Psychiatrist who’s assessed 1000’s of ADHD women: ‘This will always terrify me!’ | Dr Asad Raffi

1. 0:00 – 1:34

   Trailer

   1. SPSpeaker0:00

      People with ADHD are more likely to face traumatic situations or traumatic events due to the, the nature of their risk-taking behavior, the situations they've put themselves in. The impact of that trauma can then have a significant detrimental impact on their ADHD and even expose their symptoms. You know, if you think about anxiety, unlike stress, which is ex- very external, anxiety is internal. It's disproportionate to what you're worrying about, and it's that constant... There isn't a trigger, and it's often maladaptive.

   2. APAlex Partridge0:27

      Dr. Asad Raffi is a leading psychiatrist who's assessed thousands of people for ADHD.

   3. SPSpeaker0:33

      He specializes in the nuances of female ADHD.

   4. APAlex Partridge0:36

      He's here to help your sleep, manage stress, tackle RSD

   5. SPSpeaker0:40

      and achieve optimal mental wellness. How do people with ADHD react to stress? How does that then coincide with anxiety, which is more prolonged? Without stress, we're gonna be underwhelmed. Too much stress, we'll be overwhelmed. And actually, if we think about being in a state of chronic worry or stress, then that's when we end up burning out. Stress itself will have a negative detrimental impact on your executive function.

   6. APAlex Partridge1:04

      [upbeat music] Dr. Asad, thank you so much for joining us.

   7. SPSpeaker1:10

      My absolute pleasure, Alex.

   8. APAlex Partridge1:12

      We've got a lot to talk about today. Late diagnosed ADHD women, unusual ways that ADHD can affect sleep, and how people with ADHD deal with stress. But I think first it's probably a good idea to address the elephant in the room. Um, we're obviously two men talking about ADHD

2. 1:34 – 4:23

   Why two men are talking about female ADHD

   1. APAlex Partridge1:34

      women. Why do you think it's okay for two men to sit here today and talk about ADHD in women?

   2. SPSpeaker1:42

      It's a really emotive question that you ask there, and I think before I can answer that question, we've got to think about the journey and, and what brings us here. I think for, for, well, since, you know, f- since the beginning of time, females have been effectively silenced, and hormonal fluctuations and consideration of the female presentation, be that mental health, be that physical health, has been neglected. And it's not been considered by a male-dominated society, and, you know, we, we lack, obviously, that lived experience. So, you know, people have every right to question the motive, you know, behind why we might be, you know, raising that agenda. You know, is it, is it right for us to do it? Um, I guess the answer to that is it's dependent upon the intention, number one. Number two, it's about the experience, and, you know, certainly clinical experience should far outweigh gender. And with respect to yourself, Alex, I guess you are an individual who has a certain platform, and ra- and raising that female agenda is fundamentally important. You know, you, you, you are truly influencing and, you know, in the right way. And, um, it's absolutely important, imperative, that females have equity when it comes to healthcare.

   3. APAlex Partridge3:20

      It was perfectly said. Thank you, Dr. Asad, and I, I 100% agree. And it was a, quite a shock, actually, when I started this podcast two years ago, um, from my bedroom at home. Um, no real intention for it to grow. Um, but when I look at the analytics today and see that 85% of the listeners and the viewers are female-

   4. SPSpeaker3:42

      Mm

   5. APAlex Partridge3:42

      ... and I think that just in itself obviously is quantifiable, quantifiable evidence of the demand.

   6. SPSpeaker3:49

      Absolutely. And, and, and I guess it begs the question, you know, that demand and that awareness is certainly there, and you're perpetuating that, that demand and, and that understanding. Um, and, and if people do have a, an issue with that, then, you know, go ahead and w- create that platform for yourself.

   7. APAlex Partridge4:09

      Mm-hmm.

   8. SPSpeaker4:09

      And then there is more than enough space, you know, within, within this landscape for, for p- people to be able to do that. But it has to be done with humility. It has to be done with the right intention, um, and with the right motive.

3. 4:23 – 15:57

   Dr Asad’s mission in the world of ADHD

   1. APAlex Partridge4:23

      Mm-hmm. What would you say your mission is in the world of neurodiversity, ADHD, autism?

   2. SPSpeaker4:30

      That's a really interesting question. Um, I guess it's to sincerely help individuals and, and I guess it's the individuals who do not have the privilege to be able to gain access to, you know, the assessments, the, the treatments available to them, be that through the NHS, be that through the private sector. And, you know, I'm, I'm, I guess I'm privileged enough now, haven't come from significant privilege, but certainly I'm of, you know, a, a, a, a certain level of privilege now whereby I can address that agenda and, and help children, also educators, when it comes to assessment of their, you know, conditions and also managing their conditions as well. So I think that would be my, certainly my ultimate utopia, and we've got to start somewhere.

   3. APAlex Partridge5:24

      Absolutely. Um, and I share a lot of that mission with you. Um, it, it, it... What drives me is when I get so mad at the difference between the characteristics of ADHD that I read in a lot of places online and just generally in society-

   4. SPSpeaker5:42

      Mm

   5. APAlex Partridge5:42

      ... compared to what I know as someone who's lived with ADHD and who's chatted to over 200 people now who have ADHD, that the, the gap between those two narratives. Still if you Google or speak to many doctors and you ask, "What is ADHD?" They'll say, "It's a neurodevelopmental disorder characterized by traits of impulsivity-Forgetfulness and disorganization

   6. SPSpeaker6:06

      Mm

   7. APAlex Partridge6:07

      Um, but I've spoken to so many people, I reflected on my experience, and I truly believe that ADHD, yes, it is those things, but it's also a lifetime of being told that you're too much-

   8. SPSpeaker6:17

      Yeah

   9. APAlex Partridge6:17

      ... and you're too sensitive-

   10. SPSpeaker6:18

       Yeah

   11. APAlex Partridge6:19

       ... or you're not enough or not understanding why you're so sensitive to rejection, why your life seems to be controlled by avoiding shame. Like, from your perspective, you're, you're in a unique position. You've, you've, you've assessed so many people. How would you characterize ADHD?

   12. SPSpeaker6:38

       Uh, uh, again, we've, we've had to reframe that particular narrative around the textbook definition. The textbook definition isn't something that everyone relates to. Invariably, there will be people who, who kind of meet that stereotype, and straightaway, you know, the term ADHD itself is, is, is pejorative. It talks about attention deficit. It's not attention deficit. Um, it's about variability in attention. It's situational, and as you know, it's where interest far outweighs-

   13. APAlex Partridge7:10

       Mm

   14. SPSpeaker7:10

       ... um, you know, your, the importance of what you're doing, and, you know, you're led by novelty, you're led by passion, deadlines. And, you know, I, I thought for a long time, how could we conceptualize the understanding of ADHD in a way that it relates to, you know, almost everyone? And, and this is something that when I start an assessment or I talk to somebody about the need for an assessment for ADHD or even autism, you know, we'll, we'll talk about brain health in general. Um, but the way I talk about it is to say, "Well, think about the three following things, and if these apply to you, then consider whether or not you need to have an assessment. Number one, have you achieved your true potential in life? And that true potential isn't just academically or in the workplace. Look at your relationships. L- look at your social functioning. Look at, you know, how you've performed yourself, you know, your own health, your own we- your own wellbeing." The second question is for you to achieve that, 'cause many might say, "I've achieved so much," and especially the high performers, okay? And I guess I could ask you that question, okay? Uh, you know, I, I perceive you as a high-performing individual, but at what cost? How stressful was it, okay? And then the third question is how sustainable is it, okay? Now invariably, people will be able to relate to that because when you think about a high-performing individual with ADHD, and, you know, many of those, many of those people don't relate to the narrative around the textbook definition. When you talk in those terms, they'll think about the deadlines. They'll think about doing things at the last minute. They'll think about the lack of external structure, the scaffolding that often compensates for them.

