ADHD Expert: Why You Feel Motivated But Can't Do Anything

The Jefferson Fisher Podcast

Dr. Sasha Hamdani joins Jefferson Fisher to redefine ADHD not merely as an attention deficit, but as a fundamental regulation disorder affec

Key takeaways

• Dr. Sasha Hamdani posits that ADHD is a regulation disorder encompassing emotion, motivation, energy, sleep, and appetite.
• Rejection Sensitive Dysphoria (RSD) is identified as an intense neurological response to perceived rejection or criticism.

Main topics

• ADHD as a regulation disorder
• Rejection Sensitive Dysphoria (RSD)

Notable quotes

It's louder in there.

Conclusion

By understanding the neurological basis of ADHD, partners and colleagu

Transcript preview

Speaker 2 (0:00) If I were to compare a non-ADHD brain with somebody who has ADHD, what would be the difference? It's Speaker 3 (0:05) louder in there. You're taking in all of this information all at once, and you don't have that great of a filtering system to tell you this is important, this is not important. So you have much higher likelihood of things raising threat levels than the average person. So ADHD is truly a regulation disorder as it pertains to emotion, motivation, energy, sleep, appetite. So people can be extremely motivated and it's still hard for them to get it. get to what they need to get to because of that dysregulation. I've treated so many people with ADHD. I have ADHD and I've experienced it. I was diagnosed in fourth grade because I presented atypically for a girl. I was hyperactive, really loud, truly disruptive. I started a coup in my classroom. Teacher called my mom and I was in the doctor's office the next day. Did not know I was being treated. Speaker 2 (0:49) What is not helpful to do in communication with those who have ADHD? Why is it that simple feedback to an ADHD brain can feel like a personal attack? Do you have any advice for people who have ADHD to improve their communications? I Speaker 3 (1:04) have a couple Speaker 2 (1:04) of things. Number one, it feels like to me. at least a third of my audience either has ADHD or loves in relationship with, knows somebody close who has ADHD. And so in terms of definition setting, Speaker 3 (1:25) what Speaker 2 (1:26) is, I want to know what's the clinical definition of ADHD and can kind of maybe from your perspective, what is the? urban dictionary kind of definition of ADHD? Okay, Speaker 3 (1:39) I'm going to answer that. But no, I'll answer that first. But then I'm going to give you like a caveat and like my hot take from that. So the clinical definition of ADHD is it is a neurodevelopmental condition that impacts inattentiveness, hyperactivity, and executive function. So it is a brain-based kind of functioning that historically definition has kind of focused a lot on attention. So it stands for attention deficit hyperactivity disorder. I'm going to get more into that. Speaker 1 (2:12) Yeah. I'm ready. Speaker 3 (2:15) You know, and everybody, like if you're looking at the urban dictionary definition, ADHD is for people that can't focus. Right. Right. That's Speaker 2 (2:24) what Speaker 3 (2:24) you kind of think of. Now, here's my hot take. I think ADHD, I agree that it's a neurodevelopmental condition. It's something that generally speaking, you are born with and you grow and develop over time. I believe it's so much more than attention. I think ADHD is truly a regulation disorder. It has to do with, yes, a regulation issue when it comes to attention, but also as it pertains to emotion, as it pertains to motivation, as it pertains to energy, as it pertains to sleep, as it pertains to appetite. Just a regulation disorder across the board. Speaker 2 (2:59) If we're saying... that ADHD is not so much leaning towards attention and instead is more leaning towards regulation. Speaker 3 (3:09) Or not solely towards attention, but yes, I think at its base, it's a regulation disorder. Speaker 2 (3:14) Okay, well, let's just put it on the spectrum. Yeah. And we have the needle in the middle, and we're going to be super umbrella over this and say, you feel like it's not all just attention. It's also other things, including... regulation. What would that mean? So if we accept your definition of it, Speaker 3 (3:35) what's Speaker 2 (3:36) the implication of that? Speaker 3 (3:37) The implication is that when we talk about ADHD comprehensively, historically, we've always been taught to just look at focus, inability to focus, inability to complete tasks, inability to stay organized. I am countering that, especially since as my career has like... specialized in ADHD, as my research has been in ADHD, as I've treated so many people with ADHD, and as I have ADHD and I've experienced it. Speaker 2 (4:03) Yeah, you have it. Speaker 3 (4:04) I have it. Yeah. So this is like a very lived experience as I'm going through this as well. I think when you look at it in its totality, I think, yes, attention is definitely impacted. But I also think a dysregulation when it comes to emotional stuff is a huge, huge part of it. And just to put things into perspective, I'm not the only person who believes that. In Europe, they changed the criteria in 2019 to reflect emotional regulation as part of ADHD. Speaker 2 (4:35) Okay. The Speaker 3 (4:36) U.S. is just kind of behind. Speaker 2 (4:37) Yeah. Go figure. So I want to take what you're saying and I want to take it one step further. And that is when I ask, what's the implication of that? What I imagine is if we're saying, hey, this is now a regulation thing on top of it. Speaker 3 (4:51) Yes. Speaker 2 (4:52) That means there is hope of X. There is a solution for X. There should be a more focus on X. Oh, Speaker 3 (4:59) my God. Yes. Speaker 2 (4:59) Okay. Speaker 3 (5:00) Okay. So I think if we reframe this as more of a regulation condition, number one, I'd like to talk about what