Dr. Sasha Hamdani — known on social media as @thepsychdoctormd — is a board-certified psychiatrist and ADHD specialist. She shines a light on the unique ways ADHD presents in women, the impact of late diagnoses, and the surprising interplay between hormonal changes and ADHD symptoms. Dr. Hamdani also shares her personal insights and expertise in managing her own ADHD diagnosis.
Hello Sunshine, Hey bestsies.
Today on the bright Side, it's Wellness Wednesday, and in honor of ADHD Awareness Month, we're joined by Board certified psychiatrist and ADHD specialist, doctor Sasha Hamdabi. It's Wednesday, October twenty third. I'm Simone Boyce, I'm.
Danielle Robe and this is the bright Side from Hello Sunshine, a daily show where we come together to share women's stories, to laugh, learn and brighten your day.
Today's Wellness Wednesday is presented by Coli Guard.
So October is ADHD Awareness Month and this year's theme is awareness is key. ADHD stands for attention deficit hyperactivity disorder and according to the CDC, it's one of the most common neurodevelopmental disorders of childhood and often lasts into adulthood.
That's true, but what's really fascinating about this is that women and girls are underdiagnosed and undertreated when it comes to ADHD, and identifying symptoms of ADHD can manifest differently depending on age and gender.
I mean, Simone, I actually feel like particularly interested in hearing from doctor Hamdani because you've said before that you feel like you have some symptoms of ADHD.
Oh.
Yeah, I've definitely had my questions and my doubts for a long time about my inability to focus. I identify as a hypergirly, so maybe there's something to that. But I think if you're chronically online, you've probably seen this conversation pop up on social media. It seems like people are talking about it more and more, and there are upsides to that, but there are also downsides. Some of the downsides include misinformation, like are we really getting the truth when we're engaging in these discussions online. So that's why it's really important to bring in the experts, someone like doctor Sasha Hamdani, who knows her stuff.
Is one of the upsides Doing viral Instagram videos with your husband in a pool about being hyper.
I don't know if my husband would call it an upside.
I certainly enjoyed that experience.
I certainly feel it's an upside as if you were I do. But okay, jokes aside, because this is a serious topic. Joining us today to answer all of our questions and clear up any misconceptions about ADHD is doctor Sasha Hamdannie. She's a psychiatrist, the author of Self Care for People with ADHD. And what feels very unique is she's someone who has ADHD herself. You might recognize her from social media where she shares insights on ADHD and mental health to her almost two million fans across platforms.
So let's bring her in.
Doctor Sasha Hamdannie, Welcome to the bright Side.
Hi, thank you for having me.
We're so happy to have you, especially during October, which is ADHD Awareness Month. Yeah, you are a board certified psychiatry. You also have ADHD yourself, and you actually disappeared at the White House to talk about this very subject.
So we are in such good hands.
Why do you feel called to speak out about ADHD awareness?
Well, partially because I have it, and so it comes very naturally because this is something that I'm speaking about from firsthand experience, but also because I think as.
Someone who has.
Lived through it, it's really frustrating trying to navigate these waters. With one, for a long time, there wasn't a lot of great information about it. Yeah, and number two, there was a lot of stigma around it.
I mean, women are historically underdiagnosed and untreated when it comes to ADHD. Yes, from your research and just your experience as someone who lives with this condition and speaking to others about it.
Why do you think that is?
How much time do you have because I could go on before we have time. Honestly, Good Right volumes on this just because it is such a rich area of why women are under or misdiagnosed, and so some of the reasons they're just historical.
Right.
For a long time, ADHD was considered as like something that hyper little boys have and it was outside of the scope of everything else, like if a woman was diagnosed, Nope, you don't have it, because it was only hyper little boys. The other reason is that women have different societal pressures, and so they are you know, trained from a very young age you have to conform, you have to do these things. You can't cause trouble, you can't act up in class, you have to So they're forced to mask all these symptoms and kind of toe the line. Whereas you know they're feeling all these things, they're feeling restless, they're feeling impulsive, but they are so afraid of getting in trouble or they're told like, you cannot be anything besides this one image, and so they just hide their symptoms because that's what they're told to do the high the mask. So that's another thing. Another humongous thing is hormones. There is a huge correlation between hormonal cycles and ADHD expression, and so like for example, with PMDD or PMS, people's symptoms just like body symptoms, everything gets worse. But then your focus also and executive function gets significantly worse. And so a lot of times when people are going to the doctor, they might be on their cyclone. People are just like, it's puberty, or it's hormones, or it's mommy brain, and so everything is getting blamed on hormones throughout it.
