The ADHD Doctor: How to Focus, Stop Procrastinating, Manage Your Emotions, & Feel in Control

KEYPOINTS

• 01

  ADHD is a regulation problem, not just an attention problem.

  Psychiatrist Dr. Sasha Hamdani describes ADHD as difficulty regulating attention, motivation, energy, emotion (which she calls 'a huge one'), sleep and appetite. If you only picture a jittery kid who can't sit still, you miss most of how it shows up, especially the emotional side, which doctors often put down to anxiety or depression.

• 02

  The diagnostic criteria were built around hyperactive young boys, so women get missed at every life stage.

  She walks through the pattern. A 13-year-old girl with mood swings and friendship struggles hears 'it's hormones.' Pregnancy's higher estrogen and dopamine can help, then the postpartum drop 'rocks your world' and gets labeled postpartum depression. Perimenopause brings another estrogen drop and brain fog, and the answer is 'you're hormonal, give it 10 years.' Mel says this described her whole life. She was diagnosed at 47 and says that once she found the right medication she finally 'felt like I was in my body.'

• 03

  In the ADHD brain, feelings arrive loud and the brakes are slow.

  In her deliberately simplified version, the frontal lobe (decision-making, judgment) is a bit thinner and less responsive, the amygdala (emotional alarm) is more reactive, and the connection between them is weaker. So you feel things strongly, and the thinking part is slow to filter the alarm.

• 04

  There are three types, and girls usually show the quiet one.

  Inattentive: daydreamers who are forgetful, disorganized, lose things and struggle to start or avoid big tasks. This is the most common presentation in girls. Hyperactive-impulsive: fidgeting, trouble staying seated, interrupting, blurting out answers. Combined: both. She herself is the combined type.

• 05

  Untreated ADHD can look like anxiety and depression, and treating only those can miss the cause.

  Constantly falling short of what you know you can do breeds anxiety. Bursts of energy followed by crashes look like depression. She has seen patients go through up to 10 medications with little relief, then improve dramatically once the ADHD was treated. Her analogy: giving a diabetic who's losing their vision glasses instead of treating the diabetes.

• 06

  Masking is camouflaging your symptoms, conscious or not, and women are especially good at it.

  From a young age, girls learn not to get in trouble or stand out, so they compensate. That makes ADHD harder to spot and more exhausting to live with.

• 07

  Rejection sensitive dysphoria is common, and you can wait it out.

  RSD is an intense emotional, and sometimes physical, flood in response to real or perceived rejection or criticism, or the fear of disappointing someone. She says almost everyone with ADHD has some version of it. Her tactics: move your body to get blood flow back to the thinking brain, and delay your reaction. She knows that in 10–15 minutes she'll feel different, so she sets an alarm and reassesses then.

• 08

  Step 1 is to track symptoms for about two months before or during an evaluation.

  Track three things in plain notes on your phone. Tasks: are you struggling to start, staying on track, or finishing? Sleep: how long, how fragmented, how hard to fall asleep. Mood: any format works. She wants enough data to cover two hormonal cycles so mood can be compared with your cycle.

• 09

  Steps 2–4: see a qualified professional, discuss all the options, and use reputable sources while you wait.

  She's biased toward psychiatrists because they're medical doctors who can rule out other causes. Options include medication, therapy, coaching, tools and systems, and being diagnosed doesn't automatically mean Adderall. Declining medication is 'a perfectly reasonable choice.' She found therapy to work out her own patterns and skills 'life-changing.' While you wait for an appointment, rely on journal articles or news that cites them, not random people online.

• 10

  Stimulants work in peaks, while non-stimulants can cover 24 hours.

  Stimulants (Adderall, Ritalin, Vyvanse) increase alertness and steer the brain toward reward, and she mentions a recent Washington University study on how they work. They're controlled substances, and coverage is short: about 2–4 hours for short-acting and usually 4–6 (up to 6–8) for long-acting, then they wear off quickly. Non-stimulants include some antidepressants and blood-pressure medications. Many act around the clock, and some help anxiety or depression at the same time. Medication decisions belong with your prescriber.