← Hacking Your ADHD
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- [00:00]
Drive-Thru Driver
Take the exit, turn right into the drive thru.
- [00:03]
Podcast Host (possibly the main interviewer)
Nope, I'm making dinner tonight.
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Drive-Thru Driver
You don't have time. Josh has practice.
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William Curb (Podcast Host)
Oh, that's right.
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Podcast Host (possibly the main interviewer)
I'll just get a salad and fries. No, just the salad.
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Drive-Thru Driver
But salad cancels.
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William Curb (Podcast Host)
Fries.
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Podcast Host (possibly the main interviewer)
Salad only.
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Drive-Thru Driver
Fries.
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Podcast Host (possibly the main interviewer)
Salad, fries.
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Chandler Garcia (PICU Nurse and Global Health Advocate)
Food noise isn't fair, but Mochi Health is the affordable GLP one source that
- [00:20]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
puts you on the road to successful weight loss.
- [00:22]
Podcast Host (possibly the main interviewer)
Hey, can I get the fries? Salad? Sorry.
- [00:25]
Chandler Garcia (PICU Nurse and Global Health Advocate)
Learn more@joinmochi.com Mochi members have access to licensed physicians and nutritionists.
- [00:29]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Results may vary.
- [00:30]
Chandler Garcia (PICU Nurse and Global Health Advocate)
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- [01:33]
William Curb (Podcast Host)
Welcome to Hacking youg adhd. I'm your host, William Curb, and I have adhd. On this podcast, I dig into the tools, tactics and best practices to help you work with your ADHD brain. Hey team. This week I'm talking with Dr. Anupriya Gonier, a psychiatrist at Brown University Health in Rhode Island. Dr. Gagne works at the crossroads of addiction, psychiatry and neurodevelopmental disorders, with a specific focus on treating ADHD during pregnancy and the postpartum period period. She's dedicated to clearing up the misinformation surrounding medication safety during pregnancy, which can be seen in her book Neurodevelopmental Disorders in Adult Special Considerations and Perinatal Period.
- [02:13]
Podcast Host (possibly the main interviewer)
In our conversation, we dive into why
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William Curb (Podcast Host)
hormonal fluctuations turn ADHD symptoms into a perfect storm, the actual science behind Mom Brain, and why your internal Systems for keeping your life together tend to implode
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Podcast Host (possibly the main interviewer)
the moment a baby enters the picture. We also get into the nuances of
- [02:27]
William Curb (Podcast Host)
how ADHD presents in Women vs Men, specifically regarding internal hyperactivity and emotional regulation. If you'd like to follow along on the Show Notes page, you can find that@hackingyouradhd.com 281 all right, keep on listening to find out how to stop comparing your internal chaos to everyone else's curated highlight reel.
- [02:51]
Podcast Host (possibly the main interviewer)
Looking over your bio and your clinical experience, I'm like, there's a lot to offer here, so I'm really excited. Could you at least get a start going with telling a little bit about what you do?
- [03:02]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Sure. Thanks for the opportunity. I'm really excited to be here. So I'm Dr. Anupriya Gogne. I'm a psychiatrist at Brown University Health in Rhode island and most of my work is outpatient psychiatry, but in particular addiction psychiatry and neurodevelopmental disorders in adults. A lot of trauma work. I'm also a perinatal psychiatrist and so treating ADHD in pregnancy and postpartum is also part of my work. I just wanted to come on and share my knowledge with if there's trainees in psychiatry watching this, that's great, it might help them. But also I think this is a great way to reach a lot of people. The podcast.
