Life Uncut - What We Get Wrong About ADHD, Masking & AuDHD - with Dr Kieran Kennedy

Episode Date: September 10, 2026

Hey Lifers! ADHD has well and truly come into the spotlight in the last few years. Diagnoses have increased substantially in the past decade. But, this surge in diagnosis hasn't necessarily come with a surge in understanding; especially for women, who are so often missed, misdiagnosed, or told it's "just anxiety". So we've brought back one of Australia's most trusted voices on mental health and neurodiversity, consultant psychiatrist and TV doctor Dr Kieran Kennedy, to break it all down. Kieran is fresh off the release of his brand new book, This Explains Everything: A Psychiatrist's Guide to Navigating Adult ADHD, and he's here to unpack why so many women aren't diagnosed until their 30s, 40s or even 50s, what "masking" and "scaffolding" actually look like day to day, the difference between hyperactive, inattentive and combined ADHD, what AuDHD is, and why "high performing ADHD" might be one of the most misunderstood terms on the internet right now. We also get into ADHD burnout, the link between ADHD and disordered eating and substance use, the romanticised "superpower" side of ADHD on social media, and what steps to take if you think this conversation sounds a little too relatable. Kieran shares: Why ADHD in women is so often missed, and how it shows up differently to the "naughty kid in the classroom" stereotype What "scaffolding" really means, and the difference between adaptive and maladaptive coping What "high performing ADHD" actually is (and why the term can be misleading) The three types of ADHD - hyperactive, inattentive and combined What AuDHD (ADHD + autism) is, and why it's not a "made up" internet diagnosis The link between ADHD, dopamine seeking, disordered eating and substance use What ADHD burnout looks like versus everyday burnout Why women are diagnosed on average nearly 20 years later than men, and the role hormones, pregnancy and menopause play Options beyond medication The difference between masking in men and women TIMESTAMPS 0:00 — Intro & Kieran's most mortifying career story8:16 — How ADHD shows up differently in men and women10:55 — Scaffolding, masking & "high performing ADHD"17:16 — How ADHD is actually diagnosed (and the 3 types)23:19 — What ADHD looks like day to day (counting, parenting, forgetfulness)27:21 — Why women are diagnosed later: hormones, pregnancy & menopause30:28 — Treatment beyond medication, AuDHD & autism in adults38:13 — Burnout, dopamine seeking, myths & what to do next Follow Kieran on Instagram Grab Kieran's new book, This Explains Everything: A Psychiatrist's Guide to Navigating Adult ADHD:  Listen back to our first episode with Kieran (on binge eating) Listen back to our CLOUD mini-series See omnystudio.com/listener for privacy information.

guys and welcome back to another episode of Life Uncut. I'm Laura. I'm Brittany. Now, as you know, this will come as no surprise to anyone. ADHD has definitely entered the chat and has done for the last couple of years. Like, people have been talking about it on social media. We did our own mini-series cloud that was hosted by Keisha all about ADHD and ADHD late diagnosis. Now, diagnosis have increased by approximately 300% in the last few years. Which is wild. It really is. And, you know, I think that there's two trains of thought at the moment. There's a lot of people who see this online and see the conversations that happen and then they have the dismissive perspective of like, oh, everyone thinks they've got ADHD.

Yeah. And then there's people who have genuinely been struggling with parts of their life that they thought either something was wrong with them or that it was just a normal thing that they were supposed to deal with. I think that if you were in the second camp, you understand why people get to a point where they're seeking this out later in life. Yeah, and I think there's also a bit of a disconnect as much as, there is an increase in 300% in diagnosis, that doesn't equate to a 300% increasing understanding

and especially understanding ADHD in women and late diagnosis. Which is exactly the reason why we have an expert here to talk about it, because it's certainly not us. Now, we are joined today by consultants, psychiatrists, ADHD specialist, TV doctor, and one of Australia's most trusted voices on mental health and neurodiversity. It is Dr. Kieran Kennedy. Hello, guys. Welcome back again.

It's so nice to be back. We say welcome back. If that name sounds familiar and it's not because you've stalked him on social media or send him on TV, Dr. Kennedy, we're just going to call you Kieran if that's all right. Love that. Kieran's been on the podcast before a few times. You did an episode with us a little while ago, probably a couple of years now on binge eating, and you also featured quite heavily in our miniseries cloud, which was based around ADHD with Kisha.

So welcome back officially to the podcast. Thank you. It's so nice to be back in these cushy chairs. Well, they're new chairs, but it's also very nice to see your new book. The reason why we do have you here is because so perfectly positioned. But Kieran has just brought out a brand new book. Now, it's called, this explains everything, a psychiatrist guide to navigating adult ADHD, which is what we're going to be talking about, ADHD, autism, A-U-D-H-D, and what masking looks like.

And also, I mean, this is not for you guys to diagnose yourselves or to listen to this episode and think like, ah, aha, maybe that's what it is that I have. But ultimately, if this is something that you've been thinking about, it is a conversation that, I guess, is to bring a little bit more understanding to what those signs and symptoms might be, those things that you might be dealing with yourself or also how to support other people in your life who might be going through a diagnosis. Before we get into it, this is also not an appropriate question for everyone. Maybe not for you, but most people start with an accidentally unfilled and embarrassing story. Some doctors opt out. Some doctors opt out because it doesn't fit the medical... Understandably. Do you have anything you want to show?

in any capacity? Look, I had to think on this one because there's certain things where I'm like, will I have a medical license in the morning? Will APRO? Will anyone still find? No, you'll still have the license. Just no one will respect you enough to come into the clinic. That's the difference.

It's really, really quiet here today. But I do have something which is like medically themed, which is possibly the most embarrassing career moments of my life. In a nutshell, basically, after medical school, you do your intern years, right? So you're like a junior doctor. You're rotating through different specialties. I think this was my literal first year as a doctor. And I was rotating through a plastic surgery rotation.

And so I'd been there for about three months. At that point, I really wanted to be a plastic surgeon. So this was like high stakes for me. I used to think I wanted to be nip-tuck kind of vibes. Yeah, that's where the money's at, isn't it? Very different career I've ended up in. A hundred of the opposite. But at that time, plastics was the god.

