That's not such a big gender issue. The entrepreneurs, you know, there are, as you mentioned, subtypes of ADHD. And the ones that get to me in entrepreneurship tend to have the more hyperactive impulsive package of you know, predilections.

H: It's what I call the sports package.

G: The sports package.

H: Yeah. Some of us have the sports package. Some of us has more of the utility.

G: The women I'm thinking right now that the women entrepreneurs that come to mind that I've worked with have been athletes or were athletes when they were in high school and college.

H: And what an advantage. Some of the things and this is this is purely anecdotal from my own experience as a coach and former therapist. I haven't done any research or participated in any, you know, big studies on this. But in my personal experience of the three different subtypes, hyperactive impulsive, combined, and inattentive distractible, the ones that I see struggling the most in entrepreneurship are the inattentive distractible. And my theory about this, and I would love to hear your response, is that I happen to be combined type. And I think that if you're either combined type, which means you also have impulsivity and hyperactivity or purely hyperactive impulsive with very little inattentive, distractible, symptoms, you're probably going to have an easier time in entrepreneurship because of the propensity for taking action because of the need to be in momentum.

And because you're gonna take more actions, you're gonna take more risks, you're gonna make more mistakes, but you're either gonna flame out and move on, or you're gonna get up and you're gonna try something else and you're gonna fall down and you get up and you try something else. So you're gonna sort of desensitize yourself to the fear that so many have about failing. I mean, you literally fumble your way to success in many cases as long as you don't give up, or do something illegal. So I think that the hyperactivity and the impulsivity of both the combined type and the impulsive hyperactive type is actually a decided advantage.

G: Oh, yeah, definitely. Not only in ADHD, in entrepreneurship, but across the board as it relates to academic and employment outcomes. The what's you know, what's critically important for success academically and, in one's career is, motivation, goal engagement, and persistence. And people who are more hyperactive tend to have elevated levels of motivation, elevated levels of goal engagement, and elevated levels of persistence. People with the inattentive subtype of ADHD have problems in all of those areas. And as a result, just don't do as well in college and in work. You know, net people with ADHD, the issues tend to be more of a disability than a strength from the majority of people with ADHD for this reason.

If you look at studies of large numbers of people with ADHD over time what happens is higher incidence of divorce, worse career outcomes compared to what you would expect based on their level of education, lower level of educational attainment, you know, a lot of downward drift among people with the ADHD. By contrast, the, some people with ADHD significantly outperform everybody else and have very, very, you know, exceptional positive academic and career outcomes. I think you interviewed somebody recently who was a full professor of entrepreneurship and also has ADHD. And, you know, he channeled it in a great way. And the entrepreneurs that I work with, many of them are way more successful than I'm gonna ever be. So, it's bimodal, if you will. But for a lot of people, I think the motivation goal engagement, follow through persistence, those can be the things that really undermine life success in a lot of domains.

H: What I call, starting, stopping and switching gears. You know, it's like we have problems getting things started. We have problems bring bringing things to a conclusion. And we have trouble switching our focus from one thing to another and tend to get derailed. So it's like, oh, we just have three problems, starting, stopping, and switching gears. Unfortunately, that covers a whole hell of a lot of territory. You said something a few minutes ago that I wanna circle back to and a little bit in our pre chat. We are both in agreement, Michael, that entrepreneurship is just hotter than hot right now.

I mean, there have always been people who've gone their own way and started companies. And the broad category of entrepreneurship in our current culture is any manner of self employment from the freelancer to the person who creates an online business, coaches, consultants, small business owners on up to people who run enterprise organizations I think, and I know you agree, that right now, there it's really being glamorized. In fact, sometimes to the point where and I think especially directed towards women, marketed as a path towards women. And it's like, well, if you're not doing your own thing, like, I don't know. Like, you're really selling yourself short. And I know there's probably a lot of reasons for that, but what are some of them from your perspective?

G: Why is it being glamour well, first of all, there's an entrepreneurship industry out there. Huge industry. It's a billion dollar industry. These are university based entrepreneurship programs, incubators, accelerators, venture capital firms with money they need to spend, banks that are in the business of giving loans to small businesses, the Small Business Administration. The economy cannot create enough jobs for everybody who needs to be employed without entrepreneurs. In terms of the glamour aspect, you know, in America, people like heroes. It's the twenty first century version of cowboy adventurism.

H: Sells a lot of movies.

G: It sells a lot of movies. And it has the allure of get rich quick, which appeals to a lot of people. And there are many examples of entrepreneurs with no particular formal education or training who did something great and then were able to cash in on it. But I think the entrepreneurship industry itself creates a lot of propaganda around this. And there are many research articles in the last five years or so about the abuse of, these nascent entrepreneurs, young adults who wanna become entrepreneurs, who will spend money and take time out of their lives. And then, you know, what happens is that most companies fail, most businesses fail.

And a lot of people who shouldn't have been entrepreneurs in the first place get sucked into it, and then they get friend money from friends and family, and then the company fails, and then they have to spend five years, like, literally painting houses or doing stuff that is a big detour for them just in order to pay back their loans. So I would say if you're listening to this podcast and you're thinking about being an entrepreneur, I would put a lot of time and energy into the front end of that decision making process, to really think about, do you have the right personality?

