No.1 AuDHD Expert: What AuDHD Really Feels Like, This Habit Means You Have AuDHD!

0:00This episode is brought to you by Palmolive. Family time isn't just the big moments. It's weeknight dinners, sitting around the table, everyone talking all at once. So when the plates are empty and the sink is full, use Palmolive Ultra. Palmolive's most powerful formula removes up to 99.9 % of grease, leaving your dishes sparkling clean. And the new convenient pump makes cleaning even easier, so you can spend less time tackling dishes and more time together. Shop now at palmolive.com. Autism acts like a parent to ADHD. And ADHD acts like a friend to autism. One is very ordered, disconnected from the world in a nice way.

0:38On the other side is the ADHD. It is disorganized. A parent steers children in the right direction. Autism takes that responsibility. For autism, it is a friend because the friend does not let another friend be in silos. They just pull them out. They are able to connect with the world in a very nice way. Dr. Karam is a world-renowned psychiatrist. An author of Explaining ADHD. He's here to explain how to spot the signs of ADHD and how to thrive with it. Neurodiversity does not mean a neurodevelopmental condition. You see a neurodivergent person might not be fitting in all the boxes of neurodevelopmental condition, but their brain would be different and they will think differently because they have got overlaps of so many small bits of dyspraxia, dyslexia, autism, ADHD, not fulfilling the full diagnostic criteria.

1:20They can see things differently.

1:22Dr Khurram:What consequences could occur to someone if they are living a life with ADHD and not knowing it? I think it's such an honor to have such a authority on the topic of audio HD here in the studio. And I think without a doubt, if anyone is confused as to what audio HD is or whether they have it themselves, I think by the end of this episode, they will feel considerably understood and have answers. I want to start with a question that I know has got such a beautiful answer. And always strikes a chord with those who hear it. You said to me that autism is like a friend to ADHD. What do you mean by that?

2:08Dr Khurram:Can the two conditions be friends? Yeah, these two conditions can be friends. Autism acts like a parent to ADHD, and ADHD acts like a friend to autism. What it implies is because they're on two opposite sides, opposite spectrum. One is very ordered but that order leads them to be very secluded sometimes very recluse disconnected from the world in a nice way whereas on the other side is the adhd which is if it is pure form it is anarchic it is disorganized there's a potential to gain in order to gain more stimulation they get involved in things that can destroy the careers at there and they can go a completely different direction.

2:58So what I meant was like a parent steers children in the right direction, at least where I come from. This is their responsibility. And autism takes that responsibility. So somehow when I've spoken to people with ADHD and they say,

3:16Dr Khurram:I want to do something, but something reigns me in. And that reining themselves in is autism. and for autism it is a friend because the friend does not let another friend be in silos they just pull them out they give them the energy they give them the social life that they deserve and they do get exhausted after that once the energy of adhd runs out but they are able to connect with the world in a very nice way can it be confusing to someone who is experiencing these internal push and pulls, what toll can that have on someone's understanding of themselves? I think the first thing is that people who have lack of understanding, they will definitely confuse it because people have come to me, even when I use the word, they exist in synergy, or they can actually, a symbiotic relationship, and they say, well, my RDHD is different.

4:15and I completely agree. Everybody out at ADHD is completely different. The push and pull is just one form of it. All they have to do is to understand it. And this is, again, the push and pull that I'm talking about, autism and the ADHD. It lets them be in the center, not at the extremities. And once they start to learn it, they will understand more the analogy because it's a very advanced level of analogy. It's not the basic level of analogy. One of the other analogy that I use, like you're sitting in a plane, you're at 10 000 feet the pilot tells you that you can see the beautiful city let's say prague and you look down and there's a cloud cover you cannot see that in a minute minute later the cloud cover is blown away and you see the city the city because it's constant it's autism the cloud cover is adhd the blown away is management either by strategies or by medication so there's a constant then there's something that comes and goes depending on your neurotransmitters and how good your pathways are or how bad your pathways are connecting different parts of your brain.

