Psychiatrist Who's Diagnosed 10,000 Women With ADHD & Autism: "THIS Still Shocks Me!"

1. 0:00 – 1:27

   Trailer

   1. SPSpeaker0:00

      ADHD and autism are almost opposite sides of the same coin. The ADHD brain is free-floating, creative. The autistic brain is a bit more sticky, likes routine, structure. They can end up hiding each other. Dr Shyamal Mashru is an award-winning psychiatrist and ADHD expert. Having treated thousands of people with ADHD, his enormous understanding of ADHD-

   2. APAlex Partridge0:23

      Makes this one of the most detailed episodes ever- On the pros and cons of an ADHD diagnosis.

   3. SPSpeaker0:29

      Children with ADHD, by the age of 12, have received 20,000 more critical comments. If you're constantly receiving those messages from early childhood, that's gonna start battering your self-confidence. Then you're gonna go into work environments where you're struggling much harder than others to get things done. That narrative, it just keeps going and going and going.

   4. APAlex Partridge0:50

      Can getting an ADHD diagnosis and understanding ADHD rebuild self-esteem?

   5. SPSpeaker0:55

      I often tell patients-

   6. APAlex Partridge0:57

      Can I have just a second of your time? If this podcast has helped you understand your brain or made you feel less alone, can you do me one favor? Can you hit the subscribe button? And I'll repay the favor by continuing to book the best and most exclusive conversations on this topic. Please enjoy the episode, and always remember, you're not broken, just different, and you have always been enough. [instrumental music] Some people don't get diagnosed with ADHD. They get an explanation for their entire life.

2. 1:27 – 3:52

   The Most Life-Changing ADHD Diagnosis Story

   1. APAlex Partridge1:27

      What's the most life-changing late ADHD diagnosis you've ever seen?

   2. SPSpeaker1:33

      Yeah. Um, so good question. Um, one story that really sat with me was a lady that came to see me. She was in her 70s, and she had a diagnosis of cancer, and she probably had two years left to live. She had seen our first podcast, and she wanted an explanation for herself. She didn't actually want treatment. She just wanted the assessment to really know. And her story was a tragic one, so she'd had three divorces, lots of broken friendships. She'd lost contact with her siblings. Even her children were a bit estranged to her, and educationally, she struggled. Um, she had a very checkered employment history, breaking down relationships with her colleagues and with her employer. Lots of people around her had labeled her selfish, careless. Um, she just felt like a horrible human being, and so she was really broken when she came to see me. We did an ADHD assessment, and it was a very clear history of childhood symptoms, but we analyzed her relationships 'cause that was the big problem area of her life, and we realized that she had very impulsively got into romantic relationships with a lot of enthusiasm and then suddenly felt trapped and bored, and then she impulsively ended them. Similarly, with friendships, she was described as too much for people, too intense, overly sensitive, and then she would take that really badly and break those friendships. And she was much more sociable when she was younger, but as she had got older, she had just become much more of a recluse. When we joined the dots and she started to understand why she'd been the way she'd been, she s- could look at her life in a different way. There was a shift from, "I am the problem," to, "I have a problem that hasn't been managed." Now, a diagnosis in her case didn't repair her relationships, but I would like to think that the last couple of years of her life she spent in a much more compassionate way towards herself, and I think that's a really critical time for her to have that moment.

   3. APAlex Partridge3:47

      That's a super impactful story, Shy. Thank you so much for sharing it.

3. 3:52 – 5:18

   The Emotions Nobody Warns You About After an ADHD Diagnosis

   1. APAlex Partridge3:52

      When someone gets a diagnosis later in life like that lady, what sort of emotions does somebody experience when they get that, "It's ADHD. It's been ADHD all this time"?

   2. SPSpeaker4:03

      There's a mixture of emotions. There is a sense of grief, um, a bit like a bereavement process, where they mourn the lost years, right, of not understanding why they were struggling where other people weren't struggling. There's a sense of relief as well because they finally understand the cause behind their lifetime struggles. It all... The, the kind of the, the jigsaw pieces come together, right? But then inevitably, for most people, there is a sense of anger because they feel angry that other people didn't pick it up sooner. The same people that might have labeled them, actually, right? Especially when there's very clear-cut childhood histories of symptoms. One remark that someone said to me stuck with me about this. They said, "It's, it's like I've begun... given an instruction manual to my brain."

   3. APAlex Partridge4:56

      [chuckles] Yes.

   4. SPSpeaker4:56

      Right? So I often tell patients, "You've been blaming your character for what is actually your wiring." And when they fully understand that, they move from a place of self-loathing and self-criticism to understanding awareness and self-compassion, and that's when the work can really

4. 5:18 – 6:48

   Why People With ADHD Believe They're Broken

   1. SPSpeaker5:18

      begin.

   2. APAlex Partridge5:19

      Why do so many people with ADHD grow up believing they are fundamentally bad or broken?

