AuDHD Expert: What Female AuDHD Really Feels Like, THIS Trait Makes You Vulnerable!

1. 0:00 – 1:57

   Trailer

   1. SPSpeaker0:00

      AuDHD neurotype is different to pure ADHD and pure autism, but it overlaps with autistic girls and women's social communication patterns. We are driven to connect. It can come across as looking quite innocent, having dissonance about how people feel, what they tell you, and what they really want. It's not that we do not sense it, it's that we sense so much. Dr. Samantha Hiew is a highly specialized female ADHD and autism expert.

   2. APAlex Partridge0:25

      With a PhD in medical science.

   3. SPSpeaker0:27

      She's here to give you a detailed crash course in AuDHD. And help you spot it. With AuDHD, there is that heightened cue detection, the salience network trying to pick up stimuli from your environment. But an AuDHDer who had been through trauma in their lives, that salience network then becomes a threat detection more than cue detection.

   4. APAlex Partridge0:47

      How would you explain how it feels that might help somebody recognize it?

   5. SPSpeaker0:51

      First of all, if someone's thinking that they might be AuDHD, I would-

   6. APAlex Partridge0:56

      So sorry to interrupt your hyperfocus for 30 seconds, but you're gonna wanna hear this. I've been working on an epic side quest. I've just launched the ADHDChatter Patreon, which is where I'll be connecting with my community on a much, much deeper level. I'll be doing live body doubling sessions, behind the scenes bonus questions with all of my world-renowned podcast guests. I'll be sharing the best, most transformative ADHD hacks over there, as well as hosting a private chat between myself and all of you guys. And that's really exciting because it means we all get to hear each other's coping strategies, as well as feeling much less alone. The ADHDChatter Patreon community really is the place to be if you want to transform your ADHD from a place of understanding into one of truly thriving. You can join right now using the link in the description. Back to the episode. If someone's listening or watching who has ADHD, and they suspect that they might also have AuDHD,

2. 1:57 – 4:29

   What AuDHD feels like

   1. APAlex Partridge1:57

      what could you describe the condition? How would you explain how it feels that might help somebody recognize it?

   2. SPSpeaker2:05

      Yeah, so first of all, if someone's thinking that they might be AuDHD, I would, um, question what brought them here. Um, with AuDHD, because of the co-occurrence of the ADHD traits and the autistic traits, and I've spoken about this before in the last episodes, where it is often a collision of the nervous system, of, um, wanting sameness and also craving freedom and s- you know, adventure. So for someone who is AuDHD, your life would look like on any given day, maybe you just want things to stay the same, but then there's a part of you that really want to do something new, you know? And many people with, um, this AuDHD neurotype tend to end up in squiggly careers, you know, throughout their lives, where it's like you have so many different hobbies and interests and jobs, you know, and, you know, different [laughs] maybe different relationships. Um, but yeah, definitely that, uh, wanting to chop and change just when things are good and stable and secure.

   3. APAlex Partridge3:17

      I mean, that sounds like quite a confusing existence with so many different push and pulls and perhaps contradictions. Can that be quite a s- distressing experience for somebody living with, with that two c- opposing sides of their brain?

   4. SPSpeaker3:32

      It is more distressing when we're in the middle of change or when we're at a place where we want change because it's when you feel like, you know, your life has stabilized, and then all of a sudden, you just don't want that anymore, and you want something completely different. And often it is that middle place, you know, that people can feel destabilized in, you know, are looking for an anchor.

   5. APAlex Partridge3:58

      I, I said at the beginning, AuDHD is such a big conversation within the community at the moment, and there are lots of people having conversations on it, which is, which is brilliant, and I always like to bring, um, the, the, the best, most credible people onto the podcast. Could you explain your qualifications to the people who are watching and listening?

   6. SPSpeaker4:17

      Yeah, so it's interesting 'cause I mentioned a squiggly career, and if I were to bring the qualification that is relevant to this, it's that I have lived experience- [laughs]

   7. APAlex Partridge4:25

      [laughs]

   8. SPSpeaker4:25

      ... for 44 years, going on 45 now,

3. 4:29 – 26:29

   Sam’s story

   1. SPSpeaker4:29

      and I've lived with a brain that I didn't understand for decades, and it was only in my 40s when I was diagnosed that I, you know, only began that excavation. But my career began in cancer research. Um, I studied genes, um, molecular biology, biochemistry, and cancer research. So I looked at how people's genes manifest into diseases, and I culminated in a PhD in cancer research at the age of 30 and then came out and swiftly landed in 16 different industries-

   2. APAlex Partridge5:01

      [laughs]

   3. SPSpeaker5:02

      ... one of which I told you about, which is in commercial modeling and acting. And for a really long time, I was really ashamed of it, and it was because I keep hearing from people who said to me, "But you have a PhD, Sam. Why are you doing modeling?" And I did it because, part of it was because there was something inside me that really wanted to come out. You know, I wanted to express myself. You know, so much of my life was so inward, and it was so contained. And also, the other part was because I was a mom, and being a freelance model was something that earned me better wage, you know, be- better rate, you know, at a more flexible, uh, timeline. And it was hard after I gave birth 'cause I had a period of postnatal anxiety and really low, low mood and wondering who I am and what am I doing, and I bring the science head and the heart of living as an AuDHDer to this, and I think that's, that's what-People resonate with

   4. APAlex Partridge6:06

      Mm. And you've clearly stuck at and done incredibly well in the field of neurodiversity and raising awareness about ADHD, I think predominantly, but now more so AuDHD. What is it, do you think, about this particular topic that has maintained your attention or made you the most passionate that you've, I, I imagine been about any of your different points in your squiggly career?

