Understanding Neurodiversity: Thriving with ADHD and Autism

What does it really mean to be neurodivergent, and how can we better support people with ADHD and autism at work, at school, at home and in everyday life?

In this episode of ConnectForHealth, the live well-being webinar and podcast from Cigna Healthcare Middle East and Africa, produced with mentl, Scott Armstrong, founder of mentl, and Maissa Al Khafajy, Head of Government Affairs and Strategic Communications at Cigna Healthcare Middle East and Africa, explore neurodiversity through clinical expertise, workplace insight and lived experience.

Scott shares his own experience of being diagnosed with ADHD later in life, and the emotional process of reinterpreting school, work, relationships and self-belief through a new lens.

He is joined by Sarah Christensen, Organisational Psychologist and Chief Executive Officer of Christensen Consultancy, who also brings lived experience of ADHD, and Dr Valentina Faia, Specialist Psychiatrist and Psychotherapist at BioPsychoSocial Clinic, with more than 20 years’ experience and specialist expertise in neurodivergence, including ADHD, autism and giftedness.

Together, they unpack what ADHD really is, why diagnosis can be missed for years, how neurodivergence can show up differently in adults, children, men and women, and why support should focus less on “fixing” people and more on understanding how they function best.

This conversation explores the myths, stigma and practical realities of neurodiversity, from children struggling in school to adults masking at work, from parents seeking answers to organisations trying to build more inclusive cultures.

Topics include:

• What neurodiversity, ADHD and autism really mean
• Why ADHD is not simply distraction or hyperactivity
• The emotions that can come with late diagnosis
• How girls and women may be missed or diagnosed later
• Why high performance can hide hidden struggle
• What parents should look for in children
• How assessment and diagnosis can help
• Medication, exercise, therapy and other support routes
• What workplaces can do to reduce unnecessary friction
• How to support neurodivergent colleagues, children, partners and friends

This episode is for anyone who recognises themselves, their child, their partner, their colleague or their team in this conversation.

Neurodiversity is not about lowering expectations. It is about understanding difference, reducing shame and creating the conditions where people can thrive.

Chapter list

02:17 Meet Sarah Christensen and Dr Valentina Faia
02:46 What neurodiversity really means
08:07 ADHD beyond distraction and hyperactivity
13:27 Sarah Christensen on recognising her own ADHD
15:04 Why ADHD affects relationships, teams and daily life
19:36 Late diagnosis, stigma and being open at work
22:27 Poll: the biggest myths around ADHD and autism
26:37 How assessment and diagnosis work
32:24 The emotional impact of late diagnosis
35:17 Workplace support and reasonable adjustments
36:25 ADHD in children: what parents should look for
43:40 Poll: what practical support would help most
45:37 Masking, burnout and invisible effort
47:35 Audience questions: work, speech, fairness and emotional regulation
51:36 Supporting neurodivergent children at school
55:11 How to keep performing when the wheels start to come off
57:05 ADHD, relationships and rejection sensitivity
59:07 Where to find support and final reflections

Transcript

SPEAKER_00 0:10

Welcome to Connect for Health, the live webinar and podcast brought to you by Signa Healthcare Middle East and Africa with a little bit of help from Mental. I'm Scott Armstrong. I'm the founder of Mental, a platform that tries to tackle the stigma of mental health and help the community thrive. And as always, I'm joined by my fabulous co-host, Mesa Alkafaji, the head of government affairs and strategic communications at Signa Healthcare Middle East and Africa. Now, today's topic is one that is very, very relevant to so many people. And I can see you're already getting very, very engaged because the questions are coming in already. Understanding neurodiversity, thriving with ADHD and autism. It's a topic that's been in the news a lot. A lot of people are also getting diagnosed with late-stage ADHD. I'm one of them. This is a safe space. I have ADHD. One of our guests as well has ADHD. We've got two amazing guests, but if you want to get involved, please ask the questions because we've got two amazing experts. So please ask your questions. Whether or not you think you have ADHD, your child may have, or you want to know how to support a partner, friend, or a colleague at work. As always, um, we would also ask you poll questions. If you're watching on the catch up on YouTube or on the podcast channels, you can't get involved. But if you want to be with us next time live in the room, reach out to Signa Healthcare for details of membership. So let's get into this. My two guests today. Firstly, we've got, and if you watch the Mental Space podcast, you'll know Sarah. We've got Sarah Christensen, who is an organizational psychologist and the chief executive officer of Christensen Consultancy. And Sarah works at the kind of intersection of human behaviour and workplace performance and organizational culture. And our second guest is Dr. Valentina Fire, who is a specialist psychiatrist and psychotherapist at Biopsychosocial Clinic with more than 20 years' experience and specialist expertise in neurodivergence, including ADHD, autism, and giftedness. That's the intros out of the way. Welcome both to you to Connect to Health. Great for you to be here. So let's start with an overview. And if I may, I'll start with you, Dr. Valentina, and I will call you Valentina from here on in. Thank you. When we're talking, and obviously we hear a lot about neurodiversity, but just give us an uh you know an overview of what neurodiversity is. You know, talk us through ADHD, autism, and and other varieties of other uh conditions that are captured within that umbrella.

SPEAKER_02 2:46

Thank you for the question. Um so neurodiversity is the collective term that indicates that our brains can work in very different ways.

SPEAKER_03 2:58

Okay.

SPEAKER_02 2:59

So the neurodiversity refers on a population level, the term neurodiversity refers on a population level to the fact that different people might have brains that work in a different way, which seems um a given right now because we're talking so much about the topic, but it's actually quite a recent um understanding because we tended to think that all brains are probably the brain of uh, I don't know, 25 years old six foot 70 kilos guy, which is what typically medicine has been looking at.

SPEAKER_03 3:31

Okay.