5:21Dr Khurram:So an understanding of ADHD suddenly makes so much make sense and everything becomes clear or a lot of stuff that perhaps was clouded in confusion suddenly becomes clear. When somebody gets a or ADHD diagnosis, what do you see becoming clear? Do people look back and they look at behaviors, decisions, and think, wow, that was my ADHD at work? Yeah, I think they reflect, when they come to that stage, when they come to me looking for an answer, they have gone through a lot already. They have reflected a lot on their choices. And a lot of the time, they're unable to say whether they are autistic or they are ADHD.

6:06A lot of them, they know that they are ADHD. Some of them, they want to know whether they are ADHD or autistic. But once they come to know, for example, somebody hypothetically is diagnosed without ADHD, A, it is overwhelming to start with. B, it can bring about a lot of grief in that person. Thirdly, the missed opportunities, the trauma that they might have received or kind of been in the path of as a result of their ADHD but the best thing is once they come to know that they have an answer I think their life changes and I always tell them that diagnosis is not the end of the debate it's the start of the journey it's like starting a new book very first chapter you're on you're on introduction now so i can take you to a certain extent but again i can give you avenues where you can explore yourself and where your life makes will make more sense to me because your life is very different from another rdhds life and you will have to make sense of it i will help you make sense of it and i have seen people where they have been going from denial to embracing it, their lives have changed.

7:25Dr Khurram:It's incredible. And you've dedicated so much of your career to raising awareness and understanding of Audie HD. Your book, Explaining Audie HD, is phenomenal. And I always wonder when I meet someone who has dedicated so much of their mind, their career to a particular topic, where that passion comes from. So what is your mission and where does that stem from? Well, it all started from the grieving process that I went through when my father passed away in 2022. Before that, I was doing combined autism ADHD assessment. I myself at times was not able to understand the intertwining of it. And I was in the process of learning it and reflecting on it because I knew that I was ADHD at that time.

8:17But the whole mission is to break down complex issues into small gullible parts, digestible kind of pouches of knowledge where people can understand where I'm coming from. It's about combination of neuroscience and the intertwining of stories with the outcomes that makes sense to a lot of people. And this is my forte. I'm a storyteller, just like my father, just like the family of us. When I look at my uncles, my fathers, they used to be together at nighttime with my aunts and my mother. And they used to tell stories and stories with eventually a moral in it. And it was humorous, it was entertaining, it was captivating.

9:10And how my father broke down very complex issues into small parts and helped us understand that. I understood he was an engineer. When he was teaching me maths, he would teach me maths in a way which I have never seen anybody do that. like in my GCSE's paper I was explaining the questions and the answers to the GCSE's examiners by creating more diagrams and creating so my father asked me because this is how you taught me I understand it so much better now so my mission is to kind of bring together the complexity of neuroscience the brain with the stories stories of real people who have gone through it and make people understand through their experiences.

9:57Dr Khurram:It's fascinating. I remember, Karam, when I first heard you explain what Audie HD is and what it feels like, and it completely changed the way I think about it. If you were to have a classroom of five-year-olds, for example, how would you explain Audie HD to that audience? It will be very difficult to explain it to them. I will start with the basics. I will not go into the nitty-gritty of the ADHD. I will explain to them how different brain works, how brain can be so much different, how what you're doing does not make you bad or lazy or make you extraordinary. It's the way you do things. This is how your brain is wired up.

10:43This is how the different brain structures are connected with each other. and to make them understand that different is not bad different is not fearful different is not strange different is beautiful at the end of the day i think that's the most important concept we should be teaching the five-year-old i don't think that they will have that capacity to understand autism and adhd but you can break it down break it down into smaller pieces smaller chunks as some brains can can can get entrusted in certain subjects they will go deeper into those subjects they will understand those subjects much better than so many and they can become an expert without even getting a degree on it and they want perfection and they want precision at the same time like the structure and then in that context i'll explain them different mind without giving them any labels so when they grow up they don't go for the labels they don't see the label they They see the people and they understand that, yes, this makes sense.

