31: Wait. Am I ADHD? with Dr. Sasha Hamdani

Many adults, like me, are diagnosed with ADHD later in life. It is fascinating to hear the stories of how this diagnosis is missed in their childhood years. I’m joined by Dr. Sasha Hamdani, a board-certified psychiatrist and ADHD clinical specialist who just happens to spend some of her spare time on TikTok. Let’s get the facts from an expert! Join us for this interesting conversation!

Show Highlights:

  • The basics: What is ADHD?

  • Why reframing is helpful for adults diagnosed with ADHD

  • Why many of us do self-diagnosis, especially in today’s social media-driven world

  • Factors that can cause a child to fly under the radar and go undiagnosed

  • Why ADHD can be described as “an interest-based nervous system”

  • How most people with ADHD have an “I’m dumb” moment because of how their brains process information and overlook details

  • Why ADHD diagnosis is overlooked in so many people because of the ways they learn to compensate for symptoms

  • Why people with ADHD mask their internal symptoms by learning to respond to their external environment

  • Dr. Sasha’s advice about educating yourself and learning more about ADHD

  • How to decide whether or not to take ADHD medication as an adult

  • Dr. Sasha’s advice about noticing red flags in dealing with your healthcare provider

 Resources:

Connect with Dr. Sasha: TikTok, YouTube, Instagram, Book, Self-Care for People with ADHD, and the Focus Genie App

Connect with KC: TikTok, Instagram, and Website 

Get KC’s book, How to Keep House While Drowning

We love the sponsors that make this show possible! You can always find all the special deals and codes for all our current sponsors on our website: www.strugglecare.com/promo-codes

  • KC Davis 0:05

    Hello, you sentient little ADHD balls of stardust. This is Struggle Care, the podcast about self care by a host that hates the term self care. And today I have Dr. Sasha Hamdani. Did I do it right?

    Dr. Sasha Hamdani 0:18

    Yeah, it was beautiful.

    KC Davis 0:19

    Why don't you introduce yourself?

    Dr. Sasha Hamdani 0:21

    Hi. Okay, so my name is Dr. Sasha Hamdani. I'm a board certified psychiatrist and ADHD clinical specialist. And someone that intermittently fools around on social media.

    KC Davis 0:33

    Love it. Okay, so not only did I send you the link to log on, like three minutes before we started recording, I actually have not even really talked to you about the topic or sent you any question. That's fine. And I'm hoping that maybe you can just roll with that.

    Dr. Sasha Hamdani 0:46

    Yeah, that's what I do best random rolling with things.

    KC Davis 0:50

    Me too. People always like, Would you like me to send you some questions? And I was like, no, no, stressful. Okay, so here's what I want to talk about. I want to talk about adult ADHD diagnosis. Oh, my God love it. Okay, because I got diagnosed as an adult. Yeah. And I think it's really interesting to talk about how it gets missed as a child. Yeah. And like, how do you know when to go in? And like, there's just so many interesting things about it that like when I finally got in front of a psychiatrist, that understood, ADHD, and understood its adult presentations and understood its adult presentations and women. Yeah. She was like, Oh, I clocked you from the moment you started talking about it. And she asked me all these questions about my life. And I was like, yes, yes, yes, yes, yes, yes. Yes. Yes. Yes. Yes. And then what really was wild to me was when because I was still like almost gaslighting myself. Like, am I making this up? Is this just because I had kids and now I feel scatterbrain. Like, you know, because I had a really successful career. I did pretty well in school with the exception of like, some addiction issues. But what really finally got me to stop feeling impostor syndrome was when she started asking me things about my childhood, and not things like ADHD symptoms. Would, she said, Have you ever been diagnosed with a learning disability? And I was like, Yes, I was diagnosed with auditory processing disorder, dyslexia and dysgraphia. She was like, Oh, well, there's a really high incidence of comorbidity with particularly auditory processing and ADHD. And I was like, Okay. She's like, did you have any addiction issues as a child? And I was like, Yes, I went to rehab at 16. She's like, Oh, because there's a very high crossover comorbidity between addiction and ADHD. And the one that really freaked me out was when she said, Did you ever have any vocal tics as a child? Hmm. And I was like, Yes, I totally did. It wasn't very long. It was like in a stressful period after my parents got divorced, but I developed this weird vocal tic, and this weird thing with light switches. And I can't remember there's anything else. And then I was telling her like, I just didn't think I was ADHD because like, I did so well, in school for so long. Now. I didn't do my homework, like ever. And she was like, Well, I mean, we're just on and on and on. So I know, there's probably a lot of listeners that either are ADHD or they're like, wondering if their ADHD and so I thought maybe we could just start with like, if somebody were to ask you what ADHD is, how would you like answer them on an elevator?

    Dr. Sasha Hamdani 3:28

    So this does happen to me on elevators. So if I was talking about what is ADHD, just like a little blurb about it, I would say it's a neurodevelopmental condition that presents with inattentiveness, hyperactivity, impulsivity, and it doesn't need to be all of those, but it can be like an amalgamation of all of them, or one specifically more than the other. But basically, this is something that you were born with, and this has progressed through your life and is in fact, you know, a lot of people have beef with the disorder part of ADHD. But I think that's really important, because I think that it causes dysfunction. And even if like, in your story, Casey, like going through your life that you did, well, there were other facets of your life that were like exploding, right? So there's a disorder part of it. It's not just smooth sailing. So ADHD causes dysfunction in some capacity.