   3. SPSpeaker5:24

      When you've had a lifetime of forgotten appointments, missed deadlines, struggles with education, struggles with employment, struggles in relationships, so every facet of your life has been a struggle, it's an understandable conclusion that you're gonna feel like you're fundamentally flawed or something's wrong with you because why are other people not struggling the way you are? On top of that, you get given all these labels. So when you're younger, you get labeled by your teachers as lazy, bright but not meeting your potential, um, careless, overly talkative, for some people very disruptive, for other people actually very socially anxious so they don't say anything at all. You feel misunderstood.Right? That's what people feel like, and that's one of their earliest memories when they're neu- have, when they're neurodivergent, for many patients. So it's a f- when, when people keep telling you that you are a certain way, eventually you're gonna believe it, right? It's y- that's gonna be part of your personality, you think. Maybe you're not just smart enough. Maybe you're not good enough. Maybe you're just not enough. So it's just a natural foregone conclusion. You're never, ever gonna think, "Well, is my brain wired differently to the environments that I'm in, that assume it to be working in a different way?" You're never gonna think like that, because you can only compare yourself to you and the struggles you've had throughout your whole life.

5. 6:48 – 8:24

   The Damage of Spending Decades Thinking You're the Problem

   1. APAlex Partridge6:48

      What happens if someone does spend decades believing that they are the problem?

   2. SPSpeaker6:53

      That's the most painful part of undiagnosed ADHD. So there's been lots of studies done, and there's a certain figure that gets quoted quite a lot, where children with ADHD, by the age of 12 years of age, have received 20,000 more critical comments than people without ADHD, right? So if you're constantly receiving those messages from early childhood, that's gonna start battering your self-confidence. It's gonna start making you view yourself in a different way, and essentially, you're gonna just feel like you're not enough from such a young age. Then you're gonna go into work environments where you're probably struggling much harder than others to get things done. So again, that narrative just plays itself out again. "I'm not good enough here." You're gonna struggle in your relationships. Your partner might have to carry a lot more of the household chores, for example. That's gonna put a strain on your relationships. So that narrative, it just keeps going and going and going throughout your life, and that leads to a lot of shame, and the shame leads to a lot of breakdown of confidence.

   3. APAlex Partridge8:06

      Yes. Those 20,000 extra horrible comments in your formative years essentially creates an adult who's got absolutely zero self-esteem.

   4. SPSpeaker8:14

      Yeah.

   5. APAlex Partridge8:15

      And I saw a quote on self-esteem that said, "Self-esteem changes when you stop asking what's wrong with me and start asking what happened

6. 8:24 – 12:23

   The ADHD Assessment That Saved a Life

   1. APAlex Partridge8:24

      to me."

   2. SPSpeaker8:24

      Mm-hmm.

   3. APAlex Partridge8:25

      Have you seen an ADHD diagnosis arrive at the exact moment when someone was about to give up?

   4. SPSpeaker8:30

      Yeah, absolutely. I've seen a number of cases like that, but I'll, I'll give you one that stuck out to me. So I met a mother who had had two children, and after the birth of both those children, she was diagnosed with postnatal depression. She'd had various antidepressants, CBT, but she came to see me and she said, "Something's not right. I'm feeling overwhelmed all the time, and that's affecting my mood, and I think that's why I've been, been diagnosed with postnatal depression." When you looked at her on the surface, she was, quote-unquote, high functioning or low support needs, right? So she had a successful job, um, married, good house, kids in good schools. She looked like she was doing really well, but when we scratched under the surface of it all, the home life was a lot more chaotic. So there was missed parents' evenings, which she felt horrendous about. She'd got the dates and times wrong. There were m- late school forms that needed to be done. Um, children were wearing school uniform on mufti day when they're meant to wear-

   5. APAlex Partridge9:39

      Mm. Yes

   6. SPSpeaker9:39

      ... you know, casual clothes, right? Which is a big deal when you're at school, actually-

   7. APAlex Partridge9:43

      Yes

   8. SPSpeaker9:43

      ... for that, f-f-

   9. APAlex Partridge9:45

      Yes. [laughs]

   10. SPSpeaker9:45

       Not, not for the parent, for the, for the student, right, as well. She was constantly running late for work, constantly apologizing. The home life was a bit messy in terms of her husband had a very, um, sort of highly successful job, working a lot of hours, but he felt like he had to pick up a lot of the slack in terms of household chores, and that it wasn't a 50/50 split there. So that had a strain on their marriage. But the worst bit about it was, and this is when she came to me, she felt like a bad mum, right? So she'd look at all the other mums and say, "Well, they can get the basic things done, and I'm struggling here, like, in a way that I don't understand." Also, her maladaptive coping mechanisms that she had before, you know, when you have two young kids, you can't do the lace, like, the last-minute PowerPoint presentation to the exec board-

   11. APAlex Partridge10:39

       No. [laughs]

