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The Jefferson Fisher PodcastThe Jefferson Fisher Podcast

She Treats ADHD Patients Every Day (Here's the Truth) Ft. Dr Sasha Hamdani

If you’ve ever wondered why a simple conversation can feel so overwhelming with ADHD, this episode is for you. Dr. Sasha Hamdani joins me to explain what’s really happening inside the ADHD brain—and how it impacts emotions, rejection, relationships, and communication. We talk about why everything can feel “louder,” why feedback can hit so hard, and practical ways to communicate without shutting down, spiraling, or becoming overwhelmed. Buy Dr. Hamdani’s new book: Too Sensitive – Rejection, Resilience, and the Science of Feeling Deeply – http://us.macmillan.com/books/9781250423764/toosensitive/ Order The Next Conversation Workbook: https://www.jeffersonfisher.com/workbook Want a FREE communication tip each week? Click here to join my newsletter. https://www.jeffersonfisher.com/newsletter Thank you to our Sponsors: David. Subscribe and save 10% on every order’ at https://davidprotein.com/jefferson Cozy Earth. Upgrade Your Every Day. Get 20% off at cozyearth.com/jefferson or use code JEFFERSON at check out. BetterHelp. Click https://betterhelp.com/jeffersonfisher for a discount on your first month of therapy. Like what you hear? Don’t forget to subscribe and leave a 5-star review! Order my new book, The Next Conversation, today! https://www.jeffersonfisher.com/book Suggest a topic or ask a question for me to answer on the show! https://www.jeffersonfisher.com/topic Join my School of Communication. https://www.jeffersonfisher.com/membership Follow me on Instagram https://www.instagram.com/jefferson_fisher Follow me on TikTok https://www.tiktok.com/@justaskjefferson?lang=en Follow me on LinkedIn https://www.linkedin.com/in/jeffersonfisher/

Jefferson FisherhostDr. Sasha Hamdaniguest
Sep 25, 20261h 9mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 1:22

    What an ADHD brain feels like: “It’s louder in there”

    1. JF

      If I were to compare a non-ADHD brain with somebody who has ADHD, what would be the difference?

    2. SH

      It's louder in there. You're taking in all of this information all at once, and you don't have that great of a filtering system to tell you, "This is important, this is not important." So you have much higher likelihood of things raising threat levels than the average person. So ADHD is truly a regulation disorder as it pertains to emotion, motivation, energy, sleep, appetite. So people can be extremely motivated, and it's still hard for them to get to what they need to get to because of that dysregulation. I've treated so many people with ADHD that have ADHD and have experienced it. I was diagnosed in fourth grade because I presented atypically for a girl. I was hyperactive, really loud-

    3. JF

      Yeah

    4. SH

      ... truly disruptive. I started a coup in my classroom. Teacher called my mom, and I was in the doctor's office the next day. Did not know I was being treated.

    5. JF

      What is not helpful to do in communication with those who have ADHD? Why is it that simple feedback to an ADHD brain can feel like a personal attack? Do you have any advice for people who have ADHD to improve their communications?

    6. SH

      I have a couple of things. Number one...

    7. JF

      It feels like, to me, at least a third of my audience-

    8. SH

      Okay

    9. JF

      ... either has ADHD or loves, in relationship with, knows somebody close who has ADHD.

    10. SH

      Got it.

  2. 1:22 – 3:37

    Clinical definition vs. the “can’t focus” stereotype—and a reframed model

    1. JF

      And so in terms of definition setting-

    2. SH

      Yeah

    3. JF

      ... what is... I, I wanna know what's the clinical definition of ADHD.

    4. SH

      Okay.

    5. JF

      And can, kind of, maybe from your perspective, what is the Urban Dictionary kind of-

    6. SH

      [laughs]

    7. JF

      ... uh, definition of ADHD?

    8. SH

      Okay, I'm gonna answer that. But, no, I'll answer that first, but then I'm gonna give you, like, a caveat and, like, my hot take from that. So the clinical definition of ADHD is it is a neurodevelopmental condition that impacts inattentiveness, hyperactivity, and executive function. So it is a brain-based kind of functioning that historically definition has kind of focused a lot on attention. So it stands for attention deficit hyperactivity disorder. I'm gonna get more into that.

    9. JF

      Yeah.

    10. SH

      [laughs]

    11. JF

      I'm ready.

    12. SH

      Um, you know, and everybody, like, if you're looking at the Urban Dictionary-

    13. JF

      Mm-hmm

    14. SH

      ... definition, ADHD is for people that can't focus.

    15. JF

      Right.

    16. SH

      Right?

    17. JF

      Yeah.

    18. SH

      That's what you kind of think of. Now, here's my hot take.

    19. JF

      I'm ready.

    20. SH

      I think ADHD, I agree that it's a neurodevelopmental condition. It's something that, generally speaking, you are born with, and you grow and develop over time. I believe it's so much more than attention. I think ADHD is truly a regulation disorder. It has to do with, yes, r- a regulation issue when it comes to attention-

    21. JF

      Mm-hmm

    22. SH

      ... but also as it pertains to emotion, as it pertains to motivation, as it pertains to energy, as it pertains to sleep, as it pertains to appetite.