    KC Davis 4:20

    Well, I also thought was interesting was like, Okay, so like, I went to school, and there were some bumps along the road, but like, also, like, went to college and went to grad school, but also, like, I changed my major, because like, the first one was too hard. And the first one had too much math, and the first one had too much reading or whatever. And so what was interesting to me was thinking about, like, number one, what could I have done? If I had actually had my full capacity available to me?

    Dr. Sasha Hamdani 4:48

    I mean, number one is a big thought in and of itself, right? Because I think a lot of people that are going through this process, especially people that have late diagnoses, there is a mourning period, right? Because you're just like, What could I have done? I wasted all of this time. And that's, I think that can be, that's something that should be acknowledged because it is a common experience. But also something that could benefit from a little bit of reframing, like, what you went through is like, if you had gotten a diagnosis earlier, yes, maybe life would have been different. But during that time, you were also building coping skills, and you were building like collateral circuitry and trying to compensate for some of these things. And maybe some of those alternative kinds of things that you arrived at, are really going to suit you now that you have a diagnosis that you have a possibly medication that you're addressing it appropriately now. So I mean, not last time, just different.

    KC Davis 5:43

    Well, what's interesting is that she said, like, so it happened, or the pandemic, so I was doing like a virtual visit. And I laugh all the time at how like, I wonder how different this would have been, if it hadn't been a virtual visit, if I had like, gone into the office, right, because I would have like woken up and gotten ready, gone to the office, like sat there, like had this calm conversation and been trying to like recount things. But what happened was, we were on a video call, and she says, What makes you think that maybe you have ADHD, and I was like, well, like, I feel like I can't remember things unless they're like visual to me. And and I started talking about my kitchen and how my kitchen is always messy, but I'm trying to get it functional. And I have to do these four things every night. But I can't remember the four things unless they're written down. And I like took her into my kitchen and started like explaining my system for keeping my kitchen clean. And she was like, you could like see her eyes like get wider and wider. She's like, looking at me pan across the kitchen and talk about my kitchen. And it's funny to me, because I feel like she probably wouldn't have had that experience of me if I was like sitting in her office. But her actually seeing my space. And the like nine I swear that I looked like that meme of the guy with like, all of the conspiracy board with all the strings where I was like, so I hang these here. And then I have to put this here so that the dishes go here. And if I don't forget the dishes, then I have this thing over here though. And she was like, oh,

    Dr. Sasha Hamdani 7:04

    okay, okay. Yeah, I mean, that's part of the cool thing about being able to do telehealth because you're actually getting to see the patient in their environment, which gives you a huge amount of data also, which is great.

    KC Davis 7:19

    So I feel like so you know, you and I both do tick tock. And there's a lot of content out there about ADHD, some very helpful, some kind of random and maybe not that related. But what I think is interesting is that there are a lot of people right now sort of listening to things about ADHD and for the first time in their lives going, do I have ADHD? Like, I'm sort of relating to this? And I'm curious, like, how do you as a psychiatrist that works with ADHD? Like, how do you view that phenomenon? Like, are you on the now everybody thinks they have it because of social media? Or are you on the like, we have a, you know, there's been an epidemic of undiagnosed people that are coming out of the woodwork now, like, how do you see that?

    Dr. Sasha Hamdani 8:03

    I don't know. So here's kind of my two cents on that, because I think this is related to that. Right? So I think why people like the crux of what you were saying, like, if you boil down the two sides of that, it's like, how do you feel about self diagnosis? Right? Like, is that kind of like where people would go? And so my view is, I think self diagnosis is kind of something that we all do, like whether or not it's from social media or not, like you're trying to explain your own internal environment. So I actually don't really have a problem with self diagnosis, like, trying to get information and learn about yourself, whether it's through social media, or through a podcast or through, like talking to other people that, you know, what I do have a problem with is when people get overly entrenched in these things, and like, I'm telling you, like, I am a psychiatrist, I've spent my whole entire life working up to this point and spending all my effort into this kind of academic training. And there are days where I'm like, I don't know if I'm hungry or sad. I don't know what that is. I cannot adequately describe what's happening. So I think it's difficult when people are trying to self diagnose, and they get absolutely, like, entrenched in this has to be ADHD, and it can't be anything else. Because then I think what you're doing is you're limiting yourself because it could be a lot of different things. And ADHD is so nuanced. It could be anxiety, it could be a thyroid disorder, it could be like some underlying learning disability, it could be so many, many, many different things. And so I think that yes, if you have suspicions, learn about your brain, understand it as much as you can get from other resources. But if it's accessible to you find a way to corroborate that information or to discuss that possible diagnosis with a medical professional because I think that's where you're gonna get the most comprehensive thing. So whether or not it's like this huge burst and like, I think with COVID, we were all on our phones more. So I think that there was just a lot of time where people became more introspective, and they had this new information out to them. And they were like, Oh, this looks like me. Although we all had this seismic shift in what we were doing, right. We were previously like out and about and multitasking. Now we're at home and teaching our kids at home and doing all of that, like a lot more responsibility was thrown on us in a small period of time. So I don't think it's this epidemic, or I don't even know what you would call it. I don't think it's like this huge, rapid burst of people that like new diagnoses coming out of nowhere. I think these people probably had it. And it was just like, Okay, now we're starting to realize it more because of this unique spot in time.

