Transcript of Sasha Hamdani (on ADHD)

Welcome, welcome, welcome to Armchair Expert Experts on Expert. I'm Dan Chepard, and I'm joined by Monica Maus. Hi. Today, we have Sasha Hamdani on. A long time coming. We've been talking about ADHD ad nauseam. I think we've even maybe lost listeners over it. But we finally have brought in an expert to either correct, confirm, who knows? Just explore this topic that we are obsessed with.

That's the fun thing about this show. We get to talk about something that we know very little about and then get real answers.

It is awesome. Sasha is an MD. She's a board-certified psychiatrist specializing in ADHD, RSD, and emotional regulation. Her books include Self Care for People with ADHD, and an upcoming book that comes out in October. Look forward to when people start serving pumpkin spice lattes and dressing in Halloween costumes.

Psl.

Too Sensitive, Rejection, Resilience, and the Science of Feeling deeply. I love this. This is a great episode. Yeah. Please enjoy Sasha Hamdani. This episode of Armchair Expert is presented by Apple TV, the new US Home of Formula One. Starting March seventh, you can watch complete all-access live coverage of every Grand Prix, including practice, qualifying, and sprints all in one place. Watch every race live only on Apple TV.

He's an armchair expert.

I'm nervous to be too optimistic, but we had a microbiome expert on who has a probiotic that actually is real. Okay. I've been on it for, I think, two weeks.

Probably not even. Probably like a week or something.

No, you're right. I was in Detroit and I cheated on Sure. I had gluten and sugar, and I didn't have any rash, and my joints didn't hurt. I'm like, Did it fix my leaky gut in Ms. Oliver?

That fast? Maybe. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know.

I don't know. I don't know. I don't know.

I don't know. I don't know. I don't know.

I don't know. Maybe that with that exclusionary diet?

Yes.

Because I've been gluten for five years because of this.

You have psoriasis growth rate? Yeah.

You do.

Don't you think it's the sexiest autoimmune? Oh, it's so good.

I'm walking around, I'm like, I could feel like it's cold outside. My husband's like, Oh, no.

How long have you had it or been diagnosed with it?

I was diagnosed with psoriasis in fifth grade. Oh, wow. Early. Long time. But it didn't affect my joints until I got out of medical school and I was like, What is this? Why am I elderly? I did my residency in Phoenix, and it was warm and nice, and I didn't really notice things. And then I moved back to Kansas City where it was cold. I was like, Something is wrong with me. It was horrific. And then I was Okay, well, let me just up Pilates or up something else that's going to help me with this.

Must be my fault.

Yeah. Right? I must need to do more. Okay. And then I went. I got the full work up. I also have horrible rashes all over my actual joints. And then they were like, Well. I was like, Okay.

I have to point out we're all wearing blue. That's really nice. We're wearing basically the same outfit, black pants in a blue top.

You also both have the most beautiful skin tone and hair tone. We're the same here. Wow.

Oh, my God. Long lost twins.

You could bridge the divide between Pakistan and India.

That's what I'm doing.

That's what we're here to do.

When we leave here, that'll be solved. But I am curious because you must experience this bit of dissonance, right? Where you've gone to medical school and then things are happening to you, but you're somehow not using the same criteria or it's hard to apply to yourself what you already know, right? It's so hard.

And also I'm a psychiatrist. Anything with the body and like, okay, I forgot about that.

He beats me.

Okay, you're from Santa Barbara. I once lived there. And what part of Santa Barbara did you live in? In Monestado. Monestado. Okay, so what did mom and dad do? You feel guilty, right? We just had a guest who currently lives in Monestado. And he said Santa Barbara, and I said Montecito, and he said, Yeah.

Do you go to that amazing bookstore, Godmothers? Do you know about it?

No.

What? Maybe it's after your time.

You've been gone for a while. I've been gone for a while.

Okay.

It's incredible. I've been gone for like 18 years. I've moved out. It's changed a lot. But my mom still lives there. I was able to come to the podcast, and then we had a sleepover last night. That's why I was hoping. Hoping you got to go to Santa Barbara. There's a huge ice storm in Kansas City. My flight has already been canceled. Oh, no. I'm like, Okay, I guess I'll have to go be in Modestina for a couple of days.

Oh, my God. We'll go to Godmothers. It's very, very cute.

Wait, how do I not?

Where is It's on a really cute street. There's only that one main street.

There's maybe a main street. A parallel to the train tracks.

There's State Street. State Street, right?

It's not there. It's on Lily Avenue.

Lily.

It's on Lily?

Ding, ding, ding.

I know.

Lily. It's her middle name. I know. It's as close as Summerland Beach.

That doesn't count. It doesn't. That's not Monte Cido.

I think it is because we went to lunch in Monte Cido, and it was 10 minutes away or nine.

Ten minutes away. It could be Carpenteria.

Oh, wow, you guys. It could be Santa Barbara. You guys are...

Monte Cido is like- 3 blocks long. Yeah, it's like 14 blocks.

You guys are so picky.

We lived there, I think is what it is.

I guess so. I guess so.

I think I know.

Okay, that's fine. Drive the 10 minutes.

We'll see.

What did mom and dad do in Santa Barbara?

It's a funny story because my mom and dad got married, and they were from Pakistan. My dad applies all over the US for a job. Doesn't get anywhere. The first job that gave him an opening as an engineer was in Santa Barbara. He's like, sweet. So we go there. My mom's in training because she is a pediatrician, so she's still going through a residency. And then I came out. And then we just lived and grew up there. You didn't grow up there? No. It's a weird vortex.

It was weird when I got there from Detroit. I was like, this is a very weird- It's a weird microcosm. Please pinpoint the things that you thought were weird because I have my own specific.

So growing up there, it is this weird mix of people That have been there for a million generations and are just trickled down, and they're on level 1,000 of their trust fund. They're not really- Engaged? Yes, and humanity. No concept of work or motivation. So some people in my high school, currently, right now, they have the same jobs that they had in high school, but they're just working until their parent dies and then they can move upstairs.

I'm delighted that We have the same observation because I got there and I started meeting. I remember I met this girl at a coffee shop, and she was shooting math, and she was also very interesting and pretty. And I went to her house, and it was this very nice house in Monacito. And there were other children of rich kids that were just completely neglected. There's this whole cadre of rich, neglected kids there that I thought was so freaky and weird.

It's weird.

I'm so curious. How old you are?

I'm 39. I can cut it out.

Okay, 39.

We're very close in age.

Yeah, very, very close.

We're the same. Basically the same, but I am 38. I'm sorry.

Don't ask me about it.

You have to be honest. I have to be honest. You're committed to being honest. I am. You've had a very similar trajectory in that you two were trying to very much hide from your culture.

I happen to know this from a host of yours.

I had purple contacts for a while because I thought that was just blending in beautifully.

I wanted them.

You had the violet ones, the color blends.

Yes, I wanted them.

The irony, you guys are both such babes. It's incredible that you would be trying to become- You're going through that in your formative years, and you're already feeling othered.

Yes. So you really do whatever. When I'm saying othered, I mean from a physical... In ninth grade, I show up to public school coming from private school, so I didn't really know anybody. I have my violet contacts. I have headgear during the day.

Oh, boy. Not even nocturnal. We could have taken a fucking break for six hours.

Oh, I did. Two periods into that school, I was like, this goes.

You're a survivor if you went to high school No, you can't.

You don't make it out.

You don't make it out. I was like, wrong. Let me deal with the palate issues and the overbite. I'll deal with it. Yeah. At a different time.

Yeah, that's right.

Okay, but you're a Wunderkind, and you get diagnosed with ADHD at nine years old, which that's the beginning of these diagnosis. Yeah, maybe the uptick in these. That's early.

Well, it depends.

Where you're at, probably.

Also, gender. For boys, typical age of diagnosis is between five and seven. For women, do you know what it is? Never. 40. 35 Thirty-five years old. Thirty-five. Yeah. Yeah. Dangered age. Usually, if they've had their own kids, they're like, This is weird. They go to the doctor, the kid gets diagnosed, and then the mom gets diagnosed. Interesting.

Okay, so you do get a diagnosis, and then that's immediately helpful, yeah, in that you get medication that starts working?

Yes. I'm hesitating because it's a weird story. Okay, great. Tell us. Okay, so, fourth grade, I was pretty boisterous as a kid. Substance teacher comes along. I created an insurrection in the classroom. I got everyone to stand up on their start chanting it. And that's horrifying. I have kids. I can't imagine treating a teacher or a substitute teacher like that ever. But I was just the person who did that. Within an hour of that happening, the substitute teacher calls my teacher. My teacher calls from a doctor's appointment. She calls my parents and she's like, Do something. And so then my parents got me. My mom was a pediatrician, so I got in with a physician. I got diagnosed, and I got treated. But it was so stigmatized at that time. They didn't tell me my diagnosis. Oh, interesting. That's why I feel like I was diagnosed twice because I was on medication. Hugely helpful. My parents were like, Okay, take this vitamin. I was like, Whoa, this vitamin is working so much.

Beats the shit out of Flintstones. Well, I took those, too.