Do you have the right temperament? Do you have a vision for something that is more likely to succeed than that? Do you have a previous history of leadership? Were you the captain of your basketball team, or did you lead a, you know, camping expedition for the boy scouts? Or have you done anything at all to give you confidence that you can actually lead something? And then I would also suggest, talking with, a couple of people who have started and run businesses and just to kind of get your own personal board of directors before you make decisions that are pretty hard to reverse.

H: I am so grateful for you saying that because I agree a 100%, Michael. There is a lot of glamorization. There is a lot of hype. I love that you put it in the context of the entrepreneurial industry because there are a lot of organizations that are promoting that message. And there it is a form of propaganda, especially when you're directing it towards a group of people that are already impulsive to begin with and have a hard time, frankly, taking orders. I think that's one of the reasons why I recently interviewed a tech founder female who dropped out of high school because she didn't like other people telling her what to do and what to pay attention to and what to study and, essentially, other people telling her what was important. She's like, I'm gonna determine what's important. So I think this notion that anybody can do this, it's absolutely not true. I mean, the reality is, hate me for saying this, you've also said it, the vast majority of businesses fail.

The vast majority of small businesses aren't even gonna make it anywhere near to the five year mark, whether you're ADHD, not whether you have the right genetics, like, whatever. But it's not as easy, as fast, or as reliable as people are led to believe. And most often, they're gonna blame themselves, and may have a hard time digging themselves out of the size hole that they can get into. So I really, really appreciate, you saying that. And you know, being we are as a group of people not generally known for being realistic. I think it's one of the things that makes us be audacious enough to start a company and that's a wonderful thing. But we also have to be resilient. We also have to have risk tolerance, and we also have to be able to think on our feet and figure things out that because we can't afford to get someone to do it for us.

And all of those things can really build your character. I think it comes down to I say it rests on two things and I wonder if you would agree. Radical self acceptance, which is I know who I am and how I am. I know my strengths and I know my struggles, and I'm going to build the company with both of those in mind, and resilience. And you also talked about fun, which I would like us to end on that. Why is fun a nonnegotiable for entrepreneurs with ADHD?

G: I like that way of framing it. It's self acceptance, and importantly, as part of it is self awareness.

H: Yes, sir.

G: I often tell entrepreneurs don't believe everything you think because you're inclined to have cognitive biases that are just baked into the recipe of ADHD. Resilience, the ability to bounce back is very important because you're gonna fall down and scrape your knees quite a bit in that process. It is a roller coaster ride, and it doesn't have to be as emotional as it is for a lot of people if you learn how to regulate that. But fun, for people with ADHD, you know, fun is the reward that, all of this activity is designed to deliver. And so when people with ADHD get into sports or, you know, it's going on adventures with travel. Or being a first responder or building some new product or service or some innovation. A lot of it is really about having fun, and people with ADHD are uniquely gifted in their ability to have more fun than other people. You know, we didn't get a chance to talk about marriage and relationships, in this, but, obviously, the relationships of business founders are critically important.

H: Absolutely.

G: And part of what makes those relationships work is that, the person with ADHD in the relationship is just a lot of fun to be with. They're doing cool stuff. They have great ideas. There's always the next adventure and so it's the reward value that goal engagement. The reason that people with ADHD engage in goals is to get some kind of a reward and fun is part of the reward.

H: So so true.

G: When entrepreneurship stops being fun, that's usually when you need professional managers, and then they'd like to go on and do the next fun startup.

hink I would agree with you a: 1000

A lot of us are very performative, very entertaining. But solving problems for the benefit of people is absolutely intrinsically fun and rewarding for us. And it is, frankly, where I think most entrepreneurial ventures it's the foundation. Solving a problem that people have, and they are looking for a solution, and they're willing to pay for it. If that's fun for you, get on board. There are plenty of problems to be solved for people, I think.

G: Yeah. That's right. And they one of the superpowers of ADHD is creativity, innovativeness, the ability to improvise, and that all makes it easier for some people with ADHD to spot those problems and to conceptualize a solution that other people haven't figured out yet.

H: Can I say how, lucky we are as an entrepreneurial community that even though it wasn't your original intention, you became an ADHD enthusiast and a supporter and an advocate, a researcher, a coach, a therapist, a psychiatrist, and an entrepreneur yourself? That deep body of understanding of this particular group of people who often don't understand themselves is so valuable. And, being a beneficiary of that knowledge, I just have to thank you.

G: My pleasure. I'm really happy to be here. And I wanna thank you also for this podcast that you're doing and the knowledge that you're bringing to the community of listeners, because, knowledge is power. And you're conveying a lot of knowledge, which I'm sure is very helpful to everyone.

H: I'm gonna wind us up with this, Michael. I was overheard at a Starbucks with a friend saying, well, you know, Kevin, knowledge is power. And the barista leaned over the counter and motioned for me to come close and I'm thinking, what's happening? And he said, actually, applied knowledge is power. And I thought, wow, I love it when somebody corrects me and like, you know, takes things to the next level. So in this conversation, you have no doubt heard many things that have been validating, affirming, inspiring, and rewarding. So take what you will from it, and whatever you take, apply it. That's the ultimate reward for both of us being here.