And I was placed on this really, like, high-level boss dog, female surgical team. I had two female surgeons, absolute guns, top of their game. They were, like, reconstructive breast surgeons and plastic surgeons. And they had very high standards, were like notoriously, I say with absolute respect, quite hard to crack, like very serious and all about the work, obviously. Probably what you want in a surgeon. I was going to say for a surgeon, sounds great. But I'd spent the whole time, like months, working really hard, showing up early,

being really interested, trying to win them over. And I felt like I'd just done it. And we had this huge surgery coming out one day, this huge case. And I got a call in the afternoon from one of the nurses saying the surgeons have asked if you want to come down to theater and, like, assist. Like, they want you to help with the surgery. And I was so stoked. I was like skipping. Had this stupid big grin on my face.

face. I was like, yes, I'm in. Like, I finally want them over. I crack them. And so I scoffed down lunch and then I balfed down there to get ready because I didn't want to miss anything. Got in there, went into theatre, in the theatre, the patient's already there on the table, open, like, the surgeons are operating. And I come up and I'm standing there with my like arms cast down, huge stupid grin on my face. And then people were like looking at me, like the nurses and stuff, turning around and I was like, bye. Yeah, yeah, ready to assist.

And tell me what you need. And then the surgeons look up and they look up and I'd seen that they'd clopped me and I just started rambling. I was like, thank you so much. Like I'm so happy to have this opportunity. Like I'm just so happy to be here. This means heaps. I really want to do plastics.

Like, thank you. I'm so excited. And the room was just deathly quiet. And in the back of my head I remember being like, something is wrong. Something is not right. Then she was like, Karen, what are you doing? And I was confused because I was like, oh, I got a call.

I thought you wanted me to come in assist. Like, thank you so much. This means so much to me. And then she just goes, Karen, and they put their like surgical tools down. And she's like, what are you wearing? And I had gone into theatre, walked through the entire theatre thing, gone into like a live, open patient operation. You didn't put scrubs on. not changed into scrubs. I had not put a gown on. I had no mask on, no booties on my gross shoes.

And there was food down my top from lunch because I'd been so excited. You're like, I'm drunk. I'm actually drunk, but I'm here and I'm ready to help. And then I'm standing there with this golden retriever grin on my face being like, thank you so much. I'm here to help. I'm here to assist. I don't even know if it's, I don't know if it's embarrassing, but I understand. I was a theater radio grab up for 10 years. There's one fucking rule. And it is you do not walk into an operating

theater without your scrubs. I don't work in hospitals. Even I know that. I've watched enough Grey's Anatomy to know that that's a fucking rule. But it's not even like, oh, you silly sausage get out. It's like shut down. You have an open body. You can, like, that's like really bad.

So they've got to touch anything, but it was like the most mortifying moment. You can't recover from that either. I just death steered me and I just remember one of the surgeons being like, get out. You're dead to me. And I just like left and went back to the ward and now I'm a psychiatrist. And that was my very short-lived plastic dream. And so my dream of becoming plastic surgeon's died.

Especially because you're like, thank you for trusting me. He's like, I can't even trust you to get dressed. So yeah. So that was probably one of my. Guys, don't worry though. Kieran's a fantastic psychiatrist. I promise. Fantastic.

And he's written a fantastic book, okay? And so sometimes, like, one failed attempt just sends you in the right direction to where you're meant to be. Yeah. Course correction. You can turn it around from Mints on shirt. Well, obviously we're going to talk a lot about ADHD today. But one thing that I think has been spoken about quite a bit, but it's still an interesting part of the way in which people have misunderstood ADHD for so long is around the ways in which it presents in real life. So, like, how it shows up in men and boys is.

so different to how it shows up for girls, which is why there seems to be this, like, massive surge of women in their 30s and 40s going, oh, what was that? I'm not just erratic and careless and forget everything. Oh my God, maybe it's ADHD. Like, it seems like it's women who are discovering this about themselves because they are the ones who have been misdiagnosed all this time or not diagnosed. 100%. And that's kind of the whole one of the main reasons I wanted to write the book.

Like the book dives into, in particular, actually explaining what ADHD is. looks like in real life because anyone can look at the DSM diagnostic criteria, but even those are just so vague, it doesn't really show how that shows up for adults in everyday life. And for women and girls especially, it's not what we'd think. Like it's not that little boy running around the classroom, climbing walls, jumping on top of desks. And then by the time we reach adulthood, even for men as well, it looks very different. or we've gotten very good at like paper maching over it, hiding it, just learning to scaffold it, mask it.

I think that's why I love what I do because I just spend my whole day like uncovering these little things that are actually big things with people where they're like, well, shit, I never realized that me doing that for four decades is actually me trying to force my brain to focus or not forget a conversation. So then what does it look like for women and girls? Yeah. So for women and girls, we know that it can often be particularly inattentive. And so often we think of ADHD and we think fidgeting, we think running around, talking

nonstop, you know, quote unquote, naughty, you know, kids in classrooms. But for girls and women, we now know it's often predominantly inattentive, especially as girls get older. And so what that looks like is often nothing on the outside. You might not ever know that someone has an attentive ADHD. because underneath it's them struggling to focus. It's them trying to read a book or have a meeting and take in all the details. It's time management struggles or procrastination feeling like they literally get paralyzed

trying to make themselves start tasks. And so for girls and women, we now know that's often the predominant picture. And it's so much more easily covered up en masse. But especially back in the day when we didn't know so much about this, it was missed for women for so long. You talk about this idea of scaffolding or like creating ways in which to cope or I guess like to kind of meter the symptoms of ADHD. What does that look like for most people? Yeah. So we often hear about masking, which is kind of these heaps online about masking, but it's often broken down into different ways that we try and mask or hide or manage symptoms.

So scaffolding is one that I talk to people about a lot. And that looks like using other things or tools to really try and scaffold and manage the symptoms. So honestly, I've seen some of the most intricately phenomenal calendar coding. People show me their calendars. And I'm like, how are there that many different colored boxes and bits of text and flags? And, you know, so it's calendars. It's reminders. It's these super detailed routines and structures that people have to have so that they don't

forget something or so that they get things. done on time. But then how do those same people, because surely those same people have problems putting things into a calendar and keeping the organ, I know it's like an ambitious cycle. You need to have it to be able to keep your life in order. But the idea of, I'm not diagnosed ADHD, but I often hear people talking about things. And I'm like, I have so many things, but also you could just be normal. But I struggle to put anything into a calendar in when I need to, and I don't know why. But then how do those people manage their life when the whole issue is, that they can't manage their life.