    KC Davis 10:38

    Yep. So there are certainly a lot of kids that get diagnosed with ADHD. And I remember being 16 and being in a partial hospitalization program, because I had a lot of addiction issues and mental health issues. And there was a kid in there, that was ADHD. And I remember him like not being able to stop moving, he could not stop moving, he could not stop talking, it was almost like compulsive. And then like, the next day, he came in, and they had medicated him. And he like, was in he started crying and was like, I can't do anything. Now. I can't do anything now. And I feel like I've just always had this picture of what ADHD looks like as sort of a stereotypical, like, young white boy that isn't focusing in class, and is being really disruptive. And as always getting in trouble in class for not like, you know, getting really poor grades and not being able to pay attention. And so that was not me. So I'm curious if you have any insight into like, how so many diagnosis,

    Dr. Sasha Hamdani 11:47

    we all thought that.

    KC Davis 11:48

    Yeah, like, why did we all think that and like, why is it we're like, are there other presentations that we're just like missing and childhood? Like, what factors could make a child go undiagnosed, or like fly under the radar despite having this disability, so think we're getting

    Dr. Sasha Hamdani 12:03

    better? But yeah, like, I know, when I was growing up, and things like that, I was diagnosed in fourth grade, but it's because I presented like a boy, like I was super hyperactive, and I was off the wall. And I literally, like it came to my parents attention, because I started riot in my classroom, like, I got all the other kids to stand up on their desk. So like, as disruptive as one could be, that's what I was doing. So I think that clinically the presentation, that's what kind of stuck out and I thought about this a lot, because everybody has that like young hyper boy. That's what they think of with ADHD. And I think it's become problematic because a lot of practitioners grabbed ahold of it. I think what they were grabbing onto was the dysfunction part where they were like, if it is like they are disrupting the entire classroom, and they can't progress through learning, it's causing dysfunction. But they were skipping over all of these, mostly girls who were inattentive, they were sliding by their classes, but they weren't doing as well as they could. And they weren't, like, appropriately building relationships or doing things like that, that's going to aid them that when things actually get hard. And when they're like, maybe it's like middle school and high school. Now they're dealing with like social things to where now they're victims of impulsivity and judgment issues and other things like that. And they can get into like, bigger, scarier, problematic areas. But by that time, it's like you don't have as a kid, you're fine. And so like, then from that point onwards, girls go through puberty, and then they're gaslit. You didn't get it. You didn't have it as a child, when really they did. It just presented differently.

    KC Davis 13:41

    Well, and I remember listening to someone say that, like, ADHD isn't about not being able to pay attention. It's about not being able to regulate your attention. And that the way that shows up for a lot of people is like, the young, hyperactive boy that can't pay attention in class. And when I was talking to my psychiatrist, and she was asking me about my experience in school, I told her like, I remember liking school. Now I didn't like the structure of it. Like I was kind of that kid. That was a little bit, but I liked learning. And I found it really easy. And once they identified the auditory processing and moving to the front row, it was easy for me to pay attention because I thought it was interesting. And I would listen, the way that my school was set up is that if you listened to the lecture, and what was happening in the class, I would retain it all. And then when I go to take the test, I would remember it all and I would get hundreds 90s 95 on the test. However, I never did homework. Yeah, never did homework. I was so fast at my a lot of classes. The way they were structured was like, Okay, do this worksheet. And if you finish first then you can start on homework. So or they're saying homework is if you don't finish the worksheet and I was working so quickly, that I either always finished everything in class, or I finished it and then some other thing. But the work that never got done was anything I was required to do or structure on my own time. And what was interesting about it is I think about that age is like, and it was a problem, like I got in trouble. But nobody really pushed it that hard because I was still a straight A student. And I was like forging my parents signatures on the like, notes that I that I wasn't doing homework. And even if you would ask me at that age, why I wasn't doing homework, I don't think I would have been able to verbalize like I am today, because I can tell you today, what would happen is that they would say what the homework was, and I would think to myself, I'll remember that, and then I wouldn't, or I would think, Okay, I'm gonna write that down. And then I would shut the journal, and it would disappear from my life fine, I would never remember to take it out and look at it again. And there was after school, and even my little after school care, like, but there was nothing after that, that was like, and now you have to sit down and open it up and recheck the list and look at it, like it disappeared from my existence. And what happened was, I did well in school until we hit high school, where they restructured how they weighted the grades, when suddenly, you know, it used to be okay, we'll do a lecture on chapters one through three. And then the test is on chapters one through three, and then I got to high school, and it was we'll do chapters one through three in class, and you'll go home and read chapters five through 10. And then the test will be on chapters one through 10. And I was incapable of doing work outside of class.

