AuDHD Expert: What Female AuDHD Really Feels Like, THIS Trait Makes You Vulnerable!

0:00Propel Fitness Water. With Gatorade electrolytes, zero sugar and vitamins. Propel hydrates better than water to help you get the most out of your workout and get back to your best self. What propels you? Propel with Gatorade electrolytes. ADHD neurotype is different to pure ADHD and pure autism, but it overlaps with autistic girls and women's social communication patterns. We are driven to connect. It can come across as looking quite innocent, having dissonance about how people feel, what they tell you and what they really want. It's not that we do not sense it. It's that we sense so much. Dr.

0:36Samantha Hugh is a highly specialized female ADHD and autism expert with a PhD in medical science. She's here to give you a detailed crash course in Audie HD and help you spot it. With Audie HD, there is that heightened cue detection. The salience network trying to pick up stimuli from your environment. But an Audie HD-er who had been through trauma in their lives, that salience network then becomes a threat detection more than cue detection.

1:02Dr. Samantha Hiew:How would you explain how it feels that might help somebody recognize it? First of all, if someone's thinking that they might be Audie HD, I would... So sorry to interrupt your hyperfocus for 30 seconds, but you're going to want to hear this. I've been working on an epic side quest. I've just launched the ADHD Chatter Patreon, which is where I'll be connecting with my community on a much, much deeper level. I'll be doing live body doubling sessions, behind the scenes bonus questions with all of my world-renowned podcast guests. I'll be sharing the best, most transformative ADHD hacks over there, as well as hosting a private chat between myself and all of you guys.

1:40Dr. Samantha Hiew:And that's really exciting because it means we all get to hear each other's coping strategies as well as feeling much less alone. The ADHD Chatter Patreon community really is the place to be if you want to transform your ADHD from a place of understanding into one of truly thriving. You can join right now using the link in the description. Back to the episode.

2:04Dr. Samantha Hiew:if someone's listening or watching who has adhd and they suspect that they might also have all dhd what could you describe the condition how would you explain how it feels that might help somebody recognize it yeah so first of all if someone's thinking that they might be all dhd I would question what brought them here. With ADHD, because of the co-occurrence of the ADHD traits and the autistic traits, and I've spoken about this before in the last episodes, where it is often a collision of the nervous system of wanting sameness and also craving freedom and, you know, adventure. so for someone who is ADHD your life would look like on any given day maybe you just want things to stay the same but then there's a part of you that really want to do something new you know and many people with this ADHD neurotype tend to end up in squiggly careers you know throughout their lives where it's like you have so many different hobbies and interests and jobs you know and you know different maybe different relationships um but yeah definitely that uh wanting to chop and change just when things are good and stable and secure i mean that sounds like quite a confusing existence with so many different push and pulls and perhaps contradictions can that be quite a distressing experience for somebody living with with that two opposing sides of their brain?

3:47It is more distressing when we're in the middle of change or when we're at a place where we want change because it's when you feel like you know your life is stabilized and then all of a sudden you just don't want that anymore and you want something completely different and often it is that middle place you know that people can feel destabilized in you know are looking for an anchor

4:12Dr. Samantha Hiew:i said at the beginning audi hd is such a big conversation within the community at the moment and there are lots of people having conversations on it which is which is brilliant and i always like to bring um the the the best most credible people onto the podcast could you explain your qualifications to the people who are watching and listening yeah so it's interesting because I mentioned a squiggly career and if I were to bring the qualification that is relevant to this is that I have lived experience for 44 years going on 45 now and I've lived with a brain that I didn't understand for decades and it was only in my 40s when I was diagnosed that I you know only began that excavation but my career began in cancer research and I studied genes molecular biology biochemistry and cancer research so I looked at how people's genes manifest into diseases and I culminated in a PhD in cancer research at the age of 30 and then came out and swiftly landed in 16 different industries one of which I told you about which is in commercial modeling and acting and for a really long time I was really ashamed of it and it was because I keep hearing from people who said to me but you have a PhD Sam why are you doing modeling and I did it because part of it was because there was something inside me that really wanted to come out you know I wanted to express myself you know so much of my life was so inward and it was so contain and also the other part was because I was a mom and being a freelance model was something that earned me better wage you know better rate you know at a more flexible timeline and it was hard after I gave birth because I had a period of postnatal anxiety and really low low mood and wondering who I am and what am I doing and I bring the science head and the heart of living as an ADHD to this.