- [03:45]
Podcast Host (possibly the main interviewer)
So yeah, I'm excited because there's a lot that goes along with ADHD and these hormonal shifts in lease, both pregnancy and perimenopause and all of these things. And not a lot of people realize how much hormones affect adhd. Can you talk a little bit about how someone might kind of like realize that they are having these effects? Like because a lot of times people are like, oh, I'm just because ADHD is such a condition where people are like, I'm blaming myself for what's going on rather than being like, oh, there's
- [04:15]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
actually something happening or like I have quirks or I'm just lazy or I'm just careless or something, or absent minded or something. I used to tell these things to myself all the time. But yeah, there is a lot of that goes on. And many people think about ADHD as just executive dysfunction, which is basically attention, concentration, your ability to strategically plan something and those kinds of skills. But actually it is a lot more. There's a whole emotional regulation part of it, which manifests differently in men and women. There is a whole sensory part of it, hypersensitivity to certain things. There is impulsivity which is part of it. And then there's things that come after that. For example, risk taking is more common. So you know, those people are predisposed to head injuries which will then make the ADHD worse or substance use. Right. People whose we know that people with ADHD if they are not treated during childhood, that they are predisposed to using substances to self regulate. And so I see a lot of people like that now in my practice where they're struggling with the substance use disorder. But really if you go back into the history, it started in a way to cope with untreated ADHD symptoms. So you know, ADHD in pregnancy and the postpartum time is like the perfect storm for someone with untreated adhd. And so we know that in pregnancy in the beginning there's a lot of, in the first trimester, there's a lot of hormonal ups and downs. Estrogen, progesterone, cortisol, right. Then by the second trimester, hormones kind of plateau stabilize a little bit. So in the second trimester people do feel better just by themselves. A lot of them, if they are not sick, if they don't have any other complications, then in the third trimester the hormones peak by the end and then two weeks after delivery they very steeply fall. And that is when you know, the biggest change in mood can happen because of the hormonal influence. Hormonal influence is interesting because it has different effects on different people. There are some women where it doesn't affect them that much or it affects only their emotional processing, or it affects gives rise to mostly physical symptoms like pain and things like that. Right. Or pelvic discomfort. But then there are some women who are very, very responsive to hormonal changes. And so those would be the women if you pre pregnancy they would have had PMS like symptoms where before the period or mid cyclic when the hormones change, they would experience a change in their mood, but also executive functioning. So a lot of my female patients who are on certain medications for ADHD will tell me that the week before their period it doesn't work that well. And again, so this is related to estrogen because estrogen is related to dopamine in the brain and ADHD is a state of dopamine dysregulation. So simply one can say that that dysregulation that already exists in the ADHD brain of dopamine and norepinephrine, it gets even more dysregulated when the hormones are a factor. And that's why girls are More likely to get diagnosed around adolescence because that's when once puberty hits, then the estrogen progesterone is going to go crazy. We also know that girls are more likely to be inattentive type, right. So they might not be behaviorally very obvious that they have. Might be the kid in class at the back last desk just staring out the window, not concentrating in class. But they won't be disruptive. So no one would actually know that they might have had it. But around puberty, once puberty hits and the hormones come into play, then with the estrogen variations, there'll be dopamine variations. And so in certain periods, they will feel much, much the attention, concentration, emotional regulation, which is like ups and downs. It'll be harder to manage, basically. And so throughout pregnancy, in different trimesters, different challenges exist. But postpartum, really the first two weeks postpartum, after that, when the hormones fall very quickly, that is a shock to the system. Like, I think sometimes people don't realize that even if a pregnancy is intended and happy and like a wanted, desired event and everything went okay medically during the delivery, even if everything goes okay, it's a state of physiological stress for the body. Right. And so your stress system is already activated. Right. What that means is that your norepinephrine, dopamine, serotonin levels are already a little bit out of whack. And then postpartum, you know, mothers also stop sleeping because they're taking care of a baby. And it's not a one day or two day or one week. It's like months. Right. In the first year of audios. Yeah. And so, and especially if then they don't have a lot of help for childcare.
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Podcast Host (possibly the main interviewer)
Right.
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Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
And then they are the only ones who are staying up with the baby. So then there's periods of prolonged sleep deprivation and deeper stages of sleep is where memory is consolidated and the events of the whole day kind of are encoded in our memory centers. So if you're not getting those deep stages of sleep, then over time you're going to lose those memories. And so a lot of women who, a lot of moms would come and say, hey, I think I have like dementia, Alzheimer's or something, because I've never been this forgetful. I used to be the one who would always be on time for my appointments. Now I miss them. Like, that's really not like me. I'm forgetting things. I'm forgetting names of people that I might have met just once or, you know, I'm losing things constantly around the house because I don't remember where I kept them. I think I have dementia. So that's not actually dementia, that's basically working memory, which is our day to day memory as we are doing things. So it's not getting encoded. So there's prolonged sleep deprivation, there's a dip in estrogen, progesterone levels, a rise in cortisol levels, and then there's a baby now that they have to take care of. And so that changes their environment as well. So usually ADHD symptoms show up whenever there's a major change in life because it probably puts higher demands on the person. And so for moms, their entire family structure changes, the demands on them change, the expectations from them change. And so it's internal chaos with hormones and sleep and external chaos with everything changing. And so even if they were really put together pre pregnancy, which a lot of people with ADHD that have not known that they had ADHD is because it's not a problem of intellect. So kids usually learn to build all these compensatory systems. So, you know, so that I don't lose my keys, I'm going to keep them at the same spot every day, so then I will remember where they are. But once you have a baby, then you might come home, you're placing the baby, the keys are somewhere else. So the same systems that they had put in place to compensate don't work
- [11:59]
Podcast Host (possibly the main interviewer)
just like a perfect storm. Because I know like, yeah, your external environment has a huge factor on how well you're able to manage your adhd. And then your sleep is such an important factor of like for anyone with ADHD getting consistent sleep. And it's just like, oh yeah, all of these things coming together, just everything.