   15. APAlex Partridge9:07

       Mm.

   16. SPSpeaker9:08

       Okay? This is why a lot of the time, you know, especially the children that we see, you know, who are of high intelligence, very capable, they've got school structure that affords them that scaffolding. They've got parents overcompensating for them. They've got absolutely everything in place. All they've gotta do is perform, okay? The first time they truly become independent is when they go to university. It's when the wheels fall off. That, that's what we tend to see. It's those transitions, and I often say it's primary into secondary, secondary into college, college into university, university into the workplace. As you can imagine, we've all been there, the net widens, doesn't it? And, and that's when you get exposed.

   17. APAlex Partridge9:50

       Mm.

   18. SPSpeaker9:51

       And, and these symptoms then start to become very much apparent.

   19. APAlex Partridge9:55

       I've spoken to many people who, by society's standards, would be labeled as high achieving. They've done amazing things. They've, they've summited Everest. They've, they've sold their business for millions. Um, but I feel like it's this stress of constantly worrying like you're not enough or you are gonna be left behind if you don't work harder.

   20. SPSpeaker10:20

       Mm-hmm.

   21. APAlex Partridge10:21

       I find it really hard to enjoy doing nothing. I've tried. [laughs]

   22. SPSpeaker10:27

       Yeah.

   23. APAlex Partridge10:27

       I've tried sitting on the sofa and just fi- just peacefully watching a film. Every time I do it, I feel like I'm not fulfilling my potential, and there's something inside me that, that, that com- compels me to, to jump up and, and continue working towards my mission. Is that a trait? Like, where does that come from? Is that, is that an internal feeling of not being enough?

   24. SPSpeaker10:51

       I, I think certainly in the context of a condition like ADHD, it's something that we see all the time, uh, that chronic sense of underachievement, regardless of what you've achieved. You know, whether you are an elite sportsman, an entrepreneur, you know, someone who might be deemed to be super successful, and, and we, you know, as a society, we, we champion success. You know, the 5:00 AM club, the, you know, I only sleep... Margaret Thatcher used to say... Sorry, sorry to mention Margaret Thatcher-

   25. APAlex Partridge11:21

       [laughs]

   26. SPSpeaker11:21

       ... on this podcast, but yeah, Margaret Thatcher used to say, you know, uh, I only sleep, I think, four hours, and we th- th- think, wow, you know, that drive, that ambition, and actually that's, that's not healthy, okay? Um, and invariably, you know, we see success, but at what cost, okay? And success, wealth, and having worked in those spaces with high net worth, ultra high net worth individuals, what you tend to find, especially when you're work- working with generational wealth, is that those circumstances can often enable other behaviors. Again, gives you that structure. It gives you that scaffolding, okay? It hides a multitude of other problemsHow many of those entrepreneurs who have made millions have relationship difficulties? How many of them have substance misuse issues, alcoholism, weight management problems? The nature of their success usually comes as a byproduct of, you know, addiction to probably work and, and achievement. And I often ask the question of successful individuals, "How many failures have you had?" Okay? We not talk about those. We see the destination, we don't see the journey. Okay? Let's talk about the journey and let's think about how difficult and how stressful that has been for you to achieve here. And invariably, I'm not saying this applies to everyone, but very commonly, those individuals will say to me, "Even when I got to that peak, even when I ran the marathon or I did, you know, whatever I achieved, sold out for millions, biggest anticlimax of my life."

   27. APAlex Partridge13:03

       Mm.

   28. SPSpeaker13:04

       Where's the next buzz? Where's the next excitement coming from? And it, and it's not about the reward. Often it's about the thrill of the chase. And you apply that to anything. That new pair of shoes, that new car, the new handbag. Okay? New relationship, type of food. Okay? Could be the job. Could be absolutely... You could apply it to a friendship. Apply it to absolutely anything. Once the novelty wears off, once it gets difficult, once it gets hard, the honeymoon pe- period wears off, tend to move on to something else. Okay? That's actually when the hard work starts.

   29. APAlex Partridge13:36

       Mm.

   30. SPSpeaker13:37

       Yeah? And how many of those trends do we see, well, we see them all the time. People with ADHD and, and, and a lot of the successful people that we see invariably are driven by fear of failure, okay? Fear of being found out, huge amount of imposter syndrome. They're racked by self-doubt, self-esteem issues, and, you know, often it's that internal critic that will lead to a lot of the self-sabotage. We don't see that, okay? And again, they will use their ADHD towards, you know, their own... Their, their benefit, the benefit of others because they'll use those skills that ADHD brings. But actually think about the things that they're not good at. You think about, you know, when you were scaling your business, okay? The things that you didn't like doing. Who did it for you? You'd probably outsource it-
4. 15:57 – 18:07

   The difference between stress and anxiety

   1. APAlex Partridge15:57

      of not doing anything? Is there a difference between stress and anxiety?

   2. SPSpeaker16:02

      In- in- invariably there is, and, and, you know, stress is something that, you know, we all experience on a daily basis, and, you know, I, I, I experienced stress this morning coming to the studio. Okay? That pressure to get here. Okay? It, it's an external trigger, and I've got to get to Alex.

   3. APAlex Partridge16:22

      Mm.

   4. SPSpeaker16:22

      Right? And it's prompting that automatic response within your brain and your body towards an action. Okay? Once you're in the cab, once you're here, okay, that, that fear, that apprehension subsides.

   5. APAlex Partridge16:39

      Mm.

   6. SPSpeaker16:40

      You see the cameras, then it goes back up again. But, uh, you know, if you think about anxiety, unlike stress, which is ex- very external, um, anxiety is internal. It's disproportionate to what you're worrying about. Okay? And it's that constant... There isn't a trigger, and it's often maladaptive. And I think, I think a good analogy is think about stress in the following way. Okay? Assume you're wearing a backpack that's really heavy, and you know what's inside the actual backpack. You know why it's heavy. Okay? That's what stress is, and once you take the backpack off, the weight subsides, doesn't it? Now, anxiety is different. You've still got the backpack on. The challenge there is you don't know what's actually in the bag or what's making it heavy, and even when you take it off, you still feel the weight. That's the distinction.

   7. APAlex Partridge17:45

      And someone with ADHD, h- if... What are some... Because I've, in the past, when faced with stress or anxiety, I, I've always turned to alcohol. For me, it was an immediate release.

   8. SPSpeaker17:58

      Mm.