SPEAKER_02 3:32

The neuro term neurodiversity suggests there are so many differences between the the different ways different people uh operate, think, and process emotions and knowledge as well. Neurodivergence instead is a work in progress. It's a definition that is being built now with the understanding that amongst neurodiversity, there are individuals who tend to position themselves somewhere in a spectrum for what concerns the way they process their thoughts, the way they feel their emotions, um, the way they relate to others, and lastly, their behaviors, which is the only thing we see objectively. We see an ADHD child because he acts in a certain way, or someone is um suspected of being autistic because maybe interact in a slightly different way socially. So neurodivergence is not a coded term still in medicine. We're working on it. It's like probably what we would call a proposition. We're trying to understand whomever can fall into the term neurodivergence. And at the moment, we have a variety of experiences. We have people who have ADHD, people who position themselves somewhere in the spectrum, um, so they are autistic to different degrees. But we have also people with a variety of learning difficulties, dyscacholia, dysgraphia, dyslexia, and they also belong to this population which is called people with neurodivergence. And also people who have very specific symptoms that are properly neurological, like Tourette, Tourette syndrome, and they also fall into the same domain. So what are what we're looking at now is truly, and it's it's amazing, I guess, to be part of the process, to try and understand how um neurodivergence can encompass so many different presentations. De facto they are very, very different and very varied, um, and still be a thing, if you let me say it so. What we do when we assess and diagnose someone is that we purely tend to stick to the behavior of the individual. Because we it's what comes out. That's why there are so many misconceptions, for instance, amongst uh ADHD, everybody has a little bit of ADHD. Well, actually, no, not everybody has a little bit of ADHD. A lot of people are inattentive, that is true, but ADHD is very well coded, it's very well defined. But when we assess someone, we have to look in depth because what shows through behavior typically is neurobiologically coded. There is a genetic, there is an epigenetic. We do know that some people only show symptoms of ADHD after the trauma or because of trauma. And we do know that these people have the genetics, so have the kind of base, but the environment works towards making them express the genes. So I guess what I'm trying to convey here is the complexity of a developing field, that it's still in our hands somehow to explore. And I'm talking, you know, I'm mentioning it to Sarah because that that is a struggle that we have when we try to explain what neurodivergence is to companies or to big organizations.

unknown 7:23

Yeah.

SPEAKER_02 7:23

Because it's so varied, and and you can't you I can't I can see that five minutes into the conversation, people are lost. And they're like, So you're saying what exactly is the exactly. I have a lot of questions, and so do our audience.

SPEAKER_00 7:40

I I can see that you're already asking lots and lots of questions. We will get to them. Um, because there's so many questions out there, and I think you know, we talk about misconceptions and all that kind of thing. Well, I mean, let's focus on ADHD and then autism, but just talk me through actually, you know, I know, and also having been diagnosed, I know there are sort of slightly different strands or flavours of ADHD, but just talk us through what ADHD is from a clinical perspective.

SPEAKER_02 8:07

Yeah, from a clinical perspective, we do define ADHD through the main concept of the attention deficit, which is the core of ADHD. So um we know that from a diagnostic point of view, we can have ADHD with or without hyperactivity, but it's much more um complex than this. And I'll um so if the attention deficit is probably the core of ADHD, the hyperactivity is somehow always in the back lines and can be an hyperactive brain. The definition of ADHD historically is based on a seven years old who climbs you know the walls and is impossible to keep seated and uh blurts out answers and is very uh provocative at times. And again, a boy and a boy and a girl. Yeah, and now we know that there are so many differences in the presentation between children, boys and girls, so gender law, gender-determined differences. The majority of women, as a matter of fact, are diagnosed later in life. Yes, either adolescents, but I am seeing a population of perimenopausal women who come and say, I don't know what is wrong with me. I fixed the hormones, I'm on HRT, I'm training, I'm weightlifting, I'm taking 140 grams of protein every day, and I'm still brain fogged. And I don't know what is happening to me. And what is happening is that the coping mechanisms that have been implemented for a lifetime are falling apart. Because we hormones have an impact as well on cognition. Yeah, and that is why at times and with ages, we see those increases, those peaks in diagnosis around uh puberty for children, and then around menopause, sometimes in postpartum as well. Interesting. Very interesting, yeah. Very, very interesting, yeah. I can I kind of miss the point over there.

SPEAKER_00 10:11

No, I because again, I'm aware and obviously I'm I'm aware because I've been diagnosed and was diagnosed last year, but you know, I you know, if we talk about inattentive, attentive, combined, you know, there are these different different sorts of flavours, what they are, but also you talk about how it shows up, you know, the differences between men and women and ADHD, for example, and we'll come on to autism in a moment, but how you know how does that actually show up then? Because as you say, the stereotype type stereotype is that hyperactive trouble-causing seven-year-old boy at school.

SPEAKER_02 10:45

If I have to sum it up, you know, the neurobiology is quite clear at the moment. So we do know that technically, from a neurobiological point of view, we have a lack, either of production or of the ability of the brain to use dopamine, which is a very powerful neurotransmitter, in the right prefrontal cortex. So it's a very specific part of the brain. What the prefrontal cortex does is that it executes plants. So the struggle of someone with ADHD is not about cognition per se. They're super capable. I mean, I think on average, the the average person with ADHD has probably a hundred notes and lists on their phone. Yeah. Super good at making lists, they're super good at making plants. They know, they wake up in the morning and they know exactly what will make them feel better. I should get up now, exercise, have a very healthy breakfast, and then shower, and possibly go for a walk with my dogs and make my my wife happy, by the way. And then straight to work, and this is all before nine. Six hours later, yeah, they're hooked on their phone, and the sundae is gone. Yes, yeah. Yeah, yeah, yeah. So, what the pre-frontal cortex does is that helps actualizing what the brain knows is the best way forward. I think this is the best definition that I can, which is applicable to our children. Because our children as well, they perfectly know what they should be doing, how they should be doing it. The point is, how do you get from that frozen status where you are in this knowledge? Yes, and this knowledge is so complete that the different ten different taps open in your brain and know exactly what hundreds of times. How do you go from there? Okay, how do you go from there to pushing out your duvet and heading to the bathroom? That's it. It's that execution, yeah, and it's so deeply frustrating and painful. That's the thing. Because I think if you didn't know, yeah, well, maybe whatever. I had such a great time, I spent six hours in bed scrolling my Instagram. That's something that someone could say, someone who knows the damage and feels the pain, that's so destabilizing as well.

SPEAKER_00 13:18

Sarah, I can see you obviously sharing the same thing. Um I don't think you'll mind me sharing that you have a lived experience with ADHD as well. Um when were you when were you diagnosed and what's your experience been? You know, how did it show up for you?