It's perimenopause, it's menopause.
So there's so many different things that people are just saying it's hormones. Everybody goes through this one. It's actually not. It's hormones on top of an existing condition.
When you talk about these symptoms being different in girls and boys, I'm curious how they show up for women. Yeah, like, what do we associate as a typical ADHD case in.
A woman, So you know, for males versus females, And when I'm saying females assigned female at birth, I think we have to look at the fact that females present more as this inattentive picture. For ADHD, there are three different types. There's inattentive, there's hyperactive, and there's combined type, which is a combination of the two of them. Females present more as this inattentive picture, so like the classic daydreaming. So difficulty organizing things, difficulty staying on tasks, difficulty forgetting daily routine like walking out of the house, did I brush my teeth, did I, you know, close the garage, all of these things, difficulty with you know, people are talking to them and they can't maintain the conversation or pay attention within the conversation, getting easily derailed off task, or having difficulty with prolonged focus in tasks. That's typically how women present, and even younger roles present. Males typically present as this combined type or hyperactive picture, which is more of what you think of with that physical impulsivity and hyperverbosity. So they're super talkative, they are interrupting, they're being disruptive in class, they're fidgety, they're getting up, they're running around. So those are the things that maybe a female presents like that, but it is you know, it's shut down. That behavior is shut down pretty quickly, and you know, they're not the ones typically running around there's they're not the ones getting kind of a past, so they mask those symptoms.
I keep reading about studies that say that all of our attention spans are decreasing at a rapid rate. So I can imagine people listening thinking, well, my attention span is sort of low, Like, what is the marker of regular sort of twenty twenty four lack of attention Instagram era versus a woman who suffers from ADHD.
So I think it's important to note that brain mot is for real, right, That's something that we are in an increasingly digital age, and we are attention is constantly being fragmented by one hundred million things, by notifications, by dings, by social media, by you know, work, all these different reasons. Yeah, so it's hard to distinguish that. But what we're looking for with ADHD is that this is a pervasive pattern of behavior since childhood. So this isn't just a twenty twenty four problem. This is coming from a really young age. This is something that is causing significant dysfunction to your life. And this is where a lot of people have issues with the terminology of ADHD. Like the name ADHD attention deficit hyperactivity disorder not great. I don't love the name, honestly, but a lot of people have beef with the disorder part. And I think the disorder part is actually really important because ADHD causes dysfunction. It is a disorder. It's not a lot of people, you know, when they're talking about ADHD within the context of neurodivergence and feeling like, oh, everybody's brain works a little bit differently. I think that's entirely true. But I also think that the disorder part is really important because it causes that person dysfunction and it feels like a disorder and it is negatively impacting their lives.
Right.
I rarely do this.
I'm literally taking notes as you're speaking, because this all just feels so relevant, Like for me personally, I've wondered if I have it or have a later in life diagnosis.
As a parent, I think this is so informative.
Yeah, let's talk about late diagnosis and how it impacts women. So I've heard anecdotally, you know, stories of mothers who have reportedly discovered their own ADHD after their children are diagnosed because it's the first time that it really causes them to think about how these symptoms might be impacting them. How does a late diagnosis impact us.
Yeah, so the unfortunate thing is statistically males get diagnosed between six and eight years old.
It's so early.
Females their average age of diagnosis is their mid thirties. Who so it's not late like this is our average time of diagnosis, which is really unfortunate because they present at the same time. It just gets skipped and ignored, or or people just get passed from grade to grade to grade and they don't really you know, no one picks up on it or is unwilling to do things about it.
Well. Also, then, like these women have suffered all throughout studying for tests in school and college, potentially college years and early work years.