   9. APAlex Partridge17:59

      Um, I now know that I can't do that because I'm an alcoholic, and if I have one drink, the brakes are off, and it's a very risky landscape for

5. 18:07 – 20:58

   Unhealthy ways ADHDers deal with stress

   1. APAlex Partridge18:07

      me to enter.Have you noticed some common ways that people with ADHD or unusual ways that, what, what, what's a get out, what's an escape plan for extreme anxiety, extreme stress for someone with ADHD?

   2. SPSpeaker18:22

      I, I think for... And, and, and, and let's, let's con- Let's reframe that. As, you know, how do people with ADHD react to, um, you know, stress? How do they... How does that then coincide with anxiety, which is more prolonged? And if you think about acute stress, which is something that will, you know, it, it won't be something that's continual. It actually helps. So you've got to have a degree of su- of, of, of stress itself to be able to perform. Okay? Without stress, we're gonna be underwhelmed. Too much stress, we'll be overwhelmed. And actually, if we think about being in a state of chronic worry or stress, then that's when we end up burning out.

   3. APAlex Partridge19:14

      Mm.

   4. SPSpeaker19:15

      Okay?

   5. APAlex Partridge19:16

      [clears throat]

   6. SPSpeaker19:16

      And if we think about that physiologically or even biologically, it starts to make sense. Okay? But invariably then, stress itself will have a negative detrimental impact on your executive functioning, which is obviously the framework around ADHD. But ADHD itself contributes to stress.

   7. APAlex Partridge19:40

      Mm.

   8. SPSpeaker19:41

      So there's a bidirectional relationship there. It's a bit of a chicken and egg type scenario-

   9. APAlex Partridge19:45

      Mm

   10. SPSpeaker19:45

       ... isn't it?

   11. APAlex Partridge19:46

       For me, it's, it's so interesting. I think the, the stress for me comes from, there's this constant, and it really is constant, like narrative in my head that I always feel like I'm gonna let someone down.

   12. SPSpeaker19:58

       Mm.

   13. APAlex Partridge19:58

       That something I do is not gonna be enough, or something that I do is going to result in someone's approval from me being taken away, and essentially therefore, some kind of social rejection, whether that's someone I don't know or someone I do know, an element of their approval that was there before being taken away, and that is terrifying to me.

   14. SPSpeaker20:22

       Mm.

   15. APAlex Partridge20:22

       Uh, that stirs up so much, like shame inside me, so much pain, physiological pain. It's like all of my hard work, all of my effort to, to be perfect, to be liked, to be the version that I want them to think that I am, that camouflage has been seen through in that particular moment. Um, like they've seen my inner child, and they kn- and they, and have seen that it's actually-

   16. SPSpeaker20:48

       Mm

   17. APAlex Partridge20:48

       ... not good enough, despite the effort that I'm putting into making it appear that it is good enough. Like that experience of masking,

6. 20:58 – 23:42

   RSD

   1. APAlex Partridge20:58

      going through life, avoiding rejection, how common is that with, within the ADHD community?

   2. SPSpeaker21:04

      That's 110% of people that we see with ADHD. That's the driving force behind it. And, and if, y- the, the listeners n- right now, if they, if they rewind this particular segment, you've mentioned some of those traits or features that we would typically see within the moods and emotions, you know, with, which we term as rejection sensitive dysphoria. You talked about people-pleasing tendencies, that need for external validation. The one thing I say to my clients is, "Before we can get validation from others, we've gotta, we've gotta validate ourselves internally." That's the biggest challenge.

   3. APAlex Partridge21:46

      Mm. Wow.

   4. SPSpeaker21:47

      Okay? That's a big challenge.

   5. APAlex Partridge21:49

      Mm.

   6. SPSpeaker21:50

      How avoidant are we of that? Okay? So what you're describing right now isn't just one thing, it's a whole cocktail of things coming together. Okay? So you've got that constant sense of, um, you know, potential rejection or the, the need to people please, perfectionist type traits. Good enough isn't good enough for people with ADHD. We wanna be the best at everything we do. Okay? Wanna be the best father, the best partner, wanna be the best at what we do in our careers, the best at playing football, whatever it might be. Okay? Sometimes good enough's okay, right? And yes, that's where those perfectionist trait, type traits might become apparent, and we will often disguise procrastination as perfectionist type traits. We've gotta get it perfect.

   7. APAlex Partridge22:40

      Mm.

   8. SPSpeaker22:40

      Okay? Not true.

   9. APAlex Partridge22:42

      Can't start-

   10. SPSpeaker22:42

       Yeah

   11. APAlex Partridge22:42

       ... until it's perfect.

   12. SPSpeaker22:43

       Absolutely. But also, we'll struggle to delegate to others. We don't... We have a distrust of others to be able to do it to the same standard. Okay? But then putting on that good front, masking, camouflaging, okay, all driven by, as you said before, that chronic sense of injustice for others as well. We feel other people's pain.

   13. APAlex Partridge23:05

       Mm.

   14. SPSpeaker23:06

       Okay? And when, going back to the first question, and ADHD is one of those topics where you can't simply just say, "Well, here's a question, here's the answer." You fi- You'll find that it, the journey is, is like this, and we'll be going backwards and forwards. And talking about reframing ADHD, it's a condition where often people are driven by shame, they're driven by fear, they're driven by pain. That's the underi- you know, the underlying current that I, that I see in most

7. 23:42 – 26:09

   Tiimo advert

   1. SPSpeaker23:42

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   2. APAlex Partridge23:43

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   3. SPSpeaker25:55

      Mm

   4. APAlex Partridge25:56

      ... um, or what you're doing is wrong. Like, stop fidgeting. You know, so many comments from the outside world that have built up this narrative inside of you that's so persistent and so stubborn, regardless of what you look, look in the mirror

8. 26:09 – 31:10

   How to love yourself despite RSD

   1. APAlex Partridge26:09

      and tell yourself in the morning. Like, how, how does one even start to genuinely love yourself and, and, and, and see through that internal narrative?

   2. SPSpeaker26:19

      Alex, if I had the answer to that question, I don't think I'd be sat here right now.

   3. APAlex Partridge26:23

      [laughs]

   4. SPSpeaker26:24

      And, and I think that's the perpetual difficulty, and I think we try and externalize a lot of these challenges through success, through achievement, going back to, you know, the point that we were making before, uh, about entrepreneurs, about, you know, climbing that particular, uh, mountain, whatever it might be. And actually, once, once you've done it, anti... it's an antic- anticlimax, isn't it? Yep, you sold LADbible. What's next? Well, actually, for many other entrepreneurs, they'd start again once they're out of that, you know, that gardening period-

   5. APAlex Partridge26:56

      Mm

   6. SPSpeaker26:56

      ... or whatever it might be, um, and they'll start all over again and over again. It's almost like a rollercoaster continual. Um, but invariably, what we'll find is, think about the nature of what you were doing. You know, you were good at what you did. You know, you were interested in it. You were passionate about it. Okay? That wasn't work. Yeah? You, you must have felt like y- you, you going to work every day is, oh, it's stressful, it's boring. It's difficult to motivate at times. It's not when you've got those ingredients. You probably love doing it, almost kind of addictive in its nature, and you've got... Y- you know what we tend to find then is people, people's addictive tendencies or behaviors, once one, one dissipates, they'll move on to something else.

   7. APAlex Partridge27:38

      Mm.

