No. 1 AuDHD Expert Reveals 5 Hidden Signs of AuDHD | Dr Khurram Sadiq

Alex Partridge 0:00 ADHD and autism. How would you describe the conflicting characteristics

Dr. Khurram Sadiq 0:04 Order and anarchy living together in a single person. So many different things that you're organized at, but yet you're so forgetful about the things of daily lives

Alex Partridge 0:12 Dr. Khurram Sadiq

Dr. Khurram Sadiq 0:13 A neurodevelopmental psychiatrist, the author of Explaining AuDHD He's the world's leading expert in AuDHD

Alex Partridge 0:19 Whose TED Talks have been viewed over one million times

Dr. Khurram Sadiq 0:22 In a way, society is telling us that females have to be shy, polite, have to speak in a certain way. It leads to a lot of anxiety, leads to a lot of depression, eating disorders, self-harming behaviors, 'cause they're unable to express themselves. If they express themselves, they will be different. They'll be called broken.

Alex Partridge 0:38 What do you think neurodivergent people are looking for from the world?

Dr. Khurram Sadiq 0:42 I think from the world, they need to be listened to. They are telling you something different. It does not mean that it's bad, because the world is petrified of anybody coming up with new idea

Alex Partridge 0:51 This episode is dedicated to anyone who leaves the house with 2% phone battery because they forgot to charge it. [upbeat music]

Alex Partridge 1:00 Whenever I interview s- people who have dedicated their life to better understanding the, the nuances of different neurodevelopmental conditions, I always question where their motivation comes from.

Dr. Khurram Sadiq 1:13 Yeah.

Alex Partridge 1:14 Is there a story there that might add color to our listeners in their understanding of where your drive comes from?

Dr. Khurram Sadiq 1:21 Yeah. There is... There are lots of stories, but again, one, one story that kind of sticks out out of the lot is that of my father. Again, I started to realize six months before his demise and before his, um, untimely death that he was a neurodivergent, a person who was misunderstood, a genius, could speak for hours about the things that he loved, yet he was so impulsive about making decisions, like agreeing to have the properties, paying people money for houses that he has not even signed for 80% of the time, and then we have to... There have been frauds, and we had to go after those people to get those things done. It, it, it was a series of those episodes, and people would say, "Oh, he has got personality disorder," uh, because he would not get on with, with a lot of people. He would switch a lot from being very precise, very detailed, to being very flippy. Um, you would be walking around kind of eggshells around him at times, but he had a wicked sense of humor. He had an amazing storytelling, um, conceptually, and it was then when I was grieving for my father, I realized, like, what an amazing brain he had, which we didn't realize, which I miss so- still so much, uh, talking to him on so many things that I could have done, only if I'd known it earlier, only I ha- I had those reflections. But unfortunately, we live in a world where we reflect after somebody's gone, and, and he was part of the grieving process, um, that I had. And after his death, we kind of came to realize how much he was holding together, being, being a senior citizen, having heart condition, diabetes, um, leg ulcers, and yet he would get up early in the morning, sit outside, talk to people. He was into plants. He had, uh, he would not even decorate his own house, our own house, with plants, but he would give the plants to neighbors, and he would take care of them. So the whole street was, was looking really flowery, and it was very green. Um, he knew everybody who would pass by, and then it, it, it made me think that I should do something about it. I'd seen people like him, and I had been doing autism, ADHD assessment. But again, when you're so much close to something, 'cause I've got AuDHD, I've got autism and ADHD, and it's slightly different from my father. Um, but it was, it was a realization that I'd seen people like him. I'd seen people like me, and I'm very similar to him in so many different ways, and I'm so much different in so many different ways to him. But I think it, whatever is happening, it is because of my father, that he gave me that thought process. And his death and his grieving process was, was of which I'm here.

Alex Partridge 4:22 It's a truly remarkable, moving story. Um, and y- you listen to it, and you can quite quickly get a sense of where your, your passion and motivation comes-

Dr. Khurram Sadiq 4:32 Yeah

Alex Partridge 4:32 ... to, to create this understanding.

Dr. Khurram Sadiq 4:34 Yes.

Alex Partridge 4:34 Your father sounds like a brilliant man. The, the link between ADHD and autism, the, the dual-- Having, living with both, we've, we've had guests on the show who have the dual diagnosis of, of AuDHD, and, um, one particular guest, Jay, Jay Beach, stands out, and he, he said it's like having two siblings inside your head that are constantly pulling in different directions. Um,

Alex Partridge 5:03 how would you describe the conflicting characteristics of ADHD and autism?

Dr. Khurram Sadiq 5:08 I would describe exactly the same way I did in my TEDx talk, that it's order and anarchy living together in a single person. So many different things that you're organized at, but yet you're so forgetful about the things of daily lives. Um, you lose things, you misplace things, but some of your organization, like your bookshelf, is immaculate, with very much order, and even somebody moves it, you will know that it has been moved. Um, you can be very attention to detail, but, but l- having lack of attention at the same time. Um, you can be very disorganized, and you can be very organized at the same time. You can be present, and you can be absent at the same time.

Alex Partridge 5:49 [laughs]

Dr. Khurram Sadiq 5:50 It's, it is unbelievable how it happens, but again, I believe that there's a natural equilibrium that holds it together. Uh, AuDHD as, as, uh- The colloquial term which is used by the neurodivergent community and which is becoming more popular now, like it's the intertwining is about 60 to 70%. We could not diagnose people with autism and ADHD together till 2013. Um, before that we could actually diagnose one condition or the other. Um, and I, uh, it has become a quote of mine that I see autism as a parent to ADHD, like it does not let it be too anarchic or too disorganized, whereas ADHD is like a friend to autism that does not let it become too recluse. So AuDHD presentations are completely different to pure ADHD or a pure au- autistic person, um, in so many different ways. And again, for, for me, seeing people, uh, talking to people because now I've, I've become ... It, it has become moments in my pro-clinical settings that moment they start talking about something, I know that there's something underlying. For example, if it is autistic, then I can see the ADHD, and if it is ADHD, then I can see the autism underlying. So based on that, for me, there are three kind of presentation. One, one where is, one where is autism prominent, and you try to find ADHD underneath or incidentally come across ADHD. And then there's ADHD prominent AuDHD, where ADHD symptoms are prominent and completely masking the autism features. And thirdly, vary- which is variable, where they don't know w- which one is shifting. It's kind of seesawing all the time. And because of these presentation, people have not come forward to ask for another assessment. I have seen so many different people who had delayed their assessments for years. There's one person, for decades, three decades, she did not do that because she thought, how can she be asking for ADHD assessment when she's organized in certain aspect of her life? And then she did not ask for an autism assessment, that how can she be disorganized and be autistic at the same time? This is a lot of confusion. And, uh, only now that we are learning more about autism and ADHD separately, now there's comes another intertwining, another light bulb moment where they're kind of intertwined and they're kind of living in, in, and it is difficult for a lot of people, including professionals, to see that because they're not trained. Eyes can't see what the mind does not know. You have to educate people in order for them to see that. This is how I see it.

Alex Partridge 8:37 It almost sounds like a, a mind full of contradictions pulling in different directions. But I guess by the sounds of that, sometimes they can be quite complementary contradictions. I've had guests on who have said that if they are trying to do something and they're just ADHD, pure ADHD, the thing that helps them is that they find the yin to their yang.

Dr. Khurram Sadiq 9:04 Yeah.

Alex Partridge 9:04 Somebody who has perhaps contrasting traits that, that, that picks up their shortfalls and-

Dr. Khurram Sadiq 9:09 Yeah

Alex Partridge 9:10 ... has strengths where-

Dr. Khurram Sadiq 9:11 Yeah

Alex Partridge 9:11 ... their weaknesses lie, so they work well together. I guess if you have AuDHD, can you sometimes be your own yin to your own yang?

Dr. Khurram Sadiq 9:20 Yeah. Oh, yeah, absolutely. Absolutely. I think, for example, I've seen so many people with ADHD who are super organized, and people come to me and said, "How can they be ADHD?" And there can be two explanations around it. One explanation is that ADHD is so ... they're so distraught by their ADHD that they develop mechanisms and there are scaffoldings. But that scaffolding, they take a long time to develop, to understand. Or they can have auto- underlying autism, which is a natural inclination towards order and organization. If that is the case, one is gonna be ego syntonic, which is kind of say with their own thought process. It comes natural to them, which happens in autism. And then other would be ego dystonic, which is against their nature, and it comes with a lot of struggle and stress and when they be- become organized. And the difference between two is something happens as a result of that, and the system shatters. Autism- autistic people will be distraught, but then they will get back into it very quickly, and they will develop that mechanisms again. Whereas for ADHD, it takes sometimes years to do, do that because they will, they will not have the strength to do that. So as you said, yin and yang, yes.

Alex Partridge 10:35 Mm.

Dr. Khurram Sadiq 10:36 They, they kind of complement each other in so many different ways. Um, and again, we hear a lot about overlapping. We hear ... When people like ... Well, one of the, uh, moment where I get really annoyed is when people say, "I'm not able to differentiate what autism and ADHD is." I said, "How can you not?" They said, "Yeah, but then they don't, they don't have attention span. They, they have inattention in both." I said, "No, if you divide attention span, attention can be divided into five of six different components," um, which I've addressed in the book. And indifference can come across as inattention as well. With autistic people, when they're indifferent, they don't want to do anything, they will not do it. You cannot say that it is inattention because they are, they're not interested. They're not doing it. They're not putting any effort into that. Whereas for ADHD, they will start to put an effort. They will start to, to, to, to manage it, but it, it is unmanageable to the extent that they will get distracted and sidetracked and move from one thing to another. There are so many different explanation about different features that they present, which comes across as overlapping, but that is not the case.

Alex Partridge 11:46 Mm. It's fascinating. I mean, the impulsivity of ADHD, you can start something quite easily-

Dr. Khurram Sadiq 11:54 Yes

Alex Partridge 11:56 ... probably before you even had a moment or any time to consider whether it's a good fit for you or not.

Dr. Khurram Sadiq 12:04 Yes

Alex Partridge 12:05 Often it won't be-

Dr. Khurram Sadiq 12:07 Yeah

Alex Partridge 12:07 ... because you're just jumping on loads of things, and the ones that aren't a good fit, I guess you'll quit. Whereas the autistic person might be more considered in, in those early stages.

Dr. Khurram Sadiq 12:18 Yeah. And they're more consistent. For example, they pick on something, and they will probably carry on for the rest of their life till they get bored, till they know that there isn't any much fun in that anymore.

Alex Partridge 12:28 Mm.

Dr. Khurram Sadiq 12:29 'Cause they extract a lot of fun out of it. A fun, a happiness. They feel happy. They feel excited about it. Right, so ADHD, it's a, a lot of dopamine hitting. They will see some- some- someone ... Like, I remember myself being a child and mo- watching a lot of Bollywood movies, and everybody, every time there was a lawyer or a police inspector or something like that, I would like to be that. And I would start working towards it, and I decided to learn more about it. It was a dopamine hitting. We lack stimulation, and we need stimulation by something. It can be f- it can be hobby, it can be food, it can be shopping, it can be gambling. It can be so many different things. Dopamine shots, you require it, and hence you do it. Once the novelty is gone and the dopamine is not getting released because your frontal brain tends to know that it was, it was because of that s- that, and it stops it from releasing. And hence you know that you're not really interested, and then you find something else to, to do that. Whereas with autism, it is completely different thing. Um, the obsessions that people say, which I do not agree with as, as, as a word, because it's a, it's a, there's a negative condemnation to that, connotation to that. But preoccupation or something they are, they are deeply enthusiastic about, they'll be the masters on that, in, in that they will have an expert. I remember somebody coming in, uh, when I was doing a clinic in Manchester 2011. It was an ADHD assessment, and, um, person probably did have an underlying autism and started looking at the board and said, "Is it Abraxas?" In the next half an hour he was telling me about Abraxas like an expert, and he had learned it a few weeks ago because he wanted to know about the poisoning side of it. This is how good they can become. They have the mastery that comes with it and excitement that comes with it. It's not for dopamine hitting, but it is for their own comfort, and it gives them harmony and tranquility, and they f- they find some grounding and solace doing those activities.