I love those.

They were so chalky and disgusting.

Yeah, but I know. They're terrible. But it's so nostalgic.

I could sit through class. I could pay attention. I wasn't getting in trouble. School wasn't painful for me. It was never hard for me I was so bored. I was like, I can't sit here and do this. So it became very manageable. And that propelled me through this stupid vitamin. And then I did well enough throughout my schooling through high school that I got into a combined undergraduate program. So I started medical school at 18.

So it got condensed to a six-year program, right? Yeah. At University of Missouri, Kansas City? Yes.

Also, my dad went there.

He did? You shut up right now.

Yes, he did. Was he really? A show I did before he went to tech. Something spooky is happening.

Ashoka's in the mix here. Really? Yeah. His sim is in the mix right now. Oh, the sim.

Okay. He's very proud of us.

Yeah, he is.

So I went there, and that was the first That was the first time I had been away from my parents. That was the first time I had been by myself. I'm like, There's so much stuff and freedom and also laundry and all of this other stuff that I've never had to worry about because my mom would do it. I don't know how to feed myself. No.

Oh, sorry. How dare you.

Your mom waited on you hand and foot.

I did my laundry starting from age eight.

Okay. My mom tried.

Could you scream, make me a milkshake from the bottom of the stairs and she would make you one?

No, that's nowadays. Now, you're thinking of the wrong story. I was making a milkshake in basically the middle of the night. Okay. She was calling from her room like, Stop. There was a blender going and everyone was asleep. She She was like, What are you doing? I'm like, I'm making a milkjag. So I was making it. Okay.

She also- So you have some things- Sorry.

I probably could yell. My mom would be like, Yeah. Amazing. She did try to instill skills, and I just was uninterested. In high school, I was playing sports, and I was doing all this other stuff. If you had told me, your laundry is not going to get done, I'd be like, Okay, I'll just wear my park at a school. It's fine. I don't care about that stuff. I still I don't care about that stuff. There was a lot going on. I went from being one of the smart kids in my school to all of a sudden being quite literally the bottom of my class. When I realized something was wrong, and I brought it up to my parents, is I did this neuro test. So neuroanatomy. They stayed up, really tried to focus, and I was like, I know this brain inside out. It was really interesting to me, and it was visual. I was like, I got this. This is so easy. Going to the test, I'm like, This is amazing. I'm getting all of them. This is perfect. I'm the first one out of that test. Then they had this thing where they would post your grades with your ID number.

The next day, I'm showing up. I'm still looking for my ID number. You're looking at all of these grades, and you're like, 90, 80, whatever. I was like, There is some loser who got a 32. I was like, That's me.

What happened? What? Yeah. What a disconnect.

I didn't flip over the test.

Oh, you just did half of the test.

I got 100%. I didn't flip it over.

Okay, you think the perf...

Oh, you would think. I went and I was like, Please, this is going to break my self-esteem. And I was like, I'll be on the other side of the room. You can give it to me orally. Just read me the questions. I will tell you the answers. The guy was like, You're either going to learn from this or you're not. And I was like, Okay, well, I guess I'm not. So I remember telling my parents, they're like, well, are you taking your vitamin? I was like, respectfully, I don't even know where that is.

I don't know what you're talking about. And you still thought it was a vitamin and you're in college.

Straight up thought it was a vitamin.

Okay, so I have a little I have a little beef with your parents. Me too. This is an ongoing beef. You also could have been told at nine years old that this notion that there's all these things we can't tell kids is so silly. I don't understand why.

It was a different time, though.

So maybe- It was terribly different. I mean, you guys were pretty young.

No, no, no. Even when My brother was little, which is eight years below me. Add was if you have that, you're problematic.

Sure, but there's no reason that the child couldn't understand that they have ADHD and explain what limitations and what other things are going to be coming their way so they have an expectation and some tolerance. They can understand that.

I think that could have happened. But I also think, I don't have thought about this a ton since I'm a parent now. How would I have handled that differently? In that time, it was so stigmatized. There was a kid who had ADHD a couple of grades above me in that private school. That kid got expelled for putting fireworks in a toilet. They were like, This kid is nothing. He's broke. He's bad. We don't know what to do with him. He can't be at school anymore. All the room parents were talking about it. I was just very highly aware of this. Then I was also the only brown kid in this sea of white children. I already felt weird. I think my parents probably were doing at that point what they thought was the best. They were trying to intervene.

They think they're protecting you.

Yes.

But I don't think lack of information is ever protection, personally.

You're not wrong. They redeemed themselves big because I'll tell you what they did that was correct. So after that, I'm like, Yeah, I don't know where my This vitamin is.

Next topic.

Yeah. They're like, Okay, heads up. This vitamin is actually ADHD medication. You have ADHD. I was like, No, I don't. I've been medicated against my will. I feel really angry about this. Deceived? Yes. I was like, Let's just start over. So then I really tried to apply myself in school. I would wake up at 5: 30 in the morning. I would start studying. I would study for 12 hours a day. I'd be so into it that I would get into periods where I was like, I should probably go eat. I was like, no, I got to finish this chapter. I was just trashing my body to get those results. And I took another exam, and after my best efforts, I still got a 60 %. Why? Because I was so tired the day before the test and so run down that I was foggy and I couldn't think at that time. And I was like, Previously, when I was on this vitamin, I never had those problems. I don't understand what's happening. And so then my dad was like, Listen, you might not make it through medical school. Just come home. Who cares? Let's learn about your brain.

He brings me back to California, and we go to a library, straight up old-school library, pulling out textbooks. Both of us were just sitting on the floor. He is reading textbooks about ADHD, and he's like, This sounds like you. I'm like, That does sound like me. And so we learned so much, and I thought it was handled in such a curious and open way. Him and my mom both were like, We wish that we had that verbiage to tell you. We didn't know. And And you were under our care for so long. We didn't know what a fracturing there would be when you left and you were out of that environment. So then truly, I had to scrape and clog to get out of that hole. But eventually, I tried a bunch of different medications, and some of them wouldn't Let me eat. And some of them wouldn't let me eat, and some wouldn't let me sleep. There were some that were a disaster. But then it was a combination of finding a good medication and finding the right therapeutic things. And I don't think I truly figured it out until I got into residency.

So after med school, I was just surrounded by psychiatrists and therapists. I was like, This is my happy place. This is great. Because med school, it was so hard. The whole entirety of med school, it was all of my attendings. I don't know whether I was already pegged as a problem, but I had an episode where there was an attending who came to my office. I didn't do very well on a test, and he had been rough on me the whole time. But he's like, Don't worry about it. You know what we're going to do? And we had these little cubicle offices. And he just brings a box of them, and he starts packing up my office. And he's like, You could just go You came here for a reason. Maybe you'll meet your husband here. And I was like, Oh, wow.

Oh, my God.

I was so... Especially now as a mom of a girl, I was like, If anyone spoke to my girl like that, I would be feral. In that moment, you're so embarrassed and you're so confused. Why is someone who's supposed to be helping me through my educational steps doing this? You just don't do anything. And so I just carried that. But then I feel like residency just reversed all of that because I felt traumatized in med school. And then in residency, all those pieces got rebuilt. They were like, This is what you're good at. Lead with that, and then we'll work on the back end.

Okay, so you have become specialized in ADHD.

I'm taking off my shoes. Oh, please.

Yeah, do it.

You can dump the socks, too. Whatever you want.

No one's ready for that. Okay.

I would love to know the historical understanding of ADHD as a condition. I'd love to start with when maybe first enters the DSM, or when does it appear, and what did we think it was then, and how would we now define it today?

The problem with that is it has had such an evolving course, and it has had so many different names. When it was first noticed, it was in the 1700s, we had a patient who was extremely restless. That's what we're describing now as fidgeting or a sign of that physical impulsivity. Then as it moved on, it got the name a hyperkinetic condition. That was an interesting segue because it really dialed down on the hyperactive component. Then as we progressed, we didn't get into formal ADD territory, which it's not called anymore, until the '80s, I believe.

That's when I was introduced to this concept. It was ADD.

Add, yeah. That's what I was diagnosed with initially. That came later. Then just recently in the DSM-5, I got beef with the DSM-5, by the way.

There's a lot of beef to be had with the DSM in general.

Now what our standard diagnosis is, is ADHD is attention deficit hyperactivity disorder. It's broken into three subtypes. If you have ADHD, it's always called ADHD, but you can have the inattentive presentation, you can have the hyperactive presentation, or you can have the combined type, which is a combination of both. A huge problem is people sometimes are like, I can't have ADHD because I'm not hyperactive. Because it's in the name.

Yeah, I don't like that.

It's too wide of an umbrella, we would say, maybe.

It's too wide, but it's also too narrow. It focuses so, so, so stringently on just the focus components, and it It doesn't touch at all on other areas of regulation. Because I think ADHD at its base, it's a dopamine dysregulation error. You have dopamine dysregulation when it comes to attention. You have dopamine dysregulation when it comes to impulsivity. You have dopamine dysregulation with sleep, with appetite, with emotions. All of that is so huge, but we never really touch on it. With the emotional side of things, in particular, if we don't change that with ADHD, this is why people are going to get misdiagnosed with anxiety and depression for a million, billion years.