Well, often it's just as you say, it's this like vicious cycle of trying to do it and being organized, but then finding it really hard and it all falls over. Or it's just almost through this like white knuckling death ride ridden, like I have to do this to function. And so that's why I also meet so many adults and especially women who are incredibly burnt out. Like they're presenting kind of with what we call neurodivergent burnout, out, which is the mental energy it takes to force themselves to keep the calendar updated or to

set phone reminders even though it's hard. You know, on the surface, people can look extremely organized and people often are extremely successful. Like I've seen lawyers, surgeons, other doctors, you know, politicians, like this does not sort of discriminate on someone's job, career, level of success, how organized they look on the outside because sort of scaffolding and masking and internalizing often kind of covers over it. And women, we know particularly women, are more likely to internalize and hide symptoms or mask them, scaffold them.

So it gets missed. Talk to me a little bit about this concept of high performing ADHD. Like I've heard that thrown around a little bit recently. And there seems to be like quite a few women who work in media who are like, oh, high performing ADHD. is it just referring to the fact that they're still able to get through what people will perceive as being like quite challenging tasks or whatever? But like what makes someone high performing yet also kind of having ADHD and that being, I don't know, I guess a tag in its own? Yeah. I mean, I think that's a term that's very real and valid, but I think we need to be a bit careful with it because I think it does get pushed into again being associated with your high functioning if you have a really prominent job or.

a really stressful, high position. And that's not necessarily the case. But I think high functioning ADHD, as you've seen online, kind of refers to people that do function, you know, really well overall in terms of what we see on the outside. They're juggling a lot. They're managing kids. They're tackling a career. They've got a very demanding high level career. And so they are functioning at a high level. But what we often don't see underneath that is that maybe internally they don't feel they're functioning at that same level. And people might be riddled with anxiety. They might not be sleeping. They're incredibly exhausted and burnt out. Not really functioning that well at all. Exactly. So I think it's a bit of like a dangerous kind of murky name or concept because we can

function and feel different in different ways in different areas. But I think it often refers to that sense of rightly so, but pushing back on the sense that to have significant ADHD, you must not be able to function in work or with family life or kids. And that's not the case. Like every week I meet people who are doing incredible things and holding it all together with a lot of the scaffolding and just white knuckling and natural talent and effort and everything else, but they still can have very significant ADHD symptoms. ADHD and autism is really having a moment on social media at the moment. It's getting a lot of attention. Do you think that's a positive thing or is there anything negative attached to the level of attention it's getting?

Yeah, I think it's positive overall. Like I think for way too long, neurodiversity has been kind of backblocked to this very misunderstood, stigmatized concept. And I think for both ADHD and autism, it's a really, a really great thing that there's so much more awareness out there now. you know, we've got people coming forward all the time feeling comfortable to be open about their diagnoses. I think I saw just recently, I think Robbie Williams has just come out recently saying he has ADHD and autism. I think he said, quote, I'm a little bit autistic. I think that was end quote, yeah. It was a good summary.

But yeah, you know, so I think there is a real benefit to kids and teenagers as well, seeing that it's not something to kind of be ashamed of or hidden. But I think the dangerous side of that is what I spend so much time seeing online and even talking to patients about is some of the misinformation that comes with it. Like there's a lot of myth and kind of fiction and things out there. And I think some of the way, like you said right at the start, Laura, that sense of like, oh, everyone's got ADHD now. That kind of gets pushed, I think, a little bit because it's in the media so much. But how do you navigate that, like as a clinician, as someone who's diagnosing? I'm sure that there's times where you have people come in and you're like, I don't think you have ADHD.

I don't think that that's what that is. How do you, I guess, like go through the criteria and what are the checkpoints that you have where you say, yeah, I agree. I think you fall into this bucket or I think that you have been reading too much online and identifying as something that's not you. Like, how do you see through that? Yeah, it's really hard. You know, it's a hard to sometimes let people down because I think there are times where there is a lot of, of investment in I think this is kind of the answer or this is the missing puzzle piece. And often it is, but often it might not be.

So I guess for me, it's really grounding in knowing that diagnosis of ADHD, it can't be done with some of those Instagram things where it's like, if you see blue in this picture, you've got an ADHD. I've clicked on that. Have you laws? You've never been served in Are You ADHD ad? Oh, yeah, loads, but I don't ever do them. Oh, I do them, but then I get to the end and you've got to sign.

up to get your diagnosis and I'm like, fuck, I'll never know. I just baited me this whole lot. Mine's like the opposite. I get three quarters the way through and I'm like, bored now. And that's how you know. At the end, it's like, if you don't make it to the end, what does that mean? It's like, did you check out early? But it's, no, the actual processes are really obviously detailed.

What do they look like a little bit? So, because I, you know, I've heard a little bit from Keisha. Obviously, we've spoken about cloud quite a lot. the mini series we've done. If you're interested in it, go back and have a listen to that. It's very comprehensive. But part of it was like, what has shown up in your childhood, how your parents remember you, like what is written in your school reports, not just how you are identifying, experiencing the world now. A hundred percent. So the crux for ADHD and autism is that these are, at the moment at least, they're conceptualized as neurodevelopmental

conditions. So the idea is these conditions, I guess, there are symptoms that come to develop in terms of how the brain develops from very early on in life. So at least for ADHD at the moment, the formal criteria for a diagnosis are that there have to be some symptoms present before the age of 12. So even if you're an adult now, we still need to look back and get a clear sense as much as we can. Like, I can't even remember breakfast,

so I feel mean like saying people tell me what you were like in primary school. But, you know, we get their recollections. We get info from parents if we can, school reports. It's trying to knuckle down that there was some type of struggle here early on that's then stayed across someone's life. So that's key. And then we obviously move through what's there now. And there are a number of different diagnostic symptoms and criteria. But I guess my job is also not just to look at ADHD.

