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ADHD Chatter PodcastADHD Chatter Podcast

The AuDHD Expert: 3 Alarming Risks of Undiagnosed Female AuDHD | Dr Samantha Hiew, PhD

AuDHD (The dual diagnosis of ADHD + Autism) is on the rise, but how can we spot AuDHD in ourselves, or in those close to us. How can we spot it early in children and what are the risks of staying undiagnosed.

Dr. Samantha HiewguestAlex Partridgehost
Mar 25, 202551mWatch on YouTube

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Transcript

  1. 0:00 – 2:00

    Trailer

    1. SH

      They think that AuDHD is Autism plus ADHD, but AuDHD is a different animal altogether. We have the AuDHD presentation that at times looks so stable, and then all of a sudden you can completely swap to be a different personality.

    2. AP

      Mm.

    3. SH

      That can appear more chaotic to people, and it gets confusing-

    4. AP

      Mm

    5. SH

      ... to others and to yourself. Dr Samantha Hiew is a highly specialized ADHD expert neurodiversity and women's empowerment activist

    6. AP

      with a PhD in medical sciences

    7. SH

      late diagnosed with ADHD and autism herself. One of the strategies that they recommend for autistic individuals is energy management. You know, and when you feel, hear, and see more, of course the tank's gonna go fall a lot quicker than other people. Sometimes we can be overcomplicating the matter. It could be as simple as just understanding energy management. If we don't sleep well, like, we know that inflammation can increase in our brain. If we don't see enough light, that can affect the mitochondria in your cells that makes energy. And also, are you eating well? That gives you all the co-factors to power different organs and actually helps your brain.

    8. AP

      Loyal listeners and viewers, I can't thank you enough for tuning in. If you've ever felt broken or different, I hope this helps in your search for answers and community. And do you know what would really help me in return? By clicking the follow or subscribe button wherever you're listening. It might not seem like much, but at ADHD Chatter, it means a huge deal, and with this, I can book more incredible guests and keep the self-discovery fire alive for all of us, myself included. Just one click of a button goes really far, and remember, you have always been enough. [upbeat music] Dr Samantha Hiew, thank you so much for joining us.

    9. SH

      Thank you for having me, Alex.

    10. AP

      It's a real, real honor to, to have you back. Um, AuDHD, the, the, the, the, the term given to someone if they've got a dual diagnosis of autis- autism and ADHD. And to really start, um,

  2. 2:00 – 4:53

    The latest stats on the percentage overlap of Autism and ADHD

    1. AP

      the latest stats, I mean, what, what exactly are they? Like, what, what is the stats around the overlap percentage of between ADHD and autism?

    2. SH

      Yeah, so this is really interesting. Depending on which study you look at, it's also how that study is set up as well. Were they looking at, you know, ADHD in autistic individual, or were they looking at, um, autism in ADHD-ers? You know, and most of the stats were going from 20% to up to 70 to 80%.

    3. AP

      Mm.

    4. SH

      But given that there is such a rife underdiagnosis and the fact that we couldn't even diagnose both autism and ADHD together until 2013, then the figure, I imagine, it's a lot higher. But I guess it's up to that level, you know, of maybe 80%. But I can't say that for everyone, obviously, 'cause we're all different.

    5. AP

      Mm. Why, why do you think it was that it's only sort of recently that the, the community has recognized that you can have these two, two diagnoses together?

    6. SH

      I think it's, um, really stems from that mass diagnosis following the pandemic, you know. And so many people were get- getting diagnosed, you know, with either ADHD or autism later in life. And, you know, the fact that you have managed to, you know, be missed or fly under the radar for so long, you know, really goes to show that perhaps there is more to meets the eye. And as for myself, I didn't fully identify with the entire ADHD label, and I thought, you know, okay, that might be due to my upbringing and my culture, 'cause I'm cross-cultural, kind of raised in Asia, and then kind of grew up in-

    7. AP

      Mm

    8. SH

      ... in London, I would say. [laughs]

    9. AP

      [laughs]

    10. SH

      Mature in, in the UK.

    11. AP

      [laughs]

    12. SH

      So, so yeah, so it looks different. You know, it, they think that AuDHD is autism plus ADHD, but AuDHD is a different animal altogether.

    13. AP

      In what way do you think it's different? Because y- y- I've, I've heard AuDHD mentioned, and, like, I know what the sort of stereotype and, and how I present as ADHD can be very impulsive, very, um, say yes a lot, um, very hyperactive, very fast-working. That's always been my understanding of sort of what ADHD is for me. But on the, the other side, uh, this, this potential autism characteristics of the, the, the sort of being able to pick apart information and analyze data in a way that lots of people that I speak to who are just ADHD don't really relate to, and it's that aspect of it that, that makes me suspect that there is a little bit more there, plus some sort of sen- sensory, um, and lots of social issues.

  3. 4:53 – 11:47

    Why is there such a common overlap in Autism and ADHD

    1. AP

      I mean, for, for two conditions that seem so opposing and so in contrast with one another, why is there such a common overlap between ADHD and autism?

    2. SH

      Yeah, so it's really interesting. I always say that being an AuDHD-er, you are a mystery wrapped in an enigma-

    3. AP

      [laughs]

    4. SH

      ... to yourself and to other people. 'Cause you think that you know yourself, and then you go and do something different one day, which kind of completely surprises even you and the people around you. You know, AuDHD is different to pure ADHD and pure autism because we're looking at underlying genetic neurobiological differences. But also, you know, they are situationally variable. You know, we say that about ADHD, but with AuDHD, there is an underlying dopamine regulation difference in that it is not just a lower level of neurotransmitters like you would see with ADHD.