Yeah. I guess currently, though, it is diagnosed through symptoms. You're reporting symptoms. It fulfills enough criteria, we would say you have it. My curiosity is, are we approaching or do you believe We'll get to a point where there will be different diagnostic tools, DNA markers, where we'll go, Oh, we see this clumping of this here. Would it be fMRI, brain scan, where we would see something that would let us know? Is there going to be a where we can read the actual percentages of neurotransmitters and say, Oh, you have this exact cocktail that ends up to this? Are we approaching any diagnostic tool that's not just symptom-related?

No.

Okay.

Let me tell you why on all of those fronts, I think about that all the time. If there was something tangible we could grab onto and check a level of something, that would be amazing. So with the levels of dopamine, dopamine, serotonin, you can usually check those. There are a lot of things floating around with a urine test where you pee, and then they check your levels. The reason why those are incredibly unreliable is because sometimes it's not truly that you don't have enough dopamine. It's just not present in the spot where you need it to be at the right time. It's a dysregulation.

So what happens if I come to you and I'm like, Okay, I think I have it. What do you ask?

So there's a couple of things. The thing that makes a good ADHD diagnostic interview is that not only are you checking for symptoms, but you are simultaneously ruling out other things. I think that's what makes it such a complicated thing to do. Because I have patients who have come in and they're like, I went online for an assessment and it says I definitely have it. I'm like, What? And I understand the thing about ADHD that I know because I have it. When you are right in the middle of trying to navigate a brain that feels so overly chaotic for you, you are willing to point yourself in any direction to fix it. Yes, that's right.

You're desperate.

That population is a vulnerable population because they are the people desperate to want help. I understand why people are taking tests online. It's just not a super valid test because it's capturing you in a very subjective manner. It's not giving good timelines. It's not rolling out any other things. It's giving this very skewed thing. With ADHD, when you're looking at the criteria, you're screening for both the inattentive symptoms, the hyperactive symptoms, and then obviously, you'll get if it's combined from both those. You want to check timeline, see if these symptoms symptoms presented before 12. When you're assessing for an adult, that can get tricky because if you're asking them to recall retroactive data, that's hard. A lot of people don't remember, and a lot of people have spent so much time during their childhood where their parents have masked, covered up, fixed symptomology that it's hard to assess. So that's difficult. You have to really dig back to get good criteria. And then when you're asking questions, for example, with the inintentiveness, you're asking, is it hard to stay engaged with the task? Do you feel like it's difficulty to organize things? Do you feel like you get distracted halfway through the conversation?

You're asking things about focus and focus-adjacent topics, but you also have to ask, is this present during a depressive episode? Is this present when there's substances involved? Did you notice this before or after you got on thyroid medications? You're asking all of these things while you're doing a simultaneous screening for other things. So it becomes It's pretty complicated. It's so dynamic. You're doing a comprehensive medical rule out. It's confusing from a psychiatric perspective. Like, is this bipolar? Is this ADHD? Is this depression? Is this anxiety? Is this trauma? They're all things that overlap really beautifully and can mimic it. So you need to be able to pull from the diagnosis what the patient is saying, ask the right questions to get to where you're going. I'll tell you, a lot of people come to me A hundred % dead side, I have ADHD. And by the time we're done with the interview, it's like, no, you didn't. I mean, this was trauma. This is what was causing it. And so it takes someone who's been trained to be able to discern that.

Over a protracted period of time as well, I would imagine. This isn't something you're doing in five minutes. You really need to learn quite a bit before you're there. You do need to learn a lot. And then we probably get into the other issue, which is I'm sure it is a spectrum condition. So what do we say that 79 % of these symptoms equals it or 71 % or whatever? When is it a disorder? When are you one deviation below a disorder? You could still be suffering a lot of the symptoms before you're chronically in this. Formally in this. Yeah, formally or pathologically in this condition. And it doesn't mean that's irrelevant that you're just a step before it. So my great curiosity is, so what are the inattentive symptoms? I also want to talk about how it manifestsests differently in men and women and boys and girls. To your point, my hunch is the DSM was originally just assembled with the boy symptoms. Correct. I imagine they really present differently in males and females. So how do they? And what are those symptoms?

So with inattentive, you're looking at difficulty with starting a task, staying engaged in a task, completing tasks, having difficulty with disorganization. You're looking at issues with executive function, the skills that are required for processing and getting a goal done, goal-oriented behaviors done. Those are more the inattentive symptomology. Hyperactive, you're thinking more like physical and verbal impulsivity. These are the kids and adults who have difficulty staying in their chair. They're constantly fidgeting. They're blurting out things. They're- Interrupting. Interrupting.

Also, we should say Dax is looking for a diagnosis by the end of it.

Can I just tell you one second how I got interested? You must know Gabar Mate. Yeah. I'm walking him to his car, and he says to me, Have you ever been diagnosed with ADHD? And I just went, that's a weird thing for him to say, and he's an expert on it. So I just went like, That's really interesting. He said that. And then I, too, my algorithm became like everyone else's. And I start seeing these different things. I interview a friend who's been diagnosed since he was a kid, and he tells me that ADHD folks have an outsized sense of justice. And I'm like, if that, in fact, is one, I definitely suffer. So I'm just not oblivious to a lot of these things do sound a lot like me.

Here's the deal. I am not going to diagnose you. I don't want you to.

I'm not. I'm actually not looking for that. I don't care if I do or I don't have it. Well, you should.

I think that there is nothing more liberating than understanding your brain. You deserve to have a good diagnosis and to know how your brain works. When I went from not knowing what was going on, and then I sat with my dad, and then we actually went back to a physician and he explained, these are the things that are going on in your brain, and this is why you might have difficulty with this. I gave myself so much, number one, grace about things that I beat myself up about for years and years.

Right. The self-flagellation, which is, again, as I understand, one of the conditions.

Emotional regulation needs to be as part of that. For example, so my dad passed last year in April of 2020.

I'm sorry.

We found out he had lung cancer. We found out he had this spot, and they were like, It's annoying, but we'll get it treated, whatever. So we go, we get it treated. He goes through the chemo, he goes through the radiation. He calls me one day, and he's like, I just don't feel great. So I abort a flight. I go over, I'm like, You look awful. I He take him to the hospital. Everyone's like, No, we can't do a PET scan. It's too soon. I was like, Do it. We don't care if insurance doesn't cover it. Something's wrong. It was everywhere, and he died 13 days later. What?

Thirteen days.

Oh, my God.

Thirteen days. But what I noticed, I think this is probably why I feel so passionately about the emotional regulation part, is that the colliding of grief and ADHD was so destabilizing for me. It was like my brain exploded. The brain fog was so... And grief, horrific for everybody. But I think for someone with ADHD who's experiencing that emotional dysregulation already, I had no idea how I was ever going to get through coping with those big emotions. I was like, This is too much for my brain. I can't parent. I can't get through a workday and see these patients without just losing it. So when I was going through all of that, and I had a really tough time with that, because I knew I had ADHD, it was hard because I was like, This is tremendous. I felt like I was completely broken down and starting from scratch. I was like, because I know how my brain works, I need to create systems that are very low lift for me right now and find a way to rebuild that way. If I didn't have a diagnosis or an understanding of my brain, like this actually makes sense to me, or this is what I believe is going on, I think I would have just kept trying to do what everyone else told me to do, which didn't work.

Yeah.

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I'll tell you, after he passed, I don't drink. I don't really do anything super interesting. I was just like, my brain is so loud. I wanted to be quiet right now.

Yeah. It's in the middle of it.

I wanted to be quiet. And I was just like, what can I do? I knew at that point It was my emotional regulation, and I was looking for a way to medicate this.

Yes. You needed relief.

Yeah. And I was like, that isn't something that I can medicate. My brain is having a really hard time with things that are really big. And so I need to find safety to get through these moments. And my husband, his mom passed because of brain cancer years before. So he was really well first and supported all of us through it. He saw what I needed and helped me through that moment. But I think if I didn't know about ADHD, I would have ended up in a really weird spot. Yeah. Yeah.

I believe that. That makes a lot of sense. Okay, now back to the male/female differences. And my hunch was that the original criteria was probably just addressing the boy issues. And you thought You agreed. So how did they express differently?

Going back to boys getting diagnosed way earlier than females. Typically, boys present with more of the hyperactive symptomology. So they're the ones who are causing problems in the classroom. They are disruptive. They're getting up in the class. They're Are you bothering others.

Which is probably why you got diagnosed early because you were behaving like that. Because of the coup.

