Dr. Anupriya Gogne: ADHD & executive dysfunction in the perinatal period

0:00 [SPEAKER_01]: Treatment doesn't have to be about XYZ being the certain way.

0:05 [SPEAKER_01]: It really depends on what the person at that point in their life's want.

0:09 [SPEAKER_01]: For their goals, for their family's goals, for their professional goals, and all of that can be facilitated by the medication, but there may be a lot of behavior change also needs to happen.

0:25 [SPEAKER_00]: Hello and welcome to the women and ADHD podcast.

0:29 [SPEAKER_00]: I'm your host, Katie Weber.

0:31 [SPEAKER_00]: I was diagnosed with ADHD at the age of 45, and it completely turned my world upside down.

0:37 [SPEAKER_00]: I've been looking back at so much of my life.

0:40 [SPEAKER_00]: School, jobs, my relationships, all of it with this new lens, and it has been nothing short of overwhelming.

0:47 [SPEAKER_00]: I quickly discovered I was not the only woman to have this experience, and now I interview other women who like me discovered in adulthood they have ADHD, and are finally feeling like they understand who they are and how to best lean into their strengths, both professionally and personally.

1:05 [SPEAKER_00]: Hello, hello and welcome back you are in for a wonderful episode today and before we get started just a quick reminder make sure to head over to women and ADHD.com our education and advocacy hub for neurodivergen adults like you.

1:20 [SPEAKER_00]: At women in ADHD.com, you'll find all the resources you need to help you better understand your brain so you can thrive.

1:27 [SPEAKER_00]: You can book a free consultation with any of our fantastic team of certified ADHD coaches.

1:33 [SPEAKER_00]: You'll also find tons of free infographics, our recommended self-tests, and myself guided course, hey, it's ADHD and much more.

1:41 [SPEAKER_00]: Again, head to women in ADHD.com.

1:44 [SPEAKER_00]: Okay.

1:45 [SPEAKER_00]: Here we are at episode 203 in which I interview Dr. Anupria Gogne.

1:52 [SPEAKER_00]: Dr. Gogne is a board-certified addiction psychiatrist who specializes in women's mental health.

1:57 [SPEAKER_00]: She's also the division director of outpatient psychiatry at Brown University Health in Rhode Island.

2:03 [SPEAKER_00]: Over the past eight years, she has worked closely with adult and perinatal women navigating a wide range of psychiatric challenges.

2:09 [SPEAKER_00]: After her own late-in-life ADHD diagnosis,

2:15 [SPEAKER_00]: particularly in high achieving women who had spent years feeling overwhelmed, misunderstood, or misdiagnosed.

2:21 [SPEAKER_00]: Her personal and professional insight led her to write her recent book, the book is called neurodevelopmental disorders in adult women, special considerations in the peri-natal period.

2:31 [SPEAKER_00]: And it offers a clinical guide for trainees and practitioners and sheds light on the often overlooked experiences of neurodivergent women and mothers.

2:38 [SPEAKER_00]: In this episode, we discuss how ADHD often presents very differently in women, especially during the perinatal period, and how executive dysfunction can so often be mistaken for laziness, depression, or general character flaws.

2:51 [SPEAKER_00]: We also talk about how new mothers and fathers experience executive dysfunction very differently, and the strong need for strength-based individualized approaches in perinatal psychiatry.

3:00 [SPEAKER_00]: So without further ado, here is my interview with Dr. Gokene.

3:04 [SPEAKER_00]: Well, Dr. Goatneye, oh, I know I was going to do that.

3:07 [SPEAKER_00]: Goatneye, goatneye, can you tell me how to pronounce it?

3:10 [SPEAKER_00]: Goatneye.

3:11 [SPEAKER_00]: Goatneye, okay.

3:14 [SPEAKER_00]: I don't know, my mouth is having a hard time with it.

3:16 [SPEAKER_00]: I apologize.

3:17 [SPEAKER_01]: No, no, it's an unusual name, even by Indian standards, so it's okay.

3:22 [UNKNOWN]: Is it?

3:22 [SPEAKER_00]: Okay.

3:23 [SPEAKER_00]: Well, I think it's because I think I want to pronounce it like it's French.

3:27 [SPEAKER_00]: I think that's what it's like.

3:29 [SPEAKER_00]: Please tell me, I'm not the only one who does that.

3:31 [SPEAKER_01]: No, no, a lot of people.

3:33 [SPEAKER_01]: I usually just see a gene, a patient call, and a doctor, a gene, everyone calls me a doctor, so you can see the perfect.

3:39 [SPEAKER_00]: Well, thank you so much for joining me.

3:41 [SPEAKER_00]: I am really excited.

3:43 [SPEAKER_00]: I feel like, I don't even know where to begin.

3:45 [SPEAKER_00]: I have so many questions as usual.

3:47 [SPEAKER_00]: But first, let's talk about your...

3:51 [SPEAKER_00]: sort of journey with your own understanding and your own diagnosis of ADHD and sort of what when was that and what was happening in your own life as a psychiatrist, as a clinician, that you started to put the dots to connect the dots for yourself.

4:10 [SPEAKER_01]: Yeah, so I think it was both as a clinician and in my personal life a lot of changes were happening.

4:18 [SPEAKER_01]: So I did my residency in psychiatry then I did an addiction fellowship and then I was doing the reproductive psychiatry fellowship because I wanted to work with women who also have substance fuse problems and specifically the perinatal women and I did the fellowship there and I stayed back as an attending for like seven years.

4:39 [SPEAKER_01]: But what happens from residency to attending her is that overnight, your case loan doubles, your teaching responsibilities can.

4:49 [SPEAKER_01]: And so suddenly I was then very busy at work and I was lagging behind on notes and I hate to do notes like everyone hates to do notes.

5:00 [SPEAKER_01]: But I was starting to notice that I'm staying back to like seven eight o'clock and I'm still not done what is going on.

5:07 [SPEAKER_01]: And I had kind of always suspected it, that something was off.

5:11 [SPEAKER_01]: I think this is at least in my experience, patients have told me, other women have told me, who have had diagnosed in untreated ADHD all their lives, that it's almost like they feel like there is some, like a glass wall between them and the rest of the world, and they are different in some way, they just don't know what it is.

5:33 [SPEAKER_01]: And so that's how I felt I would compare myself to like other trainees I had trained, other women who actually had children were had busier posts in the lives than me and they seemed to be juggling everything perfectly and I was like, what is going on?

5:47 [SPEAKER_01]: Around the same time I met my now husband and we moved in together and then I had never had the experience of having a bet

6:00 [SPEAKER_01]: But then we did no research and very impulsively, in a very ADHD fashion, we got a husky puppy.

6:09 [SPEAKER_01]: Stuff.

6:10 [SPEAKER_01]: I know a like dog mom is not the same as mom, challenging a different, but in a very short period of time, a lot of transition happened and a lot of increased demand on my executive functioning happened.

6:25 [SPEAKER_01]: And I was objectively starting to feel dire all the time and irritable and restless, I think.

6:33 [SPEAKER_01]: And so by that time, you know, I was already in therapy, like as part of psychiatry training, I've always had a therapist.

6:41 [SPEAKER_01]: And so I was already in therapy and I was just discussing with my therapist, like, and I was already on a couple of medications.

6:52 [SPEAKER_01]: And I was not depressed.

6:54 [SPEAKER_01]: I did not have any more PTSD.

6:57 [SPEAKER_01]: I was not anxious.

6:58 [SPEAKER_01]: In that way, like generalized anxiety wasn't there.

7:01 [SPEAKER_01]: But I felt like why am I so tired and why am I so.

7:08 [SPEAKER_01]: I'm not living my full life.

7:11 [SPEAKER_01]: I felt like that.