    5. AP

      Mm.

    6. SH

      You know, it is more that your dopamine and norepinephrine and serotonin, glutamate, you know, GABA. There's so many more neurotransmitters that we don't often talk about enough, and these are all in flux, you know. And depending on what you're doing in your life, what life stage you are at, and what are the effects on, of your biology on your, um, neurotransmitters and your hormones, you know. And also, I guess, what you're doing in your day to day as well, what is your lifestyle, you know, impact on- You know, those regulation of your-

    7. AP

      Mm

    8. SH

      ... neurotransmitters-

    9. AP

      Yeah

    10. SH

      ... your personality could very well change. Um, we talked about the different brain networks, right? That are impacted-

    11. AP

      Mm

    12. SH

      ... in, well, I would say, um, I won't say impacted because [laughs] that sounds as if we're patients. And I always think that if you're born with this neurodevelopmental condition, we're not patients, we are, you know, just individuals that our neurological development just diverges from the norm.

    13. AP

      Mm.

    14. SH

      Right? Um, and with AuDHD, it affects, um, the same brain regions, you know, in Autism and ADHD. It's the, uh, frontoparietal control networks, the default mode network-

    15. AP

      Mm

    16. SH

      ... and the salience network. Like, okay, so it affects those areas. So y- you, you look at the quality and, and the levels of neurotransmitters-

    17. AP

      Mm

    18. SH

      ... in any of those networks. You know, and if your dopamine regulation changes, you know, and your other neurotransmitter regulation changes, you know, throughout the day, the month, you know, and the year, then you're gonna get very different personality.

    19. AP

      Mm.

    20. SH

      So the fronto-pari- parietal network, you know, um, controls, um, the default mode network and the salience network. So it's basically the part that, um, kinda instructs, you know, you to... When it works typically, it instructs you to do the task that you're supposed to focus on. But if it doesn't work the way that you need it to, then it might, you know, kinda switch on the default mode network at the same time as the task positive network. So it means that you are in that perpetual looping, you know? But also, if you have more neurotransmitters in the frontoparietal network, and this is the prefrontal cortex and the other parts in it, then you are better able to have that top-down regulation that gives you that, you know, goal-directed pursuit-

    21. AP

      Mm

    22. SH

      ... um, ability to think about the long-term consequences of your actions.

    23. AP

      [laughs] Mm.

    24. SH

      You know? Um, and when you have those, um, yeah, regulation in the right place, then you could potentially show more kind of, uh, autistic traits, like the need for control, the rigidity, non-agile, need for routine. And if you then have the lower levels, you know, of the neurotransmitters, then you will introduce more instability in the rest of the brain, and that's when the ADHD traits start to come out. You know, and if you see that for most of our lives [laughs] we have been, I have been anyway, and I've seen it being mentioned in Dr. Sadiq's, um, Khurram Sadiq-

    25. AP

      Mm

    26. SH

      ... your previous guest's, um, uh, book. He, he wrote about the Jekyll and Hyde personality.

    27. AP

      Yes.

    28. SH

      I've been caught that-

    29. AP

      [laughs]

    30. SH

      ... in my relationship. And I guess it was really useful because I couldn't really understand what I was doing, and then my expert say that to me, you know, "You have this Jekyll and Hyde personality," and I wonder why. I never really understand. And I think one of the reason is, yeah, we have the AuDHD, you know, presentation that at times, you know, looks so stable, and then all of a sudden you can completely swap to be a different personality-

  4. 11:47 – 12:55

    How can the two co-existing conditions make life a struggle

    1. AP

      What struggles could that create in someone's life?

    2. SH

      Mental health challenges during transitions. When your life, um, no longer has, you know, all the structure and routine in place, you know, and your coping strategies go out the window, you know, and you're desperately trying to find safety and stability, you know, then not have it-

    3. AP

      Mm

    4. SH

      ... you know, that can create a lot of internal chaos inside. But on a good side, though, you know, I think being an AuDHDer is great, but you really need to learn to manage or harness, you know, the good bits about it. 'Cause, um- It's, it's so easy, you know, just to go the opposite way and think about the challenges. Um, but it's interesting because if you have an autistic and ADHD personality traits, right, then you're able to tap into so many of the good parts of AuDHD. Like, you know, being able to have scaffold and structure for yourself-

    5. AP

      Mm

    6. SH

      ... and at the same time, being able to take some risks, you know, and be impulsive with, you know, an, an, an idea and run with it.

    7. AP

      So fascinating.

  5. 12:55 – 15:28

    For someone with AuDHD, which one is more likely to be diagnosed first

    1. AP

      F- from your experience, what do you think would be the first diagnosis someone might get, which would get picked up first-

    2. SH

      Mm

    3. AP

      ... and, and why might that be?

    4. SH

      Yeah. So obviously, it's different for everyone, but I do say with AuDHD, the autistic trait may be more subtle. Although, you know, if you are a parent [laughs] to someone with AuDHD, a child, you know, an, an autistic ADHD child, then they're likely to begin their lives with sensory sensitivities.

    5. AP

      Mm.