Oh, your boy. Yeah. Absolutely. I think about that a lot, and I'm like, I'm actually pretty grateful for that presentation because it got picked up. But girls, on the other hand, are mostly inattentive. They're like the daydreamers that are spacing out in class and they're doodling. Those girls are pleasures to have in class. They're not bothering anybody. They're getting passed along. And then what happens is as the external pressures rise. As they're doing harder things, as they're doing more adult things, like getting into relationships or starting families, your needs exponentially increase and what is demanded of you increases, and you just aren't able to cope anymore. Then it feels very much like a breaking point. Two other reasons that people assign female at birth don't get diagnosed. Number one is the hormonal part of all of this. When women are going through hormonal shifts, when your estrogen is dropping, your dopamine drops also, your symptoms get worse. Now, these women or girls who are going through their first periods or things like that, their ADHD symptoms are 10 out of 10. Horrible. They're going through all of these attentional issues. They're also going through emotional dysregulation because they're like, What do I do?

My dopamine is all off. And that's when they're like, She's bitchy because of her period. Right.

Are you on your period? Well, yeah, I saw a post of yours that was like 30% PMS symptoms for ADHD girls versus 10% for the general pop.

It's significant. Wait, really?

You feel it 30% more? Is that what you're saying?

It's more common. Pmdd is significantly more common in the ADHD population. It sucks because you're in a situation where you're like, Okay, well, my mood is already garbage around that time before my period, but now I can't focus and I can't do the things I want to do. And it's even harder for me to emotionally deal with it. That doesn't seem fair. Yes, exactly. So That's another huge one. And then the last one is quite literally just... I'm not trying to get political here, or it's not even political, but there is a societal difference in expectations for females. So females are expected to toe the line and mask. So what is acceptable for a boy to be doing in class is very unacceptable for a girl. So the girl now learns to hide that behavior. But then what happens is that this high-achieving, very capable student or child When a child goes through life. They are now getting applauded for masking their stuff. And so when at times it becomes overwhelming and they can't, people are like, What's wrong with you? Why are you so emotional? What's happening? Why are things falling apart? Why are you breaking down at work?

It feels like such a huge shift in their baseline functioning. But really, they're just busting their ass trying to feel and look normal.

Yeah.

Okay, I want to ask if these The things I've heard anecdotally around the digital campfire are, in fact, people ADHD over indexing. So there's a rejection.

Sensitive dysphoria?

Yeah. Tell me about that.

I would love to tell you about that. So I've become obsessed with that. Since my dad was sick, I mean, I was just like, what's happening? Why am I so sensitive to certain things? So rejection sensitive dysphoria is the very, very real emotional, sometimes physical pain that comes from real or perceived rejection or criticism. So someone criticizes you or rejects you or you think that that's happening. And all of a sudden, you can't stop thinking about it. You're beating yourself up about it. No one likes getting rejected. That's not it. I have told my husband, it is like someone sucked the air out of my lungs. It feels that significant to me. Rejection sensitive dysforia. I think it's so important to recognize and to know about because it's so hard for the person who's experiencing It's also so hard for the people around that person. Oh, yeah. The relationship- That's the tiptoe around them. Oh, my God. So when my husband and I get into fights, I'm so sensitive that if I know we're beefing with each other, he'll look at me and I will just start crying, and then I will chase him around the house, and I'm like, And another thing, and another thing.

He's like, Show out. Because I feel this urgency that I have to resolve this so that this feeling goes away.

This is the email, right? Yes.

So what we do, I'm not an effective communicator when I'm in that state. I'm emotional, and I'm angry, and I'm scared, and I'm sad, and all of the things all at once, and it's too much right in that moment. So what I do is I literally write an email, and I draft it, and I draft it. It usually take three or four passes because I'm like, That's not what I wanted to say. So already by the end of it, I've come down pretty significantly.

You've regulated a bit.

Yeah, because I've had this safe place, the safety of my laptop. I'm like, This is my happy place. I can write this down, and I could take as many tries as I I want to make it sound the way I want. Then I send it off to him. We have a whole folder of this. Usually, I'll send him a text message. I'm like, I sent you something. He'll read it, and then he will think about it and process it. Usually, by that time, I'm like, I'm going to just go somewhere else. I'll go sit in my closet, or I'll go sit in the car, or I'll go and hang out with the kids. I don't want to be around him because I'm looking for as he's reading it what his face is doing. And so then what he'll do is he'll respond to it, and he'll make pizza rolls. And then he'll put it out. And then we'll have a fun snack, and we'll talk about it, and then we'll be done. And it's the best system we've ever had.

I loved reading that because I guess me knee jerk, this exists in my relationship. And my knee jerk is, we are good enough communicators, and we are smart enough, and we've all done enough work that we can sit down and talk about this. That's where I come from. It feels like a failure that we would have to be texting each other or emailing. But then hearing you say that, I was like, I also must admit it does go smoother if those couple steps happen before we confront something verbally. I'm happy to be relieved of the shame of us failing and being great at talking immediately, I guess.

I don't know how people do talk immediately.

Whether it's ADHD or not, I think time is important.

Time and giving yourself that space to regulate before you come into and try to resolve the situation, because otherwise, this is so messed up. But I think I'm realizing now that if I come off of an argument and I want to address it right away, I want to show him how hurt I feel and how badly that hurt. It's not about resolving it.

Exactly.

It's about wallowing in it. Then I get angrier and madder.

I mean, it's pause when agitated. It's the whole thing. Yeah.

How about this inflated sense of justice or this inflated discomfort within justice?

It's not a clinical term. You see it a lot in autism as well. But it has to do with rigidity, being very rigid and having a set expectation in your brain and then having it not not come to fruition in the way that you planned. I think that's where it stems from. And so they're looking at a huge gamut of presentations of ADHD. So there's some people who in order to maintain their ADHD, they have become very rigid about things. They have built these structures for themselves where it's like, this is how it has to be because this is how I can function.

That's where I can have compassion for it is you're very easily dysregulated. You somehow learn this about yourself, whether you're conscious of it or not. And yes, the more things that you can map out and plan out and control, the less chance you'll have at dysregulation. So I'm sympathetic to it. My thing is like the airport. All my character defects come out at the airport because I'm being asked to cooperate with the TSA to do things that I think are illogical or make no sense. I'm powerless. People are taking photos of us. I don't like that. They might be taking pictures of my kids. This big storm of things. And I do a pretty effective job of controlling my day normally. And so, yes, I have learned that before we leave to the airport for the best outcome, I have to have that expectation. That helps me enormously to just go like, Okay, we're going to get there, and some guy is going to tell you to hold your pants up and also hold your hands over your head at the same time, which you know is impossible. People are going to take pictures. They're curious.

Get over that. But if I walk in ill-prepared or unprepared for what's going to happen, that's when some massive dysregulation happens pretty quickly.

Yeah. We're all trying to by. There are some brains that are just more sensitive to these things than others.

Do you ever spend any of your time or focus thinking about the evolutionary aspect of it? I do wonder if this would even be a condition without the incredible amount of stimulation. What do you think about that?

There's been some thought about if we're looking at ADHD, just from evolutionary perspective, and we're looking at hunters versus gatherers. The ADHD people are the people who are going off in their hunting, and they're doing these things that involve risk and adaptation and impulsivity to some degree.

Novelty seeking.

Yeah, and they're great at that. Now we're putting that same group of people that would thrive in that environment in a new environment. I don't necessarily think it is... Well, maybe it is due to all the stimulation, but I think it is just society adapts and evolves based on what its needs are. The needs are there is just a much larger neurotypical population. But the world is built for a neurotypical... Now, you're expecting this population of people whose brains are wired differently to occupy space in a world that just wasn't built for them. A really easy example of that is for ADHD, a lot of people have delayed melatonin onset. Their brains don't feel a normal, I feel sleepy at 10: 00, and then I'm going to wake up at 7: 00. Theirs are like, I want to go to sleep at 1: 00, and I would love to wake up at 10: 00 AM. But that's not where society runs. You've missed three hours meetings already. Yeah.

You're right. There was a lot of different outlets for a lot of different types of brains before, but we have really homogenized the work experience, which is you go to a box, you sit in a chair, you do this thing. There's not like, oh, yeah, why don't you go explore over that other peak? We'll weave the baskets. We're more apt to sit here and weave these baskets. Everyone has a bit of an outlet. Now it's like, no, no, everyone's supposed to wake up at 6: 00. Everyone's supposed to do this and that. So you had funneling us all into the same thing. There's There's going to be a lot of tension there.

I think it's tough because you are expecting people as you're growing up to function and learn skills in an environment that's not built for them. So you're already starting off at a deficit. Then you hit adulthood and they're like, Okay, fend for yourself. You haven't really had time to build good skills unless you've actually really dialed down, understood ADHD, learn how to make accommodations for yourself. It's like you're going through this environment that you never really figured out with schooling, you never really grabbed hold of it, and then now you're an adult and you have to figure out what to do with it, but you don't have any of those foundational skillsets.

What do you think about the fact that so many people, especially from social media and stuff, are self-diagnosing? I have a problem with that. This comes up a lot on the show. That's partly why we were so excited to have you. But I think it's a problem that so many people are walking around saying, I have ADHD, when they don't know if they have it or they think they have it based on what they've seen. Because for me, I'm like, well, what about the people who really have it? To me, that takes away from it is something happening in your brain.

A neurodevelopmental condition.

Right. What are your thoughts on that?

