In a world that thrives on endless stimulation and distraction, it’s easy to fall prey to the myth that ADHD is merely a side effect of our fast-paced society that rewards short attention spans with a culture of instant gratification. Anything and everything all of the time, as Bo Burnham says, would make any brain weary, but the nuances of the ADHD experience permeate much deeper than the inability to stop doomscrolling on TikTok. It’s also important to highlight the fact that people with ADHD can still be high-functioning, successful, well-adjusted individuals when the condition is properly managed—and this is where women and people with high IQs are frequently overlooked. There’s a pervasive stereotype that people with ADHD exist in a state of perpetual chaos, and while the ADHD brain is usually spinning a mile a minute, it doesn’t always manifest itself externally. Dr. Sasha Hamdani, MD is a perfect example of this. She’s a board-certified psychiatrist and ADHD clinical specialist, but she still has to manage her own ADHD symptoms each and every day. She discusses this, in conjunction with comprehensive medical information, on her TikTok and Instagram platforms which have amassed over 100k followers. And it’s this vulnerability paired with educational content that makes her videos so approachable to anyone who either has ADHD or is considering whether or not they should seek screening or diagnosis. I also have ADHD, and I question my own abilities in the face of my diagnosis on a daily basis. You can succeed in many aspects of life and still feel perpetually limited by a brain that doesn’t always do what you want it to. So, in the spirit of vulnerability and spreading awareness about the disorder, I sat down with Dr. Sasha Hamdani to talk about the nuances of ADHD, mental health social media, and what it means to be neurodivergent in 2021. This interview has been edited for length and clarity Kate Nelson: To start us off I’d love for you to tell me a little bit about yourself, your background, and what led you to ADHD as your specialty. Dr. Sasha Hamdani: Ok yes, jumping right into it! So my journey started in fourth grade when I was diagnosed with ADHD after I legitimately started a riot in my classroom. It was a substitute teacher and I got all the kids to stand up on their desks, it was a whole big thing. And so, my teacher approached my mom about it, and soon I was diagnosed and began treatment. So I did pretty well from fourth to 12th grade. But instead of telling me I was taking ADHD medication my parents told me I was taking a vitamin because they were worried about me being stigmatized. So, every day I would take my vitamin and I continued to do well, well enough that I got accepted into an accelerated medical school program right out of high school. So here I was starting medical school at age 18. The school was in Kansas City and this was the first time I’d really been away from home. Suddenly I wasn’t taking my “vitamin” and I didn’t know how to take care of myself. It was the first time I had a lack of structure and a lack of oversight and so my world basically imploded. Since my parents saw how difficult medical school was for me they finally told me I had ADHD, and my reaction was “absolutely not, that’s impossible”. I really limped through the first part of medical school, trying to figure out my bearings. But then eventually I told myself, okay I need to figure out if this is real because I’m clearly struggling way more than my peers, and they’re managing to get through all this material that’s extremely difficult for me. I ultimately did my own research and talked to the counselors at my school and built a sort of team there. Then, with the help of my parents, I got back on medication again and was able to get through school. But yeah, it’s a long story but that’s what got me interested in ADHD because the struggles expanded far past my inability to focus and impacted every facet of my life. I wanted to understand as much as I could about the condition and help others navigate the complexities and learn how to manage it in order to live their best lives. Kate Nelson Wow, thanks so much for sharing all that, and I think it’s a story that a lot of people—women in particular—can relate to, the late diagnosis, or in your case the knowledge of diagnosis, which inevitably leads to massive amounts of self-reflection—it certainly did for me. I also really appreciate how candid you are about your experience with me now, but more importantly on social media. Which is something I think sets you apart from a lot of other physicians sharing educational content on social media platforms, that vulnerability. Your content is highly informative but simultaneously relatable. Could you tell me about your journey into that realm, how and why you decided to start making educational content, and what it’s like to have this rapidly growing following/major platform? Dr. Sasha Hamdani: Social media is a weird place right now, it’s pretty bizarre. I’m not going to lie, I spent the beginning of the pandemic making fun of it because I thought it was just kids dancing around on the internet. At first, I didn’t see a place for me on it. But then I started having more and more patients doing telehealth appointments, and they would hold their phones up to the screen with a TikTok video on it supposedly about ADHD saying, “see, this means I have it” and my reaction would frequently be, “No, that’s a 12-year-old telling