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?
Yeah, it was beautiful.
Why don't you introduce yourself?
Hi.
Okay.
So my name is Dr. Sasha Hamdani.
I'm a board certified psychiatrist and an ADHD clinical specialist and someone that intermittently
fools around on social media.
Love it.
Okay.
So not only did I send you the links 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 questions.
That's fine.
And I'm hoping that maybe you can just roll with that.
Yeah, that's what I do best.
Random rolling with things.
Me too.
People are 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 diagnosis 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 in 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, 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 scatterbrained?
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 imposter 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, OK, 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
ticks 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 tick and this weird thing with light switches.
And I can't remember if 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.
She was like, well, I mean, it was 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 they're 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?
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.
Well, I also thought what was interesting was like, okay, so like I went to school and
there were some moms along the road, but like I 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?
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 kind 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 it's I mean, not last time just different.
Well, what's interesting is that she said like, so it happened during 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 said, so 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 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 cleaning 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 that we're right.
And she was like, Oh, okay.
Yeah.
I mean, and 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.
So I feel like so, you know, you and I both do TikTok 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?
What?
I don't know.
So here is 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 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 going to get the most comprehensive thing.
So whether or not it's like this huge burst in 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.
Also, we all had this seismic shift in what we were doing, right?
We were previously like out and about 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.
Yeah.
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 and
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 is 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 diagnoses.
Are we all thought that?
Yeah.
Like why did we all think that and like why is it where like are there other presentations
that were just like missing in childhood?
Like what factors could make a child go undiagnosed or like fly under the radar despite having
this disability?
So I think we're getting 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 rioting 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've 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 hold 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 in
attentive.
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 too
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.
So like then from that point onwards, girls go through puberty and then they're gassed
like you didn't get it.
You didn't have it as a child.
When really they did, it just presented differently.
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 and 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, 95s 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 said 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 parent signatures on the like notes thing 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 going to write that down and then I would
shut the journal and it would disappear from my life.
That's 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 the 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 waited the grades.
And 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 ten.
And then the test will be on chapters one through ten.
And I was incapable of doing work outside of class.
So that's so common with ADHD because, you know, we hate structure but we need it.
So like within the confines of a classroom, you may be able to be like, okay, I understand
how this goes in 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?
Hard.
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
too because their brain works differently.
But 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 with 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 on math because it was never interesting to
me.
So I thought that was fascinating.
I don't know how it's interesting to anybody.
I think that there's a, 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.
Okay.
So I want to ask you specifically about the criteria when we come back from this little
break.
Summer is on its way and that means more daylight hours to get outside, get active and enjoy
the outdoors.
The one key ingredient that you're going to need, a good night's sleep.
Wake up feeling rested and refreshed with the softest, most luxurious sheets with bowl
and branch.
I've got bowl and branch in my guest room right now and I always get comments on how
soft and breathable the sheets are.
And that's because each sheet set is slow made for an unmatched softness with 100% traceable
organic cotton that gets softer with every wash.
So sleep better at night with bowl and branch sheets.
Get 15% off your first order when you use promo code struggle at bowlandbranch.com.
That's bowlandbranchB-O-L-L-A-N-D branch.com.
Promo code struggle.
Exclusion supply, C-site for details.
One of the things that can happen when you struggle with mental health is you can find
it difficult to get into the shower.
And if that's you, I have a brand that you really need to know about.
And it's called Lumi, a uniquely formulated PH balanced deodorant.
It's a whole body deodorant, the first of its kind.
Lumi is seriously safe to use anywhere on your body.
Pits, under boobs, thigh folds, belly buttons, butt cracks, vulvas, feet.
And it's aluminum free and skin safe.
Lumi starter pack is perfect for new customers.
It comes with a solid stick deodorant, cream tube deodorant, and two free products of your
choice like a mini body wash or deodorant wipes.
And free shipping.
As a special offer for listeners, new customers get $5 off a Lumi starter pack with code struggle
care at lumideodorant.com.
That's L-U-M-E deodorant.com.
$5 off.
That equates to 40% off a starter pack.
So visit Lumi deodorant and use code struggle care.
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 talked about inattention.
And it talked 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 TikTok of the girl 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 planned out.
I was going to do this on this day and this on this day.
And then I go to class and say, oh, it was due this Monday, not next 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, in your like master's
classes.
And the one C 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 like that.
And I never understood like how I could be so stupid.
Yeah, I mean, I cannot 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 yourself
esteem, right?
Because you're just like, I'm dumb.
There is 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, it was cadaver based.
So like we were looking at like cuts of the brain.
And I was like, so, I mean, it was gross.
How much I enjoyed that.
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, finished 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 got enough 32%, which is like, I didn't fail.
I like, I don't know what I was doing.
And I was like, what in the, 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 dumb.
I was like, that's it.
I don't know what this is.
Like, that's dumb.
And what helped me and like my parents were like trying to help me make sense of 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 he'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 going to make mistakes.
And I feel like I guess I always thought to my head like, oh, well, like everyone makes
mistakes like this.
No, no.
I mean, maybe.
But it was like, I mean, but I had 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 grownups around me is that I 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 your time.
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?
Interest-based 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, because that's interesting to them.
Like, that is something on their neuro slot machines.
Right.
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?
I'm like, which one do you think you're going to do a better job focusing at?
Like, it just doesn't like, I think to me, it's a little bit different because I had
ADHD.