It's not even just that, Danielle. The thing that I really like think is worth talking about with ADHD is it's not just a focus issue. I think the scope of the DSM is kind of narrow, but ADHD bleeds into everything else. If you don't have enough attention to figure out what's happening actively in your life, you're also things are falling apart at home, and so your home like gets impacted, your relationships are impacted, you are, the way you integrate with the rest of the world is impacted. So these women that are getting diagnosed much later in life, they've gone through a significant portion of their formative years without a diagnosis, without understanding how their brain works, and instead getting, you know, the input that I'm lazy, I'm dumb, i can't live up to my potential, I'm not as good as anybody else. And so that's what I think. We're dealing with an entire generation of women that were skipped and that are now kind of making amends and you know, helping their children through this while also trying to heal themselves. So it's a really complicated and confusing snapshot of their lives.
Well, speaking of coming a long way, you've said that the diagnostic criteria basically all comes from a book called the DSM. Yeah, the Diagnostic and Statistical Manual of Mental Disorders. I learned about this manual about four years ago. It encapsulates basically every mental disorder you can think of.
Yes, but in the.
DSM, the criteria for ADHD is really centered around focus and I know we've been talking about other symptoms, but ones that you've mentioned that are not focused enough.
On our anxiety and mood.
How does that sort of like come up in people with ADHD.
Honestly, I think with I see it a lot in patience of mind. I've also experienced this myself. I think they travel hand in hand. And so if your ADHD is unregulated and not properly controlled, you get overwhelmed, you get exhausted, you get it looks depression, it looks like anxiety because you're trying to make up for these deficits and can't. A lot of times, like without proper instruction or methods to cope, it's really difficult to stay on top of these things. And so I think that you know, a lot of women get diagnosed with depression and get diagnosed with anxiety, but really you need to look at that underlying cause. So I think that like in a dream world situation, the DSM would have like a line in there, or like a credentialing kind of thing where it's like, Okay, well we will look at the criteria for depression and anxiety, but it's ADHD the cause of it.
If that's the case, then ADHD is.
A diagnosis rather than ADHD plus these other things.
We need to take a quick break, but we'll be right back with doctor Sasha Hamdanni. And we're back with doctor Sasha Hamdannie.
You mentioned earlier that one of or some of the symptoms that women deal with, particularly when they're younger, get internalized. Yeah, what are the symptoms that we don't talk about as much?
You know? I think like if you're strictly going along with the DSM, I think one of the biggest things is that, partially because of the name attention deficit hyperactivity disorder, people get really hung up on like, oh, if I have ADG, I have to be hyperactive. You don't have to be what you think of typically as hyperactive. It could be like a mental hyperactivity that your brain is moving along and clipping along so quickly that it's hard to organize thoughts or categorize thoughts or figure out what your next steps are. I think a very commonly overlooked one that people usually call stress or mommy brain is this feeling of being catastrophically overwhelmed, just like all of these things piling up on your plate and not knowing where to start. Or how to attack the problem. And with this like that problem gets compounded, like every single day you're not addressing the underlying issue, your problems are getting bigger and more complicated and increasingly more difficult to solve. So I think that's one really important thing that we don't talk about enough.
So you mentioned hyperactivity. I've heard you talk about two other subtypes of ADHD, which are inattentive and combined. How do each of these three how are they distinguished from each other?
Yeah, So, I mean the way that we make our diagnosis is based on this set of criteria in the DSM, which is the guidebook for symptomology and medical criteria. So the hyperactive is more of what you think about with impulsivity and hyperactivity, like difficulty staying in your seat and you're constantly fidgeting and you are talking a lot, interrupting a lot, blurting on or not letting other people participate in conversation. And then combined type is a combination of both of those. You need to hit a certain number and have a combination of both criteria.
When you mentioned hormones, my first thought was I recently interviewed a woman who is making a running shoe, a performance shoe for women. I was unaware, but most of the running shoes that we're all wearing are actually basically made from male molds, and we're just wearing smaller sizes. And when I was asking her what the impacts are, one of the things she brought up was that our hormones actually really affect our physiology and how we're running, and that we need certain things at different times of the months. But the issue is that it's completely understudied and it's expensive to study hormones. I was really interested to see you talk about how much hormones can impact ADHD and our experience with it as women.