- [12:17]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
And I think the other thing that happens if someone was already on medications during pregnancy, most women stop taking their medications. So if they were on an ADHD medication, stimulant or non stimulant, oftentimes if people, the physician treating them, they're obviously is not well versed or even a psychiatrist, if they're not well versed with the latest safety data of medications in pregnancy, they are advised to stop and stop suddenly. So then all of their symptoms really get worse. And then when they come to us, then we can give them the correct information and tell them and often restart them on medications. The truth is that there's a very few medications that are absolutely contraindicated in pregnancy. There are a lot of medications we can use, but common primary care doctors or even psychiatrists who are not perinatal specialists don't always know that. So the other factor is that if they were stable on, let's say bupropion or amphetamines or methylphenidate, now they've also stopped taking those and they don't start them postpartum also because they're breastfeeding. So again, they worry that the baby would get some amount of medication, but actually it's quite insignificant and nothing happens to the baby.
- [13:36]
Podcast Host (possibly the main interviewer)
That's good to know. Yeah. Because I remember hearing that there was some changes in those recommendations coming.
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Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Yeah, there's been a lot of change. When I first got into the field like 10 years ago and when I was in training then at that time there was more concern about use of stimulants during pregnancy, mainly because of the risk of high blood pressure, the risk of high heart rate. So these physiological problems and some other problems like placental abruptions and things like that, abnormalities which can result in premature labor or really complicated labor. But now, I mean, I think there's newer data coming out every day. And now we have a lot of studies where we have used these medications during pregnancy and the effect is not as much as they thought it was. And so, for example, bupropion, which is a non stimulant, it's a common treatment for adhd. You know, it has some data, very weak data that shows some association with heart defects. So if the mother took it in the first trimester in pregnancy, there was some association with heart defects in the baby. But if you really critically go into the data, that association is very, very weak. Like it's not significant enough. And so people don't know that. Right. They don't know that if they stop that medication, then their depression might precipitate. And that also places stress on the pregnancy and the baby. Because when you are stressed out, then your stress axis is activated and you have high cortisol levels and those cortisol levels are passed on to the baby through the placenta and a little bit of spike here and there is not a big deal. But when they remain elevated, if someone remains stressed for months or weeks, then it does affect the baby. And we know that it can affect brain development, it can affect overall development, like low birth weight and things like that. And so the thought is that the fine, the medication might have some effects, but not taking it might have worse effects. And so that's how we kind of make that decision.
- [15:51]
Podcast Host (possibly the main interviewer)
Yeah, I mean, I always love thinking of the concepts of like, because I know a lot of people are very Medication hesitant, good reasons. But they also don't think about the effects of not taking the medication, which is in adhd, a big factor.
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Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Yep, yep. Especially for, I feel like women who are working or even if you're not working, even if you're a stay at home mom, there is a lot of the things that tasks that women have to do involve executive functioning. That has to do a little bit with gender roles and how society and culture is. I think it's changing now as we have, you know, newer types of families. We have same, same sex families. We have all types of different things now. And even gender is, is a different concept now than it used to be. Like 10 years ago. I did interview some of those couples to see is it, is there any difference? Because in heterosexual couples what we see is mothers are like expected to do certain things for the child. If the child is like not well put together, people often question the mother. They say, oh, what kind of a mother you are? Right. Or many women would come to me and say, hey, you know, if my husband doesn't clean or doesn't know how to clean, he doesn't feel like a bad father. But if I don't know how to clean my kid's room, I feel like I'm a bad mother. So they take it as a reflection on themselves. So, you know, things are different because of external factors as well as internal factors. We know that women also, the way our brains are, we have a tendency to ruminate and internalize things, which is again different from men. It's not that they don't have any problems, they just have a different set of problems.
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Podcast Host (possibly the main interviewer)
Yeah. And it's important to. Yeah. As we were talking earlier, you know, like the differentiation does mean the way you go about things is different as well.
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Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Yep, totally. And the emotional effect then it will have on you.
- [17:46]
Podcast Host (possibly the main interviewer)
Oh yeah, 100%. And especially if, you know, you have things like the rejection, sensitive dysphoria taking effect or just, you know, the. One of the interesting things I think is like thinking about the impulsivity side of emotions. Because we often just think of impulsivity and being like, oh, it's just the doing things. But it's also been like that, you know, like anger at like the drop of a hat over. You're like, oh, I didn't even realize I was getting angry. And suddenly it's. I'm furious.
