E29 | Dr Khurram Sadiq: Managing AuDHD, misdiagnosis & masking

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Hey, Ryan Reynolds here from Mint Mobile. Now, I don't know if you've heard, but Mint's premium wireless is $15 a month. But I'd like to offer one other perk. We have no stores. That means no small talk. Crazy weather we're having. No, it's not. It's just weather. It is an introvert's dream. Give it a try at midmobile.com slash switch.

Upfront payment of $45 for three-month plan, $15 per month equivalent required. New customer offer first three months only, then full price plan options available. Taxes and fees extra. See MintMobile.com. Hello and welcome back to WTF is Audie HD with Late Diagnosed Sisters Ellie and Paige. We were diagnosed late. And we're here to educate. Yes, and today's episode is part two of our chat with Dr. Haram Sardik, the TEDx speaker.

the neurodevelopmental psychiatrist who specializes in audio HD. He's audio HD himself. And in today's episode, we talk about the family connection, the sibling connection, why he thinks clinicians should all be trained to spot all neurodevelopmental. conditions. That was a very interesting chat. Yes, please. We talk about the unique traits of Audie HD. We cover a little bit of PMDD. We talk about just managing Audie HD. How do you do it?

And he gives some lovely parting advice. Plus we answer some of the questions that you put in our Reddit community. You can join that in our link tree. Plus we also. We've still got the giveaway going for a signed copy of Dr. Haram Sadik's book. So go on and scram and tag a friend, let them know about this potty, and you're in the draw to win that. And we will draw that in about... In the next week or so. Next week or so. Yeah, yeah. So we hope you enjoy this.

next hour. Honestly, it's just as jam-packed and just as interesting as the last one. And again, we've put the time codes in the description if you'd rather just go to certain points. But other than that, enjoy the chat! We see a lot of kids and adults getting diagnosed, but then their siblings, for example, being overlooked. Like Paige and I are an example of this where it very much looked like Paige was and I wasn't. And that's a very... Externally? Yeah, externally.

Do you think it's likely that if one sibling is neurodivergent, the others definitely are? Or do you see families where there is just one neurodivergent sibling and the rest are not? Do you think that it does run in sort of families quite... A lot? Yeah, it runs in families, but at the same time, it depends. For example, if you have got five siblings, there can be three who are neurodivergent and two who can be very neurotypical at the same time.

So it doesn't necessarily have to mean that all three of them have got All five of them have got neurodevelopmental condition. No, it doesn't necessarily have to be. It depends on the genes and interaction and when your brain is forming as to what kind of genes you're getting from the mother.

from the parents, from your ancestors. So that defines your genes and the heredity of that very condition. So it can change. I've seen people who were the first in their family, but they remember that somebody saying that great-grandfather was similar to them or grandfather was similar to him or her. It varies. But again, the chances of if one sibling has no developmental condition is quite high, that the other one will have something plus.

The presentation can be very different. It also depends on your intellect. It also depends on the severity of the condition. For example, whether the autism is mild, the ADHD is mild, you use your intelligence, you have good peer. Be a peer group. Your teachers are good. Your schools are really accommodative. So these are multiple factors that kind of define it. And it varies so much. There's so much variation that goes on.

Yeah, yeah, totally. Do you think, I think with getting more research now, I think a lot of us in these generations had parents who were probably undiagnosed. Do you know much about or have you done any research on sort of the trauma that kids then get who are neurodivergent?

being brought up by parents who probably were but were undiagnosed? And like poor emotional regulation. Yeah. How do you think that trauma affects people as well alongside the neurodivergence? Like definitely there is. For example, if...

If you are neodivergent, there's a very good chance that you will go through different traumatic experiences throughout your life, at different stages of your life. And I was talking to somebody yesterday, and they were like, if a 15-year-old is listening to this conversation of ours, what should they do about it if they have any problem? I said,

What they have to do is to constantly persevere. For example, if they have difficulties, they go and tell their parents about it consistently, seek help from others as well. But the undiagnosed, for example, if... If the parents are undiagnosed and there is emotional dysregulation, definitely it will impact the child. And they will grow up being emotionally dysregulated because they don't know. No matter what they do, they will be at the brunt of those.

emotional dysregulation episodes from either of the parents or both the parents or one of the parents. So I see that a lot. But again, I have seen... things going the other way around as well. For example, diagnosis of a child leads to the parents thinking that they have got the same condition and then parents getting themselves checked.

after a very long time. And I remember one of the persons who came to me with an ADHD assessment and talking about the child and they said that my child would be so happy. that I've been diagnosed with this because child felt so alone and on its own. And the next time when it came, we so much discuss about our autism or our ADHD together. And the child was like seven to eight-year-old and said, We connect on so many levels now since we know we both have the same conditions.

The child inquires with me about my medication and how do you feel without medication and with medication. So all those conversations that were not happening before, they found a very unique bond. Trauma is there, but at the same time, there are some really positive stories that come out of it where people have bonded based on this. Yeah. What are some common misdiagnoses that people end up getting that potentially could just be ADHD?