you that if you sneeze multiple times in a row you have ADHD” and it was literally that video that made me get on TikTok. There was such a vacuum for solid, medically accurate information, and I saw an opportunity to create educational content that would be of actual value to people. And I feel like I got in right when ADHD information was starting to take off, so while now there is a lot of really wonderful information on there, it’s such a hot topic right now that it’s offset by these videos making all kinds of ridiculous claims about the condition. I feel like the internet is just this unbridled arena for getting information and it’s catering to a pretty vulnerable population. People are trying to figure out their diagnosis and walk through the challenges of accessibility to care, and they fall down this rabbit hole where they convince themselves they have ADHD. Or alternatively, what makes me even madder is the people who don’t have any sort of clinical background talking to people in the comments saying things like, “Well that can’t be ADHD because of this or you don’t have ADHD because of that” and my reaction is A) you’re not a doctor, and B) umm no, you can’t surmise if someone has ADHD or not based on one fact, that’s just not how ADHD works. It gets into really dicey territory. Right now on Tik Tok and Instagram there are a lot of hurt feelings and opinions on what is the right or wrong way to manage your symptoms, is a clinician giving you your information, or is it lived experience? It’s really important for everyone sharing information on social media to preface where they’re getting their knowledge—is this how I felt personally or is this from data and research? It’s so important to pay attention to this difference when researching ADHD on social media. Kate Nelson: I can definitely vouch for the explosion of ADHD-centric content on my feeds over the past year, but I agree it’s tricky to suss out what information is legit or what I should actually be paying attention to. Thinking about what kinds of topics these videos cover, what would you say are some key elements of the ADHD experience that are the most under-discussed, or that you wish people understood more? Dr. Sasha Hamdani: A really dismissive outlook about ADHD is that everybody thinks it’s a focus problem, right? And yes, focus is a huge part of it, but this popular description indicates that it’s some sort of unilateral condition where people assume you only have ADHD if you can never focus. So there are a lot of people who think if you’re able to hold it together and you can get through school and you can figure out how to stay on task that you don’t have ADHD, which is complete garbage, because ADHD is extremely nuanced and multifaceted. To be honest I don’t like that the name has “attention deficit” in it because really it’s a regulation issue where sometimes you have way too much focus on the weirdest thing. Kate Nelson: Yes, that’s such an important thing to point out. And I personally notice that inability to regulate focus not solely within the binary of “I am focused on a task” and “I am no longer focused on this task” but in terms of how sensitive I am to my surroundings and external stimuli. People with ADHD are hypersensitive to everything and your focus is split in seven different directions. You can be at a crowded bar with a friend and it can feel physically impossible to listen to what they’re saying because you are suddenly immersed in three separate conversations taking place around you, the sound of the bartender shaking cocktails, the singer warming up across the room, and the man behind you who is tapping his foot on his chair. You don’t just notice these things, rather your brain latches onto them with intensity and prevents you from being present in whatever activity you’re doing. It feels like this dysregulated state where your brain doesn’t know where to stop or settle. Dr. Sasha Hamdani: Absolutely, people with ADHD are just in this constant state of being overstimulated. Which actually bleeds over into another often overlooked ADHD symptom—emotional dysregulation. People with ADHD have a weak connection between the emotional, limbic part of the brain and that frontal lobe which is in charge of decision making and processing. When that connection is weak, you feel stuff so robustly and then you can’t talk yourself out of it. So when people talk about ADHD as not really being that big of a problem or say it just something that kids have, it’s very clear to me they haven’t been afflicted by it, because when you actually have ADHD, you recognize that it’s something that impacts every second of your life. Kate Nelson: Right, and I like that you mentioned the differences in wiring because that aspect of it can make it a lot harder to cope with the pressure to perform according to a set of behaviors that are accepted by society. I really like that the discussion is shifting towards broadening awareness of neurodivergence, and is attempting to accommodate people who have to work a lot harder to come across as “normal”. Dr. Sasha Hamdani: It’s just unrealistic to expect someone with ADHD to perform exactly according to the standards of a neurotypical world. And what can be really difficult is that a lot of times it feels like you just can’t win either way. Because you might get into a spot where you have ADHD and you cannot function, then you’re penalized for it, but if you can function, no one thinks that there’s