11:46Everybody is different. Everybody thinks different. Everybody's perspective is different. And it's good to bring people with different perspective because that will help you grow. And that will help the environment grow and the communities grow.

11:59Dr Khurram:It's so important and such a strong message. You might get a diagnosis of ADHD or ADHD or perhaps autism, but you have to focus on the people behind them. It's so important, I think, to start simple with the explanations to get that clarity. And I very much count the ADHD chatter listeners and viewers in this category, educated people. How would you describe ADHD to an educated room of students? Well, again, I will go with the simple steps that I've done with a five-year-old, explaining to them what neurodiversity is because what we sometimes lose track of is neurodiversity does not mean a neurodevelopmental condition you see a neurodivergent person might not be fitting in all all the boxes of neurodevelopmental condition but their brain would be different and they will think differently because they have got overlaps of so many small bits of let's say dyspraxia dyslexia or autism adhd not having a full diagnostic not fulfilling the full diagnostic criteria but you can see that they can think they can see things differently so even for the educated people that's this is where i'm going to start from and then talking about how the dichotomy of brain is how you can have two operating systems in your brain you can be operating on an ios and at the same time window how you merge them together how you integrate them together how you take the best parts of each other and integrate it for example on windows because Word or Microsoft Office is a Windows product, but we use a lot on Mac as well.

13:36We use the Excel sheets on Mac. So this is an integration, and this is how you learn about the other system. There's no system which is ultimately good or ultimately bad. It is relative, how you bring the strengths together and you create an environment where everybody thrives. So this is what I'm going to tell them. And then going to the nitty-gritty and specificities of it, I will tell them about how an ADHD person is. Like, I see it as three different patterns. I speak about it, but I speak about it more based on the observation, the number of patients that I've seen. That autism-dominant presentation, where you see the autism, you don't see the ADHD.

14:19But once you get into the nitty-gritty and exploration, you will see that the ADHD is lurking around. It's like an engineer who says, I love creating beautiful systems, but ADHD runs through those systems like a child scattering the papers away. Or the ADHD dominant form where ADHD is more prominent, they are into novelty, they are into kind of bringing in more ideas, but somehow gravitate towards precision and perfection led by autism. And it's like a musician saying that I've got two different drummers. One is absolutely innovating on its own and other one is following a metronome like boom, boom, boom, not shifting from it.

15:02And the third one where there's a push and pull when people say variable, ADHD can be in the steering seat and in one moment and autism the next. And I have seen a student who said, I do coding in the mornings. It's intense. It's amazing. But by the afternoon, I've lost everything. all the progress that I've made. I've started five different subjects, five different assignments, five different tasks, because it keeps on switching the pull and the push and the variable nature of autism and ADHD coming in. So this is how I'm going to explain them with examples, with real people who have come to me and used those analogies to help me understand, to help them manage it.

15:45Dr Khurram:It's certainly fascinating, Karam. And I feel like many of the people watching and listening and they'll be thinking, do I have Audie HD? And perhaps they've seen signs of Audie HD on TikTok or social media. And I feel like many of those signs can be slightly misrepresentations. But I remember the time I saw you on stage and you were explaining the real signs of Audie HD. And I remember being completely shocked by them. What are, would you say, five signs of actual Audie HD? I would not give a number to it, but again, I would say there are disparities between the two. For example, silence versus noise.