   8. SPSpeaker27:38

      It evolves. It changes.

   9. APAlex Partridge27:41

      It's tricky though, isn't it? Because I feel like in order to, to start loving yourself, you have to truly be able to believe the positive things that you know about yourself.

   10. SPSpeaker27:49

       Mm-hmm.

   11. APAlex Partridge27:49

       And just then you said, with, with my previous career, I was good at social media, and I guess objectively I must have been because it was a success. But after I sold the company... And with many people with ADHD, we do stuff that is praised and is, it is, quote, unquote, "successful," and then we kind of forget that we're capable of doing it.

   12. SPSpeaker28:09

       Mm.

   13. APAlex Partridge28:09

       And you mentioned imposter syndrome, and I think it's because I alwa- always live in the now. Like, I'm, I'm very good at focusing on what's in front of me in the here and the now, and my success and my achievements and being able to do X, Y, or Z, they're in the past, and I struggle to remember-

   14. SPSpeaker28:26

       Yeah

   15. APAlex Partridge28:26

       ... that they exist, and therefore, when I'm tasked to do that thing again, I think that I can't do it, and that creates a lot of anxiety. Is it... That surely creates an additional challenge for someone with ADHD who's trying to love themselves, but they forget the reasons why they're great.

   16. SPSpeaker28:42

       Mm-hmm. Uh, y- you're absolutely right because we, we don't appreciate being in the moment, do we? We're ei- we're, we're either thinking about what's next or what's happened in the past. We're overthinking the past, or we're thinking about the future. We're not present.

   17. APAlex Partridge28:58

       Mm.

   18. SPSpeaker28:59

       And you might think about your relative success in, in what you created at, at, at, um, LADbible, UNILAD, and you've emulated that with this podcast. Okay? You know, how successful is the podcast? Respectfully, you're probably better known for this than you were for that.

   19. APAlex Partridge29:20

       Yes. Yeah.

   20. SPSpeaker29:21

       Right?

   21. APAlex Partridge29:21

       No, totally.

   22. SPSpeaker29:22

       How successful it is this? What is the impact of this? Okay? Impact and success isn't always measured in pound notes. Okay? And that's what you've gotta remember. How many people are you impacting on to go out there to seek knowledge, to become educated? You're educating probably the, the, the medics and the doctors as well-And that won't come as a surprise to you. Most of us don't know what we're doing. Um, but-

   23. APAlex Partridge29:50

       [laughs] It does come as a surprise

   24. SPSpeaker29:51

       ... No, it doesn't. It should-

   25. APAlex Partridge29:52

       That imposter syndrome

   26. SPSpeaker29:52

       ... it shouldn't. It shouldn't.

   27. APAlex Partridge29:53

       [laughs]

   28. SPSpeaker29:54

       Um, there is a big need for education.

   29. APAlex Partridge29:56

       Mm.

   30. SPSpeaker29:56

       That's a, that's a podcast for another time. Um, but, you know, l- look at the impact that you're having and, and, and, and that domino effect, and you've gotta be proud of that.
9. 31:10 – 39:04

   The difference between female ADHD and male ADHD

   1. APAlex Partridge31:10

      to be in this room.

   2. SPSpeaker31:11

      Yeah.

   3. APAlex Partridge31:11

      Do you see, like, a difference in the s- between the sexes in how that plays out, like imposter syndrome, stress, anxiety? B- ADHD men, ADHD women, is that a similar narrative?

   4. SPSpeaker31:26

      Absolutely not. If I could have you and I s- stand in the shoes of fema- of a female with ADHD, even for a day, we would not survive.

   5. APAlex Partridge31:39

      [laughs] No, for sure.

   6. SPSpeaker31:41

      And I, and I, and I say that with absolute humility.

   7. APAlex Partridge31:44

      Mm.

   8. SPSpeaker31:45

      And I have to be completely open and honest about this. Took me a long time to realize that. And, um, I guess personal experience gives you that understanding when, you know... Y- you can only really empathize with people and, and start to understand that journey when you experience it for yourself. And, you know, my agenda when it comes to females and female brain health was born out of, you know, my daughter having ADHD, and there isn't anything more precious to me than my children. I lie, actually. My, my cat's number one.

   9. APAlex Partridge32:31

      [laughs]

   10. SPSpeaker32:32

       Yeah, they're number two.

   11. APAlex Partridge32:33

       How many cats have you got?

   12. SPSpeaker32:34

       Just, just the one.

   13. APAlex Partridge32:35

       Nice. Yeah.

   14. SPSpeaker32:35

       Shout out to, uh, Rocky. Rocky Raffi.

   15. APAlex Partridge32:38

       Rocky. [laughs]

   16. SPSpeaker32:38

       Yeah, yeah. Cats, ADHD, the best treatment. You know, they can absolutely chill you out and relax you.

   17. APAlex Partridge32:47

       I've got a dog, and it is obviously s- I imagine similar, but yeah, on the sofa with Milo-

   18. SPSpeaker32:52

       Yeah

   19. APAlex Partridge32:52

       ... totally amazing for regulation.

   20. SPSpeaker32:54

       Yeah. And he will come and sit on the laptop and stop me working.

   21. APAlex Partridge32:57

       Mm.

   22. SPSpeaker32:57

       He's the only, um, family member that can stop me from doing anything. Okay? So anyway, we, we, we, we digress there. But, um, going back to the point about, you know, the, the, the female agenda here, fundamentally important to understand kind of, you know, wh- where my narrative comes from, where, where my agenda comes from, and it's driven by my own daughter's experiences. And I see that parallel between how I might struggle, and I mi- I might also succeed with my ADHD, and it's much harder for her. Right? And invariably, when we ask about, you know, is there a fundamental difference? 100%. There has to be, and there will be, okay, 'cause the demand is there, and certainly there are moves afoot to address those challenges and difficulties. Because even looking at the assessment process for ADHD, the understanding that we have, it's all research born out of, you know, white Caucasian males from, from Middle America.

   23. APAlex Partridge34:02

       Mm.

   24. SPSpeaker34:02

       Okay? And I can't relate to that, okay? Um, neither can most females. You then bring into the mix the experience of females from Black and ethnic minority groups. Good luck.

   25. APAlex Partridge34:16

       Mm.

   26. SPSpeaker34:17

       Ain't no one looking at their agenda. Yeah. And I say that now. Maybe this is that platform to be able to r- to raise it.

   27. APAlex Partridge34:24

       Mm.

   28. SPSpeaker34:24

       Okay? We are way behind the curve when it comes to Black women, when it comes to women of color, and neurodivergence. That is something that I feel significant weight about, you know, being from that background, and I have to address that agenda-

   29. APAlex Partridge34:40

       Mm

   30. SPSpeaker34:40

       ... and I have to fly that flag for them. Okay? Um, but the... As I said, there are, there are moves afoot. Um, there has been a working group around, um, adapting the diagnostic interview for ADHD, a female-specific version. And if you really wanna speak about imposter syndrome, you get into a room where you're on a Zoom call with some of the world's best researchers-
10. 39:04 – 52:48

    How hormones impact female ADHD

    1. APAlex Partridge39:04

       How drastic do you see hormones impacting, say, women with ADHD and their stress? How much of a conversation needs to happen around this?