anything wrong with you. It’s this weird paradox where people don’t want to talk about a diagnosis that is outside of that neurotypical mold because the intricacies of what is going on in the ADHD brain isn’t impacting them. Kate Nelson: It can feel like the neurotypical and neurodivergent brains exist in completely different realities, which can make understanding the condition a lot harder. Now, transitioning a little bit, I’d love to hear your thoughts on how ADHD manifests itself differently in girls versus boys, because it’s understood that girls are often overlooked when it comes to early diagnosis. Dr. Sasha Hamdani: Men and women, starting from an early biological age, will typically have a difference in presentation of ADHD. Men are more likely to have that hyperactive type of mind so they’re more likely to be the loud, hyper, disruptive kid. That is going to divert a lot of attention from the teacher because, well, that kid is overtly disrupting class and they have to deal with it. And as a result, that kid is more likely to get treatment. Whereas you have another kid, oftentimes a girl, who is dealing with the inattentive type. Maybe they’re doing well enough in school and they’re not bothering anyone or constantly in and out of their chair getting in everyone’s business. That child is going to fly under the radar because they aren’t impacting anyone besides themselves. The opportunity for early intervention is missed, and then these girls get older, life gets harder, academia and social dynamics get harder. And a lot of times, when puberty hits, the symptoms of ADHD get dismissed as symptoms of hormone fluctuation. Girls are told that those feelings are just a part of becoming a woman, when really it may be ADHD and no one is telling them that their brains are wired differently. And so then what happens is maybe you get to college and are suddenly pulled out of the structured environment of your teenage years, and you’re expected to create a life as an adult, but haven’t been given any tools or routines or organizational skillsets to build on or adapt to. You’re just reinventing the wheel every day, and that’s what people in their early adulthood constantly tell me—they are just treading water in the same place that they were ten years ago. And it’s because their ADHD wasn’t diagnosed early enough so they don’t have that way to cope and live their lives in a way that is tailored for their unique brain. Kate Nelson: Wow yes, this is a terrific explanation, and your point about ADHD-related symptoms being dismissed as teenage hormones really stands out. I think that’s something people aren’t talking about enough. Onto a related topic—as someone who was diagnosed late and can relate to much of what your patients have expressed, something that has always been tricky is the prevalence of medication stigma, especially when you haven’t been medicated since childhood. People with ADHD are frequently made to feel like taking a stimulant is cheating in some way, even though their brains don’t produce enough dopamine on their own. What do you tell people who are really resistant to it, who want to be treated but are worried about the side effects of stimulants or becoming dependent? Dr. Sasha Hamdani: Honestly, when patients come to me and they’re having that debate about medication, telling me they don’t really want to, it feels like cheating, it doesn’t feel like it’s right… I don’t give it to them. I say come back when you’re ready for medication because I’m never going to push that otherwise—it’s not my role. If you decide that that’s an avenue that you want to explore, then you need to mentally be in a spot where you feel ready for that. Because if you feel like it’s cheating you’re going to carry a lot of guilt and shame with you about your diagnosis. And when I can tell that you’re ready about medication, it’s because you’ve come to the realization that your brain is just built differently. You can confidently tell yourself, I’m smart, I am able, and there’s no shame in it. It’s like wearing glasses, you don’t think twice about it. And when you’re at that point, then that’s the time to talk about medication because I know that you’re going to be doing the necessary behavioral modification as well. Kate Nelson: It’s super enlightening to hear that from a doctor because the popular narrative is so often that psychiatrists and the pharmaceutical industry are just pushing medication. I love the emphasis on it being a journey because it’s so true, it’s a journey of accepting your diagnosis and it’s a process to find what treatment works for you. I think a lot of people will appreciate that candidness. The next topic I’d love to get into is relationships. A lot of what pops up on my social media feeds in conjunction with ADHD is how to love someone with ADHD or how to have a successful relationship with ADHD, and speaking from personal experience there are times where it’s definitely a challenge. Dr. Sasha Hamdani: Relationships, subjectively, are difficult all the time, right? You’re in this vulnerable position, trying to attach yourself to someone in a healthy way, trying to determine if this person you’re seeing fits into that mold of your life. It’s just a weird process no matter what. That being said, having ADHD makes the process even weirder, because your attachment is very different. People with ADHD are always chasing that dopamine surge, so the initial phase of a relationship, the honeymoon