So I have a hot take on that. And my hot take is that I think self diagnosis is actually good to a point. And the reason for that, and I'll tell you what the point is, too. I think that it is incredibly valid to have someone learn about what is happening in their brain, find things out on social media or in books or in literature or research that looks like them, and grab hold of that and start learning verbiage of how to describe their own internal environment. I think that's a wonderful thing, and I think that that can be a wonderful stepping stone to accessing care. I know that's not an accessible step for a lot of people, but that next step. I have problems with it when it moves from self-diagnosis to the medication standpoint. That's really where I start to draw the line, because when you start trying to treat yourself, you haven't done the exclusionary thing to figure out what else is going on. And medications of any type, they're not without risk. You're doing things that could potentially impact other things in big ways. So if you think you have ADHD and you want to learn behavioral strategies that help an ADHD brain, go for it, man.

My hunch, Monica, is that your issue is much more the person who says, I have ADHD so deal with this.

Using it as an excuse. I don't think you would ever have a problem with someone going, I think I have ADHD, so, wow, I should explore these tools that have been shown to work really well with ADHD. Let me try them. Great. These are helping. I think your fear is probably more like, I claimed I'm this, and you have to lower your expectations of me now.

Yeah, exactly. Obviously, if someone's like, Oh, I think I have it, I'm going to do research and learn about it and figure out how to help myself. That's amazing. That's what I would want for everyone. But that, to me, is not what's happening. I think people are saying, I have it, and so I'm late.

I think the reason I don't have an issue with it is I come from a background where alcohol is self-diagnosed. That is the full premise. No one can tell you're an alcoholic. You have to tell yourself you're an alcoholic. Then you have these steps at your disposal if you want to try this. No one's declaring, I'm an alcoholic, so deal with the fact I didn't come to work. For me, the association with the self diagnosis is very positive.

I think you're right. If you're using ADHD as an excuse, and if you're saying, I can't do this, and you don't have a formal diagnosis for someone who does have ADHD, that can be extremely irritating. I've been guilty of that, where people have said that, and I'm like, You don't know what it's like. You can't possibly know like I do. At the end of the day, I have no way of knowing that. I have no way of knowing what's going on in their brain. What they're feeling. Yeah, you don't know. What their dysfunction is. I don't know. I've tried to peel that back and figure out and look at why is this bothering me so much. But using self-diagnosis as a tool to get steps to get a formal diagnosis or get more access to knowledge about things and research about things so you can learn about your internal environment, I think that there is a huge space for lived experience and talking about that.

Yeah. You're here, someone will be like, I am ADHD. I have time, blindness. Don't ever expect me to be on time.

Yeah, and that happens. And it's like, guys, I don't want to be on time either.

But I think it should be more like, I have ADHD. I think I relate to this time-blindness thing. What are the three best tools? Yes. Because I know I do have to be on time places.

We all have stuff, and we have to figure out how to live in this world. We're not islands.

That's why I'm going to just quickly say neurotypical is bullshit as well. It's the same reason the DSM is fucked up, because it has some premise of normal, which simply doesn't exist. There might be eight people who don't have something going on.

There's zero people.

We're all variable.

I think the neurodivergent terminology, it was It was like a psychological term that came out in the '90s. It was really this umbrella term to talk about autism and ADHD and all these other things. The neurotypical was just like a byproduct. What's the opposite of this? Yeah, DSM has problems.

Yeah. How do stimulants work? Why is that an effective medication?

This is a weird area of medicine because it's not this cut and dried mechanism. Basically, where a majority of that deficit happens is that frontal lobe, so directly underneath your forehead. That's where all that executive function judgment processing happens. What a stimulant does from just a very rudimentary perspective, if your brain has a million different things going on, a million different times because of that underlying dopamine and norepinephrine dysregulation. Everything is just floating by in an incredible space. You can take a stimulant, a Ritalin derivative, something in that family, and it actually works a little bit counterintuitively because it slows things down. Really, it's not that it's slowing things down. It just speeds everything up to match what's going on with your brain.

It like, synchronizes it almost. Yeah, it is very counterintuitive. I very much feel like I would benefit, but I also know I can't be on that.

Oh, my God. There's so many better things.

Than being on a stimulant. Yeah.

Oh, tell me. Okay, so here's the deal. If you're trading ADHD, you could do it behaviorally or you could do it medicinally, right? And with medicine for ADHD, there are stimulants and there are non-stimulants. And so the stimulants are what everyone thinks of. And they're our gold standard right now because they work well, they work reliably. And you could tell pretty quickly, is this going to work or is this not going to work? Those are things like Adderall derivatives, Ritalin derivatives. Those are all part of that class. But for a lot of people with ADHD, stimulants, even the long-acting ones, they'll give you a 6-8 hour coverage. But ADHD exists outside of that 6-8 hours. Then it's like, what are we doing for the rest of that? So non-stimulants, a lot of them give you a 24-hour coverage. For the great majority, they either fall under the category of an antidepressant or a blood pressure medication or some other class Yes. Interesting. You are getting additional benefits. For those people who have ADHD who are also anxious, here's a medication that's going to help with ADHD. Like a beta blocker? Well, it is a blood pressure medication.

There's long-acting formulations of blood pressure medications that can help with anxiety and ADHD. Or you're doing an antidepressant, which is going to help with depression and anxiety and ADHD. Or you can do something long acting that people take for shift work disorder. So it really depends on what you need and what you're looking for and what else is happening at the same time? But for a lot of people, when they're coming to the doctor, they're assuming, If I have ADHD, I need to be on a stimulant. I need to be on 5-Ants. I need to be on Adderall. I need to be on Ritalin. And 90% of the time, That's not the direction we're starting at. Because I always tell people, We need to build skills, so we need to work on that. If that's not possible because your ADHD is dysregulating everything, we need to give a medication that's going to give 24 hours coverage as much as possible so that you have a chance to see and build. There's some people who just that diagnosis immediately lifts them. It gives them the permission to study and make changes and do those things that they don't need to be on medication.

So it's not like an absolute, you have to be on medication to treat your ADHD. But there are a lot of people that in order to build and cement those habits, they need to be on medication. And that's also incredibly valid. It just depends on how your brain is wired.

You're In your first book, Self Care for People with ADHD, you have over 100 tips. It's fast moving. It's for an ADHD brain to read this book.

Just little page long blips. I could tell you my favorite one in that book, and it's Do A Headstand. That's not the one that's It's not going to work the best or anything. It's just the weirdest one. But there is something about that change. One, you're doing something weird. How I figured this out is when I was in medical school, I was studying for organic chemistry. It was just so boring to me. I was like, I can't do this anymore. My mom would be like, Just do something to change your position or just do something to distract yourself a little bit. And it was that inversion of a headspace. That's hilarious. Not necessarily the most impactful, but that's one. If you're bored and in the middle of stuff. Another one, I think that is important. So the book is broken up into separate areas, and it breaks it down in terms of emotional self-care, physical self-care, professional self-care, all of those other things. I think if I were to pick from those, because some of that book is also things like giving yourself permission to grieve if you haven't gotten a diagnosis, because a lot of these people are coming to a diagnosis late in life.

I'm done with the career portion of my life. I'm done with the child-rearing portion. I missed on so much, and now I'm having to grieve this diagnosis.

I I bet there's a feeling of, Oh, man, I could have blank, which is heartbreaking.

It's hard. But what I tell patients who are in that position is that this whole time, you have been building skills. You have been building structures. You have had this brain this whole time. And so now it's what you do with it, and it's what you make of it with this new opportunity. And so you wouldn't have built those skills that you needed if things were different, potentially. Another very, very important one is just making time for physical activity. I feel like such a hypocrite because I hate exercise. I think it sucks. It's so boring, and it's so hard for me to motivate myself, but it truly does make my brain work better.

Let's talk about the forthcoming book that will be out. That's called currently- Too Sensitive. Too Sensitive. Rejection, Resilience, and the Science of Feeling Deeply.

I like this.

Thank you so much.

This is exclusively ADHD because this feels like this could encompass more than just ADHD.

No, it's not. Exclusively. But No, the thing about, we were talking about rejection sensitive dysphoria. Almost 100% of people with ADHD have rejection sensitive dysphoria.

I feel like I have ADHD now. I also have hypochondria.

The irony of all this would be I know that if I have it- Don't self-diagnose.

No, I'm not.

I'm not.

I'm not. But I do have that.

So the concept of rejection sensitivity for you, I started writing this book when I was all dysregulated with my dad. It came about during that time, and I was like, This is the worst part of my ADHD, my emotional dysregulation. This is the thing that will bring me to my knees every time. If I can't focus or if I can't do things, I'll make a hack around it or I'll delegate. I can't delegate someone to take care of my emotions. I'm like, there has to be a better way to think about this and learn about it and talk about it. I think that's why I have so much beef with the DSM. By the way, Europe changed their criteria in 2019 to include emotional dysregulation as part of a core component. We haven't. I look at it like, say your diabetes. So bad. That you started to lose your vision. Now, instead of someone being like, Oh, okay, well, let's fix your diabetes. They're like, No, no. Okay, let's just give you glasses. Let's treat anxiety and depression instead of treating the underlying diabetes. The underlying diabetes is ADHD. And the anxiety and the depression and the rejection sensitivity and the emotional dysregulation, that's what's causing the vision loss.

