What happened in this episode?
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”.