SPEAKER_01 13:33

Well, it's been more along the case of uh I was doing an assessment on a client and I was like, so there I was with my screening questions, going through everything, and she was providing the responses back. And as she was doing that, she was also talking about how she was compensating for these things and what she was describing and how she was going through it. And I was sitting there, I was writing my notes, and I was like, I do that. Yeah, I do that too, and I do that, and I do, and it was this light bulb moment. I was like, Oh, okay. So I think I've just discovered something about myself today. Um, and I think from that side of things, it was this aha moment of like, oh, now it all makes sense. The challenges with school, with relationships, with doing things. I'm like, now it makes sense. Um, and I think for me a lot of that was it was kind of just a weight lifted off. And I think you can you felt the same as well. There's a weight lifted off because it was like, okay, so it was validation. I'm not stupid. I I just do things differently. My brain is different, and that's okay. And I think that was such an enlightening moment um to be able to have that, um, to be able to have that experience. Like, oh, okay, right. So, and then understand what it is I do, how I do it, and learn more about the experience, what that looks like, what the more efficient strategies that I can put in place to to kind of be able to engage in the world um as effectively as possible. So, yeah, it was uh yeah, interesting way of learning that you have these things.

SPEAKER_05 15:09

I wanted to just touch on a point that you mentioned, Sarah, and that was when you said in retrospect, everything started to make sense. And I feel that when there are discussions taking place around ADHD, they still pretty much focus on um the earlier stages. So, like the impact when it comes to processing knowledge, being at that education stage in one's life. But I I don't feel that there is enough that is said as to how being, say, in a relationship with an ADHD, I hate using the word sufferer, person, when you are working as part of a team, or you there are so many things in everyday life that ADHD spills into or makes, I would say takes quite a substantial part of our day-to-day. Um, but I just don't see enough of that, you know, conversations happening, or it always seems to be something that's trending rather than something that is a true reality. And I how how do you feel, you know, things are moving, if at all?

SPEAKER_01 16:27

So I think um it's a great point because I think our awareness about neurodivergence in general has progressed loads in the last sort of you know, 10-15 years, and there's a lot of reasons why I think our access to social media, there's a lot of people talking about it that we've got very public figure individuals talking about their lived experience. As do they, yeah, yeah, and uh and and even sort of from a research perspective, from an evidence base, we have so much more robust knowledge about what that is now. So I think our understanding of what it is, how it shows up, our awareness is good. Okay, but where we're not there is moving it to the next level is how do we integrate it? Yes. What we're in is is like what we'd kind of call it is we're still stuck in this medical model idea of neurodivergence, of that um, which is person needs to be fixed. We need to diagnose them, we need to treat them, we need to cure them, and the world is right again. Rather than that, what we we should be looking at is much more around creating that inclusive culture. What do we need to do in society to rather having this individual fit in with how we do things around you? How do we create that more inclusive culture where everyone is seen, where everyone has heard, their differences respected, and and they're able to kind of leverage their strengths and be able to integrate in that world? And I think you know, a lot of the work that you know we see happening in organizations, for example, great at doing awareness days. We have awareness days left, right, and center. But my question is, and what next? What next? What are we doing to take this not from this this training session, this virtual session we've just done with how does this impact on a Tuesday afternoon meeting for our team?

SPEAKER_05 18:23

I want to really like piggyback on that comment. And it was something that I had a discussion I had with a friend of mine who was looking at a team member, and they were sitting down and they were looking at his performance appraisal and just doing his assessment. And he had basically, you know, said that, and it wasn't it wasn't something of like, you know, um a sympathy card. He was basically saying that, you know, as a person who has been recently diagnosed with ADHD, um, he was very um vocal about some of the challenges that he was facing in the way he was able to deliver work, um, able to perform. And that just got me thinking about what are we doing day-to-day within organizations when we're looking at these metrics, when we're looking at, you know, these draconian ways of trying to um, you know, measure performance.

SPEAKER_00 19:25

Um it's fascinating as well, though, because I mean I and it and we'll come on to perhaps relationships as well, but I I changed my LinkedIn status um to to say ADHD. Yeah. Um, obviously, because we tackle stigma and that's part of our role. Yeah, uh, my wife was furious about this. So, well, how's that gonna look professionally? You know, no one's gonna hire you. I mean, thankfully I run my own business, so I'll hire myself. But you know, but that that idea, but then it also struck me. Um, you know, I left school with five GCSCs, I did very, very badly. Um, that's not specific to anything, there was different things going on, but when I got my cognitive profile, it actually showed there was five things I was really, really good at, and one thing that needed help, needed support. Um, and we're almost at this point where actually we should, if you were thinking from an organizational perspective, if we could walk through an interview and we, you know, and go, right, this is my cognitive profile, this is what's happening with me, then we can optimize and go, yeah, you're perfect for that role. Yeah. And we'll do this, you know, from a performance perspective. Yeah. But that stigma is still there that we'll never get. I mean, Deloitte did a big study, and 1% of women in the workplace said they were prepared to delge that they were neurodivergent. Yeah. So it shows you that there's a massive stigma there. Yeah.

SPEAKER_02 20:40

And if I can tap into this, from a neurobiological point of view, genes that don't matter tend to be deleted.

SPEAKER_04 20:48

Right. Yeah.

SPEAKER_02 20:49

You know, evolutionarily, this is very clear. So there must be a use to people with ADHD, which we know. Yeah. This is very interesting.

SPEAKER_01 20:58

Get stuff done.

SPEAKER_02 20:59

Get stuff done. Creative, cool under pressure, creativity, ability to read a room, to see patterns. To see patterns. Connecting the dots is something that I'm very good at. Exactly. But also seeing things how things go, like traders, for instance, a lot of them have ADHD because they kind of see and they sit behind 16 screens and they can't see that the markets in Hong Kong, and that has happened five years ago, and then New York, and they sell New York, and it kind of saved the boat. You know what I mean?

unknown 21:29

Yeah.

SPEAKER_02 21:30

So there's so many positive um skills that actually get deleted because we want the single employee to be on time. Yes. And that is never gonna happen. And I know it because I I mean I come from a I work clinically, so sometimes I address HRs and I send letters and I send emails. And they're like, Oh, I'm so understanding, yes, of course. And uh and we want to invite you to speak to us, but yeah, but what about this employee? Well, can't you help? Them being on time, and I'm like, this is the exact point. This is the person rather than the culture. Fixing the the this side detail of their personality, but do you notice the amount of work that this person is taking up? Have you seen how much that she contributed that to the company?