    Dr. Sasha Hamdani 16:42

    So that's so common with ADHD, because, you know, we hate structure, but we've made it. So like within the confines of a classroom, you may be able to be like, Okay, I understand how this goes. And as long as you're adequately engaged in the material. And it's still kind of interesting to you, you can keep up and you can process a lot of information at a small amount of time. When you pull that structure away, and you're you go home, and you're expected to self motivate yourself or stay organized without those kind of structures in place. It's nearly impossible, especially if you don't know how your brain is working. It's really difficult to do that. And especially as a child, like how are you supposed to do that on your own heart. So as parents, like, if you don't know, your kid has ADHD, if the kid doesn't know they have ADHD, I think it's really hard to parent that kid and kind of lead them the right way to because their brain works differently.

    KC Davis 17:35

    Plus the impulse control of like, when I'm at home, the amount of like executive functioning skills it takes to be like, I could go watch TV, I could go hang out my friends, but I will sit down and do homework. I didn't have it. So it was so fascinating for my psychiatrist to go like, well, that's because you were interested, you could pay attention because it was interesting to you like it was like a weird, almost like a lining of the stars that you just happened to be interested. And then of course I was I never did well in math, because it was never interesting to me. So I thought that was fascinating.

    Dr. Sasha Hamdani 18:08

    I don't know how it's interesting to anybody. I think that there's, you know, with ADHD, to me, I feel like it's an interest based nervous system like you regulate and you turn on and activate and you turn off and deactivate based on what you're interested in. So if there's something that you're engaged in, you fire and your neurotransmitters are working and you can like process, a tremendous amount of information, maybe more so than a neurotypical person. But if you can't get to that spot where you're engaged, it's like nothing is happening, like things aren't firing.

    KC Davis 18:40

    Okay, so I want to ask you specifically about the criteria when we come back from this little break. Okay, we're back. And here's my question. So when I was looking over the criteria, when I was first trying to question whether I had this diagnosis, it talks about inattention. And it talks about often fails to give close attention to details or make careless mistakes. And I think what was hard for me was not understanding like at what frequency was considered clinically significant, because it wasn't like, that was happening so often that I was like, I remember the TIC tock of the girl like crying in her car and being like, I think maybe I'm just stupid. I can't remember anything like, that wasn't my life, like I was super successful. I was very responsible. But there are these like key moments in my life that I could point to where I would read something. And I thought I knew what it said. And it said something different. And it caused me to miss a midterm or not turn in a paper on time. And it wasn't like I'm not being responsible. It was like I had it planned out. I was going to do this on this day, this on this day. And then I go to class and say, Oh, it was do this Monday. Not next. It's Monday. And I remember like, at one point, I really wanted to get a PhD. But the programs I wanted to get into you couldn't make less than a B in your classes and your like masters classes. And the one see that I made was because of one class where I misread the syllabus, the date on the syllabus, and I remember being like, I don't understand how I'm doing this. And so again, it wasn't like a thing that happened every day or every week. But there was like, these handful of times in my life, where I would like miss an important meeting or or like that, and I never understood like how I could be so stupid.

    Dr. Sasha Hamdani 20:40

    Yeah, I mean, I can't even tell you how much I relate to that. And I think that's kind of why ADHD is such an important thing to discuss because of these lapses in executive function. And these like gaps. It just like, deteriorates your self esteem, right? Because you're just like, I'm dumb. There's literally no other explanation for this. But I think that what helped me. So when I was in medical school, like one of my very first exams at a neurobiology exam, and I was like, This is awesome. Like, I like it was cadaver base. So like, we were looking at, like, cut up the brain. And I was like, so I mean, it was gross, how much I enjoyed that like, like, I was like, This is so interesting. Like, I understand the anatomy, because it was visual, like, I'm engaged in visual stuff. I did the test finish before anybody else. I'm like, I'm fully a genius. This is great. Like, every question was easy to me. They posted the grades later that day, and I had gotten a 32%, which is like, I'm fail. I like, I don't know what I was doing. And I was like, what? I thought I did well, and it's because I didn't turn over the test. So I literally did not flip the sheet. And so I remember at that point, like I had been by myself for a little while. It's the first time I've been away from home. And I was like, I'm done. That's it. I don't know what this is like that stuff. And what helped me and like my parents were like, trying to help me make sense that and this is like I was diagnosed earlier, but like, I didn't really understand that it was ADHD. So finally, around that time, like I was starting to put together the pieces. And so my poor dad was like trying to like, help me understand this better. And he was trying to understand better, and he's like, your brain just moves too fast. And so you're processing way too much information. And so things fly by. So it's like, we just have to figure out a system that works better for you. And I literally did not figure that out until I was well into residency. But like, that was so helpful for me because I'm like, Okay, it's not dumb. It's just I'm doing too much. My brain is doing too much. It's processing too much too quickly. And so obviously, if you're doing it so quickly, you're gonna make mistakes.