    23. JF

      Yeah.

    24. SH

      Just a regulation disorder across the board.

    25. JF

      If we're saying that ADHD is not so much leaning towards attention-

    26. SH

      Yeah

    27. JF

      ... and instead is more leaning towards regulation-

    28. SH

      Or not solely towards attention, but yes, I think at its base it's a regulation disorder

    29. JF

      Okay. Well, let's just put it on a spectrum.

    30. SH

      Yeah.

  3. 3:37 – 6:21

    Why the regulation framing matters: misdiagnosis, earlier intervention, better tools

    1. SH

      The implication is that we, when we talk about ADHD comprehensively, historically we've always been taught to just look at focus, inability to focus, inability to complete tasks, inability to stay organized. I am countering that with, especially since, you know, as, as my career has, like, specialized in ADHD, as my research has been-

    2. JF

      Mm-hmm

    3. SH

      ... in ADHD, as, as I've treated so many people with ADHD, and as I have ADHD and have experienced it-

    4. JF

      Yeah, you have it

    5. SH

      ... I, I have it. [laughs]

    6. JF

      Yeah. Okay.

    7. SH

      And so this is, like, a very lived experience as I'm going through this as well.

    8. JF

      Yeah.

    9. SH

      I, I think when you look at it in its totality, I think, yes, attention is definitely impacted, but I also think a dysregulation when it comes to emotional stuff is a huge, huge part of it. And to, just to put things into perspective, I'm not the only person who believes that.

    10. JF

      True.

    11. SH

      In Europe, they changed the criteria in 2019 to reflect emotional regulation as part of ADHD.

    12. JF

      Okay.

    13. SH

      The US is just kind of behind.

    14. JF

      Yeah.

    15. SH

      Yeah. [laughs]

    16. JF

      Go figure. So let's, I wanna, I wanna take what you're saying, and I wanna take it one step further.

    17. SH

      Okay.

    18. JF

      And that is when I ask, what's the implication of that? What I imagine is if we're saying, "Hey, this is now a regulation thing on top of it"-

    19. SH

      Yes

    20. JF

      ... that means there is hope of X. There is a solution for X. There should be a more focus on X.

    21. SH

      Oh my God, yes.

    22. JF

      Okay.

    23. SH

      Okay. So I think if we reframe this as more of a regulation condition, number one, I'd like to talk about what, what we're going to fix-

    24. JF

      Mm-hmm

    25. SH

      ... and then I'll talk about what, what I, I hope it'll, we'll see in the future. I think if we're talking about, okay, ADHD also has this emotional component, then we're going to avoid misdiagnosing people who show any sort of emotional spectrum with their ADHD with anxiety and depression. 'Cause that's what's happening right now. We don't really have a framework for talking about emotion when it comes to ADHD.

    26. JF

      Mm-hmm.

    27. SH

      So whenever someone is swinging one way or the other, whether they're getting more anxious or they're getting more depressed, then it's just like, "Mm, you need an antidepressant." Or, and I'm not against antidepressants. As a psychiatrist, I mean, we utilize them. It's a good tool.

    28. JF

      Mm-hmm.

    29. SH

      But if it's not actually treating the underlying cause, then you're just giving medication for the sake of giving medication. It's not actually addressing the root cause.

    30. JF

      Yeah.

  4. 6:21 – 9:13

    Is ADHD ‘everywhere’ now? Social media, detection, and uneven diagnosis

    1. JF

      Is ADHD an epidemic?

    2. SH

      [laughs] Um, well, define what you mean by that.

    3. JF

      Something that is growing in both dissemination, uh, like of, of more people now saying they have it.

    4. SH

      Okay.

    5. JF

      Okay? And now becoming almost more of a... I'll e- I'll even go so far as saying it feels like a lot of people I know have it more than the people I know who don't. Because-

    6. SH

      Really?

    7. JF

      Yes.

    8. SH

      Okay.

    9. JF

      Because, and it might be truly sourced through that the, the, the field that I'm in.

    10. SH

      Yeah.

    11. JF

      Every- It feels like every other Q&A that I have, the person begins with, "Hey Jefferson, I have ADHD and I battle with depression," or, "I have ADHD and I am neurodivergent. I have like..." It's-

    12. SH

      Yeah

    13. JF

      ... um, and friends, I have two of my best friends, both-

    14. SH

      [laughs] Yeah

    15. JF

      ... uh, take, you know, ADHD medication.

    16. SH

      Yeah.

    17. JF

      Okay? One has done it since like junior high.

    18. SH

      Right.

    19. JF

      Okay. The other has kind of, I, I don't know, kind of self-diagnosed. I mean, he, he went and saw, um, um, a clinician to talk about it. Of now he's an adult and is, "Oh, I've had ADHD this whole time."

    20. SH

      Okay.

    21. JF

      And so what I mean is, it feels like I know a lot of people that have it, and it's more in discussion of conversation more than it's ever been.