And what do you kind of wish clinicians knew more about ADHD so that they don't miss that diagnosis? Yeah, it happens all the time. And again, I tell people that the kind of surge that we have of... autism, ADHD, ADHD. It's not just because you're learning more about it. It's like people who had no answers for the past 30, 40, 50 years. That's a backlog of five decades, four decades that we are dealing with now because

Information is more prevalent. And I see people diagnosed with anxiety, with depression, with bipolar affective disorder, with psychotic disorder. I remember, and again, it was one of the most fascinating stories. work in a community mental health team and not as an autism as a neurodevelopmental psychiatrist but but as a general adult psychiatrist and i i use my

My clinic used to be on the second floor. The waiting area used to be on the first floor. And a lot of the times when I would go and pick somebody out and help them to my office, I would know.

If somebody had autism, just shaking hands with them, making eye contact with them by the time in those three minutes when they would come to my office. I had an inkling that there's something else, there's something beyond the obvious. And then I would start exploring around that time. And there was one person who had probably a burnout in about... 20-25 years ago and was on a very minimal dose of an antipsychotic medication and was diagnosed with schizophrenia.

And when I started talking about the person, the person was an intelligent person, with so much information, so much knowledge base, made all sense. And then I started exploring, I came to know that the person is autistic. So I had to revoke the diagnosis of schizophrenia to autism spectrum disorder. So this was kind of the disparity, as I said.

The 15-year-old who told me that he could smell weather, and if he had said that 20 years ago in a clinic, he would have been suctioned in a mental health ward and saying that... probably you're having a psychotic disorder and you need to medicate it with antipsychotics. So we see that quite a lot. And I think the skill set is missing. First of all, I do not agree that...

ADHD or autism is a specialist diagnosis. A prevalence of 6% to 10% population of ADHD, which is much more than schizophrenia, anxiety, depression, but all together. even personality disorders, and autism diagnosis, which is bordering on about 2% to 3%. How can that be a specialist diagnosis when every general adult psychiatrist, every psychiatrist is trained?

to identify, to diagnose bipolar affective disorders, schizophrenia. So the skill set is clearly missing. And I advocate that it should not be a specialist disorder. It should not be a specialist condition. Everybody should have the skill set. If everybody developed that skill set. we would not have the waiting list. We would not have these problems. We would not have this misdiagnosis. So it will take decades because despite of knowing what is happening, people are still...

not putting things in place. The organization that are responsible for training people, the organization that are responsible for managing their registration, their professional registration, they're not doing anything about it. Whatever people are learning.

They're doing it still on their own accord and out of their own interest. And because they see autism and ADHD in their own clinics that much, if they don't know it, then it will become a problem for them. This needs to change. Definitely. The skill set needs to be prevalent. Yeah, I agree. I feel like in an ideal world, I know this isn't an ideal world, it's possibly not possible, but I wish every child just got screened for it. Just in case.

Just to see, because I think it explains a lot of things later in life, especially when the mental health decreases and you end up with depression, anxiety. Often for me, I did get diagnosed with that, but in... In the end, it was actually, I had undiagnosed audio HD and no one picked up on it. And so I do really do wish that it was just kind of a baseline.

piece of knowledge, like you say, that clinicians just go, let's just test this first, then we'll rule that out. Because yeah, I think that happens quite a lot. What is the biggest diagnostic blind spot for people when... When it comes to ADHD or autism and ADHD, what's that big, is it like one big blind spot? Is it just not looking for it at all in the first place? Is that the blind spot? I think it is.

they see what is very obvious. Like they're not trained to look beyond the obvious. For example, if somebody comes with social anxiety because of the situation, they will focus on anxiety. Maximum, they will focus on depression. At one time, nobody was looking at checking with them about autism because autism is one of the most common conditions that can cause so many different variables. And undiagnosed autism and ADHD can cause depression and anxiety.

Depression and anxiety emanates because of the troubles of not being misunderstood and not being diagnosed at a very early age and putting things in place. So that is one. One thing is, not seeing beyond the obvious, it's the biggest blind spot that they have. Especially if the brain is a push and a pull because...

And when I see ADHD, I see three different presentations. One is the push and pull that we see. For example, sometimes it's autism and sometimes ADHD. And there's another one where it's an autistic dominant ADHD.

Autism is the dominant part. ADHD is mask. And then the ADHD dominant part, where ADHD is the prominent part, and autism is mask. I think if we are not looking thoroughly, if... For example, if you see an ADHD, you're not exploring autism. If you're seeing an autistic person, you're not exploring ADHD. And if you're seeing social anxiety, you're not exploring the different causes that can lead to it.

I think these are the massive blind spots that we have because we are not thinking beyond the obvious. We are thinking probably this is what we see, but we are not trained for that. We are trained. to go beyond the obvious, to see the etiology, the reasons causing it. And once you start exploring it from the childhood history, you will know that the anxiety that you're seeing now, it does not make sense.

because it's emanating from something else. Yeah, exactly right. Is there any traits that you see in ADHD people that seem unique to the combo? Like I think a lot of people might have one diagnosis only and they're wanting that like...

What is the thing that's going to tell me I've actually got both when they suspect it? Is there something in Audi HD that makes you kind of go, yeah, it is that combo? Or is it, again, it's too holistic, you've just got to keep... I think it's too holistic, but again, a few things that... got me into this ADHD and that got me very fascinated was the organization and the disorganization because if you see a person with ADHD who's organized, you should be asking this question.

why are they organized? Because the national inclination of ADHD is to be disorganized. So if they're organizing, either it is because of the pressure of ADHD and their world falling apart, they have to create those structures that's scaffolding together.

but they are like hearts of cards. If one thing blows away, the whole thing collapses for them. When I want to talk about the ego dystonic structures, for example, the creating of those structures can be very nerve-wracking for them because it is so difficult to have that inclination to bring order in a chaotic situation.

