ADHD and emotions, from anxiety to boredom (Dr. Sasha’s story)

Dr. Sasha Hamdani is a psychiatrist who specializes in ADHD and anxiety. She was diagnosed with ADHD in fourth grade after starting what she calls a “riot” in her classroom. But she didn’t find out she had ADHD until much later, when she hit a wall in the competitive medical school environment. After discovering her diagnosis, she unplugged from academics to learn more about herself — and about ADHD. Now she debunks ADHD myths one by one on social media.

Dr. Sasha shares her story, including her thoughts on her parents’ decision to not tell her she had ADHD until she was an adult. Stay tuned to the end to hear Dr. Sasha talk about the connection between ADHD and anxiety. And get her advice on how to ask kids about ADHD symptoms. 

Related resources

• ADHD and anxiety

• ADHD in girls

• ADHD and boredom

• Pre-order Dr. Sasha’s book

• Dr. Sasha’s Instagram

Episode transcript

Sasha: My "aha" moment really would be when I went home and after I'd been struggling for a long time in medical school and being able to sit in a safe environment with my parents and have the luxury of actually learning about symptoms and learning about ADHD and learning about "Is this truly what's happening in my brain?" I think when I was able to pull myself away from drowning in my academic place and trying to function on my own, I could actually relate to the symptoms and see what was going on. And that's when things clicked. And I was like, "OK, yes, I definitely have this. Now, what do I do?"

Laura: From the Understood Podcast Network, this is "ADHD Aha!," a podcast where people share the moment when it finally clicked that they or someone they know has ADHD. My name is Laura Key. I'm the editorial director here at Understood. And as someone who's had my own ADHD "aha" moment, I'll be your host. I am here today with Dr. Sasha Hamdani. Dr. Sasha is a psychiatrist who specializes in ADHD, anxiety disorders, among other things, and she is also busting stigma about ADHD all over social media. I highly recommend checking out Dr. Sasha's Instagram. Dr. Sasha, welcome.

Sasha: Hi. Thank you so much for having me.

Laura: Thank you for being here. And I think your cats are in the background as well. So, people watching on video...

Sasha: They're going to start fighting. Sorry.

Laura: That's OK. We'll just roll with it. It's OK.

Sasha: Yeah.

Laura: Dr. Sasha, I think you need to tell me and the "ADHD Aha!" listeners, about what you described as a riot. Tell me what happened.

Sasha: OK. So, fourth grade, I always knew I was on the rambunctious side, but we had a substitute teacher that day, and I organized a coup in my classroom and got everybody to stand up on their desks and start chanting. And in retrospect, I don't know why I did that. Like, horrible. Especially now as I've gotten to the point in my career where I recognize how extremely essential teachers are. It makes me feel terrible. But yes, at that point I got everyone else to just behave badly with me. And shortly after my teachers talked to my parents about getting me evaluated for ADHD. And right after that was just like in very quick order, getting diagnosed, getting medicated, turning things around. So that's the coup.

Laura: What kind of behaviors were happening around that? Like when you say, bad behaviors or behaving badly.

Sasha: Yeah. And I don't necessarily mean bad, just inappropriate for the environment, I guess. The symptoms that I was experiencing were very typical for a combined type presentation of ADHD. So, you have a lot of inattentiveness and difficulty focusing and engaging in the task at hand, but you also have some hyperactivity and impulsivity. So, generally, when you have that combination of symptoms, you have these kids that are capable of doing work, but they're getting bored and so they're entertaining themselves. And that's very much what was happening. That was entertaining to me in that moment in time.

Laura: At that time, do you remember feeling like you were struggling with ADHD symptoms, or was it really that the teacher said something and that's what started the whole path?

Sasha: I remember feeling very bored and I remember thinking to myself like, "How do people get through the day? This is so long." Unless we were doing something very hands-on that I was actively interested in, it just seemed like agony. So that's what I remember.

Laura: Lots of kids with ADHD struggle with boredom. Yeah. What do you remember about that evaluation process? What was that like? How did your parents react to the thought of you needing an evaluation?