7:13 [SPEAKER_01]: So I kind of suspected ADHD, but I had never been tested.

7:16 [SPEAKER_01]: And in India, when I was a kid,

7:21 [SPEAKER_01]: people tested for.

7:24 [SPEAKER_01]: It's still not not a thing, but I went my therapist at the time.

7:30 [SPEAKER_01]: It referred me for neuropsychological testing.

7:32 [SPEAKER_01]: So I thought if, you know, even if I don't get any information, it's going to be a fun exercise.

7:36 [SPEAKER_01]: Let's see what happens.

7:38 [SPEAKER_01]: And so I went for the testing and fortunately had a very good tester because I think that makes a huge difference

7:50 [SPEAKER_01]: And so, two weeks after that, she called me in and she went over the report and she confirmed the ADHD and she also, which I was not surprised by, she also confirmed the diagnosis of non-verbal learning disability, which is now kind of considered on the autism spectrum.

8:13 [SPEAKER_01]: she was able to she tested for some video spatial stuff and that's why she was able to diagnose that.

8:20 [SPEAKER_01]: But she had not tested me for any social deficits because that was not what I went to her with.

8:27 [SPEAKER_01]: That was not my complaint that was not what the therapist had seen.

8:31 [SPEAKER_01]: It can be so well masked that no one would know if they don't look.

8:37 [SPEAKER_01]: And so she said to me, you really fit this category,

8:41 [SPEAKER_01]: You have everything but the social part, and I told her that I do have the social part, I've just learned to mask it very, very well.

8:49 [SPEAKER_01]: And so after that, I had a little bit of a, so I feel it's like a grieving process.

8:57 [SPEAKER_01]: Like initially I felt not shocked, but finally I could, I felt relieved because it's like all the pieces of the puzzle fit into place.

9:07 [SPEAKER_01]: then I felt that, you know, I need to educate myself and I need to read more and reading more.

9:14 [SPEAKER_01]: I had read, say, soldems book of course and many, many other, and I started listening to the I did your magazine podcasts.

9:22 [SPEAKER_01]: And so for about six months, that's all I did just to reading what I just did.

9:27 [SPEAKER_00]: As one does after the ADHD diagnosis, right?

9:31 [SPEAKER_01]: As one does, and you know, I went through kind of all the phases where I felt angry that, you know, my parents were doctors, my whole family, doctors and no one ever suspected it, no one ever caught it, no one would know it, I'm a doctor, I questioned how did I become a doctor with these difficulties, how did I get through men's school, I questioned those things, I felt like how am I,

9:57 [SPEAKER_01]: I think I'm a good enough therapist and I feel like if I have the social deficit, how am I with therapist?

10:02 [SPEAKER_01]: So, I really kind of ran back to my supervisors and asked them what they noticed.

10:09 [SPEAKER_01]: all of this kind of ground work had me to assimilate these two parts of myself into my sense of self in a positive way.

10:18 [SPEAKER_01]: There was some I think as one has when you make someone self aware of those things there's also more frustration because they notice a bit more.

10:26 [SPEAKER_01]: So now I notice it more when I'm having a thought and if I don't write it down it vanishes into the next

10:34 [SPEAKER_01]: And so it's so frustrating when that happens, but now I'm aware of it, but I also now know coping strategies for it.

10:43 [SPEAKER_01]: So

10:44 [SPEAKER_01]: At the same time, I was working with perinatal patients, and so pregnant and postpartum women, postpartum women who were breastfeeding.

10:53 [SPEAKER_01]: I also was working with girls who at the NDD, and then I was also working with Dynonk patients, gynecology, cancer patients who often were postmenopausal.

11:07 [SPEAKER_01]: right.

11:07 [SPEAKER_01]: So I was seeing these different times in which for women are more than changes as a major influence.

11:15 [SPEAKER_01]: And for the first time now, if there were never diagnosed before, for the first time now, they were having a lot of executive dysfunction, a lot of mood ups and downs, and just not understanding what happened.

11:29 [SPEAKER_01]: And the ones who were diagnosed already felt

11:35 [SPEAKER_01]: I felt in treatment, I was at a point where, if they didn't have a diagnosis of ADHD, I had stabilized everything else, and this was, you know, a population, I specifically worked with dual diagnosis, and so, you know, these were women who had histories of trauma, who had depression, chronic depression, and generalized anxiety, and so a complex kind of

12:04 [SPEAKER_01]: treated all of that.

12:06 [SPEAKER_01]: And similar to myself, what they were reporting was that still there is something that doesn't feel right.

12:12 [SPEAKER_01]: And so I started to get more patients tested and luckily I found a place in Rhode Island.

12:20 [SPEAKER_01]: I found a place where I really liked their reports.

12:24 [SPEAKER_01]: So I started to read reports.

12:26 [SPEAKER_01]: And like, you know, we are trained at, like we know what new psychological testing is, but I really had to look up the individual terms, specific parts of executive functioning, neurocommoner functions that I didn't know exactly what they were by definition, but also how they translate into data-to-day life.

12:46 [SPEAKER_01]: And so what I started to do was kind of this, I started to take those women's histories their anti-natal histories to see if their mother's pregnancies with their husband complex and looked up data on that.

13:01 [SPEAKER_01]: And then I would use the, sorry, sold-in screening questionnaire.

13:08 [SPEAKER_01]: I really liked that questionnaire because one is for women.

13:11 [SPEAKER_01]: And two of it goes by symptom domains and that was very helpful to me because often patients people don't know where to start and that I had to say initial so it helped structure us and so I tried to get that real world information integrated with what we found on your psychological testing.

13:32 [SPEAKER_01]: and combined the tool and treatment was about not just about describing a medication, although I am primarily a medprescriber, but also other skills and kind of understanding of yourself as a whole.

13:47 [SPEAKER_01]: And so then the last bit of history is that then I had a lot of psychiatry trainings from brown trainees from brown and I was every month they rotate every month and every month I was repeating the same things telling them all this so I know I'm just going to write it somewhere and then we will see what happens.

14:07 [SPEAKER_01]: It'll be much easier.

14:08 [SPEAKER_01]: So I wrote the book that was two years ago.

14:13 [SPEAKER_01]: So long the answer to what that's what happened.

14:16 [SPEAKER_00]: Okay, wow, yeah.

14:17 [SPEAKER_00]: I mean, cash so much of that I related to and even just as somebody who was diagnosed with postpartum depression and postpartum anxiety, you know, I've related just so much of what you were saying, not only just about the hormonal peaks and valleys, when you look back over the course of your life and think like these moments where it felt like

14:39 [SPEAKER_00]: It's very difficult to even parse am I struggling more than other people or is this just a time in your life where you're supposed to struggle right I think that's a really difficult way to gauge and even with the example of the husky like you don't talk I had when I I've never had a dog growing up and so when I first got our dog I was very impulsive as well and I was in way over my head because they really are just like having a toddler for for years.

15:04 [SPEAKER_00]: So, but, you know, those moments where it's like that you're just suddenly thrust into chaos in some ways, and then you start to say, like, okay, I'm really, really struggling.

15:16 [SPEAKER_00]: But I think also, how do I even gauge if I'm struggling?

15:19 [SPEAKER_00]: You know, what's a normal quote unquote, a amount of struggle, right?

15:24 [SPEAKER_00]: And I think we're just so programmed to think, well, it's not that bad.

15:27 [SPEAKER_00]: It can't be that bad, it's not that bad, right?

15:29 [SPEAKER_00]: I love what you said about a series sold in assessment too because I feel like I had a very similar experience in my own life where I took the adult diagnosis, you know, the adult assessment based on the DSM and I'm trying to remember what it's called it's not the snap for it's

15:44 [SPEAKER_00]: Whatever is for the adults, but it's, you know, based on the DSM questions, right, right.