And the other thing that I look for is if that organization comes natural to them, for example, they love doing that, then I start exploring about the autism side of things, whereas autism can be the one. which is helping the ADHD person be more organized. And then I remember, like, what you're listening to and what you see in your real life, these are two different things.

in practical life. I remember seeing somebody who was there to do an assessment of ADHD and as I walked in with my piles of stuff kind of

put in a very disorganized way on top of each other. I had my laptop and then I had my tablet and then I had my phone and I was holding it together. All of a sudden my charger fell and the person... just gave a startle response i said fair enough it fell on the floor it made a loud noise probably this is what it is and something else happens i dropped something else it was not a charge at this time it was something else and the patient made the same kind of

it was a very gasping response towards a stimulus which was not that strong i said okay that the two two incidents happening within within mesophysia the one with very strong stimulus one with comparatively less stimulus let me explore further and when i started exploring i explored the sensory overload which was very common and then

And I started feeling it layer by layer. I started seeing the autism coming out slowly and gradually. And I started seeing the autism in a person's personality and the person's... uh demeanor in in person's uh kind of posture and in the way they were making eye contact with me so even for an expert who knows rdht very well

Sometimes it's so must, so you have to give really good attention to all the small details that are happening around you to make sense of it. I think one other thing which is kind of is... that if it is hyperactive kind of ADHD, we all are a combined type of ADHD in which hyperactivity is very profound. We assume that people who are hyperactive will be social as well.

Whereas if you start exploring it, you come to know that they are hyperactive, but they're hyperactive. They like to do activities in silos and in solo activities. For example, they will be trampolined. or they will be running, or they will be hiking, or they will be doing it on their own, or they will be cycling. Whereas people with ADHD, who have got strong ADHD, if they're hyperactive...

they'll be involved in social games. So they'll be like playing football or they will be playing cricket or they will be playing with a group of people. So they're interacting and they're enjoying themselves as a result of that as well.

So those are the things, small things, small details that you have to look at. Plus the social interaction. They like to interact. but they still do not like the social gatherings. They can mingle, but they hate small talk. They can talk to people at length, but... Again, even with people that they know very well, they will be off for the next two days because they have to regather and rejuvenate the energy of their body back into shape. Yeah.

So one, organization and disorganization, and then social seeking versus isolation. These are one of the most prominent things that should let you to explore further. in the person's presentation. That's so interesting. Thank you. I have like a, I've made an observation and it's not a theory backed by science or anything, but I know quite a few people who have been diagnosed with OCD and I just wonder if sometimes...

that can actually be a secondary thing to mismanaged or like a stress response to undiagnosed or ADHD potentially or one or the other, particularly autism. Is there any science backing that? Is it a secondary thing generally? And if someone's just got that diagnosed... should they be checked for autism or ADHD? I think when people come to me and they say they've got OCD, the first thing I check is what do they mean by OCD?

If they mean that they want things in order, and if things are moved, then they will know about it, and they don't like the things to be touched because they know that they're put in a certain order, but they don't have the reputation. For example, they don't have the... the thoughts because OCD is about intrusive thoughts, intrusive images happening over and over again, leading to a ritualistic behavior. That is the germs, the germs, the germs. So what do you do?

wash your hands, wash your hands, wash your hands. Somebody is breaking in, somebody is breaking in, somebody is breaking in. And they know that it's irrational because they have checked and they know everything, but they have to go and check and check and check. So first of all, what I do is I try to... differentiate and to kind of explore what their concept of OCD is because for a layman person, putting things in order and keeping an order in their life.

is considered ocd whereas ocd is not ocd this is not ocd this is more like an orderly behavior that that stems from autism but saying that people with autism, they have a comorbidity of OCD quite a lot, like 10 to 15% of the population, they do have it, but it does not stem from it. I think they have very similar traits.

when it becomes more intense, the orderliness, it can turn into an OCD. Yeah, that's very interesting. Yeah. Thank you for clarifying that. It happens less often in ADHD because otherwise it will be a disaster. You have OCD and ADHD on two sides. Again, exactly. This will be a recipe for a massive disaster. So I do not see it that much with ADHDs and autistics.

Yes, I do see it quite a lot. Very interesting. Can you explain why masking is so subconscious and whether there's any advice you have on how to unmask after a life of masking, generally talking about late diagnosis, but also... not like dinos who mask their whole life. Why is it so subconscious? And is there any way to unmask easily? And again, like I think we discussed it when we were talking about the gender as well. So that.

masking is a kind of societal pressure on us. Masking is a pressure on us as a specific gender. Even with males, as you said, male masks as well. But again, and the male mask because of different reasons, because... and they don't want to show their pain.

They don't want to discuss their problems with anybody. They don't discuss. There are only a few people that they can open up to. And if those people are not around, that they would not open up with them. And hence, they started masking. And as a result of that. it becomes very much ingrained. Unmasking can happen as a slow process, especially if they trust the person. And it happens mostly with people who are neurodivergent. If you create a safe...

safe place, a place where you're able to say things, do things, and you're not judged by it. Why do masking happens? Because everything that you're doing, there's a negative comment coming on top of it. Whatever you're saying, people are criticizing you for that. At the end, you feel not able enough. Hence, you start masking. You stop telling them. You try to put process in place.