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Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Yeah. I cannot, I cannot tell you the number of times the number of moms of not just babies, but younger kids because then we would, I would see them For a few years out. How many moms come for treatment? Used to come to come for treatment to me for the first time, because they were feeling guilty about yelling at their kids. They felt they were bad mothers, they would yell at their children, they were very irritable and they didn't want to be that kind of a parent. And a lot of it had to do with, in some cases, untreated adhd, where it wasn't just, you know, the fact that she's trying to maybe do the laundry and then the kid comes and distracts her and wants her to do something else, and then she's not able to go back and re engage. So task re engagement is a problem. And so then she has these multiple unfinished tasks unfolded, laundry, half done, dishes and so on and so forth. And we know that in adhd, your attentional shift, which means like, and not just attentional, also mood shift from one context of a situation to another. So for example, you know, if I'm doing notes on my computer, that involves a different set of centers in my brain than the ones I have to use when I wash dishes, right? And so this shift is the problem, is one of the problems in adhd, voluntary shift of attention for moms. They're like constantly have to shift and shift gears, right? Especially if they have multiple children who are young. And so what happens is. And then there's also sensory overload. Something that we don't think about is. And it's worse when you're sleep deprived. So, you know, like a lot of times moms would come to my office with their babies and the babies sometimes are colicky, so they cry and the cry is so shrill that it would dysregulate me. I mean, imagine that mom with untreated ADHD who's been up all night listening to that. Like, you know, how will. I mean, it's understandable. Her frustration tolerance, which is the technical term we use for how quickly you get frustrated, is very low. Because she's like her system is just set to explode. But then she also feels so guilty afterwards.
- [20:41]
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- [21:16]
Podcast Host (possibly the main interviewer)
I mean, I remember after my kids were born, we got like the pamphlet about never shake a baby. And I was like, why would we ever need this? And then like one colicky night, I'm like, that is why they gave that pamphlet. That's not what's going to happen here. But, oh, my God, I can see why someone would go there.
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Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Yep. And like, oftentimes, you know, the general layman doesn't know that there are. There's a colic clinic. Like, Rhode island is a very small place where I practice and we have, you know, a clinic where pediatricians only manage colic in the babies. But like, a lot of times the moms that used to come to us didn't know. And it is such a small place, like, everyone knows everyone and they still didn't know that these services were available. They still didn't know that they were psychiatrists who knew the data in pregnancy and could help them. So it leads to, like, a lot of delay in care and a lot of suffering and in case of mothers, silent suffering because they don't want to burden anyone else and they don't. They want to be the best mom ever. Which is a good thing in some ways. Right. But also becomes like a perfectionistic cognitive distortion, which we know that women with ADHD more often suffer from that. The perfectionism.
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Podcast Host (possibly the main interviewer)
Yeah, because they're often using it like as a masking. Like, oh, no one can complain if I. Everything I do is perfect.
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Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Exactly. But also they've had years and years of growing up experiences where they haven't been able to do certain tasks the same way neurotypical people have done. And so, you know, like, they might have seen their friends study for a test, get stuff done in like half an hour, whereas it takes me to complete the same task in like homework in like four hours. And I'm the one who's laboring at night. Right. But no one knows that. Like, I don't show that later. But you constantly compare yourself to your siblings, your cousins, your peers. So low self esteem develops over time and confidence gets eroded with these small, small insults. And, you know, women have a tendency to internalize them. So many women with ADHD usually tell me, I have. My thoughts are like a loop. Like if the song was on a loop, that it's negative self talk on a loop, which has developed not in one day, but throughout life because they were untreated. No one knew what was going on,
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Podcast Host (possibly the main interviewer)
including them with untreated ADHD and not knowing that it's there. It's just easy to be. This is me not being able to perform at a. And especially with, like, being the inconsistency of adhd, where sometimes, like, I was amazing when I did that. Why can't I do that every day? So it's like, you see that, like, potential and it's so frustrating when you can't get there. So it makes sense that the negative self talk just builds up because, like, oh, I know I could do better, but I'm not now, so that must mean I just don't want to or something. And. Or I'm just broken somehow.