15:49 [SPEAKER_00]: So it's questions like, do you feel like you're run by a motor, which was, I never understood that.

15:54 [SPEAKER_00]: I was like, I don't know.

15:55 [SPEAKER_00]: What does that even mean?

15:56 [SPEAKER_00]: Are we all kind of, isn't that what our heart is?

15:58 [SPEAKER_00]: Like, I was like, um, and I think I got kind of a middling score on that and never really felt like a connected with it, but that when I took Jerry sold in score, it was like my entire, or when I took her assessment, it was like my entire life flash before my eyes.

16:12 [SPEAKER_00]: such a different experience of thinking like like you said like oh I had no idea this is what people are talking about when they're talking about ADHD and like you said too right like I was a doctor my parents were doctors how did they not see this were you able to talk to them about this I mean have you been able to have conversations with them unfortunately my parents my mother had passed away before I was diagnosed and she's like the one person I really wanted to

16:41 [SPEAKER_01]: I did at that time, by that time, I think my father had already passed away during COVID.

16:47 [SPEAKER_01]: So this is like, I think, like, nearing the end of COVID.

16:50 [SPEAKER_01]: But my mother was still alive at that time.

16:53 [SPEAKER_01]: So I took her anti-natal history when she was pregnant with me.

16:56 [SPEAKER_01]: And she did have hyper-immacens.

16:59 [SPEAKER_01]: And she did have pre-Atlantia.

17:01 [SPEAKER_01]: And I was a little bit

17:03 [SPEAKER_01]: lady, although that did not continue into mine, I don't know, but I think she was able to clarify some things, but because in India people think about psychiatry many differently and it's changed over the years, but I don't think that she was very psychologically minded in that way that she was not really a mental answer.

17:26 [SPEAKER_01]: Like some of the executive functioning questions are

17:29 [SPEAKER_01]: What it kind of came down to was that, and I tell people over time, it's not a problem of intellect.

17:37 [SPEAKER_01]: That's what's so frustrating about it.

17:39 [SPEAKER_01]: I always felt stupid, but I knew no one not stupid.

17:43 [SPEAKER_01]: If I just like do overnighter, I'm going to pass this test and pass it with playing colors.

17:48 [SPEAKER_01]: So obviously, I'm not stupid.

17:50 [SPEAKER_01]: but why do I need to wait until the last moment, I never understood that.

17:55 [SPEAKER_01]: So things like that, she brought back to my collection.

17:59 [SPEAKER_01]: But I think what I realized from talking to my supervisors, from residency was, and this is more kind of talking about the social aspects, both with ADHD and autism, that something that is very important is context.

18:15 [SPEAKER_01]: And this context in which I am interacting with the patients,

18:20 [SPEAKER_01]: is a context that and very well trained in.

18:24 [SPEAKER_01]: So it's not a deficit because one and really hold in because that's what I'm interested in.

18:30 [SPEAKER_01]: And too, I understand this context and how to interpret it very well.

18:36 [SPEAKER_01]: In personal relationships, context, talk context vary all the time and the different things happen.

18:44 [SPEAKER_01]: There's more distractions, right?

18:47 [SPEAKER_01]: And so, you know, kind of my this question that how did I become a good therapist, what I answered, that, you know, if I had, thank God I had structure, I had a, like I think the things that worked for me were that I had a lot of structure, strict parenting came with a lot of structure.

19:05 [SPEAKER_01]: But also I think I was lucky to have supervisors in residency later on who I was always asking questions and curious about something thing that the kid in class was always embracing their hand and they encouraged that I think and so.

19:23 [SPEAKER_01]: you know, I saw how that helped me to contain some of this and to channel all this energy into something productive and it actually motivated me further to see that if I can do this, my patients can do this, like they just need structure, they need a lot of other things,

19:51 [SPEAKER_01]: they will be okay eventually they will be okay they'll find a way.

19:56 [SPEAKER_00]: Right?

19:56 [SPEAKER_00]: Well, this is where I feel like there's the two pillars there in terms of the structure and the tools that help with executive function, but also the other, you know, integral piece is mindset like you said string space mindset and also having that language.

20:22 [SPEAKER_00]: You know, from the, from the luck of the draw, we might end up in situations where you're in med school or you might up and depending on a situation or your treatment, especially if you're marginalized child, you might end up in a very different path, right?

20:35 [SPEAKER_00]: And so it's like, so much of it comes down to the luck of the draw.

20:39 [SPEAKER_00]: So I think this idea of like, we have to look at at what costs.

20:43 [SPEAKER_00]: So, you know, like you said, like it's not an intellectual based disorder, but also

20:49 [SPEAKER_00]: There is some cost there.

20:51 [SPEAKER_00]: There is some cost to being high performing.

20:53 [SPEAKER_00]: There is some cost to always masking and the anxiety around that.

20:57 [SPEAKER_00]: And so again, it's like the cost, which is the why am I exhausted all the time, why am I so down on myself, why am I, you know, that

21:07 [SPEAKER_00]: question of why all the time, why am I so frustrated?

21:10 [SPEAKER_00]: I think that was the big thing for me was when I was thinking about like you said like I was diagnosed with depression but never felt depressed and I sort of always felt like why do I insist on being depressed?

21:23 [SPEAKER_00]: You know like why there was just this huge question mark all the time.

21:26 [SPEAKER_00]: It's in terms of like why is my behavior so different from my intention?

21:30 [SPEAKER_00]: And that's where I feel like that

21:32 [SPEAKER_00]: idea of frustration exists in that, you know, that that it's not necessarily despondency.

21:39 [SPEAKER_00]: I remember getting asked a lot in terms of perinatal depression.

21:42 [SPEAKER_00]: I'd like do I want to harm my child?

21:44 [SPEAKER_00]: You know, some of those questions I never related to, but it mostly came down to why do I feel like a horrible mother and a horrible

21:51 [SPEAKER_00]: partner and horrible person, right?

21:53 [SPEAKER_00]: And so much of it comes down to understanding the behavior and then getting the support and tools.

21:59 [SPEAKER_00]: Because I feel like if we're just given the support and tools and we're still in that deficit-based mindset, they're not going to help us, right?

22:06 [SPEAKER_00]: No, no.

22:07 [SPEAKER_00]: And we're going to feel like even bigger failures.

22:10 [SPEAKER_01]: Yeah.

22:11 [SPEAKER_01]: Well, the thing is that something I talk about in

22:18 [SPEAKER_01]: is kind of this idea that the stimulant or any medication is not like the full answer if they can, they may be helpful if used in the right correct appropriate dosing and way, but they would have to really reassess and restructure their life and kind of teach themselves how to get the most out of any of the areas to medications, mainly stimulants.

22:45 [SPEAKER_01]: while they are processing.

22:46 [SPEAKER_01]: Like I tell them, I don't even call it a disorder because I feel like this is different from obsessive compounds of disorder.

22:54 [SPEAKER_01]: This is different from the schizophrenia.

22:57 [SPEAKER_01]: This is to me more a state of, and I'm not minimizing the suffering that people with ADHD untreated ADHD go through.

23:06 [SPEAKER_01]: I think it can be highly disabling when someone doesn't

23:15 [SPEAKER_01]: And so around that time, I think when I was reading all this, the Superman movie had come out.

23:21 [SPEAKER_01]: In the end, I was watching it and basically in the beginning of the movie Superman, then he's a kid and he doesn't know that he's Superman.

23:28 [SPEAKER_01]: He's just overwhelmed by his superpowers, essentially overloading everything and he's an outcast and can make fun of him.

23:35 [SPEAKER_01]: But then once he realized what his powers were and how to kind of focus on them and channel

23:45 [SPEAKER_01]: And so I look at it more as neurodivergence as, you know, it's a different brain.