    22. SH

      Mm-hmm. I would agree with that. I think it's part of the cultural conversation more than it has been. I don't think there's necessarily an increase in just like general population ADHD.

    23. JF

      Mm-hmm.

    24. SH

      It's kind of like, uh, uh, but I think we're getting better at picking it up, and I think we're getting better at talking about it.

    25. JF

      Mm-hmm.

    26. SH

      'Cause a lot of people are now, especially since it's so prevalent on social media, or at least on my algorithm, and people [laughs] -

    27. JF

      I mean, let's-

    28. SH

      Right? [laughs]

    29. JF

      It would make sense for you, truly.

    30. SH

      I know.

  5. 9:13 – 11:25

    Sponsor break + skepticism about self-diagnosis and attention as ‘human condition’

    1. JF

      Before we keep going, I want to take a moment to tell you about Cozy Earth. I love Cozy Earth as a sponsor, because everything they do is top, premium quality. Not only am I somebody who I like to be really comfortable wherever I'm going, whether I am going to an airport, I'm traveling, I'm hopping around with the kids, I'm going to go pick up kids, drop them off, I want to be comfortable. Everything that Cozy Earth has, from pants to hoodies to T-shirts, it just feels good. It looks good, and I always get compliments wherever it is, and people are like, "Is that Cozy Earth?" I'm like, "You know, you know [laughs] that it is." Right now in this cold front that's about to come through, hopefully through your town, we got ours two days ago, you can go to cozyearth.com/jefferson, use the code Jefferson, get up to 20% off your order. So if you're out there and you need to get ready for this fall season and look your best, look no further than Cozy Earth. You will not be disappointed. Cozyearth.com/jefferson, use the code Jefferson for 20% off. And now, let's keep going. I don't believe... I've never been treated for ADHD. Um, and so I want to put that out there as I, that's, that's my bias of where I come from. You have ADHD, so that's your bias of where you come from, so we have two different perspectives. Sometimes I feel that there are those that, this is probably the exception to the rule, that it's, it's a, it's like an answer that's looking for a problem. Like some, uh, finding... Th- their, their whole life is dysregulated, so they're looking for some way to blame it on something.

    2. SH

      Okay.

    3. JF

      And so I like that you include regulation in this-

    4. SH

      Mm-hmm

    5. JF

      ... because it makes it much more holistic in my mind-

    6. SH

      Mm-hmm

    7. JF

      ... that we're taking it not just from I can't pay attention-

    8. SH

      Right

    9. JF

      ... because this guy, I have trouble paying attention.

    10. SH

      It's part of the human condition.

    11. JF

      Exactly.

    12. SH

      Yeah.

    13. JF

      Um, you know, I, I definitely have trouble paying attention to anything. But I th- I like that what you're saying is if we add in the regulation component, which is something that I go, "Okay, that's something we can talk about. That's something m- we can help a lot of people with."

    14. SH

      Mm-hmm.

  6. 11:25 – 13:02

    Born with it? Why many women are diagnosed later—and the “my kid got assessed” pattern

    1. JF

      Do you find that the people you talk to, uh, and the people that you've treated have AD- have had ADHD... Let me just ask it this way. Is ADHD something you're born with or is it something that you can find out that has arisen when you're in your 40s?

    2. SH

      A lot of the time you're born with it.

    3. JF

      Really?

    4. SH

      Just, uh, yes. Now, what I will tell you is that, you know, for a long period of time, ADHD wasn't really talked about. So a lot of people weren't getting diagnosed in their childhood because it wasn't part of the conversation or because of their presentation, especially for girls and women- When they were going through their schooling, when typically it would've been picked up-

    5. JF

      Mm-hmm

    6. SH

      ... they weren't outwardly facing with behavioral issues. They weren't being impulsive. They weren't being, they, they weren't causing issues in the classroom, and so they weren't picked up. And then it kept, they kept getting passed from classroom to classroom, and then, you know, when they got into situations where they just could not cope, that's when things started to fall apart, and then at that point, it was, "You're hormonal," [laughs] or-

    7. JF

      Yeah

    8. SH

      ... "This is depression," or, "This is anxiety," or, "This is mommy brain," and it just kind of gets kicked down the line. And then what happens usually, what I'm, uh, what, or at least what I'm seeing within my own patients is a lot of times people come to me and they're like, "We actually got our kid assessed, and then [laughs] when I was sitting in the evaluation I'm like, 'This sounds like me,' and then I got assessed." And so it, it was kind of like this, we've, we've seen this huge rise in people that actually are coming in after their kids are getting assessed.

  7. 13:02 – 17:52

    When to assess kids + ADHD subtypes and spectrum-like presentation

    1. JF

      Do you think there's a certain time or age that a parent should consider getting their kid assessed?

    2. SH

      [sighs] No. I mean, I, like, I think it's-

    3. JF

      Are there any, like, indicators or markers?