Right. It's a symptom, not the cause.

It's a core part of it. It's not a separate diagnosis. And so if we don't get on top of this, what happens, and I've seen it so many times, is that for women in particular, I'm seeing women who are on antidepressant number six or seven. They're coming to me and they're like, I don't know what to do anymore? I think I have ADHD. Did you talk to someone about this? Yes. I've talked to my doctor for years. What did they say? First thing that they're going to hear is they're going to say, Well, you're doing too well. There's no way you could have ADHD. The second thing they're going to hear is, No, it It's anxiety and depression. Let's treat that first. The third thing they're going to hear is after they're six or seven antidepressants in, then they're going to say, Listen, these antidepressants aren't working. Can I please look into ADHD? They're going to be like, We can't treat ADHD until your anxiety and depression are clear. These people aren't getting help, and it's because emotional dysregulation isn't in the criteria.

I have a loved one who has come to this late in life, and it's so fucking impressive because they've done it without any help on their own. But they said to me, I finally I realized that I'm processing everything different than everyone else around me. And I'm realizing that these really crazed states I am going through are that thing. Yeah. And it has not fixed it, but it has helped me go, oh, that thing's happening, and no one else around you is really experiencing it. So if I pop off now at work or try to let everyone know, A, they don't care because they're not experiencing it. And this is without any help from anybody. Just This is his ability to go, Oh, that thing's happening. It's incredibly powerful. It really, I feel like, takes a lot of the heft of it away.

It probably gives you a little bit more agency. The way that this book is set up, the first part of it is truly just the science behind. And a lot of the evolutionary perspective and just the history of it, how it came about, the neurobiology, what is actually happening, what areas of the brain are being triggered, that amygdala is being hyperactive because it's assessing threats all all the time, even though it's not appropriate. And then the second part of the book is how deeply do you feel? So it's actually an assessment where you can actually walk through and be like, Is this me? Where do I fall? It's broken down into like, you're probably in a spot where emotional sensitivity isn't a huge issue. You should read this if it applies to other people you love so you have better understanding. Or this probably does apply to you. Maybe it's not all the time. Or this is probably you. This is probably something that's pretty significant, but you haven't had really all that much verbiage for it because we don't talk about it. Then it goes into the tools you use. There's just 12 tools that you use.

Then the last part of the book, which is my favorite, are real-world examples of how you get triggered. It's a quote, and then it is what's happening in your brain, and then how you get out of that moment. So when I was researching, I was pulling from all these different psychological principles. I'm like, What actually does work? So this is just an amalgamation of all of those principles together to actually help with this select thing.

Yeah. I mean, I can immediately think of several people I can't wait to buy it for, which will be triggering, but then...

Well, good. I can't decide on the cover, so you guys can help me with that. Oh.

When you see it on your night stand, don't be triggered.

Well, Sasha, this has been a blast. You have a very popular Instagram account that would be very fun for people to go through because I think a lot of stuff would feel quite familiar as you decide I'll describe it. Oh, there was one last thing selfishly I wanted you to talk about, and that is parenting with ADHD. What can you tell me about that?

It's hard. It's hard. Parenting with ADHD is a huge expansion of what your needs are, because not only are you having to manage your own brain, you're having to manage and guide little people's brains as well.

Help them regulate. That's really your job. Yes.

Model good behavior. From the logistical standpoint, it feels like It's just a lot to do. My kids are in two separate classes, which is two different class party schedules, two different field trip schedules, and two different teachers, and end-of-school things, and parent-teacher conferences. And that probably doesn't sound super overwhelming, but that's so hard for me to keep track of. And which one is this? Which one is this? And you have to really create good systems around that. I think the most, most First vital thing that I could tell anybody who is parenting with an ADHD brain, give yourself grace. Let yourself mess up and have a hard time. Because when I got pregnant, I had numerous Pinterest boards of the parent I wanted to be, like what I wanted their nursery to look like. Immediately, you have this kid, you're sleep-deprived, you have breast milk everywhere. This is just not what you thought it was. And that goes out the window, and you're just like, this is probably going to be harder than what I thought. And one of the best things that we've done as a family is work through moments that are hard and difficult together as a team and problem solving.

So there are times this literally happened two days ago where I was just like, this is hard for mom because there is so much. So when you give me a show and tell bag and you're like, I have to do this by tomorrow, and it's 8: 30 at night right before you're going to bed, you run downstairs and you're like, I forgot to do this, and I have to bring it in the morning. That's hard for me. And I'll I'll do that, but this is why I snapped at that, or this is why I had a hard time. And then what I tell my kids when we have conversations like that, any idea is a good idea. Come up with solutions and let's talk about it. And so it runs They're like, Well, he could have turned in his bag to you earlier today. Well, he could have figured out what he wanted to put in there.

Siblings are great at coming up with ideas for the other sibling.

So many good ideas. I know what he could have done.

So many good ideas. They're not great I'm trying to figure out what they should have done, but boy, they can see right through the problem in their sister.

Yeah. I think it's just giving yourself grace when you mess up. Use it as a learning opportunity for everybody. I think I was so focused on hiding parts of myself from them where I'm like, What am I doing? I don't know what their brain is going to look like.

Well, again, your asymmetric rejection reaction. You can feel rejected from your family. You can feel rejected. I do. Yeah.

Getting burned by my five-year-old. I feel like, but here we are.

Okay, well, this was lovely. Cannot wait for the new book. Currently, though, you could start with, Self Care for People with ADHD, and then, Look forward to Sensitive Rejection, Resilience, and the Science of Feeling Deeply. I hope you come back. This was a blast. Stay tuned for more Armchair Expert, If You Dare. We hope you enjoyed this episode. Unfortunately, they made some mistakes. I have to say I'm only three days into No Derry. How's it going? And I'm already noticing. Oh, that's good. I hate it.

Well, that's good.

I was saying last night, I almost would rather have a runny nose all the time.

You have to, yeah, decide, I guess.

It's the worst when you know. It's better to live in ignorance. That's true. Just go, Oh, I'm just someone with a runny nose.

I know. Well, then you can pick if there's something you really want with cheese, and you just know what you're getting yourself into.

You just go, Okay, I'm going to cough. I'm going to cough for a day.

Yeah, exactly.

I'm going to blow my nose a lot.

Exactly.

That's going to be that.

Yeah. Well, but also good. If you know you don't want to be coughing, if you have a big thing to do, if you have something to do on stage.

If I'm going to be talking. For a living. For a living. Yeah. Someone's got to edit around your coughing and through a clearing.

Sure. That's good to know. I would never I mean, never say never. If I had to, I guess I would. But I could never give up cheese. It's my favorite food.

It's so good. It can make something that's virtually tasteless, like a macaroni noodle on its own in a box of Kraft macaroon cheese. You're not going to eat that. You add that cheese to it, now you've got one of nature's greatest offerings.

Best, best, best, best.

Okay. I wanted to tell you that in a very fun way, Lincoln has now joined a little bit into our sim talk insofar as we were laying in bed a couple of nights ago, and she was telling a story about a girl in class had a caterpillar on her shoulder. Okay. Apparently, there's a season for this. There's caterpillars all over the trees at school, and they're dripping down on people.

Okay. That just made me feel gross.

Then we were just talking about caterpillars, and all of a sudden, I just had this thought, and I said, Lincoln, when we die and we wake up in a medical room and they go, You were in a simulation. I think one of the things they're going to say is, and by the way, you thought that there was a tiny little sleeve of mayonnaise and that that little sleeve of mayonnaise went into a dark cloth and came out as a butterfly. You bought into that. You don't call it... Oh, God. That's what it is. A caterpillar is just a little tube of mayonnaise. We have bought It comes into the idea that that thing somehow goes into a dark cloth and comes out as a butterfly. It's preposterous. When we're talking about the bus, maybe as proof of the sim, I now think the caterpillar butterfly metamorphosis story we've been told is insane. How would it go from mayonnaise to a butterfly?

Well, how would a seed this small turn into you?

Oh, the Like the embryo?

Yeah. It starts as a Sesame seed size.

I know. That's crazy. That is crazy. But I don't think as nuts as a little tube of goo goes into a cloth and is now a flying the most beautiful, colorful structure. Where's it all coming from?

That man is-I just really don't call it that. It is. It's so nasty. Oh, my God.

Then we were having a lot of fun with what else they were going to say to us. You guys, he's thought an octopus could swim over an environment and immediately become that environment without even looking. Their eyes are looking up at the surface of the water, and then they just hover over some coral, and then their whole body immediately is the color of the coral.

Oh, camouflaged.

Get real. Look. Get real.

Beings are very impressive.

Is there anyone you want to add to this one? So right now, it's like leading the charge is like, Butterflies, we're going to feel so stupid that we bought into Then for us, the octupi camouflaging. Okay, that's a big one. Have you watched it recently? It's in Monica. It could swim over your face, and it would just be your face. What are we talking about?