6:18And I think that's what people resonate with.

6:21Dr. Samantha Hiew:And you've clearly stuck at and done incredibly well in the field of neurodiversity and raising awareness about ADHD, I think, predominantly, but now more so ADHD. What is it, do you think, about this particular topic that has maintained your attention or made you the most passionate that you've, I imagine, been about any of your different points in your squiggly career? Yeah, so the career really started from trying to figure out what happened to me and what happened to us. That's why when I created ADHD Girls in 2021, it was very much to try and understand what ADHD looks like in women. You know, because what we have known is that the assessments that are done for ADHD and autism is very much gender bias.

7:07and because of my own cultural difference, you know, I also noticed that some of the things that were, you know, tough for me was highly masked and I wasn't really able to relate to the diagnostic criteria, which led to then also difficulty in getting my autism diagnosis, which took me seven months, you know, to almost try to convince them that I'm autistic. And the whole excavation into ADHD led me to then you know to speak to the community and people were talking about what it's like to be autistic too and I was like oh my god that's me and they were saying how they could be quite blunt in meetings in workplaces and I've offended my boss in my first week at work when I was working in Imperial College and he pulled me into a room after we had a meeting and he said that the way I was challenging, the way things were done, is not how you do things here.

8:10And he's like, you don't talk to people who've been here for 20 years that way. And I was like, was I rude? I didn't even know because all I really wanted to say was the truth and what I saw as the truth. But to someone else, it looks like I was this rude, inexperienced person who came up from university, well, from academia. and you know I've got to say the world of academia we're very much like secluded we're academics we look at books and we don't communicate science very well you know so when I kind of went into communications doing that work then yeah people were shocked by the lack of social you know understanding and yeah so that brought me to really excavate into ADHD and it was not only Only after I was denied an autism diagnosis three times that I've wondered what in the world is ADHD?

9:04What is ADHD? Look like in women, you know, why don't I recognize myself in the diagnostic criteria that we're using, the ADOS? You know, and they put all of my challenges down to trauma. because I was going through a lot of trauma in the time when I was going through the assessments. But is ADHD different to trauma or is ADHD something that can co-occur with trauma? And I went ahead and did the live experience research myself. I created the first comprehensive ADHD women's survey and within a month and a half, we had 400 replies. It was a very long survey as well. So well done, you know, to everyone who filled that in.

9:53And we, you know, then found out that it does look different to what we were assessed on. And then a month later, Gina Rippin published a book called The Lost Girls of Autism. And she said herself in there that she had been part of the problem that she was trying to solve in that before she thought that there was no gender differences between autistic girls and autistic boys and autistic men and autistic women, but then she realizes that there is. And there are a lot of differences in that autistic women tend to be more worried to look for social connection. And in fact, their social connection patterns look like neurotypicals.

10:36So what does that tell you then about the assessment that we're doing, where we're asking autistic women and girls, can you socialize? Can you make eye contact? Can you make friends? And what if we say we can, you know, but we may not be able to maintain them for long, but we can, you know. And perhaps not maintaining it is the most painful part about being an ADHD woman.

11:00Dr. Samantha Hiew:You said a moment ago that you were denied an assessment for autism three times. Who denied you and why? I talked about it before and they have since been very sorry about it. then there was two clinical psychologists and i went through the nhs route it only came four years after i first you know um approached my gp for it uh because it was on nhs so i just thought okay by then i had really self-identified as autistic as well but i i thought you know just go and see what it's like so these two clinical psychologists um who interviewed me over a period of half a day. And I very blatantly remember thinking I didn't prepare because I thought, ah, I'll be fine.