    4. SH

      Well, I think, uh, so the, the difficult thing-

    5. JF

      Mm-hmm

    6. SH

      ... about psychiatry in the childhood population is just it, sometimes it's really hard to tell, like, what's normal childhood development and your kid being a kid-

    7. JF

      Right

    8. SH

      ... and what's ADHD and what's not. I always tell patients and parents, I'm like, "You know your child the best."

    9. JF

      Yeah.

    10. SH

      So if there's something in you that is like, "I think there's something going on. I think there's a focus issue. I think there's an emotional regulation issue," if you're concerned about it or if it's come up, like, at school where other people are concerned about it, there, if, if it's accessible to you and if it's affordable to you, I don't think there's any harm in getting evaluated. Like, talking to someone who from a medical pr- professional standpoint can evaluate your child.

    11. JF

      Right.

    12. SH

      But at that point, even if they say, "Yes, this child has ADHD-"

    13. JF

      Mm-hmm

    14. SH

      ... I think there's so many different treatments that you could do. You don't necessarily have to jump to medication. That's another important thing.

    15. JF

      I do want to talk about that, 'cause I know, I know you have an opinion on that. Uh, and I, I, I wanna make sure we get into it. The, this-

    16. SH

      I wanna know what you think my opinion is. [laughs]

    17. JF

      It's gonna be a good one. I think your opinion's a good one.

    18. SH

      Oh.

    19. JF

      Um, are we saying, fundamentally, is ADHD a spectrum, where you can be f- full on, you know, h- h- like, is it something you can have more of or something you can have less of than others?

    20. SH

      Um, I think, I mean, yeah. I think everything, right? Everything is probably somewhere on a spectrum. The way you, how we, how our diagnosis sits right now is ADHD is broken into three types. There's inattentive type, which is, you know, the classic daydreamer presentation, difficulty focusing-

    21. JF

      Mm-hmm

    22. SH

      ... difficulty completing tasks, difficulty organizing tasks, forgetful, losing things. There is hyperactive, which is physically and verbally-

    23. JF

      Mm-hmm

    24. SH

      ... impulsive. These people can't stay in their seat. They're interrupting others. They're, they're impulsive and/or hyperactive. And then the third one is combined type, which is a combination of both.

    25. JF

      Okay.

    26. SH

      Y- so you can present at different ends of the spectrum on all of those kind of things, and the thing that becomes hard is that there's outward behavior, where you can see it, and you're like, "Okay, this person cannot stay still, and they can't-"

    27. JF

      Mm

    28. SH

      ... "stay in their seat, and they are, like, physically touching everybody [laughs] else."

    29. JF

      Yes.

    30. SH

      And then there's other people who I would argue their ADHD is just as disruptive. They're staying in their seat. They just can't focus.

  8. 17:52 – 19:33

    RSD (Rejection Sensitive Dysphoria): defining it and linking it to communication

    1. JF

      I want to make sure I congratulate you. This book is fantastic.

    2. SH

      Thank you.

    3. JF

      Too Sensitive: Rejection, Resilience, and the Science of Feeling Deeply.

    4. SH

      Yeah.

    5. JF

      Dr Sasha Hamdani.

    6. SH

      Mm.

    7. JF

      I love this. For, uh, those-

    8. SH

      Thank you

    9. JF

      ... that aren't familiar with RSD-

    10. SH

      Yeah

    11. JF

      ... I encourage anybody who's listening to this episode, if you go, "I love, I think I really like Dr Hamdani"-

    12. SH

      [laughs]

    13. JF

      ... you're gonna love her book. Uh, or if you've ever really been told you're too sensitive.

    14. SH

      Yeah.

    15. JF

      How about that? If you've ever been told you're too sensitive, this is the book for you. Uh, what is RSD?

    16. SH

      Yeah. RSD is an incredibly robust emotional response to real or perceived rejection, criticism, possibly disappointing someone else. It's a neurological phenomenon that happens as, like, your body's defense mechanism to threat.

    17. JF

      What's, uh, what is RSD stand for?

    18. SH

      Re- Oh, yeah. That would've helped. Rejection sensitive dysphoria.

    19. JF

      Rejection...

    20. SH

      Sensitive.

    21. JF

      Sensitive.

    22. SH

      Mm-hmm. Dysphoria.

    23. JF

      Dysphoria. In plain language, that means?

    24. SH

      That rejection is exceedingly hard to bear.

    25. JF

      Overwhelmingly-

    26. SH

      Overwhelmingly

    27. JF

      ... shut down hard to bear.

    28. SH

      Shut down hard to bear.

    29. JF

      Okay. And the tools you provide in here, what I love about it is that it really does, it, it turns this from feeling of am I too sensitive to a feeling of, of strength. And what I'm excited about to talk about with you now is if we take some of the principles of this book and we say, okay, what you already talk about in your background on ADHD, in my group, my community-

    30. SH

      Yeah

  9. 19:33 – 23:14

    Communication tools for ADHD + emotionally sensitive/RSD brains (slow down, structure, repair)

    1. JF

      Which I'm very excited about. First, what do you need to be thinking about? What's the number one thing you need to consider when you are speaking to somebody, communicating to somebody that you know has ADHD?