- [24:23]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Yeah. And, you know, not just you yourself misinterpreted, but other people too. So, like, other people might think, oh, you get an A in class. Like, what do you mean? That you were up all night doing homework? Or like, what do you mean? Like, no one. These symptoms are masked. Like, no one actually when the kid doesn't know why, it takes them four or five hours instead of half an hour. Like, they don't. They just feel embarrassed about it. Or if there's a certain thing they're not able to do, they don't go and announce that, oh, I couldn't do this. Like, they try to mask and they try to be the same as their peers and kind of keep up with whatever the trends are all the time. But we don't realize that, you know, a lot of our systems, social systems or our academic systems are not ideal for an ADHD brain. Not because something is wrong with it, but because it is different and it needs a certain different set of conditions to work. But this confusion about, oh, you know, you're not stupid. Like, why can't you figure this out? You figured that out. It must be because you, you care about that and you don't care about this. And so it becomes like that.
- [25:33]
Podcast Host (possibly the main interviewer)
And, and it can be so frustrating when you're trying to figure out why that's the case. Because especially with ADHD and women being more inattentive, because that's not what we see in culture. In culture, we see the hyper little boy or, you know, the squirrel, whatever. You know, that kind of thing where it's like, oh, we only seen that. That side of ADHD in pop culture. And so it never feels like that could be what's going on.
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Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Oh, yeah. And this is not just for people who are not doctors. Even. Like, I grew up in a family of doctors, some of them being in pediatrics. And even they, you know, if, if there's like 20 years ago, 25 years ago, when I was growing up, we didn't have all this Information about adhd. And what it was, you were just kind of the culture was that you just sit and study. That's your only job. And you just get stuff done. Like, no one even thought, even doctors did not think that they might be missing something. And it was often, like, put on the child that, oh, you know, you're just making excuses or you don't like this because, I mean, I see you go outside and play and do really good. You do really good when you play certain video games. Why can't you do the same when you do this? Because a different part of the brain is being used.
- [26:51]
Podcast Host (possibly the main interviewer)
Yeah. And it's. Well, and I mean often too. It's just like, oh, yeah, like for video games. Like, it's hitting those right dopamine switches right at the right moments. Like that is by design. Whereas doing the dishes is not doing that.
- [27:04]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Exactly, exactly. But also, not everyone finds reward in the same kind of things. Right. Like, if I take my example, my husband loves to clean. And he, after cleaning, he feels good that, oh, I did this. I hate to clean. It takes a lot of mental energy to clean. And when it's done, I'm just thankful that it's done. I don't feel great that, oh, my God, I did something. I would have rather done something else that I was interested in. Right. But you do it because, you know, those become chores and not things that you're interested in. And this is something that people should know about adhd, if especially you are very good at certain things that. And those are the things that you're interested in and other things you struggle with, especially tasks involving a lot of steps, or if you're a student, then you know, subjects that bore you. You might be very good at some subjects, like I was very good at biology, history, more kind of theoretical things, but I was not good at math. Right. And so. Or physics or things like that. So it varies so much. But also usually what happens is if you send these kids for testing, or even as adults, when you test them, neuropsychological testing, which is a detailed testing of your all your cognitive functions, what you see is a discrepancy in the scores. Some scores will be very high and some very low. So whenever that is seen, that is indicative of something to do with neurodevelopment gone awry. And so that is one way that if your kid is really good at something but struggling with a very specific set of things that you should take them to the. You should report it to the doctor and get evaluated further. That doesn't really change in adulthood, like when people are struggling at their jobs.
- [28:59]
Podcast Host (possibly the main interviewer)
Yeah, absolutely. Because I started working with a producer, it's last year now. And the number of tasks that I can send his way, that I am just, I can't get through, and he's just like, oh, yeah, that took me two minutes. And I'm like, thank you. Like, this is, this port makes life so much better to be able to go, oh, yeah, I don't have to do everything on my own.
- [29:19]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Exactly. And so part of treatment, when I start treatment with someone like an adult who has been undiagnosed all their lives, this is their first time exploring the question that they might have adhd. I often say that the goal of treatment is not just to prescribe a medication. And that's, you take it and everything will be magical, everything will be done. Now the goal is to create an environment in which your brain can function the best. And so really the whole initial diagnostic process, the questions I'm going to ask you, the tasks that I'm going to give you during testing, all of that information will help you to understand how your brain functions. For example, in my testing, it showed I process auditory stimuli better than visual. Some people it shows visual processing is better. So you can actually use all that information and translate it into day to day life. And you would understand why certain things are your weaknesses and why certain things are your strengths. And the goal of treatment is to identify the strengths and really hone in on them and help you create an environment where you can use them and get support for the areas of weakness without feeling guilty or criticizing yourself. Right. And so if I just choose the example of mother's young mom who used to come with me, come to me for treatment, like for them, it would mean. Because what happens is when the person cannot do those tasks, their reaction often is, I'm going to try harder, I'm going to try harder. And the more they try harder, the more frustrated they get with themselves. So it's never helpful. And so what I tell them is that needs to stop. Let's say you really hate doing household tasks, but you're really good at your job, right? And so that's okay. You can do your job, earn enough money to hire a maid to do the household stuff, like, that's not a bad thing. That doesn't mean that you're not a good mother or you're not a good wife or so on and so forth. And you would be, you would achieve much more and waste much less time if you Just focused on your strengths.