   12. SPSpeaker10:39

       ... the night before. You can't do that anymore, right? So she was really struggling. And when we took a... And, and the, actually the reason why she never came for an ADHD assessment was because she's like, "Well, I'm too high functioning to have this, so w- you know, I'm not gonna come for one." And then she started learning more about it 'cause she was watching different podcasts and, you know, learning more about this, and she said, "You know what? I'm gonna have an ADHD assessment." And when we did an assessment, there were childhood symptoms, but it was slightly different. She wasn't disruptive at school at all. She was well-behaved, but there was a lot of reports around her being bright but not meeting her potential, essentially. And what was more interesting is that she raised concerns about her children. She said, "My kids are reminding me of me," right? So they were high energy, very emotionally sensitive. Well-behaved, but they could get... you know, have tantrums at home. And so our child psychiatrist saw them, and they were diagnosed with ADHD. And then we developed a tailored management plan, so for her, medication, psychoeducation. But for the children, we worked with the SEND tutor at the school, um, to develop behavioral strategies for them, and the outcome was a positive one, obviously for her, but also for the children, because the earlier you diagnose ADHD and the earlier you start management, the better the prognostic outcomes, so they might not have to go through the same struggles that she did.

   13. APAlex Partridge12:13

       So interesting. I guess with her beating herself up over being a bad mother, you have to forgive yourself for decisions that you made when you didn't have all of the information.

7. 12:23 – 14:12

   Why Self-Understanding Changes Everything

   1. SPSpeaker12:23

      Mm-hmm.

   2. APAlex Partridge12:24

      How important is self-understanding for someone who has spent years and years and years hating themselves?

   3. SPSpeaker12:30

      Well, I think self-understanding is at the core of self-esteem. Yeah? So when you can look at your life in a different lens, so you stop blaming yourself for everything, and you start understanding that, "I have an ADHD brain. I have to approach certain tasks differently. My brain is wired for, um, novelty, um, and interest rather than dull, repetitive tasks."

   4. APAlex Partridge12:59

      Yes. Yes. [laughs]

   5. SPSpeaker13:00

      Yeah. You, you start... You can then, hopefully, try to modify certain circumstances in your life to suit your brain, and then if you start being able to achieve the things that you were then struggling with because if you have those supports in place, that helps build your morale and, and the way you look at yourself.

   6. APAlex Partridge13:20

      And in the story of that mother, can getting an ADHD diagnosis and understanding ADHD, can that genuinely rebuild self-esteem?

   7. SPSpeaker13:29

      Yes, because the first thing it does is it gives you an explanation for why you struggled. Right? The next thing it does is it starts to reduce the shame, 'cause shame comes in because you feel you're incompetent in some way, right? So when you start to reduce the shame, that's when you start building that self-confidence, and ultimately, I think the self-confidence develops when you start to develop strategies to help in those areas that you're weak in. You're never gonna be great at those things, but if you develop techniques to, to get around them, then you'll feel less of a bad mum, for example.

8. 14:12 – 18:34

   The Pain of Rejection Sensitivity Dysphoria (RSD)

   1. APAlex Partridge14:12

      We touched upon Rejection Sensitivity Dysphoria briefly earlier, um, where one small criticism can feel emotionally catastrophic-

   2. SPSpeaker14:21

      Mm-hmm

   3. APAlex Partridge14:21

      ... when your nervous system has spent years bracing for rejection, so it anticipates it around every single corner. But how painful can Rejection Sensitivity Dysphoria really get?

   4. SPSpeaker14:36

      It can have some real devastating consequences, and I think the best way for me to describe this is actually through a patient that I had seen, um, not so long ago. So he was a university student in his final third year of his degree, which is the most important year in terms of those assignments carry the most weight towards your final grade.

   5. APAlex Partridge14:55

      Sure.

   6. SPSpeaker14:56

      And he hadn't actually asked for the assessment. His parents had, because they were really worried about him. So he was living in a house with three other housemates, students, and he wasn't coming out of his room very much, and they actually discovered that he was self-harming, like he was cutting himself. Yeah. Um, so they were quite panicked, and they called his parents. So his parents called him to see me. The university had concerns because he hadn't been showing up for any lectures, none of the workshops, um, he hadn't submitted any of his assignments in that final year, um, and he had a big dissipa- dissertation coming up as well, and he hadn't even responded to any of his tutors' emails. So he reluctantly saw me. He'd... He wasn't keen to see me at all. Um, and he was very withdrawn, actually. And essentially, when we analyzed him over a few sessions, we realized that it wasn't that he wasn't concerned about his degree. He was too concerned about his degree. So he was absolutely terrified and paralyzed in fear about getting this dissertation wrong and not getting a good mark or getting some bad feedback from his tutors. He'd, he'd got through the first two years with last-minute cramming, revising for exams, like lots of students do, but he couldn't get over this, and this is a symptom that's often called procrastination.