we're going to fix, and then I'll talk about what I hope we'll see in the future. I think... If we're talking about, okay, ADHD also has this emotional component, then we're going to avoid misdiagnosing people who show any sort of emotional spectrum with their ADHD with anxiety and depression. Because that's what's happening right now. We don't really have a framework for talking about emotion when it comes to ADHD. Speaker 2 (5:30) So Speaker 3 (5:30) whenever someone is swinging one way or the other, whether they're getting more anxious or they're getting more depressed, then it's just like, you need an antidepressant. And I'm not against antidepressants. As a psychiatrist, I mean, we utilize them. It's a good tool. But if it's not actually treating the underlying cause, then you're just giving medication for the sake of giving medication. It's not actually addressing the root cause. So I feel like it'll help counter a lot of misdiagnosis. I also feel like my hope for this in reframing this as a regulation condition is that. Earlier intervention. We'll be able to kind of talk about this more comprehensively. So we'll be able to see things a little bit earlier. We'll be able to educate people from a younger age with behavioral techniques that can kind of help them regulate a little bit better and just better management overall. Speaker 2 (6:20) Is ADHD an epidemic? Speaker 3 (6:28) Well, define what you mean by that. Speaker 2 (6:31) Something that is growing in both dissemination, like of more people now saying they have it. Speaker 3 (6:42) Okay. Speaker 2 (6:43) Okay. And now becoming almost more of a, I'll even go so far as saying. It feels like a lot of people I know have it more than the people I know who don't. Really? Yes. And it might be truly exhausting that the field that I'm in, Speaker 3 (7:02) it Speaker 2 (7:02) feels like every other Q &A that I have, the person begins with, hey, Jefferson, I have ADHD and I battle with depression or I have ADHD and I am neurodivergent. Speaker 2 (7:15) And friends. I have two of my best friends. Both. Take ADHD medication. Yeah. Okay. One has done it since junior high. Right. The other has kind of. I don't know, kind of self-diagnosed. I mean, he went and saw a clinician to talk about it. Now he's an adult and is saying, oh, I've had ADHD this whole time. And so what I mean is, it feels like I know a lot of people that have it and it's more in discussion of conversation more than it's ever been. Speaker 3 (7:52) I would agree with that. I think it's part of the cultural conversation more than it has been. I don't think there's necessarily an increase in just like general population ADHD. It's kind of like, but I think we're getting better at picking it up. And I think we're getting better at talking about it because a lot of people are now, especially since it's so prevalent on social media, or at least on my algorithm. I mean, it Speaker 2 (8:17) would make sense for you, truly. I know. Speaker 3 (8:20) I feel like because of that, people feel more comfortable talking about it with their providers, talking about it with their peers, talking about it with their family members. And so now we are, you know, discovering and more. Is there actually more of it in the public? I don't know. Maybe we're just better. It's like saying, you know, we got a super. like a better telescope and now we're discovering more stars. Well, the stars were probably there in the first place, right? We just can see them better now. So I don't know if there's more of it. And I would say that this over-diagnosis kind of thing is really population dependent. Like it's, there's some racial and socioeconomic groups that get it picked up a lot more often. And there are other groups that are wildly underdiagnosed. So it just kind of depends on. where that trickles down because I don't think it's across the board. Speaker 1 (9:13) Before we keep going, I want to take a moment to tell you about Cozy Earth. I love Cozy Earth as a sponsor because everything they do is top premium quality. Not only am I somebody who I like to be really comfortable wherever I'm going, whether I am going to an airport, I'm traveling, I'm hopping around with the kids, I'm going to go pick up kids, drop them off. I want to be comfortable. 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Sometimes I feel that there are those that, this is probably the exception to the rule, that it's a... It's like an answer that's looking for a problem. Like some finding their whole life is dysregulated. So they're looking for some way to blame it on something. Speaker 3 (10:49) And Speaker 2 (10:49) so I like that you include regulation in this because it makes it much more holistic in my mind Speaker 3 (10:57) that Speaker 2 (10:58) we're taking it not just from I can't pay attention. Right. Because this guy, I have trouble paying attention. It's part of the human condition. Exactly. You know, I definitely have Speaker 1 (11:07) trouble paying. attention to anything. Speaker 2 (11:10) But I like that. What you're saying is if we add in the regulation component, which is something that I go, okay, that's something we could talk about. That's something we can help a lot of people with. Do you find that The people you talk to and the people that you've treated have had ADHD. Let me just ask you this way. Is ADHD something you're born with or something that you can find out that has arisen when you're in your 40s? Speaker 3 (11:44) A lot of the time you're born with it. Speaker 2 (11:46) Really? Speaker 3 (11:47) Yes. Now, what I will tell you is that, you know, for a long period of time. ADHD wasn't really talked about. So a lot of people weren't getting diagnosed in their childhood because it wasn't part of the conversation or because of their presentation, especially for girls and women. When they were going