Alex Partridge 14:24 Mm. I know having spoken to people in the ADHD community, there's a lot of shame and low self-esteem when they go through their life undiagnosed and they don't know why.

Dr. Khurram Sadiq 14:41 Yeah.

Alex Partridge 14:41 They abandon lots of projects, relationships fail. And then they get a diagnosis later in life, and they look back, and lots make sense, but so much damage has been caused.

Alex Partridge 14:54 What are the consequences of having undiagnosed AuDHD, do you think? And how can that manifest into somebody when they're an adult?

Dr. Khurram Sadiq 15:04 I think it's ... With, with AuDHD, I think, a- again, we have to understand that with AuDHD, there are more coping mechanism and defense mechanisms than it is for pure autism and pure ADHD, because they bank on each other for a lot of things. And hence you see a lot of AuDHD who would not get into drugs and who would not get into, in, in, in, into, into trouble with the law, police, or criminal justice system. It is because their, their autism is on the side of caution, where it is not allowing them to, to have that risk-taking. So for, for undiagnosed AuDHD, it's a sigh of relief, and they try, and they understand it better, and once they know that there are both components there. I've seen a lot of people who mask, whose ADHD mask autism and autism a- mask their ADHD, that they still h- have unfulfilled answers because it explains one side of things, not the other side of things. Um, and just like a diagnosis of autism or diagnosis of ADHD, many a times they just burst into tears. They're very emotional about it. A lot of the times, like the, the oldest person, uh, I've seen was around 78 years of age, and, um, he came with his wife, and wife wanted answers for everything that has been happening all his life, and there were different diagnoses that did not explain him at all. He'd been on different medication, but once I started doing the assessment, started explaining things, it fits it well. And again, I saw them again after a few months' time, and he had developed some insight into that. He knew the answers, and he was at peace with those answers. So with AuDHD, it's, it's a very different experience as compared to ADHD, because ADHD, a lot of damage is done, not just because of ADHD, but because of impulsivity that happens as part of ADHD. They, they, they get into trouble. But answers always leads to reflection. The reflections leads to insight, and insight leads to change in behaviors in a lot of people, and that's exactly what we have, what we see in undiagnosed AuDHD who are diagnosed at a later

Dr. Khurram Sadiq 17:18 age.

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Alex Partridge 19:27 I, I was watching one of your brilliant TED talks. Um, you start off by referring to a naughty child crying outside of a classroom. So my question is, what is a naughty child in this context, and why might that child be misunderstood as one?

Dr. Khurram Sadiq 19:47 Because the whole scenario starts with a girl standing outside the classroom, um, crying inconsolably, and the perception is that she has been given some punishment because she has been naughty. That's why she had been standing outside the classroom. And the reality was that she didn't want to go into the classroom, so a lot of passersby would have this perception that that's a naughty girl. When I was writing that, I wanted to bring a lot of stereotypes in, in the, in, in a very short hook. A child, female, a girl, and then, uh, naughtiness is, is usually, uh, a stereotype around people with neurodivergence at a very young age. And you would not believe it that as I finished and came to the back and then to the front, uh, during the break of, um, a man in his late thirties came to me and shook my hand and said, "I cried for the first few minutes because what you described was my daughter. She's six." So that was my thing to kind of look at the stereotypes and kind of entice one mind that this is not the case, looking at a lot of stereotypes. I did not use deliberately a male. I did not depict that as to be somebody running around, moving around, or en-engulfed in their own world. I wanted to really address the stereotype, and the reason was because that girl was having a lot of sensory overload in the classroom because of the noises, because of the sounds, because of people coming near her, the smells, different people. And hence, that was my, my reason for showing that stereotype earlier in the TEDx.

Alex Partridge 21:34 Mm-hmm. It, it's, it's a topic close to my heart. I had a very anxious time at school. Um, looking back, I, I think the school could have done a lot more. Um, I speak to a lot of parents in the community now who have kids. Lots of them are unfortunately deciding to, to, to take their child out of the school system and home educate their children because they're so concerned, um, with the levels of anxiety in their, in their child because there's sometimes a lack of awareness, lack of funding. Um, from speaking to your

Alex Partridge 22:09 patients, do you think the current educational system is set up to accommodate neurodivergent conditions?

Dr. Khurram Sadiq 22:16 Okay. I think that the education system is crap. Imagine, like the analogy I give, for example, you go out and you, you buy-- you're, you're preparing a meal for yourself. You buy spaghetti, you, you, you buy, uh, pasta sauce, meatballs. So it's evident you're, you're, you're making spaghetti bolognese, right? How do you expect these ingredients to turn into a biryani? You cannot. Exactly this is what we're doing. We're using-- We are generalizing everybody's strength, every child's strength, and we're expecting the same results. I come from Pakistan. When I was growing up, even now, either you could be an engineer or a doctor. There was no third choice. Teacher was when you are unsuccessful in every field of life, you become a teacher. This is how bad it was. And still, n-now we have got IT and MBA, so you do-- you, you, you have those four or five things. Um, but it's, it's the expectation of what a child could be. I, I know that a relative of mine wanted, um, his child to be doctor. Child was an amazing writer, writing fifty thousand, sixty thousand words of fan fiction each time that he would, he would, he would learn something, and he was getting a lot of, uh, traction because of that. Um, even Amazon came to him and asked him to write something, and he was writing a book. I went to the person and said, "Look, it's-- that's not his strength. He cannot be a doctor, but he can be an amazing writer." He said, "But what will that give him?" I said, "That will give him a lot of satisfaction, and he will excel in his field that he enjoys." A lot of troubles. And then eventually, he got into creative writing and IR and journalism. Outshone everybody, literally. Um, the, the, the, the dean's writing to the father about the progress that he has made and amazing he's on top of the class, getting scholarships now. So that's the thing. We, we expect A system that is conducive for everybody, that is not. We don't understand it. We don't understand the neurodivergence. We want people to stand in straight lines and not move. If somebody is moving, then that's not right. I remember a patient saying to me, and that was one of the most important moments of my life, and I was telling her about things and she turned around and said, "Khurram, normal people do not like different." Gave me goosebumps straight away. That is the case. You, you're out of line, you're not following something, all of a sudden you're not compassionate, you're not, you're not, you're not paying attention, you're distracted. Um, as a matter of fact, I think there is a, uh, there's an amazing TED Talk done by Sir, uh, Sir Robinson. Um, he, he's, he's a scholar who moved to America. Um, he's deceased now. It- it's, it's called, um, How Schools Kill Creativity. I completely agree with that. Um, I think there's so much we can do with education. There's so much we learn from other cultures. For example, Japanese, till six years of age or seven years of age, they don't... In schools, they don't learn anything education-wise. They learn the life skills. They learn how to cut vegetable, they... how to clean their room, how to be tidy, how to, uh, um... So they're learning a lot of social skills. Social skills that here are taught through SEN teachers when they find somebody who's neurodivergent. So imagine if these skills are taught to people irrespective of whether they're neurotypical or neurodivergents. It's embracing their differences and teaching them something that is gonna be helpful. That covers a lot of things. It, it gives a lot of food to your brain to think about. Um, and for youngsters till the age of five, your brain is growing so much, and after that it starts to prune and in different directions, and if you miss those critical time periods, then you're... With the brain, the premise is you use it or you lose it, and hence we see a lot of problems, a lot of behavioral issues with children. So in short, as you said, our system, and again, whether it's, it's, it's, it's developing countries or developed countries, apart from a few Scandinavian countries and Japan, I don't think that they're conducive at all.

Alex Partridge 27:01 Mm.

Dr. Khurram Sadiq 27:01 They're not looking at the strengths. They're not looking at the strength-based system.

Alex Partridge 27:06 Is it, is it literally trying to hammer in a, a, a circular peg into a square hole?

Dr. Khurram Sadiq 27:12 Oh, absolutely.

Alex Partridge 27:12 And the more you hammer it in and the more it doesn't go in-

Dr. Khurram Sadiq 27:16 Yeah

Alex Partridge 27:16 ... the more that child is just gonna feel like it doesn't belong.

Dr. Khurram Sadiq 27:19 Absolutely.

Alex Partridge 27:19 And it's, and it's broken, and it's gonna reinforce that feeling of-

Dr. Khurram Sadiq 27:23 Yeah

Alex Partridge 27:23 ... of being different. It is incredibly personal to me because I've, I've shared this story before. I felt very different at school. I had my first anxiety attack in a classroom. Um, at break time I kept myself to myself. I disappeared, um, to the library. I wasn't really very sociable. I very much ostracised myself because I was quite fearful of-

Dr. Khurram Sadiq 27:44 Yeah

Alex Partridge 27:44 ... of, um, integrating with everyone else who I considered to be normal.

Alex Partridge 27:49 So I'm fascinated, what, what do you think is the effect of feeling ostracised can have on a, on a child-

Dr. Khurram Sadiq 27:56 Yeah

Alex Partridge 27:56 ... in the school system?

Dr. Khurram Sadiq 27:58 And exactly, and it's, it's not just the school system. It's, it's where the families don't understand the child as well and they push child to do better when actually they're understanding, not understanding what the underlying issues are. Um, like I can give you one example. Have you heard of Romanian orphans? Have you heard of those?

Alex Partridge 28:18 No. No.

Dr. Khurram Sadiq 28:20 So it's, uh, in, in Romania, um, there came a time when the government thought that if they increase the birth rate and the population increases, that kind of, it will be synergetic to now economic growth. And there was a fine of people who are not having more than a certain number of children. People, the birth rate increased, and they had children. The problem was that they were unable to sustain it. They could not afford the children. Hence, they started dropping the children or leaving the children outside hospitals, orphanages, and those children were everywhere. Till one American journalist, he found out about those Romanian orphans, and he found them in, in the worst state possible. So they were in, they were abused, physically abused, emotionally abused in every possible way. And finally, when, when he agreed the government to kind of intervene, they put them in, in nice houses with foster care available, but they noticed that they were very robotic, very mechanical in the way they used to do things, and emotion was devoid. Initially, they thought that they might be autistic or they might be, uh, they might have underlying condition, learning disability. What they noticed was that, um, when somebody said, "Let's do a scan," instead of the temporal lobes here and the frontal lobe here is black holes. Means that those parts of the brain had not developed at all 'cause they had, one, not given the right care, right amount of care, the right amo-amount of warmth. Um, they could do things. They were very m-motor in following orders and do things, but again, they were not able to feel the warmth empathy. And it was not that they were autistic, it was because the brain did not develop in that. So if you do not care about the child- If you exclude them, if you don't understand them, you ridicule them, it has consequences. Not just emotional, just not behavioral. It's, it is biological as well. It is-- it impacts on your brain development at a very young age. And I think it, it scares me to that thinking about it, how they must have gone through. And exactly what, what we do here is we don't do it to that extent, but, um, we do it to the extent that they are stressed. The cortisol levels goes up, the stress thr- threshold decreases, to able to, to manage things become very difficult for them. Um, the amygdala, which is the primitive side of the brain, which is responsible for, for developing stress, the hippocampus, which is part of it, which is about memories, that becomes very deficient. That grows, um, in a very asynchronous way. Um, the frontal lobe development is hampered. Plus, at the same time, as a result of all those changes that are happening at a very young age, they drop out, they don't learn a lot from school, um, they, they get involved in different kind of activities and, uh, they're very much dependent on other people. So this, this is the outcome of somebody when we exclude them like this without knowing what is going on with them.