   7. APAlex Partridge16:24

      Mm-hmm.

   8. SPSpeaker16:24

      But sometimes this is misunderstood, and, and this is where RSD can play a role, because he was absolutely fearing failing that dissertation, right? So w- we did a lifelong history, um, an assessment of him, and his symptoms were a bit more tricky. He had gone to a very academic school, but he hadn't met his predicted GCSE or A-level grades, so he went to a school which had very high expectations of him. His parents had high expectations of him. But he hadn't met his grades, so he feel like... he felt like he'd let people down. Then he went therefore to a university that wasn't his first choice university doing a degree that wasn't his first choice degree, which is very hard for an ADHD brain.

   9. APAlex Partridge17:09

      Yes.

   10. SPSpeaker17:09

       It's hard for anyone-

   11. APAlex Partridge17:10

       Yes. [laughs]

   12. SPSpeaker17:10

       ... but that's very hard for an ADHD brain. So we developed a management plan for him. We worked with the uni, explained what's going on here. We even had one of our coaches explain how they might wanna give feedback to him as well in a, in a more sensitive way. He had a one-to-one tutor. He had some reasonable adjustments. He had some extra time for his assignments. We did give him medication as well to help with some task initiation. A lot of the therapy is working around explaining to him that he has a brain that is not geared towards initiating tasks, especially tasks that he's not particularly passionate about, but also an over-amplified nervous system that is very sensitive to the potential of rejection. It's a work in progress. He's no longer self-harming. He doesn't have suicidal thoughts. He's now working through his assignments, but the next piece of work for him will be to try and develop emotional resilience when he goes into the workplace, 'cause this could really occur again. That's a very strong example of how RSD can impact people in a very serious way.

   13. APAlex Partridge18:14

       Wow. Yeah, no, it's really powerful. If someone is suffering like that in that way, like they've got such an intense fear of critical comments from the outside world, and they isolate themselves, and they don't socialize, or they don't submit work because not they're capable, it's just the idea of getting any criticism is so painful, so they withdraw. Can that...

9. 18:34 – 20:45

   The Loneliness of ADHD Nobody Talks About

   1. APAlex Partridge18:34

      That sounds lonely. Is that a lonely experience?

   2. SPSpeaker18:36

      It's an incredibly lonely experience. When you have very strong RSD, it's like walking through an emotional minefield in your life. So your natural coping mechanism is to avoid things that are gonna trigger that, the emotional bomb going off. So you might, in its worst case, completely avoid relationships. You might avoid social interactions. I've had lots of patients tell me, "Oh, you know, when I was younger, I was actually a lot more sociable. And as I've got older, I, I have minimal contact with people," or, you know, "I've tried to contact friends," or, "They've tried to contact me rather, and I might cancel meeting them at the last minute." That can impact people in a work setting as well because if you work in certain sectors, like certain corporate industries, you don't attend work events like social work events. Those are not work... You know, they, they're not social events. That, that can impact your career in some way. So people, as a protective mechanism, they think it's a protective mechanism, will avoid situations, and that can start to become incredibly lonely. And loneliness in itself can have a great impact on someone. So from a psychological perspective, loneliness naturally, as you can imagine, leads to depression, anxiety, and in some cases, suicidal thoughts. There's a lot of medical literature studied, um, in the more elderly populations where loneliness on its own is a risk factor for mortality beyond other physical health conditions. So, so, so loneliness can play its role in terms of affecting you mentally and physically.

   3. APAlex Partridge20:22

      If you do suffer from Rejection Sensitivity Dysphoria, I guess a key coping strategy is to almost hide who you are because you've been told 20,000 times that who you are is defective, so you put on a character, you shape-shift, you adjust yourself to fit in. But I suppose you can mask to such an extreme that you end up losing sight of who you really are.

10. 20:45 – 22:22

    The ADHD Identity Crisis After Unmasking

    1. APAlex Partridge20:45

       Have you ever met someone who was masked so severely they don't know who they are anymore?

    2. SPSpeaker20:51

       Yes, and this is actually the reason why we have all these pre-assessment forms before an ADHD assessment, and I know they're the bane of people's lives, and they often complain about doing those forms. But there are two things that I really want to know. Firstly, what were they like as a child before they learned what masking even was, right? And often you're gonna see a profile of them with sort of explosive emotions 'cause they don't know how to explain what that feels like inside, all that emotional turmoil. Secondly, how do they present in their home lives, right? So like the mother example, on the outside surface, they might look like they've got everything together. But in, at, at home, they've spent so much energy at work with their maladaptive coping strategies-

    3. APAlex Partridge21:48

       Mm. Yes

    4. SPSpeaker21:48

       ... they're completely spent by the time they get home. And then if you have a new stressor in your life, such as the birth of new children or, um, a promotion in your job to a more senior role that you then struggle with, which has much more responsibility, or perimenopause and menopause, you know, sex hormones come into play, and then that make, makes it a lot harder for you. That is where the struggle is, and the difference between the public persona and their personal life often reveals their ADHD profile.