It's to tease out whether your forgetfulness might be because your brain is jam-pat full of catastrophizing and generalized anxiety every second of the day. So it's really teasing out what is there and where is it coming from, plus the fact that this has to be kind of a passion across your life. It is interesting. And a lot of people are saying now, because we've seen this 300% increase, a lot of people are saying there's an overdiagnosis and misdiagnosis. How often are you having people come in saying, I want to be diagnosed, I've got ADHD, and you actually say, I don't think you have it, you have something else. Like, how often are you turning people away? Yeah, I mean, it's definitely not an uncommon occurrence, you know, and so sometimes, as I said, a difficult part to the process can be talking around what else might be there or what at the moment

might be representing those struggles. Yeah, more so. So it is common for me to talk to people around. Look, I think we need to look at treating your mood or anxiety first or this might be coming from complex trauma or even PTSD. there is a lot of overlap here with symptoms. I will say I think by the time people get to me, GPs and other doctors,

often psychologists have been involved. So I do find by the time people come to me for assessment, there's been a lot of workup and discussion done already. And so often there is a really valid, clear sense of, oh my God, yes, I can't believe we haven't looked at this view up until now and you're 42. But it's definitely a part of the process is sometimes, having to discuss, you know, quite complicated, tricky situations where this actually is coming

from something else. Well, there's three sort of buckets that you can fall into with ADHD, hyperactive, inattentive, and both. What are the main differences with these? Yeah, and this is one of the big kind of old misconceptions and stereotypes. I think traditionally we think about hyperactive and pulse of ADHD, which is fidgeting, we're always on the go, can't relax, nonstop, people around us are. Can you just chill out or on holiday?

Can we actually just relax by the pool? Is it even things like if you have to sit and you constantly have to push your legs going like 100? Yeah, you might fidget, be tapping your foot the whole time, kind of that inner restlessness. It can look like talking quickly, interrupting people, cutting them off. And then there's impulse control. So people can really struggle to not intrude on others or make decisions really quickly or rashly. That's kind of the core of hyperactive impulse. of ADHD, whereas inattent of ADHD can look completely different.

Someone might have none of those hyperactive symptoms, but internally they struggle with things like actioning things or procrastinating, staying focused on a conversation or sticking to a task without diverting and switching into another task. They might forget things. They lose their items. They leave drink bottles or their phone on top of the car and drive off. before they like. So Laura's laugh.

Stop describing me, Karen. Go away. Laura's like sinking back into the. I was intentionally then, my internal monologue was like, don't look at Laura. Because I didn't want Laura to think I was like, but I was like, I knew that Laura would be clocking that. Look, when you speak as scaffolding, it's something I find really interesting. This will come as not a surprise to any of our lifers who have been listening.

It's an ongoing joke that is no longer an ongoing joke. Because every time I say anything on Instagram, people are like, It's because you've got ADHD. All the life is trying to like... She's been diagnosed by the life. Literally. But I do this thing which has been described to me by somebody else who we interviewed quite a while ago and I've forgotten who they were, which is also not surprising.

But it's called mental fidgeting where I count constantly. I'm always counting. I'm counting the road on all the mics. I'm counting in fours. I'm counting in twos. I'm counting the colours behind you. Are you counting while Kieran's talking all the time? All the time.

Because I can't concentrate on one thing. without doing a second thing because... I was just going to say, do you find you need to do something at the same time as trying to concentrate so that you've almost got like something to like tether you? Like it's something to bounce between or do it at the same time? If I'm watching TV, I'm always counting at the same time. It's also, it sounds like silly, but I'll be on my phone, but it's just because it's something to do while I'm listening to someone else.

And it's not because I'm not trying to listen. It's because otherwise I'm... Anyway, I know it's something I've always done as a... kid. Like, I would always count. Trying to go to sleep, I would count, listening to what mom was saying count. And I remember, we were talking to Emily Weir, that's who it was. And she was talking about how she had a few, like, spicy things going on. And I was like, oh, I do this thing. I count. And everyone was like, what the fuck, Laura? No one ever knew you're just counting quietly. It does make a lot of sense because sometimes

she looks at me like, there's nothing in there. And I'm like, you're counting my paws? What are you counting right now? You're like, I wonder what she's counting. Oh, she'll get my forehead so intensely. I would say that in my life, and obviously I haven't been diagnosed, I don't want to speak in any way of myself as though that there are assumptions. But there has definitely been times where I have felt way more erratic and that like things just went wrong for me consistently and I couldn't get my shit together and I was losing things and I was hurting myself and I was like upsetting other people and failing at jobs and there has been very erratic periods of my life

and then there have been periods that are far more manageable. And I would say now in this period of my life, it is a far more manageable period of life because I have lots of scaffolding. And when you describe that, I feel that that is like the most relatable. Like, I've got all the things that make life run as smoothly as it could possibly run. Do you think, running at the moment? And do you think in a way, since having kids, as much as having kids makes life more chaotic, do you think it's part of your scaffolding because they have routine and structure as well? Like you have to get something done before this time because you pick them up?

It's not so much that their routine. It's more so with kids. I have to know their timetable because no one else is going to know it. So like, now things are calendared. Force. And like we, yeah, and we share calendars and we share responsibilities. And so, like, we keep each other accountable on that. I think something I hear from parents so often as well is you can't just procrastinate on

feeding Poppy. Totally. Like, you can't just be like, oh, I'm just going to like tap away on my phone or watch TV and kind of put that off till later in terms of like something for the kids for school tomorrow or feeding them and getting dinner. Like there are very real things. And so ADHD doesn't mean you're incapable of being a parent or attending to very important things, obviously.

And so like you said, I think sometimes things like parenthood do provide some scaffolding because there ain't no way around it. Do you know what I mean? 100%. And I think it's not even just the fact that they've got like basic needs to be met. But like you're constantly propel by wanting to be like a good mom. And so like I want to remember that my kids have dance recital. I want to be there.

I want to make sure I'm there at like, you know, book week. So I make sure that those things, even though normally if they were like a doctor's appointment or something, I'd forget and have to reschedule. But like those things I'm like, I will make sure I'm there. Because you know that if you don't turn up to the recital, it will hurt your child. If you turn up to the doctor, they might just have a rash a little longer. For myself. I'm like, I can my own rash sort of.

Why do you think women are diagnosed so much later than men? Is it because we mask better and we handle things better? Speaking for my species, I would say probably yes, because women do most things. Because we definitively now know that that's the case in terms of super interesting looking into some of the research and stats. Boys or men are diagnosed with ADHD on average in late childhood and their teens. Women, the average is closer to nearly 30. And many women are not diagnosed until 30s, even 40s. We actually had just a couple of weeks ago, Julia Monarch.