Wait, really? Yes. It's just seeming the camouflage.

The bioluminescence or whatever the thing it's called, it's identical to whatever it's swimming over. No way. It's not a LCD TV. It is. They're telling us it is.

Also a TV. I mean, all of it. It's all...

Tv I'm fine with. No. A TV. This is a prehistoric glob of goo. Okay, you're fine with it.

I'm still... I just think humans, to me, that's a bigger leap from going from a Sesame seed to you. It's bigger to me than the mayonnaise, God.

But at least the thing is cell-dividing, and it's taking on building blocks through nutrition to create the new cells. And you can just see the course of It's like it's doubling every time it divides. It's very tractable.

That's a Sesame seed with no eye, nothing.

Becomes a human.

Yeah.

It's wild. It's wild. But again, this gooey slug enters a cloth, and then it flies away. Okay. Yeah. You're not as perplexed by it, but I just think it's one of the- It's a miracle. It's one of the hardest to believe things that happens in nature.

Yeah. I mean, there's some things like lady bugs that I don't like, but have grown to like a little more.

Okay. What are they doing? That's so startling.

Really, just the way they look. It's like, wow. Or same with fruits or the pineapple. It's like nature made this. Nature made this pineapple, this thing with spikes and this hat on it and the sweet in it.

I know, but I'm struggling with- You're not letting me- The Gap between these two organisms. If you were to just look at all in nature, and we didn't know that those were the same things, they'd be two of the last things you ever even put in a category, a caterpillar and a butterfly. Sure. It's like an elephant going under a cloth and coming out as a rattlesnake.

Yeah. Okay. You don't like my examples. Or not my examples. They're just things that I find wild about the world.

Yeah. You're really blown away with growth. Yeah.

The lady bug doesn't grow. It's just, how is it read with polka? Nature made polka dots, perfect polka dots. That is astounding. On top, on an insect? What? That doesn't even make sense.

It is crazy. Then if it turned into a screwdriver at some point, you'd be like, Hold on.

What are you trying to say? I guess, yeah, I don't have that... I'm not that beware bewildered by metamorphosis and change.

One animal turning into another animal.

Yeah, because of the seed turning into you. I'm primed with that.

Yeah, my distinction is it was one thing and now it's another. At least the seed was always a human.

Well, the butterfly was always a caterpillar. That's what they're trying to tell us. That's what they want us to believe. Yeah, I mean, yes, the sim is crazy. It It is. I mean, what about magic? We're going to feel foolish.

We're going to feel foolish.

You're going to feel foolish because they're going to be like, No, that was magic. Like, those tricks that David Blaine did aren't tricks. That's magic. And you spent so much time trying to figure out What were the tricks since there are no tricks?

Yeah. I mean, as you know, I spend no time trying to figure it out because I know I can't figure it out, and I know it's not magic.

Yeah, but you're going to find out it's magic.

Oh, we were playing 32 I had two questions last night at dinner, and Delta really stumbled upon one. Now, I would argue that she was wrong on both fronts, but one of the questions was, is it manmade? Oh, okay. Or is it from nature?

Okay.

I like that. Yeah. So it wasn't manmade. We figured that out early. Then later on the line, it's not from nature. Then so I bailed out of the game. I'm like, well, if it's not manmade and it's not from nature, then it can't be anything. Okay. There's nothing that's neither of those things.

Let me think. Not manmade. And not from nature. And not from nature. Did she mean like cotton or something? That is nature. Again, that's from nature. But I could see her think. Well, what it was was, weirdly, it was both nature and manmade, which is maybe why she didn't think it was either.

An eyelash.

Oh.

So that's both nature and manmade. That feels like she stumbled upon a riddle.

Oh, that is a good riddle. Yeah. What is manmade and made from nature? Made from nature.

And eyelash. Although she said it was neither. Yeah, she meant both. But I can understand why she said neither. It's like, is it manmade? No. At That moment, she was like, No, the body made it. Nature made it. Right. Then is it from nature? It's like, no, it's human made.

Sure. Well, yeah. Interesting. That's a fun game.

Yeah, it was. It's fun for a I bail out pretty early. My attrition for 30 questions is brief. Okay. I guess I lose hope. Again, when I heard it's not manmade and it's not from nature, I'm like, Well, then I can't continue to run in a fool's errand now. Oh, wow. Because there's nothing that is not either one of those things. Okay.

Comment if you can think of something that's neither. That's a riddle. Well, it's not really a riddle. It's just a hard question. Would we say thoughts?

Or manmade?

Well, I guess it depends on how we're saying manmade.

If we're saying- They can't exist without a human. Okay. Like a wrench doesn't exist in nature.

Yeah, exactly. But a man didn't, I guess, construct thoughts, but it's more abstract than that. They didn't invent thoughts.

I think it's an example of it's both in that case because it is the human thought. Is human thought manmade or nature made? Yeah. And it's both.

Or neither. Or I'll play with Delta.

Stay tuned for more Armchair Expert. If you dare.

Let's play.

Play.

32 questions. Why don't you want to play?

Okay. You have something?

No, you have to do it. No. Oh, okay.

Think of something.

Okay. I have it.

Is it manmade? Yes. Would it be sold at Walmart? Yes. Is it smaller than a microwave?

Yes.

Is it for personal hygiene?

No.

Do you plug it in? No. Okay. It's smaller than a microwave. You don't plug it in. They sell it at Walmart.

Is this where you give up?

We're getting close. It's to where I would give up. Okay. Rob, do you have any questions? Is it food-related?

No. Okay.

So we're not eating it. It's smaller than a microwave. Is it bigger than an iPhone? No. Wow. Okay, great. We just really got. So it's microscopic.

But they sell it.

They sell it. It's smaller than an iPhone. It's not personal hygiene, and it's not electric. Is it a pen? No.

Is it home improvement related?

No.

Would it be Would it be in your living room?

I would say no. It could be.

Would it be in your kitchen?

Not traditionally.

Would it be in your bathroom?

No.

Would it be in your closet?

It could be in your closet.

Could be in your closet.

Your night stand?

Yeah. I'd probably put it in my night stand.

Wow.

Not electric. Well, not plugged in. Is it battery-powered?

I think. It's not plugged in.

But it has a mechanism.

But it has a mechanism.

It's an electronic. It's electronic. Is it electronic? Is it electronic? Yeah. Is it a vibrator? No. We were led there. Night stand. Yeah. It has a battery smaller than an iPhone.

These days, you do plug in your vibrators.

For a period. They're not tethered.

Right. That's correct.

If you've got one that's tethered, I tip my hat to you. You need that voltage. You're working hard. A remote?

Is it a remote? No, it's not a remote, but you're in the right zone. Ish.

In the night stand, not a remote, not a vibrator, is electric.

I don't know if it's... God.

I don't know if it's electric.

Okay. Can be. It can be.

Oh, wow. Now, I'm picturing a night stand drawer.

I mean, don't get so stuck in the night stand. It could be there. Okay.

You said it is or isn't electric.

It can be. It can be. Batteries. Let's say it has batteries.

Does it tell time?

Is it a watch?

Close. Very Very, very close. Some would say it's a...

An Apple Watch? No. Like one of those fucking rings you wear, like a health monitoring?

Think a little more archaic. A stopwatch? Yes. A stopwatch. Good job.

A stopwatch. Yeah. Do you have a stopwatch?

I have one in my night stand.

Okay.

You have a stopwatch? No, I don't.

No, a stopwatch.

What made you think of a stopwatch?

Because there's a stopwatch we're using at the SAG Awards.

Top of mind, as you would say. Top of mind. Okay.

I mean, I feel like I keep it in the night stand or I'd keep it in the garage toolbox.

I'm going to meditate on why the game for me gets frustrating.

Okay.

Probably just because I don't know and I don't like not knowing.

Sure, probably.

Calvin likes it, and it's frustrating for me, too. Yeah, it's hard, right? Especially when you...

I'm not sure he's always answering correctly.

I have the same, and is this a male thing? I'm suspicious that either they forgot or... Yeah. Vinnie, we can't play with because he's got- He'll just change it, right? Yeah. That's the other thing. You catch these kids changing it. If you guess it too quick, they don't like that. Yeah. Sure. What should happen is it should be written down on a piece of paper to keep everything above board.

Well, I mean, playing with kids is different than playing with adults. I think if you play with kids, sure, it could be a little like, are they switching it? What are they up to?

Do they remember? I mean, a lot of the time, this is a long game, and I'm not even sure if they remember.

Sure. But if you're playing with an adult and you don't trust it, that's on you. Adults know what they're doing.

Yeah. Whether or not they would change it is another thing. There is some legion of people that would change it.

Sure. But if they don't know the answers, that's a little like...

It was very easy when they were tiny children because you knew it was something they could see in the room.

Of course.

It's the glow. Yeah. You could narrow it down pretty quick and go, Is it a light switch? That's because they look at it immediately, too, and then say they have it. Every time you ask, Is it brown? No.

Yeah, I know. It's so cute. See little caterpillars turning into butterflies all over the place. All right, should we do some facts?