    KC Davis 22:50

    And I feel like I guess I always thought to my head like, oh, well, like everyone makes mistakes. Like, no, maybe, but it looks like I mean, but I have like a handful of them. And I guess I was under the impression that it had to be something happening to you, like daily or weekly to be like clinically significant. But then when I was telling my doctor, like, I mean, there was the time that I missed the midterm, there's the time that like that she was like, yeah, that's like clinically significant that you have like four or five instances in your life where something that really mattered to you was like, bungled, because you like missed a detail. And I think what was hard for the grumps around me is that I'd never went home and did my homework. And yet, like, I was a theater kid, who would prep, prepare, nail the star role, and then have the entire script memorized. And they were like, well, you know, it must be that you don't care enough, it must be in your trunk. Because if you can do that skill in this area, why aren't you doing it in this area? And so there was like, That mismatched? Like, is that part of it? Like, is that a thing? Like, I feel like if I had been consistently in deficit across like every area that maybe that would be something else? Or if I was like, consistently performing, but it was almost like the patchwork of when I was able to excel. And when people were like scratching their heads? Like how could you not be able to do this

    Dr. Sasha Hamdani 24:17

    interest base nervous system, you were interested in the other stuff, and you weren't in that, like, so there are those like, with patients I hear all the time, where they're, you know, I'll have like, the kid and then the parents in the room and the parents are arguing in front of their kid, like at me. And it's just like, they can't have ADHD because they can focus on their video games for hours. And I'm like, Yeah, cuz that's interesting to them. Like that is something

    KC Davis 24:46

    on their neuro slot machines, right?

    Dr. Sasha Hamdani 24:49

    I mean, like, this is stuff that is releasing a tremendous amount of dopamine they are able to engage in this. If you are like, Would you like to play Minecraft or would you like to read out of this algebra textbook? Which one do you think you're going to do a better job focusing on? Like, it just doesn't like, I think, to me, it's a little bit different because I have ADHD. So I kind of understand that flip side of it of like having it and also treating it, like interactions like that, where parents are so frustrated. Like, I understand the frustration, I understand how this may seem so contradictory. But like, if you can boil it down to like, what are you interested in? And what are you not? And the stuff that you're not interested in? How much dysfunction is that causing you? Is it like I can kind of get by? Or is it this is non functional, I can't get by this is not going to happen. That's going to indicate where what the clinical level of severity is, like, do we need to address this or not.

    KC Davis 25:49

    And what's interesting is like, when I the first time I started reading through the criteria, I had a hard time relating. But then when people who either had ADHD or were experts in ADHD, would talk about what the experience of ADHD is like, then I would start to relate. So like when you talked about, your brain is moving too fast. Like all the sudden, I have 1000 sort of memories and experiences that come to mind. And one of them is like, I don't know if your school ever did this. But they used to tell us in school, when we had a test, like first read through the whole test, then come back and start to take it and I was incapable. And they weren't even, there was one time when they did a test where it was like the last question was don't do any of the questions because it was like a little like, see if you can whatever. And it wasn't just, I don't have time for this, I'm too smart. For this. It was like, it was almost like painful to slow my brain down enough to like read each word without like I didn't. It's like it worked. It didn't work as well. And so like I had to move fast. And I've had that experience with like, if I'm interested in something, I can read about it for hours and hours and hours. But then I'd have like one form for something that I needed to fill out. And it was almost like, I can't make my brain. Like look at each word. You know what I mean? And so all of a sudden, when people are talking about that experience, I'm going oh, that's it shows up here. It shows up here. And I remember one time taking the like self rated score. And actually, let me let's take a break. And I'll tell you about my the existential crisis of my self rated score when we come back, okay. Okay, so let me tell you about myself credit score. So I remember getting to the questions. And there was one where it was like, you have difficulty finishing projects, like you always leave projects undone. And I had recently redone my third floor, we have like a game room slash den slash and I had redone and I got so into it. And I mean, there were so many steps involved. And like, I did it, and I completed it. And I remember thinking like, No, I don't leave projects on time. And so I said, like, No, I don't do projects, I'm done. And then I would like needed to go get a drink or something. And I walked down my stairs. And on the landing of my stairs, were all of the tools and supplies that I had used to redo my third floor three weeks ago, okay. And I looked at it, and I was passing by every single day. And I realized that the Oh, like, okay, in my mind, I completed the project, because the room looks the way I want it to look now. But I never, I always struggled to like clean up after myself or to like, put my hammer away, or like figure out what to do with those two frames that I didn't hang in the room. And it was like an epiphany where I was like, Oh my God, I don't finish things. Like when I'm over it, I'm over it. And it just sits there. And then the other part of it was I like went down, I got my drink. And like you can pick it I was like, like opening my little soda, thinking about it and walking up. And then I like looked in the room. And I remembered that. I mean, I had my mom come in town to help me with this room. And part of that is because I think it's fun to do things like that with my mom. But the other part of it is because I've learned in my life, that when I'm in the middle of a big project, I hit this like lol in the middle, where I don't want to do it anymore. But if my mom's there, she'll be like, Let's just hang the pictures. Let's just hang that we could just do it right now. And I won't want to do it, but I'll do it cuz he's like, let's just do it right now. And then I was like, Oh my God. I do have trouble finishing projects. It's just that I've created all of these like compensatory behaviors. And I didn't even realize like that's why I like my mom to come over when I'm unpacking. That's why I invite my mom when I want to do some big project that when I am doing little projects, I'm never putting things away afterwards. That that's all that same behavior.