23:52 [SPEAKER_01]: It's not necessarily a defective brain.

23:55 [SPEAKER_01]: And it's a brain that you are born with and basically for me treatment is about, for them to understand if there's the first time in their diagnosis, really understand how they're brain functions.

24:08 [SPEAKER_01]: and what are the strengths, and what are their weaknesses.

24:11 [SPEAKER_01]: And I even go through the Nehrocycological report sometimes, because you will see this discrepancy in scores.

24:18 [SPEAKER_01]: Some scores are going to be high, very high.

24:21 [SPEAKER_01]: Some scores are going to be very low.

24:23 [SPEAKER_01]: And this is the gap.

24:24 [SPEAKER_01]: This is the last one I was feeling.

24:26 [SPEAKER_01]: And so when I'm able to take that information and say, hey, so your visual processing is better than your auditory processing.

24:38 [SPEAKER_01]: You know, attention was really, really bad to like anything I would say to him, like I would have to say three four times, but she could read sheet music and she could play music very easily like and I had tried to read sheet music once before when I wanted to learn to play some instruments, but like when I told her it's so your visual processing is better so, you know, you might do better at jobs, which involve

25:06 [SPEAKER_01]: quick grasping of something and putting it into context and then and she was like yeah I mean maybe like music like I was like yeah it could be like music like sheet music like I don't think she became a musician but I think it was validating for her that she's not that this is not in execution she's not making excuses she's not lazy she was not crazy you know this is an explanation

25:34 [SPEAKER_01]: And so I feel like this is where kind of and this is what I try to teach the trainees and to really approach diagnosis in a different way in this way and treatment in this way because the goal is to optimize your strengths.

25:49 [SPEAKER_01]: While asking for support for the areas of weakness without feeling guilty and that for women.

25:55 [SPEAKER_01]: And mothers, in particular, is very, very hard.

25:58 [SPEAKER_01]: Like I think the, like many needles like I actually really open my eyes to how hard mothers work.

26:07 [SPEAKER_01]: Like I don't have children, but I have so much respect from others and from my own mother now.

26:13 [SPEAKER_01]: because they it's like having four jobs like some of them are working.

26:19 [SPEAKER_01]: They have kids of different agents.

26:21 [SPEAKER_01]: They have some of them live with their partners families.

26:25 [SPEAKER_01]: So they have to.

26:26 [SPEAKER_01]: So it's like all the social multitasking and all this exactly functioning.

26:30 [SPEAKER_01]: But what is different is kind of the societal gender roles where

26:35 [SPEAKER_01]: when I would see now I see men.

26:37 [SPEAKER_01]: I see both men and women now.

26:39 [SPEAKER_01]: And so, you know, men are confident of, oh, I can't.

26:43 [SPEAKER_01]: And that I don't do dishes that I don't clean my wife gets mad at me and you know, I should do better and I do better, but when a mother or a woman would say that she would say, oh, I can't clean, I must be a bad mother.

26:56 [SPEAKER_01]: So really internalizing that which is so specific to women in the social context and it's driven by social context like she would not think that it's that was not expected of her.

27:07 [SPEAKER_02]: Right.

27:08 [SPEAKER_01]: So that's where I think the very main aspect kind of came in, and I feel like women have sort of gender-specific, like biological differences, hormones, in presentation, in the challenges that they're going to face throughout life, and it presents differently.

27:28 [SPEAKER_01]: And if we are not aware of those,

27:36 [SPEAKER_01]: Requestness or stupidity or whatever you want to call it, you can call it a DSM diagnosis, it doesn't matter.

27:45 [SPEAKER_00]: I also think too, like modern society has moved away from multi-generational households as well, too, which I think has also compounded a lot of that, like you're saying, just too many roles all at once, and not enough support.

28:00 [SPEAKER_00]: I mean, there's just no social support structures.

28:03 [SPEAKER_00]: There's no support systems anymore.

28:04 [SPEAKER_00]: And I think so you have the shame element where we're socialized to feel shame about being inadequate, but also, you know,

28:12 [SPEAKER_00]: oftentimes we are kind of the calendar keeper and you know that the mental load that they talk about is that I mean is that social is that biological?

28:23 [SPEAKER_00]: I don't know.

28:25 [SPEAKER_00]: But you know, just we still seem to fall into such traditional biological roles.

28:32 [SPEAKER_00]: Yes.

28:33 [SPEAKER_00]: Despite how much, you know, how far we've come socially.

28:36 [SPEAKER_01]: Oh yeah.

28:37 [SPEAKER_01]: Yeah, because I think some of the biological

28:43 [SPEAKER_01]: which which plays into it.

28:45 [SPEAKER_01]: But like I come from I grew up in an extended family.

28:48 [SPEAKER_01]: So, you know, I saw I had a lot of people in the house and different people would like there was division of labor so people would function effectively.

28:57 [SPEAKER_01]: And what my parents were working, but I was never alone because there was always my grandparents.

29:02 [SPEAKER_01]: and I had cousins.

29:04 [SPEAKER_01]: So I was never like isolated.

29:06 [SPEAKER_01]: But with that, also comes more distractions, more chaos, comparing yourselves to others in different ways.

29:17 [SPEAKER_01]: And all of those things become in your formative years that all of those experiences add to your sense of self.

29:25 [SPEAKER_01]: So, you know, like every society, every society has rules and every rule has the positive and negative about it.

29:34 [SPEAKER_01]: And what I encourage patients to do is really kind of not look at this as, oh, I have another illness now, but oh, I have another diagnosis now.

29:46 [SPEAKER_01]: But, you know, just

29:53 [SPEAKER_01]: some of the things you do, that's why you do them.

29:57 [SPEAKER_01]: And it can change in a way that you wanted to change.

30:01 [SPEAKER_01]: If you don't want it to change, that's absolutely fine.

30:04 [SPEAKER_01]: Like when an I was like the first thing that made sense to me, then my text editor told me, you have the visual spatial deficits,

30:14 [SPEAKER_01]: was that, oh, that's why I could never, I was so bad at my surgical rotations in my internship.

30:21 [SPEAKER_01]: I could not like visually integrate, and I tried so hard, and my parents wanted me to become a surgeon, and I felt like having a file like the conversation that would be so bad, and I would feel like a bad doctor, but I did not go with what they told me to do, which is often all used to

30:41 [SPEAKER_01]: And I found psychiatry and I think it helped me to understand the really different experiences of people and how they experience the world and luckily then I pursued like I landed up in the right place at the right time and it shaped my career some people some of my patients are not that lucky they might be stuck in the wrong profession and sometimes the work becomes and you really want to do this managerial job like.

31:08 [SPEAKER_01]: Or, you know, you didn't like to write horses and take care of animals and if you ever think about working with animals and a patient said, yeah, but I couldn't get through the application for the bed deck like the application was so long.

31:23 [SPEAKER_01]: I got frustrated, no one helped me.

31:25 [SPEAKER_01]: All right.

31:25 [SPEAKER_01]: Let's help you with it.

31:27 [SPEAKER_01]: Like it's never too late.

31:28 [SPEAKER_01]: That's the one thing I really like about this country that you can go back to school at any point.

31:32 [SPEAKER_01]: And it's not like a thing.

31:34 [SPEAKER_01]: You know, sometimes it becomes about that.

31:36 [SPEAKER_01]: And so it's treatment doesn't have to be about XYZ being the certain way.

31:42 [SPEAKER_01]: It really depends on what the person at that point in their lives want for their goals, for their

31:54 [SPEAKER_01]: facilitated by the medication, but we are a lot of behavior change also needs to happen.

32:00 [SPEAKER_00]: Yeah, I mean, I'm back in school now and I credit my ADHD diagnosis absolutely because I don't think, you know, I had always just thought I was too stupid for school.