11. 22:22 – 23:42

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    1. APAlex Partridge22:23

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12. 23:42 – 27:27

    A Quick Test to See How Much You're Masking

    1. APAlex Partridge23:42

       Is there a quick way someone could almost do a self-test to see how much they're masking? Are there some questions you could ask yourself? Like, for example, did I walk away from that conversation feeling energized, or did I walk away from that conversation feeling drained? What do I, what do I watch when I'm on my own, or what do I listen to, and is that different to what I say I like to listen to when I'm in company? Like, how do you explain masking to somebody who doesn't understand it but might be doing it themselves?

    2. SPSpeaker24:14

       So masking is when you're either consciously or often subconsciously hiding your ADHD traits in this exampleUm, I say subconsciously 'cause you've never been diagnosed with ADHD, you don't actually realize what you're hiding, right? But the point of it is, is that you're trying to appear together. Now, why does that happen? Most times it's actually because of stigma and shame, right? So you see this happening in a lot of people, but let's just take someone who's potentially, quote-unquote, again, high-functioning or lower support needs. If you're in a really sort of high-flying job, right, how embarrassing is it to say, "Yeah, but, you know, I, I, I left my clothes in the washing machine for two days and, you know-

    3. APAlex Partridge25:05

       Yes. [laughs]

    4. SPSpeaker25:05

       ... I boil the kettle loads of time and I make the cup of tea." It's just, it just, it just feels embarrassing, right? So you try and hide that embarrassment, and that's why you mask. Yeah? So, um, that's the cause of it. Now, in terms of questions asked, you know, pe- One question which really cuts through people is, before you go to that event, do you rehearse conversations? That one-

    5. APAlex Partridge25:37

       [laughs]

    6. SPSpeaker25:37

       ... people feel naked when you ask that question.

    7. APAlex Partridge25:40

       Yes.

    8. SPSpeaker25:40

       Right? And then especially when they realize that not a lot of people do that. And yes, like you said, do you find that you're agreeing a lot? You know, people will often not just interrupt in conversation, because that's one of the symptoms of ADHD, but they'll almost be, "Yeah, that happened to me too, me too, that's happening to me." They're, they're trying to fit in, and if you think about it, that's coming back from childhood, where they didn't feel like they ever fitted in. They always felt like they were on the periphery of social circles, struggling to be accepted. Those patterns are playing out subconsciously in later life. Also, masking is exhausting, right? To, to, to do this, either if it's conscious or subconscious, it's tiring. So one question is, well, when you finish your day of work, what are you like? You'd ask their partner what are they like. They're not listening, then you end up ticking the box, they're not paying attention to conversation, which is a symptom. But why are they not listening? 'Cause they're knackered. Mentally, they're done. The brain is like, "Enough is enough, I'm packed in." And long, prolonged periods of masking will eventually lead to burnout, and that's when... That's your brain's self-protective mechanism to say, "I'm not doing this anymore." And burnout is actually one of the leading causes of sort of sickness from work nowadays.

    9. APAlex Partridge27:05

       High masking can look like high achievement-

    10. SPSpeaker27:08

        Yeah

    11. APAlex Partridge27:08

        ... to the outside world. You can look like you've got your stuff together, you, you get that promotion, you're, you're doing amazing things, but the real you is crumbling and, and falling apart behind the scenes. But that's, that's the mask. That's behind the mask. That's the invisible part that nobody sees. The, the shame and the having to contend with that inner turmoil,

13. 27:27 – 31:37

    When Shame Leads to Addiction

    1. APAlex Partridge27:27

       can people lean on unhealthy mechanisms as a masking mechanism?

    2. SPSpeaker27:32

       Yeah, absolutely. Um, I'm gonna give a, actually, a, a real-life example of this, just, just to show what, what this can do to people. Some people will lean on alcohol and substances in a very unhealthy way, and that can lead to addictions, actually. Um, up to a third of people in substance misuse services have undiagnosed ADHD. That's what the research shows. That's a huge number. The problem is, when they go to the substance misuse services, then healthcare professionals will naturally focus on the presenting problem, which is we've got to g- get them off the alcohol and the drugs, which is, of course, important. But really what's important is, well, what caused them to do that in the first place? So I met a man who was in his 50s, and he had decades of alcohol and cocaine abuse. He was under substance misuse services, and they had referred him to our clinic. This guy was a real high-flyer. He was working in insurance. He had a very senior position. He'd lost his marriage, he'd lost contact with his two kids, who are now young adults, and he had lost his job over the years. And we did an ADHD assessment, and in his childhood history, he was very high on the impulsive spectrum, so he was, uh, often getting into arguments with other kids, a very explosive temper, talking back to the teachers. Classically quite hyperactive as a child. Then in adulthood, when he went into work into his role in, in insurance at a junior level, he had become a more introverted person, and that's because he was very self-conscious. He felt like he shouldn't have been there. We call this imposter syndrome now, because he said, "Well, I didn't do that great at school," but he was very good at his job. So he described when he would be in social settings, his m- sort of mental activity was ceaseless, and what he would do is use alcohol to help numb his mind a bit so that he could actually sit there and take part in conversations appropriately and not overthink everything. In that culture, he said that there was a lot of alcohol use, but then there was also cocaine use, and he experienced what's called paradoxical drug effects. He said that when he took cocaine, he s- he felt absolute clarity. He felt totally calm and peaceful, and he actually craved that feeling. Wasn't... It, it was what the cocaine was doing to his mind. The reason why that happens is because cocaine is an amphetamine, and slightly varying the form-