16:25You love your tranquility, but at the same time, you like the stimulation of certain situations as well and you gravitate towards it as well. um organization versus disorganization where you like your own routines and structures you want to create it but you're unable to sustain it it's it's reputation versus novelty it's like you like to eat the same food you want to watch the same programs over and over again but then you're unable to follow your daily routines on on on a day-to-day basis um it's it's it's about people who their autism kind of grounds them to be risk aversive but at the same time they like the novelty of different situations and they throw themselves into those situations unknowingly so for me those are the the opposites and kind of the disparities of the brain and the contradictions i would say the contradictions of the brain that helps us to identify that this is what it is they want to be focused but at the same time they want to be distracted at the same time

17:32Dr Khurram:but things that interest them so relatable karam i have my suspicions that i am or dhd i haven't gone for an autism assessment yet um i crave being in a clean environment but i cannot clean i hate loud noise but i will listen to my favorite song in my earphones on full blast and it's not the volume of the noise that irritates me. It's the fact that I'm not in control of the volume. When I'm in a public place or a bar and there's noise playing, it's because I'm not in control. And that's always fascinated me. If someone's listening and they're thinking that sounds like me, I could have all DHD based on what Karam has just said.

18:17Dr Khurram:How can they be sure? I think the first thing is curiosity is not a diagnosis. Curiosity is the first step towards it, towards knowing yourself. And it becomes Audi HD when it follows a certain pattern. It has its own consistency in an inconsistent way where it starts impacting your life, your interpersonal life, your relationships, your friends, your workplaces. You're trying to do something. You do it amazingly, but you have not followed the rules. and all of a sudden people see you as as a maverick not as somebody who is who's an innovator so for me the important thing is to kind of log why you think you have got rdhd what are the patterns that you've noticed reflect on yourself talk to your parents about it as to how you were look at your report cards look at the friends that you have and what they say about you if you have an older sibling what how did they see you and if if then you still believe that this is the case and go to the credible websites um i would i would refrain from going to non-credible website because people are using their own experience it's not that it's authentic it's the context which is important and you can completely take it out of context so go to those authentic websites speak to people who have been diagnosed and see whether your experiences are relatable and it's important to see that whether you want a label or whether you you need a label for something if it is imminent and if it is you really want it because it will open a lot of doors yes go for it but if just knowing yourself understanding yourself it helps then you do not need a label you you're enough till you need a label until you go for a person but again choose the person right choose the person who actually has lived experience but also able to understand the intertwining nature of autism ADHD because a lot of people they like to see autism ADHD in the same person as two different entities whereas the pathway is very intertwining what a bit of push I get towards the narrative of I don't want a label is that the people I speak to who suspect they have ADHD, they tell me that the label they get regardless of a diagnosis is that they're like Dr.

20:48Dr Khurram:Jekyll and Mr. Hyde, like these fluctuations in mood and the optics of what that looks like to those around them. What labels, social labels, do you think someone with ADHD might get other than ADHD? I think they will see them as inconsistent, brilliant one time, and kind of not performing the other time, they will see them as very passionate at one point about a certain thing, but not passionate about the general day-to-day stuff. They will be seen as lazy, but energetic when it comes to activities that kind of entices them or stimulates them. So people will see them in contradictions that, and eventually it will be, you're capable but you're not pushing yourself enough you you need to you need to do more sometimes they are too much and sometimes they're not enough for people so these are the kind of social labels that they might get um i still remember the having the conversation i don't know whether i've spoken about it or not but um i remember when i was in grade eight or ninth and And my parents were coming from a parents' teachers meeting.

22:02And my father was a bit disappointed because I had come second in a class of 40. And I knew that he was not happy. He was a perfectionist. So he looked at me through the rearview mirror and said, Horem, you are so consistently inconsistent. consistent and i just because again i i used to be scared of him when i was when i was young so i muster up all the courage and i said but father abu isn't this consistency and he just smiled at me and he did not say anything but he got what i wanted to say so this is how the picture is like sometimes you're performing you on one grade you'll be amazing and the next class when you go to it will be you are not doing a lot and when you understand the context it's because the teacher is not interesting or something is happening happening around you which is not letting you achieve your standard but if you get a good mentor if you get a good teacher if you get a person who takes you through that journey i think your whole life changes

23:16Dr Khurram:perfectionism you mentioned your your father was one yes what does perfectionism look like in ADHD because it's a topic that comes up time and time again in the ADHD conversation. And I feel like many people just think that it's an executive function challenge, but there's such an emotional element to it. I feel like it's the fear of letting people down. It's the not wanting to expose yourself to a criticism. So it's easier sometimes to A, not start, or B, if you do something, you have to do it to such a high standard and it's exhausting. But the ADHD mind, What does perfectionism look like there?