SPEAKER_00 22:21

I'm gonna because the audience did just all the backing up. Uh, first, I'm gonna ask you to get involved in our first poll of the day. So if you can uh look to your screens, you should see uh the questions coming up. But our first poll of the day is gonna be interesting to see what you guys think out there. What do you think the biggest myth around ADHD and autumnism? I will answer this poll and then I'm gonna bring in some of your questions because you've been very patient so far. But biggest myth, so that ADHD just means that people being distracted or hyperactive, that autistic people all behave or communicate the same way, that neurodivergent people cannot be high performing, that support means lowering expectation, that annoys me and Lart that one. Um, that people should just try harder and be more disciplined, or that it only affects children. I mean, from your you know, from your two both your perspectives through work, which do you think the audience is going to come down as one of those uh big the biggest myths that people hold?

SPEAKER_01 23:26

Oh, I I think purely from a work perspective, I think there's that link to high performance. It's that when we talk about neurodivergence, we see difference as deficient. Yes, and that's the big thing. It's this idea that when you've got some form of neurodivergence, you're you're broken, you're you're less than, and that you're never going to be able to perform because you're always going to be struggling. It's not actually the key. So I think there's a big piece around that, around that performance. Um, and I'm sure we'll we'll talk more about that. So I'd say that's the same thing.

SPEAKER_00 23:57

Well, let's see what the results are. We're going to try and bring in the results now, see what you've actually voted for. Um, and the biggest one we have is the ADHD, yeah, or it's close as well. It's it's an arm wrestle between it only affects children and that it just means being distracted or hyperactive. So they're the two biggest myths.

SPEAKER_02 24:18

Very limiting, very limiting definitions, yes, of course.

SPEAKER_00 24:22

So, how should or should we be defining it though as well? Is is our is is our focus on this almost like too narrow?

SPEAKER_05 24:28

Yes. I mean, I like it. I I have it. No, so um lived an experience, but also looked at people around me over the years. And I'm looking at how we mentioned awareness has really come through to the surface, but again, it's still it's still kind of, but what do we do with that knowledge? And almost tragic because there's like a whole generation of people who are still living it and they're being diagnosed at a later stage. But what happens to them? I mean, is it like that's it now? You know, like it's I mean, we can talk through those.

SPEAKER_00 25:12

I mean, being diagnosed. I mean, one of the first things you kind of go through is that kind of you you have to kind of and thankfully I went through it pretty quickly, but it's that almost like anger and frustration of what could have been.

SPEAKER_02 25:24

Yeah, you know, yes, exactly.

SPEAKER_00 25:26

Yeah, I don't know if that resonates with you, Sarah, as well, but you've done pretty well, anyways.

SPEAKER_01 25:31

Track on what else can you do?

SPEAKER_00 25:33

Yeah, and that is something we do. Right, and I'm gonna I'm gonna put some questions in because we've got them all stacking up. Uh Raj Shri, I hope I've pronounced your name right. I am very passionate about this topic, so please excuse my long list of questions. Or you're gonna do my job for them. Um, how can someone get tested and get a diagnosis? Uh, disclosure of a neurodivergent condition can be a difficult decision. How can organizations create a safe space for employees to feel comfortable to disclose their conditions? We'll come on to that. And are there any cultural or workplace considerations for organisations in the UE to be mindful of before developing neurodiversity strategies? And for you've really gone for it, uh, any low-cost, high impact adjustments that employers can put in place to support neurodivergent people. I think the first thing we need to say is also we've got the new UE mental health law, which means it's illegal for employees to discriminate against employees with mental health uh conditions. So that's that's a first starting place. Let's take um Raj Shri's first question, though, which is about how can someone get tested and a diagnosis? Um, what's that process? Because for some people that they they're still not quite sure.

SPEAKER_02 26:49

Well, first of all, it would be great if insurances will pay for that.

SPEAKER_05 26:53

Well, that's that's a push. Well, actually. I mean, um, I know that there are like um certain insurance. I I'm I'm Imarati, I I am covered by Thika, and um uh thika insurance does. And I believe um so does Signa on certain policies. But yeah.

SPEAKER_00 27:14

So reach out and sometimes I think as well, we've talked about health literacy in the past, and and and sometimes we don't actually know what is or isn't covered within our health insurance business. And I know my health insurance business, which isn't Signa, um, it wasn't covered, yeah, and that can be a barrier as well because it can be quite expensive.

SPEAKER_02 27:30

Yes, yeah. Um especially if you want to have a complete assessment. Yes, because otherwise, you know, a psychiatrist can diagnose a patient through a very quick 15-20 minutes testing, but that would be very, very limited. Yeah, a very limited understanding of how that person works, what their strengths are, yeah, what the neurobiology behind the behavior is, what the um emotional support, kind of emotional support that person might need. So I recommend always to go through a process which is a complete neuropsychological assessment, which takes several hours, is expensive, and but gives you a clearer picture for the carer and for the individual of what they have been going through, what different elements have played because cognition is also a byproduct of emotions, it's a byproduct of trauma, of a history, so all of that has to be explored. What we add very peculiarly at BPS is that we do also personality assessment, so we kind of see how the neurobiology, how the neurodivergence has affected development and has translated into the personality of the individual. And when it's children, instead we look more at what their emotional needs might be. Because that's also part of the process of assessing children, that we want to support parents. One of the things um that truly bother me, sorry, because I'm going back to them to the myths about around ADHD, is when people say um that it's a matter of uh, you know, that those children are not well raised. When I was younger, it's a parenting issue, it's putting the blame on parents and putting the blame on society or school uh or whatever structure. Um because one of the things that we notice um is that when we assess someone, typically, then we end up taking on the family. So the individual that because there's a genetic, because there's a predisposition, let's call it this way, for neurodivergence. We often assess the kid, and then we look at the mom or the time, we're like, why don't you come in for an assessment? Yes, buy one, get one free.

SPEAKER_00 30:00

Friends use their children.

SPEAKER_02 30:02

Even the the strategies you implement, right? You should be you're supposed to co-regulate with your autistic child. But if you are dysregulated, how are you supposed to co-regulate before you you know make an intervention on your child? And if you are impulsive and you end up in shouting, yeah, you know, fights with your child, how can you really do that? So true. Yeah.