Can you elaborate on that a bit?
I think you're absolutely right. I think this is a hugely understudied area because hormones are fluctuant with ADHD. How this presents it is actually really distinct and really important to notice because with those hormonal cycles, and you know, if we're talking about the menstrual cycle, there is a period of time premenstrually, so before your period actually starts, where your estrogen drops. Okay, fine, whatever you might be, you know, PMS having all of those symptoms, But what people don't also kind of notice is that estrogen and dopamine kind of go hand in hand. So when your estrogen levels drop, your dopamine levels drop, and that just leads to this chaos. In all of a sudden, you're unable to do simple tests that you were able to do before. So you're having a much harder time with like planning how to do things, executing tasks, making sure things get done. You're dropping the balls on things, and so it gets even more confusing because then you're just like, well, I know I feel bad that it's because I'm not getting as much done or I'm not but people don't actually put those two things together, that your hormones are making your ADHD symptoms worse, and so that's you know, these are some of the things that you look at when you're doing an assessment for someone like do you have a cyclical variation? Do you notice your symptoms get worse? Which is why I think it is so so, so so so vital to track your patterns.
I'm so mad right now. I gotta be honest, I'm so upset.
I'm so upset that I am just now finding out about all of this at thirty six years old, Like.
That is so messed up.
I know, I've learned so much about my body in the past few years, particularly since I became a mom, and I know where I am in my cycle at all times. I know that my lutel phase is going to be chaos every month. But you just helped me make the connection between my desire to seek out dopamine inducing experiences and also my lack of focus during that week before my period.
Yeah, and spoone don't even feel bad about that because I literally I'd gone to school essentially the entirety of my whole life to do psychiatry to learn about the brain. And it wasn't until you know, it was during COVID that I was like, oh god, you know it is so it was so hard to stay on top of my ADHD symptoms, and so I started thinking about, like, what are ways that I could make this better and reach more people with this, And so my sister and I created an app. And one of the things on the app is like a focus tracking thing where you get to see your patterns and you see it very visually. I did that so when I was beta testing this app, I did eight months of that it was a four day period every single month where I was like, I was tracking my impulsivity and I was like, oh, my impulsivity time and impulsivities high.
It would be four days.
And then I went back and I looked at my credit card statement and there was a six hundred dollars bump like on average those four days. And it's because I was just sitting, not like spacing out and like going on Amazon or going on Revolve or going on I just was doing this so mindlessly. And then I was like, that's so weird. Why does this happen every day and every time at the end of the month. And I was like, oh, okay, that's why it's so hormonal.
As you're sharing more about your own symptoms, I'm really curious about your own diagnosis and how old were you when you were diagnosed.
The first or the second time. I was diagnosed kind of twice both.
I didn't know you could be diagnosed twice.
Okay, So the first time, I was in fourth grade, and it was like I was just I presented kind of like a boywood. I was super disruptive. I was starting riots in my classroom. I was like getting up on the desk. I was just out of control.
Also legend though, legend, So you know.
The teachers in the school talked to my parents.
My mom was a pediatrician, and she's like, okay, yeah, there could be something. She got me in to see, like somebody. I was diagnosed with ADHD and I actually started medication. Now this was many years ago, and it was still super super stigmatized. I was a really sensitive little kid. My parents didn't tell me I had ADHD. They just gave me my vitamins. So every day I took my vitamins, and I felt better, and I started doing really well in school and enjoying school. And I did. I continued to do well. I didn't change my dose. I didn't do anything, continue to do well all throughout high school. Got into medical school out of high school, and that was the first time I was away from home.
I obviously, you skipped college, You're a genius.
So I did college and mid school at the same time. Oh my gosh, So I applied. I got into this program. So I started my med school classes when I was seventeen.
Oh my goodness. Wow.
So I got into my classes and I was used to being awesome, like in high school, I was awesome. I was on top of it. I didn't have to try really hard. I was just like great at school and I really loved it. I got into med school. I had a neurology test and they would like post the scores on the board and you'd go and find your number and figure out which your thing was. And I remember going to that thing and I was like, oh my god, somebody got a thirty two. What is wrong with this person? And then I was like, oh wait, that was me. I got a thirty two.