Alex Partridge 31:56 Those, those children that were sadly neglected and they missed out on that fundamentally important part of that, uh, interaction with, with adults, and therefore they felt neglected, how does that transfer into behavior, uh, beha- behavior as an adult?

Dr. Khurram Sadiq 32:14 A lot of anxiety, a lot of depression, a lot of personality issues, a lot of behavioral issues, a lot of inability to manage the stress. Uh, their response to a stressful situation become very different. Um, they panic in a lot of situations. So-- and it leads to a lot of, um, manifestation of mental health issues, depression-

Alex Partridge 32:37 Mm

Dr. Khurram Sadiq 32:37 ... anxiety, personality disorder, bipolar disorder. It can lead to schizophrenia because stress is a killer at the end of the day. Stress leads to a lot of physical health and mental health issues.

Alex Partridge 32:48 If you are someone who's missed out on that fundamentally important part of your childhood, and you've lacked that intimate connection which has enabled you to learn how to communicate,

Alex Partridge 33:00 other people around them, is it possible to spot someone who is unable to communicate their wants and needs because they are struggling with the language?

Dr. Khurram Sadiq 33:10 Yeah, it can happen. Um, I'll start with giving example of a book. Um, the book written by a Japanese child when he was 11 years of age, The Reason I Jump. And, uh, till a journalist from an English-speaking country, I don't know whether it's America or whether it was Sta- uh, England, they, they identified that, and they published it into different languages, and it was amazingly written. This was 11 years old, non-verbal, um, boy who had-- who was later diagnosed with autism, and he was autistic. And he wrote why he does different things, why he stims, why he doesn't make eye contact, why he behaves in a certain manner in different situations. And it was... If, if you read that book, it's a revelation in, in its own, how an 11-year boy can do that and write those things. Very much attention to detail.

Alex Partridge 34:14 Mm.

Dr. Khurram Sadiq 34:16 If you look at communication, how much your voice makes 7% of, of the communication bit. I think the rest of 30% is more about the tone and how you articulate that language. The rest of it, almost 60%, is the non-verbal communication. So just because a person is not speaking, it does not mean that you cannot pick up those things. You have to be observant, you have to look at the patterns. You look at the body language, the facial expressions, and you connect it with different situations. Then you look at the behaviors, observing them, what kind of behaviors, whether it's stimming, whether it is, it is restless leg or bouncy leg, or, um, whether they-- th- there's a repetition of behavior, repetition of how they eat, how they, um, watch things, read things, um, wear things, connection with people. So if you bring all of it in to- together, like when we-- Uh, the, the good thing about psychiatric training is the first thing that they teach us is what is called mental state examination. It's not what you are listening, it's what you are observing. So you're making notes, but the rest of mental state examination is your observation, how it is connected to that person. And, uh, whi- which gives us a lever as to kind of connect those words with the behaviors. Or if there are no words, you can see, you can say a lot of things just looking at a person, just observing the person. People who have got autism, they're not very good at picking cues, social cues. So what they do, a lot of them, they, they go into that overthink mode. They lea- learn to l- they learn about it by, by using different kind of mediums, videos, books. And then they start spotting people. They go to areas where they can see things so that if they're in a situation, they're able to pick up things. A lot of the times, they can overthink about things, situation. But just by observing people, they can-- you can, you can read a lot of pattern. Being my autistic mind- Um, I have predicted things before it actually happened-

Alex Partridge 36:42 Mm

Dr. Khurram Sadiq 36:42 ... in my own life. And they turned out to be true just because I picked on something which nobody else was able to pick. It's just changing from how you eat from your right hand to left hand or something on those lines. Or you're seeing a person all of a sudden, because I'm clumsy, I drop something, and I, I hurt the person, or I saw the person respond in a very different way, and then it happened again because I've got dyspraxia as well. And it happened again, and then that changed my interrogation, my, my approach, uh, towards asking questions. So there's a lot of thing that you can do without hearing the words. It's about l- seeing the person, observing the person, how meticulous you are in observing those different scenarios in different scenarios.

Alex Partridge 37:34 Mm.

Dr. Khurram Sadiq 37:34 It gives you a lot of information.

Alex Partridge 37:36 I've heard that 7% statistic before, um, that only 7% of communication-

Dr. Khurram Sadiq 37:42 Yeah

Alex Partridge 37:42 ... is verbal, the actual words that come out of our mouth.

Dr. Khurram Sadiq 37:44 Yes.

Alex Partridge 37:45 And I'm convinced that people with neurodivergent conditions are better at spotting that 93%, the other stuff.

Dr. Khurram Sadiq 37:54 Oh, yes.

Alex Partridge 37:55 The stuff that isn't spoken. It's, it's... You alluded to, it's, it's the little, it's the little extras, the, the, the slight changes in tone of voice.

Dr. Khurram Sadiq 38:03 Yeah.

Alex Partridge 38:04 The, the, the mannerisms, the micro facial expressions that a lot of people miss, I think.

Dr. Khurram Sadiq 38:10 Yes.

Alex Partridge 38:10 If someone walks into a room and their, their footsteps are heavier than, than they were five minutes ago-

Dr. Khurram Sadiq 38:16 Oh, yes

Alex Partridge 38:16 ... you can sense that they're in a bad mood and something's annoyed them.

Dr. Khurram Sadiq 38:19 Oh, yes.

Alex Partridge 38:20 Um, or that they hate you for some reason. [laughs]

Dr. Khurram Sadiq 38:23 [laughs]

Alex Partridge 38:23 The awareness piece is the keystone of all of this. Everything that this show is about, having that awareness is, is fundamentally the foundation that everything else is built on. Like, there are so many how to hack your ADHD, how to manage it, all of these things. Sure, they help, but really the foundation is the awareness. It can go so much to alleviate a lot of the shame, anxiety that come with not understanding why you behave in certain ways. That awareness piece can, can be life-saving. It can be relationship saving. You, it can stop you from, from getting into that relationship that probably isn't good for you or starting that job that isn't a fit with your-

Dr. Khurram Sadiq 39:09 Mm

Alex Partridge 39:09 ... intrinsic motivations. Um, [lips smack] a general question, but from your

Alex Partridge 39:16 perspective, is there a beauty in difference or being different?

Dr. Khurram Sadiq 39:22 Beautiful. Difference is beautiful. Um, I was, um, as I said, we, our team is quite neurodivergent, so, um, o- one of the staff members brought some cutlery. And when, when you expect cutlery, be- because we are missing some, uh, we expect it to be silver or gold, mostly silver, sometimes gold. I looked at it, I was like, "It's beautiful." It was from one of the stores, and it was black. It was the first time I've seen a black cutlery, black spoon, black fork, black knife. Like, oh my God, it is so good. It is different from what we normally see, plus it is so appealing and it stands out. The difference, how difference is different in different mindsets, different in how you're brought up in a different culture, learning different things. Imagine bringing it all together. It gives different perspectives. It gives a different angle to a problem that you're looking at. It gives a different thought process to it. It gives a different shape. You all come together, you learn from each other so much about culture, about where you come from, about the food that you have. Even coming from different cities, like from London and Manchester, there's so much differences in between, or Newcastle and, and London, or Edinburgh and Manchester. So learning about those things is so much important, and that's brings out embracing it. Like again, we are human race. We, we have got different ways of living, and we come from different part of the world. We vibe differently, but once we bring the vibe together, it creates something very amazing, and that's how I see it.

Alex Partridge 41:08 Mm. Yeah.

Dr. Khurram Sadiq 41:09 And that's the same about neuro- neurodivergence. You have people who are neurotypicals, and then you have got people who are autistic, who are q- quirky. You have people with ADHD, amazing creativity, energy. You have got people with dyspraxia, dyslexia. They have their own strengths they bring to the table. You combine it together, you'll be able to sort out problems.

Alex Partridge 41:28 Mm.

Dr. Khurram Sadiq 41:28 A lot of solution, I believe that incorporating neurodivergent into workforce will solve a lot of problem because neurodivergent brain is about problem-solving. There's a problem, it has, there has to be a solution. And I started in my current job, um, because the whole focus is about waiting lists, and you must have heard about it, that the waiting lists are long. Like s- in some places, it's decades. And I was, I had a plan that I came out with, and I've been writing it for a very long time, and it is difficult to convince people when it's not been, um, done because people will think that you're mad coming up with this idea, even tackling a problem that has already been there. And the first thing I heard was, "Well, we have to look at it. It's a national issue." I said, "It might be a national issue, but for us it's a local issue, and we can solve it." We got together, and we have decreased the waiting list. And this is how neurodivergent brain, brain works. Like l- 80% of neurodivergent team, 20% of neurotypicals, and we have done things that nobody had imagined that they could do in a two years' time. And this is difference When you work with two different sets of people, learning from each other, always motivated, motivating each other, supporting each other, and knowing about each other, that makes a hell of a difference

Alex Partridge 42:49 The c- the connection to problem-solving has always fascinated me. It, it's, it's... A- ADHD people seem to be brilliant at, at problem-solving, and I'm convinced it's because we've, we've had to solve problems to, to survive and, and to sort of get over the, the wave of criticisms and, and feeling different. So we've had to carve out our own-

Dr. Khurram Sadiq 43:11 Mm-hmm

Alex Partridge 43:11 ... unique solutions to, to the challenges that we've faced in our life. Um, I'm 100% with you on the, in the workplace as well. I think a diverse pool of talent is always gonna be a, a bonus to any company. Different brains thinking differently, th- thinking at things in a different way with different solutions is always gonna be a bonus.

Dr. Khurram Sadiq 43:32 Absolutely.

Alex Partridge 43:34 I wanna talk about the word spectrum.

Dr. Khurram Sadiq 43:36 Yeah.

Alex Partridge 43:36 Um, it's a word that I hear a lot.

Alex Partridge 43:39 What is a spectrum, and why are neurodivergents measured on a spectrum?

Dr. Khurram Sadiq 43:45 Okay. Now, before I go into spectrum, I, I picked on something about survival, when you mentioned survival. Uh, ADHD and autism are neurodevelopmental conditions. This, these conditions have existed as m- as, as long as the human race has existed. There's an evolutionary aspect to it. There, there's a theory which is called, um, hypothesis, which is called gene environmental mismatch. That's what it's called. Which it is said that the genes environment has changed very quickly, um, from, from hunter society to agrarian society to industrialist, and then we went into a kind of a, um, um, world where there's social media, and now we're entering a world of artificial intelligence. There's change at a massive pace, the environment, whereas the genes have not been able to catch up to be able to mutate that effectively. But those skills that we're talking about, those works that we're talking about, that used to be survival toolkit for us. We are not able to get distracted. If you're not able to smell things, uh, the way we did at that time, or to be able to hear things am- in an amplified way. If you were not able to make a decision, um, a split-second decision in, in crisis situation, you would not have survived that terrain. Uh, of course, coexisting or cohabiting with wild animals, our race would have obliterated, and this is a new field of psychiatry called evolutionary psychiatry. They are, they're looking into that. So just because these features have become redundant, because we have become more stagnant in, um, in our lifestyles, does not mean that they cannot be applied anywhere else. And that's why I say ADHD is not about taking medication. It is about finding the right thing where you can accommodate yourself, and you don't have to take medication at times.