11:51You know, I know enough about autism. And I went in. And the first thing I said was, do you know there's a gender bias in assessment criteria? And they were like, yeah, we'll try and ask you questions in different way. or, you know, we can also, you know, get you to look at the masking scale, which is quite common for autistic women. And I was like, okay. And then we went through the assessment. And yeah, in the end, they put my challenges down to trauma. And it was traumatic. The whole assessment was traumatic. Because it asked so much about the friendships and the relationships. They asked if I was bullied, you know, things like that.

12:28And could I make friends? When did I have my first friend? you know and my mom would always say that I was very sociable as like a little girl always had friends I was very cheerful and yeah I was very talkative which is everything against you know what we know about autism so because of that they they thought that I didn't you know I wasn't and also because my work that I said I'm obsessed about they said but that's what you do you would be and i'm like well i have to be obsessed about it in order to do it you know and and that was also discounted but later we know that autistic women tend to have different interests you know to autistic men and our interests tend to be more geared towards understanding human behaviors and that's why so many of us are in the helper profession very highly empathetic and you know

13:15Dr. Samantha Hiew:really interested in helping people you think that empathy is what drives you today to raise awareness of all dhd and women part of it yeah the empathy helps me it helps me do the work well it is the sense of justice of being underrepresented that drives me every day and lately because i have realized there's a difference in how people with different neurotypes whether it's adhd and all dhd respond to treatment and care you know that drives me to do this work because I have my own health crash two years ago from being in a period of high stress and everything collided and yeah I then went you know through a very long journey to kind of dig myself out of that hole and actually then realized that because of my way of being my neurotype that is different from what people conventionally know as you know ADHD and autism.

14:19I respond to medication differently you know hormone replacement therapies don't work the same way as people would imagine for me because I'm also hormonally sensitive and because I have also been through some pretty traumatic times pretty dark times that changes how the nervous system reacts to treatment and also people and you know so everything else has to be tailored to

14:46Dr. Samantha Hiew:this population in a different way that hole you mentioned two years ago how deep did that hole get and what did that look like very deep it was uh very painful you know i listened to your interview with dr william dodson he talked about rsd and he talked about this woman with one of his patients who apparently even two years after leaving a relationship was still experiencing RSD, you know, or what you then ask him, is that CPTSD or PTSD? Does that look like that? And he said, yeah, it can look like that. And that whole lasted so long because, and that happens so more often than we talk about, you know, what really led me to do this work is that during the toughest time of my life I was speaking to a trainee therapist you know I was going through a divorce I was then also dating somebody who was doing a push-pull dynamic with me and then it was only recently I read an article in the psychology magazine, it talked about the intermittent reinforcement that these women who's all the HD women also went through and I resonated with everything because the RSD that I got the PTSD that I got from the relationships wasn't

16:28strictly my fault. You know, it wasn't because I was abandoned or I felt like it was unsafe. It was more because someone had led me to think that they were going to be there and then very abruptly disappeared when I started to ask for something that I need. You know, it was that wish pool that lasted over two years. and I allowed that to continue because I would receive that person back you know each time they go away and then after they've regulated they come back to me and I was like okay come in and I never put a stop to it because I wanted connection you know I wanted this great love you know but it was a form of self-harming in some ways you know but it was also a situation where I could not really control and in my period of going through that I was quite dysregulated when I was speaking to my therapist because it is hard you know you come to think about it you're having a divorce your ex-husband you know blames you for everything and took no responsibility for what they appeared to be in all the years when you try to make the relationship work and then And then you have someone who clearly needs you because you can help them, but then has made these promises that they cannot keep.