Morris, who everyone loves TV star, she was diagnosed in her 50s. Yeah. Talk to me a little bit about menopause and how that for some people is a significant transition for identifying ADHD. Well, I think even just not menopause, but like any hormonal fluctuations, like pregnancy and postpartum. And it's a massive factor in terms of why some women actually only start to notice symptoms really ramping up and changing when they do enter perimenopause and menopause.

And so to your question before, like it definitely is, Women are more likely missed, especially the current generation who are now 30, 40, 50. Back then, ADHD was, as we said, naughty, quote unquote, little boys running around classrooms. Girls were missed and inattentive symptoms were missed. And we do know that girls and women significantly mask and internalized symptoms compared to boys and men. So that's a big factor in why it's often late age, but also now we're seeing more about the hormone side. So absolutely, there's really strong linkage between ADHD symptoms and a woman's menstrual cycle. So we know that over the course of the month, the changes in progesterone, estrogen, they link to influencing dopamine and noradrenaline in the brain.

And dopamine and noradrenaline are the central factors felt to be involved in ADHD. They're the reason ADHD medications help ADHD. So if those hormones are changing for a woman across the month, and that's, you know, influences her neurochemistry to some degree, so common for me to hear from women that they notice their symptoms getting worse with their period, like in the lead up to enduring. It's not just feeling physical symptoms. It's often feeling like they are noticeably more forgetful, brain fog, they can't concentrate. Well, pregnancy does that anyway. So I imagine it's tenfold. Definitely. I think for women with ADHD, we're now seeing that pregnancy can often shift and influence symptoms significantly

that's something that I see from mothers kind of before, during and after pregnancy, is that ADHD symptoms can significantly worsen and ramp up, then drop and change. And so we're really starting to get that sense now finally from science that the hormone side of things for women is huge. And I see a lot of women who only realize that ADHD might be something that aligns for them when they enter perimenopause or menopause, because symptoms maybe that were always milder once the hormone profile starts to shift, symptoms that were once manageable, I can scaffold this, I can mask it, I can kind of white knuckle and get through, suddenly those

symptoms become really significant or different because of the hormone changes. What about for people who have sought diagnosis, what are the options? I mean, apart from going and having and taking medication, like for some people, does a scaffolding work? Like, is that enough for some people to be able to just identify it? What are the other things that people are doing, apart from, I guess, like, using medication? Yeah, it's a super good point because I think, especially if someone comes to me, they're like, oh, well, sometimes at the end, if we talk about ADHD, they're like, well, I guess now I've got to think about taking some meds from you, and I'm like, no. Meds are not the only option. Yeah, interesting. So we now know that there's

some really good solid evidence as basic doctor speak as it sounds and we'll all roll our eyes, but things like sleep, nutrition, regular meals, even physical exercise and activity. Fascinating stuff out there now about exercise, exercise increases dopamine in the brain, and it increases it in some regions to levels potentially consistent with medication. So when people exercise and for the period after they exercise, I have a lot of patients that tell me their ADHD feels better. And so, yeah, physical activity, diet, sleep, these things can all. improve symptoms. And then there's really evidence-based amazing psychology, psychobi behavioral work for ADHD

that tackles adaptive scaffolding, you know, things that really help support symptoms and support our life overall without draining us because I think that's one of the crux points with masking and scaffolding. It's not to say that learning tricks and tips for how to work your brain and scaffold things, that's not bad. It's like we shouldn't be saying masking and scaffolding is this bad, negative thing. But if it's leaving people feeling burnt out, drained, sometimes anxious and hypervigilant around, I cannot function unless everything is like this

or I have my calendar exactly like this. Maybe that's elements of scaffolding and things that are less adaptive because it's actually draining you. So there's a lot of psychology work around retraining parts of the brain, but also learning adaptive ways to manage with symptoms. and so a lot of people might not actually want to or need to go down the medication path at all. If you were going to define it, what would be an example of adaptive scaffolding?

So I think adaptive scaffolding, for example, might look like knowing that we work a whole lot better with a task or with study, for example, if we're breaking it into chunks and having regular breaks. And like, that's a really basic one because we've all kind of heard about that tip and the Pomodoro technique and things. But I think that's an example of a really simple adaptive one that kind of just has. helps us get through the task. Maybe more maladaptive scaf holding or masking might look like only being able to function if we are so hypervigilant around structures and everything going in a specific order because that's the only way we can get through tasks and remember how to get through things. Being so rigidly held to that that it actually creates a lot of anxiety or maybe even impacts our relationships or life at home because other people are feeling kind of

hemmed in by that. That's something that I see quite often. Sometimes people start to feel a little bit shackled by their scaffolds in terms of I have to do this to function and live, but it's actually draining me and negatively impacting me at the same time. Yeah, interesting. Talk to me about AUDD, what that is and why that conversation's increasing now as well. Yeah, there's probably, you know, people listening are seeing and hearing a lot about this now, and Ord, ADHD is something where we're hearing, yeah, well, I think people say both. Okay, I always said it as AUD-D-D. Even me, I'm learning like new names and words every week from people and patients.

But yeah, however we say, it's really this concept that ADHD and autism spectrum disorder symptoms can both exist together and people can have dual diagnoses of ADHD and autism. Back in some of the old diagnostic versions of the DSM, our diagnostic manual, they actually made it very difficult to diagnose someone with ADHD if they had autism, which is wild to think now. And they removed that criteria because we now know so many, you know, people with autism also have ADHD and vice versa. So awed ADHD or however we say is this concept of sort of overlapping symptoms of ADHD and autism. And that can make life really hard. And sometimes the symptoms

even buffer back on each other. You know, you've got autism on one side wanting structure, routine, needing things to be done in the same way. But then on the other side, you've got ADHD pulling it apart. Difficult to kind of stick to that routine and structure. So it almost can like counteract or contradict each other in a way. Is that way harder to diagnose knowing that there's like this intersection of symptoms? It can be really tricky because it often doesn't look like on either side like that stereotypical or maybe more classic picture. Someone presenting with autism and ADHD might not present with really classic clear-cut symptoms of ADHD. So again, it's a very detailed comprehensive process when we're kind of looking at.