Alex Partridge 45:42 Mm.

Dr. Khurram Sadiq 45:43 In order to do that. And same is the case with autism as well. Put an AD- ADHD person into an admin job, disaster. Is a recipe for disaster. You can put them into a situation where it's in, it's enthralling, it's riveting for them, they will excel in those situation. And hence, a lot of ADHDers, they do well in complex situation and in difficult jobs, whereas if you put them into mundane, normal kind of a job, which is easygoing, consequences for them will be disastrous.

Alex Partridge 46:14 Mm. The evolutionary piece is fascinating. Do you think RSD, rejection sensitive dysphoria-

Dr. Khurram Sadiq 46:22 Mm-hmm

Alex Partridge 46:22 ... is a part of that equation? Is there a scenario where a s- heightened sensitivity to criticism could be an advantage in the wild?

Dr. Khurram Sadiq 46:34 I think, I'm not sure about the wild, but definitely the RSD is, has been an amazing... Imagine an ADHD who's seen all those failures and all, all that ridicule and, and always been told that they're not good enough, always been compared to others. Um, and they come across and always making mistakes and not doing anything right. This is years of sens- s- years of ridicule that they have borne. And out of that, what emerges is that they become very sensitive to it. A, they won't do it. If they do it, if something goes wrong, the impact of that rejection stays for longer period of time because they are anticipating it. And hence, it becomes ingrained as part of them. So for me, that's the rejection sensitivity that has built up over a period of time. RSD is not the same in, in every ADHD or everybody who's, who's got autism spectrum condition. It's very much different. And it is because how they've been brought up, which environment they were in, and it changes from person to person.

Alex Partridge 47:36 A lot of people I speak to, they, they report getting obsessed with things, a, a new job, um, or a new hobby, or even a person.

Dr. Khurram Sadiq 47:47 Mm-hmm.

Alex Partridge 47:47 You can hyper focus on, on a particular thing. And with that, they report the, the, a lot of shame comes with that because they, they know that the, the obsession doesn't always last.

Dr. Khurram Sadiq 48:01 Mm.

Alex Partridge 48:01 And they can take steps and action things to make that thing or person-

Dr. Khurram Sadiq 48:06 Mm

Alex Partridge 48:06 ... a part of their life, and then they move on, and that person falls out of their now.

Dr. Khurram Sadiq 48:11 Mm-hmm.

Alex Partridge 48:11 It ceases to exist, and, and they mo- and the ADHDer moves on with their life.

Dr. Khurram Sadiq 48:16 Mm-hmm.

Alex Partridge 48:16 And, but because of that, there is some shame.

Dr. Khurram Sadiq 48:18 Yeah.

Alex Partridge 48:19 Do you think being obsessed with something sh- should be a shameful trait?

Dr. Khurram Sadiq 48:24 Again, when, when you say about obsession, A, I do not agree with that word. Um, it's, it's, it's a very negative word. Um, it can be preoccupation, or it can be something they're passionate about. Um, it happens both in autism and ADHD. In ADHD, it lasts for shorter period of time And they do not go to the extent of that what happens in autism. In autism, they go to lengths at learning about something because they enjoy doing it and they like it. And it's not usually picked up by them, it is the society who picks, picks them out and say, "You're obsessed about this thing." Uh, it can be football stats, it can be Manchester City or Liverpool. It, it can be, um, something about science, it can be something about figurines, Legos, uh, fast cars, things like that. You name it, and they, they will, they will be master at it. When I was growing up, one of my favorite hobbies end of the school, because my father used to come late in picking me up, is I would count the motorcycles and their brands. Like, there- at that time in Pakistan, there was Yamaha, Honda, Suzuki, um, and Kawasaki. So they were the four brands, and I would feel so much pleasure in counting those. At the end of the day, I said, "I've seen those many, those many, those many." And then my mind would go into rabbit hole as to why is it the case? Is it the better quality? Is it better ride? So many different things that comes with it. I used to write the stats of cricketers. Like, I was-- my stats were better than a lot of cricketing magazines because I would follow each and every country playing cricket, and I would write it in my notebook, and I would, I would be kind of preoccupied with it, listening to radio, updating my stats, l- uh, reading newspapers, sports section about it, just to update. And I used to f- feel pleasure in doing that. I was happy doing that. So A, it, it's not obsession, it's, it's, it's a preoccupation. It's a passion that they follow, especially in, in autism. Um, it brings them to mastery. What you have to realize is people like, um, um, Albert Einstein and Newton and Thomas Edison, despite of all the failures that they had in early life, like Thomas E-Edison, he talks about the bulb, but we don't talk about the other failures that he had reaching up to the bulb. If he had let it go, if he had given it up, if it was not attention to detail, we would not have light. We would not have bulbs. We would not have, um, things to illuminate us, um, in, in the dark. So it leads to mastery. It leads to upskilling yourself. Again, it leads to a lot of happiness, a lot of grounding for those who are autistic. But the shame, it comes from the society who are seeing them like that.

Alex Partridge 51:30 Hmm.

Dr. Khurram Sadiq 51:31 They, they will never say that, "I have this hobby, I'm, I'm ashamed of that." They're not. They're very proud of it, and they will talk about it every time they have an opportunity to do so. We are hurling that, that kind of obsession onto them, that you're obsessive about it. Why do you keep on spending a lot of time on this? What are you gonna get out of it?

Alex Partridge 51:51 The preoccupation thing is fascinating. I, I, again, I told this story before. When I was younger, I was preoccupied with, it's quite funny, the stock market. I was fascinated. I won't use the word obsessed [laughs] .

Dr. Khurram Sadiq 52:03 [laughs]

Alex Partridge 52:03 I was preoccupied with the, with the stock market, and I got called weird by my classmates because of it. But when I was preoccupied, and I was busy hyper-focusing on the stock market updates, I was very happy-

Dr. Khurram Sadiq 52:20 Yeah

Alex Partridge 52:20 ... and very at peace. That was where I went to, to, to find pleasure, to soothe the-

Dr. Khurram Sadiq 52:25 Yeah

Alex Partridge 52:25 ... anxiety that was there if I integrated with the other kids.

Dr. Khurram Sadiq 52:28 Oh, yes.

Alex Partridge 52:28 So it's very relatable.

Alex Partridge 52:31 The people you treat, is there a common thread of insecurity? And what do you think the root of that is?

Dr. Khurram Sadiq 52:38 I think, again, it, it, it comes back to things that we've already discussed. If, if, if you are, um, been picked on, if you are not understood, if you are ridiculed, if you-- there's expectation and you don't follow the expectation. There's so many different factors to it. If you are asked to read maths, and you're not good at maths, but you're good at science, but that does not matter because you're still not good at maths, and every time you get your maths results and ev- and you're ridiculed about it, you-- the parents are not happy, teachers are not happy. They always write that, yeah, the, they have not reached the potential. Again, a problem with the education system, a problem with us understanding them, a problem with us not encouraging them to do something different to what they'd like to pursue. They will develop insecurities about it. They will, they will develop that. Um, and the insecurities, uh, leads to, um, low self-esteem. The thing about failure, the, um, with their-- they're scared of failure, and hence they won't attempt a thing. A lot of the time, they will know so many things, and when you ask them, "Why you have not done it?" They said, "What if I fail?" So we have that incorporated what if into them, because everything has a consequence. If they fail, there will be more things that will be thrown at them, and that will get them more down. So insecurity stems from all those. Plus, people develop anxiety, people develop depression as a result of that, and they become more recluse as a result of that. They don't meet people. They don't meet their potential as a result of that. So everything, when you talk about it, it's so much interconnected. It's not just one line that you have to follow. It is everything that has happened-

Alex Partridge 54:22 Hmm

Dr. Khurram Sadiq 54:22 ... um, in a, in a, in a, in a very holistic way, in a 360 degrees way, that leads to that situation.

Alex Partridge 54:30 Hmm. Has there been a change in the stigma towards neurodivergence since you, you've practiced as a, as a psychiatrist?

Dr. Khurram Sadiq 54:38 Yeah, I think a lot. Um, and I remember when, when I had my first ... encounter with the person who's at then diagnosed with Asperger's, and my, my consultant asked me to go and speak to him. And he said, "Oh, the person is autistic." And my mindset was, "Oh, so is he disabled?" And then all of a sudden he was doing something and just, uh, moved his concentration towards me and moved his head and said, "You need to learn about autism. Go and read it first, and then see the patient." And I was fascinated because that person was astrophysicist and blew my mind away in so many different ways, and probably that was the first time I related to somebody like that. I was tearful during the interview so much, listening to the stories, and I was fascinated, and there has been no, um, going back from there. When I was training, the only, the only place you could do autism assessment was Sheffield around that area. And we were, we were in Lincolnshire, and again, every specialist referral was sent to Sheffield, whereas now we have developed different hubs. We, although not formally training, but people who are neurodivergents are kind of gravitated towards neurodevelopmental conditions, and they're learning it themselves, that there's more traction in autism and ADHD to the level of normalization. Like again, it's going to the other end now, where people are thinking that it, it is, it is a normality, and people are thinking that, "Oh, it's a, it's a social media, uh, trend that we are developing." It's called TikTok diagnosis now. So which is again, is going from one extreme where nobody knew about everything to an extreme where it is known so much that people are speculating it to a certain social media trend, which is not the case.

Alex Partridge 56:37 Hmm. Yeah, it's very true. I think I've spoken before, I think ADHD in particular, but other neurodivergent conditions, if anything, because of the social media content, they-- there's a risk that they can be going through a period of overexposure-

Dr. Khurram Sadiq 56:54 Yeah

Alex Partridge 56:54 ... to the point where actually it's having the opposite effect of what the original, orig- original cause was-

Dr. Khurram Sadiq 57:00 Yeah

Alex Partridge 57:00 ... which is, um, over-awareness, um, and therefore a lot of ignorance. And it does wind me up when someone says, because I hear it a lot, "Everyone has ADHD these days."

Dr. Khurram Sadiq 57:14 Yeah. Yeah.

Alex Partridge 57:14 And it's, it's the-- obviously, they don't.

Dr. Khurram Sadiq 57:16 No.

Alex Partridge 57:16 It's, it's when a neurotypical experiences these symptoms, these traits of ADHD, like forgetting your car keys or zoning out of conversations, because everyone does that from time to time.

Dr. Khurram Sadiq 57:27 Yeah. Oh, yes.

Alex Partridge 57:27 It's, it's the sort of, um, it's the wave. It's a small wave. It's the up and down, whereas when an ADHD person does it, it's, it's the, it's the summit of Everest-

Dr. Khurram Sadiq 57:35 Oh, yes

Alex Partridge 57:35 ... and then it's the lowest point on Earth.

Dr. Khurram Sadiq 57:37 Oh, yes.

Alex Partridge 57:37 It's that continuousness and the extremeness of these swings which can cause the, the comorbidities. Um, you know, unfortunately, people with ADHD are four times more likely to take a, an attempt on their life at some stage.

Dr. Khurram Sadiq 57:52 Yeah.

Alex Partridge 57:53 Um, is everyone four times more likely to take an attempt on their own life?