    2. SPSpeaker39:13

       You should not be assessing any female for mental health issues, for their physical health, or just their health in general without consideration of hormones. Do we do that? No, we don't. Okay? I will not see a female without consideration of at what age did she go through puberty. That's relevant. What were her menstrual cycles like? Were they, um, were they regular? Were they irregular? Tell me about the nature of those cycles, 'cause that tells us a hell of a lot. Okay? Tell me about that seven to 10 days before you're due on your period, the luteal phase of the menstrual cycle. Then let's talk about what it was like when you were pregnant. What was it like postnatally? Okay? And the catastrophic impact that many females can face when they reach perimenopause and menopause, which can often be very early in, um, females with ADHD. It's interests a lot of my female clients when I ask them questions like, "Tell me about your heavy periods. Tell me about your cramps. Were you ever diagnosed with endometriosis?" And they're going, "Why? W- what's that got to do with it?"

    3. APAlex Partridge40:31

       Mm.

    4. SPSpeaker40:32

       Well, I'm sure we'll come on to it. A hell of a lot.

    5. APAlex Partridge40:34

       Mm.

    6. SPSpeaker40:35

       Okay? But hormonal fluctuations and hormonal change, and this is something that I talk regularly about to some of the schools where I, where I do a lot of educational work, is let's just take away, you know, the whole principle that, you know, purpose of why we're here, which is to talk about ADHD. Let's just talk about the human brain, okay? And we're all, we're all neurodiverse. We're not neurodivergent, but you think about the neurodiversity that exists, and when you walk into a, a workplace, or you work in... You, you walk into a, um, an academic environment, and you say to them that the likelihood is that every single female within this school is gonna be compromised for at least seven to 10 days every single month that they're here. Okay? So that makes up 25 to 30% of the time within academia, within the workplace because in that luteal phase, you're losing the protective effect of estrogen on dopamine, your ability to focus, your ability to concentrate. It's affecting serotonin. Okay? So estrogen has a protective effect on serotonin, and invariably then the mood related issues, motivation, all of these things become compromisedIt's then further exaggerated when you have ADHD. So for someone who doesn't have ADHD, yeah, they're gonna see that gap for seven to 10 days. It's not persistent. Okay? For someone with ADHD, the difference is it's always there.

    7. APAlex Partridge42:14

       Mm-hmm.

    8. SPSpeaker42:14

       It's persistent, but it's more exaggerated within that time period. And that's, that's, that's telling, isn't it? Where going back to that first question about the female agenda, if that impacted males, do you not think we'd have found a solution for it? Do you not think we'd have a policy in place, okay, that for 25% of the time, "It's all right, Alex, take some time out. Yeah, we won't expect as much for you. We'll make sure that exams are designed at a time when you're not compromised. You're, you're at your absolute best"? No. That places them at a distinct disadvantage. It's not a level playing field, is it?

    9. APAlex Partridge42:52

       I mean, it's a travesty, and I think, like, do you think the injustice is closing? Is it, is it... The emotional knock-on effects for women just having an understanding and awareness of what we're talking about now must be huge because I don't wanna speak on behalf of women, but the amount of women I've spoken to who have said that the fluctuations in their mood throughout the month, coupled with their ADHD, has genuinely led them to believe that they're crazy.

    10. SPSpeaker43:21

        Mm-hmm.

    11. APAlex Partridge43:21

        And then they hear someone like yourself explain-

    12. SPSpeaker43:23

        Yeah

    13. APAlex Partridge43:24

        ... almost their entire life th- through hormones-

    14. SPSpeaker43:27

        Mm

    15. APAlex Partridge43:27

        ... and it's like, "Oh my God." [laughs]

    16. SPSpeaker43:29

        Well, th- they're in a persistent state when they, when they reach menopause.

    17. APAlex Partridge43:33

        Mm.

    18. SPSpeaker43:33

        And, and that's when you start to see the significant impact of, you know, the, the estrogen levels dropping, progesterone levels dropping, not just on mental health, on, on physical health. I, I, I refer to estrogen as the second most powerful hormone in the human body.

    19. APAlex Partridge43:54

        Mm.

    20. SPSpeaker43:54

        I'll reveal what number one is later.

    21. APAlex Partridge43:56

        [laughs]

    22. SPSpeaker43:56

        In my, in my humble opinion.

    23. APAlex Partridge43:57

        Yeah, yeah. Nice little hook for-

    24. SPSpeaker43:59

        Yes

    25. APAlex Partridge43:59

        ... for the thing.

    26. SPSpeaker43:59

        There you go. There you go.

    27. APAlex Partridge44:01

        So how would you say stress impacts ADHD, and how can that manifest in the physical body?

    28. SPSpeaker44:07

        I've often said that, going back to the conversation before about reframing ADHD, you could almost reframe it as a condition where people are in a chronic state of stress. And where we talked before about stress being something where there's an external trigger, it evokes a response, you know, and, and there will be a spike in cortisol, okay? Which prepares your body, your brain towards an action, okay? Now, that's an adaptive response. I've no issue with that. If you're chronically stressed, this is when cortisol becomes dysregulated, and what that can then lead to is actually low-grade inflammation. So going back to calling ADHD a condition where you're run... I- in a chronic state of stress all the time, that sense of fight or flight, okay? It doesn't come as any surprise that most people with ADHD that I see have significant signs of low-grade inflammation. Okay? And what's really fascinating now is, without name... I will name check actually, 'cause it's really important to, um, you know, highlight the work, the really important work of people like Jessica Eckels, James Custow, who talk about ADHD being a brain-body condition. And something like stress or even anxiety... And the n- if I had a pound for every time someone said to me, "I've been diagnosed with anxiety," and I say, "Well, don't tell me what it is. Ex- ex- describe the experience," it doesn't have that hallmark of what might seem to be anxiety. They'll describe this experience of internal restlessness, okay? Which often doesn't have a trigger. It's always there. And for a lot of females, actually, that's the experience. It's not external. A lot of it's internal. That's the fundamental difference. And as we get older, a lot of the external physical hyperactivity also internalizes. So number one, that stress itself is something that you subjectively experience. More interestingly then for someone like me, 'cause I'm always keen to try and find objective data and evidence to support that, we can measure it. So the best... Currently, the best physiological marker of stress that we have is something called your heart rate variability. Now, you can wear a device like this as a wearable tracker. Um, won't, won't name the company, but the... You can wear various devices. Heart rate variability is your heart's, you know, changeability or reactivity between consecutive beats. The more adaptable it is, the higher it is, the better. The less adaptable it is, the lower the score. And what we tend to find is that HRV, especially when it's lower, shows that dysfunction of the autonomic nervous system. So this is where your fight or flight-

    29. APAlex Partridge47:20

        Mm

    30. SPSpeaker47:20

        ... your sympathetic, starts to outweigh your parasympathetic, which is your relax and retreat or chill out. Okay? And that's regulated by your vagus nerve. Okay? So when people talk about vagus nerve stimulation, jump- jumping into, you know, cold plunge pool, you know, all of these elements, these are the things that will readdress that balance. So this, this is kind of helping the ADHD agenda here. So that stress or that so-called anxiety or whatever you wanna call it, the internal restlessness, it's tangible. It's experienced subjectively. It's measurable through HRV. But also, then we can see it physicallyOkay? So we'll talk about the concept of dysautonomia and connective tissue disorders, and dysautonomia presenting as things like POTS, which is postural orthostatic tachycardia syndrome, or in simple terms, feeling quite dizzy when you're going from sitting to standing really quickly, easily bruising, that hot, that cold intolerance, issues with your blood pressure, your, your heart rate. So again, physic- we, we're seeing it physically.
11. 52:48 – 59:35

    The truth about ADHD and sleep

    1. APAlex Partridge52:49

       How does this whole conversation translate into sleep? I wanna go into that a bit further. I mean, do you see any unusual sleeping habits with those who have ADHD?