32:10 [SPEAKER_00]: And now I'm like, Oh, no, I just did support.

32:13 [SPEAKER_00]: And now I know what I need.

32:14 [SPEAKER_00]: So it's not when it's been a breeze, but it's definitely that kind of information is is so integral.

32:22 [SPEAKER_00]: I think to how we view ADHD that was also beautifully said.

32:26 [SPEAKER_00]: Now, you had mentioned earlier that you don't think, you know, you kind of joked about how ADHD diagnoses would never happen when you were at kid and you were like, oh, it still doesn't exist.

32:35 [SPEAKER_00]: In India, is it because it's just, you know, a neurodivergent brain, a neurodivergent nervous system is just more accepted in terms of like, yeah, you know, sometimes you just think differently.

32:47 [SPEAKER_00]: It's totally fine.

32:48 [SPEAKER_00]: There's not that like, there's not that pathologizing element to it.

32:56 [SPEAKER_01]: How psychically developed in India and how it was perceived like when I was a student back in med school, really the focus of treatment in most cases is like psychopharmacology, like news of medications.

33:09 [SPEAKER_01]: Psychotherapy, yes, there was some, but there was not a lot of people practice that and there was not a lot of training there.

33:16 [SPEAKER_01]: And so, and that was one of the reasons that I came to America to get more training.

33:22 [SPEAKER_01]: For example, like my aunt was a pediatrician

33:24 [SPEAKER_01]: I recently diagnosed her adult daughter with ADHD who had already diagnosed herself, but I confirmed that I really had to explain to my own and just like because I think they're still, they don't have the latest data.

33:40 [SPEAKER_01]: Some of them, I'm not saying again, we cannot generalize things, but I think that they have to have the most updated data.

33:49 [SPEAKER_01]: Once I gave her the updated data that it

33:53 [SPEAKER_01]: It is not a problem of intellect because her picture was more like of a boy jumping around.

34:00 [SPEAKER_01]: And she was like, I've seen kids with ADHD, like we refer them to psychologists all the time.

34:04 [SPEAKER_01]: And it doesn't that.

34:05 [SPEAKER_01]: And I've put people on Riddle and this and that.

34:08 [SPEAKER_01]: And I was like, yeah, that's one of them which represents.

34:11 [SPEAKER_01]: So I think the data has to catch up to certain societies.

34:16 [SPEAKER_01]: I feel up to mistake, I feel it will catch up.

34:19 [SPEAKER_01]: There was from, I recently went back to India and I feel like things are moving very quickly now, but like they're getting more and more research.

34:28 [SPEAKER_01]: Now there's more opportunities for psychotherapies, different kinds of psychotherapies, not just like pharmacology.

34:34 [SPEAKER_01]: And so now the scope is broader.

34:38 [SPEAKER_01]: But I think in my parents' times, or when they were younger, I think their bearings are then themselves were not very psychologically minded at way.

34:48 [SPEAKER_01]: So that's what I try to explain to people that it's not about intellect.

34:51 [SPEAKER_01]: It's about how you perceive something and make sense of it.

34:55 [SPEAKER_01]: And for them, like I think,

34:58 [SPEAKER_01]: part of the cultural difference is India has come back to America, like as a much newer country in itself, like it got independence not very long ago.

35:09 [SPEAKER_01]: And it was a poor country, it was a country that had to build itself.

35:13 [SPEAKER_01]: And so the focus of people at that time, like my grandfather when I think about or my father when he was younger, like people who were good academically,

35:26 [SPEAKER_01]: would become doctors or engineers or lawyers, they were the people that could afford them would lifestyle.

35:32 [SPEAKER_01]: So those were the respectable professions.

35:36 [SPEAKER_01]: So everything was like very intellectualized.

35:39 [SPEAKER_01]: And it was all of the service of, you know, you have to be productive.

35:43 [SPEAKER_01]: Like the common man's priority is putting the next meal on the table, not

35:50 [SPEAKER_01]: like thinking about their sense of self.

35:52 [SPEAKER_01]: So I think the focus was different.

35:54 [SPEAKER_01]: When I was a kid at that time, you know, my options were either become a doctor or become an engineer.

36:00 [SPEAKER_01]: That has changed much now.

36:04 [SPEAKER_01]: And parents are more tolerant to other professions and other professions are getting more like creative professions are getting more productive financially like that.

36:14 [SPEAKER_01]: But

36:16 [SPEAKER_01]: like it was more like, you know, once you're a doctor on engineering, you have this job security, you have a stable source of income, you can support your family.

36:24 [SPEAKER_01]: So it was like, many, the focus is different.

36:26 [SPEAKER_01]: Yeah.

36:27 [SPEAKER_01]: The focus was not so much on like self development or self explanation.

36:34 [SPEAKER_01]: It was more you do school, you don't take any breaks by your 30s you all done and you just now.

36:42 [SPEAKER_01]: you are now you socialize as much as you're shocked.

36:45 [SPEAKER_00]: So yeah well and I think that's so well said too in terms of the like the focus on the self because even you know with the increase in diagnoses especially in the increase in diagnoses and women you just see the response is this like sexist eye rolling everybody thinks they have ADHD nowadays it's so endemic of that social

37:10 [SPEAKER_00]: emphasis on self, right?

37:11 [SPEAKER_00]: Which is like whether or not you are struggling, it doesn't matter.

37:15 [SPEAKER_00]: Right?

37:17 [SPEAKER_00]: So quit your whining.

37:18 [SPEAKER_00]: You're just lazy, you know, move on with it.

37:21 [SPEAKER_00]: And so I think it's just fascinating to me to think about like that shift in, like you said, how we look at it, but also this are to think our shift in like our identity as individuals and why the diagnoses are probably

37:37 [SPEAKER_00]: listic societies are at the forefront right now.

37:41 [SPEAKER_01]: Yeah, I have another thought about that.

37:42 [SPEAKER_01]: I don't know.

37:43 [SPEAKER_01]: I'm curious to hear what another professional in the same area or another person with the same diagnosis things.

37:49 [SPEAKER_01]: But I, you know, sometimes as a prescriber, while I was learning all of this and, you know, I was already describing ADHD medications, but then once I started to screen more, I was picking up more than

38:04 [SPEAKER_01]: of the control substances.

38:06 [SPEAKER_01]: And I felt like one of my colleagues asked me, so like everyone has ADHD now, like, like everyone has phones, like everyone is distracted all the time, everyone has to make feels pressured to make money, to be successful.

38:22 [SPEAKER_01]: And of course, like when you are working so much and doing so much 16 hours, it is,

38:29 [SPEAKER_01]: course you're going to be tired and of course you're going to have some executive dysfunction.

38:33 [SPEAKER_01]: So like are we just going to put everyone on adder all now or is that really everyone has really actually.

38:40 [SPEAKER_01]: And so you know I think that's an important question I think because if we are not careful we are going to I mean we're already in the middle of now is stimulant epidemic.

38:51 [SPEAKER_01]: It's used to be both

38:53 [SPEAKER_01]: I think there's a balance between a proper assessment of diagnosis and careful prescribing, response and prescribing versus overprescribing, but my part about why the diagnosis has increased.

39:06 [SPEAKER_01]: I think one definitely there's more information, the spread of information people are more aware.

39:13 [SPEAKER_01]: I think during COVID,

39:15 [SPEAKER_01]: Tiktok played a huge role and like people started sharing their stories, a lot of women shared their stories.

39:22 [SPEAKER_01]: And so, you know, people got more self-aware and started to look into these things.

39:29 [SPEAKER_01]: So I think that is part of it.

39:31 [SPEAKER_01]: I think the newer data, more research and females and all that data now coming out was part of it.