    3. APAlex Partridge30:14

       Yes

    4. SPSpeaker30:14

       ... chemical formulation of cocaine is, is what is an am- amphetamine-based stimulant. So we treated him initially with medication.Um, with long-acting amphetamine-based stimulants, which you, you know, they don't produce euphoric effects, so it doesn't make you wanna have cocaine. And when-- in those cases, you have to be very careful because if someone is using cocaine on top of their stimulants, they are at increased risk of things like a heart attack or, uh, going into cardiac arrest. So we work closely with the substance misuse team. He remained abstinent. He's still been abstinent for the last couple of years. But then was the therapy work, which is the really important part in the longer term, because we wanted to shift him from labeling himself as just an addict to someone that had undiagnosed ADHD, who was just using whatever tools was available to him to survive. Now, his diagnosis and treatment's not gonna magically repair his relationships. He still hasn't much contact with his ex-wife or his children, but at least it allows him to carry on his life, a new chapter perhaps, with a much more positive lens.

    5. APAlex Partridge31:28

       So addiction, clearly a huge complication in the ADHD conversation, and another complication that is coming up more often at the moment

14. 31:37 – 36:48

    How Common Is AuDHD?

    1. APAlex Partridge31:37

       is the joint diagnosis, ADHD and autism-

    2. SPSpeaker31:40

       Mm

    3. APAlex Partridge31:40

       ... or AuDHD, as the community have called it. Um, and you mentioned earlier you had a patient whose autism masked their ADHD so well that they were actually denied treatment that could have changed their life?

    4. SPSpeaker31:55

       Yeah. So, um, well, they're, they, they were actually a patient that had come to us for what's called a combined assessment. So in our clinic, we have combined assessments. Um, in fact, one of the clinicians that does them, you know them very well, Dr. Khurram Sadiq.

    5. APAlex Partridge32:11

       Yes.

    6. SPSpeaker32:12

       Um, he's been on this show a couple of times. So that's quite a unique assessment where we look at both. Now, the case of this patient was someone that actually had gone to other providers for separate autism and ADHD assessments, because not everyone does combined assessments, so they'd gone separately, and they'd been told by both providers that they didn't meet the diagnostic criteria of each one. So they came to us really quite lost-

    7. APAlex Partridge32:38

       Yeah. [laughs]

    8. SPSpeaker32:39

       ... and kind of wanting a second opinion. They were, you know, a bit, bit upset about it all. The reason why this happened is because ADHD and autism are almost sort of opposite sides of the same coin, right? And one can hide the other one, right? I know Khurram calls it order and anarchy in the same person-

    9. APAlex Partridge33:00

       Yes

    10. SPSpeaker33:00

        ... right? Which is quite a really lovely ana-analogy. But the ADHD brain is free-floating, creative, 'I want the, the new thing, I'm interested in the novel ideas.' The autistic brain, and there's... I'm gonna get a lot of negative comments in the, in the video for this-

    11. APAlex Partridge33:19

        [laughs]

    12. SPSpeaker33:19

        ... but, and I'll try and explain myself, but the autistic brain is a bit more sticky, okay? Likes routine, likes structure, likes certain things the way they are, and that's how they should be. So they can end up hiding each other, and I'm gonna give some real examples of that, right? So during an assessment, one question that w- an ADHD assessment, if you just did that on its own and you said, "Are you very talkative?" They'll say, "Oh, no way. Like, I'd be way too anxious to just start talking about things like that in front of people." Then you would say, "No, they're not talkative. They don't have that ADHD symptom." But if you dig a bit deeper, they'll say, "Well, I was actually bursting to say something, but I was so conscious, you know, socially conscious or anxious to do that. 'Cause, I mean, how would that look?" So the autistic side is masking it. But then if you start getting them to talk about, you know, a certain PlayStation game that they're really into, they can talk about that for hours-

    13. APAlex Partridge34:26

        [laughs]

    14. SPSpeaker34:26

        ... right? Nonstop. And they know everything about it, or, like, their favorite TV show. They know all about the actors and the characters and everything. Or, for example, um, one of the questions that we ask in an ADHD assessment is about, you know, are they very organized? And they'll say, "Yeah, no, I've got lots of color-coded diaries and long lists." And so you'll say, "No, they don't have that as a symptom." But if you dig a bit deeper, but do they actually execute those tasks? Do they know how to prioritize them? No, they don't sometimes, right? Unless it was an area of absolute passion. So they can mask each other and camouflage each other, and unless you go to someone who really has a true understanding of both of those conditions, you will never understand your full sort of neurodivergent profile.