    2. SH

      I do love that question. [laughs]

    3. JF

      Yeah.

    4. SH

      I think, um, well, first let's back up. I, I think people with ADHD, they, again, like what we talked about, the, everybody can present a little bit differently.

    5. JF

      Right.

    6. SH

      So are you asking me about ADHD, or are you asking me about, like, someone who's extremely emotionally sensitive and has RSD?

    7. JF

      Let's do both. So first let's do, and that's a great, um, differentiator. So let's go just A- uh, ADHD, and let's talk about that, and then we're gonna move into the RSD of it.

    8. SH

      So ADHD-

    9. JF

      Okay

    10. SH

      ... I, I think if you're communicating with someone with ADHD f- I, it really depends on how they present and what's going on. I, uh, but for the most part, uh, it would be normally, you, you pres- Uh, like, I don't think you have to communicate any differently. Now, if there is, this person is getting really overwhelmed, or if I'm giving them too much information, it might be something like, "Okay, I, you know, I, I sped up. Let, let's slow this down." Like eg- especially, you know, when I am seeing patients-

    11. JF

      Mm-hmm

    12. SH

      ... wh- which, again, it's a little bit different of a conversation, and I'm, you know, this patient might have ADHD. Sometimes I'm like, "I just gave you a lot of information." [laughs]

    13. JF

      Right.

    14. SH

      "And I'm sorry. Let's break this down, and let, let's talk about, um, I'm gonna write this down for you so you can have it, and you can look at it later, but these are the three most important things we're gonna talk about today." And I kind of go over them-

    15. JF

      Mm-hmm

    16. SH

      ... and I list them so it's easy to kind of go through and follow. Um, from the emotional side of things, uh, and I guess I'm starting to answer-

    17. JF

      Yes

    18. SH

      ... the RSD question. [laughs]

    19. JF

      Yeah, you got it.

    20. SH

      For people that are emotionally sensitive, I think phrasing things in a way... So part of the issue with RSD and for people that are emotionally sensitive is that even if what you're saying is neutral, and I don't know, Jefferson, if you've experienced this, but, like, sometimes if I'm already kind of in that place where I'm, I feel anxious about our relationship or something, and then someone tells me something neutral, my brain will attach a negative thing to it-

    21. JF

      Mm-hmm

    22. SH

      ... and I'll just start spinning about that. Or if there's a delayed text, I'll just fill in that space with, "They're mad at me. Something went wrong."

    23. JF

      Right.

    24. SH

      "Uh, there's a problem," and then I'll spin, spin, spin. So I think for someone who does that, and I know I do that, I'm emotionally sensitive. I know for my son, he's kind of wired the same way.

    25. JF

      Yeah.

    26. SH

      Um, it's, i- it's doing s- i- it's understanding that communication style. So now within our house, you know, if, like, I have a tone shift, which I'm tired, man, I can't [laughs] regulate my tone all the time.

    27. JF

      Yeah, yeah.

    28. SH

      But sometimes I'll do that, and then I'll, I'll recognize what I'm doing. I see in his face that something has kind of shifted, and that he feels like, "Oh, God, is she upset?" And I'll say, "I, you know what? I'm so sorry. I don't know why I came out that way. Let me try again."

    29. JF

      Mm-hmm.

    30. SH

      Or I will, you know, if I'm, i- if, if he looks... Or, like, even when my husband is talking to me, and there's something that we, uh, uh, him or I just kind of crossed wires on-

  10. 23:14 – 24:54

    Conflict dynamics: shutdown vs pursuit, and why writing can prevent “new beefs”

    1. SH

      Okay, thank you. Um, sometimes when we beef, um, I feel like that conflict that happens, it is f- on both of our parts, it's difficult to experience in that moment. Me, because I'm looking at everything his face is doing, like, if he's sighing, if he's turning away. Like, my body and my brain is reading all of that.

    2. JF

      Sure.

    3. SH

      And I feel so incredibly overwhelmed, and, like, then two things happen. Either one, shut down, can't have this conversation, or two, more likely- [laughs]

    4. JF

      [laughs]

    5. SH

      ... I want this conflict to resolve immediately, and I will chase him around the house. I'll be like, "And another thing." [laughs]

    6. JF

      Yeah, yeah. The, the anxious attachment type of like-

    7. SH

      Yeah

    8. JF

      ... yeah, we need it now.

    9. SH

      Just hunt him down, and he's like, "Oh, my God." [laughs]

    10. JF

      Yeah. And he, he wants to avoid it. Yeah.

    11. SH

      He wants to be quiet and process what I'm saying-

    12. JF

      That is common

    13. SH

      ... without watching me crumble.

    14. JF

      Yeah.

    15. SH

      So now what we've found has been most effective is that when we get into that, I have to write because I feel like I'm most eloquent when I do that, and I get to, I, I'm able to hone down my thoughts instead of just this rapid s- Like, otherwise, you let me go, I'll bring up everything I've ever felt bad about in my [laughs] entire life. ... one conversation. [laughs]

    16. JF

      Yeah, that's true.