Sasha: So, I wish I had a better recollection of all the details, and I've talked to my parents since then about it. So, when this got confronted to my parents, it was more like emergent. My teacher was like, "No, no. We can't have riots every day. Like, you need to do something."

Laura: I almost spit out my water.

Sasha: So, like they kind of like were pushing my parents, like "Something needs to be done. This is not an isolated event. We need to do something." What my mom said is "It didn't really seem like this was a choice. It seemed like you needed this to go on." And my mom is a pediatrician. So, it was really lucky for us in that we had this opportunity to just get in with one of our peers and get evaluated. But also, I went through this laborious, long educational panel where I did this formal ADHD testing with an educational counselor. I'm assuming he's a psychologist, but I remember being there at his office for five hours. "Oh, my God, I cannot answer another question. Let me out of here." So that's kind of what I remember of the educational and the testing process, although I will tell you that noticing from practicing how difficult access to care is, I think I was really lucky in that respect.

Laura: What kind of feelings did it bring up for you as a fourth grader? Were you afraid of getting evaluated? Were you worried about being different? Were you excited?

Sasha: So, I will preface this with "I'm telling this story with, you know, I don't know if at that point in time I would have done things differently," but my parents made the choice not to tell me that it was ADHD. They did not tell me those words. They did not tell me what was kind of happening. They were like, "This is what everyone's doing, and your teachers recommended this " So, I didn't really feel that kind of isolation and difference and things like that, and I didn't even know when I started medication, am I taking this because it was called my vitamin. So, I was taking this. And, you know, I've talked to my parents after that and I was like, "Why did you make that choice?" I wasn't like, I had a barely developed frontal lobe, so I'm not here to pass judgment. "But why did you go there?" And the reason they told me is because ADHD really wasn't talked about extensively during that time, that they felt like I was so sensitive and was having a hard time already because I was the only brown kid in a sea of Caucasian, well-off, affluent people. And I had already felt very different. And my parents said, "We didn't just want to add one more thing to your plate." Ideally, I wish it could have been handled differently, but I understand where they were coming from. And I understand the kid that I was, and I was very sensitive to things being different. I didn't want a different shoe, I didn't want a different lunchbox. I wanted everything to be the same so I could fit in as seamlessly as possible. So, all of a sudden, things didn't seem as terrible. Like, all of a sudden, I was able to sit through class and I'm like, "Oh, OK, I haven't gotten in trouble for tapping my foot against a desk. I haven't gotten in trouble for talking. That's weird."

Laura: OK, so you got diagnosed in fourth grade, you received treatment for ADHD. Things got better. Was it just smooth sailing from then on out or were there any other kind of...That was it, right? Should we stop the conversation?

Sasha: That's it. That was the end of my story.

Sasha: For a long time. It was smooth sailing. I did really well in elementary school and I really like I think I found my stride. Like I really enjoyed learning and that became part of my identity, which I had never had before. I started like engaging more in school. I wanted to run for class office. I wanted to volunteer for things. I wanted to speak up in class. I stayed on the same dose from fourth grade to 12th grade, and I think that's where my problems slide because then starting at the tail end of 10th grade and again, I don't know if this was like behavioral, if this was just like normal development but it was like a shocking difference to my parents because of like "What is happening to you." I think I was experiencing more of that boredom, more of that hyperactivity, more of that impulsivity. And then as you're in those late high school years, you also have this additional freedom. So, then I was getting into trouble more, and not anything bad, but like stuff that you're… within the context of my own family fabric was just like a no go. And so, I felt like that impulsivity was getting more. And then I applied for medical school out of high school, so I got in.

Laura: That's not typical, right?

Sasha: So, when I was in my early years of high school, I knew I wanted to do medical school because I wanted to do pediatrics like my mom. So, I started looking into programs that had combined undergrad and graduate programs. I started looking at what was fastest, and I found two six-year programs that you didn't have to take the MCAT if you get certain grade levels and continue through it, you start your med school right out of high school, so you start that process right away. So yeah, it's not common because I don't necessarily think it's a great idea.

Laura: Why did you want to go so fast? What was the attraction to that?