- [31:35]
Podcast Host (possibly the main interviewer)
Yeah.
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William Curb (Podcast Host)
And it's such a hard thing to
- [31:38]
Podcast Host (possibly the main interviewer)
initially get your head around because it does feel like you're failing. Like, oh, I can't do this thing that seems like everyone else is doing it. But I always try to remind myself when I'm doing like I'm comparing myself to someone else's. Like I'm not internal, comparing myself to their internal life. I'm comparing it to their. What they're curated, showing me what their life is like.
- [31:59]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Exactly. You might not even know what goes on. Like they might be masking. You might not know. But even if you knew, it's like comparing apples to oranges. And in the long run it won't really matter. Like I'll tell you, when we were kids and I was very bad at math and physics and so I used to think I'm a dumb student. I just like biology because I can like kind of, I'm good with rote learning, which means that you can memorize facts the if you just read them enough number of times. So I thought, oh, you know, that, that is, that seems like a nerdy thing. But like I'm not smart like my brother and I don't know math I can't do. My brain can't think like that. Whereas in the long run it doesn't really matter because then I chose psychiatry, which is a branch of medicine where you don't need a mind like math, you need a mind in biology. You need to memorize facts, do like take in a lot of theoretical information and then translate it into day to day behavior and how then one person's behavior affects other behavior, other people's behaviors, and so on and so forth. So it involves a lot of thinking outside the box in a different way. It's not that I was dumb, it's just that I was different and good at something else. I hope kids, parents give kids this message where, you know, they can say it doesn't matter if you're good at A and your brother is good at B, both can be successful. It doesn't matter in the long run.
- [33:38]
Podcast Host (possibly the main interviewer)
I do vastly different things than any of my siblings. So it's like.
- [33:42]
William Curb (Podcast Host)
Yeah.
- [33:42]
Podcast Host (possibly the main interviewer)
And so one thing I was thinking about here too is so we were talking about early on with the mother being the head of the household often like running things and was recalling in our pre interview, you were talking about too how often she's taken on this role of bringing in family members to get this diagnosis because she's not seeing it in herself, but is Seeing it in other family members, either the husband or children.
- [34:09]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
I mean, the context in which I see it clinically. So what I see and what we know is that boys and men have more externalizing symptoms in adhd. What that means is that if they are hyperactive, it comes out externally in the things they do in their behavior. So it's very noticeable. Women might be hyperactive too, but theirs might be more internal in the form of releasing thoughts. So it's a hyperactive mind, not necessarily, necessarily a hyperactive body. And so, and then the emotional regulation part, men struggle more often with anger management. And so what tends to happen for men is that they get angry very quickly and very intensely. And that's when they're also not able to regulate their behavior. And all that externalization of distress happens. So they might yell, they might throw things, they might drive very fast because they're angry and get into accidents, things like that. And so a lot of times what I would see in families is the mom noticing that she would come in and say that, hey, like, you know, I'm walking on eggshells around my husband. Something is off with him, but he doesn't want to get help for his anger. And it's, it becomes like around the anger and that being some kind of diagnosis where it's coming from something else. And even for boys, the mothers might notice those things more, especially like stay at home moms, they notice the child's behavior in different contexts and so they are observing more. And if the father is working, he would not be observing all of that and so he would not have that information. And so I think by virtue of the social situation, the social aspect of mothering and women being more internalizers, which also involves self reflection and reflection on others, like being more mindful of other people's behaviors, that they are more likely to go and get help rather than men. And it happens a lot of times.
- [36:16]
Podcast Host (possibly the main interviewer)
Yeah, well, and it's interesting too, with the highly genetic factor of ADHD being like highly heritable. And so especially when you do have one family member getting diagnosed, it tends to spread out.
- [36:27]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
And also sometimes I've had mothers who noticed when they're, that they have these problems, when their kids were diagnosed with these problems. I have a mom who is now diagnosed both with ADHD and autism. And her diagnosis came about because she took her son for the testing and was like, oh my God, I can't do this too. Like, oh my God, oh, so this is what this is. And that's how then she explored her own diagnosis. And so, you know, definitely. Then, you know, in my job, working with the moms, you end up helping the whole family sometimes in this way.