   5. SPSpeaker6:30

      Yeah. So the career really started from trying to figure out what happened to me and what happened to us. That's why when I created ADHD Girls in 2021, it was very much to try and understand what ADHD looks like in women. You know, 'cause, uh, what we have known is that, um, the assessments that are done for ADHD and autism is very much gender bias. And because of my own cultural difference, you know, I also noticed that some of the things that were, you know, tough for me was highly masked, and I wasn't really able to relate to the diagnostic criteria, which led to then also difficulty in getting my autism diagnosis, which took me seven months, you know, to almost trying to convince them that I'm autistic. And the whole excavation into ADHD led me to then, you know, to speak to the community, and people were talking about what it's like to be autistic too, and I was like, "Oh my God, that's me." And they were saying how they could be quite blunt in meetings, in workplaces, and I've offended my boss [laughs] in my first week at work, um, when I was working in I- Imperial College. [laughs] And he pulled me into a room c- after we had a meeting, and he said that the way I was challenging [laughs] the way things were done is not how you do things here.

   6. APAlex Partridge7:55

      [laughs]

   7. SPSpeaker7:55

      And he's like, "You don't talk to people who've been here for 20 years that way." And I was like, "Was I rude?" I didn't even know, 'cause all I really wanted to say was the truth and what I saw as the truth. But to someone else, it looks like I was this rude, uh, inexperienced person who came out from university. [laughs]

   8. APAlex Partridge8:14

      [laughs]

   9. SPSpeaker8:14

      Well, from academia. And, you know, I've gotta say, the world of academia, we're very much, like, secluded. [laughs] So we're academics. We look at books and we don't communicate science very well, you know?

   10. APAlex Partridge8:24

       Mm-hmm.

   11. SPSpeaker8:24

       So when I kind of went into communications doing that work, then yeah, people were shocked [laughs] by the lack of social, you know, understanding. And yeah, so that brought me to un- really excavate into AuDHD.

   12. APAlex Partridge8:38

       Mm-hmm.

   13. SPSpeaker8:38

       And it was not on- only after I was denied an autism diagnosis three times that I've wondered what in the world is AuDHD? 'Cause what is AuDHD look like in, in women, you know? What's... Why don't I recognize myself in the diagnostic criteria that we're using, the ADOS, you know? And they put all of my challenges down to trauma, and because I was going through a lot of, um, trauma in the time when I was going through the assessments. But is AuDHD different to trauma, or is AuDHD something that can co-occur with trauma? And I ran ahead and did the lived experience research myself. I created, um, the first comprehensive AuDHD women's survey, and within a month and a half we had 400, um, replies. It was a very long [laughs] survey as well, so well, well done, you know, to everyone [laughs] who filled that in. And we, you know, then found out that it does look different to what we were assessed on. And then a month later, Gina Rippon, uh, published a book called The Lost Girls of Autism, and it... She said herself in there that she had been part of the problem that she was trying to solve, in that before she thought that there was no gender differences between autistic girls and autistic boys and autistic, uh, men and autistic women, but then she realizes that there is. And there are a lot of differences, in that, um, autistic women tend to be more wired, you know, to look for social connection. And in fact, their social connection patterns look like neurotypicals. So what does that tell you, then, about the assessment that we're doing, you know, where we're asking autistic women and girls, "Can you socialize? Can you have... You know, can you make eye contact? Can you make friends?" And what if we say we can, you know, but we may not be able to maintain them for long, but we can, you know? And perhaps not maintaining it is the most painful part about being an Au- AuDHD woman.

   14. APAlex Partridge10:45

       You said a moment ago that you were denied an assessment for autism three times. Who denied you, and why?

   15. SPSpeaker10:52

       [laughs] I talked about it before, and they have, uh, since been very sorry about it. [laughs]

   16. APAlex Partridge10:57

       [laughs]

   17. SPSpeaker10:59

       Um, there was two clinical psychologists, and I went through the NHS route. It only came four years after I first, you know, um, approached my GP for it, uh, 'cause it was on N- NHS. So I just thought, okay, by then I had already self-identified as autistic as well, but I, I thought, you know, just go and see what it's like. So these two clinical psychologists, um, who interviewed me over a period of half a day, and I very blatantly remember thinking I didn't prepare, because, um, I thought, "Ah, I'll be fine, you know. I know enough about autism." [laughs]

   18. APAlex Partridge11:38

       [laughs]

   19. SPSpeaker11:38

       And I went in, and the first thing I said was, um, "Do you know there's a gender bias [laughs] in the assessment criteria?" And they're like, "Yeah, uh, we'll try and ask you questions in different way, or, you know, we, we can also, you know, get you to look at the masking scale, which is quite common for autistic women." And I was like, "Okay." And then we went through the assessment, and yeah, in the end they put my challenges down to trauma. And it was traumatic. The whole assessment was traumatic.'Cause it asked so much about the friendships and the relationships, and it asked if I was bullied, you know, things like that, and could I make friends? When did I have my first friend? [laughs] You know, and my mom would always say that I was very sociable as, like, a little girl, always had friends. I was very cheerful. Um, yeah, always very talkative, [laughs] which is everything against, you know, what we know about autism. So because of that, they, they thought that I didn't, you know, I, I wasn't... And also because my work that I said I'm obsessed about, they said, "But that's what you do. You would be." And I'm like, "Well, I have to be obsessed about it in order to do it," you know? And, and that was also discounted, but later we know that autistic women tend to have different interests, you know, to autistic men, and our interests tend to be more geared towards understanding human behaviors. And that's why so many of us are in the helper profession, very highly empathetic and, you know, really, uh, interested in helping p- people.