at diagnostic assessments for both and seeing how they fit together. But it's a very real thing. It's not a, I saw something online just recently. Someone was saying, we need to stop making up diagnostic terms and letting people invent their own medical conditions. You know, so I want to make it very clear that people can and do have ADHD and autism spectrum disorder. And the concept of AOD ADHD or however we want to term it, this is not an inventor

social media diagnosis. What are some of the probably less stereotypical, more overlooked, harder to diagnose symptoms of autism in adults, not children, but I know a lot of adults are also being diagnosed as on the spectrum. What are we starting to see that people might not be so obvious to people? Yeah, I mean, again, I think it's important to point out that autism or ASD exists very much on a spectrum. And so autism spectrum disorder can look really different across,

that spectrum. Some people can be significantly and severely impacted. Other people can have more sort of lower level kind of symptoms and impacts that we might not actually see day to day or under the surface. For adults, that's often kind of sensory triggering that we might not even see on the outside. So people might become very overstimulated or triggered with too much light, noise. There might be sensory sensitivities around texture of different fabrics or clothing, even sensitivity to different textures of food is a common one I talk to people about. And then it can also be a real gravitation towards the need for kind of structure, routine, sameness, but in a very rigid, sort of more triggering sense. If things don't go the way I expect or that I've planned or usually

done, that is extremely triggering. You know, none of it. of us like it if our normal routine is put out of whack. But you can still function. For someone with ASD, that might be significantly kind of impactful in terms of anxiety. So when you say triggering, that's usually like it causes like them to feel extremely anxious about even proceeding with anything. Or significant emotions. Sometimes it's emotional over when I'm feeling incredibly distressed, sometimes even

frustrated or agitated. Tell me a little bit about the significance of people who have ADHD seeking out, I guess, things like drugs or alcohol and being more susceptible to, I don't want to say like necessarily substance abuse, but I know it can be that, but like more like feeling and I guess like. It's like a dopamine hit. Yeah. And also it is a dopamine hit, but I don't think when people don't realize that they have ADHD, they're not like, I'm going to go and take drugs because it's my dopamine hit.

But it's like you're getting something out of it that you might not be aware of. Yeah. I mean, impulsivity and dopamine seeking or a drive for things that, inherently feel good or give us that dopamine hit it. Or even adrenaline seeking was kind of what I wanted to describe it as because I have a friend who is a skydiver and he's also being diagnosed with ADHD but he's like just needs more almost is like the way of describing it. Yeah. Definitely. And I mean obviously again everyone will be different. There will be some people with significant inattent of ADHD who are like I am the opposite from impulsive or wanting to jump out of a plane.

But definitely for hyperactive impulsive ADHD, that can be a big part of the picture. You know, there's that drive for stimulation, newness, activity, mental and physical stimulation. And that impulsivity or quickness of drive within the brain can present in a whole lot of different ways. Last time we chatted, we talked about binge eating disorder. Those with ADHD are three to four times more likely to have an eating disorder than people without ADHD. and the most common ones are bulimia and binge eating disorder. So there's an involvement here around impulse and urge when it comes to food. The same can be the case for alcohol and drugs.

It's not to say that ADHD is linked to substance use or misuse, but the chances of someone with ADHD struggling with substances is two to three times more likely than someone who doesn't have ADHD. So absolutely there's a connection there between kind of stimulating, newness, things that do provide the brain with that kind of hit of kind of reward. And neurologically, there's very good science now to show that the reward processing in certain parts of the brain and ADHD is slightly different. And so that might translate to kind of urgent impulse control and reward processing from

everything. Fascinating. Interrupting, emotions, drugs and alcohol, eating. That can be a big picture. You talked a little bit earlier about burnout, this idea of like ADHD burnout. What does that look like for people? And I guess like what are the symptoms of culminating to get you to ADHD burnout? Yeah, I mean, sort of that concept of burnout, it's become a little bit of a

Everyone's burnt out. Yeah, and it's one of those things where it's like we talk about burnout so much. Everyone is experiencing, yeah, experiencing different versions of it. But like what does it look like from ADHD perspective? So for ADHD in particular, it's sort of that concept that managing the symptoms of neurodiversity and of your ADHD is really, even if it's keeping things flying, everything looks great on the surface. People don't see all the work underneath. You know, actually it's in the book somewhere, but I had a discussion with a patient and we were talking about the, you know, the duck feet under the water. Like the duck looks so graceful and swimming along, but no one sees how hard its feet are like flipping.

in. But that sense of like so much work underneath in terms of how hard people are working to you know, really just keep things flowing. And whether it's scaffolding, masking, all of those little ways we talked about to kind of prop things up over time that can be incredibly draining and people end up feeling really mentally and physically fatigue even if they're sleeping and they feel otherwise rested. They can feel like things are starting to lose their sparkle, there's less motivation or enjoyment in things, we can start to feel cynical. And so people often tell me, people don't realize how hard they know they're working compared to other people. They feel like they're having to work at 300% to someone else as 100% just to kind

of reach the same level, you know, so it's really, really common. Also really interesting, because I guess, like we said, there are so many versions of how people describe feeling burnt out. And I think we live in an economy where, if you're not doing more, then you're not succeeding and you're not achieving. Like hustle culture. Yeah, and we don't have overview of like how and what other people are doing. So even that idea of like, well, if I have to work at 300% for that person, it's like we kind of really don't know what's going on under the surface for so many other people. 100%. Yeah. And again, someone can look like everything's going amazingly and they're smashing

it on the outside. But I think it resonates with just mental health in general, right? We never know what someone's going through on the inside and someone can look on the outside like they've got it all and everything's great, but actually they're really, really struggling on the inside. Talk to me about the concept of forgetfulness a little bit, because we've been talking about this on and off, and I'm sure by the time this episode comes out, we will have talked about it on the pod so far, so this won't come as a surprise to anyone. But is it mostly around the organization of things, or can it be around the forgetfulness of people or places? Like I, and I'm speaking from my personal experiences here. I have a real issue remembering people. I cannot remember people.

Like, we've... Like faces, yeah. People. I come in sometimes. She's like, who are you? Who the fuck is that? Who's that? Like, in our jobs, we meet lots of different people all the time. It's really hard because it's like out of context, in context. Like, you will meet someone, have a meeting with them, then you might run into them at the shops. Like, I fucking don't know who you are. I cannot. And this has happened recently where people that we've like gone out for lunch with who's like organized contracts. And then I got into a lift and I was like, blank, couldn't remember. I can't place them. No, oh my God, they're riddled with guilt once I realized. Like, because I, because there's no reason to not remember. But that's one of the things for me, there is no scaffolding or no help that I

have been able to come up with that helps me remember people. And so that's where it shows up the most for me. Like my memory around things that have happened and stuff, whatever, my memory around timetabled stuff, I can sort that out. But people, horrific. Like going to the Logies, fucking don't know who anyone is. Couldn't tell you a single person. I was like, just hi to everyone. Just said hi to everyone, told everyone they looked amazing. Couldn't remember a single person's name.