    15. APAlex Partridge35:15

        In your professional opinion, how many people do you think who have ADHD would reach the criteria for an autism diagnosis as well?

    16. SPSpeaker35:25

        [lips smack] So, I mean, I think the figures show around 15%. It's more the other way around, actually. When you have autism, you'll, as a diagnosis, you probably likely have ADHD traits. Um, and you... It's, it's, it's quite complex because you can have both but show, reveal a bit more of an autistic profile or more of an ADHD profile. Um, but that's why really careful sort of history-taking and examination of that is really important to understand it.

    17. APAlex Partridge35:55

        Are there any specific mental health challenges that can come with having an AuDHD profile?

    18. SPSpeaker36:01

        Yeah. So there's one cohort of, um, patients that have been studied quite a lot. Um, these are females with autism and ADHD, and that group is particularly vulnerable to very high levels of masking, but in particular, masking their emotions. One of the core traits of autism is an inability to express your emotions or communicate, you know, how you're feeling very clearly.So if you start having more negative thoughts, depressive thoughts, you're less likely to reach out for help, and there's a lot of research that shows that that particular group are much more vulnerable to suicidal ideation and suicidal attempts. So that's where it can become really quite clinically significant.

15. 36:48 – 38:38

    Why ADHD Burnout Can Appear Out of Nowhere

    1. APAlex Partridge36:48

       Is it possible that someone with ADHD, diagnosed or not, can they go years and years and years without issues and then suddenly, out of nowhere, burnout springs up and takes them by surprise?

    2. SPSpeaker37:02

       So burnout very rarely came out of nowhere. It might feel like that to the person because they might have subconsciously been sort of using their coping strategies, masking, for all these years, and then suddenly there'll be a trigger, a new stressor. So like some of the examples we gave in, you know, um, birth of children, change in your sex hormone profile, you go through perimenopause or menopause, um, more responsibility at work. At that point where you can't use your coping strategies anymore, you can't do last-minute work, essentially, you then really struggle, and then people describe feeling overwhelmed. Over time, the brain can't take that anymore, and then it-- that leads to exhaustion, and we call that burnout, essentially. But it hasn't come from nowhere. It, it's come from, from years of doing this and then a new stressor in place which sort of propagates the problem.

    3. APAlex Partridge38:10

       I wanna move on to the most unpredictable part of the show, and that is audience questions.

    4. SPSpeaker38:16

       Mm.

    5. APAlex Partridge38:16

       And there's thr-three of them.

    6. SPSpeaker38:18

       Okay.

    7. APAlex Partridge38:18

       And they're in the Washing Machine of Woes, and it's called the Washing Machine of Woes because they're woes from the audience, and the washing machine is a public service announcement for everyone listening-

    8. SPSpeaker38:26

       [chuckles]

    9. APAlex Partridge38:26

       ... to remember to empty their machine if it's, uh, if they've forgotten to empty it after the cycle.

    10. SPSpeaker38:31

        Yes.

    11. APAlex Partridge38:31

        Do you do that? Do you forget to empty your machine?

    12. SPSpeaker38:33

        I can't say I do. [laughs]

    13. APAlex Partridge38:36

        [laughs] I do rely on the Tiimo app,

16. 38:38 – 40:16

    What Happens When You Stop Masking?

    1. APAlex Partridge38:38

       which is the sponsor of the show, to help me, but I'm still very much a work in progress. So Shai, the first question that somebody from the audience has written in and asked: "I've built my entire life by masking my ADHD, but I'm completely burnt out. What happens if I stop pretending?"

    2. SPSpeaker38:58

       If you stop pretending, you'll get better. Um, that's actually a big focus on the recovery side that we do in therapy around prolonged masking. First of all, you have to ask, "Why do people mask?" They mask because of stigma and shame, because they might be getting some of the hard things right, but they're getting the simple things wrong, or they're finding the simple things really difficult, and they can't explain that to anyone. So first of all, have an assessment, learn more about yourself, and then learn to drop your mask in situations where you feel safe to do so. Right? So maybe around your loved ones, first of all. Talk about this condition. Initially, some people are gonna be cynical. That's life. But in today's modern society, people are actually quite intrigued. That process is not to educate other people about your condition. That process is actually therapy for yourself because the more open you can start to become about your vulnerabilities, naturally, the less you're gonna mask about them, and then you won't burn out as often.

