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