Sasha: I don't know. I knew where I wanted to go. And I think with typical ADHD, there's like a sense of urgency. I was like, "OK, now I know I just want to be a doctor now." And the reason I probably wouldn't do it is just because they make it fast by just taking out breaks. So, then it was just like such a high burnout, right?

Laura: Did you ever burn out?

Sasha: Yes, as soon as I got there, it was like a complete 180. I actively thought that I had a stroke. I remember calling my dad and being like, "I need to get evaluated for something because nothing is working." And he's like, "Are you taking your vitamin?" And I was like, "I don't even know where my vitamin is. I don't know where it is. Like, my dorm is a disaster. I don't know what is happening. I can't wake up for class, I can't study, I don't know what's happening." And so, my dad at that point was like. "OK. It's not a vitamin. It's actually an ADHD medication. You have ADHD." And then like I went totally off the rails in that I didn't believe that I had ADHD. I thought I had been just taking medication without my knowledge. I felt very betrayed by the whole process. I was just inherently angry that I didn't know where my baseline was, so I felt like I lost a lot of identity. And then I was just like, "OK, if I can't do schoolwork, I'm just going to be fun. I'm going to focus on having fun. I'm going to go to concerts. I'm going to hang out with my friends. I'm going to be the person who is always there for a good time because that's what I'm good at. I know I'm good at that." Inherently, in an accelerated medical program, those people don't do great. And so, I crashed and burned.

Laura: I don't think I realized when we talked earlier that you weren't aware that you were taking ADHD medication then until you were 18?

Sasha: 19. I'd just turned 19.

Laura: 19, because your parents were still getting your medication.

Sasha: Sending them to me.

Laura: Was it like not in an RX bottle or was it like...

Sasha: I think it was in an RX bottle and I literally never looked or paid attention.

Laura: Wow.

Sasha: I just saw that as normal. And to be honest, I don't think I knew those words yet. I didn't know then methylphenidate was for ADHD. I didn't know. So, like, nothing clicked.

Laura: No, I understand. No judgment. I see you now as this expert in ADHD, so it's hard to imagine you not. But you hadn't gone through medical school. Yeah. Wow, I didn't know that. So that was, God, mind-blowing.

Sasha: It was a big realization. And I think that was probably — and I'm not being facetious when I say this — I think that was the most difficult spot in my life because I didn't know who I was. I didn't know if I was going to make it through medical school. Like my only goal that I had had since I was eight was to be a doctor. And so, I was like, "I don't think I could do this." And then as I was going through, I just got worse and worse and worse and dug myself into a hole. And I'd gotten to the point where I was doing stuff like I was like hiding information from my parents because I'm like, "It looks so bad that I don't want them to know that I failed my last test, so I'm just not going to tell them." And so, it just it progressed. And then on top of the already shame and guilt, then adding on this delicious layer of deceit on top of that. So, it was getting confusing and difficult. And by that time, I mean everybody thought I was an idiot. So, like the person who was supposed to be like shepherding me into residency, that guy was like, "You should maybe do teaching." I was like, "I don't want to do that. I want to be a doctor. I want to have that title in front of my name." And he's like, "You could just marry a doctor." And I was like, I can't talk to you anymore.

Laura: Oh. No, no, no, no, no, no, no.

Sasha: I cannot talk to you anymore. I'm going to have a panic attack. And that was what was happening. Like every time I was exposed to him, like minutes afterwards or minutes before, I would have huge panic attacks. And that was what was also debilitating because I never had that before. So that was precipitating that meltdown where I talk to my parents because I'm like, "OK, it's not just like this focus and not being able to find my way. I'm going through experiences where I've been to the E.R. twice because I think my heart, I felt like my heart was exploding." I was like, "I cannot function like this." And so, I ended up telling my parents. And so, my dad was like, "I don't want you to be by yourself. Just come home." So, they flew me back home and I just spent a week and it was just like my dad force feeding me bananas. Like he said, "You need to eat, eat a banana." And so, I was just like eating fruit all weekend and he's like, "I don't even want you to study. This shouldn't be your priority" he's like, "Just learn about ADHD. You don't need to, like, buy into it, learn about it, see if it applies. If it doesn't, let's figure out what really is going on. But you sit and deal with it. There's no pressure to go back to school. We'll figure it out. You'll be a doctor either way, we will figure it out." It was like a pressure cooker had been released. Like I just felt like this immediate de-escalation, and I felt very safe. And I was like...