SPEAKER_00 30:24

Yeah, and it's an interesting, I mean, you know, access to diagnosis. And again, Judy's asked the question as well. How do you approach getting a diagnosis and what help is likely with a diagnosis? Because there are also different treatment plans. And we're still talking about ADHD. I will bring in a question in a moment about autism as well, but if we just stay with ADHD for a moment, you know, what are the different sort of um I mean, I remember my diagnosis was it was the best money I've ever spent, genuinely. But it is a bar that is a barrier to kind of overcome. But the things it tests for, but then the help you can get on the other side of it. So perhaps for example, just imagine that I've just had a diagnosis from you. What's the support that you're then going to be suggesting that uh I could access?

SPEAKER_02 31:10

There are many different avenues. You know, I'm a psychiatrist, so everybody thinks that just, you know, give drugs. This is part of the part of the process. You know, sometimes we really want to trial, to make a few trials of different medications, and we usually start with a medication that is known as a non-stimulant or a light stimulant, and then we progress depending on the response. But I would say that probably the main task that Um ever as is the first kind of point of interaction with a patient because can be a coach, can be a support group, can be a friend, um, who's like, you know what, I think you have a DHD. Can be someone who self-diagnoses on a website. Because we have people, I have people coming in and saying, okay, so Claude said this. And Chat GPT said this. And then I've taken the 16 free of charge online.

SPEAKER_00 32:03

Which are all weighted train selling your product.

SPEAKER_03 32:05

Yeah.

SPEAKER_02 32:06

Whatever, you know, and but they come and they've done the the the bit of work, you know, they're they're genuinely being in the process of understanding, and this is understanding as well. But whomever is the first point of contact, you need to be aware that there's a cognitive different way of functioning, but there's an emotional roller coaster. That person who's just been diagnosed is going at the same time through anger, relief, yeah, resentment, disappointment, yeah, and in a word, grief. Yes, I was just about to say that grieving the life they could have had. Literally, just about to say that. They're grieving the relationships that they think they grow in. Yeah.

SPEAKER_00 32:54

When I got my cognitive assessment through, yeah, it made me cry.

SPEAKER_04 32:57

Yeah.

SPEAKER_00 32:58

And I I I almost couldn't accept it. You know, it was like, this cannot be true, you know, because of what the story I'd told myself all my life. Sarah, I want to bring you in as well because it when we talk about different kinds of treatments, and I think that's one of perhaps one of the other stereotypes that you were certainly around in the media in the US and the UK was well, it's just drugging children now. Yes, you know, um because I do take medication and it's been a game changer for me. But you don't. Um, but you're you still, you know, you medic almost like medicate through exercise and so yeah.

SPEAKER_01 33:34

So I think everyone, and I think the biggest thing that we need to understand is that everyone's going to present in a very different way. We've got these universal titles that we're giving people, but again, we keep talking back to this idea about the cognitive um components and the cognitive profiles that we have. And I always kind of explain it like, do you know the audio mixing boards you get? Yes, you've got some. Yes, yeah. So think about your brain like that. And each one of the dials and switches and the sliders are a different form of cognitive trait. So we've got one for working memory, we've got for one for organizing, we've got one for sensory processing. And each one of those dials can move up and down. And for the majority of the population, those dials are somewhere in the middle for everybody. That's nice and that's how we operate. That's what neurodiversity in general just looks like. We're all got the same plate to start with. But when it comes to people who are neurodivergent, some of those sliders and dials are turned really high up. We see really high creativity or exceptional problem solving, or sometimes they're actually really low and you know, difficulty with working memory or sustaining attention. Um, and it's kind of like that this idea that because you're different and that you're somehow deficient, and that there's more weaknesses within people who are neurodivergent, that there's something wrong with them, and that's not actually the case. We're just different. Um, and and I think we can't just take one brush and kind of put that through everyone. Um, so when it comes to the workplace stuff, like when I'm doing workplace assessments, I will kind of take the overall broad view of okay, what have you kind of come in? What does your report set? Yeah. All right, how does this affect you on a day-to-day basis? What are the challenges, unique challenges that you experience on a day-to-day basis? Okay, is it time management? Is it sequencing? Is it working memory? Is it whatever? Understand that. Then you have to go and you've to understand from a work perspective well, what does your job require you to do? What are you needed to do on a day-to-day basis to be able to perform? And where is the mismatch from that? And we want to then try and layer that over the top to create a set of reasonable adjustments that's going to be applicable to you. So your set of reasonable adjustments is going to be different to mine, is going to be different to yours, or whatever. And that's what's important about creating that inclusive culture. Rather than going, okay, we need to fix Scott to put him into our culture. Let's fix our culture so that every single one of us can leverage our strengths that we bring. We're removing those barriers that stop each one of us really giving off our full potential, and we're getting the supports, the individual supports that we need to be able to thrive and do our absolute best. Yeah.

SPEAKER_00 36:26

Can I bring in another question as well? Uh I'm just gonna stay with ADHD just a little bit longer. But we've had a couple of parents also um messaging in. Um, Shafa, thanks for your question. As parents, what should trigger us to pay attention to ADHD in our child? Uh and another parent has also asked, I remember the question from earlier. Um, yeah, Buvenash, uh, for a child with ADHD and emotional dysfunction, is it is medicine safe or go for therapy first? And also how to handle a child with ADHD meltdowns. So there's a lot there. But let's just start with uh limited to children. As parents, you know, what should we be looking at? And because there's we were talking before we came on camera as well, that there's almost two different lenses. I have ADHD, so I need to be very, very careful about not putting my perspective onto my daughter, even though it's genetic, like just seeing my condition in her everywhere, you know, in everything that she does, versus also what should parents be looking out for in their children?

SPEAKER_02 37:31

Well, I would say in the UAE there's a lot of attention in schools. So I would say what not to not to do. So don't assume that because your kid is very uh successful in school, they're not struggling. Yeah. Yes. Because we read the school reports.

SPEAKER_05 37:51

Because we did the school reports. No, but we've had a few, we've had I've had a few encounters, one of our guests as well. You have highly functional ADHD people, yeah, but they had really struggled to get to that point of recognition and conformity. Yeah. Because especially girls.