- [37:06]
Podcast Host (possibly the main interviewer)
Yeah, well. And I've even seen it go even, like, you know, the next generation up, too, where they're just like, I have adhd. I think my mom has adhd. And it's like. And it was like, oh, yeah, that's
- [37:18]
William Curb (Podcast Host)
just how, like, your great grandma was.
- [37:20]
Podcast Host (possibly the main interviewer)
And it's like, okay, this is a really strong pattern in this family.
- [37:25]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
And so, you know, definitely there is a genetic predisposition, but then there's also the role that external structure plays. Like, I can say, when I was growing up in India, like, we had, like, very kind of strict parenting and structure in schools that is different from how it is here. It's not good or bad, it's just different. But I think for me, that was really helpful to contain the restlessness and to impose a structure on me, which felt like an imposition at that time. But it really kind of really structured me towards striving towards a goal. Otherwise, without it, I would have been completely lost and not being able to realize what I should be doing in life. So, you know, there's genetic predisposition, and then what happens to you in school, what. What that environment is like, and then what's going on at home, what the family system is like, and how much guidance you have. Like, I think one thing that's been helpful throughout my training and career is like, finding a mentor. Like, wherever I went for training, I always found one person who can be like a mentor and who can kind of guide me through each step and keep me focused, focus to stay on task. Because that is really difficult in adhd.
- [38:40]
Podcast Host (possibly the main interviewer)
Yeah, absolutely. It's very much a condition where it can feel like we know what we need to do, but often we are missing a few of the steps in between. And so we're like, I know I need to get there, but I don't know how to get there at all.
- [38:53]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Yeah. And the fact that you know that you have to do it, but you're not doing it makes you feel worse.
- [39:01]
Podcast Host (possibly the main interviewer)
I know what I'm supposed to be doing, but I'm not doing it, and I don't know why.
- [39:04]
William Curb (Podcast Host)
And makes it really hard.
- [39:08]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Yes, definitely. Like, I think that on one hand, I say, we want to say that neurodivergence is not like, these neurodevelopmental disorders are not all disorders. It's divergence, biodivergence, neurodivergence, that it's just a variation in the type of brain. And I completely believe in that. Right. But as a clinician, a disorder for me, any disorder for me becomes a disorder when it starts to affect your functioning. It starts to affect your relationship, it starts to affect your mood and your physical condition. And when someone's ADHD is untreated, all of these aspects of life can be affected, and it can be highly disabling if it's not treated. And it can really get in the way of, like, you being a respons. Like feeling like a responsible adult. Because a lot of tasks which adulting involves are like, even like opening the mail. Remember to open the mail. Going grocery shopping, cooking. Like, if you think about it, all these tasks have so many steps.
- [40:13]
Podcast Host (possibly the main interviewer)
Yeah. And with that untreated ADHD side, it makes it just seem just bonkers that you would be able to get through it.
- [40:21]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Yeah. Yeah. It seems like when people come to me and they're starting treatment for the first time, or they're just exploring what is wrong with me, that's usually their initial question. I explain it to them kind of like this. I take the example of the Superman movie, the one with Kevin Costner, the latest one that came out. And basically when Superman is a kid and he doesn't know he's Superman, he has all these powers and he's just overwhelmed with it. He doesn't know what to do. He's an outcast, Kids are bullying him, he's by himself, and he's just basically has sensory overload from all his powers. But once he learns how to channel then towards a certain direction, then he's Superman. So at the beginning of treatment, we are at a point if I say to someone, hey, you have these superpowers, like, you are really good at xyz. You know, they don't believe me at that time, and they shouldn't because they're having so much difficulty with usual adult life and usual tasks. And so, you know, on one hand, I think it's. It can be really disabling. But also if we can help these people with or without medications or, you know, even many people actually don't end up needing medications. And we can do a lot of other things to help them, but once we are able to help them and they are able to realize their full potential, then they are very good at what they were interested in and they can excel in that field a lot. So in that way, I don't think it should be called a deficit or a disorder. Like, I feel attention deficit hyperactivity. Impulsivity disorder. Like, there's two words in there which can have a negative connotation. And so it can be a negative if we are not channeling it right and we are not supporting. Supporting the person how they should be supported. But if we do, then there is nothing wrong with them. This is different from other psychiatric illnesses like schizophrenia or bipolar disorder or severe ocd. Like, those are different where, you know, there are certain chronic things that go on, and with time, things happen to the brain if it's not treated. ADHD is a little bit different. Like, you know, it's more a state of dysregulation rather than deficit.
- [42:48]
Podcast Host (possibly the main interviewer)
Yeah. And if you can figure out those ways to get yourself back into regulation, it's. Yeah, it's not the same huge issue that OCD would needs to have a very, you know, corrective approach, because without intervention, it gets much worse.