Push yourself to do things, to be very similar to them, make every effort to fit in. For example, if somebody is autistic and, for example, coming from Pakistan. And they push them to kind of mingle with people, relatives every time they come in to strangers that do not know. And it has a very detrimental effect on that child.

But unfortunately, they're not able to because they're bound by certain rules. You have to be obedient. You have to listen to your elders. You have, because society tells you that you have to meet your relatives. and have a cordial relationship with them and hence they start masking the struggle within those silos but the moment you give them the space if they know that they can talk openly in a place five people

Just like I would give reference of Ted Lasso or in the Order of Phoenix, the Dumbledore Army. For example, the moment they come.

into those situations where they were not judged, where they were helped, where they were supported, all of a sudden, things started to come out and things improve as a result of that. Oh, come on, like Roy Kent, why would he join it in the end, in the last episode? Why would he want to be part of the Diamond Dogs in Ted Lasso? Because he liked that environment. He knew that no matter what I say.

I would not be judged and people will listen to me or they will give me a compliment or they will say, yeah, you're not thinking right. This is what it is. And it will not have an impact. In fact, it will improve. So creating those. Diamond Dog situation or Dumbledore Army situations in your personal life or in your professional life will help a lot of newer developmental people come out of their silos and perform amazingly well.

I agree. This leads into sort of employment and being neurodivergent. Do you have any advice for businesses and companies on how they can accommodate for neurodivergent people or are there any good resources that...

neurodivergent people themselves could send to their company that can help because I really believe that companies are missing out on the potential of these neurodivergent people and their company's only going to do better because of it. Do you have any advice for businesses or people who want to talk to their bosses about it. and lets you choose your ideal comfort on either side. Your sleep number setting. Enjoy personalized comfort for better sleep night after night.

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No big contracts. Four, I use it. Five, my mom uses it. Are you playing me off? That's what's happening, right? Okay. Give it a try at mintmobile.com slash switch. I think the important thing is that you have to first of all, you have to embrace the difference. I think if the CEOs, if the leadership of the company is very stringent, then they do not allow, for example, they want people to work nine to five. That's it. If somebody is working at six o'clock and seven o'clock, that is not allowed.

or somebody working hours starts at 11 o'clock and finishes at 7 o'clock, that is not allowed. That's not a very right environment. But you have to, first of all, you have to be open. Everybody is different. Everybody works differently in a different environment. Everybody has got different challenges. For example, there's a thing called access to work in the UK now, which is becoming very popular, in which they go to occupational health or they talk to a team for access to work.

And they talk about their problems and troubles. And then on the basis of that, they provide them with provisions. For example, somebody will give them a tablet or they would give a high chair or kind of the loop. AirPods, which will help them to kind of not distract them and noise cancellation or give them a separate room. So I think these provisions should be there by default. Everybody who comes in.

should have that assessment and should be dealt with accordingly rather than going through a different pathway after a performance review because they are not doing well. Do you listen to Simon Sinek? No. Simon Sinek, Simon Sinek. So Simon Sinek is a leadership guru, and I think he's one of the most prominent leadership orators in the world at this moment in time. That talk is amongst the top ten watched globally of all time. And he...

And the talk was about why, but he talks a lot about leadership. And in one of his interviews, I was watching it, and he said that I think he was referring to Vegas. So he went to Vegas, and he was talking to... a barista who was working there in four seasons. And he said, so do you like the job? And he said, I love my job. I said, being a leadership coach and being a leadership...

a person who's invested in MediChip, our next follow-up question is, why do you like your job? And he said that the managers here and the senior staff here are so helpful when they come to you and they say, do you need some help? they actually mean it and they will do everything to accommodate you. And everybody is very supportive and everybody is very caring. So I do my very best.

Like I outperform everybody else because I love this place. I take it as my own responsibility. I take the ownership. And then he said that I work in another hotel. I think he mentioned another one of the Vegas hotels. But when I'm there, I'm working below the radar because the managers are there. They're looking for things that have gone wrong. So they penalize you. They point it out to you.

They kind of undermine you for those things. So there I work under the radar. So it's so amazing that the same person had been provided with two different environments. And he thrives in one because he knows that it is supportive. He's not going to be judged. He's going to be supported. And he owns it. Whereas in the other one, his performance goes down.

He's just doing it nine to five to earn some extra money and get out of there. Yeah. That's so interesting. I think this is, yeah. And this is what it is for you. You provide them with the right environment. You will see them thriving. And if you don't, you will see that they will, an amazing, a good manager, a good leader can make a small workplace, a difficult, a challenging situation. look like heaven and a bad one can turn the heaven into hell for you yes

And the staff turnover will be wild and also that will cost the company money. Yeah. Hiring new people. Absolutely. Yeah, exactly. Yeah. Agreed. Well, research for like managing ADHD or treatment, I guess, is very young. You talk about this in your book because the actual diagnosis is only like 12 years old. The actual treatments and stuff are even younger, I guess.

have any research backed or just lived experience in terms of tips on treating or managing audhd because it's hard because it's so contradictory it feels no no i know i know and again um i When I'm discussing the diagnosis with people, I tell them autism is a lens through which you see the world. ADHD is something which is manageable because it is to do with...

with your neurotransmitters, the norepinephrine and dopamine. I tell them that the ADHD brains are smaller or the pathways between the brains are smaller. For example, you're living in two different cities. And you're not connecting by a motorway, but you're connected by a small B road or an A road. So the traffic is going to be massive and everything is going to slow down for you. So what we do with ADHD is we kind of...

increase the pathway, turn the B-road into a motorway by medication and by putting strategies in. But I also tell them that, look, there's a fine balance in which autism and ADHD operates. So if you feel... that all of a sudden you're having a personality change. You're not having a personality change. It's because your autism is becoming more prominent. So I tell them that the most important thing that they can do is to educate themselves about...