Dr. Khurram Sadiq 57:57 Exactly, and again, uh, how I explain to people is when I was growing up, uh, our learning was through books and newspapers. Um, my father made me r-read Reader's Digest at a very young age, News- Newsweek, Economist. I started studying Economist when I was twelve or thirteen years of age. Uh, then came a time where internet prevailed, and, and then there was social media, and then there were reels, and then we're looking at, um, artificial intelligence. So every generation, now in-- well, now the beta generation has started this year. So alpha generation has stopped, so 2010 to 2024. Every generation has their own way of learning. This is their way, way of learning. This is the way of learning of Gen Ys, Gen Zs, alpha generation, and now the, the beta generation. You cannot say something is right or wrong till you have s- till you have gone deeper into, into it and known, for example, um, two different newspapers, um, Guardian or Sun, where you get the information from, the right information from. You have to go, and you have to study, and you'll know where you'll find the right information from. Same way, there's so many different reels. Um, it, it imparts a lot of information, a very good information. Then there are other information which is not very pertinent and not, not very, uh, evidence-based to ADHD. It's up to us to decipher what is the ri-right information and what is not, what we have to shut down and what we have to kind of go into and, um, do deeper research about it.

Alex Partridge 59:34 Mm.

Dr. Khurram Sadiq 59:35 So the onus of responsibility is not them. They will-- Our attention span is a commodity. They will try to explore it as much as possible to monetize it. But it's up to us to see what we are, what we're going through and to make up our mind and with doing more research rather than superficially looking into that.

Alex Partridge 59:53 Mm. Regarding the, the stigma towards these neurodivergent conditions, what, what would you like to see happen?

Dr. Khurram Sadiq 1:00:01 I'd like to see embracing it, not just accepting it, embracing it, that it exists, and this is how it is, and we, we are gonna work together towards it. Um, I also feel that there's onus of responsibility on both the groups, neurotypical as well as neurodivergent. As much as neurotypicals has to know about neurodivergence, the neurodivergent should, should be knowing about the majority that is neurotypical as well. It works both ways. You cannot be calling from a position of entitlement that, because we're in minority, but we are special, so you have to learn about me. I don't have to learn about you. That should not be the case. And that's how the integration will take place, where we will learn about the neurotypicals and neurotypicals will learn about us and it will all come together, creating a mosaic, creating an environment which is so vibrant, which is so amazing, which has so many different perspectives that they bring to the table. And once, once this, once people start seeing that, I think things will change.

Alex Partridge 1:01:10 Mm.

Dr. Khurram Sadiq 1:01:10 But as I said earlier, the most important bit is psycho-education, educating the communities, educating everybody around us as to what these neurodevelopmental conditions are.

Alex Partridge 1:01:21 Mm. Yeah. No, it's, it's spot on. Have to start with awareness and build from there. I wanna talk about the defined differences in an ADHD diagnosis between males and females. But first, I wanna draw attention back to the table-

Dr. Khurram Sadiq 1:01:37 Okay

Alex Partridge 1:01:37 ... and understand

Alex Partridge 1:01:39 why Dobby- [laughs]

Dr. Khurram Sadiq 1:01:41 [laughs]

Alex Partridge 1:01:42 ... from Harry Potter is your ADHD item. Please explain.

Dr. Khurram Sadiq 1:01:46 All right. So I'm fascinated with the Harry Potter world. I think it's, it's, it's a very good depiction of neurotypicals and neurodivergent, um, M- Muggles and wizards.

Alex Partridge 1:01:58 Mm. [laughs]

Dr. Khurram Sadiq 1:01:58 And then in wizards, there are good wizards and there are bad wizards. Uh, so wh- which, which, which is the case everywhere. So people from, from different parts of life, they come together to Hogwarts. Um, they're different. They have different strengths. They have been picked up because of those strengths. Some strengths are good, some are not, some are in developing stages, some, some are really superior, and they all combine together, make a community which is so vibrant, which is so different, which thinks so differently from the rest. For me, that's a neurodivergent world. Harry Potter world is a neurodivergent world. And Dobby is a depiction of what an undiagnosed or ADHD is like. It's ... It does not understand its strengths. It does things in a different way. Um, throughout, throughout all, all, all the, all the movies that he has been in, uh, uh, trying to prevent Harry Potter to going to Hogwarts because his life was in danger by endangering his life actually. Uh, that happens in the second episode. And he has these powers. Uh, and Harry because of his humility and because, because of his, um, amazing character he ki- and being intelligent, he c- he, he makes him come out of a very toxic environment where he understand his own powers. And he's so down to earth and he doesn't realize the strength he has. In the end, he saves Harry Potter from dying before he dies himself on the beach.

Alex Partridge 1:03:39 Mm.

Dr. Khurram Sadiq 1:03:41 So for me, a person who is so skillful, so amazing, so full of surprises, but because of how people seeing, see that person, ridicule them, low self-esteem, so low self-confidence, low self-belief, that's the best description-

Alex Partridge 1:04:00 Mm

Dr. Khurram Sadiq 1:04:00 ... of neurodiversity to me.

Alex Partridge 1:04:03 Yeah. No, that's-

Dr. Khurram Sadiq 1:04:04 In this world.

Alex Partridge 1:04:05 Mm. That's-

Dr. Khurram Sadiq 1:04:06 We exist.

Alex Partridge 1:04:07 Is there a parallel between Dobby getting his freedom and getting the sock to, to somebody who is trapped behind uncertainty getting their diagnosis?

Dr. Khurram Sadiq 1:04:21 It's, it's the moment where, and I have seen it not in neurodivergent services. I used to work in crisis teams, a lot of crisis situation we used to deal with, and 30% of people who are undiagnosed autism and ADHD, they would come with, "Oh, the person has got depression, person has got anxiety, person..." And once you started talking to them, you realize that they are neurodivergent. And once you tell them, that's a light bulb moment for them, like it's a sock given to them and say, "I'm free. I can-

Alex Partridge 1:04:50 Mm

Dr. Khurram Sadiq 1:04:50 ... understand myself better." And then leads to a pathway which, which leads to their own self-discovery and their own reflection, then their insight, and they strengthen, not necessarily getting a diagnosis because the, the waiting lists are that long, but again, giving a string of hope to them that they hang on to till they are diagnosed and they learn more about it. And going through that journey of diagnosis, for me, that moment is that sock when somebody tells them that, "I don't think you are depressed, but there might be something. You might be autistic. You might be having problems with ADHD. You have a lot of features of ADHD." That's the sock for me.

Alex Partridge 1:05:30 Mm. It's fascin- It's a powerful, powerful explanation. Um, I'm gonna watch Harry Potter soon, and I will, uh, yeah, have a different, different lens as, as how I'm looking at Dobby through. So

Alex Partridge 1:05:44 thank you. Khurram, I wanna do the ADHD agony aunt section. Um, every week-

Dr. Khurram Sadiq 1:05:51 Yeah

Alex Partridge 1:05:51 ... it's called the Washing Machine of Woes because my ADHD item is a washing machine because I always forget my clothes in the machine.

Dr. Khurram Sadiq 1:06:00 Yep.

Alex Partridge 1:06:01 Do you forget your clothes in the machine?

Dr. Khurram Sadiq 1:06:04 I-

Alex Partridge 1:06:04 [laughs]

Dr. Khurram Sadiq 1:06:06 My AirPods have, have taken showers in, in the washing machine at least six or seven times.

Alex Partridge 1:06:12 [laughs]

Dr. Khurram Sadiq 1:06:14 And I, I leave a lot of stuff in the fridge.

Alex Partridge 1:06:16 Okay. So that's the, that's the ADHD tax too because I imagine-

Dr. Khurram Sadiq 1:06:20 Yeah

Alex Partridge 1:06:20 ... that would have broken them.

Dr. Khurram Sadiq 1:06:21 No.

Alex Partridge 1:06:22 They survived the washing machine?

Dr. Khurram Sadiq 1:06:23 They survived the washing machine like-

Alex Partridge 1:06:24 Oh, wow

Dr. Khurram Sadiq 1:06:25 ... this is-

Alex Partridge 1:06:25 What a good, um-

Dr. Khurram Sadiq 1:06:27 There might be neurodivergent. Never know.

Alex Partridge 1:06:28 Brand shout-out. Yeah. [laughs] Um, yeah, I, I always forget my, you know ... The, um, the smell of wet clothes is quite a common feature in my flat.

Dr. Khurram Sadiq 1:06:37 Yeah.

Alex Partridge 1:06:37 But, um, I have been using the Tiimo app, and I have been getting a lot better at remembering. Um, but I ask my ADHD Chatter Instagram community for their woes every week, and I put one in the machine, and I read it to see if there's any wisdom from the guest.

Dr. Khurram Sadiq 1:06:54 Yep

Alex Partridge 1:06:55 This week, someone has asked, "I'm a teacher and a pupil who is eight years old keeps leaving class due to panic attacks and they're falling behind. Is there an explanation for this response within her? And how can we harness her creativity as a school?"

Dr. Khurram Sadiq 1:07:17 I think if somebody is having a panic attack because they are in a classroom, I see it as sensory overload. I think, um, the first thing they need to understand is to ask the pupil as to why they're leaving the classroom. What is it and why are they having a panic attack? What is causing that panic attack? Because in my practice, what I've seen is usually in these scenarios, it's a sensory overload. Because distraction in ADHD is completely different to sensory overload in autism. Distraction is curiosity. Distraction is moving from one thing to another and being fascinated with it. Whereas sensory overload in a person, it's, it's as if there's a physical thing piercing your ears if there's noise there. That there's a physicality to that. If the smell is too much, then it can make them gag and make them-- If people are getting closer to them and they're not used to, it gives them a very strange and scratchy feeling. So that needs to be explored further as to why the person is leaving, why the person is having panic attacks, looking into how busy the classroom is, how can they accommodate, for example, giving, um, uh, the loop earphones or, uh, making them sit a bit distant to the other, um, uh, to the other children, either in the front or in the back, wherever they feel confident, or, um, asking them about how they would like to do that. Because most of the time what we do not ask is, when it's children, we assume things. We should be asking, having proper conversation with them as to what they would like and what that would help them or at arou-around those lines.

Alex Partridge 1:09:01 Hmm. No, it's fascinating, and it's, it's truly particularly interesting for me. I had, uh, my first panic attack in a classroom, um, when I was six, and I've told this story a lot, but it's essentially I was very happy at the back of the classroom, minding my own business. The teacher put me on the spot. All of the other kids turned around and looked at me, um, and in that moment, I had a panic attack and I left the classroom. I've always put that down to pressure, but I've never looked at it through the lens of overstimulation.

Dr. Khurram Sadiq 1:09:34 Yeah.

Alex Partridge 1:09:35 Can attention be a form of stimulation?

Dr. Khurram Sadiq 1:09:40 It can be, yes. All of a sudden, all eyes on you and you're expected, and again, you're expected to give the right answers because you have this belief that if you do something wrong, then you will be ridiculed for that later on as well, and people will make fun of you. In order to do that, um, you have to be perfect and looking for perfection, looking for the perfect answer or perfect response. Or if you have inattention and all of a sudden you have not listened to what have been said and you have been asked that question and you're clueless about it, that's, that's a, that's a very similar scenario where you will not want to, to be in that scenario because you're going-- people will ridicule f-you for that.

Alex Partridge 1:10:22 Hmm.

Dr. Khurram Sadiq 1:10:22 And if you already experienced it from your own experience.

Alex Partridge 1:10:25 Hmm. That's fascinating. Oh yeah, I'm alwa-I'm always looking for explanations, um, and that makes a lot of sense.

Alex Partridge 1:10:31 As I mentioned, do you have any defined differences between the diagnosis of ADHD between male and female?