    6. SH

      You know, that's something that almost is a given, and they might wanna separate their foods. Um, they don't like the texture of certain things. And also being born AuDHD, you might have, um, a difference in your gut microbiome composition, which makes you taste, uh, food, uh, differently. So what you think, you know, "This tastes really great, these green beans." But to [laughs] an autistic ADHD child, you know, with that difference in the gut, uh, microbiome composition, they might like, "This tastes awful, and it's bitter." It tastes different to them, basically. So then, you know, there's the sensory sensitivities, but, um, there's also that social, uh, element. You know, some children, the AuDHD children, might want to make friends but actually realize they're much happier with themselves, or they might be happier, you know, with toys or pets [laughs] rather than actual human. But then there's also the ADHD side that can be more pronounced because we're dealing with that imbalance i- with neurotransmitters. So you're gonna see the more inconvenient ADHD traits first because some of these autistic traits, they can be internalized. You know? They might be something that, as a child get older, they, they realize, "Okay, to be socially accepted, I'm gonna have to hide this." You know, and that's p- perhaps more true for girls, you know, and then women, and that's why so many of our traits are internalized. And then we start to develop this persona and archetype on top of that, you know, the perfectionists, the people-pleasers, you know, and then when no one's looking, you have meltdowns and shutdowns, or sometimes when people are looking, [laughs] you have meltdowns. 'Cause it's just not always easy to control it, you know, the social, sensory differences. Uh, um, technically, for, for most, um, I think the ADHD traits can, can be more pronounced for us, but more also because children with AuDHD may be looking for that top-up of the-

    7. AP

      Mm

    8. SH

      ... neurotransmitters.

  6. 15:28 – 17:39

    If you are AuDHD, do you think it's common to go missed for both diagnoses

    1. AP

      So fascinating. And do, so is it possible for someone, say, who, who is AuDHD or, or might be AuDHD to look, look at a list of traits that are associated with autism, just autism, and also look at a list of traits that are associated with just ADHD? And because their internalized way of thinking doesn't necessarily match up with the stereotypical list of both diagnoses, then naturally they therefore go on and get missed for both?

    2. SH

      Yeah. Yeah, that, that was definitely my story, and I guess, you know, a lot of people as well were diagnosed later in life. When I looked at, um, you know, all the things they were saying about ADHD is that during similar times in my life, I had a great life, and I was okay. You know, I had order. I was good at planning, you know, time management, never. [laughs]

    3. AP

      [laughs]

    4. SH

      But, um, yeah, so, uh, the ADHD label itself didn't fully explained my challenges. And then when I went for the autism assessment, that was quite difficult because a lot of the challenges that they were trying to tease out, they weren't, um, catered for the female presentation.

    5. AP

      Mm.

    6. SH

      So it was the male presentation, and also they were, it's very outdated. It was around, like, you know, what kind of special interests do you have, you know, and women, um, autistic women, autistic ADHD women tend to have more acceptable, um, special interests. Like perhaps, you know, for, for example, you know, reading about psychotherapy, you know, and, uh, understanding the human behavior or, you know, really diving into nutrition. These are the things that are not commonly thought of as autistic special interests. You know? You would think, like, but also very outdated, collecting stamps and train spotting. Yeah, we're living here in the 21st century, you know? [laughs]

    7. AP

      [laughs]

    8. SH

      Um, for you, it could be a fascination with social media or sports. You know, there are things that actually light you up. You know, we tend to go for the special interests that make us feel good, right? And what are they? You know, and it changed over time.

  7. 17:39 – 19:40

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    1. AP

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  8. 19:40 – 20:04

    Minimal age to show AuDHD traits

    1. AP

      Is there like a, a, a minimum age that someone could noticeably show an interest in a specialist subject?

    2. SH

      Very young age, I think. I think you get the little professors or the hobbyists-

    3. AP

      Mm

    4. SH

      ... very early on, and you can tell when they just can't stop talking about it. Um, one of my children loves cats,

  9. 20:04 – 25:05

    How does AuDHD develop with age

    1. SH

      and she would tell me lots of little facts about them. You know, she'll start the day with, "Did you know that this-

    2. AP

      [laughs]

    3. SH

      ... this is this happened?" And I was like, "Great. Awesome." And for me, the ADHD brain doesn't catch on to that-

    4. AP

      [laughs]

    5. SH

      ... because that's not my special interest. But for her-

    6. AP

      Mm

    7. SH

      ... it's so, so helpful for her to be able to tell me. And so you definitely do start very early on, and you see that talking to yourself, you know, arranging the toys and talking to each other, doing more role play. You know, I definitely find that you'll have a very rich internal life-

    8. AP

      Mm

    9. SH

      ... which is so beautiful. You know, and it's like, over time-

    10. AP

      [laughs]

    11. SH

      ... gotta make friends and, [laughs] you know, channel that out. But some people prefer that setup, you know, 'cause it's very regulating. You go in flow, and I think that's why special interests are really helpful for-

    12. AP

      Mm

    13. SH

      ... you know, neurodivergent children.

    14. AP

      And if there's like a little girl or a little boy who, they might not know it yet, but they, they, they are AuDHD. The parents don't know it, but they are presenting in this, in, in this fashion you've just explained. They're, they're very into a particular thing. Um, how does that develop, that, that AuDHD develop as that child develops and essentially grows up?