    2. SPSpeaker52:57

       Let's just think about poor sleep in general. Regardless of whether you have ADHD, it's gonna affect your executive functioning. It's gonna affect your ability to concentrate, to focus, to sustain attention, your decision-making abilities, your emotions. When you have ADHD, that's gonna be even, you know, exaggerated even more. So again, that's the reason why you've got that bi-directional relationship. You then bring stress into the mix. So when you don't sleep, stress levels are gonna go up. Okay? You're putting the stress on your body, and invariably, if you're stressed, you're gonna overthink. You're not gonna sleep. So you've got this trifecta of ADHD, sleep, and stress. Okay? And then there's a third friend called hormones, right, which we've spoken about. So they're the three things that certainly impact brain function and certainly amplify how ADHD then manifests. And here's a simple, simple... It's not simple, but here's the trick. If you can manage a large part of your stress, sleep, and your hormo- hormones, you will manage-A large part of your ADHD, okay? And one of the things that we certainly look at to qualify this is your corti- what we call your cortisol awakening response. And what we know is that when you don't have a problem with cortisol release, or if you're not stressed, naturally, there should be a spike in cortisol about 30 to 45 minutes after you wake up. It's kind of your... It's nature's starter motor in that respect. Now, for many people with ADHD, that can be exaggerated, it can be blunted, or it can be delayed, but it's fundamentally important because that will set the tone for the day. What do we usually do within that particular circumstance? Well, people are gonna start using coffee as a means to try and get them going, and that's probably the worst thing you can do 'cause that will blunt your cortisol response, your natural cortisol response. Okay? So actually try and delay having that coffee in the morning for about 30 to 45 minutes. Get some light exposure, do some yoga, take a cold shower. Okay? These are some of the things that might well help, and they're all natural-

    3. APAlex Partridge55:19

       Mm

    4. SPSpeaker55:20

       ... in, in, in, in their, um, you know, i- in, in terms of their accessibility. So, you know, we absolutely need to understand ADHD as a condition where we need to also then consider sleep, we need to consider the stress, and hormones.

    5. APAlex Partridge55:37

       Do you think RSD, we mentioned earlier, rejection sensitive dysphoria, is a, is a ingredient that goes towards people struggling to sleep? Because I think having spoken to many people, they a- it's often the worry of letting someone down, um, you know, that they set 10 alarms 'cause they're so scared about being late for their appointment in the morning, or they're sat overthinking about a social interaction that day, and that's what's keeping them awake. Is RSD a key contributor to poor sleep?

    6. SPSpeaker56:07

       I, I, I'll, I'll, I'll echo what I said before. RSD is the primary driver of ADHD, and it's understanding how it comes about.

    7. APAlex Partridge56:17

       Mm.

    8. SPSpeaker56:17

       You know, that in itself is triggered by those stresses. Consider them to be almost kind of c- cu- uh, accumulating microtraumas over the course of someone's life and the significant number that people face. You know, if you think about the experiences of a condition like rejection sensitivity, it mimics a condition like complex PTSD, and it, it brings into question that whole debate around, you know, stress, and at the, at the other extreme of stress, I guess, is trauma. And invariably, there's always been that dialogue around trauma and addiction. I actually think we're missing a part of the equation here, where we know that people with ADHD are more likely to face traumatic situations or traumatic events, and due to the, the nature of their risk-taking behavior, the situations they put themselves in. But the trauma itself and, and, and, you know, what the nature of that trauma might be different for different people, but the n- the impact of that trauma can then have a significant detrimental impact on their ADHD and even expose their symptoms. We often see that. You know, it can be a traumatic event that can expose people's, you know... Uh, uh, that I, I often say it compromises-

    9. APAlex Partridge57:55

       Mm

    10. SPSpeaker57:55

        ... their psychological toolbox and exposes the symptoms beneath. And I, and I see RSD as being a, an accumulation of those microtraumas, and that's something that we really need to address because trauma isn't just about what's happened. It's also the absence of repair. So we need to be doing both.

    11. APAlex Partridge58:18

        20,000 microtraumas, right? That's the estimation, neurodivergent children.

    12. SPSpeaker58:23

        That's... I think that's that one quote that really riles m- many people, doesn't it? And, and I think sometimes we need to be less hung up about-

    13. APAlex Partridge58:31

        Mm

    14. SPSpeaker58:31

        ... you know, the, the, the statistic and, and try and understand the message behind it, which is, yes, people with ADHD are going to be facing, um, a significant number of perceived, okay? It doesn't necessarily always mean that that trauma has occurred. It might be a perceived trauma. It might be an actual trauma. Um, and you know, what they've not had the ability to be able to do is to articulate it, to, to verbalize it, to actually manage it. So there's lots of unresolved trauma that people with ADHD, um, end up, you know, accumulating, uh, over a period of time, and invariably then that shapes their coping mechanisms, you know, be they adaptive, what we might see as kind of positive outcomes, but invariably, a lot of the time they can be seen to be maladaptive, leading to negative consequences.

    15. APAlex Partridge59:25

        Mm. What would you think the most common addictions are that someone who has been told so many times, 20,000, whatever the number is, and they're dealing with the

12. 59:35 – 1:09:32

    The most common ADHD addictions

    1. APAlex Partridge59:35

       pain of that, what common addictions do people turn to to ease that?

    2. SPSpeaker59:40

       I think the propensity towards what might be deemed addictive or problematic, 'cause we have a, we have a notion around addiction, um, and, and, and I think a, a lot of the time we need to kind of reframe it again in the context of, if used excessively, is it likely to become problematic-

    3. APAlex Partridge59:59

       Mm

    4. SPSpeaker59:59

       ... or does it have addictive potential? Because the way I see addiction evolving from ADHD through that loop of microtraumas, the stresses, the sleep issues, the hormonal issues, the RSD-It gets to a stage where being impulsive means you're more open to new experiences. You... There's a degree of suggestibility and vulnerability about you. People take advantage of that, okay? You're a people pleaser, don't forget. You're not... You're gonna struggle to say no, so you, you game for a laugh.

    5. APAlex Partridge1:00:33

       Mm-hmm.