   20. APAlex Partridge13:03

       Do you think that empathy i- is what drives you today to raise awareness of AuDHD in women?

   21. SPSpeaker13:09

       Part of it, yeah. The empathy helps me. It, um, helps me do the work well. It is the sense of justice, of being underrepresented that drives me every day. And lately, because I have realized there's a difference in how people with different neurotypes, whether it's ADHD and AuDHD, respond to treatment and care, you know, that drives me to do this work because, um, I have my own health crash, um, I think two years ago, from being in a period of high stress, and everything collided. And yeah, I, I, I then went, you know, through a very long journey to kind of dig myself out of that hole, and a- actually then realized that because of my way of being, my neurotype that is different from what people conventionally know as, um, you know, ADHD and autism, I respond to medication differently. You know, hormone replacement therapies don't work the same way as people would imagine for me because I'm also hormonally sensitive. Um, because I have also been through s- um, some pretty traumatic times, pretty dark times, that changes how the nervous system reacts to treatment and also people. [laughs] Um, you know, so, um, everything else has to be tailored to this population in a different way.

   22. APAlex Partridge14:34

       That hole you mentioned two years ago, how deep did that hole get, and what did that look like?

   23. SPSpeaker14:38

       Very deep. It was, uh, very painful. You know, I listened to your interview with, um, Dr. William Dodson. He talked about RSD, and he talked about this woman who's one of his patient who apparently even two years after leaving a relationship was still experiencing RSD. You know, or what you then ask him as, is that cPTSD or PTSD? Does that look like that? And, and he said, "Yeah, it can look like that." And that hole lasted so long because, um... And, and that happens so more often than we, than we talk about. You know, what really led me to do this work is that during the toughest time of my life, I was speaking to a trainee therapist, and I was going through a divorce. I was then also dating [laughs] somebody who was doing a push-pull dynamic with me. Um, and then it was only recently I read an article in Psychology, um, Magazine. It talked about the intermittent re- reinforcement that these women with, uh, whose was... or these AuDHD women also went through, and I resonated with everything. 'Cause the RSD that I got, the PTSD that I got from the relationships wasn't strictly my fault. You know, it wasn't because I was abandoned or I felt like it was unsafe. It was more because someone had led me to think that they were going to be there and then very abruptly disappeared when I start to ask for something that I need. You know, it was that push-pull that lasted over two years, and I allowed that to continue because I would receive that person back, you know, each time they go away, and then after they've regulated, they come back to me. And I was like, "Okay, come in." And I never put a stop to it because I wanted connection. You know, I wanted this great love, you know? But it was a form of self-harming in some ways, you know, but it was also a situation where I could not really control. And in my period of going through that, I was quite dysregulated when I was speaking to my therapist 'cause it is hard. You know, you come to think about it, you're having a divorce. Your ex-husband, you know, blames you for everything and took no responsibility for what they appeared to be in all the years when you try to make the relationship work. And then, and then you have someone who's, who clearly needs you because you can help them, but then has made these promises that they cannot keep, and there's this dissonance about what's going on with me. And then I have two children who I need to be there to hold space for. And in that moment of my dysregulation, the trainee therapist said, "It sounds like you have borderline traits." There was just something in me just broke there, and I was just like, "Wow." And she was meant to be a friend. [laughs] You know, she was my neighbor.And she said that, and I had a feeling that maybe she was taking sides. You know? I said, "Of course, the woman who is dysregulated is the crazy one," you know? And the man who can appear to be okay and, you know, keep up the facade is, is the calm one. But why is the woman dysregulated, you know, in a relationship? Could it be that she doesn't feel safe? Instead of telling someone who is in a moment of deep crisis, you're telling them, "You have borderline traits," would you ask, "Are you being abused? Are you going through something that makes you think that your reality isn't real?" I was constantly being dismissed here and rejected, rejected there, but really it was cowardice on the other person's part that I took responsibility for, and no one could really understand where I was, and I was in deep victim mentality. You know? And I know how hard it is to be so misunderstood when no one is in your corner because no one thinks you need help, you know? And years later, someone was saying to me, "You know, it's because you are the strong one." I was like, "Is it true? Is this what the strong ones have to go through?" You know? But there was so much in there, 'cause when I was going through all that, I think maybe there is some truth that I appeared intense, but what is autism but intense, you know? We are on a spectrum of intensity, and women, autistic women are intense, you know, 'cause of the way our brains are wired quite differently to autistic man. And, um, yeah, then I... This is related, but it was something I watched recently, um, on a podcast, uh, with Dr. Anna Lembke, who wrote the book Dopamine Nation, and she's a psychiatrist. Uh, she said that, uh, people who, who are in the deep throes of addiction can appear with those borderline traits or narcissistic traits or personality disorders, and, mm, in some ways, I don't disagree. Because when you are in that intermittent reinforcement with somebody, that push-pull dynamic, you know, where someone comes, you know, your nervous system is, "Ah, I feel safe," oxytocin gets released, and then they pull away, you get a withdrawal. You know? And over time, when that keeps repeating, you develop a person addiction, not really by choice, but because of that pattern. And so the dysregulation that happens then when you go to the mental health services, the trauma and mental health services, if you do not have the means to advocate for yourself, you could very easily be sectioned. [laughs] You know? Like, I, I, I, I know, um, people who, uh, treat borderline patients in, at the NHS, and they said that these women often have a history of addiction, but that it's also quite severe 'cause they have multiple things that they are, um, addicted to, [laughs] whether it's, um, alcohol, you know, drugs. But often there is a relational connection, you know, some relationship didn't work out in their lives, and then, you know, in that, the difficulty, they end up there. You know, and, and I asked, "What is the actual thing that helped them?" You know? "Is, is, is it the DBT, the dialectical behavioral therapy that people prescribe to, you know, those with intense emotions?" And they said it's the, um, it's learning in that group setting and keeping each other, like, accountable, but apparently at first they hate each other [laughs] 'cause there's a sense of competition. Um, but I find that so meaningful because the field of, uh, psychology, you know, and mental health services now do not see borderline personality disorder as something that, you know, is, um, on a surface level. Like, they, they don't see it as something that we should stigmatize 'cause they're using a different term now, and it's called disorganized attachment, and they're saying, "Please don't stigmatize disorganized attachment like we did borderline." You know? And the number of AuDHD women I know who end up in mental health services and psychiatric units because they were thought to have EUPD or BPD is really upsetting. You know, a- and I feel personally upset at because someone did say that I, you know, have those traits, and I was like, "Wow, okay." You know? But I know myself, and I knew that there are times where even though I'm dysregulated, I can get back to baseline, and guess what helped me. It was a friend of mine who told me that, "Sam, you are going through so much in your life right now. Of course you're gonna be upset, you know, and in distress. You're not this, you know?" And, and for once, I'm, like, really grateful, you know, that I do not believe in the label.