    15. SH

      Yeah. So if you think about a child, you know, very early in life, they may or may not, you know, but I'm talking about a protective life experience where they are able to channel their focus into something they love to do, and they have the time and the nurture to do it, you know. But then eventually they have to go to school. Um, if they go to a state school, right, there is less of that accommodation for somebody to, you know, spend all their time doing what they love. But also, it will be more obvious when they start going to school, when they have to look after their things, you know, pack the bags, and the executive functioning, uh, challenges would come to the fore. You know, that, that, um, you know, variable attention where you find it hard to focus on something when it's not interesting, and you get called out for it, you know, in class. And then over time, you become more self-aware of the traits that don't actually fit-

    16. AP

      Mm

    17. SH

      ... into the system. And that becomes quite difficult to deal with because you're a little person in a body, and your emotional systems isn't as fully, uh, you know, developed yet. So first of all, then your stress and anxiety system will come online, you know. And without that prefrontal cortex maturing at that age, because that doesn't come online until you're 17 or 20, you know, and, and without that, you can't make sense of your experience. So your whole body is feeling what the world feels to you-

    18. AP

      Mm

    19. SH

      ... without the ability to make sense of it. And you can understand why children get school anxiety, and they're trying to find a way to cope with that. And then when you get to the teenage age, your reward system comes online. You're like, "What can I do," you know, "to kind of fire up the-

    20. AP

      Mm

    21. SH

      ... neurotransmitters, the dopamine, the happy hormones?" And if we are channeled to, you know, unfavorable social circles, then maybe you might go down the self-medication route-

    22. AP

      Mm

    23. SH

      ... to deal with that incessant thoughts, you know, without being able to make sense of it. Because the chaos, you know, in the AuDHD brain, you know, is substantial, when you think about the AuDHD brain dynamics. So we're almost always trying to make sense, you know, of how to get back to that flow, that balance, 'cause you know what it feels like, right? And it makes sense then that people would then go and develop the habit to look for that state, and you wanna get back to that state of who you are when you feel calm.

    24. AP

      Mm.

    25. SH

      And I would hope that, you know, children have the guidance to find regulating activities that are actually healthy for them. Because if it's, you know, unhealthy for them in terms of drugs and alcohol, then that affects the quality of their prefrontal cortex when they become adolescents. 'Cause then, you know, what you have in late adolescence is pretty much shaped by your existence before that-

    26. AP

      Mm

    27. SH

      ... or the activities that, you know, we get into.

    28. AP

      And I mean, it's, it's, I guess when that child, AuDHD child, has to leave their room, they go to school, that's, I guess, where the masking starts.

    29. SH

      Mm.

    30. AP

      'Cause they learn quite quickly-

  10. 25:05 – 28:05

    Can the two conditions mask each other

    1. AP

      how does the, the, the traits of ADHD mask the traits of autism and vice versa? And, and, and, you know, it's, it's a very misunderstood time. How can that process of masking to that extent play into so- one's struggle to understand themselves?

    2. SH

      I guess it depends if they are actually, you know, even aware of, of, of what they are doing. You know, it's like some- sometimes you can channel both, you know, to, you know, and, and, and bring it into the world. But if you think that one side is more palatable, then you're gonna try and be more of that one side. But it also depends if you have any control over it because I, I think girls are better at masking because we've been told from a very young age that [laughs] actually this is the r- this is the better way to be, so we tend to internalize a lot of it. But also because we may be able to do that more 'cause our neurobiology is wired to not, you know, show so much of that overtly hyperactive, impulsive traits, whereas the boys, you know-

    3. AP

      [laughs]

    4. SH

      ... actually are, you know, wired to be more hyperactive, impulsive, you know? That's why I, I think that the ADHD presentation is very misunderstood.

    5. AP

      You know, tragically, one of the, the key themes that comes up with our listeners is a, a feeling of being misunderstood.

    6. SH

      Mm.

    7. AP

      Um, and that can go on for years and years and years. You don't understand why you, you operate the way that you do.

    8. SH

      Mm.

    9. AP

      And then you get the diagnosis, say, just for this example, you get diagnosed with ADHD, and then you look into ADHD. Some bits make sense. Some bits don't. The actual fact is you've got AuDHD, but that hasn't been picked up. You've just been labeled with ADHD, and therefore, is there a risk that post-diagnosis of a condition which is only telling half the story can create a bigger feeling of-

    10. SH

      Mm

    11. AP

      ... being misunderstood than you had previously?

    12. SH

      Yeah, 100%. I think that the label is powerful, but also it can take over people's minds, you know, also your, your own, you know, to cause, like, stigma or also internalized self-stigma. Like, the, the full story is more than one half, you know? It's, it's almost like an entirely different being altogether because we're not just talking [laughs] about AuDHD. We're talking about what this neurotype predisposes you to do in any situations that you go into, right? 'Cause there is, um, difference in how you respond to stress, difference in, you know, how your, uh, dopamine and norepinephrine levels are and how calm you feel, how you regulate your emotions. So it can cause a lot of, uh, misunderstanding for sure, but I think the most important thing really is to understand yourself first before you expect others to understand you.

    13. AP

      Dopamine is a word that gets mentioned a ton on this podcast.

  11. 28:05 – 31:43

    How can the pursuit of dopamine cause problems in an AuDHD mind

    1. AP

      Um, for an AuDHD person, how might the pursuit of dopamine differ from someone who's just ADHD?