What did the thirty two mean?
It was a test in like a neurobiology lab, so you were like writing down like okay, these are the structures of brain. And I was like, I studied, I don't understand. I went I went to teacher. I was like, this is impossible. How did this happen? I didn't turn over the test, so I turned in the exam, didn't turn it over. I've done that and I was like, oh my god, I've made this mistake like four times this month, Like I did this with a homework assignment, I did this with a lab and I was like, there is something wrong with me. This happened again and again and again, and I was like, I like, it got so bad to the point where they were like you need to, Like, I don't think you're gonna make it through. So my dad at this point was just like, you know what, come home, let's figure out what's going on.
So I go home. He was like, are you taking vitamins?
I was like, I don't know where they are, so no, obviously no, I'm not. Oh wow, And he's like, okay, so you have ADHD. I was like, there's no way, there's no way. I'm super angry. I felt really betrayed. I felt like, you know, I was given medication without my knowledge. You know, I just didn't believe it. I go back to school. I'm like, I'm going to try now. I know I don't have a medication. I'll prove to you I don't have ADG, for sure have ADG. It didn't get easier. I was just falling more and more behind. My dad pulls me out again. We sit and he's like, I don't want you to worry about school. He's like, for the next week or however long I have, we will just go and study the brain. So we were going to the library and we were like reading about ADHD, We're reading about the brain. We're reading about these like different like brain structures and how people grew and developed and like from evolution and genetics, and I mean, it was just incredible the amount of information I got.
And then after that I was assessed again.
They were like, yeah, you have ADHD, and so then I got more ownership of like, Okay, now I understand how my brain works a little bit more.
What do I want to do? What are the medications going to do?
And then I was just trial and error with medications and then that's my story.
Your dad sounds awesome.
Yeah, he was the most.
I mean, and my mom super My mom is a pedaedrician, really really educated about this stuff, but my dad was the most.
He was my biggest cheerleader always.
I've thought about this and I was like, you know, I wish they had like it had been handled differently or I had been explained. Yeah, but I don't think they had been given that knowledge either. It was just this highly stigmatized thing. They were like, honestly, we got that information. We were scared. Like the information we were given is like, this is psychiatric disorder. People typically don't live alone you know, if they have ADHD, and so they were like, it sounded horrible. We didn't know how to frame that to you. We just wanted to try something to see if it helped. It did it never came up again, so we've come a long way since.
Then it's time for another short break, but don't go anywhere because we'll be right back to wellness Wednesday with doctor Sasha Hamdani.
And we're back with doctor Sasha Hamdani.
Well, I want to talk about how you manage your ADHD. Yeah, you mentioned going through the pandemic and how that really revealed to you a lot of the patterns that ADHD has brought into your life. And I'm curious, what did the pandemic teach you about how environment and circumstance play a role in the management of this condition.
So I think it has a lot to do with it, right, So I struggled for a long time throughout medical school trying to figure out like what the right combination of medication and altered my environment could be.
I got through.
Medical school, but I don't feel like I gained mastery or ownership of it until I got into like psychiatry residency. Because as soon as I landed there, I was surrounded by psychiatrists and therapists and they were just.
Like, oh, let me help you, let me, let me make your life easier.
And it was like a crack, like three years of intensive like restructuring and building up my self esteem again, which had been basically zero after medical school. And so I think that they in that program, I think they kind of also taught me how to manipulate the environments that I'm in for the greatest success. And so I think that's what's been the greatest thing that I've learned from that, Like what do I need to do to adjust the environment that I'm in to make it more conducive for my brain. They'll give you some examples, like for me, I don't learn if I'm typing on a computer, and so like even with my patients, I take notes on the computer. I put their information on a on a medical chart in the in the computer. But while they're talking, I'm writing because it's going into my brain and that's that's how I learn, and that's how I'm absorbing what you're telling me. Things like with sleep and with waking up. I tried as much as I can to keep to the same routine. I need to kind of manipulate my schedule or plan things so it's not running past that ten PM because if I get if I'm not in bed by like eleven, things get real weird the next day. So like trying to figure out things like that. Eating was a huge, huge thing for me because it's taken me a long time to figure out, like how to eat to sustain and nourish my body in a way that's gonna not make me feel number one disgusting, where I'm like, I'm forcing myself to eat and I hate every second of it. But something that's going to help my brain. What can I What can I eat that's not going to make me sleepy? What can I eat to give me long lasting energy? What can I eat at night to keep me full through the night so I'm not waking up at two am and I'm like, oh, I'm hungry and fully awake.