Couldn't remember where I'm in it. Like, it's real. I find that the most challenging thing for me. So I find it interesting when people talk about forgetting places, sorry, forgetting like tasks and things that they need to do. Yeah. Because, but I think for me it's more like forgetting people, beginning really important stuff.

And it can show up differently for different people. You know, I think the crux point is that it's. It's obviously very different to losing, like, experiential memories, right? So obviously, if someone came to see me and they were starting to get lost or they couldn't find their way home or they were starting to forget their wedding day or, you know, those things are concerns where we're like, okay, is the actual cognition of memory, you know, something's not right here. But if we're talking about a meeting, if we're talking about meeting someone once or for an

occasion and then that slipping. We know with ADHD parts of memory across the board for things we've talked about, people names, logistics, dates, important things coming up for friends. You know, I was supposed to text her on Sunday because she had that important work, you know, interviews. Birthdays. Sorry to my friends. Sorry to everyone.

But, you know, it's stuff that requires attention in the moment in that more working memory sense. So we tend to find that people struggle with forgetfulness and memory for things that involves taking in details or information kind of in the moment, especially if it's less like emotionally experientially charged, you know, like if it's an amazing family event or a pivotal point in your life, you're probably not going to forget the occasion or that that happened at all. But for bits of information from conversations, meetings, remembering people, putting names to faces or where we're, you. We saw them, where we met them, who they are, logistics. That stuff requires us to be attentive and then the brain to be focused enough to take in the information in the moment and kind of lock it down almost. And for people with ADHD, that can be really difficult because of those differences in attention and the processing. So, yeah.

So I don't think we're diagnosed with dementia. Did you dress yourself this morning? Unfortunately, she did. No, I'm joking. Hey, go fuck yourself. I'm joking. But, I mean, that is interesting. It's a conversation, Laura and I've had many times, like, privately on the pod with Kisha.

We've done a lot of chats around ADHD. And I think that you know that you have a lot of traits of it without having being diagnosed. But I think a conversation like that with Kieran is important because with your memory situation, you are sort of worried that you're teetering on the edge of it not being ADHD and maybe it being something more severe. No, not that. I just wonder if other people or forget it as badly as I do.

I agree. Like, yeah, that's always a concern for me. It's something that runs in my family. But it's like... I think Kieran's explanation is perfect of you when you meet someone. I just imagine... I'm too busy counting.

I imagine, yes. I imagine you're talking to them and your brain's like... Not like that, but I imagine your brain's doing something else. It's like the dog dancing on the chair with the accordion. The dancing baby that's on the... I want to ask you, though, obviously we've talked about a lot of the negative things and things that are challenging, but there has been almost a romanticized version of ADHD that we've seen happen on social media as well. It's the creative. It's the person that's able to stay up all night because they're hyper fixated on a task and they've gotten really excited about house plans, whatever it is. Like, that is also a very real part of the conversation. How real is that? How real is that for people that have ADHD? I mean, I think it's very real and it's really important. You know, I think a lot of

lot of the time we can frame this. And obviously, I'm a psychiatrist, so someone's probably not coming to see me if they just feel your life is amazing. I'm so inspired on my ADHD. I just want to come chat with you about how great my life is. I forget everyone's face, but I'm having a great time. I love it. So, you know, we focus a lot on the negatives, obviously, and supporting those things. But there is a lot about neurodiversity, ADHD and autism included. There are real strength-based, positive, you know, a patient laughed at me this morning, a teenage patient when I use the word superpower. He just like rolled his eyes and was like, are you for real? He's like, you're so uncool. Shut up, dad. But, you know, there are real positives to this.

And, you know, people can feel very strongly, you know, like we talk about emotional dysregulation, but there's some really interesting work now showing that that can flip towards people with ADHD also experiencing positive emotional states a lot more strongly than others. But then do they experience the negative emotional traits just as strongly? Exactly, which is the hard part. There's links to creativity, entrepreneurship. There's some really interesting stuff coming out. And even hyperfocus, for example, that might not be in the DSM diagnostic criteria

for ADHD, but it's a very real valid phenomenon. You know, having ADHD doesn't mean you cannot focus at all. it can often be that the balance of focus and how the brain manages that is slightly different. So yeah, people often tell me they freaking love going down like a hyperfixation, hyperfocus spiral on, you know, flax until like 2 a.m. Or, you know, so there can be some real benefits of this. And I think we need to focus on that too. But we also not, you know, we need to not let that start to sift into kind of misinformation,

especially on social media. One of the things that, again, we go into in the book is kind of a bit of fact-first fiction around, is it true that if you like showers, you have autism, but if you prefer baths, you have ADHD. You know, like, I've literally seen a reel, like, saying that. So there's just so much out there where it is kind of just really diluted down into this not medically evidence.

You just roll your eyes. You're like having it's not a superpower. I'm like, well, you might probably. refer bars, but that's probably got little to do with it. It must be so infuriating when you work in the space to see how, when you say, you call it dilute, I think it's a perfect word for it, but like just how much conversation and noise there is on social media and how it leads people down the garden path to self-diagnose, to, you know, pick apart bits and pieces that they think they identify with and kind of

really confusing what ADHD diagnosis is. Yeah, because I think it's important as well to point out that we could sit here and go through all of the diagnostic criteria for ADHD, and every single one of us could say, oh, yeah, I've done that before, or sometimes I do that, or because it's also really, really important to point out that when we talk about ADHD and autism to a degree, we're talking about spectrums for how the brain kind of functions and works and engages with things, and we will all have elements here. You know, we're not cyborgs just yet or, like, integrated with Claude or whatever, so

we're not nearly. We're not perfect, but we will all be a bit forgetful at times, or we might have that story where we left something on the roof of the car once and drove off. But for people with ADHD, this is like... What if you do it once a week, Karen? Asking for a friend. What if it's once a week? Just checking.