    2. SH

      So it's interesting, right? 'Cause your dopamine is in flux. You may not always have low levels of dopamine. A lot [laughs] of AuDHders tell me, "My ADHD isn't, doesn't present as bad planning or, you know, bad time management. Like, I'm actually really organized and always get to a place on time." So you are looking at somebody at, you know, maybe the most optimum state. They are having sufficient amount of dopamine in their brain to power their day-to-day, but then look at it, like, towards the end of the day maybe, and that has to do with more factors other than dopamine. It's what can affect the levels of dopamine throughout your day, and for a man it could be your testosterone. You know, that tends to dip, uh, in late afternoon. For a woman as well. And but then you look at the days and the weeks and a mon- uh, with- within a month, you know, we can have a different personality due to estrogen having a dual personality. So our pursuit for dopamine is pretty much controlled by all these external factors, you know, that can change the levels of our neurotransmitters. So when we are likely to have less of it, you know, or if you, as a woman, you are approaching ovulation, estrogen wants you to go out there and be the Beyonce.

    3. AP

      [laughs]

    4. SH

      You know? [laughs] And look for social stimulation. You know, you're more articulate, and you wanna connect. You know, then your dopamine seeking will be higher, too, you know, but you're already at quite a higher level of dopamine. But then when you approach menstruation for a woman, then you get the dip in estrogen, and dopamine goes down, and you almost have that drop, you know, that, that mood, that, that despair, you know, at that time. So estrogen then has a despair quality, so it has dual personality. So the pursuit of your, um, the, of the neurotransmitters that you seek will then change. But I think because so many AuDHders have trouble regulating-

    5. AP

      Mm

    6. SH

      ... you know, these levels, 'cause they, they do say that ADHD is more of a challenge with regulation rather than a lower level all the time. But with AuDHD, when it spikes, you know, when your dopamine level spikes so high, whether it's through self-medicating or, you know, connecting with somebody [laughs] that gives you very high dopamine, and then it drops, you know. But maybe it doesn't drop. Maybe the challenge with AuDHD is that we, some of us may struggle to get rid of dopamine fast enough. And that has to do with the dopamine metabolism, you know. And, and not just dopamine, but norepinephrine too, um, or epinephrine. They're the molecules that involve in a stress response. So when you have too high, that doesn't just give you, like, lots of happiness or highs, it can give challenges, like more susceptible to stress, you know, anxiety-

    7. AP

      Hmm

    8. SH

      ... anger. Um, you may also look like you're having a manic episode if you- your AuDHD co-occur with bipolar. And yeah, then as we know, everything that goes up needs to come down. Then that l- high high and the low low, you know, that, that can, yeah, be quite challenging to navigate.

  12. 31:43 – 32:49

    Is there any known tie between an AuDHD diagnosis and being Bi-Polar

    1. AP

      You mentioned bipolar there. Is, is there a tie between AuDHD and bipolar, or is there a confusion between the split characteristics that you can present with if you have AuDHD and, and, say, something like schizophrenia?

    2. SH

      Hmm. Yeah. So it... They are different. So the autism and ADHD, they share gene variants, you know, genetic, uh, mutations. And a lot of the genes that are implicated in AuDHD are also, you know, found in bipolar and schizophrenia. But you need additional factors, you know, other gene variants outside of that, but also environmental triggers, you know, that can cause, um, those challenges. But they- I think one of the things that I read in the early days of ADHD is that emotional regulation for ADHD always has a trigger. Something or someone will remind you of something, and it'll cause you to h- go from zero to 100. But then with bipolar, they say it can come without any of that trigger.

  13. 32:49 – 34:52

    How could someone with AuDHD look from the perspective of a new partner

    1. AP

      A- and these, these swings-

    2. SH

      Mm-hmm

    3. AP

      ... that you're describing f- w- within an AuDHD person, how does that look like from the perspective of, say, a friend or a new partner or a boss?

    4. SH

      Mm-hmm.

    5. AP

      Can, can someone with AuDHD be quite a tricky character to crack?

    6. SH

      Not everyone, but sometimes you had a Jekyll and Hyde. You know that-

    7. AP

      [laughs]

    8. SH

      ... that, like, "What are you? I thought you were this person-"

    9. AP

      [laughs]

    10. SH

      "... and I liked that one." You know-

    11. AP

      [laughs]

    12. SH

      ... and then all of a sudden, you're really unpredictable.

    13. AP

      [laughs] Yeah.

    14. SH

      What? Um, yeah, so it's, it can be quite challenging, you know? It's like, where does this come from? And it also is really difficult to ask that because maybe that person doesn't even know.

    15. AP

      Hmm.

    16. SH

      You know, 'cause we're dealing with more than AuDHD at that point. You know, if they have a family history of bipolar or schizophrenia, then yeah, you're dealing with more of that, the symptom of the accumulation of various environmental triggers, you know, on your nervous system and your cells. You know, so [laughs] that's, that's how my brain works. I look at a person, and I kind of look into their cells.

    17. AP

      [laughs]

    18. SH

      You know, it's, it's, it's, it's, um, it's fascinating to me-

    19. AP

      Hmm

    20. SH

      ... because I, I, I really think that so much can be explained, you know, by our biology. And of course, you know, our triggers, our, our triggers will have that traumatic imprint or the life that we've had, you know, 'cause that constitute the emotions behind our reactions.