If people listening feel like any of these symptoms ring true, or they have a suspicion that maybe they have gone undiagnosed, what do you think the first step is?
What do you suggest that they do?
My first step is learn about it as much as you can, I mean even before you go to a doctor, if you just immerse yourself in it, because I think that you are the only person who understands your own internal environment. And it's important to have a vocabulary and learn about things because you might get into and be like, oh, that actually doesn't sound like me, or you might get into it and be like, oh, this really does sound like me, Like and I didn't even realize that this was related to it. So having understanding that is going to be huge. Number two, Track your patterns, Track your patterns, And this is like why I keep screaming about it, because then you're gonna know, like, is there a hormonal swing with it? Is there times where like is this all caused because I did not drink a single glass of water for the entire month of October?
Yes? Probably?
And then if you still feel strongly about it, it's seeking out the right type of help. So you can get assessments through a therapist. You can get assessments through a primary care doctor, get assessment through a psychiatrist. Psychiatrist not only can they diagnose you, but they can treat you. If medication is the option you want to go through. And I think getting specific therapy. Like I will tell you that I would not be in the position that I am right now if I hadn't had those instructors giving me that specific therapy and helping me kind of restructure my life because it you know, with medication, it's great, but when the medication wears off, I'm still still have stuff to do. So it's important to have those good basics to build on.
Okay, you developed an app that you mentioned earlier that's geared to be an ADHD companion. I need to better understand this. From what I read, it's really about tracking patterns. Is that correct?
So Focus Genie is the name of the app, and it's kind of just like this comprehensive platform. So it's got educational modules, which I mean they're just like really it feels like an Instagram swipe through going, but like by the end of that two minutes you have learned something new about your brain. So there's educational modules. There's a focus tracker where you could track like how much water I drank, this is what I ate, this is how much I slept, this is how impulsive I was, and so you can see your patterns over the month.
There's a journal.
There's also this is coming out later this month, and I'm actually so excited about this. I felt like where I was getting stuck is sometimes I was like, I can't even make my to do list, Like I can't even break down this task because it is so complicated and hard and overwhelming for me right now. But we just integrated AI into the app. We're rolling out hopefully by mid November, maybe maybe a week earlier. So now you type in what you want to do, it'll break it down for you in eight steps. If you're still having difficulty with it, it'll break it down further. You can import that into your to do list and you can go through and continue along your day.
I love that. That's so good. I can't wait to download this app. I feel like, even if you don't have ADHD, your app sounds so helpful.
Yeah, just to all of us living in the digital age.
It kind of helps break things down because I feel like, especially with housework, especially with stuff that is so boring to me, so boring that I don't want to do it. I really like being able to break things into those tiny little chunks.
Doctor Hamdannie, thank you so much. This sum was really enlightening.
But thank you for having me. That's so much fun.
You're the coolest psychiatrist ever.
Oh, come on, come on, be real. Doctor.
Sasha Hamdanni is a Bored certified psychiatrist and the author of Self Care for People with ADHD. You can find her on Instagram, TikTok and YouTube as the psych Doctor MD.
That's it for today's show. Tomorrow, it's a double simone day. We've got the one, the only Raven Simon here with us. Thank you to our partners at Coligard, the one of a kind way to screen for colon cancer in the privacy and comfort of your own home. Talk to your doctor or healthcare provider, or go to coliguard dot com slash podcast to see if you are eligible to order online. If you're forty five or older and at average risk, ask your healthcare provider about screening for colon cancer with Coliguard. You can also request a collar guard prescription today at coliguard dot com slash podcast. Join the conversation using hashtag the bright Side and connect with us on social media at Hello Sunshine on Instagram and at the bright Side Pod on TikTok oh and feel free to tag us at Simone Voice and at Danielle Robe.
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