    6. SPSpeaker1:00:33

       You'll try it. Okay? You don't wake up one day and decide, "I fancy becoming addicted to alcohol." You didn't have that day, did you? Okay? You were open to new experiences. That's the likelihood. So how much did influence... How much of an influence did impulsivity and people pleasing have? But also then think about the compulsive nature of some of those behaviors. What does... What do compulsions do? They ease that internal emotional turmoil. You, you're getting that quick fix from the, from the RSD. Anything to take that pain away, and invariably will turn towards substances that might well give us some rebalance of that dopamine in the prefrontal cortex that manages the executive function challenges. You bring those three things together, you've got the perfect cocktail towards addictive behavior, and I'm conscious I've not answered the question. What you're likely to use in a problematic way, so substances or even behaviors, in my view, is dependent upon what you've got access to and what you can get away with. Okay? So it's accessibility, and what I say is concealability. So we see an emerging pattern or a, or, or a, a variable or a changeable evolving pattern throughout the life course, and it's different in different cultures, um, and, and certainly within the, the genders as well. If I was to look at the whole population, the number one... In fact, I'll do this 'cause I do this with my clients. I'm gonna do it with you. What do you think is the number one substance of abuse within my clients here in the UK?

    7. APAlex Partridge1:02:17

       Sugar?

    8. SPSpeaker1:02:17

       Correct. Number one. Number two?

    9. APAlex Partridge1:02:22

       Alcohol.

    10. SPSpeaker1:02:23

        That's number three.

    11. APAlex Partridge1:02:24

        Okay.

    12. SPSpeaker1:02:24

        Number two is actually processed food. Okay? And again, go back to conversation about gut health. Okay? How many of the things that we eat these days do we actually understand the ingredients on the actual packet?

    13. APAlex Partridge1:02:39

        Mm.

    14. SPSpeaker1:02:39

        It's not worth eating if you can't understand it. It... I, and I al- also say to my clients, "If you, if you, if your great-grandparents couldn't, can't recognize that food, ain't worth eating. If it's not at the sides or at the front of the supermarket-

    15. APAlex Partridge1:02:53

        Mm

    16. SPSpeaker1:02:53

        ... or at the back where all the boring stuff is, don't buy it." Yeah. 'Cause of the hyperpalatable processed rubbish is usually l- usually at eye level right in the middle. Okay? It's retail psychology for you. Um, number three, as you say, is alcohol. Number four, caffeine. Number five, nicotine. You get cocaine and cannabis way down the list, okay? But then if you think about something like nicotine and that evolving nature, if you look at, you know, Gen Zs now, they're not smoking behind the bike shed. They wanna be seen... You know, they wanna be seen with a cigarette. It's gonna be a vape. But invariably then something like a vape isn't, you know, like cigarettes where you can actually quantify how many-

    17. APAlex Partridge1:03:44

        Mm.

    18. SPSpeaker1:03:44

        I ask them, "How many puffs do you have a day on your vape?" No idea. Okay? So you can't quantify how much you're using. The other worrying trend that we're now seeing is the use of a substance called snus.

    19. APAlex Partridge1:03:56

        I've heard about this. Yeah.

    20. SPSpeaker1:03:58

        Okay?

    21. APAlex Partridge1:03:58

        That's right. Like a... It goes in your gums. It's like nicotine release.

    22. SPSpeaker1:04:00

        That's right. Well, it's, it's, it's, it's a small nicotine pouch, Scandinavian origin-

    23. APAlex Partridge1:04:05

        Mm

    24. SPSpeaker1:04:05

        ... um, and you put it between your, your lip and your, and your gums, and you're getting that instant hit of nicotine.

    25. APAlex Partridge1:04:11

        Sure. Do you think people-pleasing can be an addiction? Because I've, I've heard a few people refer to themselves as a recovering people pleaser, and I think, like, I drink to escape from pain, but with people with ADHD, the thought of being criticized or rejected is so painful, and we people please to avoid that.

    26. SPSpeaker1:04:27

        Mm.

    27. APAlex Partridge1:04:27

        Can we be addicted to people pleasing?

    28. SPSpeaker1:04:29

        Abso- Abso- Seeking validation from others, 100%. Absolutely. Okay? And but how tiring is that-

    29. APAlex Partridge1:04:36

        Mm

    30. SPSpeaker1:04:36

        ... or how exhausting is that for that particular person? And invariably then that will also start to influence your... the likelihood of you being able to say no to things like, you know, like snus.
13. 1:09:32 – 1:11:09

    Dr Asad’s ADHD item

    1. APAlex Partridge1:09:32

       I want to draw attention back to your ADHD item-

    2. SPSpeaker1:09:36

       Yes

    3. APAlex Partridge1:09:36

       ... which has been patiently waiting underneath that cloth on the table in front of us. Um, and I'm gonna reveal it now. It is ... That is a Padel racket?

    4. SPSpeaker1:09:48

       Absolutely.

    5. APAlex Partridge1:09:49

       I'll give that to you, and if you could kindly-

    6. SPSpeaker1:09:50

       Thank you

    7. APAlex Partridge1:09:50

       ... explain why a Padel racket represents ADHD.

    8. SPSpeaker1:09:54

       I need to hold this in a way that it shows that I actually know what I'm doing with it. But Padel-

    9. APAlex Partridge1:09:59

       [laughs]

    10. SPSpeaker1:10:00

        ... if anyone knows what Padel is, it's the fastest growing sport in the world, and I s- and I certainly start to see this trend, and it's ... And, and certainly the benefits of a sport like Padel, and I'm guilty of someone who is now almost kind of addicted-

    11. APAlex Partridge1:10:15

        Mm

    12. SPSpeaker1:10:16

        ... to playing, 'cause what does it give you? Okay. Certainly for someone with ADHD, it's really fast-paced. It's intuitive. It's plug and play. But it gives you connection. It gives you that social element, and, you know, I think it's almost kind of the perfectly designed for people with this condition. Okay? And, um, you know, I'm certainly seeing many of my clients on, on social media or LinkedIn wax lyrical about their Padel playing, and I'm going, "This is not a coincidence. The two must be linked." Okay? So I, I, I would highly recommend you start playing, and, um, we'll then have to have a game.

    13. APAlex Partridge1:10:58

        Fascinating. And you've promised me a game, right-

    14. SPSpeaker1:10:59

        Absolutely

    15. APAlex Partridge1:11:00

        ... in the next couple of months after this.

    16. SPSpeaker1:11:00

        In Manches-

    17. APAlex Partridge1:11:01

        Yeah

    18. SPSpeaker1:11:01

        ... You're gonna have to come, come to Manchester.

    19. APAlex Partridge1:11:02

        Absolutely.

    20. SPSpeaker1:11:03

        Yes.

    21. APAlex Partridge1:11:03

        I'll gl- look forward to it, and it will grace the, uh, the shelves behind us-

    22. SPSpeaker1:11:07

        Absolutely

    23. APAlex Partridge1:11:07

        ... as with all the other ADHD items.

14. 1:11:09 – 1:18:14

    The ADHD agony aunt

    1. APAlex Partridge1:11:10

       I wanna move on to the ADHD agony aunt section, penultimately, Dr. Asad. Um, a member of the community writes in, and it goes in the washing machine 'cause my ADHD item is a washing machine.

    2. SPSpeaker1:11:21

       Yeah.

    3. APAlex Partridge1:11:21

       Because my item represents memory loss 'cause I always forget my laundry in the machine after the cycle's finished. And to make myself feel better, hopefully, I ask, do you do the same?