39:37 [SPEAKER_01]: So now we are screening more because we are looking more

39:43 [SPEAKER_01]: But the other thing I think is that like, you know, the more our society and as we are going through evolution, we are, yes, we are progressing more and more, but we're also getting more and more complex life is getting more and more complex in certain ways and having a brain, which is.

40:04 [SPEAKER_01]: You know, might have a problem with regulation, but is very receptive and wants information all the time and wants stimulation of time, maybe it's adaptive to to that lifestyle.

40:16 [SPEAKER_01]: And it's not a bad thing, but you know, through evolution, so maybe our brains are just trying to not that everyone is easier, but we have to kind of understand our brains are constantly trying to catch up and this feeling that I can never catch up.

40:30 [SPEAKER_01]: regardless of diagnosis is a very common fear of in people, right?

40:36 [SPEAKER_01]: Yeah.

40:36 [SPEAKER_01]: And so in all cultures, I feel in a lot of countries, not just America and India.

40:42 [SPEAKER_01]: And so isn't just that our brains are trying to keep up and it's kind of, you know, evolutionary changes don't happen in one generation or two generation with things like hundreds of generations.

40:56 [SPEAKER_01]: So it's the brain adapting

41:01 [SPEAKER_01]: neurodivergent have certain advantages now in the directions that things are moving and so that's positive growth, that's things which were decided before maybe ten years down the line, it's not a disorder anymore, this was actually a strength.

41:17 [SPEAKER_01]: So,

41:20 [SPEAKER_00]: the way that I've started looking at ADHD at least over the years as I've tried to understand this increase in diagnoses and like you said this, are we contributing to a stimulant epidemic or are we calling it an epidemic because of stigma of round stimulant medication, which is incredibly well-research, um,

41:42 [SPEAKER_00]: You know, it's almost calling like was there an insulin epidemic after it was discovered for diabetes, right?

41:47 [SPEAKER_00]: So I feel like there are ways in which even just calling it an epidemic leads to our own inherent biases.

41:53 [SPEAKER_00]: But also like I look at it as like this, you know, like you said, we have there are specific brains.

41:59 [SPEAKER_00]: There are specific like hyper arous...

42:02 [SPEAKER_00]: nervous systems that are responding to their environment in a way that is a reaction to what is ultimately trauma, right?

42:10 [SPEAKER_00]: And I love the way that you talk about trauma in your book too and that intersection of trauma and our nervous system because I don't think it's just like Gabor Mate and those people say like you know well ADHD is trauma.

42:22 [SPEAKER_00]: I think it's mostly when you

42:30 [SPEAKER_00]: more intensely to traumatic experiences and so where I've been mostly fascinated by it is the intersection of neurodivergence and autoimmune disorders and that way in which what is the literal physical response that our body is having to masking and trauma and all of that stress of tamping everything down because we're seeing those numbers and you know not only are we seeing

42:59 [SPEAKER_00]: maladaptive coping skills or coping mechanisms that always go with neurodivergent populations, but also just the physical reaction that bodies are having.

43:09 [SPEAKER_00]: And I feel like for me the way I understand it is not necessarily that we all have ADHD, but like ADHD is this catch all way in which we are describing dysregulated neurodivergent people.

43:23 [SPEAKER_00]: And so then I'm like, well, what are we call neurodivergent people?

43:27 [SPEAKER_00]: Is that autism?

43:28 [SPEAKER_00]: Are we just going to call it neurodivergence?

43:30 [SPEAKER_00]: Is that the spectrum that we're talking about here?

43:33 [SPEAKER_00]: That's where I find it super fascinating, which is like, where does one end and the other begin?

43:38 [SPEAKER_01]: Well, in terms of treatment, this is how I can conceptualize it for patients as well.

43:43 [SPEAKER_01]: Like the godlyism, whatever the DSM diagnosis is, or the diagnosis, the hospital is going to build for, let's forget about that for a minute.

43:51 [SPEAKER_01]: That's why I really like to say so into this question here, because I find for adults it is more useful to really kind of morning on symptom domains.

44:01 [SPEAKER_01]: And so, you know, when people are saying, oh, everyone has ADHD, no, what we are really referring to is that people are highly over-stiminated, people are sleep deprived, people have executive dysfunction, people have with more social complexity relationship problems, emotion regulation is difficult and so these are parts of functional of the brain.

44:32 [SPEAKER_01]: understand where that intersection of trauma and the ADHD is because like I don't think like there is a consensus on which came first and I don't think we even get to that answer but that doesn't matter to me.

44:46 [SPEAKER_01]: I think as a clinician what I have to see is this a brain that was already wired a little bit differently.

44:54 [SPEAKER_01]: But then certain things happen to that person, trauma in different forms happened.

45:00 [SPEAKER_01]: Maybe because of their differences, they got hurt multiple times.

45:05 [SPEAKER_01]: They had TDI multiple head injuries.

45:08 [SPEAKER_01]: Maybe they also had a serious disorder.

45:11 [SPEAKER_01]: Maybe they went through a lot of bullying in school.

45:14 [SPEAKER_01]: Maybe they were so hyperactive that they got beat up all the time.

45:17 [SPEAKER_01]: And then there was head injuries, right?

45:19 [SPEAKER_01]: So obviously, that you know that, and then there's the role of substances.

45:23 [SPEAKER_01]: they might have been self-medicating with cocaine, right?

45:27 [SPEAKER_01]: And not even knowing it.

45:28 [SPEAKER_01]: And not just cocaine, I had a person once who was drinking like 12 to 15 cups of coffee just to steal it.

45:36 [SPEAKER_01]: And obviously then she was anxious because it was much caffeine.

45:40 [SPEAKER_01]: But once she was trying to do was self-medicate without even knowing it, it's caffeine is a similar.

45:47 [SPEAKER_01]: And so I find it more helpful to

45:50 [SPEAKER_01]: separate the symptoms into these domains and then think of treatment options because symptoms overlap like hyper arousal can be part of hyperactivity and ADHD but a lot of these women do also have traumatic experiences.

46:06 [SPEAKER_01]: Hyper arousal can be because of that also.

46:09 [SPEAKER_01]: Sleep disturbances can be from coming from there also.

46:12 [SPEAKER_01]: However, from a medications standpoint, I have an awful medication that I can use kind of for both.

46:18 [SPEAKER_01]: So like, but what am I treating?

46:20 [SPEAKER_01]: I'm not treating a diagnose and I'm treating this particular symptoms.

46:23 [SPEAKER_01]: For example, we use clonidine a lot for this particular symptom, for sensory overload or for racing thoughts, or internal hyperactivity.

46:32 [SPEAKER_01]: Because this stimulant actually doesn't help with that.

46:34 [SPEAKER_01]: So,

46:36 [SPEAKER_01]: You know, there's nothing wrong with what I teach my trainees is that you don't have to be scared of described as stimulants.

46:44 [SPEAKER_01]: And especially because I work in a substance use clinic, there's a much more stigma like people are really hesitant to describe stimulants to people with histories of substance use even if they're completely stable.

46:55 [SPEAKER_01]: And there is no evidence to support it.

46:57 [SPEAKER_00]: There's actually evidence.

46:58 [SPEAKER_00]: There's actually research to support the opposite.

47:01 [SPEAKER_00]: Yeah.

47:02 [SPEAKER_01]: Yeah.

47:03 [SPEAKER_01]: Yeah.

47:03 [SPEAKER_01]: But people get nervous, right?

47:05 [SPEAKER_01]: Because there is a lot of knowledge after behavior that has accumulated over the years.

47:09 [SPEAKER_01]: But then what I try to teach is like, you have to do a realistic risk assessment.

47:14 [SPEAKER_01]: And it doesn't have to be that you give them months and months of stimulants, like you can go slow.