    21. AP

      I've been called an introverted extrovert before, and it's only sort of recently I'm putting it together that it, that's... Again, it's going back to that, "You've got extreme mood swings, Alex." It's really a, an easy label to put on me from an outsider that would explain these internal conflicting characteristics. And, you know, in other words, sometimes the ADHD's winning, and I'm like-

    22. SH

      Hmm

    23. AP

      ... outgoing, happy to be impulsive and take risks, whereas some days, the autistic side, um, if that's there within me, wins, and I'm much more quiet-

    24. SH

      Hmm

    25. AP

      ... introverted.

  14. 34:52 – 37:55

    Link between AuDHD and being an introverted extrovert

    1. AP

      Is there a link between AuDHD and, and this idea of being an introverted extrovert?

    2. SH

      Yeah. I, I think there are multi-layers, [laughs] as usual.

    3. AP

      [laughs]

    4. SH

      It's never just one thing. It's like you could, like, go beneath the tip of the iceberg.

    5. AP

      Hmm.

    6. SH

      Um, I, I, I think, okay, you're dealing with quite a lot of different layers here, okay? You're... The, the difference between when your AuDHD comes out and where... No, sorry. When, where, where your autistic traits comes out, and then where, where the ADHD traits come out, and, and what do you associate with them? What personala- what personality do you associate? I- is your autistic trait more, more of the Mr. Professor and your ADHD traits more the life of the party, you know? And, and then what then makes you channel those two things? Is it your energy? You know, sometimes we just can't be bothered, right?

    7. AP

      Hmm.

    8. SH

      And we wanna kinda go back and regulate, because there's only so much, you know, our tank, uh, can, can take before it kinda overflows. And that's why one of the strategies that they recommend for autistic individuals is energy management. You know, and, like, because we are so open to the world, it's almost as if, like, every single cell in our body is exposed to stimulation- [laughs]

    9. AP

      [laughs]

    10. SH

      ... into the world.

    11. AP

      Hmm.

    12. SH

      We're going into it like, "Come get me," you know, um, since a very young age, you know. And when you feel, hear, and see more, of course the tank's gonna go full a lot quicker than other people, you know. And you may not always feel like going out, you know, and sometimes you just wanna be by yourself to recharge. But then when, once you have recharged, then you feel great again. And it's, it's so interesting because then I see, you know, the, um, relationships that we tend to have as, uh, autistic [laughs] AuDHDers. It's very much characterized by that push and pull dynamic.

    13. AP

      Hmm.

    14. SH

      You know? And part of it is our inability to handle stress. You know, and when there's too much stress, whether it's expectation or pressure from our partner, we can retreat and almost have a different personality and say like, "Please give me space." And that space is warranted actually because that's when you need to regulate And then you come back and, like, you actually want more of that person because you've had space. But then I f- also feel that because of that, and we see it so much, that relationships experts have gone on to create this entire archetype of that anxious avoidant attachment style-

    15. AP

      Mm

    16. SH

      ... which, you know, sometimes, I'm not saying all the time, but sometimes we can be overcomplicating the matter. It could be as simple as just understanding energy management.

    17. AP

      Mm.

    18. SH

      And what gets in the way of that. 'Cause, you know, if we don't sleep well, like, we know that inflammation, you know, can increase in our brain. If we don't see enough light first thing in the morning, that can affect the mitochondria in your cells, you know, that makes energy for your brain. And also, are you eating well? That gives you all the co-factors to run all the biochemical pathways inside your body, you know, to power different organs and, you know, your entire body system-

    19. AP

      Mm

    20. SH

      ... which actually helps your brain.

    21. AP

      It's been so fascinating, Dr.

  15. 37:55 – 42:30

    Message of hope for all undiagnosed AuDHD adults

    1. AP

      Samantha. If, if you could have one bit of advice for any pre-diagnosed woman listening out there who feels like they have this internal tussle, this internal-

    2. SH

      Mm

    3. AP

      ... tug-of-war and are confused by it, what would your message of hope be for them?

    4. SH

      I mean, for me, it always goes back to finding balance, because if you're having this tug-of-war, then your system is currently in a dysregulated state. But having been on this journey for a while now, I would say that radical acceptance of who you are, but first waking up to who you are. You know, we're not just that one l- label. We're multidimensional. Understanding who you are and accepting it radically, and learn to own who you are as well. It's, it's a tough one, because once you, you know, get a diagnosis or you're looking for one, you're doing the research, you relook your entire life and you wonder, you know, "Why did this happen to me?"

    5. AP

      Mm.

    6. SH

      And now I'm gonna be authentic and be free, you know? But in order to be truly free, you need to feel safe within yourself, and it's to look for how to anchor in yourself.

    7. AP

      Yeah, and it's a big one, isn't it? I suppose y- I've heard it time and time again, which is it, the advice of sort of go so easy on yourself, be gentle to yourself, and really take time to process, like, what's, what's really you and what is the mask after all of these years? But I suppose it's tricky when the nuance of it being AuDHD is in the mix-

    8. SH

      Mm

    9. AP

      ... and you don't know y- what parts of the mask [laughs] is a, a camouflage from a part of y- part of the autism-

    10. SH

      Yeah

    11. AP

      ... and what's a camouflage from the part of the ADHD. It's, I think it's a lot more juggling balls-

    12. SH

      Yeah

    13. AP

      ... than somebody who's just had a singular diagnosis.