   24. APAlex Partridge23:33

       Thank you so much for sharing that.

   25. SPSpeaker23:34

       Yes.

   26. APAlex Partridge23:34

       Um-

   27. SPSpeaker23:35

       That was a huge monologue. [laughs]

   28. APAlex Partridge23:36

       No. [laughs]

   29. SPSpeaker23:37

       It took me two years to come up with that. [laughs]

   30. APAlex Partridge23:40

       Are you okay?
4. 26:29 – 28:09

   Tiimo advert

   1. APAlex Partridge26:29

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   2. SPSpeaker27:58

      [laughs] Yeah.

   3. APAlex Partridge27:58

      Like, I feel like that is the explanation for, for the struggles and the challenges that I'm experiencing, and, and to get a diagnosis will cement that suspicion, but what if the psychologist says

5. 28:09 – 30:14

   Fearing your self diagnosis is wrong

   1. APAlex Partridge28:09

      I don't? Do you see that fear during the assessment process? Is that quite a common emotion?

   2. SPSpeaker28:16

      100%. 100%. I, I went through it myself. Like, I was invalidated. It wasn't even a fear anymore. It was fact.

   3. APAlex Partridge28:22

      Mm.

   4. SPSpeaker28:23

      And the fact that, like I say, the diagnostic criteria is very confusing to most of us because we actually do not understand it. There's a real dissonance. It feels as though you're going into a neurotypical system, even though it's meant for autistic assessment, but it feels like you're going into, you know, and, and being assessed in a way that actually you don't relate with. You know, so many fall below the threshold, the clinical threshold for diagnosis, and then what are they? You know, and, and my own question to them was, "If I don't get this label, then what am I? Am I just a terrible person?" 'Cause I went through loads of meltdowns during those difficult periods, you know, the two years where my therapist decided it was a good time to do trauma therapy, and I really appreciate her, but the modality during that time was so distressing for me 'cause I had those memories come back in real time whilst I was co-parenting my children, and I remember taking myself to the bathroom just to be a safe person for them so that I don't dysregulate and shout because some things that they were doing were triggering me. Um, yeah, I was having those meltdowns, and it was awful, and I know now that we really need to think about timing when we do this deep work, you know, 'cause no one's, not everyone's ready for that deep excavation. Some of us really, you know, really need that protective layer because if we're not ready for that work, it can unveil a whole lot of difficulties that you have very neatly concealed for decades.

   5. APAlex Partridge30:04

      So if the medical community is woefully behind in recognizing and understanding what AuDHD actually feels like and looks like

6. 30:14 – 35:48

   How to spot AuDHD in women

   1. APAlex Partridge30:14

      in women, with your experience, how would you describe it? What would you look for?

   2. SPSpeaker30:19

      So, um, I was recently at, uh, the Royal College of Psychiatry's conference, and I find that the awareness is divided. So I, I want to be fair to those who are advocating for better diagnosis and care because, uh, those are led by really passionate neurodivergent individuals who are also psychiatrists. And so we understand that there is a huge amount of co-occurring conditions inside the autistic ADHD community, and more so in, in women, you know, in nearly all the major organ systems. Um, that is a big one, physical health co-occurring conditions, especially la- later in life. I dug in, into the science, which I talked about, I think, to you, in that the autistic ADHD, the AuDHD neurotype is different to pure ADHD and pure autism. Um, but it overlaps with autistic social communication patterns. And I actually do not think that it's any autistic social communication patterns, it's autistic girls and women social communication patterns. Which is that we are driven to connect, we want to be around people, we talk, um, we also mask so much. We have difficulty really trying to understand what people want from us, you know, and it can come across as looking quite innocent, and having dissonance about how people feel, uh, what, what, what, what they tell you and what they really want. Because the thing is, it's not that we do not sense it, it's that we sense so much, and we're trying to make sense of what is it, you know, which is the truth here. And it's sometimes really hard to figure it out when the person you're trying to figure out isn't even clear about what they want. And so you're picking up all these cues, and you do not know what to do with it. That's the analysis paralysis. And somehow you feel it in your body and, you know, people get, um, anxious or, you know, avoidant in, in, in different situations. But that's, that's one part of it. But the ADHD side, if I were to say ADHD side, even though it looks different to pure ADHD, it's, it's more destabilizing. In that, um, I think the brain dynamic paper actually did a really good job at looking at how people usually follow a thought pattern, you know, how, how the brain dynamics tend to work. And so when you're in that stable autistic side, you know, when the brain networks are lit up in that way, then you have that want for sameness. You know, you want control, you could be quite rigid. But then when it then, you know, moves over to the instability, that can be even more unstable than in a pure ADHD individual, but it tends to follow the same pattern, and they do tend to emphasize the rumination that can happen inside an AuDHD individual. And it makes sense to me because, um, I've been, you know, called intense [laughs]

   3. APAlex Partridge33:32

      [laughs]

   4. SPSpeaker33:32

      ... in various situations. Um, also, I, I, I do worry about things. I worry about things, and the way I deal with my worry is I'm always looking ahead maybe a year or two years or 10 years [laughs] and figure out what I need. I have an anticipatory anxiety, you know, for everything in life, you know? And it goes back to the conversation we were having about how, why do I come across anxious?