47:20 [SPEAKER_01]: And you can do all of this groundwork.

47:22 [SPEAKER_01]: So that stimulant is only like part of the treatment.

47:25 [SPEAKER_01]: But from the beginning, you don't have to set up someone saying that, oh, I definitely need this to function.

47:32 [SPEAKER_01]: Otherwise, I'm just like this complete state of fear that they develop without this stimulant.

47:39 [SPEAKER_01]: Yes, it will be disabling.

47:40 [SPEAKER_01]: Yes, it will problematic.

47:41 [SPEAKER_01]: And for some people, you know, once you have them on a therapeutic dose of stimulant, like you finally are able to have a conversation with them, it's a completely different person.

47:51 [SPEAKER_01]: So yes, I mean, there's different degrees of the impairment, but, you know, treatment depends on what that person wants and so that time what their goals are.

48:02 [SPEAKER_01]: If their goal is sleep first, then let's work on sleep first.

48:07 [SPEAKER_01]: And stimulant is not going to necessarily help with that.

48:10 [SPEAKER_00]: I think the problem with ADHD is you want to work on everything all at once.

48:14 [SPEAKER_01]: And that is the other thing that I have to, when I tell patients about, oh, you know, this website, additive magazine dot com, but go through their podcast lists, but don't listen to all of them, like you'll want to do all of it, but I usually, if by that time, I have a idea of there's an active symptom domains, I will write down a podcast number this and this and this, you can listen to this week, nothing else.

48:40 [SPEAKER_01]: I'm telling you not to do anything else.

48:43 [SPEAKER_01]: Just read this and we first discuss this.

48:46 [SPEAKER_01]: And all of that goes hand in hand with the like the initial diagnostic process where I'm still reading their report.

48:53 [SPEAKER_01]: And I'm saying, okay, working memory is a problem.

48:55 [SPEAKER_01]: Okay.

48:56 [SPEAKER_01]: Listen to that session and see how it applies to you.

48:59 [SPEAKER_01]: Right.

48:59 [SPEAKER_01]: And then let's do some mindfulness along with whatever medication they're going to use and the pointers to slow down and stabilize because what good are superpowers if you can't use them.

49:22 [SPEAKER_00]: If there's a mother who's listening right now, or even just a woman who's listening right now, who's really struggling, how what do you say, you know, when she has that inner turmoil of am I struggling more than other people, maybe I'll get over this, maybe you know, I just need a good night sleep.

49:39 [SPEAKER_00]: That's what my doctor always told me.

49:40 [SPEAKER_00]: Oh, you just need a good night sleep.

49:42 [SPEAKER_00]: How does somebody know that the, you know, what do you tell women in terms of like, are they, you know, could this be a neurodevelopmental disorder or is this just motherhood or is this just being a woman in society today.

50:11 [SPEAKER_01]: Most of them present with the symptom of anxiety or depression which might have been secondary to the untreated ADHD.

50:19 [SPEAKER_01]: So usually then what happens is that that in treatment will stabilize those things first and then they actually feel better and become functional.

50:29 [SPEAKER_01]: And at that time that the ADHD might then now we have to treat this.

50:41 [SPEAKER_01]: they are still a good mother.

50:43 [SPEAKER_01]: It doesn't matter if you've got a cleaning relief.

50:46 [SPEAKER_01]: It's fine.

50:46 [SPEAKER_01]: If you would rather use that one hour to excel at your work and not feel guilty about hiring a cleaning lady.

50:54 [SPEAKER_01]: Like that's fine.

50:55 [SPEAKER_01]: No one said you have to clean to you with mother.

50:57 [SPEAKER_01]: That sense of motherhood should be much about much more.

51:01 [SPEAKER_01]: And the attachment with the child, like child always loves the one like child, doesn't care if you're like you don't mind.

51:10 [SPEAKER_01]: A baby

51:14 [SPEAKER_01]: of bad mother, you are not defective in any way.

51:19 [SPEAKER_01]: The regardless of diagnosis you are going through certain emotions which are distressing and report that distress to your doctor and hopefully they will be able to refer you to the right professionals to a therapist or a psychiatrist for an evaluation

51:37 [SPEAKER_01]: and, you know, you go from there, but we know the treatment of these things.

51:42 [SPEAKER_01]: So whatever it is, this distress you feel, it is treatable.

51:46 [SPEAKER_01]: It just takes time.

51:47 [SPEAKER_01]: I would tell them that it takes time.

51:49 [SPEAKER_01]: And if you have ADHD, you don't like that.

51:51 [SPEAKER_01]: You want to fix it.

51:54 [SPEAKER_01]: But then it's not fixing it.

51:56 [SPEAKER_01]: And, you know, the other thing that's very sort of very well-seen is that, especially women, because they eat to analyze so much

52:08 [SPEAKER_01]: they try harder to do it and try harder and harder and harder that over time causes more frustration and depression and kind of poor sense of self.

52:18 [SPEAKER_01]: That doesn't need to happen.

52:20 [SPEAKER_01]: You don't have to constantly apologize for yourself.

52:23 [SPEAKER_01]: You don't always try to work harder.

52:26 [SPEAKER_01]: You just have to work smarter and you have to stop feeling guilty if you need a little bit of help.

52:32 [SPEAKER_01]: Because there's nothing wrong.

52:34 [SPEAKER_01]: You're only human.

52:35 [SPEAKER_01]: like anyone would need that.

52:37 [SPEAKER_01]: And it's, you know, the half an hour that you would get to spend with your child and be present for it will go a long way for both of you and the child.

52:46 [SPEAKER_01]: And mostly, then if you had the dishes back from there, you know, someone else can do it.

52:53 [SPEAKER_01]: And so like, but you know, then there's limitations.

52:56 [SPEAKER_01]: Everyone has like this social economic situation and kind of access to resources.

53:02 [SPEAKER_01]: So I also say, you know, given your situation, okay, this is, if this is your volume, want to work this many hours, you need to work this many hours to make this much money, okay, outside of that time, how can we use that time, smuggling, so that you're not missing out on all of the life experiences and you're not bringing home.

53:23 [SPEAKER_01]: work every day and you are able to find a healthy balance because that's what's in my mind treatment is about finding a healthy balance.

53:33 [SPEAKER_00]: Well and not only that but I think also this idea that we must have exhausted all options within ourselves before we feel like we have permission to ask for help and I think that that's also so

53:48 [SPEAKER_00]: damning for a lot of women, which is just like, ask for help.

53:52 [SPEAKER_00]: Before you even struggle, just ask for help.

53:54 [SPEAKER_00]: Like, you're too fabulous to be doing all this by yourself.

54:00 [SPEAKER_00]: But I think that that's just to ingrained in so many of us, which is like, I have to be at my absolute wits in before I will even ask for any kind of help, and by then often it's not too late,

54:15 [SPEAKER_00]: struggling and just like you said like feeling terrible about yourself as a parent when you're probably a fantastic parent.

54:23 [SPEAKER_00]: Yeah.

54:23 [SPEAKER_00]: Exactly.

54:24 [SPEAKER_00]: Exactly.

54:25 [SPEAKER_01]: The other thing with mothers that is hard because like often then I would work with these moms outside of the Beninatal area like I would work with them for six, seven years some of them.

54:36 [SPEAKER_01]: And so I think even like motherhood for young children I think it's a huge challenge part of the challenge of that things keep on changing on them.

54:44 [SPEAKER_01]: Like change is hard for everyone, but for the person with the untreated ADHD, it's more desirable in it.

54:50 [SPEAKER_01]: And it takes a longer time to kind of find your new norm.

54:54 [SPEAKER_01]: But the executive functioning needed for taking care of an infant is completely different from like a five year old.