SPEAKER_02 38:13

Yes, especially young girls, because they tend to conform more. Yeah.

SPEAKER_01 38:18

To compensate more, yeah. Yeah.

SPEAKER_02 38:20

But to conform as well, you know, they're more aware of the social rules. I remember this young girl moving slightly towards um autism. She had a double diagnosis, it was A UAD ADHD. Yeah. Um and she was um, and a mom who's a patient of mine, um, called me and said, she was in tears, and she said, I think she's psychotic. And I was like, Whoa, whoa, whoa, whoa, whoa, what do you say? Yeah, no, no, no. I've been observing her, she's been talking to herself, and she's like she speaks like she's speaking to someone. She might have hallucinations or okay, okay, cool down, let's have a look at her. And this girl was rehearsing her interactions with her peers. So she was literally spending hours a night talking to not imaginary, but actually real friends, and rehearsing the way she would have approached them over lunch, which of course made her extremely weird in her interactions and was part of her isolation, you know. So what we should be looking at is trying to be curious. If I have to give a recommendation to parents, myself as a parent, is be curious, educate yourself. Do you suspect there might be something going on? Yeah, just choose your way of educating yourself. It can be audiobooks, it can be books, it can be talking to an expert. Go yourself, ask people or rewatch this episode again and again and again. From the beginning. Uh follows cut. I know you know what I mean. It's like gain an understanding for yourself, be curious, be open-minded. Try as much as possible not to be in denial. It's very difficult, very difficult for parents. For parents, especially to look at our children, us clinicians, we don't see our children.

SPEAKER_04 40:10

Yeah.

SPEAKER_02 40:11

Or better, they want us to see what they want us to see. They're very good at hiding as well.

SPEAKER_00 40:16

Yeah. Yeah.

SPEAKER_02 40:17

Right? So that it's a dynamic. It's a dynamic. But not a lot of children with ADHD, children in general, I would say.

SPEAKER_00 40:24

Yes.

SPEAKER_01 40:25

But it's also a thing that I've seen a lot as well, is that I've got this label now, my child has got this label. Alas. And it's like I can almost allow that behavior. They've got ADHD. And it's kind of stepping back from your responsibilities of providing the right support. And I think that's a big thing, is that parents who do it, they don't know what behaviours or how to challenge those behaviours and put that structure in place to allow their children to be able to thrive. And by just giving it as an excuse, going, Well, they've got you a DHD, it is not a good enough answer. Education, asks for support. There's loads of people that are there to provide support to help you understand what to do when a child melts down.

SPEAKER_02 41:09

And to be self, to be completely honest, medications are not necessarily the answer. Yes, absolutely. They work in a minority of patients. Sometimes we need doses that are too high or not compatible with the previous state of the individual. If they have a hypertension, they might not be taken, might not be able to take a medication. And I have always mentioned how I was in the UAE during COVID, and we went in 24 hours from working in person to working completely remotely. So we went into Zoom sessions and assessment, etc. And I could see a certain population of my patients who were brilliant, young, very motivated, super active people, uh super determined, you know, like typically consultants, flying in and out, Saudi, Bahrain, all around the region, etc. Being locked in in their studio apartments and deteriorating very quickly. And I made a lot of ADHD assessments during COVID, not because these people didn't have ADHD before COVID, but because their life was so transformed by the lockdown that they could not go. And then I started looking into their habits, and I was like, I remember asking some of them, can you show me around with the camera? And I could see piles of deliveries, they include CVD, chaos everywhere. And these were people that I used to see, you know, like on a Friday, 3:30, that we would come straight from the airport and they were just about to go pottying, and they sometimes they could would get changed in the bathroom in the clinic because they were pottying very hard and working very hard, and they went into I can't raise from my bed. Yeah, yeah, can't get anything done. Yeah, and what was missing? The 5 a.m. uh F45. I'm sorry, I'm gonna training, you know, was missing the super high speed dopamine, adrenaline put in place to all the things that they had to put in place unconsciously for themselves, not knowing they were self-medicating. Yes, they were.

SPEAKER_00 43:21

Well, my career is you know, we've talked about this in the past, but it's like we we we almost tend to build lives um to kind of compensate without knowing it. I mean, I was in journalism, lots of deadlines, multiple tasks, you know, plate spinning, pressure. So there is that adrenaline, there is that dopamine going in. I'm gonna ask the second poll, and then I think because I just can see this, I'm gonna grab this iPad and I'm gonna start rolling through your questions because this is for you. So, second poll of the day, if we can launch that. And that's it's because I think we'll try and focus on your questions for the last 15 minutes. Um, and because I've got ADHD, I always overestimate how much time I have to do any task. Um What change would make the biggest practical difference in your workplace, school or home environment? Clearer instructions and expectations, more flexibility in how tasks are done, fewer interruptions and better focus time, more understanding from managers, teachers or family. That's something we should come on to. Better access to assessment or professional support, or more confidence talking about neurodiversity. Any of those stand out for you, or all of them? All of them are able to do that. There isn't an all of the above. But which of those do you think would actually work for you the best? Clearer instructions, expectations. I mean, it's interesting, more understanding from managers, teachers, and family. And that's something. This is something that we've, you know, we were talking about off-camera as well. Like, and if you've been diagnosed, like my wife still hasn't really accepted that Scott has ADHD. You know, he's like, well, you were fine.

SPEAKER_02 44:56

I wouldn't say that more flexibility will work, by the way. Flexibility leaves you very on your own, and then you will end up procrastinating until the last minute. So there are things that can work and things that cannot work.

SPEAKER_00 45:10

That kind of, you know, whether it be partner or colleagues, it's like, well, you've been fine, so why are you no longer fine? Why, what, you know, and it's like, how do you have that conversation with partners or colleagues?