    Dr. Sasha Hamdani 30:01

    Yeah. So recently I started working on an app like an ADHD app. And like, I don't know anything about that, right? I don't know, I don't know anything about tech. I don't know anything about data. I didn't know where to start. And so I had all this big ideas. And I was researching into this and like, figuring out what I wanted to do, and like, in my brain, I was like, Minority Report, I was like, everything is like, moving around, and I'm like, I am a genius. And I, like, couldn't execute any of that stuff. I'm just like, I can't do this. And like, because it gets like, you get so interested in everything. And then it suddenly gets overwhelming. And then you're like, recoil. And so what helped me is exactly what you were doing with your mom, I got my sister involved. And she's the one who's like, a secondary brain doing that executive function for me like, Okay, you made it this far, what are the finishing steps? Let's do this. Let's do this. And like trying to keep yourself balanced. So I think that a lot of people, especially people diagnosed later in life, they might have difficulty looking through that initial criteria, because they're like, their variables are confounded by their compensatory mechanisms. You know, it's like, yes, maybe you would have met criteria, but you do this really well. And so I think that, especially for women, we are very good at masking symptoms. And like societally, it's just not, you know, I think boys get a lot more latitude. And so like, girls, we just have to kind of toe the line and figure out how to make it look like it's working. And so like, a lot of it gets get

    KC Davis 31:32

    when I can see how if you were to go to a psychiatrist that maybe still even with all that expertise, just has that picture of that little hyperactive white boy, like they don't even know enough experientially to ask you past the do you finish projects? Anyone? Oh, yeah. Okay, but do you really like let's talk about what does it look like when you like any, like, it's hard because not everybody that is trained is like really actually super knowledgeable and ADHD. And I remember the other one was the when it talks about the fidgeting, like often fidgets are taps with hands or feet, squirms and seat and I remember being like, No, I don't do that. Like, I don't fidget, I don't tap. And, again, because I was thinking like somebody, some little boy that like, literally can't stop moving. And I remember laying on my couch one time, and I was like, massaging my job, because my job is always really, really tight. And the reason it's really tight is because I tend to tap my teeth together all day long to the beats of songs that get stuck in my head. So I'll be like concentrating, I'd be like, there's like all day. And again, I had another lightbulb moment where I was like, Oh, my God, I can't stop moving. It's just that I had learned as a girl who no doubt had been told, like Casey stop moving. Yeah. And I developed a way of doing it that wasn't visible to others that I wasn't even, like totally aware of. And then I have this one other one, where, because I went to rehab at 16, I went to what was referred to as a therapeutic community. And one of the things that they did there, there's a lot of great things I learned. And there were a lot of things that were like not super helpful. And they tended to take all of my behaviors and make them like a moral issue. And and I learned how to basically like stamp out a lot of behaviors during that time of being institutionalized. And so, when it got too often interrupts or intrudes on others has trouble waiting their turn blurts out a question before it's been answered, talks excessively. So I remember reading those, those are like the social component ones. Yeah. And initially answering note, almost all of them because I don't do those things often. And then I started thinking about my time in rehab. And about like, every week, we got concerns. And they're supposed to be like, addressing behavioral concerns. And the concerns I always got, were like, I never forget, the first one was take the cotton out of your ears and put it in your mouth. And then I got a concern about like, you won't stop interrupting people. And you're so self centered. Like you're answering questions, you'll hear someone ask a question across the room, what time did the van leave? And you'll answer it, even though they're not talking to you. Like you need to mind your business. Or the biggest one was that like, when people would ask me questions, I would answer them before they were done asking the question, and they would say, Casey, you need to stop. You're not listening. You're not listening. And I would say I am listening and they say, Why are you interrupting? And I'd say because I already know what you're going to ask. And they're like, well, that's really egotistical of you, like you're such a No at all. And so all of these behaviors were or couch to me like I was being selfish, self centered, egotistical, arrogant, and don't get me wrong, I was in fact all of those things as a kind of like a shitty drug addicted 16 year old. But actually, it was just ADHD. Like I did talk excessively, I do interrupt people. And so as an adult, I'm sitting there going, Okay, I don't interrupt people when they're asking me a question. But it's because I've learned to bite my tongue, I'm still answering their question halfway through and not listening to the rest of what they're saying. Because if I don't get what's in my head out of my mouth, I'll forget it. And so I have to concentrate on it. So that I don't forget what I'm going to say. But in concentrating on that, I now can't hear what you're saying. And I'm trying to find the socially appropriate time to interject it. And I did not realize that wasn't neurotypical like, I did not realize that that is what that criteria is. I just had learned to stamp out the external behavior, but like, I wasn't actually changing what my mind was doing.

    Dr. Sasha Hamdani 36:10

    Yeah, I mean, that's so common. And I think that's why so like, when you're looking at masking or obscuring your symptoms, for whatever reason, like whether it's purposeful or not, a lot of times, what you're doing is you're not changing that internal behavior, you're just changing how you respond externally. And so I think that's kind of what what becomes problematic in terms of diagnostic kind of things. Because if you've been masking for so long, it's hard to know, like, Is this a real thing? Is this what I do? What? Because you're looking at your internal symptoms? And so I think that's, it's difficult sometimes for a provider to truly get to the bottom of things, right? Because you're, what there's appreciating and getting data on its external criteria.