55:00 [SPEAKER_01]: the social interaction, eye contact, attachment, all of those things are completely different, you interact differently with your old tenure, like this social multitasking happening.

55:13 [SPEAKER_01]: So like the moment the mothers would get used to it and have a system in place, things stayed on them.

55:19 [SPEAKER_01]: Now, okay, now my kid wants to play with it.

55:21 [SPEAKER_01]: Now this is added to my schedule.

55:23 [SPEAKER_01]: So like, how can I ever catch up?

55:26 [SPEAKER_01]: And I tell them, when you're gone, because like things up, I'm studying harding on you.

55:30 [SPEAKER_01]: So stop trying to catch up.

55:33 [SPEAKER_00]: Exactly, right?

55:34 [SPEAKER_00]: And yeah, just being kind, being kind to ourselves, I think is probably one of the top ways to treat ADHD.

55:42 [SPEAKER_00]: I love the super power analogy because I feel like, you know, the term ADHD is a super power is so problematic and divisive.

55:51 [SPEAKER_00]: But when you really do, I remember having

55:54 [SPEAKER_00]: Years ago at this point, who talked about the super hero analogy and they're the super hero storyline and how often times they are overwhelmed and isolated and have a really tragic origin story and all of that and so it actually is a lot more relatable than you think.

56:16 [SPEAKER_00]: But it's really difficult to actually use them to use your super power to your full potential if you don't actually have the support you need.

56:23 [SPEAKER_01]: Yeah, if you don't have, if no one is guiding you through it, you have to figure it out on your own and if then your body rhythms are dysregulated because you don't get enough sleep, you don't have enough support, you don't have enough money, you don't have enough food like these basic.

56:41 [SPEAKER_01]: Many needs are not difficult to meet, like of course on this is overwhelmed, like how, how could it not be.

56:49 [SPEAKER_01]: So like, you're not here by situations like you're not here in my office because something is wrong with you.

56:55 [SPEAKER_01]: That is actually very valid feelings.

56:58 [SPEAKER_01]: But let's say how, you know, the goal is to help you feel better and then what do we do next to help you out?

57:05 [SPEAKER_01]: Or maybe we don't do anything and just sit with it.

57:07 [SPEAKER_01]: Let's just sit with it for a second.

57:09 [SPEAKER_01]: Sitting with something is also doing something.

57:12 [SPEAKER_00]: Right, or even just the validation that it is struggle, I think is tremendously helpful to just to feel like, okay.

57:20 [SPEAKER_00]: I think it's like the book, you know, the book was, I'm not lazy, crazy or stupid, right?

57:26 [SPEAKER_00]: So it's that feeling of like, okay, so that's the, I'm not crazy part.

57:29 [SPEAKER_00]: You're not alone, right?

57:32 [SPEAKER_00]: Well, I for one, I'm so appreciative of your book.

57:35 [SPEAKER_00]: It's, I'm just so glad it's out there in the world.

57:37 [SPEAKER_00]: Thank you for writing it.

57:39 [SPEAKER_00]: I can't wait to share it and we'll put a link in the show notes.

57:42 [SPEAKER_00]: And thank you.

57:43 [SPEAKER_00]: What do you recommend to other clinicians besides reading your book?

57:48 [SPEAKER_00]: It's like in psychiatry.

57:49 [SPEAKER_00]: What do you wish the field of psychiatry?

57:53 [SPEAKER_00]: new this is probably a much bigger question than I should be asking at this point but like what so thank you wish the field uh new about women and ADHD.

58:03 [SPEAKER_01]: ADHD is more than just a second of dysfunction, there are a lot of other aspects of it, and treatment is more than stimulant, and if someone has a substance use disorder, you know, if you really look into the drug of choice, there's usually a very good reason.

58:20 [SPEAKER_01]: Like, you know, we know that patients with trauma, gravity towards downers, for affect and planting.

58:25 [SPEAKER_01]: We know that

58:27 [SPEAKER_01]: patients with untreated ADHD are very likely to use cocaine and feel better.

58:31 [SPEAKER_01]: So like substance use should not become a barrier or like for you to worry that oh my god I'm going to give this patient that role and she's going to misuse it.

58:40 [SPEAKER_01]: No, like it doesn't like just happen like that really there's reasons to why people behave in certain ways.

58:46 [SPEAKER_01]: And if you offer them the right help and you stabilize their environment,

58:51 [SPEAKER_01]: And you know, you are not the only provider.

58:53 [SPEAKER_01]: Take the help of your team.

58:56 [SPEAKER_01]: So that's the advantage I have always working with universities, programs, hospitals, because we have a micro-disciplinary team.

59:03 [SPEAKER_01]: So I will often work with therapists in conjunction to when I first start someone on the stimulant.

59:09 [SPEAKER_01]: Because as I'm starting with stimulant, I want them to explore all the other stuff and understand themselves with the therapist.

59:18 [SPEAKER_01]: And develop healthy behaviors.

59:21 [SPEAKER_01]: First understand that healthy behaviors and that all work like a met provider might not have time to do that.

59:28 [SPEAKER_01]: Like you have a 15 minute met with it oftentimes, but you know, you can at least plan the seed, think the help of your colleagues, multi-disciplinary, and be open to different diagnoses or different experiences,

59:43 [SPEAKER_01]: And you know, I think we can we can trust and it's basically humanity that, you know, we don't have to stigmatize anything.

59:50 [SPEAKER_01]: Like I think there's a reasonable degree of concern with certain substances, but you know, you can always prescribe responsibly and just someone's history should not deprive them of the proper treatment.

1:00:07 [SPEAKER_00]: Right, or at least a little more curiosity about why they

1:00:12 [SPEAKER_00]: And so if there's a way to help them responsibly with as prescribed stimulants, then they probably don't have to then misuse them on the black market.

1:00:23 [SPEAKER_00]: Yeah.

1:00:24 [SPEAKER_00]: Well, thank you so much.

1:00:25 [SPEAKER_00]: This has been a really fantastic stimulating conversation and I really appreciate your time and all the work you were doing.

1:00:32 [SPEAKER_00]: So thank you so much.

1:00:35 [SPEAKER_01]: Thank you so much for having me.

1:00:36 [SPEAKER_01]: This is a very happy to be

1:00:40 [SPEAKER_01]: For that, I think it's very important work that you're doing.

1:00:48 [SPEAKER_00]: There you have it!

1:00:49 [SPEAKER_00]: Thank you for listening and I really hope you enjoyed this episode at the Women and ADHD podcast.

1:00:55 [SPEAKER_00]: If you'd like to find out more about me and my coaching programs, head over to women and ADHD.com.

1:01:00 [SPEAKER_00]: If you're a woman who was diagnosed with ADHD and you'd like to apply to be a guest on this podcast, visit women and ADHD.com slash podcast guest and you can find that link in the episode showdowns.

1:01:11 [SPEAKER_00]: Also, you know we ADHD

1:01:13 [SPEAKER_00]: And I would really appreciate hearing from you, the listener.

1:01:16 [SPEAKER_00]: Please take a moment to leave me a review on Apple Podcasts or audible.

1:01:20 [SPEAKER_00]: And if that feels like too much and I totally get it, please just take a few seconds right now to give me a five-star rating.

1:01:27 [SPEAKER_00]: Or share this episode on your own social media to help reach more women who

1:01:31 [SPEAKER_00]: maybe have yet to discover and lean into this gift of neurodivergency and they may be struggling and they don't even know why.

1:01:38 [SPEAKER_00]: I'll see you next time when I interview another amazing woman who discovered she's not lazy or crazy or broken but she has ADHD and she's now on the path to understanding her neurodivergent mind and finally using this gift to her advantage.

1:01:51 [SPEAKER_00]: Take care till then!