So I kind of understand that flip side of it of like having it and also treating it, but
like interactions like that where parents are so frustrated.
I'm 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 it 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?
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 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 of a sudden I
have a thousand 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 would even, there was at one time where 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, this
is shows up here, 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.
If you love books and you're looking for a new job that you can do from home, consider
starting your own business and becoming a book coach.
Think of a book coach like a personal trainer or a coach for writers who are serious about
reaching their goals.
Book coaches help writers bring their dreams to life through support, feedback, project
management and accountability at each step of the book writing and publishing process.
And the best part, you don't even have to be a published author to succeed at this work.
That's where author accelerators book coach certification program comes in.
It teaches you the key editorial project management, organizational and people skills needed to
launch your own thriving book coaching process.
To find out if this is the right career for you, author accelerator is launching a new
five day challenge to help you envision your new chapter.
In their $99 one page book coaching business plan, you'll narrow down your business idea,
ideal client, ideal service and more.
Enrollment opens May 15th and runs through the end of the month.
So visit bookcoaches.com slash podcast and enter the code podcast at checkout to get
50% off that one page book coaching business plan challenge.
That's bookcoaches.com slash podcast.
Okay, so let me tell you about myself rated 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 undone.
And so I said like no, I don't leave projects undone and then I 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 read you my third floor three weeks ago.
Okay.
And I looked at it and I mean 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 I 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 like I went down, I got my drink and I like you can
picture 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 lull 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 them.
We can just do it right now.
And I won't want to do it, but I'll do it because she'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.
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 skipped.
Well, 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?
You know, yeah.
Okay, but do you really like, let's talk about what does it look like when you fit 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 fidget
or 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.
Okay, today.
So I'll be like concentrating.
I'll be like, there's like all day.
And again, I had another light bulb 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 had 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 question.
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'd 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 know it all.
And so all of these behaviors were couched 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 kind of like a shitty drug addict and 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 I like I wasn't actually changing
what my mind was doing.
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 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 they're appreciating and getting data on is external
criteria.
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 if that 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 it's
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 about it.
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
and how it's functioning and try to work on behavioral modification that's independent
of medication.
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, but 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 brain's 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.
And then my last question is, if somebody finds that they do meet criteria or they do
get this diagnosis, and sort of the next question posed to them is, 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 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 go to a job.
So they kind of feel like that's what medication is for.
Like, since when is parenting not a job?
Right.
Like, I'll never forget my doctor telling me like to do a tolerance break on Saturdays
and Sundays and of my 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 than 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 of stereotypical like studying?
I'm not the one who can make that like right as a practitioner, 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 who's internally experienced 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 boring 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 a 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 see 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.
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 have 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 there for?
Wait, you mean a other like, I guess that early, like, wait, other people just decide
to do their laundry and then get up?
I know.
Like some it's like that like efficient of water, like you don't know what wet is if
you've been in the water so long.
I think it is a matter of just kind of understanding and honestly, even prior to having discussions
with your physician is 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 practitioner's 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.
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.
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 a 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 the other 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 of or like
an underlying like either knowledge deficit or just like a bias.
Yeah, they might just feel that way.
Yeah, that's kind of those are like the ones where it's like context couldn't really help
a provider saying that.
Like the only thing I could think were was maybe like, eh, it's like if you had another
comorbidity that could be explaining like ADHD symptoms, but even then like, hmm.
Yeah, I found that especially in the realm of really any neurodivergence, 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
divergent issues, I had to find someone that had specific experience in like current.
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.
Awesome.
Well, where can people find you if they want to follow you, learn from you?
Tell us everything.
So on social media, so I'm on YouTube, I'm on TikTok, I'm on Instagram.
It's the Psych Doctor MD and Dr. D O C T O R a book about ADHD is coming out January 3rd.
And I didn't know you hated the term self care, but it's called self care for people with
ADHD.
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.
So basically that's kind of like the, 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 into 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 the app, which will be released in winter.
And that's called focus genie.
And so it's the focus genie 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.
It teaches you about here are things you can actually do.
These are areas of dysfunction.
What is the term procrastination?
Like all of these different things and then tools you can use with it.
Like how to break down your to do list, how to do a task timer, how to do body doubling,
how to do like having all of those options.
So 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.
I love that.
Okay.
And the release date for the book is January 2023.
Yeah, January 3rd.
And then the app.
Okay.
So by the time people are listening to this, the book will be out.
Okay.
Great.
So go buy the book.
Everyone go buy the book.
If you want to, please don't hate it.
They're not going to hate it.
It's going to be good.
Yeah.
So the book will be out, then the app will be out too.
So the app is, I'm just, I'm like so proud of it.
It's so cute.
And what's the name of the app?
Focus Genie.
Oh, Focus Genie.
I already love it.
It's so cute.
And 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 use, I'm like, oh, so boring.
I can't, 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.
I'm picturing like you remember the old school, like clippy, the paperclip and Microsoft word
that would show up.
I mean, can you imagine me like it's like, he shows up and he's like, looks like you're
trying to do your homework.
And we're like, looks like you're trying to do laundry.
Do you need some help?
I love that.
It's like essentially that.
There's like a little cartoon genie that kind of helps and guides you through the process.
It's the cutest.
Okay, that's amazing.
So everybody go out, download the app, get the book.
Thank you so much.
And this was wonderful.
Thank you.
Well, thank you for having me.
I'm so excited.
Of course.
Thank you.
.