- [43:03]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Yes, absolutely. Absolutely.
- [43:05]
Podcast Host (possibly the main interviewer)
All right. I was wondering if you had any
- [43:07]
William Curb (Podcast Host)
final thoughts that you wanted to leave the audience with.
- [43:09]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Times have changed. There is a lot more information within medicine that doctors have now to recognize these symptoms. There is a lot of specialized ADHD clinics that treat adults. There's a lot of different kinds of therapies that exist. Psychotherapies, I mean, in addition to medication. So there's a lot of ways that are possible now, and especially with AI and some of the gadgetry, like, I use, like, an AI agent for organizing myself. Like, so there is a lot of supports now that were not there 10 years ago. So if they are noticing any kind of pattern in their behavior or their family members are telling them something, all they need to do is get an evaluation. They can always get a second opinion if the first one didn't seem right. There are things that can be done to help them. And like, I think there's a book called Lazy. I'm not Crazy, Lazy or stupid. So they are definitely none of those things. ADHD by itself is not a problem of intellect. And so, you know, but it's also not as simple as if you put your mind to it, you'll know it's nothing is like that. No one is like that. And everyone has, you know, even if they don't have adhd, might. You don't know. Other people struggle and what goes on in other people's mind. So stop comparing yourself to people and see what you're good at and whatever is getting in the way. There is help for that now. There's a lot of things that can be done.
- [44:43]
Podcast Host (possibly the main interviewer)
Fantastic. Well, thank you so much for spending
- [44:46]
William Curb (Podcast Host)
the time with us today. It's been great.
- [44:48]
Dr. Anupriya Gogne (Psychiatrist at Brown University Health)
Yeah, it was. It was lovely. I hope people find it helpful.
- [44:54]
Podcast Host (possibly the main interviewer)
Thanks to Dr. Gagne for coming on
- [44:56]
William Curb (Podcast Host)
the show and thank you for sticking with us all the way to the end. Before you go though, let's do a quick rundown of today's top tips. 1. When ADHD symptoms suddenly appear or worsen, it's often not because the brain has changed, but rather that the environment's demands have finally exceeded the brain's compensatory systems. When life transitions occur, such as having a child, external chaos disrupts the system that previously helped keep the ADHD in check. 2. Chronic sleep deprivation isn't just being tired, it's also a failure of the memory consolidation systems. While we are in deep sleep, our brain is encoding the day's events. If you aren't getting those stages of sleep, your working memory cannot function properly. These memory issues then compound with ADHD symptoms which can make it feel like you're experiencing some early onset dementia.
- [45:48]
Podcast Host (possibly the main interviewer)
3.
- [45:49]
William Curb (Podcast Host)
In many adults, and especially in women, hyperactivity often isn't physical. Instead it's mental. It can manifest as negative self talk on a loop, racing thoughts, or just feeling like you have too many tabs
- [46:01]
Podcast Host (possibly the main interviewer)
open in your brain.
- [46:02]
William Curb (Podcast Host)
Shifting the mental model to see internal ruminating as a form of hyperactivity helps identify the need for mental breaks rather than just physical outlets. Alright, that's it. Thanks for listening. I'd love to hear what you thought of this episode. Feel free to connect with me over@hackingyouradhd.com contact if you'd like links or to read this episode's transcript. You can go to the show notes page@hackingyouradhd.com 281 and if you'd like even more hacking your ADHD, be sure to sign up for my newsletter any and all distractions which comes out every other week. In it I get give out my best distractions of the week, be they what I'm reading, what I'm playing, what I'm watching, and everything in between. I also try to give out a few bits of actionable advice in each newsletter, although your mileage is going to vary there. If that sounds like something you're interested in, head on over to hackingyouradhd.com newsletter to sign up. Also be sure to check out our Patreon, which you can find@hackingyouradhd.com Patreon it's
- [46:58]
Podcast Host (possibly the main interviewer)
a pay what you want model, meaning
- [46:59]
William Curb (Podcast Host)
all levels of the Patreon respect receive all the same stuff and every week I'M trying to give out a little bit of behind the scenes footage and also some early access to the episodes. Also, be sure to check out our Discord channel, which you can find@hackingyouradhd.com Discord and don't forget to subscribe to our YouTube channel, which you can find@YouTube.com HackingYourDahd and finally, if you'd like another way to support the show, the best way to do so is to tell someone about the show, especially if you think a particular episode would resonate with them. Just click the Share button on your podcast player. And now for your moment of dad People are usually shocked when they find out that I'm not a very good electrician.
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