    17. SH

      [laughs]

    18. JF

      I think it's very healthy, though. I know, I know, like, for my wife, when we, when we have our beef, like you said-

    19. SH

      Yeah. [laughs]

    20. JF

      Uh, we have definitely found that she will, at times, go into, she has, like, a notes in her phone-

    21. SH

      Mm-hmm

    22. JF

      ... that she'll just start working away on.

    23. SH

      [laughs]

    24. JF

      But it's, uh, it's a, it's a pross- it's a process of filtering things-

    25. SH

      Yes

    26. JF

      ... and getting it out rather than, you know, creating, uh, kind of a snowball-

    27. SH

      New beefs. [laughs]

  11. 24:54 – 30:03

    Her ADHD story: childhood diagnosis, hidden medication, and a ‘second diagnosis’ in med school

    1. JF

      Yeah, new beefs. Uh, a snowball effect. Y- you've been, um... How long ago were you diagnosed with ADHD?

    2. SH

      So first or second time.

    3. JF

      You can be done twice?

    4. SH

      [laughs]

    5. JF

      You can, double ADHD?

    6. SH

      So I have double ADHD. I was diagnosed in fourth grade. Um, and I was diagnosed because I presented very atypically for a girl. I was hyperactive. I was in everyone's face. I was really loud. I w- I was disruptive.

    7. JF

      Okay.

    8. SH

      Truly disruptive. I started a coup in my classroom-

    9. JF

      Oh, nice

    10. SH

      ... when there was a substitute teacher. [laughs]

    11. JF

      I respect that. Okay.

    12. SH

      [laughs] Yeah. And the, then the substitute teacher told my teacher, the teacher called my mom, and I was in the doctor's office the next day. Like, it was [laughs] so fast.

    13. JF

      [laughs]

    14. SH

      Um, diagnosed, started treatment at that time.

    15. JF

      Yeah.

    16. SH

      Did not know I was being treated because it was so, like, it just wasn't talked about. My parents didn't know how to bring this up with me, so they're like, "These are vitamins that are gonna help you focus, or that'll help you-

    17. JF

      Mm

    18. SH

      ... you know, that'll help you."

    19. JF

      It was medication.

    20. SH

      I don't even think it was, like, focus. I think, "These will help you." And I was like, "All right." And it was medication.

    21. JF

      Okay.

    22. SH

      Which, yes, that face was appropriate.

    23. JF

      Yeah, yeah.

    24. SH

      It, it wasn't the best move. They made up for it, but that's, that's kinda where, like, the con- uh, the conversation just wasn't-

    25. JF

      Mm-hmm

    26. SH

      ... there yet, and they didn't know how to have it with me. Also, keep in mind, exceedingly sensitive kid, um, who already felt kinda othered. Like, I grew up in a, like, a- as the only ethnicity in my school, and so I was already-

    27. JF

      Yeah

    28. SH

      ... like, "This is, this is-

    29. JF

      I can't imagine.

    30. SH

      Yeah. I just-

  12. 30:03 – 37:35

    Partner-to-ADHD communication playbook: bullet points, writing, and emotionally safer framing

    1. JF

      going. All right. I wanna, I wanna bring us back to communicating with those who, specifically on the ADHD side.

    2. SH

      Mm-hmm.

    3. JF

      All right? Now, have you found... I w- I wanna do it two different perspectives.

    4. SH

      Okay.

    5. JF

      'Cause I have people in my community who have ADHD, and they say, "Jefferson, I have a h- really hard time communicating with people because I tend to interrupt a lot."

    6. SH

      Mm-hmm.

    7. JF

      "Or I tend to go off on tangents."

    8. SH

      Mm-hmm.

    9. JF

      "Or I tend to get wrapped up into the fear of Things that aren't even in the conversation. And then on the other end of the, the, the table, I have people who are married to somebody-

    10. SH

      Mm-hmm

    11. JF

      ... who has, presents with ADHD, and they have a hard time communicating with them. So I wanna start with those that are, don't have ADHD and are with somebody who does.

    12. SH

      Mm-hmm.

    13. JF

      All right? I wanna give them some tools. I want us to give them some tools on what may be able to help in communication so we can rely on the things that you know help you-

    14. SH

      Mm-hmm

    15. JF

      ... as a case study.

    16. SH

      Yeah. [laughs]

    17. JF

      Um, I can tell you what information I've received from people is, like, bullet points-

    18. SH

      Yeah

    19. JF

      ... are very helpful.

    20. SH

      Very helpful.

    21. JF

      So bullet points are helpful. What else is helpful for somebody to communicate to someone who has ADHD?

    22. SH

      Written, I think like-

    23. JF

      Write it down

    24. SH

      ... write it down. So, so for me, within having a conversation, there's so many other things that go into a conversation that I am now, after my medical training, realizing not everyone has.

    25. JF

      Mm-hmm.

    26. SH

      Um, and I think this is part of, like, being married to someone who absolutely does not have ADHD. I'm like, "You don't have that?" [laughs]

    27. JF

      Yeah, yeah.