Laura: Wow.

Sasha: And then I read about it. I researched and I mean, this is like the internet was a thing, obviously, but, like, not as much of a thing. So, like, we were doing library runs and so like we were like deep in it, like getting all this information. And as I was going through, I'm like, "Oh, this is me." Even at that time, there wasn't a lot of information about the emotional side of ADHD. There wasn't like talking about what it does to self-esteem, or what it does with emotional dysregulation. But I still got like little snippets of it, and I was like, "That's what I'm feeling." So, then I was like, "I'm on board."

Laura: Do you have an example of a little snippet?

Sasha: I read something at that point about the self-esteem part of things, and they're like, "After years and years of not being able to function at the level that you believe you should be functioning at, it stands to reason that your self-esteem would be lower, and you might look for ways to fill that void." And I was like, "That's what I was doing." My starting semester of medical school, where I should have been like head down, really making a name for myself, building my foundation, I went to something like 48 concerts, and my mom was a pediatrician, so she was helping this process and educating herself about this as well.

Laura: I'm just marveling at how lovely your parents seem.

Sasha: Oh, God, they are the best parents in the world. I'm hearing the beginning part of the story where I kind of got duped into having ADHD medications on me. People think that I have negative connotation, but I don't think I would have done anything differently. And the way that they handled it afterwards was so beautiful. They are the reason that I got through medical school. Like at one point I was on a medication where I just stopped eating. I would get so incredibly hyper-focused on what I was doing. Then I would forget to eat. And then by the time the medication was out, I was so exhausted that I couldn't even gather my faculties to make food for myself. I'm almost 5'9", and I dropped down to like 96 pounds.

Laura: Oh, wow.

Sasha: And my mom was like, "Whoa, no." She took sabbatical from work, and she literally came in and she was a cook. Like, she just cooked food for me, just above, above, above, and beyond. So, I finally found something that worked. Limp through. Get through medical school. I think I'm doing pediatrics. Do all my research in pediatrics at the very last second, again, because I was still clinging on to this music as a coping skill, which is not a bad coping skill. But the way I was doing it was probably not great. So, I decided to go to Austin for South by Southwest, and I was like, "OK, well if I get a rotation there, I can go to the concert and no one's going to give me a hard time." So, the rotation was child psychiatry. And then I got there and I was like, "Oh, this is what I'm cut out for. This is what I like." And so, then I pivoted everything a month before applications were due for residency, and I changed everything to psychiatry. And then my parents were just, like, hysterical. Like, "You're being impulsive." Finally, I ended up in residency, and then I think that's where, like, my course changed because I went from this super, super competitive program to like this very intimate program where there were just five people per class. And I was surrounded by psychiatrists and therapists, literally surrounded. They literally built me into the position that I am now.

Laura: All right, Dr. Sasha, I have to take advantage of having an ADHD expert on the show and ask some questions that are actually about ADHD and maybe less about your personal story. But if you have personal references you want to pop in, that's always welcome.

Sasha: Yeah.

Laura: But I have been hanging out on your Instagram feed and I'm just having a ball. And I mean, the videos, they're so funny and so truthful. I mean, I'm just loving it. I can't get enough of it. I mean, what was that like, how you respond to interactions with ADHD and anxiety, I was just cracking up because it's so true. It's a topic that comes up so much on the show, ADHD and anxiety. And I'm not necessarily equipped from a medical background to really explain how ADHD and anxiety interact and how they can get all tangled up. So, I would love for you to talk about that.

Sasha: So, if you're looking at ADHD and anxiety from the absolute basics of it, ADHD, your brain is just moving too fast. Anxiety. Your brain moves too fast at inappropriate triggers. So really things that shouldn't make you anxious, make you anxious, and then you're speeding up all over the place. You put those together and it's a disaster. Like, it’s just your brain that it’s moving so fast so your ADHD can make you anxious and your anxiety can make your ADHD worse. That speeding up of the brain can be happening because of both of them, because of one of them, and it makes a very confusing neural picture. And unfortunately, it's common that they happen together and it's common that it's tricky to treat, but it can be done.