ADHD, read as much as possible about the lived experience examples. I give them a few books. And again, one of the books on autism is coming from... that part of the world where you live in. It was written by an Australian girl. It's called Pretending to be Normal. And it was about her life story. And it became so popular. Tony Atwood, who kind of specializes in autism and women, that helped her to write the second edition as well. So there are a few resources I'd tell them to, because...

As you develop more insight about it, you're able to control and manage a lot of things about yourself. And it will come to a point where you will unleash one or the other, for example, if you know that. this situation requires your autism then you will create that environment for you so where the autism thrives and you're able to focus on things in a natural way but at the same time create a situation for you whereas if

The situation is in crisis. It requires the ADHD to be out. You will unleash that. But again, it needs a lot of insight, building the confidence.

For speaking to like-minded people, there are certain voluntary organizations I give them that they should work with them because they talk about employment. and neurodiversity relationships and neurodiversity, it gives them more insight. And the more you meet people, the more understanding you have about your neurodiversity. So I think I... I give them that information. And again, as we go along, I guide them as it is, because as such, we know that the...

The ABBA, which used to be quite popular ones for autism spectrum disorder, it does not work that much. Like it doesn't have an evidence and it has a negative effect, the contrary effect. CBT for ADHD. It's a very umbrella thing. How can you expect a person with ADHD who has come part of him or her or them is ADHD? How do you expect them to sit down for 50 minutes?

do the homework, and talking generically about ADHD and one aspect of it. I believe in ADHD coaching or autism coaching where they have lived experience coaches who gives you practical strategies about it. That can be very helpful because this is what they want. What we do in children during the school-going age is we give them the skill set, we give them the emotional training, and we give them the skill set to equip themselves.

so that they're able to deal with different transitions in life. Similarly, we have to do is coach them. We cannot give them the social skills workshop because they have learned a lot of social skills as they go along, but now they leave some scaffolding, some supporting structure. I am a big believer of coaching. So it is autism coaching, ADHD coaching, ADHD coaching from a lived experience person with an accredited coaching degree. I think that would help. Yeah.

Totally. What role do you think lived experience, sort of content and literature like peer mentoring? podcasts like this one what what role do you think they play at the moment and should they be playing a big role in the future of this kind of um mental health and neurodivergent care is it Yeah, I think the evidence is growing bigger. I think we do get a lot of peer support, lived experience. We are, in the UK, they've started to hire lived experience practitioners as well.

to be able to help others. And they have started doing it in addiction services. They're doing it in other general services. I think this is the need of the day. Because people with lived experience and who have gone through it, they have so much potential to explain the situation in such a better way to people rather than somebody who has not gone through that experience at all.

So I think this is going to be massive in the next 10 years. The peer-reviewed podcasts like this, people who have had experience, and they go with... the research evidence base or the clinical experience. And again, do not believe in anything else other than that. I think these kind of... modalities are really, really strong and it has a massive impact on the person. And I think in the next 10 years, you'll see it will become part of the mainstream health system. Yeah.

Yeah, love that. What gives you hope right now in terms of, is there any exciting research about Audie HD that's currently being done that you're aware of that we can look forward to? Do you know what's going on in the science world? At this moment in time, it's very, very limited. There's an Audi HD charity that has started in the UK. So it's called Audi HD UK. That's the first charity of its kind, which is about Audi HD.

I am doing some work, some perspective papers around about autism and ADHD as well, in which I am incorporating culture. So that will be released in probably a couple of months or probably in six months' time. I'm doing another systematic review. And again, I'm hoping to kind of expand my research to kind of multi-center because I've got people I know who are in places like Pakistan, India, UAE, kind of having a multi-centered.

not quantitative, but qualitative because qualitative experiences, lived experiences and what they feel to this is, this is the key. This is like gold dust, which we do not have at this moment in time. Yeah. But other than that, I'm not very much aware of it because ADHD is, as such, it's a colloquial term which is used by the neurodivergent community. It is slightly sinking into the mainstream.

into mainstream health services. They still like to call it the co-occurring autism and ADHD. They're not investing that much into knowing more about it. A lot of it is coming from the voluntary sector or, as you said, that kind of lived experience. sector that we have where we have got peer groups or mentors or podcasts like this. So just I think we should watch the space. It will grow. But again, it will happen very slowly.

Yeah, totally, totally. Do you know much about Tourette's syndrome and or multifocal tic syndrome? And is there a cause? Or do you know that? Yeah. Or, yeah, like, is there a cause?

So basically, Tourette's is part of neurodevelopmental conditions now, neurodevelopmental disorders. So as such, like, the thing is, we have not been able to find a genet. a specific genetic linkage to that. We know that it's genetic. We know that it runs in the families.

For most of it, we don't know the etiology behind it. So still, there's a lot of research that requires going into it. Because, again, this is, again, a very neglected area, Tourette syndrome. It's been known for a very long time. It's now becoming, they've started to notice that this is part of neurodevelopmental conditions, neurodevelopmental disorders. So hence, some more research has gone into it, but as such, there isn't anything massive.

that I can let you know about it. Again, it goes for most of the conditions. For example, if you look at schizophrenia, if you look at bipolar affective disorder, yes, it is genetic, it is familial, but beyond that, we don't know much about it. Yeah. If it's genetic, can someone have it dormant and then not have tics, but then can a child like me, it be triggered by external stress?