You're watching the video I'm writing furiously on us on a note. He's going to book you in after. So I'll get the clinic to reach out. I'll forget to answer. That's fine. You know, that is the important thing. because it's like if I, I don't know, get an Uber sometimes and people are like, what do you do for work?

And I say what I do. And they're like, oh, everyone has that or like everyone can't focus at times. Back in my day, we just got on with it. It's like that's not what ADHD is. You know, for people with clinically diagnosed ADHD, these issues are common, pervasive and significantly impacting their day-to-day function and the rest of their mental health. You've mentioned a few times the word masking. Talk to us about what masking actually is and how it differs between men and women, how they mask differently.

So masking in a nutshell is kind of almost trying to mask the impacts of neurodiversity, or in this case, ADHD. And we can do that through scaffolding like we've talked about, coming up with ways to get around it and help support it, scaffold it. there is internalizing, which is basically almost just like hiding and holding symptoms. So the classic one I hear is someone who just sits and like almost bites her tongue the whole time to not be that friend in the catch up that's like jumping in every five seconds with their story or interrupting others. It might be like white knuckling it through a meeting to not like fidget with stuff on the desk. So internalizing is that really kind of containing and holding.

And then there's also something that I see a lot which is maximizing, which is basically just almost like chucking everything at the wall in terms of effort. And so that's where people talk about, yeah, I can keep up with everything and get it done. But my colleagues go home at 4pm, whereas I stay at the office until 8 to get everything done. You know, we can kind of mask by also just putting in screeds more mental effort and time and energy into things. things. And all of those things kind of equate to trying to mask the impacts of ADHD and what others see on the outside. And I imagine that's extremely exhausting. Just exhausting. You know, there's links to the more someone masks, which we know girls and women are more likely to mask and internalize compared to men. The more someone masks, the more that can link to burnout,

anxiety, mood disorders, other mental health struggles. And yes, it's because it's, even if some of the stuff we might actually be subconscious to, we're processing so much more mental energy in the background every single day. You know, if, I'm not saying that this is necessarily that, Laura, but like just as an example, if Britt and I are sitting here just having a convo and you are as well, but at the same time your brain is counting in the background,

your brain is having to expend more mental energy in that moment than Britt and I's mind might be. You know, so I think people sometimes don't equate the amount of extra mental processing that that masking can take. Yeah, I understand. What number are you up to now? I only count in fours and I'm only up to 12. And then back down.

You never exceed 12. 12, 24. What does that mean? Kieran. Back down. Back down. Back up. Does that mean something?

Just that you're fucking weird. Laura, she'd be a fucking weird. Not weird at all. No, it's not weird. It's not weird. It's not weird. Yeah, we'll talk about another day. It's fine.

we if anyone is interested we've done a couple of incredible episodes over the years with some of the contestants from love on the spectrum who speak a lot about masking and what that does to them in the day today as well and it's it did show up very differently in the women than it did in the men so we can link those in the show notes if you guys want to go back and have a listen for anyone now that's listening and is thinking to themselves I might have some of these symptoms I've always thought it was going on in the background but I'm not sure I've never taken it seriously and make Maybe that's ADHD or odd HD. What would you say is the steps that they should be taking? Yeah. So I think like obviously take everything with a grain of soul and maybe not through Insta or TikTok. But like having a look at what the diagnostic criteria or the symptoms are for ADHD, that can that can help.

Sometimes people honestly still have that very stereotypical view of what the symptoms are. So doing a bit of reading can help. But honestly, seeing your GP is always the best starting point. like GPs are just actually amazing humans and doctors and they have so much knowledge about so many different things. But that's a great starting point in terms of I've been thinking about ADHD. I've noticed these things. This is what I'm worried about. And your GP can start that process of, okay, how's your mood going?

Is it linked to anxiety maybe? How long has it been there? So talking to your GP can be a good starting point. And that can also open up, okay, well, what do we do next? And in Australia at the moment, I think we all know there's been a whole lot of chessboarding lately in terms of ADHD diagnosis, medication, who can diagnose, who can prescribe. Oh, I don't think people are necessarily aware of that. I didn't know that that's changed.

Yeah, so there's been quite a bit of change recently. So Queensland now, for example, GPs are able to diagnose and start medication for ADHD. So in Queensland, a psychiatrist might not necessarily have to be involved for everyone at all. Is this based off the fact that it was just taking, diagnosis was taking so long? Yeah, so there was a lot of bottlenecking in the system. And then also, understandably, I think sort of access and the financial side was a barrier as well. You know, obviously to see any specialist. It's really expensive in terms of it's just not feasible for some people.

So I think opening it up with more GP primary health led care has been behind that too. But yeah, and then in other states, including sort of, have been sort of differences in GP training schemes in kind of Tasmania. There's underway in Victoria now for GPs with specialist training to be able to kind of diagnose and prescribe eventually. So there's a lot of access opening up. But I think talking to your GP about the next steps is the way to go because it might be, I think we should get a referral to a psychiatrist to see what's going on.

You might start with a psychologist, perhaps. There are, you know, a lot of amazing psychologists who specialize in neurodiversions. and can do a formal assessment and diagnose as well. So a lot of different routes, but I think starting with the GP is a good way to go. Well, Kieran, for anyone who wants to find out more, how can they get your book now? Thank you so much for that segue. So the book is available through Simon & Schuster. I think by the time this comes out, the book will be out, which is kind of surreal.

Yeah, congratulations. Terrifying and exciting, thank you. As fellow authors, it's hard writing a book. You guys know with the five. I reckon yours was probably a bit harder than ours was, okay? No, I will make this far more simple. For anyone that wants to know more, we will be linking your Instagram in our show notes, but also how to access the book as well.

So just jump into our show nights. We'll put it all there. You are a wealth of knowledge and your socials reflect that as well. So please, guys, go and check him out. Thank you so much for joining us. And, I mean, for the third time now, there's only a few people that have made. You're a real frequent flyer. You're an uncle doctor.

Maybe not after I told you that story about the plastic surgery. No, we'll still have you. We'll still have you. Just not for surgery. Yeah, the buzz low. We won't go any for surgery. No plastic. We'll take you.

To be fair, give us a discount. Yeah, I could do it. Cureen 20. No, but thank you so much, guys. It's been so great. We love having you. Thanks, Kieran. Thank you.