Psychiatrist and ADHD specialist Dr Sasha Hamdani joins Lewis Howes to discuss how ADHD is diagnosed, why symptoms are often confused with stress, trauma responses, anxiety, depression, hormonal changes and medical conditions, and why she believes ADHD is better understood as a broader regulation issue rather than simply an “attention deficit”. Hamdani describes current diagnostic practice as heavily reliant on clinical history and longitudinal patterns, and argues that criteria originally built around observable hyperactivity in young boys can miss internal symptoms such as emotional dysregulation, particularly in women.
She alleges that some patients cycle through multiple antidepressants before ADHD is considered, criticising clinicians who refuse to evaluate ADHD until anxiety or depression is controlled. Hamdani also claims the average age of diagnosis differs sharply by sex, saying boys are often diagnosed in early childhood while women may not be diagnosed until their mid-30s, sometimes after recognising symptoms in their children.
The conversation also focuses on rejection sensitive dysphoria (RSD) and emotional sensitivity, with Hamdani outlining a simple brain-based model involving an overactive amygdala and an under-responsive prefrontal cortex during perceived threat. She shares personal experiences: being given ADHD medication as a child without fully understanding what it was, and later learning to connect emotional overwhelm with functional impairment. Practical suggestions include matching coping tools to how dysregulation presents (for her, movement can help interrupt spirals), and approaching a partner’s distress with calm curiosity rather than commands to “calm down”.
Dr Sasha Hamdani, a psychiatrist and ADHD specialist, says European diagnostic criteria were amended in 2019 to include emotional regulation, while the US criteria have not followed suit. She argues this gap makes it harder to recognise internal symptoms that are not easily observable in a clinic, contributing to missed or delayed diagnoses.
Read this moment →Dr Sasha Hamdani says she has seen patients prescribed multiple antidepressants before clinicians consider an ADHD assessment, which she frames as a cycle of misdiagnosis. She criticises the practice of deferring ADHD evaluation until anxiety or depression is treated, arguing it can delay appropriate care when ADHD-related emotional dysregulation is the underlying issue.
Read this moment →Dr Sasha Hamdani claims the average age of ADHD diagnosis is around 6–8 for males versus about 35 for females, arguing women are often misdiagnosed with anxiety or depression or dismissed as “hormonal”. She attributes the gap to diagnostic criteria based on hyperactive boys, hormonal effects on dopamine, and social pressures that lead girls and women to mask symptoms.
Read this moment →Dr Sasha Hamdani says she was diagnosed with ADHD in fourth grade but did not understand she was taking ADHD medication, which she recalls her parents presented as a “vitamin”. She says she later felt “extremely betrayed” when she learned what it was during medical school, describing the episode as something her parents “could have handled… better”.
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