   5. APAlex Partridge34:02

      Have you ever had a social interaction with someone who's communicated in such a way with you that, with your experience and intuition on being able to perhaps recognize AuDHD in other people, is there somebody that you've met who you've thought, "Right, that is super clear," like, that person has AuDHD, they just don't know it?

   6. SPSpeaker34:22

      Yeah. A lot of, um, women tend to come to us and ask, you know, if, um, they have AuDHD because they resonate with what I say about being, you know, you, you, you appear like a swan on the surface, but underneath you're paddling, like rigorously-

   7. APAlex Partridge34:41

      Mm-hmm. Yes

   8. SPSpeaker34:41

      ... you know, and then you dysregulate at home. That's the part people really relate to, because it's like you can function all day, you know, appearing almost neurotypical. Then when you get home, you have to go into a dark room. "No one talk to me." I've got like, you know, my salt lamp, and I've got my teddy [laughs] dressing gown-

   9. APAlex Partridge35:00

      [laughs]

   10. SPSpeaker35:00

       ... and all these fluffy things that I like to cuddle. Um, so there, there is that keeping up facade. I think that's probably the most telling thing about an autistic ADHD w- women. But for a man, [laughs] um, [laughs] in my experience, I've seen many AuDHD men aren't very resilient to stress, and I don't expect them to be, but they can be quite easily dysregulated when, yeah, in- intensity come into, comes into the picture.

   11. APAlex Partridge35:36

       What happens if you are somebody, like you said, you get home, you, you get very dysregulated, you want to decompress, you have your weighted blanket, you turn the lights down, whatever

7. 35:48 – 37:48

   When your partner doesn’t understand

   1. APAlex Partridge35:48

      your routine looks like for you, but you live with someone who doesn't get it? You live with someone who doesn't understand that you need to go through that process. Can that be quite turbulent?

   2. SPSpeaker35:57

      Yeah, because then you are masking, and you're walking on eggshells if you don't, like, have that. 'Cause if you need recovery, you know, and if that person doesn't allow that recovery, you can't live with that person. You know, like, the number of partners that I've come across who look good on paper, but actually, I just can't live with, then it's a no, you know? Like, your nervous system needs recovery from-The sensitivity to the world, you know? You, you, you take on so much, you know, you're sensitive, your brain's fast-moving, and it's changing. [laughs] And so when you get home, you need an anchor, and for me, it's lying horizontally [laughs]

   3. APAlex Partridge36:34

      [laughs]

   4. SPSpeaker36:34

      Maybe, you know?

   5. APAlex Partridge36:36

      Could somebody reach for unhealthy ways to d- d- dysregulate if they're not supported and they're not able to do it a healthy way? Could that lead to drinking or-

   6. SPSpeaker36:48

      Yeah

   7. APAlex Partridge36:48

      ... explosive arguments? How... What could that look like?

   8. SPSpeaker36:50

      Yeah. Um, so we don't reach out for those coping strategies to have fun or, you know, 'cause it's good for us. We reach for that to calm ourselves down, right? Um, for me, definitely when I go into a social situation, I, I used to need to drink, you know, to kind of be sociable. Otherwise, I'll be quite awkward or, you know, it's, it's, it's just hard. But I think what you do on a daily basis to cope very much depends on what you, people around you, and the culture really thinks that's normal. You know, and I talked about this, like, in, in this culture, it's very much drinking or, you know, various recreational drugs, or working is a really big one. Shopping for, [laughs]

   9. APAlex Partridge37:36

      [laughs]

   10. SPSpeaker37:36

       For many w- w- f- many women. But in my, the culture I grew up in, it's very much eating, you know, getting together with, with people, families, uh, drinking to a letter, to a lesser e- extent.

8. 37:48 – 40:02

   How to advocate for yourself

   1. APAlex Partridge37:48

      How do you advocate for yourself now? 'Cause I, I imagine you, you know, you are very busy. You go to events. You talk on stage. You go to social gatherings. How do you cope with those now that you have a better understanding of how your brain works?

   2. SPSpeaker38:03

      It's tough.

   3. APAlex Partridge38:04

      [laughs]

   4. SPSpeaker38:04

      I'm not gonna say that it's easy for me, 'cause I'm, I'm not a Gen Z, you know? [laughs]

   5. APAlex Partridge38:09

      [laughs]

   6. SPSpeaker38:10

      I didn't grow up talking about mental health or, you know, telling people my needs and creating boundaries. I grew up with no boundaries, you know, just people walking all over me and, you know, me doing things for people. So when I go to events now, I have minimum requirements to actually just get a picture of the room that I'll be speaking at. They, they, they send it to me, and I tell them that's... The things that I absolutely cannot live with, which is hot, you know, heating when it's too much, um, I literally cannot function. It's counterproductive [laughs] to-

   7. APAlex Partridge38:43

      [laughs]

   8. SPSpeaker38:43

      ... to actually me being there. I'll just be talking gibberish. And, uh, microphones, that's been a real problem, 'cause every time I turn up, you know, I never know the quality of the microphones. Sometimes it echoes, and that's it. You know, there, there goes the rest of presentation. But I, I tend to avoid really big conferences, and if I do have to go then, I'll just go for that slot and then come back. I really cannot deal with-

   9. APAlex Partridge39:07

      Mm

   10. SPSpeaker39:07

       ... large volume of people.