18:00And there's this dissonance about what's going on with me. And then I have two children who I need to be there to hold space for. And in that moment of my dysregulation, the trainee therapist said, it sounds like you have borderline traits. There was just something in me just broke there. And I was just like, wow. and she was meant to be a friend you know she was my neighbor and she said that and I had a feeling that maybe she was taking sides you know as of course the woman who is dysregulated is the crazy one you know and the man who can appear to be okay and you know keep up the facade is is the calm one but why is the woman dysregulated you know in a relationship could it be that she doesn't feel safe instead of telling someone who is in a moment of deep crisis you're telling them you have borderline traits would you ask are you being abused are you going through something that makes you think that your reality isn't real that's constantly being dismissed here and rejected rejected there but really was cowardice on the other person's part that I took responsibility for and no one could really understand where I was and I was in deep victim mentality you know and I know how hard it is to be so misunderstood when no one is in your corner because no one thinks you need help you know and years later someone was saying to me you know it's because you are the strong one I was like is it true is this what the strong ones have to go through you know but there was so much in there because when I was going through all that I think maybe there is some truth that I appeared intense but what is autism but intense you know we are on a spectrum of intensity and women autistic women are intense you know because of the way our brains are wired quite differently to autistic man and um yeah then i this is related but it was something i watched recently um on a podcast uh with dr anna lemke who wrote the book dopamination and she's a psychiatrist uh she said that people who were in the deep throes of addiction can appear with those borderline traits or narcissistic traits or personality disorders and in some ways i don't disagree because when you are in that intermittent reinforcement with somebody that push-pull dynamic you know where someone comes you know your nervous system is oh i feel safe oxytocin gets released and then they pull away you get a withdrawal you know and over time when that keeps repeating you develop a person addiction not really by choice but because of that pattern and so the dysregulation that happens then when you go to the mental health services the trauma and mental health services if you do not have the means to advocate for yourself you could very easily be sectioned.

21:31You know, like I know people who treat borderline patients in the NHS and they said that these women often have a history of addiction but they're also quite severe because they have multiple things that they are addicted to, whether it's alcohol, you know, drugs. but often there is a relational connection you know some relationship then work out in their lives and then you know in that the difficulty they end up there you know and and I asked what is the actual thing that helped them you know is is it the dbt the dialectical behavioral therapy that people prescribe to you know those with intense emotions and I said it's the um it's learning in that group setting and keeping each other accountable but apparently at first they hate each other because there's a sense of competition but I find that so meaningful because the feel of psychology you know and mental health services now do not see borderline personality disorder as something that you know is on a surface level like they don't see it something that we should stigmatize because they're using a different term now and it's called this disorganized attachment.

22:53And they're saying, please don't stigmatize disorganized attachment like we did borderline. You know, and the number of ADHD women I know who end up in mental health services and psychiatric units because they were thought to have EUPD or BPD is really upsetting. You know, and I feel personally upset because someone did say that I, you know, have those traits and I was like wow okay you know but I know myself and I knew that there are times where even though I'm dysregulated I can get back to baseline and guess what helped me it was a friend of mine who told me that Sam you are going through so much in your life right now of course you're going to be upset you know and in distress you're not this you know and and for once I'm like really grateful you know that i do not believe in the label thank you so much for sharing that yes that was a huge monologue it took me two years to come up with that are you okay yeah fine fine like i've

23:58Dr. Samantha Hiew:been back and forth and i'm good i'm good when you were going through that horrendous traumatic period of your life where were you at with your awareness of your own neurodiversity Had you had your ADHD diagnosis at that point? I had ADHD diagnosis, but I didn't know what ADHD really meant. You know, of course I knew what autistic mean, you know, but it was very pigeonholed to the generic consensus. I, yeah, it was not until maybe two years later that I realized that we are an entirely different species. and with the the memory of the trauma that your situation caused you when you did finally get the ADHD diagnosis or the autism diagnosis to accompany the ADHD diagnosis when you heard those words how did you feel in that moment well it came after seven months right of being invalidated and I was crying every session so I was pretty much traumatizing them as much as they were traumatizing me because I was like why would you give it to me am I just a bad person you know and the fact I was so dysregulated should probably have told them you know but after that I oh I just remember the day I received the diagnosis I thought I wasn't gonna get it and I was thinking why do they even want me to come in if they're not gonna give it to me so I sat there and I said to them that I feel like I'm the only person here who have my own back you know and they said um but we're gonna give you a working diagnosis I was like what does that mean you still don't understand it you know working diagnosis is that like a it's a draft diagnosis yeah so it's because I never had a developmental witness I didn't ask my mom to be one because I thought you know she's only gonna sound very talkative and you know things like that it's not really gonna help and Her memory is not that great anyway.