    28. SH

      And so, like, within a conversation, I'm not only thinking about what I'm saying and what you're saying, I'm also thinking about you moving your foot and, like, you-

    29. JF

      Mm-hmm

    30. SH

      ... or your positioning-

  13. 37:35 – 41:12

    Inside the ADHD communication challenge: poor filtering, “side quests,” and setting parameters

    1. JF

      I'm trying to find something in, like, if I could distill it down into, like, two sentences of when I'm communicating with somebody who has ADHD, what's really going on in their head? Like, what... If, if I were to compare a non-ADHD brain with somebody who has ADHD, what would be the difference?

    2. SH

      It's louder in their [laughs] ADHD brain.

    3. JF

      Okay, louder.

    4. SH

      It's, there's just-

    5. JF

      Everything

    6. SH

      ... a lot more going on. So with ADHD, like, if you think about what's actually happening from a neurological perspective, it's not, there's not a lot of good filtering that happens, so you're taking in a lot of input at once. You're, you're measuring visual stimuli, auditory stimuli, hearing, like, processing what's happening in real time within a conversation. So you're processing all of that stuff, and it's difficult in that moment to, to prioritize, like, "This is what I should be focusing on." Because you're like, "Okay, this, their head is turning this way," or-

    7. JF

      Mm

    8. SH

      ... "They're, they're clearing their throat. That means they're not interested."

    9. JF

      Mm.

    10. SH

      Instead of being like, "Well, let me listen to what they're saying, 'cause that's what's important." So you're taking in all of this information all at once, and you don't have that great of a filtering system to tell you, "This is important. This is not important." So you have much higher likelihood of things raising [snaps fingers] threat levels than the average person, 'cause you're taking in a lot of input.

    11. JF

      Okay. I like this. Let's keep going here-

    12. SH

      Yeah. Got it

    13. JF

      ... because this, this is making sense to me.

    14. SH

      Okay.

    15. JF

      Um, if I were to have a, a soundboard, a mixing board, and one of those says, "My five senses," right?

    16. SH

      [laughs] Okay.

    17. JF

      Okay? It sounds like that ADHD, um, it has a way of increasing and raising, you know, the, at least the bar of how much you are feeling at a given time, so everything feels really loud, like just a big traffic jam, that it's really... Every, uh, whatever you feel is magnified-

    18. SH

      Yeah

    19. JF

      ... amplified. A- and in turn, that means your thoughts are amplified as well. So your thoughts get really loud, or-

    20. SH

      Yeah

    21. JF

      ... your attention to-

    22. SH

      And busy

    23. JF

      ... little movements get very, very busy, and so that means it's very hard to just have a straight line from A to B. Is that, is it-

    24. SH

      Yes

    25. JF

      ... am I, am I there?

    26. SH

      No, no, no.

    27. JF

      Okay.

    28. SH

      You, you are there. The thing that's, that's a little bit d- uh, not different, but I mean, if we're talking about everything kind of on a spectrum base, 'cause you talk a lot about this at, as neurodivergence as a whole.

    29. JF

      Mm-hmm.

    30. SH

      Like, you talk about this with autism, where they have poor filtration as well. With ADHD, I think you, it, it depends on the person, and it depends on the, what's going on in their brains-

  14. 41:12 – 1:05:09

    What not to do: the word ‘just,’ laziness myths, and the emotion-function connection

    1. JF

      ... that I, I ask other people who I know who have ADHD of, like, how, what's helpful, what's helpful to you, what's not helpful. Uh, so I wanna ask both from your opinion and those of your patients, what is not helpful to do in communication with those who have ADHD?

    2. SH

      [sighs] Um-

    3. JF

      Like, what really gets under their skin and makes things, like, much, much harder?

    4. SH

      Do you know what I feel is very annoying, and I think my patients reflect this, is when, like, for example, if someone were to talk to me about getting something done or something like that, and their response starts with a "just."

    5. JF

      Mm-hmm.

    6. SH

      Just do it.

    7. JF

      Yeah.

    8. SH

      Just calm down.

    9. JF

      Yeah.

    10. SH

      Just get it over with. It, uh, I think that implies that there is a volitional component to it, and sometimes, quite literally, I, like, all my effort is there. I want to do something. I want to get things done, and it is so much harder for me to get over that initial momentum, whether that's because of executive function paralysis, like it's really hard-

    11. JF

      Yeah

    12. SH

      ... for me to organize and figure out what the next step is, or whether that's because of emotionally I'm just kind of paralyzed in that moment.

    13. JF

      Mm-hmm.

    14. SH

      It, it's difficult for me to get to that next step. So when people are saying, "Just, just do it"-

    15. JF

      Yeah

    16. SH

      ... "Just buckle down. Just make a list," I'm like, "You shut up right now."

    17. JF

      [laughs]

    18. SH

      I'm like, "I can't."

    19. JF

      Yeah.

    20. SH

      I ca- And I think it really became obvious because Um, part of why I wrote this book is because two years ago ... My dad passed about two years ago. Um, but even prior to that we'd been dealing with him being on and off kinda sick, and then really ramping up with sickness.