Laura: Yeah, it's tricky. This just feels a lot of chicken egg. Chicken egg, right? For me, I treated my anxiety first, and that was the first diagnosis that I got. And once I had my anxiety under control, then I was like, "Oh, there's still something going on. What's going on? Oh, I'm having trouble. I can't focus. I can't focus on anything." So, like, the anti-anxiety medication obviously isn't taking care of my trouble with focus.

Sasha: But it probably unmasks some stuff so that you could actually see what was going on.

Laura: Absolutely. You have two little kids. They're two and three?

Sasha: Yes.

Laura: If you suspect that they have ADHD and they're going to have an ADHD evaluation, how would you approach it with them?

Sasha: If that is the case? If they started exhibiting symptoms, and I've given a lot of thought because inheritability is so high, about starting that conversation early and giving them the verbiage to talk about their symptoms so that they feel like they're in control of things a little bit better. "This is what I'm experiencing. This is what could get better." And so, I want to make sure that they're equipped with that language.

Laura: That's really great advice. Any specific examples? I'm sure if we have parents listening, like what kinds of language?

Sasha: Like for example, you know, a lot of people, they ask their kids like, "How's your focus?" Like that is so nebulous and weird. Like, I sometimes don't even know how to describe my focus because I feel like it's constantly shifting. I think asking questions like specifics, like "When you're in class, do you get bored? OK, if you are getting bored, is it in math or is it in reading? Are you bored when you're with your friends? Are you bored when it's one on one with the teacher?" So, asking specific questions instead of giving like this big group thing for two reasons. One, it's dialing down and teaching the child like, "This is what I should be paying attention to." And two, it's giving them the opportunity to open up a dialog and a conversation about each of those and expanding further rather than leaving it open. I mean, as kids get older, yes, you can definitely give broader questions because they have more concept of abstract reasoning and they can be like, "OK, this is probably what she means and this is what I mean by that. And I can explain myself better." But trying to have that conversation with a fourth grader, they're going to be like, "Good."  And that's what you get.

Laura: Absolutely. I got to write that down. Those are really helpful ideas. Thank you. What about boredom? You were dealing with boredom when you are in fourth grade, and then when I asked you about your kids, like, how would you ask them specific questions? You brought up this word boredom. You're like, "Do you get bored in math class?", etc. So, talk to me about ADHD and boredom.

Sasha: So, I don't think that's only related to kids. I get bored all the time and I think that boredom is really now that when you deep dive into the kind of literature and you understand neurophysiology behind ADHD, like you can correlate that boredom to low dopamine states when there is less dopamine available in the cleft, dopamine and norepinephrine is what that ADHD brain craves, and that's what stimulates us so that we can do the things that we would normally do. And it's not totally sure why this is happening, whether it's just getting sucked up out of the cleft too quickly, or whether it is not being produced in the right amounts or whether it's present just in the wrong place. But for whatever reason, there is not enough available dopamine. So, when you're in these low dopamine states, that generally correlates to a sense of boredom, like "I don't have the faculties to figure out what to do here, but I'm bored." That's just a phenomenon that ADHD people might experience more, because for ADHD people, it's kind of this upping the ante with we need highly stimulating things. So, a lot of things that might satisfy other people might not satisfy the ADHD brain.

Laura: I want to ask you about ADHD and women, too. I'm just peppering around and just, we're popcorning. Do you think that women with ADHD often go undiagnosed because they're great at masking their symptoms?