SPEAKER_01 45:20

That's and I think it's yeah, a lot of that's around masking, and I think uh for people with ADHD have been masking. So masking is the idea of you are hiding aspects of yourself in order to fit into the broader context. But actually, when it comes to things like ADHD, you're not necessarily masking aspects of yourself, you're masking aspects of how you perform. So you've got these compensatory strategies that you've put into place for years and years and years. Like, I have to read emails two, three times to make sure I've got spelling mistakes all clear through before I send them out. I've got to practice conversations before I do them. I over-prepare for presentations because I need to sequence everything in the right way. I need to put plans and routines in place around my household in order to do it. But no one sees the invisible energy that it takes to put those things into place. All people see is that outcome. They're performing, so they must be fine. Yeah. Um, and the difficulty comes then is when you end up hitting that burnout when you kind of go, can't do this anymore. I am just done. Yeah. Um, and that's when I think you talked about people come later in life for diagnosis. And I do wonder, is that because they're they're not having the compensatory strategies to be able to do what they need to do? Or is it because they've been compensating so much in life for so long, they're so burnt out that they need tell me what's wrong with me. Oh, actually, it's a diagnosis that helps me now to understand what's going on, and I can go from there.

SPEAKER_00 46:58

So my experience was literally it was like, I can't do this anymore. Yeah, you know, and you've been pushing it down and pushing it down, and you just whether it's age, you know, over 50, but you just find it harder and harder and harder to keep pushing the things down and to keep doing the things you've already always done. And uh, thankfully, being relatively educated in this space, it was like something's wrong here, and we need to actually lean into this. I'm gonna plow through as many. Oh, top answer, by the way, was better access to assessment or professional support, which I think is really, really important. Okay, so um, we're gonna roll through as many questions as we can. Uh, Annette has asked, could a person with difficulty filtering their thoughts before speaking be related to ADHD and what strategies can help, especially with work peers? Uh, yeah, I've found that's got me in trouble a few times. Said the money's been fired from two or three ladies.

SPEAKER_01 47:54

It's a cognitive treat. Um, it doesn't necessarily mean that you have got ADHD. Um, yes, it it yes, but it's it's well, go ahead. No, no, no, no, no. No, no, no. Yeah. It it's about finding that. I think what do you do with it? Um if it's getting you into trouble, the biggest issue is if it's getting you in trouble, what are you going to be doing about it? And that thing is is is having that cognitive awareness, that emotional intelligence to go, oh, I'm about to have something come out here. And okay, let me just take a pause for a moment if you can. I appreciate that, particularly when it comes to ADHD, you don't have that filter time. No, you don't. And that's the difference with filter time.

SPEAKER_02 48:36

It depends on the topic. Yeah. The the sense of justice and I was literally about to go there. You know, it's it's incredible, it's impossible. You know, you you can't stop someone who's feeling like the very core of their very core values have been has been attacked. Attacked. Yeah, attacked. And I and it's about saving humanity. And if you don't say that this is wrong, yeah, you know, hell you're going to crumble a bit.

SPEAKER_00 49:02

You're not talking about my behavior or my performance, you are talking about me. Yeah and it could be humanity as well.

SPEAKER_02 49:09

You know, some people are extremely empathetic. Empathetic. And so it's not just about me. Some people intervene. I had I've had a patient who's being fired because his boss didn't kept being rude to one of the assistants who was bringing coffee in. And he said, You could say yes, please, and or thank you at least once.

SPEAKER_00 49:29

That sense of it.

SPEAKER_02 49:30

And the guy said, say it again, you're fired. Well, you can say yes, please, thank you, at least once, and you almost fired.

SPEAKER_00 49:36

Someone once explained to me as well, like, because I know and I've I've learned that you know, feedback and criticism, and you know, my wife Christina, she can be quite direct with her uh her assessments. I'm not saying she's wrong, but she can be quite direct. But that it was someone explained it to me. It's like it's like being stung by a bee. You know, and one person it'll be mildly irritating, and then for the other person they'll go into anaphylactic shock. Yeah, so it's the same thing, but experienced in a very, very different way.

SPEAKER_05 50:03

I find that fascinating because I used to think, okay, it's working on your triggers. And why is it that you feel so reactive and so you know vexed and have to respond?

SPEAKER_03 50:18

Yes.

SPEAKER_05 50:19

I didn't think that.

SPEAKER_02 50:20

Well, I was mentioning earlier, right? These genes must have a reason to stay. I mean, what will we do without people who stand by others or by themselves? People who are ready and able to fight, and they don't look at the consequences, they're not they don't have second thoughts, and sometimes they're very brave and very courageous, and you know, they're capable of advocating for what is right and what is true. That is so true. And it's of course we should try to support these individuals not being fight right, left, and center, and kind of be keeping a little bit of continuity in their personal life as well. But the reality is that there's a core which I admire deeply in people with ADHD, which is all about justice and fairness and kindness.

SPEAKER_00 51:09

I want to bring in Alison's question, um, because it kind of connects to what you were just saying there, particularly around I hate the word accommodation as well, that really drives me nuts. But um, if I can say that, uh, but Alison's asked, it's a great theory, particularly in the workplace, where diversity can be really valuable. But in practice, even in the schooling system, and there's there's still an expectation that children should behave in a certain way and conform entirely how to support neurodiverse children who are struggling with the expectations of the school system, and I suppose that does extend into the expectations in a workplace as well.

SPEAKER_02 51:47

Absolutely, yeah. Thoughts because often those individuals grow into having to fit into the workplace, and there have been children who struggle to fit into the whatever assignment, uh, deadline, and so on. I would say that the answer is rarely the accommodations because it technically if you give a kid with ADHD accommodations, it's just gonna move the deadline down the line. Yes, that's it. So you give in an extra couple of days means it's gonna start working two days later, most likely. But I understand that sometimes that helps, especially if there's a little bit of supervision from the parents. So there's a little bit of conflict between because my patients ask me for accommodations all the time, and I give them all the accommodations they need, and it can be for ADT or for autism, can be sensory issues, can be whatever it's needed. But the reality is that then they end up procrastinating in their deadline.

SPEAKER_00 52:45

Yeah, um so for Allison who's got a neurodiverse child, um, who's struggling with the expectations of the school system, we need to educate the school. We need to educate the school.

SPEAKER_02 52:57

We need to educate ourselves, yeah, we need to be able, as parents, as professionals, to go and be reliable, trustworthy, accurate, evidence-based, and explain and re-explain, and explain again, and try and find new ways to make them understand what truly entails neurodivergent.

SPEAKER_00 53:15

Because a good school will work with you on this as well.

SPEAKER_01 53:18

Yeah, and it comes back to the point, it's not about fixing the child, it's about fixing the system. And we've talked about this before, Scott. I guess what's the opposite to inclusion? The opposite to inclusion isn't exclusion, it's fitting in. And we don't want that, we want to leverage those strengths, and so each individual needs to understand that and their their own kind of system and what it is, supports individualized supports that's going to help them to be able to thrive in that. And I think that's a good thing.