    KC Davis 36:52

    So what would you say to someone who is maybe listening to this, or they've seen other things, and they're going well, I kind of relate to those things. Like, what should next steps be at that point, because I think the other thing is like, this is really sad to me, but I've had a lot of people tell me, I brought this up to my doctor. And they said that, you know, because I'm not in school, it doesn't matter. Or because I'm you know, because I am doing okay, at work. Like it doesn't matter. Or if that's just a thing that kids have, like, I've heard that a lot. And so I feel like people are a little bit hesitant to know who they can actually talk to you about it.

    Dr. Sasha Hamdani 37:34

    So you know, and that's part of the reason like even getting to that spot where you can talk to someone that's such a privilege in and of itself, because a lot of people don't have that access to care. So I say the first step is just educate yourself as much as possible, like, at the base of everything is a better understanding of yourself and your brain. So learn as much as you can about that. And there's so much that you can kind of learn about an ADHD brain and how it's working in how it's functioning, and try to work on behavioral modification that's independent of medication, maybe you're going to be someone who needs to be on medication, maybe you need to do both. But I always like doing that behavioral kind of imprinting and working on those stemming from understanding what your patterns are, because of two reasons. One, it's going to eventually kind of help functioning. But two is just like such a number one validating experience. And two, it gives you a little bit of grace, like, This isn't me, this isn't a moral failure. This isn't like a problem with intrinsically me, my brains moving too fast. And this is what it's doing right now. So I think that gives people I don't know, I think it gives people just this level of comfort and understanding so that they have this judgment free place to grow and expand from.

    KC Davis 38:52

    And then my last question is, if somebody finds that they do meet criteria, or they do they get this diagnosis, and sort of the next question posed to them is, you know, do you want to try medication? And a lot of the feedback that I get from people is, well, I'm not in school anymore. And actually, there's this like, very specific demographic of people. And it's like, stay at home parents, that will say, Well, I'm not in school, and I don't even like go to a job. So like, they kind of feel like that's what medication is

    Dr. Sasha Hamdani 39:26

    for. Since when is parenting not a job, right? Like,

    KC Davis 39:29

    I'll never forget my doctor telling me you like to do a tolerance break on Saturdays and Sundays, and up by medication, just like not taking it. And I remember I had to come back like three weeks later and be like, I'm sorry. I'm a mom. I actually have more to do on Saturdays and Sundays, that I need, like my executive functioning for them, like when I'm sitting at a desk. So I'm curious if you could speak just maybe generally about, you know, how do we make those sort of decisions about medication and what can medication help with outside of that sort? a stereotypical like studying,

    Dr. Sasha Hamdani 40:02

    I'm not the one who can make that like, right as a practitioner, your job is to educate the patient. But it's like surely like ego, if I'm saying like, I know better when to start medication versus you like the patient is the one whose internal experience really matters. So if they're like, this is what I'm having dysfunction with, I am really having issues kind of moving forward, as long as there isn't anything barring or I'm worried about any, like comorbidity or like medication addiction issues or anything like that. They should be able to say like, Hey, I think I need to start medication because I've done these behavioral modifications, I'm not able to sustain them or keep them up or, or I'm not able to, I have sustained them, and I can't see enough benefit from them. And by the way, like with medications, I think everybody is so like laser focused on stimulants as being the only medication option. There's so many other things besides stimulants that you can treat ADHD with. So I think it's worthwhile having a conversation and just being open and honest with your doctor, like, here's where I am, this is what I've done. This is where the dysfunction still lies, what are my options, and just having that collaborative back and forth.

    KC Davis 41:14

    And I think for me, a big part of it was okay, there, it wasn't a matter of like, I can't do this thing. And so I need medication. So I had this idea in my head that like, if I can't do something, then I deserve or then I like could qualify as someone who can try medication. But it didn't occur to me that like, okay, I can do the thing. But it is taking me so much time, energy and effort. And I'm using three times as much effort to get this thing done, whether it's getting my household tasks done, or paying my bills or returning phone calls that like Okay, I'm getting them done, but at what cost? Like, is it just my baseline productivity that I should be judging? Or, you know, is there room therefore? Wait, you mean, other? Like I said earlier, like wait, other people just decide to do their laundry and then get up? I know, like some it's, like, efficient of water, like you don't know what wet is, if you've been in the water for so long?

    Dr. Sasha Hamdani 42:20

    I think it is a matter of just kind of understanding. And honestly, even prior to having discussions with your physician, it's having discussions with yourself and figuring out like, what is this? What am I experiencing? What is this level of dysfunction? Because it's not your job to figure out if it's normal or not, it's a practitioners job to figure it out. But like, deciding within yourself, is this something that I want to discuss and find out more about like, I've had my own suspicions. Let me see if this is worthwhile to me to talk about.

    KC Davis 42:49

    Okay, so this is my actual last question. What could you tell people like, do you have like maybe provider red flags? Like, let's say that they go to their provider? Is there something that if like, let's say, if I came to you as a friend, and I was like, I saw my provider, and they said XYZ? That would make you go? Oh, I think maybe you should go find a different provider. Because I feel like a lot of people are getting really discouraged. And they don't know whether it's Oh, I'm not a doctor, I should just listen or whether it's like, I need to go ask someone else.