Yeah, let's do some facts. Okay. I didn't bring it up in the interview, although I was tempted to. What? You know, Sasha holds a very dear... It's a very important name to me.

It is. That's who you had sex with. It's a life... No. Oh, yeah, that's your first girlfriend.

Let's definitely not say that to Sasha.

That was your first girlfriend or the first person you had a crush on.

We're getting close. It's so relevant that my therapist remembered her name.

Is this because she had the sauna?

No, that was Randy. That was later. Okay, so elementary school could not... No girls liked me. I like so many girls. I was just telling Delta this the other day. I was like, I like so many girls. None of them liked me. I got to sixth grade with my new look that my brother gave me. Right, right, right, right. The most popular girl in the whole junior high, Sasha Croset. Okay, yeah. Who was an eighth grader.

Yeah, I knew she was an eighth.

Came up and gave me a note in the hallway, in the sixth grade hallway. Okay. I took it into my science class and I opened it up and it said, Will you go with me? So you dated? Yeah.

But she wasn't your first girlfriend?

I got to be careful. I'm going to call her Frank.

Frank?

I had a Valentine once. It was... Let's just leave it there.

Wait, what happened?

I had a... I don't know if you'd call her a girlfriend. I had a girl who I think- Did you talk to her? Yeah, a little bit. I think on Valentine's Day, maybe I gave her something. I want to say she gave me some fudge or something. But I do remember her name. The reason it's so important is it is a transition from no girls like me to the most popular girl in the world like me. I know. This was a humongous, the biggest 180 of my life. That's huge.

I also think I was right in saying your first girlfriend because I'm not counting this Fudge girl.

That's fine. We made out a ton. We would make out in front of the busses.

You didn't make out with fudge?

No.

She was your first girlfriend, so I'm Right. Yes. I guess I'm impressed you didn't bring it up because it's really important.

We haven't interviewed a Sasha.

No, we haven't. No.

I have only met one Sasha since then.

Sasha baron Cohen.

I guess two. Thank you for pointing that out. The other was a Russian dude I knew.

Oh, sure. I know. All right. Well, Godmother's Bookstore. I was like, It's in Montecito. Then you guys were like, It's not a Montecito. We're from there. Yeah. It's in Santa Barbara, right? Okay. Which I think Rob said Summerland. Summerland.

Oh, okay.

Everyone was like, Yeah, that's not Montecito. Okay, which is fine. But then when I googled, I said, Where is Godmother's Bookstore? It said Godmother's Bookstore is located 2280 Lily Ave. I think Rob had said that because you said Lily. That's her middle name. Summerland, California, founded by Jennifer Rudolf Walsh and Victoria Jackson in 2024. Oh, it's pretty new. I'll say. It is situated in a restored 1920s bar.

Victoria Jackson, the performer from Saturday Night Live, Victoria Jackson?

Who's that?

A beautiful blonde castmate in the late '80s.

Oh, I don't know. I see her SNL. I don't know.

It's a different Victoria Jackson. It's a cosmetics mogel. Oh. Cosmetic mogel. Great. Okay, great.

With a renowned literary agent.

Oh, well, it's situated in a restored 1920s barn, often described as a cozy curated space near Monte Cido. It says that.

Near Monte Cido, it does.

Open Daily.

You're having a hard time with this one. Because it's just there. You're having a real hard time. You're taking another swing at it.

It said it, though. I didn't I didn't say. I said, Where is it? And it even included Monestito. Yeah. It's such a cute bookstore. Oh, my God. I could live there.

Oh, brand new, too. It's brand new, but it feels old. Yeah, timeless.

I love it. Okay. Now, you know how I was on D?

Sudo-epidephrine.

Thank you. Which is meth.

Precursor.

Does meth eat alcohol? Jess said he used to make it like a Pac-Man, and it was like the meth would eat the alcohol. Yeah.

It doesn't eat alcohol, but it gets you high, which offsets the inebriated effects of alcohol. Okay. Because alcohol is such a depressant. So if you imagine you took a Xanax, and then you took an Adderall. The Adderall would lift you out of the Xanax-y feeling.

Oh, interesting.

And this is why people do speedballs. Coke and heroin, they're opposites. So you're leveling off both sides, both downsides of the drug. A heavy heroine does you're nodding off. It's not ideal. Coke, you're too edgy, gnawing on your face. So I think that's what he means. Is it right-sized as an ablation? I don't think it metabolizes the alcohol any faster. Okay. So cocaine does the same thing.

Got it. All right. What was the most popular Flintstones' vitamin flavor? Based on nostalgic discussions, the orange Flintstones vitamin was widely considered.

That's what I think of.

Really? I was a red. I'm not red. She liked great.

I think they made orange really front and center in the ads.

It says purple, and in some cases, the iron fortified versions were less popular due to taze, with some users describing purple as yuck.

Well, sure. Purple was my favorite. Really? You and Sasha could have shared vitamins.

Oh, Valentine's. That's cute. God, I loved him. Says nothing about red. I'm going to give you credit for something. Oh my gosh. You've been saying for a while that Gabor Gabor Mathe is an expert in ADHD. Every time you say it, I have to stop myself from saying, Is that true? I don't remember that. I know he was a trauma expert, but I don't remember ADHD. I thought this was my in. Yeah, to correct me. Yes. Gabor Mathe is a Canadian physician and author. He has worked in family practices and specializes in childhood development and trauma, including long-term effects on physical and mental health, such as autoimmune diseases, cancer, ADHD, and addiction. So it's in there. It's in there.

He had his circuitous path, if you remember when we interviewed him. Started working with the addicts in Skid Row there. Yes. That wasn't his thing, but that became his thing. Yeah, exactly. Kind of like Sapolsky being a fucking primatologist as a hop I think his addiction trauma stuff more was his hobby.

Right. But now he's really known for that. Yeah. He's written five books exploring topics such as ADHD, Stress, Developmental Psychology, and addiction. Now, if you guys miss That episode, you really should go back. That is such a great episode we did with him.

Oh, I guess I'd like to say one thing, too. Eric died, my friend. Oh, yeah. I'm so sorry. He was such a beautiful dude, and I think it would- Eric Dane. Eric Dane, yeah. I think it would be a lovely episode to listen to if you're curious about what spirit Eric had. Yeah.

I'm sorry. How are you doing?

Well, I was talking to Lincoln about it, and I said, I Well, first I go straight to gratitude. When you hear someone as ALS, my worst nightmare of that would be I have lock-in syndrome. And although he was very, very diminished physically at the end, he couldn't move much of his body, if at all. He could talk. So he avoided that phase. So I just immediately, in the same way when my dad died, I felt grateful. It didn't get gruesome. So I was grateful for that. I know how many people were around. That made me grateful. And then the sadness, I think for me takes a minute. I was talking last night to Lincoln. I said, I don't know, imagine you came home from school today and mom said, Dad died today. Could you comprehend that? And she's like, No. I'm like, Yeah, wouldn't it take you a long time? You'd be like, No, that's not true. That's not right. And then months later, you'd be like, Oh, wow, that really is true. That's So I think I'm in that phase where it's like, Is it? No. I mean, intellectually, I know, but also no.

I think that's totally normal. I think that's how most people are processing it. It takes a minute.

I feel guilty about that. I see people, well, in real life and in movies, they hear bad news, and then they are immediately devastated. And I'm so protective, I think. I have so much well-worn neural pathways that I'm like, I have so much shit that just engages right away to prevent me from feeling terrible. I think it takes a while for me to be willing to let that in. Yeah.

You shouldn't feel guilty about that. I think it's totally normal. And what's the problem? There's nothing wrong with it.

No. Other than, I think... Well, my fear would be like, let's say I had been standing at the hospital and they pronounced my dad dead, and then all of his friends were there, and they start crying, and I don't. And now I appear to be sociopathic. That's the fear, probably. Or I watch these fucking datelines, and the cops show up, and I've witnessed something terrible, and I'm stable, and they interpret that as guilt. Right. These are the crazy thoughts I have about- Of course, yes. Oh, you're supposed to act a certain... People expect you to act a certain way, and if you don't, they start filling in explanations as to why you're not reacting the way they do.

I know. I think that's the fear. I know. But that's on other people. That's on those people who are deciding that everyone should be reacting the way they react. I think it takes a long time to process all of these things. I'm sorry. It's really sad. Loss is hard.

When I saw them two weeks ago, there was lots of laughing.

Yeah, that's good.

Okay, sorry I interrupted that fact check for that, but I had forgotten that I wanted to say.

Yeah. Well, let's just end on that. Well, do you have another one? Well, it was just about PMDD. What's PMDD? It was really bad PMS.

All right. People with ADHD get PMS sometimes worse.

Yeah. I'm pretty sure I have PMDD. Okay.

Then I was thinking- PMDD? Are you complaining things? God.

I do think I have it. Then I was like, I also have that rejection thing. Maybe I have ADHD. Yay.

Well, you've talked about a 180.

No, I don't think I do. But it's all a spectrum. It is. That's it.

All right. Love you. Love you.