23:51Well, we have to deconstruct it from both autism and ADHD perspective. As you said, the ADHD perspective is just, you just explained it, that it is the years of being told that you're not good enough, you're not doing things right. So when you do it, you have to push yourself to perfect it so that nobody can critique it for you. and and and that is and if if somebody critiques it then all of a sudden rst comes out massively whereas for autism it's because they love the subject they love doing it they want to do it to perfection and if they start something and most of the time people come to me and say a child starts writing an essay all of a sudden on the second page if something goes wrong it just rips apart everything and restart again that is autism because they want perfection as they're going along the journey so you you mix together both autism and adhd perspective and you you're getting a person who's afraid of critique but at the same time he knows that he can achieve perfectionism and he will try to do that as much as possible but in most cases no much how hard they try they won't be able to because there will be an obstacle on their way to do that and that shatters their confidence there is impact on their confidence their self-esteem and there's a very good chance that they might not try that thing again ever again because of lack of perfectionistic and to the last project that they had how else do you think audio hd can show up in other words

25:34Dr Khurram:because I feel like it is being spoken about more now, which is obviously fantastic, thanks to people like yourself. But what can undiagnosed ADHD look like? What consequences could occur to someone if they are living a life with ADHD and not knowing it? Okay. I think, as I said, the contradictions, they will live in contradictions. People have come to me that they have said to me that they were not sure whether they were autistic or ADHD for a very long time. They were too organized to be ADHDers, and they are too disorganized to be autistics. But at the same time, things that they tried, there was a push and pull factor.

26:22They would not be able to achieve the full potential. Something stops them, and they don't understand what's stopping them. the disparity the contradictions that we spoke about for example wanting something but unable to achieve it having the attention span and the concentration but not able to sustain it for a very long period of time unless they go into phase of hyper focus where there's a consequence attached to it a lot of these people they work in very stressful environments because the stress is leading the way and stress is helping them achieve or finish things you take away that stress and if you put them in a very boring environment for it there's no consequence their work will be a very substandard level because there's nothing enticing them there's nothing stimulating them towards it and for an audi hd it's it will be a story of shattered dreams broken hearts complicated interpersonal relationships losing friend constantly without knowing it.

27:24Showing passion and aversiveness both at the same time towards their partners and towards friends and towards family. And people who cannot understand it and people who do not have the lens to understand these patterns will all of a sudden they will move away from them and they feel themselves to be lonely. They will say what's wrong with me all the time? why I have not been able to achieve, why people can do things so easily, whereas I'm not able to achieve it, despite of having all the qualities to achieve it. And people have told me that I have all those qualities. So this is how an undiagnosed ADHD will look like.

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29:17Dr Khurram:Do you think having Audie HD is generally a lonely experience? In other words, is it hard to maintain connections, friendships, relationships, when in order to do that, you need to put a true version of yourself forward? And it sounds like many people with Audie HD don't have a good understanding of who they really are. Yeah, and they start masking it. And masking takes a lot of energy. and masking led them to be what they're not. The burden of carrying that mask in those relationships can be intense and they can be volcanic eruptions from time to time because they're unable to sustain it for a period of time.

29:54Or they could be burnouts because they're unable to have that energy to sustain that mask for a very long time. And yes, they have difficulties. Not all of them, but again, it also depends on who they are with. are they part of a new divergent crowd because if they're part of a new divergent crowd if they're part of environment which helps them unmask which acknowledges their strength who say yeah if you have a weakness so what everybody has their weakness we can work on it together if they're in that kind of environment they will thrive but if they're in kind of environment where they're not understood they people are pointing fingers at them then they they tend to go into silos they They burn out, they have their breakdowns, and they're not able to achieve what they want to achieve.