    Dr. Sasha Hamdani 43:21

    So a couple of things that come to mind are stuff we've talked about, like if they're saying you did too well, in school for this to be factor, like, theoretically, I think they're trying to indicate that it's not causing dysfunction. But school is not the only metric for that, right? If they're saying, You're not a kid, red flag, if they're saying things like, you've gotten this far, does it really matter? At this point? I've heard that before. Like, that's dumb. Don't listen to that. Those are kind of some of those things. And again, it's really difficult because like, these are all hypothetical situations, and you don't know what kind of led up into this case. But those are kind of the things that if you're hearing that or if that's kind of the undertone, that you should be like, that may not be accurate. And that might be more reflective over like an underlying, like, either knowledge deficit or just like a bias. Yeah, they might just feel that way.

    KC Davis 44:19

    Yeah, that's kind of those are like the ones where it's like, context couldn't really help a provider saying that,

    Dr. Sasha Hamdani 44:26

    like the only thing I could think were was maybe like, it's like, if you had another comorbidity that could be explaining like ADHD symptoms, but even that and like,

    KC Davis 44:38

    yeah, I found that, especially in the realm of really any neuro divergence, like whether I was looking for someone to talk to about a possible autism diagnosis for a kid or my own ADHD diagnosis. Like, I found that I really needed to ask a lot of questions on the front end of the provider and I know not everybody has this privilege. But if you do, really asking for someone and like, how much ADHD do you work with? How what do you know about adult diagnosis? You know, like asking some questions about that, because I found that when it came to neurodivergent issues, I had to find someone that had specific experience in like, current.

    Dr. Sasha Hamdani 45:25

    Yeah, and also looking on like their websites and things like that. A lot of people they talk about that stuff, if they're passionate about treating it.

    KC Davis 45:32

    Awesome. Well, where can people find you if they want to follow you learn from you tell us everything.

    Dr. Sasha Hamdani 45:40

    So on social media, so I'm on YouTube, I vine, at tick tock, I'm on Instagram, it's the psych doctor, MD. I'm Dr. D, OC, T, or a book about ADHD is coming out January 3, and I didn't know you hated the term self care, but it's called self care for people with ADHD.

    KC Davis 46:02

    I love it. I don't hate it from you, I only hate and the thing is, is that there's no other term. That's kind of what I hate about it. Like there's no other term. So I do use it, I hate what it has, like come to represent.

    Dr. Sasha Hamdani 46:15

    So basically, that's kind of like the Oh, because I get it. I'm a psychiatrist, and I'm supposed to talk about medications all the time. But at the same time, I think going through this journey with ADHD, I really understand the benefit of one understanding your brain and to the behavioral modification, because I think that's really important. And so that's kind of the basis of the book. And then that's kind of the bones of of the app, which will be released cut in winter. And that's called Focus GT. And so it's the focus Jamie on Instagram and Tiktok. But basically, that is something that is like just behavioral modification in your hand. So it'll it teaches you about your brain and teaches you about here are things you can actually do. These are areas of dysfunction, what is the term procrastination, like all these different things, and then tools you can use with it, like how to break down your To Do lists, how to do a task timer, how to do body doubling, how to do like having all of those options, so it's, it's like, it's what I created that I should have used in medical school. Like if I had this, my life would be so much better.

    KC Davis 47:22

    I love that. Okay. And the release date for the book is January 2023.

    Dr. Sasha Hamdani 47:25

    Yeah, January 3, and then the

    KC Davis 47:29

    app. Okay. So by the time people are listening to this, the book will be out. Okay, great. So go buy the book.

    Dr. Sasha Hamdani 47:36

    If you want to,

    KC Davis 47:37

    please don't hate it. They're not going to hate it. It's going to be good.

    Dr. Sasha Hamdani 47:41

    Yeah. And then the app will be. So if the book will be out, then the app will be out too. So the app is I've just I'm like, so proud of it. It's so cute.

    KC Davis 47:48

    And what's the name of the app? Focus GD o focus Genie, I already love it. It's so cute. And

    Dr. Sasha Hamdani 47:55

    it's got like this little dude, this little focus, Genie. And it's, it's cute. And so like, part of the thing is when I was doing research, and like I for myself was trying to find an app I liked and for like to help me and then to refer to my patients, and every single one I used, I'm like, oh, so boring. Like, I couldn't even get through the trial period. I'm like, I cannot maintain this. This is painful for my brain. And so this is like fun. It's colorful. It's engaging. It's like little hits of dopamine as you're going through, but you're learning at the same time. It's, it's great.

    KC Davis 48:27

    I'm picturing like, you remember the old school like Clippy, the paperclip and Microsoft Word that would show up? I mean, look, can you imagine like, it's like, he shows up and he's like, looks like you're trying to do your homework. We're like, looks like you're trying to do laundry. Do you need some help? I love that.

    Dr. Sasha Hamdani 48:44

    It's like essentially that there's like a little cartoon Genie that kind of helps and guides you through the process. It's it's the cutest.

    KC Davis 48:53

    Okay, that's amazing. So everybody go out, download the app, get the book. Thank you so much. And this was wonderful.

    Dr. Sasha Hamdani 49:01

    To Well, thank you for having me. I'm so excited. Of course.

    Transcribed by https://otter.ai

KC Davis