In Tourette's, that's a massive trigger. Like, again, it can be dormant and all of a sudden trauma happens, a trigger happens, something stressful. And you will notice that in stressful situations. Ticks are massive, whereas once the stressful situation has gone, it will die down slowly and gradually itself. So yes. Interesting. Would you say it's a nervous system disorder or not? Is it not just solely a nervous system disorder?

It is a nervous system disorder and it is part of now neurodevelopmental conditions as well. Yeah, right. Oh, thank you. Thank you for that. I've just got one more. Sorry. We touched on this before and I don't exactly know what my question is. You can help me, Ali. But PMDD, do you know much about it with the menstrual cycle and maybe the rates on?

neurodivergent woman and how many experience it and or, yeah. Yeah, yeah. Just any insight you have on PMDD, I guess, would be the... Yeah, like again, PMDD is... Just like ADHD, it's not a formal diagnosis as such. But we know that it is a severe form of PMS. And it is where the mood is really, really bad.

dysregulated, the emotional dysregulation is through the roof. And it is because the female hormone levels, they dip. At the same time, if somebody has got no developmental condition, it dips as well. So PMDD is... very much associated, like again, in at least 40 to 50% of the women who have got neurodevelopmental conditions. I think more research has gone through it. Even the gynecologists, they have...

They have started picking up on things closer to very menopausal symptoms. I think if PMDDs were they using HRTT, they're using some low-dose antidepressants to kind of... up the serotonin levels around that time but with ADHD what I've noticed is if you give a higher dose around the menstrual cycle then the PMDD severity decreases massively so

I think that this is the link between the PMDD and neurodevelopmental condition, but it is becoming more noticeable. I think the awareness is getting in the past two years. from being known to only a handful of individuals, like almost everybody around me that I know, know about PMDD, and they are looking into that. I think... This time I went to Prague for an annual ADHD Congress and there was a full section on the female neurodevelopment conditions that involved BMDD as well.

Right. Oh, that's really, I'm hopeful. That's great. Yeah, exactly. It is getting a lot of attention now. Oh, that's great. Yeah, I feel like obviously because it was generally studied on the white male, the female hormones have never been looked at when really they are so linked with your neurotransmitters that, yeah, it sucks that it hasn't been researched till now. Yeah, I think like ideally we'd probably...

if we're on medication should have different doses for different times of the month. Like you mentioned, if you just up the dose, it can help. Exactly. Yeah. I want to do a couple of list of questions if you're happy to. Do another 10 minutes. Is that okay? Thank you. What tips do you have, if any, for people experiencing burnout, but specifically ADHD burnout? Because...

Often you need to be, you know, locked away in a room. Well, not locked away in a room, but resting, resting, resting. But then the ADHD gets bored. Is there any tips you have on how to recover from ADHD burnout? Yeah, I think... One of the most important things is that you have to balance both sides of it. I think the burnout is because people with ADHD, they do not even realize it.

realize the extent of it till all of a sudden it becomes too open and it becomes too obvious and it comes to a stage where a person is not able to do anything about it so The important thing is that you have sleep is one of the most important things that needs to be looked into. I think if a person is dysregulated, A lot of the times, if they do not have a proper sleeping pattern, and it's not just napping, and it is about taking their time and getting some proper sleep.

using some aids in order to get over it because that is so much important. The other thing is just simplifying the decision-making. Because everything can become so overwhelming for them. It is even from... meal plans, to outfit rotation, to default settings, I think it is important that they break it down into very, very small steps.

Each step doesn't appear to be an overwhelming situation for them because that will add to the burnout. They should look into delegating or putting a stop to it. For example, delay things. or delegating it to somebody else. Because a lot of the time we are unable to let go of things as an ADHD. We need to do things ourselves. We do not delegate it. And that's what gets the best.

out of us because then all of a sudden we realize that we are left with piles of things that we're unable to do on our own. Yeah. A routine can be a sanctuary in this. For example, kind of completely switching off from the world, going into your own silos, taking care of your own self. And for the time being, for example, it can be a day, it can be two days, it can be a week.

just cut yourself away from people. And that really helps. And seeking support, people who are like-minded people, people who have got neurodevelopmental conditions that they're friends with. And even just ventilating it out, I think that's one of the key things in an Audi HD burnout.

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Why choose a Sleep Number smart bed? Can I make my sight softer? Can I make my sight firmer? Can we sleep cooler? Sleep Number does that. Cools up to eight times faster. and lets you choose your ideal comfort on either side. Your sleep number setting. Enjoy personalized comfort for better sleep night after night.