Dr. Khurram Sadiq 1:10:38 Yeah. I think it, it's, it's, it's quite obvious. Um, when you're, when you're looking at a male presentation, you're looking at a l- a lot of combined presentation, which is a mixture of hyperactive, impulsive, and inattentive features. People who say that hyperactive, impulsive type is depictive of male, uh, it's one of the rarest kind. Like it's literally two to three percent of population because even with children who are diagnosed with, uh, boys who are diagnosed with hyperactive, impulsive type, there's a very good chance that as they grow older, the hyperactivity, impulsivity decreases, and the diagnosis also al-already dissipates. Sometimes combined ADHD type then becomes inattentive ADHD type in boys. So now the combined type is depictive of male, and then the female is more towards the inattentive side of it.

Alex Partridge 1:11:37 Hmm.

Dr. Khurram Sadiq 1:11:37 So again, it's a very complete- completely different description of a person, more away from the stereotype that we see. When we see a stereotype, we see a male, we see a boy, we see somebody who's jumping around, doing a lot of commotion. Um, when boys do it, it is not very obvious because boys are boys. It's like a boyish trait. Whereas if females do, do it, it becomes very obvious if peop- if female who have got combined ADHD, they become very prominent. But inattentive type, in a way, society is telling us that females have to be shy, females have to be polite, and people have-- females have to speak in a certain way. They cannot be rude. They cannot be disruptive. And this is something that is dictated by the society, by the norms that we have created for ourselves. So in order to conform with nor-those norms, there are-- these female do a lot of mirroring. Um, they do a lot of masking in order for them not to be counted out. And this is exactly what happens. Whereas with boys, because th-th-there's a belief that boys have to be like this, they are active, they are-- they can do things and they can get away with things, even when they're disruptive, um- A lot of it is like, yeah, they are, they're males, they're boys. And in females, because they, it's so much pressure on them, it leads to a lot of anxiety, leads to a lot of depression, leads to a lot of controlling the thing leading to eating disorder diagnosis, um, their own maladaptive coping mechanisms that can take them through the early years, but they, it becomes very obvious later on in their life. Uh, self-harming behaviors, because they're unable to express themselves. If they express themselves, they will be, um, called, uh, different, they'll be called broken, they'll be called weird, uh, an outlier. So of all those pressures, the sos- the societal expectations and the way they present themself, hence they differ. Anxiety and depression is more prevalent as a comorbidity in, um, women who have got ADHD. In males, it is the case, but not as prevalent as that in females.

Alex Partridge 1:14:16 Hmm. Gosh, I mean, you tell a heartbreaking story of the, the, the, the, the female journey through, through the, through the process.

Dr. Khurram Sadiq 1:14:24 Yeah.

Alex Partridge 1:14:24 We, we speak a lot on this podcast and in the community about getting a diagnosis later in life and looking back-

Dr. Khurram Sadiq 1:14:32 Yeah

Alex Partridge 1:14:32 ... through the, this new awareness, this new lens of ADHD and, and suddenly so much makes sense. What could have been different if I had known? Um, but on the other side of the page,

Alex Partridge 1:14:46 do you think someone can be too young to receive a-

Dr. Khurram Sadiq 1:14:50 Mm-hmm

Alex Partridge 1:14:50 ... ADHD diagnosis?

Dr. Khurram Sadiq 1:14:53 I think I'm, I'm-- I, I bring a lot of science when it comes to these things, um, scientific evidence. Brain develops massively. Brain multiply, the neuron, neuron multiply massively till five years of age. Like, from, from million neurons, it becomes three or four, five billions of neurons over a period of five years. Um, they can be, for example, autism on the books can be diagnosed as early as eighteen months of age, whereas ADHD can be diagnosed around four to five years of age. You cannot medicate a child till they're six years of age unless there are exceptions around it. I, I believe that at least they should be four to five years of age, whether it is autism, whether it is ADHD, because the brain is developing and there can be possi- there's a possibility that once the brain reaches its search, ce- certain, uh, summit of replication, and after it starts pruning, those behaviors might go away.

Alex Partridge 1:15:55 Mm.

Dr. Khurram Sadiq 1:15:56 So you have to be mindful of that. You mi- have to be mindful of the brain developing, the developmental stages, the milestones, and be diagnosed-

Alex Partridge 1:16:04 Mm

Dr. Khurram Sadiq 1:16:04 ... at the right time. I, I've not come across anybody who I have medicated when they are less than five years of age.

Alex Partridge 1:16:11 Mm.

Dr. Khurram Sadiq 1:16:11 I wait for the right time to do that. So although the books say something, but you have to use your sensibility, you have to use your common sense, the environment around you, where the child is coming from, and the severity of the features that you see-

Alex Partridge 1:16:26 Mm

Dr. Khurram Sadiq 1:16:26 ... in that child.

Alex Partridge 1:16:28 Are there some common misdiagnoses of ADHD and autism that could cause it to go missed for a little bit longer?

Dr. Khurram Sadiq 1:16:35 Oh, absolutely. Absolutely. Um, most common one is emotionally unstable personality disorder. Um, that is now complex trauma, um, in ICD-11. They've changed the kind of, uh, the title, the nomenclature to it, because emotionally unstable personality disorder, it's always, it feels like you're blaming somebody for the dysregulation of their emotions. So UPD was something that was very common to be diagnosed. Cyclothymia is another diagnosis, I believe it to be quite redundant because cyclothymia is like bipolar. They say it's like a younger sibling of bipolar, but they do not-- They have the features, but they do not meet the criteria for bipolar, but treated the same way. So for me, it does not, uh, I cannot gauge that in my mind. My autistic mind does not believe in that container. I believe that a lot of people with cyclothymia have got ADHD or severity of ADHD that has led to that. Bipolar affective disorder is something that people can associate with. Social anxiety disorder is something, or s- a pure stress, a stress of the situation or adjustment, um, going from one scenario to another are the most common features that you see as misdiagnosed, mismanaged-

Alex Partridge 1:17:54 Mm

Dr. Khurram Sadiq 1:17:54 ... um, with, with ADHD.

Alex Partridge 1:17:57 Mm.

Alex Partridge 1:17:59 From your experience, what do you think, this is a general question, but what do you think neurodivergent people are looking for from the world, from their relationships, from their work?

Dr. Khurram Sadiq 1:18:12 I think from the world, they want, they need, they need to be listened to. They need not to be shut up every time that they open their mouth. Just because they're telling you something different, it does not mean that it's, it's bad, because the world is petrified of anybody coming up with new idea.

Alex Partridge 1:18:29 Mm.

Dr. Khurram Sadiq 1:18:29 They initially call it mad, bad, and then they embrace it, because eventually that starts to work. From their relationship, they want to be understood. They want to be understood as why they do things in a certain way, in a certain order. Um, why they have to get up, why they have to move around, why they have to stim, why they do not make eye contact with people. Why is it that they're not social with people? That needs to be understood. And overall, it needs to be embraced. For example, in workplaces, uh, people should identify those, not for the reason of getting productivity, because at the moment, what is happening is, and I believe this is manipulation, that bigger firms are hiring neurodivergents because they work effectively. They're not there to help them because it will help their productivity. Their mental health, their wellbeing is not the, uh, the center stone of all of this, and I think that needs to change. They're different kind of people. You have to understand them. For example, if somebody keeps on missing things or misspelling things despite of being told, or sending you emails without getting the attachments in, I think you need to, to, to be aware of that as to what is, what is happening with the person, whether there's something going on at, uh, uh, uh, in their personal lives. Are they distraught because of something? Or this is something which might be pointing out towards ADHD or dyslexia or something on those lines. So making themselves aware will help them identify these differences, and by identifying these differences, they will be able to help those people rather than pointing fingers. One of the most common question a person with ADHD, autism ask me is to, "Shall I disclose it to my employer?" Um, I said, "It's, it's really up to you, because I cannot tell you." There are employers who are very supportive of it, help you, but then other organizations, they can scapegoat you. They can blame you for things that has happened, and you'll be an easy, easy target for them. So it is for you to ascertain how your employers are and then decide whether it's gon- you're gonna disclose it to them or not.

Alex Partridge 1:20:47 Hmm. I think falling back on that strong ADHD intuition in s- in cases like that is so important, to really trust your gut-

Dr. Khurram Sadiq 1:20:56 Yes

Alex Partridge 1:20:56 ... and to look at it as on a case-by-case basis.

Dr. Khurram Sadiq 1:20:58 Absolutely.

Alex Partridge 1:21:00 Because I'd love to be able to say, "Yes, disclose-"

Dr. Khurram Sadiq 1:21:02 Yes

Alex Partridge 1:21:03 ... "and ask for accommodations, and everything will be wonderful," but the reality is so much stigma-

Dr. Khurram Sadiq 1:21:10 Oh, absolutely

Alex Partridge 1:21:10 ... bullying, discrimination-

Dr. Khurram Sadiq 1:21:11 Absolutely. There's still-

Alex Partridge 1:21:12 ... still is, is, is there.

Dr. Khurram Sadiq 1:21:13 There is. Like, I openly say that I've autism, ADHD, but it has taken me years to do that. I'm in a position where I can do that, and I'm doing things that people appreciate of. But again, there were times when I used to do things and not appreciated. And if I told them that this is the case, and they would say, "Oh, that's the reason you're like this." So we have to be very, very careful. We live in a very different world.

Alex Partridge 1:21:35 Mm.

Dr. Khurram Sadiq 1:21:36 We live in a very ignorant world, do not know about those things, and for them, it's, it's, it's effectual information, and I always believe that it's not about knowing things. It's about understanding it and putting yourself in those perspectives as to how you're gonna be doing if you had that condition.

Alex Partridge 1:21:54 A topic that comes up time and time again on this podcast is addiction.

Alex Partridge 1:21:59 What is the link between ADHD, autism, and addiction?

Dr. Khurram Sadiq 1:22:04 There is a link, definitely. Like, if you, if you, if you look at the evidence base, 30% of people, um, with addiction, they do have underlying ADHD. Autism is far away from addiction, I think, because they are in the air of caution, so they don't get indulgent things 'cause autism is about the fear of not knowing the unknown. They need to know all the possibilities before they jump into a situation. Drugs is something that they don't know what's gonna happen. Are they gonna feel, they gonna feel good? Are they gonna feel bad? Are they gonna be, um, um, experiencing a psychotic episode? Are they gonna have an epiphany? Something on those lines. So autism stays away from it. Addiction definitely has a strong link with ADHD. I've seen a lot of people who self-medicate because of that, because their mind is going so fast. Well, one of the things when I was learning ADHD, my mentor, Dr. Peter Mason, he's based in Liverpool, one of the most amazing guys we have ever met, um, completely neurodivergent, um, an amazing teacher. And he said that one of the litmus tests of doing an ADHD assessment, if somebody says that they're using s- stimulant medication, they have misused it, ask them what stimulant medication is. If it is cocaine or amphetamines, and said, ask them, "How does it make you feel?" A lot of the time, they will say, "Well, it has no effect on me," or, "I feel that I'm very clear. I able to do things, whereas everybody's climbing on the walls. I'm able to kind of bring my thought process together and do a lot of things that have been incomplete at that time." So using cocaine is kind of litmus test to knowing [laughs] a person has got ADHD or not. But this is, no, a- and I have used that, that, uh, that litmus test. In 70% of the cases, that stands true. So a lot of people who use it, not use it because they're addicted to it. They use it because it slows the mind down. It gives them clarity. It, it, it makes them-- the things go away. Your mind going at 100 miles an hour, you're not able to sleep. A lot of people use alcohol because it puts-- it helps them to sleep. Initial insomnia is a problem in ADHD because your thought process is going so much, and you think about so much that you're unable to sleep. Your brain is still stimulated enough. Um, then there are, uh, behavioral addictions, like social media, gaming. Both the groups, autism and ADHD, they tends to gravitate towards it for different reasons. In autism, it is because they like to socialize, but they cannot socialize. The burden of socialization is too much. They get tired. They don't know what to do. They don't-- they're not into small talk. They have rather deeper conversation than superficial conversation. Hence, the creative world, a reality, parallel reality for them, where they're socializing with people online. They're creating communities online. They are the leaders in those community online, but those-- their, their reality is completely different to the reality of an, of a non-autistic person. They're happy being there And they gravitate towards gaming and they gravitate towards social media because this is a way of, of bringing kind of normality to the situation.