    21. JF

      Mm.

    22. SH

      And in that time was ... And I, I can't believe it took me that long, but it was during that period where I'm like, "This is the first time I'm actually seeing this connection between my emotional status and my functional status." Because if my emotional status is, like, chaotic or wrecked because of something, like, as big as a loss or s- or something-

    23. JF

      Mm-hmm, mm-hmm

    24. SH

      ... where my brain is just completely preoccupied with emotion-

    25. JF

      Yeah, grief. Yeah

    26. SH

      ... yeah, I cannot be productive. And it- it's like all my scaffolding falls apart, and I, I can't even figure out what the first step is, which made it really hard for me to, you know, get my job done, and to parent my young kids-

    27. JF

      Yeah

    28. SH

      ... and to do all those things. And so it was when I saw that, I was like, "There's something more to this. This isn't just, like, ADHD in, in relation to just attention. There is an emotional component." Because when that's not addressed, I, I mean, the functionality just goes.

    29. JF

      Sure. I see that-

    30. SH

      Did I get off tangent? I think I did.

  15. 1:05:09 – 1:09:48

    Feedback feels like attack: threat response, regulation tools, and practicing skills outside the moment

    1. JF

      You have it here in your book, plain as day, how to respond to constructive criticism. How do you make sure that, and I'm gonna pose it as a, a question, then I want... So you can talk about the tool that you have, which I think is, uh, perfect. Why is it that simple feedback to an ADHD brain can feel like a personal attack?

    2. SH

      Yeah. I think it's because of that level of uncertainty. You know, people are reading into that feedback, and they're like, "Okay, what are the next steps from here? Clearly, this person hates me."

    3. JF

      Yeah.

    4. SH

      "I'm gonna get fired."

    5. JF

      [laughs]

    6. SH

      It, like, this doesn't, this doesn't bode well for me. I can't fix this. It's over for me. And so already from that constructive criticism, it's not like, "What can I take positive so I can improve my performance?" It's, "This has been a devastating blow. How do I get out of this [laughs] situation unscathed?" So it's, it is, the way that it's hitting your ear already is so incredibly threatening.

    7. JF

      Mm-hmm.

    8. SH

      You've dumped out alarm chemicals that are telling your body to respond in fight or flight or freeze, and so you're responding to it as if, you know, there has been, like, a critical threat that's happened in the moment. So that's why it's, it's truly neurological. Like, your body is being flooded with, with chemicals that are telling you something is seriously wrong. So when you're experiencing that big, robust response, it's not just you. It's not just a personality quirk. Like, your body is, is sending you signals that are telling you, "This is a big deal."

    9. JF

      So when you get that email from that employer-

    10. SH

      Yeah

    11. JF

      ... who's asking you about what you did and everything in your, you know, uh, w- how, why you did X, Y, and Z in this proposal, and everything in your brain is screaming, "I'm a failure, and this is so terrible, and I should just quit and leave"-

    12. SH

      Yeah

    13. JF

      ... what you should do instead is-

    14. SH

      Okay. What did I say in there?

    15. JF

      Yeah, yeah, yeah. So this is what I'm gonna, I'm gonna put it like this, and then I'll have you comment on it. What you should do instead, okay, in your, in your book, Too Sensitive, you're gonna have your feet on the floor. You're gonna take your breath, which I'm a big fan of.

    16. SH

      [laughs]

    17. JF

      Say to yourself, "I'm safe. This is feedback, not a personal a- Attack. If you need to excuse yourself for a few minutes, collect your thoughts, let your body calm, which is that regulation piece-

    18. SH

      Yeah

    19. JF

      ... and ask yourself questions like, "Is there at least one useful piece of information that I can grow from? And what would it look like if I viewed this as actual feedback that is not personally threatening?"

    20. SH

      But here's the deal that I love about how this book is kinda structured, because it starts with, you know, this is, like, what's happening, a example, a real-world example, which I've gone through hundreds of billions of times, all of these.

    21. JF

      Yeah. [laughs]

    22. SH

      And then it talks about the tool to use, and then it talks... Well, actually, first, it goes through the example, then it talks about what's happening in the brain.

    23. JF

      Mm-hmm.

    24. SH

      Like, this is why you feel so dysregulated.

    25. JF

      Right.

    26. SH

      Then it talks about what tool to use, and then it talks about how to apply it. All of the tools in that book you've heard before. You've heard about deep breathing. You've heard about taking a walk. You've ch- heard about delaying the reaction and about moving your body. You've heard about all that stuff, but what is different is what to apply and when to apply and how to practice it when you're not in that moment.

    27. JF

      Mm.

    28. SH

      'Cause I think that's so important b- because when you are right in the throes of things, you don't remember any of that stuff.

    29. JF

      Right.

    30. SH

      So being able to practice it when you're not, it, it goes into your brain so that at least, you know, over time, you start to get more comfortable. You start practicing stuff when you're not dysregulated, so it'll start to become more second nature to you as you're going through.

Episode duration: 1:09:49

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