   11. APAlex Partridge39:09

       Are there some events that you go to where it does feel safer to retreat back to the safety of, of masking?

   12. SPSpeaker39:15

       I think because I, you know, often feel like I don't wanna mask a lot, I tend to be more of a lone wolf now. When I do go to events, I tend to, you know, try and stay by myself. Sometimes I run away from people. [laughs]

   13. APAlex Partridge39:30

       [laughs] Know where the exits are at all times.

   14. SPSpeaker39:31

       It's, it's only because... It's not the people so much. It was the whole vibe.

   15. APAlex Partridge39:36

       Mm.

   16. SPSpeaker39:36

       You know, it's like you're going there and you're absorbing everything, and it's so hard for someone who doesn't have a filter. And for me, what save me is my noise cancellation headphones, [laughs] you know, like you have music in your ears, and sometimes I'm singing out loud, but [laughs]

   17. APAlex Partridge39:53

       [laughs]

   18. SPSpeaker39:54

       No one can tell. But yeah, it's having-

   19. APAlex Partridge39:56

       Mm

   20. SPSpeaker39:56

       ... my own quiet space, and sometimes it's, it's carrying that with me, having my headphones and creating that microenvironment.

9. 40:02 – 40:52

   How Autism can mask ADHD

   1. APAlex Partridge40:02

      Do you think it's possible for autism to mask ADHD to such an extent that perhaps somebody might never ha- c- have that realization that they're AuDHD?

   2. SPSpeaker40:14

      Yeah, that's probably what you'll get from just looking at me. [laughs]

   3. APAlex Partridge40:18

      [laughs]

   4. SPSpeaker40:19

      My, uh, clinical psychologist who assessed me for autism didn't see anything, [laughs] you know? They were like, "You are fine, you know. A lot of the traits could be ADHD." And they overlap, you know, executive function, uh, sensory challenges, emotional dysregulation, all ADHD, you know? But the stuff that are autistic, you know, it's the... I do think the rumination, the worry, and the intensity is not ADHD [laughs] so much as it is, um, the, definitely the RSD. You know, it's definitely more

10. 40:52 – 47:16

    The AuDHD RSD experience

    1. SPSpeaker40:52

       painful.

    2. APAlex Partridge40:52

       What is RSD to you? And I know it's a, it's a, it's three letters that we speak about a lot on the podcast, and everyone seems to have their own individual journey with it. Um, you know, we know that it's, it's a horrendous emotional pain in, in, in response to a perceived criticism. But how does it show up in your life?

    3. SPSpeaker41:12

       So it's interesting, Alex. Like, I think every time I come and talk to you, I have a different version of it. [laughs]

    4. APAlex Partridge41:18

       [laughs]

    5. SPSpeaker41:19

       Because my very first, uh, interview with you was RSD.

    6. APAlex Partridge41:23

       Mm.

    7. SPSpeaker41:23

       You know? And at the time, I talk about the trauma that we experience, the difficulty that shape, you know, our lives that m- make it difficult when we encounter triggers, where, you know, we feel completely paralyzed by this emotion, this self-chastising that happens. And then over time, we know that there is neuroscience involved as well. You know, with AuDHD, there is that heightened, um, cue detection. I'm talking about, like, the salience network, you know, trying to pick up stimuli from your environment. But an AuDHDer who had been through trauma in their lives, that tre- d- that, that salience network then becomes threat detection more than cue detection. Then everything feels more sensitive, and you're looking and scanning for triggers. [laughs]

    8. APAlex Partridge42:24

       Mm.

    9. SPSpeaker42:24

       You know? It, it then becomes this thing, like-Am I safe to be in this [laughs] relationship, this work? You know, what is that person saying? Like, something that maybe the other person doesn't, you know, mean for it to be a trigger becomes triggering to you. But that's the thing about being an empath, an empath who has been through trauma, is that you pick up the things that they don't say more than, you know, what they are telling you. And we know people. We know people in our bones, [laughs] you know? But why won't they just say what they want, you know? That's, that's what... Our RSD can make us more hypervigilant.

    10. APAlex Partridge43:11

        If the autistic traits perhaps are causing challenges on one day, I guess you could put extra effort into masking them and hiding them, or vice versa. If the A- if the ADHD traits are causing challenges on a particular day, then you might lean more into the autistic side. But I suppose each one of those options comes with a s- a sense of abandoning who you really are, because who you really are is a, is a, is a blend of the two. So is there a degree of perhaps triggering yourself through not accepting the, the challenges that either one of them present is, is part of you, and you need to embrace them rather than mask them?

    11. SPSpeaker43:55

        Yeah, that's such a valid question. It's like, yeah, that is a reality for most of us. It's that contradicting parts are constantly trying to both be expressed, and y- you feel like if you're trying to suppress one side, it's like you're not really being true to yourself, too. So you're constantly trying to navigate, how do I satisfy, [laughs] you know, these two crazy sides? And you know, I, I, I really think that where we are at in our lives really determine how well we can integrate this, you know? It's, it's, it's really hard. How do you acknowledge what is right for you? So I guess maybe that's when you rise above these two contradicting sides and actually sh- start making decisions for you. What makes you feel at peace?

    12. APAlex Partridge44:52

        Mm.