It's our Black Friday sale. Recharge this season with a bundle of cozy, soothing comfort. Now only $17.99 for our C2 mattress and base, plus free premium delivery. Prices higher in Alaska and Hawaii. Check it out at a Sleep Member store or sleepmember.com today. Yeah. Amazing. What did I say? I just went through a bit.

thing of burnout and I got to a point where I literally did all those things that you mentioned I wasn't socializing I said no to any socializing and I said to LA oh my god when I sleep well and I focus on my sleep it is seriously the most important thing and I focused on just eating well, sleeping well, said no to interactions and I also run my own business and I gave Ellie some stuff to do and like delegated a bit and I literally did all those things and that's what finally got me back to...

being out of function so yeah nice there you go um do you have any personal life tips for living with audi hd specifically how to deal with executive function or overwhelm if stimulants are not working We need to understand the cues, the visual cues. I think we need to leave some visual cues for ourselves. Audio HD, as I said, it can be of different nature, but again...

where ADHD is prominent or ADHD seesawing, visual cues like whiteboards, post-its, visual timers, that will help. Breaking down steps, again, that's useful for... for burnouts, but at the same time, day-to-day life, it makes life so easy because you look at a task, it will be so daunting, but it can be a phone call and you can break it down.

as to why you're making the phone call. You have to talk to the person about this issue. Once you put the phone down, you follow that person's advice and you can take a day off.

thinking about it before you make that call. It will make life so much easier. Use the two-minute rule. Again, if something can be done within two minutes, do it. then there and then don't leave it to later because it is it can be so insignificant that you might forget about it and it become when it comes back to you it can be so much bigger yes good advice

Yeah, and then gamify boring tasks. Make boring tasks more interesting. And again, how you can do it, you can turn it into a game. For example, I remember I used to... In my first consultant job, it used to be so busy that I had 15 patients, 16 patients. It's a very busy team. So it was very mechanical. My autistic brain, it was good. For my ADHD brain, it was not good. So I had created a system. I had created a checklist for myself. So it was like notes. I put N and then prescriptions for P.

and dictations for D and referral letters for R. And I would put it right in front of the sheet, in front of each patient. And every time I do it, I would take that. And it becomes such an effective way of doing it. that it becomes a competition. And at one point, my outpatient clinic used to finish. The moment, for example, if it was 4.30, I would finish at 4.30. At 4.31, all my tasks would be finished and would be done. Because...

I made it so interesting for myself because it was kind of a competition. I was ticking boxes. I was generating a lot of dopamine out of it. It became so interesting and build transition between the tasks. don't expect to switch gears instantly. So again, if you have to go from one task to another, say that, okay, you'll have a cup of tea or a cup of coffee or you go.

chat with somebody five minutes later, when you come back, you'll start that task. I think that helps. And then setting boundaries around overstimulation. For example, if you're doing something important, switch off your alerts. keep your phone away from yourself, put a board outside of your room, or wherever you're sitting, like I said, please, even if you talk to me, I will not respond to you. And those boundaries can definitely help a person.

in day-to-day life. Again, in the workplace that we have, we have small naps, each one of us. And when we are going to nap, we... We'll put a kind of a white paper which said, I'm going to sleep for half an hour. Please do not come and disturb. We would be very open about it. Everybody would know that we are sleeping in the office, but that would help a person so much. Yeah, totally. Love it.

All right, well, one more from the listeners. This listener says, as a neurodiverse family, how far outside should we be thinking, outside the box? This family's trying to focus on co-curricular activities, less video games, et cetera, but it feels like trying to fit a round peg in a square hole.

do they just assimilate into neurotypical society or should they consider things like homeschooling? Like, I guess they're kind of asking, do we just continue to push through something that's not working or go elsewhere? No. Okay. So, The honest answer is that it depends from situation to situation. Again, it depends on what kind of schools you have in the area. I always tell people that.

Go for schools that has good SEN teams. Don't go for the results as to how much they're getting the A's and the B's and the C's. If your child has got no developmental condition, I want a SEN team to be good and to be better. Go for a smaller school than a bigger school because that would definitely help. But at the same time, if that situation does not help, that homeschooling and those situations have really, really helped.

But also know that not every setting will be harmful. And some setting can be really, really good for the children, especially if somebody is having a good school, is having a good SENCO team. your child will kind of find people who are very like-minded to them and they will gel well with them. So it is... It really depends. Again, communication and trying to assimilate with a neurotypical, I think you have to be very careful.

There is a good piece of research about it, which is about double empathy. And double empathy says that neurotypical brains were completely different from neurodivergent brains. neurodevelopmental people understand neurodevelopmental people better, whereas neurotypical understand neurotypical better. So again, it's a two-way traffic. We are having difficulty in understanding the neurotypicals and neurotypicals.

are having difficulty in understanding us. So again, it's all about societal pressure. It's all about embracing the difference. It's all about noticing. that everybody is different. If you go by the definition of neurodiversity, well, we all are neurodivergent. Even the neurotypicals are neurodivergent because our brains work differently. We operate differently from each other. And as I say,

You have seen one person with autism. You have seen one person with autism. You have seen one person with ADHD. It's one person. One person without ADHD. It's one person without ADHD. And same case as the neurotypical. You have seen one neurotypical person. You have seen just one neurotypical person.

So the important thing is how resistant they are towards it or how open and embracing they are towards it. If they're an embracing family or embracing situation, then yes, you can connect with them. And that would be very helpful because that will give the skill set. to your child and to your family. But if they are somebody who's resistant, who does not believe in ADHD, who kind of say that there are no differences, everybody is the same, then it will be detrimental.

for you and for the child as well so again situations can be very fluid yeah No, thank you. That's very, very interesting. And I've always likened neurodiversity to biodiversity in the environment. It's all there for a reason. Everything thrives off each other. And it's actually just important that we embrace those differences because that's what makes the world so unique and wonderful.