Alex Partridge 1:25:22 Mm.

Dr. Khurram Sadiq 1:25:23 Whereas ADHD gravitate towards gaming and social media because it's dopamine hitting. Platform keeps on changing. They get the dopamine hits. They need the simulation, and hence they stick to it because gaming gives them concentration. That's the thing that most of the time the gamers will tell you, that they, they have not able to concentrate on anything, but when it comes to gaming it helps because changing platform, it means that dopamine is there all the time. It's hitting and they go up. They're getting the dopamine hits and so able to concentrate, complete the stage, go on to the next one, have a challenge. And anything challenge is, is good for ADHD.

Alex Partridge 1:25:59 Mm.

Dr. Khurram Sadiq 1:26:00 So definitely there's a link there.

Alex Partridge 1:26:03 The gaming piece is fascinating 'cause during COVID I, like many people, s-started playing my Xbox, and I, I, I, I really got preoccupied with my Xbox to the point where it was becoming quite problematic. I would wake up first thing in the morning, I turned it on and I played it for hours, and I did this for, for months and months and months. And I played because it gave me, I can look back now, dopamine. Um, I was, uh, addicted to the rush. Um, I played it because it, it, it gave me a massive buzz. Whereas I have a friend who, who plays computer games every day still. Um, and having spoken to him, I think he plays computer games for a very different reason. For him, it, it, it, it doesn't give him a buzz, or it doesn't give him any excitement, it just gives him a calm, a peace. And it's, it's, he gets very anxious when he's not allowed to play the computer games or if, if, if it's withdrawn from him. So it's interesting you say that. It's almost you can see the different motivations-

Dr. Khurram Sadiq 1:27:01 Interesting

Alex Partridge 1:27:01 ... and the different rationale towards-

Dr. Khurram Sadiq 1:27:02 Yes

Alex Partridge 1:27:02 ... why you're drawn towards that computer game.

Dr. Khurram Sadiq 1:27:04 Oh, yes.

Alex Partridge 1:27:06 I hyper focus a lot, um, on this podcast. When I have a new hobby, uh, uh, something will come into my mind and I have to know the answer, so I go on Google and I, and I go down this rabbit hole. Um, but what I find is if, if it's interrupted [laughs]

Dr. Khurram Sadiq 1:27:27 Mm-hmm

Alex Partridge 1:27:27 ... for whatever reason-

Dr. Khurram Sadiq 1:27:28 Yes

Alex Partridge 1:27:28 ... if I'm pulled out of it-

Dr. Khurram Sadiq 1:27:30 Yes

Alex Partridge 1:27:30 ... forcibly, if someone wants to talk to me, um, I can get very angry.

Alex Partridge 1:27:37 What's happening in the mind of a- an ADHD person when a hyper focus is interrupted?

Dr. Khurram Sadiq 1:27:44 Now, the hyper focus is, is, is like sustained attention. An ADHD person, in ADHD it happens for so many different reasons. For example, they're lagging behind a deadline, they have to do a deadline. Procrastinate, leading to crisis, leading to hyper focus. This is exactly what the pattern is. When, when your dopamine and norepinephrine is supposed to be released, it's not released. It reached a crisis situation which release every possible hormone in your body, um, along with adrenaline, noradrenaline, dopamine, [coughs] and it helps you do that. Now, when you're in that zone, you came to very zone in a very difficult situation. It's a last resort. You have to finish something. If somebody kind of distracts you, you know that your attention, once broken, it is very difficult to pick up the thread again, and there's a very good chance that you might not be able to complete that thing. Hence, that frustration, irritability comes in. And it is different from the attention span, the sustained attention span in, in autism, because a lot of the time hyper focus is, is related to both autism and ADHD. Whereas hyper focus is, yes, it is ADHD related. It, it is driven by the, the release of norepinephrine and dopamine. There's a lot of incentivization about it. If you don't do it, there are consequences. You might fail your exams. You have to retake the exams. There's a deadline. If you finish, you're not gonna get the promotion. You are having a probation and you don't do it, then it will be extended promotion or you'll be fired from the job.

Alex Partridge 1:29:20 Mm.

Dr. Khurram Sadiq 1:29:21 [coughs] So many different things. Or something that interests you, but again, if the, um, something that interests you doesn't last for a very long time, unless you require stimulation. Whereas in autism, it's not hyper focus, it's sustained attention. Because they don't do it as incentivization. They do it because they're happy. They're at peace. They enjoy doing it, and hence they continue to do it. They can break themselves off it and then go back to it. They can take gaps in it.

Alex Partridge 1:29:48 Mm.

Dr. Khurram Sadiq 1:29:48 So that's the difference between hyper focus and sustained attention in autism and ADHD. And a lot of people, they confuse hyper focus. Hyper focus does not happen in autism unless it is AuDHD. And for autism, I use the word sustained attention or preoccupation with something-

Alex Partridge 1:30:10 Mm

Dr. Khurram Sadiq 1:30:10 ... or having passionate going at something, uh, that, that keeps them entangled in that situation for hours on end. But it is not because of stress. There's no incentive around it. They're simply enjoying it-

Alex Partridge 1:30:23 Mm

Dr. Khurram Sadiq 1:30:23 ... and they're loving

Dr. Khurram Sadiq 1:30:24 it.

Alex Partridge 1:30:24 And do you have any methods on how to stop your own addiction or to try to stop someone else's?

Dr. Khurram Sadiq 1:30:31 Addiction is a, a very broad category. Like it can be alcohol, it can be substances, it can be behavioral addiction. So f-first of all, you have to understand where the addiction is coming from. Um, alcohol, they're using it just because they like the taste of it. Some, some people do, um, and, and they continue. Or it, it, they like the effect of it as to what happens, or they're using it as self-medication. A lot of the drugs is, are the same. Um, is it peer pressure around it? Um, is it in, in certain situation they do that? Is it when they are trying to socialize with other people just because they are trying to mask themself, they use it for that? So there are so many re- different reasons. So unless you know the reason, you won't be able to stop somebody. I have learned in my life that Nobody can change anybody's point of view. The point of view is gonna change once you decide to change your own point of view because of what you have experienced. A lot of the time, it's not about imposing things on neurodivergent people or people who are suffering point of view. It's about having a comment and leaving that comment with that person for them to reflect on it, so that it seems that you're caring, but you're not wanting them to change because you think it's the right thing. They should know that it's the right thing for them as well at the same time. Um, again, same as the case with behavioral addiction, with social media, with, um, uh, with, with gaming. It's about finding out what is giving them that traction. Why are they going into a social media world? Why are they going into, uh, a gaming world? Um, I had developed my expertise around social media and screen time as well over a period of time, and I tell them that it is worth finding something that can replace it. For example, if you're asking somebody to come off the social media and they have been spending six hours, you should have six hours of other activities to replace it. If you don't have anything to replace it, there's a very good chance that they will go back to them, and I'm, I'm talking about ch- more, more or less children. Um, with-- and adults, we have got too many activities. We can indulge ourselves in other activities as well, and gaming is the same case as well. What is bringing them the stimulation? Can you replace that stimulation with something else which is stimulating for them as well?

Alex Partridge 1:32:57 Mm.

Dr. Khurram Sadiq 1:32:57 In a different scenario. It can be sports, it can be going out, it can be socializing. It, it can be, uh, even playing games for them together. For example, if they are on that console, you can be the other person and they ca- have a two-player game rather than playing online.

Alex Partridge 1:33:13 Mm.

Dr. Khurram Sadiq 1:33:13 So as such, there is no specific answers, but it, it is very situational, situation driven. 'Cause being a psychiatrist, I've got so many different scenarios of people getting into addiction, and you want them to come off it, but they cannot come off it a lot of the time because they're so used to it. They're dependent on it. Their body is dependent on it, especially when it comes to alcohol and opioids or benzodiazepines. But the other kind of addiction, for example, uh, where it is cocaine, it is-- the addiction is for a completely different reason. It is for stimulation. But if you can replace that stimulation with something else that is stimulating, if they're not medicated properly for their ADHD, they can look into those situation scenarios as well.

Alex Partridge 1:33:53 Mm. People with ADHD tend to have this interesting perception of time. Things are either in our now-

Dr. Khurram Sadiq 1:34:05 Yeah

Alex Partridge 1:34:05 ... or not now.

Dr. Khurram Sadiq 1:34:07 Yeah.

Alex Partridge 1:34:07 And through the context of addiction, I had a guest on called Dr. James Custer. He suggested this as a theory. When you are trying to remain sober or you're trying to not take drugs or you're trying to not gamble anymore or whatever it is for you, because your reason for stopping, your rock bottom isn't in your now-

Dr. Khurram Sadiq 1:34:36 Yeah

Alex Partridge 1:34:37 ... you forget about it. When the opportunity comes again to drink, to gamble-

Dr. Khurram Sadiq 1:34:41 Yeah

Alex Partridge 1:34:42 ... to smoke, whatever, you've forgotten the reason why you stop.

Dr. Khurram Sadiq 1:34:45 Yeah.

Alex Partridge 1:34:45 Why you stopped, so you do it again. Do you think someone's perception of time can have an impact on their ability to remain away from their addiction?

Dr. Khurram Sadiq 1:34:56 I look at it completely differently. I look at, at addiction as to why they got involved in the very first place. What is the reason behind it? [clears throat] What is their purpose to life? What we have to understand is neurodivergent people, whether it's autistic or ADHD or any other neurodevelopmental condition, there has to be a purpose to live. Uh, do they have the purpose? Are they in a job? Are they in an occupation that they're enjoying or they're thriving or they want to achieve? I've seen people who have had alcohol problems, who had had issues, but just because they found a purpose in their life, they gave up on it. So it's very important for me, it is important that they need to have a purpose of life. It is, it, it, it is way above, especially neurodivergent population, um, it, it's beyond obvious, and it, it is... That situation is that you give them a reason to live, and you give a reason to thrive, a thing that they're interested in, you will see a completely different changed person, and I've seen that so many times in my life. Give them a purpose, you give them a direction, you, you help them identify it. In a year's time, they're a completely different person. Patients have come to me and said, "I used to drink alcohol. I was on weed. Um, I was not in my-- I, I was in my parents', uh, uh, place. I did not have a relationship." A year down the line, the moment they started to take medication, they have got clarity, they moved out of their, uh, parents' accommodation, they found a job, they're in a relationship. They've stopped drinking alcohol and weed without any help, without any assistance for addiction services. They found a purpose of life.

Alex Partridge 1:36:45 Mm. Something to l- something to live for.

Dr. Khurram Sadiq 1:36:47 Something to live for, and that's what the human beings are.

Alex Partridge 1:36:50 Mm.

Dr. Khurram Sadiq 1:36:50 Like, we need a purpose to live. Especially neurodivergent, you need to have a reason to live, a reason that you enjoy at the same time. If they're doing a job, it is a job that they enjoy-

Alex Partridge 1:37:00 Mm

Dr. Khurram Sadiq 1:37:00 ... and they relish, rather than something which is nine to five and it stops at, as you, um, as, uh, the 12-- um, as, as it strikes 5:00. No, th- they're not, because they're more flexible than that, and they want more reason to live. So-

Alex Partridge 1:37:15 Mm

Dr. Khurram Sadiq 1:37:16 ... for me, this is how, this is how I deal with it, uh, when it comes to neurodevelopmental condition co-occurring with, with addictions. And then I've seen people who are addicted to it, and they need help so to stop medication, um, help, seek help in order to, uh, overcome that addiction and to come to a state where they are ready to do it. If somebody says they like alcohol and they don't want and they don't see it as a problem, no matter how much you, hard you try, you won't be able to make them part from it.