    13. SPSpeaker44:52

        You know, that's how I guide my decision-making process now. How do I feel after saying yes to this? Really turbulent is like, "No, that's a bad idea." You know, that's usually how I guide myself. Um, yeah, it's a, it's a difficult one, because I also know that just based on having looked at my own biology and genes and, you know, biochemistry from my own health crash, that if I'm not authentic to myself, my body suffers. Like, I've been in periods where when I was going through divorce, when, you know, like, the relationship, relationships break down, my serotonin levels were on the floor. Like, that, what was going, was happening in my real life, it was showing on my body, on my biochemistry. My hormones were really dysregulated. Uh, stress was through the roof, and that didn't do me any favors, so.

    14. APAlex Partridge45:49

        RSD is clearly incredibly crippling, and we, we know that well on this podcast. What would you s- describe as the most crippling anecdote of, of RSD that you've heard from somebody?

    15. SPSpeaker46:00

        So I'll, I'll go back to when I first learned about RSD, which is, um, if you internalize it, you know, it can feel like major depressive disorder when you're so depressed and you feel alone and you're cut off. There's a sense of disconnection from the world, and there's this huge, like, inner critic that goes in a loop, and you chastise yourself. All this is really bad for your health. [laughs] And then if you externalize it, it can look like anger. You know, people can have dysphoria, um, maybe actually sensitive to dysphoria in, in that... Yeah, and also it can cause suicidal ideation, where people may think, like, "It's just better to not be here," you know? But that anger can be disruptive, you know, if it's coming in a burst from the RSD. And yeah, personally, I know or, or have, you know, encounter people who, when in the heat of RSD, they will also shift the blame to the other person, but actually it was that own internal self-chastising they're dealing with.

    16. APAlex Partridge47:07

        I recently interviewed Dr. Will-

    17. SPSpeaker47:09

        Mm-hmm

    18. APAlex Partridge47:09

        ... William Dodson, and one of the top comments was, we were talking about RSD for an hour and a half,

11. 47:16 – 48:24

    Difference between RSD and narcissistic rage

    1. APAlex Partridge47:16

       and one of the top comments was, "Well, how can you tell the difference between an RSD episode and narcissistic rage?" [laughs] Um, because apparently they look quite similar, the rage. Um-

    2. SPSpeaker47:26

       Yes

    3. APAlex Partridge47:26

       ... can they look quite similar?

    4. SPSpeaker47:28

       It can be, because people [laughs] who have narcissistic rage may have, you know, very intense RSD, and as I said to you, back to the point of, um, listening to that interview with Dr. Anna Lembke, where she mentioned that those who are deep in addiction or have been perhaps, you know, have had a history of trauma in their early life, whether it's abuse or, you know, things that happened to them, maybe it's neglect or, or they also have a history of, uh, substance use and, um, all sorts of different addiction, there's more of a tendency for that person to develop narcissism, you know, or, or narcissistic personality disorder. But I, I guess there's a difference, right, between narcissism and narcissistic personality disorder.

    5. APAlex Partridge48:15

       Just focusing back on AuDHD, Sam, it, it, it's such an interesting coexisting diagnosis.

12. 48:24 – 49:57

    How autism can parent ADHD

    1. APAlex Partridge48:24

       Is it possible for the, for the two to almost form, like, a, a, a parent and child relationship within the person's brain?

    2. SPSpeaker48:32

       Yes. Yeah. It's like, yeah, I, I definitely experience that. It's like when my life is too stable for too long, I'm like, kind of want something [laughs]

    3. APAlex Partridge48:41

       [laughs]

    4. SPSpeaker48:41

       ... you know, to make me feel a bit alive or, you know? Um, I do think that there is that trauma layer in there as well, in that if you've experienced, you know, difficulties and challenges in your life, then you're more likely to need more senses to, to feed that need to feel alive. You know, and, and I've been introduced to this term called emotional junkie, [laughs] which was-

    5. APAlex Partridge49:11

       [laughs]

    6. SPSpeaker49:11

       ... uh, expressed to me by my coach. I have a spiritual coach. [laughs] And he said, um, "You're not that bad." [laughs] But, you know-

    7. APAlex Partridge49:19

       [laughs]

    8. SPSpeaker49:19

       ... some people are, like, quite-

    9. APAlex Partridge49:21

       Mm

    10. SPSpeaker49:22

        ... bad [laughs] in actually being an emotional junkie, in that even though they know what is good for them and they know what to do, but because they want that intense drama and, you know, chaos to an extent because that is what they're used to and that is what they look for. And [laughs] I was just like, "Oh, no. That kind of does, does explain me a little bit." But, you know, he said I'm not too bad, too, too far down the line, so I can... I still have hope to come back.

    11. APAlex Partridge49:53

        [laughs]

    12. SPSpeaker49:53

        [laughs]

    13. APAlex Partridge49:54

        This has been absolutely fascinating, Sam. I think, uh,

13. 49:57 – 51:50

    AuDHD Hacks

    1. APAlex Partridge49:57

       we always try and get some hacks in these episodes. Do, do you have any ha- like, uh, life hacks, any, any emotional or practical tips somebody could implement if they are AuDHD that might help them with some of the, perhaps the challenges that come with, with a contradicting brain?

    2. SPSpeaker50:12

       So, right, because, um, the AuDHD brain can shift, you know, depending on what context and situation that you live in, the most important thing is to understand what is your environment like, what is the quality of your significant relationships, are you good at keeping, you know, creating boundaries to protect your needs. So much rests on those basic needs. Sleeping well and eating well and having energy, you know, leading a relatively low-stress life and having period for recovery, that is the most important one. You know, 'cause maybe we won't be always be able to choose what environments we go into, you know, unless we wanna live in a cave, [laughs] but we can't do that.