through their schooling, when typically it would have been picked up, Speaker 2 (12:09) they Speaker 3 (12:10) weren't outwardly facing with behavioral issues. They weren't being impulsive. They weren't causing issues in the classroom. And so they weren't picked up. And then it kept. They kept getting passed from classroom to classroom. And then, you know, when they got into situations where they just could not cope, that's when things started to fall apart. And then at that point, it was, you're hormonal. Or this is depression. Or this is anxiety. Or this is mommy brain. And it just kind of gets kicked down the line. And then what happens, usually, or at least what I'm seeing within my own patients, is a lot of times people come to me and they're like, we actually got our kid assessed. Speaker 1 (12:48) And then when I Speaker 3 (12:49) was sitting in Speaker 1 (12:50) the Speaker 3 (12:50) evaluation, like, this sounds like me. And then I got assessed. And so it was kind of like this. We've seen this huge rise in people that actually are coming in after their kids are getting assessed. Speaker 2 (13:02) Do you think there's a certain time or age that a parent should consider getting their kid assessed? Speaker 1 (13:12) No. Speaker 3 (13:13) I mean, like, I. Are Speaker 2 (13:15) there any, like, indicators or markers? Well, I Speaker 3 (13:17) think so. Speaker 3 (13:19) The difficult thing about psychiatry in the childhood population is just sometimes it's really hard to tell, like, what's normal childhood development in your kid being a kid and what's ADHD and what's not. I always tell patients and parents, like. you know your child the best. So if there's something in you that is like, I think there's something going on. I think there's a focus issue. I think there's an emotional regulation issue. If you're concerned about it or if it's come up like at school where other people are concerned about it, if it's accessible to you and if it's affordable to you, I don't think there's any harm in getting evaluated. Like talking to someone who from a medical professional standpoint can evaluate your child. Speaker 2 (14:04) Right. Speaker 3 (14:05) But at that point, even if they say, yes, this child has ADHD, I think there's so many different treatments that you could do. You don't necessarily have to jump to medication. That's another important thing. Speaker 2 (14:15) I do want to talk about that because I know you have an opinion on that. And I want to make sure we get into it. I want to know what you Speaker 3 (14:22) think my opinion is. Speaker 2 (14:23) It's going to be a good one. I think your opinion is a good one. Are we saying fundamentally is ADHD a spectrum where you can be full on? you know is it something you can have more of or something you can have less of than others Speaker 3 (14:43) I think, I mean, yeah, I think everything, right? Everything is probably somewhere on a spectrum. The way you, how we, how our diagnosis sits right now is ADHD is broken into three types. There's inattentive type, which is, you know, the classic daydreamer presentation, difficulty focusing, difficulty completing tasks, difficulty organizing tasks, forgetful, losing things. There is hyperactive, which is. physically and verbally impulsive. These people can't stay in their seat. They're interrupting others. They're impulsive and or hyperactive. And then the third one is combined type, which is a combination of both. So you can present at different ends of the spectrum on all of those kind of things. And the thing that becomes hard is that there's outward behavior where you can see it and you're like, OK, this person cannot stay still and they can't stay in their seat and they are like physically touching everybody else. And then there's other people who I would argue their ADHD is just as disruptive. They're staying in their seat. They just can't focus. Speaker 2 (15:50) So Speaker 3 (15:50) it's. It's hard to compare those two. So I guess you could put it onto a spectrum in terms of like functionality, like how much people can do. But it just presents it differently. Speaker 2 (16:03) Well, in my mind, it's like if you get the chickenpox, you know you got the chickenpox. You know what I mean? You got it. And where ADHD is concerned, you know, is it just you tell me something, I go, huh? And they're like. ADHD. Or is it just that you were thinking about something else? So that's what I'm saying of like the spectrum mentality of it. I do have a question of, in your opinion, is ADHD overdiagnosed? Speaker 3 (16:34) I think it depends on the population, right? I think it's overdiagnosed in some groups, and I think it's underdiagnosed in some groups. Speaker 2 (16:42) Well, then let's talk about some groups. You mean in demographics in terms of men, women, kids? Are you talking about U.S. versus other countries? I'm Speaker 3 (16:51) talking about, like, if you look at the U.S. population and demographics of that and ADHD diagnosis, there is a significant difference in... white upper class American children that are getting diagnosed with ADHD versus people in a lower socioeconomic class that might be black or Hispanic. Speaker 1 (17:16) These Speaker 3 (17:17) kids aren't getting diagnosed with ADHD. They're getting diagnosed with behavioral disorders, oppositional defiant disorder. These are kids that are going through instead of actually looking and assessing, they're going through like. behavioral plans. They're being given antipsychotics. They're giving medication that doesn't actually apply to them to try and tamper down behavioral things that are happening, which are actually a result of impulsivity from ADHD. So it really does depend on where, and again, that's not a hard and fast rule, but if you look at trends within the U.S., that's what you see. I Speaker 2 (17:51) want to make sure