    3. APAlex Partridge40:11

       Fascinating. Thank you so much. We're gonna move on to the next question. This one's super interesting.

17. 40:16 – 41:41

    Does ADHD Medication Change Your Personality?

    1. APAlex Partridge40:16

       "I'm terrified ADHD medication will change who I am. Will I lose my personality?"

    2. SPSpeaker40:23

       Mm. I get this one a lot-

    3. APAlex Partridge40:24

       [laughs]

    4. SPSpeaker40:24

       ... in clinic. Um, okay, there's a mixed answer to this one. Coming back to what we've talked about before, autism and ADHD, in that profile of patients, if you actually remove the ADHD, um, profile, you're gonna be left with the autistic profile, and in those cases, some patients can feel more introverted. The introverted part was there before, but the ADHD that was covering that is gone, and that's where it's very important to have a clinician who understands this because that might need some therapy work and also some pre-warning. But generally, no, you're not, y- you're not gonna lose your personality. But if you are very, um, extroverted to a sense where you've regretted it afterwards and you were so, um, intense in your interactions that afterwards you felt horrendous about it, that will certainly happen less.

    5. APAlex Partridge41:35

       Makes a lot of sense. Thanks so much again, Shai. And finally, this question I think is gonna change lives.

18. 41:41 – 42:50

    Can Untreated ADHD Cause Depression?

    1. APAlex Partridge41:41

       "Could untreated ADHD actually be the real reason behind my severe depression?"

    2. SPSpeaker41:48

       Yeah, that's a good question. So 70 to 80% of people with untreated ADHD go through cycles of anxiety and depression. They give a very typical story of being prescribed antidepressants, and they feel quite emotionally numb, and that's because the medication itself was pr- potentially treating the wrong chemical pathways. But from a psychological perspective, if you keep going through your life struggling, feeling like a failure, not feeling good enough, you're not gonna feel very happy at the end of that. You're gonna feel depressed. But that type of depression is slightly different to what might be-... clinical depression that we treat antidepressants with. That dy- type of depression is more around issues of self-esteem, self-loathing, self-criticism. So it's very important to tease apart these symptoms to make sure you're on the right treatment pathway.

    3. APAlex Partridge42:47

       Thank you so much. I've got a surprise for you.

19. 42:50 – 45:15

    A Letter to My Younger Self

    1. SPSpeaker42:50

       Mm-hmm.

    2. APAlex Partridge42:51

       I want to deliver to you a letter that was written by the previous guest, where they wrote to their younger self.

    3. SPSpeaker42:57

       Mm-hmm.

    4. APAlex Partridge42:57

       If you could kindly read that for us, Dr Shy.

    5. SPSpeaker43:00

       Okay. To my younger self, never stop asking questions. Don't always do what is expected of you. Remember what makes you happy. That's a really nice bit at the end. Remember what makes you happy.

    6. APAlex Partridge43:14

       Really important.

    7. SPSpeaker43:14

       Yeah.

    8. APAlex Partridge43:14

       Especially considering what we've been speaking about.

    9. SPSpeaker43:16

       Whether you have ADHD or you don't have ADHD.

    10. APAlex Partridge43:19

        100%.

    11. SPSpeaker43:20

        [laughs]

    12. APAlex Partridge43:20

        Dr Shy, on behalf of everyone grappling to understand their brains, thank you so much.

    13. SPSpeaker43:24

        Thanks a lot, Alex. [upbeat music]

    14. APAlex Partridge43:29

        Focused are running another survey and giving you the chance to win 150 pounds in Amazon vouchers. It's just a handful of simple questions, this time about how ADHD affects your health and lifestyle. To take the survey and enter the prize draw, see the link in the description for this video, or head over to Focused and hit the link in their bio. In the meantime, the results from their ADHD in the Workplace survey are in. This survey asked people with ADHD about their experiences in employment and job interviews. Some really interesting numbers came out of this. Nearly half of people, 47%, said they'd lost a job or been fired either because of or partly due to ADHD. Over half of people, 56%, said they'd had disciplinary issues at work caused by ADHD. 59% of people said they hadn't told their employer about their ADHD diagnosis, and a further 23% did tell them but waited at least a year to do so. So in total, this adds up to a combined 82% who were either hesitant to tell their boss about the condition or chose not to. Lots of possible factors at play here. Many people may worry about how they'll be perceived by their employer if they reveal their diagnosis, for example, as lazy or demotivated, and it seems to show that there's still a stigma around ADHD in the job market. 57% of people said they'd failed a job interview because of ADHD. Again, we all know how RSD and imposter syndrome can be real issues for people with ADHD, and it's possible we're seeing some of the effects of these play out in these numbers. Again, you can find the full results over on Focused. Hit the link in the description. If you're looking to get assessed for ADHD, Focused also offer two-hour consultations with clinicians for just 289 pounds. Use code CHATTER when booking to get money off your assessment

Episode duration: 45:15