    3. APAlex Partridge50:56

       [laughs]

    4. SPSpeaker50:57

       But yeah, how can you create that recovery plan for yourself, you know, a space for you to come back to every time?

    5. APAlex Partridge51:04

       But we, we were speaking b- off camera before we started chatting today, and I think you echoed what was the first hack in a, a recent ADHD hacks episode I did, which was start with no.

    6. SPSpeaker51:16

       Mm-hmm.

    7. APAlex Partridge51:16

       If someone's asking something of your time-

    8. SPSpeaker51:18

       Yes

    9. APAlex Partridge51:18

       ... in your case, a conference or a speaking gig or, or a new cohort or whatever it might be, a podcast appearance, uh, i- it's so easy to say yes-

    10. SPSpeaker51:26

        Mm-hmm

    11. APAlex Partridge51:27

        ... instantly as a knee-jerk reaction. Um, and just rejigging that as a, as a, a no and protect that time. 'Cause I think it's so much easier to, to turn a no into a yes if you change your mind, rather than all of the, the, the panic of trying to change a, a yes into a no once you realize you've perhaps double-booked yourself, [laughs] or you just don't have the capacity to do it. Um, I wanna move on to the-

    12. SPSpeaker51:49

        Yeah

    13. APAlex Partridge51:49

        ... washing

14. 51:50 – 56:58

    Most requested audience questions

    1. APAlex Partridge51:50

       machine of woes.

    2. SPSpeaker51:51

       Okay.

    3. APAlex Partridge51:51

       Which is questions from the audience. These were the most requested questions-

    4. SPSpeaker51:55

       Okay

    5. APAlex Partridge51:55

       ... to ask you today, Sam.

    6. SPSpeaker51:57

       Yeah.

    7. APAlex Partridge51:57

       And it's a washing machine because the regular watchers and listeners will know that it represents memory loss for me.

    8. SPSpeaker52:02

       [laughs]

    9. APAlex Partridge52:02

       'Cause I always forget my clothes in the machine. Um, so it's a little reminder to everyone to empty the machine.

    10. SPSpeaker52:07

        [laughs]

    11. APAlex Partridge52:07

        Um, although I do use the Tiimo app now, which is the sponsor. It does help me to remember to empty the machine. Gosh, there's three questions.

    12. SPSpeaker52:13

        Oh, okay.

    13. APAlex Partridge52:13

        So these are the, these are the most requested questions from the audience on the topic of AuDHD. And in third place, somebody's asked, "I honestly think I'm AuDHD, and it's causing me huge anxiety as I don't know if I'm coming or going. Does AuDHD cause depression?"

    14. SPSpeaker52:33

        Yeah. I mean, it sounds like that person is, is an- anxious and depressed, [laughs] you know? You kind of like... Yeah, that makes up the entire population. We are misdiagnosed as being anxious or depressed, uh, before we come to AuDHD.

    15. APAlex Partridge52:47

        Mm.

    16. SPSpeaker52:47

        Yeah. You, um... Definitely if you're like that, like, I think, 'cause you're toggling between two different nervous system states, so that, th- this way of being is all about regulating, you know, your nervous system on the go. But yeah, obviously you can't regulate yourself out of a biochemistry trap, so look after your basics as well, as I say.

    17. APAlex Partridge53:07

        Sure. And is it... I mean, I hear a lot that people have been misdiagnosed with anxiety in the past. Is that, is that quite common?

    18. SPSpeaker53:15

        Oh, yeah, so common. Like, it, it, there's so many reasons that can make that worse.

    19. APAlex Partridge53:19

        Mm.

    20. SPSpeaker53:19

        You know, hormonal changes is one of them.

    21. APAlex Partridge53:23

        I think that actually leads into the next question, which is the perfect segue, so [laughs] thanks for accidentally doing that.

    22. SPSpeaker53:29

        All okay.

    23. APAlex Partridge53:29

        Um, how can AuDHD crop up during menopause, and is it going to be hell for me?

    24. SPSpeaker53:35

        Not necessarily. We have a mixture of, uh, an- anecdotes, but generally, during menopause when progesterone drops and estrogen is much lower, you will start to feel like the anxiety, you know, crop up first, and then the sleep goes, and then, you know, brain fog starts. Um, your whole body starts [laughs] to wonder what is going on. And then you get to feel, you know, 10 to 15 years before menopause actually happens is that period of a rollercoaster that a lot of people talk about. But, um, it really depends on each individual, um, experience. Not everyone's gonna have it bad. But yeah, definitely look into your hormones first before, you know, taking any medications.

    25. APAlex Partridge54:20

        Is it possible to almost mask so well and have all of your ducks in a row, and to go through life having not thought that you are AuDHD, but then y- something happens like menopause and there's such a big hormonal shift that that's actually what tips you over into the assessment process?

    26. SPSpeaker54:39

        Yeah, absolutely. I mean, most people have what I would call ideal conditions, where they have supportive relationships, you know, things are working out, they have great jobs. And then-The hormonal changes start to happen, the estrogens starts to, you know, oscillate, and then the progesterone starts to, you know, drop. That's when they lose the ability to filter their thoughts, and the bu- the ability to mask also diminishes.

    27. APAlex Partridge55:06

        Mm.

    28. SPSpeaker55:07

        And then all of a sudden, you are worried [laughs] about going out because you don't know if you're gonna say something to offense somebody. So yeah, um, we do see this period of time, even though it comes with instability, as a gift because it is a gift for you to be authentic and really start to advocate for your authentic needs-

    29. APAlex Partridge55:28

        Mm

    30. SPSpeaker55:29

        ... and become who you really are.

Episode duration: 56:59