phase, frequently feels amazing. And for a lot of people with ADHD that euphoria can cause the relationship to progress super fast. Suddenly you’re spending all your time with this person and thinking about this person nonstop, you get that hyperfixation. But then when things start to settle and you get into a routine, suddenly your brain says, “oh, this is boring, this isn’t right for me, I don’t want this anymore” and you pull away. In reality, it’s just that dopamine surge that has calmed down. In contrast to how it felt in the beginning stages, your brain thinks something is seriously wrong and your partner isn’t right for you, but usually that isn’t the case. This is why being cognizant of your patterns is really important. Knowing that you attach quickly, and factoring that knowledge into how you approach developing relationships, and being an open communicator with your partner about your ADHD. I know that with my husband he points out all the time when I have this urge to pick a fight simply because I’m feeling understimulated. But he knows me well enough to call me out and say, “hey, I don’t think you’re really that upset about the laundry, this isn’t actually that big of a deal” and I’m like, “Wow, yeah, ok that is unrelated”. What I’ve found is that it generally happens in cycles where things have been going well and I’m stimulated with work and there’s a lot happening on social media, or I’m watching something I’m really enjoying on TV, and then I don’t ruminate about our relationship. But then when things slow down I look for ways to stimulate myself, and it can be hard not to gravitate towards stimulation that might be a little bit unhealthy. So I mean, it’s all about two things: one, understanding your own pattern, and two, communicating those with your partner because if you don’t know what you’re doing, you’re going to continue doing it, and the person who loves you is never going to know how to help you with it, and it can be hard to come back from that. Kate Nelson: I know with my most recent relationship, we both had ADHD and there were a lot of situations I look back on and realize how those things may have contributed to us breaking up. Our symptoms manifested differently, he was always late, I had a lot of emotional dysregulation, and ultimately we were unable to reconcile the challenges. But I took it as a learning experience, like, ok I clearly need to start paying attention to my ADHD in my relationships and be super intentional about communicating my ADHD experience to my partner. Dr. Sasha Hamdani: Right, it’s self-disclosure about the nuances of having the condition that is so important. And it takes a lot of effort and intentionality to explain certain behaviors to your partner. But once you do, it takes a lot of stress off of the relationship. There have been times when I’ve been the one pushing to get lunch with my husband more often, and then I totally forget to show up, and it’s just because I got way too engrossed in another project, and so I can explain the symptom of time-blindness to him and it makes a little more sense and stings a little less. Helping your partner to understand what’s happening neurologically can take a lot of the guilt or blame out of the equation. Kate Nelson: Alright so one more question that everyone is wondering these days—what do you think are the most significant ways the COVID-19 pandemic has affected people with ADHD? Dr. Sasha Hamdani: With the pandemic, honestly I feel like one of the biggest things is the way people have totally immersed themselves in social media. And there are good things and bad things about this, right? Everyone moving online the past two years has prompted the creation of so much great ADHD-centric content, and people are finally talking about it and learning about the condition in a way they never were before. But, of course, nobody should be on their phone for 12 hours a day. It’s very easy as someone with ADHD to be scrolling and you’re getting these hits of dopamine and you’re loving it so you just keep going and going. But real life isn’t structured like that and real-life is boring in comparison to people dancing on your magic screen. For people living with the disorder, it takes that much more effort to separate yourself from the device, and it’s especially hard when we’ve sort of been given this permission during quarantine to spend a lot more time on our phones. But we have to engage in real life in order to succeed and manage our symptoms in a healthy way, and that requires very real structure and routines. And that was harder than ever during the pandemic, so people with ADHD who maybe weren’t as attached to their phones before were seriously impacted. Kate Nelson: With that in mind, do you have any final tips for ADHD management that you find particularly helpful? Dr. Sasha Hamdani: First of all, yoga, definitely. The mindfulness component combined with deep breathing combined with physical movement is my favorite way to calm down my brain. Besides that, I’d say to really pay attention to time and create structure around that. Utilize alarms, build in buffer time between engagements, break down tasks into prioritized chunks—those are the three things that honestly were the most important things to aid my executive dysfunction. And never hesitate to reach out for help, there are tons of physicians who understand how the ADHD brain works and can help you come up with a plan for treatment, with or without medication.