30:46Dr Khurram:With the masking, it's fascinating. Is it possible for the ADHD to be weighted more towards the autism or weighted more towards the ADHD? In other words, can someone mask one side of the diagnosis? Can they mask the autism so well that they never become aware that they are also autistic? or they mask the ADHD side so well that they only think that they're autistic. The masking happens at a very subconscious level or unconscious level.

31:23A lot of the time, because when you look at ADHD, a lot of ADHD, when they come to me, they're already, 50 % of the cases, they're either diagnosed with one condition or the other. so the other person the other person the assessor was not able to see the other part of it because one was masking the other part for example when I gave you the analogy of the city of Prague and the cloud cover in between and that was ADHD masking the autism once autism comes out it can actually mask the ADHD as well so the masking is different for both conditions What you have to look at is in autism, they're masking to be more disorganized, whereas in ADHD, they're masking to be more organized.

32:13Because in autism, when they look around, they're perfectionists. They do things to the T. They do want to do things in a certain order. And to them, the world is not doing what they want to do. And they see the world as more disorganized. so they have to kind of give away their autism which can be so much difficult for them because it causes a lot of anxiety to coming out of those structures and to explore the world and to mingle with them whereas for adhd it is the other way around it's like the world is so organized why i'm so disorganized so i have to be organized around this world and that takes a lot of energy so the energy the burnouts that a person with adhd experiences as a result of that putting a lot of pressure whereas with autism it's more social anxiety it is it is overwhelming situation all of a sudden all of a sudden their social the sensory overload increases massively to the extent that they won't be able to sustain it for a very long period of time and they go through a burnout as well so it's it's it's how strong the auto your autism is and how strong your adhd is and which one is is the most prominent part of it and which one do you want to mask because sometimes i've come to a stage where i can unleash certain part of my autism and certain part of adhd to be able to achieve something because if i have to think openly and i have to unmask in a situation where i i can be very open with my words with my feeling with my emotions and when i have to concentrate and I completely shut off from the world.

33:51I like to think about things and I know how to bring that out. So it takes its own time. I have my masks, but again, I use them very effectively and efficiently most of the times, not all the times.

34:06Dr Khurram:You mentioned emotions there, Karam. I want to focus on emotions. What emotions crop up when someone discovers they have ADHD? It's a spectrum of emotions, a spectrum of responses that you would get from people. Some people who have been, who did not come on their own volition, but again, their partners or their friends kind of urge them to come. They can go through a state of denial. And then from there, they would like to learn more about themselves and eventually embracing. but it takes a lot of time some people get very emotional they they cry they grieve and they grieve because they look at the missed opportunities they look at the parents why would not be parents able to pick those up and i always use this analogy i said eyes can't see what the mind does not know if the professions are missing so much on on these diagnoses or these conditions how can you expect somebody else who is not a professional who have not been taught who have not been educated about it to be able to understand that so that helps them to to kind of ease their pain some cry with joy and satisfaction and said that you always wanted that but i wanted it to be rubber stamped i'm satisfied i feel that i'm whole now i feel that i'm able to think from that very perspective and like others they they go into a cocoon because a the whole experience because when i do an htht assessment it's two and a half hours three hours long and it's like a chat a chat like we're having now it's it's not checklist it's not a test and in those stories or in those conversations are are embedded the tick the ticks the checklist that i have to do to kind of get the person diagnosed so it can be very overwhelming for them they go and rest for hours they are exhausted after that and they come back to me saying that now i want to discuss the management probably a week later two weeks later um and one of the most common thing is when people cry cry with joy because they now know that the things that they're looking for they found it now because they were kind of throwing arrows in the dark, shooting arrows in the dark.