    14. SH

      Yeah, but, like, what if the mask is also you, right? Like, neurodivergent or neurotypical, we all have masks, you know, that we bring into the world. What if that mask is just an adaptation of who you decided to be because of what you have to deal with? And you still need to bring them along, you know? Like, it's not about disowning them, because maybe your journey in owning the darkness, you know, is what is gonna make you different. And, you know, through doing the podcast, th- this po- podcast, Alex, is you've had to talk a lot about your own challenges as well, you know, and that has given you the power of vulnerability, you know, which helps your work. Um, maybe a lot of us owe, owe our power to darkness.

    15. AP

      Mm.

    16. SH

      You know, and I think, um, it's to radically accept all of it.

    17. AP

      Again, it's, it's almost like an internal contradiction because I'm certainly avoidant of change, and I read that that's quite a common characteristic of autism, is like an avoidance of change. You, you like, you like systems, you like routine, but I suppose when you get a diagnosis of AuDHD, there might need to be a lot of internal changes that need to happen in the way that you're talking to yourself-

    18. SH

      Mm

    19. AP

      ... and, and, and reframing behavior through a new lens of kindness, and, and understanding and acceptance, which by its very nature is asking yourself to change the way you're thinking about yourself. Is there a contradiction there between what you should be able to do in order to be happier and to be more self-accepting up against an internal dislike for change?

    20. SH

      Mm. I guess it's what you channel that need for change to, you know? And you can use that need for structure and routine and things to stay the same. You can use that trait to anchor you.

    21. AP

      Mm.

    22. SH

      So you can run with something, but use that earthy sense, you know, the earthy sense of knowing better, you know, to guide you. But [laughs] then actually you might need someone to pull you out of that at any one time, because you might end up being too safe.

    23. AP

      Mm.

    24. SH

      The challenge with, um, the AuDHD brain is that we can tend to go into a loop and chase ourselves, cha- chase our own tail, because we're kind of in that, um, yeah, the default mode network-

    25. AP

      Mm

    26. SH

      ... that overthinking loop. Mm.

    27. AP

      It's truly fascinating, Samantha. One, one final question-

    28. SH

      Mm-hmm

    29. AP

      ... um, before we get onto the AuDHD agony aunt.

    30. SH

      Okay.

  16. 42:30 – 44:56

    What’s the latest information on AuDHD that you've been taught by a fellow specialist that's shocked even you

    1. AP

      What's the latest information on AuDHD that you've been taught by a fellow specialist that shocked even you?

    2. SH

      That I've been taught, um, I don't think [laughs] there's a fellow specialist, but, um- [laughs]

    3. AP

      [laughs]

    4. SH

      ... [laughs] because the AuDHD research is in such infancy.

    5. AP

      Mm.

    6. SH

      Well, like I said before, I, I guess what is, one of the most amazing research I found early this year is one on the AuDHD brain dynamics, is how we have both chaos and order in our minds, and how- It is situational, right? Which one comes out. And to accept that this is you, you know, that was really unraveling for me, because then I knew that I didn't have to be one or the other at any one time. It's just choosing which one comes first. So the order and anarchy-

    7. AP

      Mm

    8. SH

      ... like, uh, Dr Sadiq said. Um, but what is more interesting is that that study had very few representation from girls.

    9. AP

      Mm.

    10. SH

      And I think that, uh, one of the reason why AuDHD women tend to be diagnosed later in life is that we don't present the same way. You know, we are hyper-empathetic, actually. We seek connection. We may even be able to give you eye contact [laughs] and, um, it manifests differently in us. But also, one thing that has been quite hard to absorb is that we tend to have a higher proportion of trauma because of, uh, the inability to read people's intentions. And that can be quite difficult when you seek connection, but also not understand-

    11. AP

      Mm

    12. SH

      ... what people want from you. You know, and that's, um, that's a tough one to, to have to m- mature through it, you know. But what is interesting, and it's, it's due to my own life stage that I looked into it, you know, being someone at a stage where perimenopause would happen, you know. People have done studies to look at, uh, the brains of, um, menopausal women to show that there is less energy there than before, but there is a bright side to menopause in that... And, and that, for me, will still be probably another seven or eight years before that happens, is that once you get there, your theory of mind starts to mature and you care less about what people think about you.

  17. 44:56 – 47:41

    The AuDHD agony aunt

    1. AP

      Just finally, normally it's the ADHD agony aunt, but we're gonna call it the AuDHD agony aunt today, for obvious reasons.

    2. SH

      Yeah.

    3. AP

      Um, and it's called the Washing Machine of Woes, because my ADHD item is a washing machine. Did we have the Washing Machine of Woes before you, when you last came on?

    4. SH

      Yes.

    5. AP

      We did. Yeah. [laughs]

    6. SH

      Yeah. That was for RSD, and then it was someone asking about, like, their friend, you know, like, kind of, yeah, not turning up, and then they wonder if they should feel rejected because of that.

    7. AP

      Yeah. Gosh, your memory's better than mine. [laughs]

    8. SH

      [laughs] I only had one episode, Alex-

    9. AP

      Yes

    10. SH

      ... [laughs] so you had many.

    11. AP

      [laughs] Well, I've since been using the Tiimo app, uh, since your last visit, and I'm getting better at remembering to empty my own washing machine. Um, but this week, in the Washing Machine of Woes, somebody has asked, "My child has been diagnosed with ADHD, but she's exhibiting behaviors of autism and maybe some OCD too, but she doesn't want to accept an autism diagnosis and doesn't want to see anyone about it. Is this a normal way to look at an AuDHD diagnosis if you've already had an ADHD diagnosis?"