25:57So I asked my ex-husband to be my developmental witness, which went down so not well. So yeah, a working diagnosis is usually given when there isn't enough evidence in the developmental timeline. But why are they looking at that now? That we know in July last year, in the summer last year, Princeton University came up with this paper where they talked about at least four new subtypes of autism that look nothing. like what we believe autism to be. And two of the classes at least do not have developmental delay and reappear neurotypical until later in life when whatever, you know, life happens. And this population tends to have a higher rate of mental health conditions.

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27:21Dr. Samantha Hiew:And now it's even more simple with the AI planning assistant Timo offers an incredible new voice transcribing service, making it even easier to use. It's almost so simple that it feels like a cheat code to play life on easy mode. Give it a go and use the link in my bio for 30 % off. Just a note though, this code is only applicable on the web browser, not the smartphone. Back to the episode. I speak to a number of people in this community. and one bit of feedback I get is that going for an assessment of whether it's all dhd autism or adhd there's a lot of fear that can come with the process because there's always like this nagging feeling in the back of your mind like what if I'm wrong what if I don't have adhd or what if I'm not autistic like then then what's wrong with me like I feel like that is the explanation for for the struggles and the challenges that I'm experiencing and to get a diagnosis will cement that suspicion but what if the psychologist says i don't do you see that fear during the assessment process is that quite a common emotion 100 100 i went through it myself like i was invalidated it wasn't even a fear anymore it was fact and the fact that like i say the diagnostic criteria is very confusing to most of us because we actually do not understand it There's a real dissonance.

28:47It feels as though you're going into a neurotypical system, even though it was meant for autistic assessment. But it feels like you're going into, you know, and being assessed in a way that actually you don't relate with. You know, so many fall below the threshold, the clinical threshold for diagnosis. And then what are they? You know, and my own question to them was, if I don't get this label, then what am I? Am I just a terrible person? because I went through loads of meltdowns during those difficult periods, you know, the two years where my therapist decided it was a good time to do trauma therapy.

29:27And I really appreciate her. But the modality during that time was so distressing for me because I had those memories come back in real time whilst I was co-parenting my children. And I remember taking myself to the bathroom just to be a safe person for them so that I don't dysregulate and shout because some things that they were doing were triggering me. Yeah, I was having those meltdowns and it was awful. And I know now that we really need to think about timing when we do this deep work, you know, because not everyone's ready for that deep excavation. Some of us really, you know, really need that protective layer because if we're not ready for that work, it can unveil a whole lot of difficulties that you have very neatly concealed for decades.

30:19Dr. Samantha Hiew:So if the medical community is woefully behind in recognizing and understanding what ADHD actually feels like and looks like in women with your experience how would you describe it what would you look for? So I was recently at the Royal College of Psychiatry's conference and I find that awareness is divided. So I want to be fair to those who are advocating for better diagnosis and care because those are led by really passionate neurodivergent individuals who are also psychiatrists. And so we understand that there is a huge amount of co-occurring conditions inside the autistic ADHD community and more so in women, you know, in nearly all the major organ systems.

31:09that is a big one physical health co-occurring conditions especially later in life I dug into the science which I talked about I think to you in that the autistic ADHD the ADHD neurotype is different to pure ADHD and pure autism but it overlaps with autistic social communication patterns and I actually do not think that it's any autistic social communication patterns it's autistic girls and women's social communication patterns, which is that we are driven to connect. We want to be around people. We talk. We also mask so much. We have difficulty really trying to understand what people want from us.

31:54And it can come across as looking quite innocent and having dissonance about how people feel, what they tell you and what they really want, because the thing is it's not that we do not sense it it's that we sense so much and we're trying to make sense of what is it you know which is the truth here and it's sometimes really hard to figure it out when the person you're trying to figure out isn't even clear about what they want and so you're picking up all these cues and you do not know what to do with it that's the analysis paralysis and somehow you feel it in your body and you know people get an anxious or you know avoidant in different situations but that's that's one part of it but the ADHD side if I were to say ADHD side even though it looks different to pure ADHD it's it's more destabilizing in that I think the brain dynamic paper actually did a really good job at looking at how people usually follow a thought pattern, how the brain dynamics tend to work.