Yeah. Yeah. Would you have one bit of parting advice or anything else you'd like to add before we wrap up? Like. what you'd say to people who might be grieving a diagnosis or someone who feels lazy and useless. Any parting advice or inspirational words you want to leave us with? Well, what you have to understand is that A, you're not broken. B, you're not lazy. And C, yes, you are different, but you're not useless. The important thing is to understand your own strengths.

where your strengths are, to have the conversation with your own self. I think a lot of stereotypes exist around ourselves. For example, if somebody was undiagnosed, but... They know that they have got autistic traits, but they can say, yeah, I cannot be autistic because I love people. That's again a stereotype that has been created by society, which does not understand a lot of neurodivergent.

population. But at the same time, it's about knowing yourself. It's about knowing the limitations and knowing the amazing things that you do. I remember when I was going through all of that. There were glimpses of brilliance. For example, in medical school, I did not do well because I was not interested. I did not understand anything, the kind of education system. But one day when...

When I got interested in one of the subjects, I changed the whole horizon of it by doing a presentation. At that time, we did not have PowerPoints. So I made my poor sisters sit down, bribe them. with a lot of chocolates and candies and got them a few books because I was bad at drawing. So they drew kind of the structure of nose, ear for me. And I was talking about epistexus, which is bleeding.

through your nose. And I took a reference book and I kind of went through it and I created a story out of it. And when I presented, like everybody's jaw dropped because A. They had never seen that part of me. B, it was the first time somebody was presenting it in such an animated way. It was a proper story rather than a presentation.

In that department, they changed everything after that. They said, from now onwards, every group who comes to our ward is going to do a very similar kind of presentation divided into batches. When people came to know that it was me who changed it, they were very angry with me. They said, it was so easy then. We had to take an exam and MCQs and everything. Now we had to do a presentation.

And from then onwards, the whole thing about that world changed and they became more open. So you have those pieces of brilliance in you. You have to just identify it. At that time, I just could not understand it. People used to come to me and say, You were such a kind of invigorating factor and kind of your enthusiasm kind of led the way and made us change a lot of things around that place. I did not think much of it.

myself at that time but when i look at it said those were the small wins i had i should have acknowledged those so it's important that along with all the negatives that you've seen yourself at that point because The whole world is telling you and the society is telling you that this is who you are, but should not turn a blind eye towards the brilliant moment that you have that can change the kind of...

the direction of things that are happening around you. So be very open about it. If you are embracing the parts that are not, that everybody is pointing towards you. as kind of a weak area of yours, but there are some really brilliant parts of yours that you have to acknowledge at the same time.

Yeah. Oh, that's wonderful parting advice. Thank you so much. I couldn't agree more. I think us neurodivergent, we are so hard on ourselves because of all those voices in our head from being told constantly. And I genuinely think once I got the knowledge of my diagnoses.

my strengths came more to light to myself. I felt like everyone else could probably see them, but I couldn't, but now I do. And I try and work to those strengths and I just, I don't ignore the weaknesses, but I just appreciate that I have those weaknesses and I don't berate myself for it. So thank you. That is great advice. And thank you so much for your time. Thank you so much. This has been an amazing, incredible chat. And I think all listening are going to.

Before I leave, I want to share something with yourselves again. Even at this level, in my office, I have a board that my trainees have created for me. And it says imposter syndrome. So it has kind of the article that was written in Guardian about me and other neurodivergence, which is framed around it.

There's all the pictures of me doing different things. The talks that I've done when I went to UN, UNESCO, everything. And it's scattered around it. And on it, it's written Imposter Syndrome. And they say, every time you doubt yourself, just look up. right in front of you, this will give you the courage and this will give you the validation that you require because you haven't put down for such a long time. And this is the positivity that you have created around you.

And it has helped you so much. Exactly. And this is how we should do things. If something is a problem, we should find a solution for ourselves. And we and NeuroDivergent are so amazing at finding solutions. If you have a problem solver.

Yes. Amen to that. Oh, thank you for sharing that. And again, thank you so much for your time. We really, really appreciate it. And we feel very lucky to be speaking to you because there's so little research still in the world. So thank you for spending time to share your amazing knowledge. and lived experience. We really appreciate it. You are very welcome. I thoroughly enjoyed it. Me too. Oh, thank you.

We hope you enjoyed that two hour, two part special of Dr. Haram Sadik. He is amazing. I genuinely enjoyed myself so much. I could have kept talking to him for hours. Yeah. And maybe we can get him on another time if he's keen to do more special. chats. I'd love to do that if we could just...

key on on a certain subject that he likes to talk about. I'll be so keen for that. But thank you so much for listening to that. Yeah, thanks, guys. Yeah, don't forget that we've got the old... We've got the old giveaway of a signed copy of Dr. Haram Sadik's book. explaining audio HD. So get in the draw before we draw the winner in the next week or so. Exactly. And come join the Reddit. Click the link in our via for our link tree and that's how you can get to our private Reddit community.

Other than that, we will catch you next week for another episode. Bye. Why choose a Sleep Number smart bed? Can I make my sight softer? Can I make my sight firmer? Can we sleep cooler? Sleep Number does that. Cools up to eight times faster. and lets you choose your ideal comfort on either side. Your sleep number setting. Enjoy personalized comfort for better sleep night after night.

It's our Black Friday sale. Recharge this season with a bundle of cozy, soothing comfort. Now only $17.99 for our C2 mattress and base, plus free premium delivery. Prices higher in Alaska and Hawaii. Check it out at a Sleepmember store or sleepmember.com today.