    12. SH

      Yeah, I, I guess this depends on how old the child is, but if she's old enough to say no, I'm guessing that she could be in adolescence or early teenagehood. And the most important thing for a child at that age is social acceptance, right? Because what pains them more than anything is rejection from, like, the social circle, um, and actually has a root in biology 'cause you literally feel pain, you know, from social rejection. So autistic, um... I, I think autism, you know, is more stigmatized in some ways, you know, because we're still dealing with what the rest of world, the world thinks, you know, about the label. And being a certain age, at a young age, you don't expect your friends to understand. You know, a lot of, uh, young people tend to not announce their diagnosis. It's not like a birthday party. You know, it's different, and at that age, what you want to do more than anything is to fit in and be the same.

    13. AP

      Mm.

    14. SH

      Um, so, but understanding or, or just knowing is enough, you know, 'cause there's a lot you can do, you know, from the lifestyle strategies, try and support them, and scaffolding, you know, in social-

    15. AP

      Mm

    16. SH

      ... um, in, in, in understanding social cues and sensory sensitivities and all that.

    17. AP

      Yeah, I mean, it's true. It's sad. The, the, the stereotype surrounding autism is very much still present. I think ADHD is, you know, is, is having its day. It's, the, the narrative around what it actually means-

    18. SH

      Mm

    19. AP

      ... to live with ADHD has very much been flattened.

    20. SH

      Mm.

    21. AP

      Whereas autism, still very much, the stigma is very real.

    22. SH

      Mm-hmm.

    23. AP

      What...

  18. 47:41 – 49:03

    Debunking Autism myths

    1. AP

      I mean, if, if you could change or debunk, particularly how it presents in women, some of the stereotypes around autism, what would you like the world to know about how it can show up?

    2. SH

      Yeah. So as I said before, AuDHD is a different animal to pure ADHD and pure autism, and the autistic traits can seem, to the world, more mild, but you know, it's more internalized. You know, there... Actually, I would say that I credit the fact that I'm here today, having achieved a lot of the things in my life that is purely based on my special interests, I credit that down to my autistic side.

    3. AP

      Mm.

    4. SH

      You know, and if it wasn't for that structure, you know, and being able to hold space for myself-

    5. AP

      [laughs]

    6. SH

      ... in my moment of chaos, you know, and always having that... It's, it's almost like a mother inside, you know, my brain dealing with the child, and they're both me. You know, it's having that sense, that sensibility come back-

    7. AP

      Mm

    8. SH

      ... you know, and, and reel you [laughs] in when you've gone too far, you know? And then maybe quieten down when you wanna go out for adventure. It's to understand that this is always going to be there, and it's to accept them, embrace them, you know, and learn how to manage.

    9. AP

      Very nice closing advice. Thank you, Dr Samantha.

  19. 49:03 – 49:39

    A letter from the previous guest

    1. SH

      Welcome.

    2. AP

      We're gonna do the final section, which is I'm going to deliver a letter to you that's been written by the previous guest.

    3. SH

      Oh.

    4. AP

      The previous guest has written three rules to live by. They've posted it through that post office, and I'm going to deliver it to you. And if you could [laughs] kindly read it out for us.

    5. SH

      Amazing.

    6. AP

      [laughs]

    7. SH

      Very on brand, Alex. Great. So three rules to live by: Learn to embrace your inner child. Yep, it's still there. [laughs]

    8. AP

      [laughs]

    9. SH

      Stay weird, it's your magic. Completely. Embrace your mask, it's still a valid version of you. I love that. You know, this is radical acceptance.

  20. 49:39 – 51:09

    ADHD Item section

    1. AP

      At this stage, I always ask my guests to bring in an ADHD item, but I think my ADHD [laughs] memory won, because I forgot [laughs] to ask you to bring one in. But you have-

    2. SH

      Mm

    3. AP

      ... explained to me off-camera what yours is. So, what's your item, or maybe it's two items, that represent, in this case, AuDHD-

    4. SH

      Yeah

    5. AP

      ... for you? [laughs]

    6. SH

      So I love these questions, because it's the first time where I feel like, okay, now I can answer it. 'Cause if you were to ask me just ADHD, I'm like, "But what about also I have the other side?" So it- it's the, um, crystal ball-

    7. AP

      Mm

    8. SH

      ... for the autistic side, for the need for certainty of seeing into the future so I feel safe, as well as the parachute, which will help me when I leap, um, I feel like there is anchor, and I will be safe. You know? So I can go for adventure and be impulsive and take risks the ri- the positive way and, you know, know what's coming. You know, it'd be great-

    9. AP

      Mm

    10. SH

      ... if that's everyday life, you know?

    11. AP

      Such a good analogy. It reminds me a bit of, um, Dr Ned Hallowell's analogy of ADHD, which is obviously the f- the Ferrari engine, but having bicycle brakes. And I guess having a parachute is a, is the autistic way of putting on the brakes if you're falling through the sky.

    12. SH

      Yeah, yeah. And it's to learn to trust that instinct.

    13. AP

      Mm. Dr Samantha Hiew, thank you so much.

    14. SH

      Really, really appreciative and grateful for this opportunity. Thank you so much, Alex. I learned a lot today as well from you. [outro music]

Episode duration: 51:09

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