SPEAKER_02 53:44

I remember distinctively a phone call with an HR that I was trying to explain that my patient was struggling to wake up, but she was often working much longer than anyone else's in the office. And she was bringing work home and she could not get out because she could not biologically get out of the hyperfocus. So she was she would continue working throughout the night, but then she would be seven or eight or nine minutes late. Yes, yeah, in the mornings. And this HR telling me, so I can't ask. I cannot ask. He finally connected and said, So I cannot ask her to be on time. And I was exactly. And she was, but so what's reasonable? And I was like, shall we say half an hour?

SPEAKER_05 54:26

Yeah.

SPEAKER_02 54:26

And they were like, Well, if what you say is true, there should be no limit.

SPEAKER_01 54:32

Yeah, ultimately, there's ultimately there should be that control.

SPEAKER_05 54:37

Yeah, yeah. Yeah.

SPEAKER_00 54:39

I'm gonna and we're gonna try and ask you to because we've got about five minutes left, so bullet point answers, which is a bit cool, but at least we can try and yeah, that we which is difficult for any of us. Uh, Kira's asked, Do you have any advice or tips on how to keep up work performance at work, especially after being a high performer, in the first six to eight months or so when you're watching sort of in great despair as your work performance goes to the dogs, context ADHD. So it is that kind of you know, when you're beginning to struggle, when the wheels are beginning to come off. Um, any tips to keep your performance up at work? And I guess that comes back to the relationship, perhaps you have a work.

SPEAKER_01 55:17

It does. So there's a couple of things. Number one, know where what you need, and that's the big thing that comes through education, working with your psychiatrist, your psychologist, yourself to know what is it that you do? Do you need time in the morning? Do you need quiet to do? Understand that you then also need to have an organization who has that psychological safety. Am I able to ask for these things? Because it's great that I know what I need, but if I'm not afraid, if I'm too afraid to ask for these things, then I'm never going to get anywhere. So we need to have those inclusive cultures where we have that ability to ask questions, to raise concerns, to speak for what we need and to advocate for what we need and for that workplace to be able to put those things into place. So understand yourself first and then be able to ask is ideally the right thing, but I do appreciate that not all organizations have that level of psychological safety to bring that into play.

SPEAKER_00 56:12

I'm just going to answer Gulnara's not question, but I I see you and I hear you. Uh, she said, could you guys please stop saying yeah? And uh and it's really annoying and distracting. Which which actually, you know, if you do have ADHD or if you have autism, that kind of you know, those pings and that kind of thing in the background can actually be very, very distracting. So Gulnara, I said it was a safe place, so yeah. Point taken, he said saying yeah again. Sorry about that. Geraldine, how does ADHD affect relationships and how do we navigate these challenges? I would only mention I think this is an entirely different podcast almost.

SPEAKER_02 56:48

It's impulsivity, yeah. For instance, impulsive decisions or blurting out answers, or and also there's a very specific feature to some of our some of some of patients with ADHD are extremely sensitive and reactive. There's a there's something, you know, in their emotional need, um, which is fear of rejection, that's it. It's called you know, reduction hypersensitivity, uh it's called in many different ways.

SPEAKER_00 57:20

Yeah.

unknown 57:20

Yeah.

SPEAKER_00 57:21

But I again when you've got that kind of inbuilt sense of injustice, you know, how can you not be reactive?

SPEAKER_01 57:27

Justified in my argument.

SPEAKER_00 57:29

Yeah, absolutely. Uh more questions, more questions.

SPEAKER_02 57:32

And also the non- sorry, partners not understanding, partners being in denial of feeling, especially with late diagnosis, feeling cheated because they married someone and they thought they got everything together, and instead they haven't.

SPEAKER_00 57:46

Yeah.

SPEAKER_02 57:46

You know, so been there, still there?

SPEAKER_00 57:49

Yeah. Rose has asked how to know whether a child is ADHD, is hyperactivity the only parameter which we've kind of covered, but let's just quickly talk about that again.

SPEAKER_02 57:57

No, hyperactivity is more of a copy mechanism because through hyperactivity, exactly like you when you exercise in the morning, or myself when I exercise in the morning, what we gain is a little bit more of dopamine. Some children only can pay attention if they are moving around. And it's not their way of not being attentive, it's actually their way of getting into a decent level of connection. I remember my son used to be on a be able to be on a phone call with his dad who was abroad, just if he was let free to run over literally chairs and and run around the table. And he would then he would be able to have a conversation. If I'd asked him, can you please sit down? Yeah. It'd be lost. Right? So the hyperactivity cannot be the only the only feature. It's probably the one that is more annoying, let's be honest, especially in young visible and visible.

SPEAKER_00 58:51

Okay. Sadly, and there are still some questions here as well, which is very, very quickly, if people want to reach out to both of you, uh, tell them where they can find you on social media if they want to ask some more questions.

SPEAKER_02 59:03

Um, I would say the Instagram page of my clinic, it's called BPS Clinic. That's the best way because someone always answers. Don't reach out to me directly on my Instagram. My Instagram is very simple, it's Dr. Valentina Faya, but I can't truly cast, but someone will probably pass the answers to me. Yeah. Yeah.

SPEAKER_01 59:22

Probably the best place to get me is on LinkedIn, Sarah Christensen. So, or Christian Consultancy, both on LinkedIn and support people either individually or at work.

SPEAKER_00 59:31

Brilliant. Um, this episode will be obviously very shortly uh on the podcast channels. Please subscribe and rate the episodes. We love that. That really helps us get discovered. And you will also see it on YouTube very shortly as well. So you can kind of play it back and go over and share with friends or colleagues who whoever you feel might benefit from it. When the podcast ends, when the webinar ends, you will be asked for feedback. Um, please uh we welcome it. It helps us shape future conversations. And I think I will try and put some sort of fact sheet together as well to go with the episode notes on this one because you've been so engaged. So thank you for being so engaged. Thank you for asking your questions. I hope you found this uh as insightful and as useful as I found it. Once again, thank you for joining us on Connect for Health. Sorry we've overrun slightly. Uh and we'll see you again next month.