    4. SPSpeaker1:11:33

       I, no, I don't even know how-

    5. APAlex Partridge1:11:34

       [laughs]

    6. SPSpeaker1:11:34

       ... to switch the, the washing machine on 'cause I was absolutely useless. And, um, yeah, so I, I'm, I'm, uh, I don't get much-

    7. APAlex Partridge1:11:41

       You don't even switch it on?

    8. SPSpeaker1:11:42

       No.

    9. APAlex Partridge1:11:42

       Then who does the washing?

    10. SPSpeaker1:11:44

        My long-suffering wife.

    11. APAlex Partridge1:11:45

        I see. Yeah. The ultimate hack.

    12. SPSpeaker1:11:48

        The, the ultimate external scaffolding and, and structure-

    13. APAlex Partridge1:11:52

        Yes

    14. SPSpeaker1:11:52

        ... and, you know, hence the word long-suffering.

    15. APAlex Partridge1:11:55

        Well, I've got the Tiimo app-

    16. SPSpeaker1:11:55

        Yes

    17. APAlex Partridge1:11:55

        ... uh, which is the sponsor, and they have been helping me. But yeah, actually, it's the smell of damp which gets me a lot of the time 'cause I walk past the room that it's in, and it's like, "Oh, I've forgotten it again." [laughs]

    18. SPSpeaker1:12:05

        Yes. Yeah, I know that. Yeah, I know that feeling. Yeah.

    19. APAlex Partridge1:12:06

        It's like a public service announcement at this point. So anyone listening, watching, I see it in the comments, "You just reminded me to go empty my machine." Um, Dr. Asad, this week, someone has written in and asked, "One of my children throws the worst tantrums. How can I help them manage his stress?" That's the question.

    20. SPSpeaker1:12:28

        What a great question.There's not a simple answer. Okay, tantrums, stress. First and foremost, let's try and understand how old the child is. Let's not try and pathologize everything. Yeah? So first and foremost, is this just a normal part of being a child? Got to answer that question. If it isn't, and it's something that's persistent, it's pervasive, and they are gen- it's generally genuinely having an impact, not just on the child, but also on the extended family, then we've got to do something about it. Okay? And the first... one of the first things that I say to any parent, to a child with ADHD, to a neurodivergent child, or to a neurodivergent parent, invariably, usually both, they might, they might, might lack that insight, is to do some parenting intervention. Okay? Some form of a parenting course. And this isn't an, an indictment or a criticism of their ability to parent, because I always say none of us were given a manual on how to be a parent. We learn on the job, and we wing our way through. I'm still winging it. My, my daughters will tell you that. And we have good days, we have bad days. And, you know, we certainly weren't given a manual on, on how to be a parent to a neurodivergent child. So it's, it's learning the skills. And, you know, many might expect a psychiatrist to turn around and say, "Well, let's, let's medicate the child."

    21. APAlex Partridge1:13:56

        Hmm.

    22. SPSpeaker1:13:56

        Okay? No. And, um, I'm gonna coin the term that, uh, Matt Gutwell used in, in, in his interview with you, which was, it's, "It's pills and skills."

    23. APAlex Partridge1:14:08

        Hmm.

    24. SPSpeaker1:14:08

        And the skills will be the things that get you through in the long term. Okay? So the other thing I forgot to mention was this. What we're, what we're increasingly now realizing is that at low doses, ADHD medications a- actually have a, an anti-inflammatory effect. Now, if you're overcompensating by using high doses of ADHD medication and not fixing sleep, stress, not doing the parenting intervention, and everything else, you're gonna revert to what? High doses. Okay? It's like saying to a diabetic, "Use more insulin. Doesn't matter if you're eating loads of cake and you've not lost weight or done anything else." We're doing exactly the same thing with people with ADHD. We're giving them high doses. In animal models now, we're seeing that high doses of ADHD medication, especially stimulants, promotes inflammation.

    25. APAlex Partridge1:15:01

        Hmm.

    26. SPSpeaker1:15:01

        Okay? And actually exacerbates those who are susceptible to it. So I wanted to use that opportunity to bring that in. But this, this just echoes that point that, you know, we've made throughout the course of this conversation. On a serious note, that number one, managing ADHD isn't about one approach. It's not about medication. It's about optimizing sleep. It's about reducing that stress. It's about understanding what support and help can be given to that child at school. Because invariably, what will happen is, a lot of the time, parents will say, "My child's perfectly fine at school." But there's a buildup of that emotion, almost kind of like that Coke-

    27. APAlex Partridge1:15:42

        Hmm

    28. SPSpeaker1:15:42

        ... Coke bottle Mentos effect, that explosive reaction, because it's the only place where they feel safe to be able to kind of express themselves, and the RSD comes out at that point. So this is about behavioral approaches. This is about considering medication, but only when it's absolutely necessary. Use it as a, a, you know, a, a foundation. Less, less is more. Start to get the-

    29. APAlex Partridge1:16:09

        Hmm

    30. SPSpeaker1:16:09

        ... understanding behind it. Start to get the, the skills around parenting. Be consistent, okay? Um, be boundaried, because there's no point in, in, you know, being in a relationship where parent... father's saying one thing, mother's saying another, and you've got sometimes, you know, parents who you've got dual households.
15. 1:18:14 – 1:19:49

    A letter from the previous guest

    1. APAlex Partridge1:18:14

       Just finally, I'm gonna deliver to you a letter that was written by the previous guest where they wrote their three rules to live by.

    2. SPSpeaker1:18:21

       Wonderful.

    3. APAlex Partridge1:18:22

       There we go. If you could kindly open that and read them out.

    4. SPSpeaker1:18:25

       Thank you. Three rules to live by. "Your gut feelings are probably just, and you feel that something's going on for you or your child, there probably is." Number two, "Success..." Oh, sorry. "School is difficult, socially, emotionally, and academically. Listen to your children when they say it's tough, and acknowledge their feelings." That can be hard sometimes when you've got ADHD yourself.

    5. APAlex Partridge1:18:56

       Hmm.

    6. SPSpeaker1:18:56

       So many competing interests. "You are doing your best, and your, your best is always enough." I think that's really important. Yeah. Sometimes we feel that we always need to be doing the best. Good enough is satisfactory.

    7. APAlex Partridge1:19:12

       Hmm. Amazing advice.

    8. SPSpeaker1:19:12

       Wise, wise words, those.

    9. APAlex Partridge1:19:14

       Um, es- p- especially the first one.

    10. SPSpeaker1:19:15

        Hmm.

    11. APAlex Partridge1:19:16

        Like, listen to your gut. It's, it's... I wish I knew that sooner, I think. You know, as soon as your gut says no, it's a no. [laughs] Um, I guess learning to trust it or be able to take action on it is harder, but-

    12. SPSpeaker1:19:28

        Yeah

    13. APAlex Partridge1:19:28

        ... it's such a good bit of advice.

    14. SPSpeaker1:19:29

        Well, knowing the link between, you know, that gut-brain axis and the significant issues that people have with gut hypermobility, inflammation, there's probably a lot more to it than just meets the eye there.

    15. APAlex Partridge1:19:43

        Dr Asad, truly fascinating. Thank you so much.

    16. SPSpeaker1:19:45

        Thank you so much. Absolute pleasure to be here. Thank you. [outro music]

Episode duration: 1:19:50