Alex Partridge 1:37:53 Hmm. We have a closing tradition on the podcast-

Dr. Khurram Sadiq 1:37:56 Yes

Alex Partridge 1:37:56 ... where I deliver to you a letter that was written by the previous guest, and it's three rules to live by. Here is the letter. I'll pass it to you. If you could kindly open the letter and read the three rules.

Dr. Khurram Sadiq 1:38:12 So always connect symptoms of neurodiversity with hidden potential. Um, focus on comparing the quality of life of those that others have written off. There's no greater source of purpose. Know that mental health can be, um, increased naturally and permanently to achieve mental strength and resilience.

Alex Partridge 1:38:45 Nice three little nuggets there of-

Dr. Khurram Sadiq 1:38:47 Yeah

Alex Partridge 1:38:47 ... of wisdom.

Dr. Khurram Sadiq 1:38:48 Oh, yes. Absolutely. And should I be leaving with my three, three one of mine as well?

Alex Partridge 1:38:53 If you could, yeah. And a- a- after we've finished-

Dr. Khurram Sadiq 1:38:56 Yeah

Alex Partridge 1:38:56 ... if, if you were kind enough to, to give us your three rules to live by, then it will pass on to the next guest. Um, but Khurram, thank you so much. This has been truly fascinating.

Dr. Khurram Sadiq 1:39:05 Thank you very much, Alex, for this opportunity. Thoroughly enjoyed it. [upbeat music]

Alex Partridge 1:39:12 Do you remember to take your reusable shopping bags when you go to the supermarket?

Dr. Khurram Sadiq 1:39:16 Oh, never. [laughs]

Alex Partridge 1:39:18 [laughs]

Dr. Khurram Sadiq 1:39:18 My wife does.

Alex Partridge 1:39:19 Your wife does.

Dr. Khurram Sadiq 1:39:20 Every time.

Alex Partridge 1:39:21 You have a... I've got a, a cupboard in my kitchen that's overflowing with them. D- do you have that? Is that a, is that a staple of your-

Dr. Khurram Sadiq 1:39:28 Yeah. Yep.

Alex Partridge 1:39:28 Yeah.

Dr. Khurram Sadiq 1:39:28 There's a, there's an area, and again, usually it's the bags that I bring.

Alex Partridge 1:39:32 Yeah.

Dr. Khurram Sadiq 1:39:32 My wife sticks with certain few. Every time I go out supermarkets, I have got more bags to-

Alex Partridge 1:39:38 Hmm

Dr. Khurram Sadiq 1:39:39 ... to face with.

Alex Partridge 1:39:40 That tax, isn't it? It's the-

Dr. Khurram Sadiq 1:39:41 Oh, yeah. Oh, yes

Alex Partridge 1:39:41 ... 20, 30 p bag again. Um, domain names, how many do you have?

Dr. Khurram Sadiq 1:39:48 I, I have, I've got one. Um, it's mentisreuna.com, so it's just one.

Alex Partridge 1:39:53 Just one, okay.

Dr. Khurram Sadiq 1:39:54 Just one.

Alex Partridge 1:39:54 So the autism one there.

Dr. Khurram Sadiq 1:39:56 Yep, yep.

Alex Partridge 1:39:56 [laughs]

Dr. Khurram Sadiq 1:39:57 Exactly, because I'm, I'm, I'm sticking to s-

Alex Partridge 1:39:59 Yeah [laughs]

Dr. Khurram Sadiq 1:39:59 ... that.

Alex Partridge 1:40:00 What's the most impulsive thing you've ever done?

Dr. Khurram Sadiq 1:40:03 Most impulsive thing that I've ever done. [laughs] Uh, I left my exam. Um, I was in doing my fourth-year medicine, and there's, there's a friend who was visiting. He was in another city, and he was supposed to be leaving in the evening. Usually what they do is, and, and I was, uh, preparing for my viva for pathology, and usually don't, nobody wants to go first. So I had to meet him. It was in my mind I would never, uh, despite of having exams, so what I did was I was the first one. I went in, did my viva as quickly as possible, got the car, got into the car, and disappeared for 10 hours, and my family was looking for me. At that time, I didn't have any mobile phones. When I came back, um, uh, uh, uh, my father was really, really unhappy about that, and he did not know till this date that I'd gone out of city and I was having my exam because that was kind of fourth-year exams, really important, really stressful.

Alex Partridge 1:41:05 Hmm.

Dr. Khurram Sadiq 1:41:05 And I was like, "Care about the exam. I have to get it done-

Alex Partridge 1:41:08 [laughs]

Dr. Khurram Sadiq 1:41:08 ... as soon as possible, and I have to go and meet my friend."

Alex Partridge 1:41:11 Did, did you give them an explanation as to where you had been for 10 hours?

Dr. Khurram Sadiq 1:41:14 Lied. [laughs]

Alex Partridge 1:41:17 [laughs] Do you like voice notes, or are you a text message man?

Dr. Khurram Sadiq 1:41:23 Uh, I'm getting used to the idea of voice notes now. Um, I more rely on text because, um, and again, it keeps on shifting in different situation.

Alex Partridge 1:41:35 Hmm.

Dr. Khurram Sadiq 1:41:35 Um, especially when I'm driving, I like voice notes, and again, if, if normally I like text notes.

Alex Partridge 1:41:41 Do you have a notebook?

Dr. Khurram Sadiq 1:41:44 Loads of notebooks. Like, again, I buy them-

Alex Partridge 1:41:47 [laughs]

Dr. Khurram Sadiq 1:41:47 ... uh, [laughs] in dozens, and then I leave it behind, but again, I've, I've finally found a solution to it. I've, I use a writing pad called Remarkable. Um, it's one of the amazing t- tools that has happened to me. Um, like, it's like carrying 10, 15, 20 different notebooks together. It's got an app everywhere in my phone as well as in my laptop. So whatever I wr- write, uh, whether it's patient's notes or whether, um, um, it's, it's my leadership things or masters or public speaking, everything is there. That's it. It goes with me everywhere, and-

Alex Partridge 1:42:26 Hmm

Dr. Khurram Sadiq 1:42:26 ... there have been time when I have left it behind, which happens a lot with us ADHDers. Um, I feel lost.

Alex Partridge 1:42:34 [laughs] I'm a terrible one for keeping my flat tidy.

Dr. Khurram Sadiq 1:42:44 Yeah, yeah.

Alex Partridge 1:42:44 Um, what's the state of your flat? Like, your, your wardrobe, your clothes, are they hung up, or are they on the floor?

Dr. Khurram Sadiq 1:42:52 Yeah, I've got a very organized wife who does, who does not let me come near things.

Alex Partridge 1:42:57 [laughs]

Dr. Khurram Sadiq 1:42:58 If that was not the case, there were in piles and piles of things.

Alex Partridge 1:43:01 Hmm.

Dr. Khurram Sadiq 1:43:02 Uh, my study is s- s- is, is somewhere where nobody else goes apart from me and my boys. My wife says that it's a no-go area for her.

Alex Partridge 1:43:10 [laughs]

Dr. Khurram Sadiq 1:43:11 And it's not in the right state most of the times. I do the cleaning, and that, it lasts for a few days, and then-

Alex Partridge 1:43:17 Hmm

Dr. Khurram Sadiq 1:43:17 ... it goes back to messy self, where everything is everywhere. It's in piles.

Alex Partridge 1:43:21 Yeah, yeah. D- does your mind, even though it's a mess, you, do you know where everything is?

Dr. Khurram Sadiq 1:43:26 Oh, yeah. Yes.

Alex Partridge 1:43:27 Yeah. [laughs]

Dr. Khurram Sadiq 1:43:27 Well, most of the times.

Alex Partridge 1:43:28 Yeah. [laughs] It's your mess.

Dr. Khurram Sadiq 1:43:29 Unless somebody has moved it.

Alex Partridge 1:43:30 Yeah. Uh, then, then no. Apart from Dobby-

Dr. Khurram Sadiq 1:43:33 Yeah

Alex Partridge 1:43:34 ... what other fictional characters do you think might have a neurodivergent condition?

Dr. Khurram Sadiq 1:43:38 Mask. [laughs]

Alex Partridge 1:43:39 The Mask?

Dr. Khurram Sadiq 1:43:40 The Mask.

Alex Partridge 1:43:41 Yeah. Jim Carrey? [laughs]

Dr. Khurram Sadiq 1:43:42 Definitely Jim Carrey. Like, definitely.

Alex Partridge 1:43:44 Yeah. [laughs]

Dr. Khurram Sadiq 1:43:45 Definitely ADHD. Um, um, I think Severus Snape.

Alex Partridge 1:43:50 Okay. And au- autistic?

Dr. Khurram Sadiq 1:43:52 Autistic.

Alex Partridge 1:43:53 Mm.

Dr. Khurram Sadiq 1:43:53 Very much. Even when he speaks-

Alex Partridge 1:43:55 Yeah

Dr. Khurram Sadiq 1:43:55 ... it's a very monotoned way. Other, other than that, um, I think all the Harry Potter, Potter characters, uh, Luna, um, she's called the loony one, Luna the Loony, and again, she, she talks in, in a very monotone way.

Alex Partridge 1:44:13 Mm.

Dr. Khurram Sadiq 1:44:13 She's very much autistic, and she brings about facts out of nowhere, random facts. Um, and she is very, very, very, uh, kind of different to the rest of the team, and again, even in the, that world of neurodivergence, she stands out quite a lot.

Alex Partridge 1:44:33 What about Dumbledore? Do you think he's neurotypical or neurodivergent?

Dr. Khurram Sadiq 1:44:39 I think he was neurotypical. I think he was neurotypical. He, he had every, um, um, T's ticked and I's dotted-

Alex Partridge 1:44:49 Mm

Dr. Khurram Sadiq 1:44:49 ... for, for, for everybody. I think he was... He, he, he was not. I w- I would not see him as a neurodivergent person. Definitely Harry Potter, definitely Ron, definitely Hermione.

Alex Partridge 1:45:01 Mm.

Dr. Khurram Sadiq 1:45:02 Um-

Alex Partridge 1:45:04 The whole Weasley family seem quite-

Dr. Khurram Sadiq 1:45:06 The whole-

Alex Partridge 1:45:06 ... quirky

Dr. Khurram Sadiq 1:45:07 ... ADHD, would you say?

Alex Partridge 1:45:08 Exactly.

Dr. Khurram Sadiq 1:45:09 A kind of mixture of ADHD and autism-

Alex Partridge 1:45:12 Mm

Dr. Khurram Sadiq 1:45:12 ... I would say.

Alex Partridge 1:45:13 Yeah, I see that, especially the dad. He's very-

Dr. Khurram Sadiq 1:45:15 Yeah

Alex Partridge 1:45:15 ... driven, but also-

Dr. Khurram Sadiq 1:45:16 Very driven, exactly

Alex Partridge 1:45:17 ... quite, um, clumsy and-

Dr. Khurram Sadiq 1:45:19 Oh, yeah

Alex Partridge 1:45:19 ... disorganized. [laughs] This has been fascinating. Thank you very much.

Dr. Khurram Sadiq 1:45:23 Thank you very much, Alex. [upbeat music]