33:08And so when you're in that stable autistic side, when the brain networks are lit up in that way, then you have that want for sameness, you want control, you could be quite rigid. But then when it moves over to the instability, that can be even more unstable than in a pure ADHD individual. But it tends to follow the same pattern and they do tend to emphasize the rumination that can happen inside an ADHD individual. And it makes sense to me because I've been called intense in various situations. and so I do worry about things. I worry about things and the way I deal with my worry is I'm always looking ahead maybe a year or two years or ten years and figure out what I need.

34:05I have an anticipatory anxiety, you know, for everything in life, you know, and it goes back to the conversation we were having about how, why do I come across anxious?

34:17Dr. Samantha Hiew:Have you ever had a social interaction with someone who's communicated in such a way with you that with your experience and intuition on being able to perhaps recognize ADHD in other people? Is there somebody that you've met who you've thought, right, that is super clear, like that person has ADHD, they just don't know it? yeah a lot of um women tend to come to us and ask you know if um they have audi hd because they resonate with what i say about being you know you appear like a swan on the surface but underneath you're pedaling like rigorously you know and then you dysregulate at home that's the part people really relate to because it's like you can function all day you know appearing almost neurotypical.

35:05Then when you get home, you have to go into a dark room. No one talked to me. I've got, like, you know, my salt lamp and I've got my teddy dressing gown and all these fluffy things that I like to cuddle. So there is that keeping up a facade. I think that's probably the most telling thing about an autistic ADHD woman. But for a man...

35:35In my experience, I've seen many ADHD men aren't very resilient to stress, and I don't expect them to be, but they can be quite easily dysregulated when intensity comes into the picture.

35:51Dr. Samantha Hiew:What happens if you are somebody, like you said, you get home, you get very dysregulated, you want to decompress you have your weighted blanket you turn the lights down whatever your routine looks like for you but you live with someone who doesn't get it you live with someone who doesn't understand that you need to go through that process can that be quite turbulent yeah because then you are masking you're walking on eggshells if you don't like have that because if you need recovery you know and if that person doesn't allow that recovery you can't live with that person you know like the number of partners that i've come across who look good on paper but actually i just can't live with and it's a no you know like your nervous system needs recovery from the sensitivity to the world you know you you take on so much you know you're sensitive your brain's fast moving and it's changing and so when you get on you need an anchor and for me it's lying horizontally maybe you know could somebody reach for unhealthy ways to dysregulate if they're not supported and they're not able to do it a healthy way could that lead to drinking or explosive arguments what could that look like yeah um so we don't reach out for those coping strategies to have fun or you know because it's good for us we reach for that to calm ourselves down right um for me definitely when i go into a social situation i i used to need to drink you know to kind of be sociable otherwise i'll be quite awkward or you know it's it's just hard but i think what you do on a daily basis to cope very much depends on what you people around you and the culture really thinks that's normal you know and i talked about this like in this culture it's very much drinking or you know various recreational drugs or working is a really big one shopping for for many with many women but in my the culture i grew up in it's very much eating you know getting together with with people families uh drinking to a letter to a lesser extent how do you advocate for yourself now because i imagine you you know you are very busy you go to events you talk on stage you go to social gatherings how do you cope with those now that you have a better understanding of how your brain works it's tough i'm not gonna say that it's easy for me because i'm not a gen z i didn't grow up talking about mental health or you know telling people my needs and creating boundaries i grew up with no boundaries you know just people walking all over me and you know me doing things for people so when I go to events now I have minimum requirements to actually just get a picture of the room that I'll be speaking at they they send it to me and I tell them that's the things that I absolutely cannot live with which is hot you know heating when it's too much I literally cannot function it's counterproductive to actually me being there i was actually talking gibberish and uh microphones that's been a real problem because every time i turn up you know i never know the quality of the microphones sometimes it echoes and that's it you know there goes the rest of presentation but i i tend to avoid really big conferences and if i do have to go them i'll just go for that slot and then come back i really cannot deal with large volume of people are there some events that you go to where it does feel safer to retreat back to the safety of masking?

39:30I think because I often feel like I don't want to mask a lot. I tend to be more of a lone wolf now. When I do go to events, I tend to try and stay by myself. Sometimes I run away from people.