Sasha: Amongst other things. I also think that women primarily present as inattentive and so they're not really impacting the class flow. Like they're not that hyperactive. They're not the combined type kid that's starting a riot. They're just kind of sitting and they're in their own world. And so, they're not causing trouble. They're passing along with their grades. There's nothing too, too problematic on there. So, they're just floating along the class. And then when they get into situations where the academic load is significantly more or not even academic load, it could be like the relationship load. Or when they have children — when all of a sudden you're not in charge of yourself, you're in charge of these other little people — that suddenly things become unmanageable. That's really when some of those symptoms start coming out. And then at that point, they've gone through their lives being undiagnosed, and then they present to the physician and they're like, "Well, you weren't diagnosed as a kid. So, it wasn't that." I don't necessarily know if it's just that they're really good at masking, which could easily be like a societal pressure trying to like, this is what you should look like and this is what you should do versus whether it's just that they're more likely to be inattentive or whether it's even like a hormonal thing, like as hormones happen and it's later in the game, at that point in time, like when that's happening, people are just like, "Oh, you're hormonal. Oh, it's PMS. Oh, it's this. That's why you're kind of acting out." But it really it's that kind of low estrogen that's triggering a low dopamine. And now you're having this like ADHD storm happening at the time.

Laura: OK, so how can people tell the difference? Because, you know, medically what's happening, but how can people tell the difference?

Sasha: I don't know. I mean, I think it's like you're looking for...

Laura: Just stop asking, Laura.

Sasha: I don't know. What I tell people is that even if you're on the fence, if you have a question, if you're like, could this be a possibility? That's so hard for a parent to figure out because you're right in the thick of it and you're looking at stuff and for a parent, for a person dealing with it, you're the one experiencing it or you're the one watching a loved one experiencing it. You're not really sure what's going on. Go and seek out a professional opinion. And I understand that access to care is super problematic and that we don't have those good avenues. But if it's available to you, I feel like that is the best way to get that secondary input. To put together those pieces, you have to look at pattern and really, to be honest with you, you have to know what you're looking for. And I think it's really hard to do that on your own.

Laura: Yeah, my last question for you was going to be what advice do you have for people who are noticing ADHD symptoms or who think that they might have ADHD? And you just answered that. So, anything you want to add to that?

Sasha: If I would add to that is, again, like talking about the access to care issue because I mean, I will talk about that until the end of time. What people can do prior to getting that diagnosis is like if you think you have it or you are concerned about it, learn about it. That's what I did, and I think that that made all the difference in the world to me, because there's so much with ADHD that is behaviorally based, you don't have to treat ADHD with medication. You can use behavioral techniques, you can optimize your life, you can do all of these different things. You can emphasize self-care specifically for your brain to help things because not everybody has that benefit of access to medication — and there's some cases that you don't necessarily need medication right away — and you're still in this very neuroplastic, your brain is changing place in your development — that if you have the right habits, if you have the right techniques, you can take that and run with it and get to a very, very functional place. So, I would say just learn about it. And I don't really care where you learn about it. If you're learning about it through a library, cool. If you're learning it through the Internet, fine. If you're learning it through social media, don't care. Cool, man. You do you. The only thing I would say is just make sure that where you're getting our information is reputable. Don't just listen to some random person. Look at credentials, try to figure out like, "Is this person someone I should be listening to?" Because if you're leaning on the Internet or social media for information, there's a lot of bad information.

Laura: Yeah, I couldn't agree more. Well, I've certainly learned a lot from you today, so I'm sure that our listeners have learned a lot from you as well. I'm just so grateful to you for coming on the show. Dr. Sasha, thanks so much for being here today.

Sasha: Thank you for having me.

Laura: And good luck with those cats. Keep them under control.

Sasha: I know, they're scratching my leg right now.

Laura: You've been listening to "ADHD Aha!" from the Understood Podcast Network. If you want to share your own "aha" moment, email us at ADHDaha@understood.org. I'd love to hear from you. If you want to learn more about the topics we covered today, check out the show notes for this episode. We include more resources as well as links to anything we mentioned in the episode. Understood is a nonprofit organization dedicated to helping people who learn and think differently discover their potential and thrive. Learn more at Understood.org/mission. "ADHD Aha!" is produced by Jessamine Molli. Say hi, Jessamine!

Jessamine: Hi everyone.

Laura: Briana Berry is our production director. Our theme music was written by Justin D. Wright, who also mixes the show. For the Understood Podcast Network, Scott Cocchiere is our creative director, Seth Melnick is our executive producer, and I'm your host, Laura Key. Thanks so much for listening.