Dr Supriya Malik Reveals the TRUTH about ADHD & AUTISM!

Abhijit: Hey everyone. Welcome back to Rationable Conversations. Today, we are live on set with our guest also here with us, so this is a big milestone when it comes to our podcast. I hope you're gonna enjoy this because we are gonna be talking about autism, neurodivergence, and a bunch of other stuff.

Abhijit: Hey guys. Welcome back to Rationable Conversations Today we have a very special guest with us, Dr. Supriya Malik. Dr. Malik, welcome to the show.

Dr Supriya Malik: Thank you for having me.

Abhijit: Oh, it's an absolute pleasure. I've been wanting to do this show actually for a very long time, and I'm so glad that we managed to get things in order.

Same and get this together. Yeah. First of all, could you just tell us a little bit about what you've been doing? What I mean? Of course. You're the executive director of the Canadian Autism Network, or the Indo-Canadian Autism Network. Canadian Autism Network.

Very appropriate for being in Delhi and in the Punjab area, of course.

Dr Supriya Malik: No, so I'm a developmental psychologist. I've been in the field for last 18 years. I founded Embrace, Which is based out of Delhi. It's a mental health and developmental care platform. my mission was to be able to bring quality, high quality therapy and assessment services to India.

So through Embrace, that's what we've been trying to do over the last four years.

Abhijit: That's fantastic. And I know about Embrace because I am one of the clients of Embrace. Because that's how I found out about Embrace. And honestly, I think it's a fantastic fantastic initiative.

Dr Supriya Malik: Thank you.

Abhijit: I wrote a book I ghost wrote a book for a friend.

I keep harping on about this 'cause it's shameless plug, but on adolescent mental health.

So a friend of mine and I, we got together, she wrote about all the facts and figures and you know how to diagnose symptoms, how to look for symptoms in your child.

And ADHD was one of the chapters. Andtowards, the appendix I added Embrace as one of these service providers. So hopefully out of the few books that we've sold I hope somebody has managed to get through and get

Dr Supriya Malik: Oh, thank you so much for that.

I didn't know that.

Abhijit: Thank you.

Dr Supriya Malik: Yeah.

Abhijit: I did want to, because we don't have a lot of time. But I really wanted to understand, first of all, ADHD is, and this is the last day. we are recording this on the 31st of October. So this is the happy Halloween, by the way.

So this is called ADHD Awareness Month. Apparently, which my therapist has told me about

Many times. And I've forgotten. So I was wondering, first of all. How does one identify that one might have ADHD. Right. And what are steps that one can take to get it screened?

So to start with ADHD looks different at different ages. So if what we see in children will look very different when it's an adult. So for example, when we are looking at children, we do want to see how long can they sit in focus, how much are they getting distracted, how often.

Dr Supriya Malik: We also look at things like careless mistakes that they're making, oftentimes losing things. These same symptoms do carry on over the years. But it's just that for an adult, they might look as more forgetfulness in things. They might look as being more scattered in their life. So different ages will determine how we look at ADHD.

There's also a difficult one where everyone understands ADHD as people being hyperactive.

Abhijit: Yeah. That is a big misconception.

Dr Supriya Malik: It's a big misconception. Yeah. And with hyperactivity there, when that word, pops into our mind the images of someone bouncing off the wall.

Abhijit: Yeah.

Dr Supriya Malik: And that's not what hyperactivity really is.

When we talk about it in ADHD it could look like fidgetiness and just shifting in our seats often to someone who might actually want to move a lot.

So again in children, we do know that children till six years of age anyways want and need movement.

So below six we don't, diagnose ADHD. It's only once the child is six or seven that we will start looking at are they being able to manage themselves and their behaviors, are they being able to control their actions? And as teenagers grow up, we know again, that hormonal shifts are happening.

So a lot of teenagers do need movement and, physical activity to expel a lot of the hormonal changes and the energy that's there in their bodies. so again, there's a high chance of misdiagnosis or misunderstanding because a lot of people will then think, oh, is this restlessness?

They're constantly, most teenagers are fidgety. So how do you decide whether this is just the fidgetiness coming from teenage years or whether it is actually ADHD that is playing up now.

Abhijit: Ah, so that makes it even more important to do a proper screening with a Trained psychologist or a psychiatrist Absolutely.

Dr Supriya Malik: Yeah.

Abhijit: Because, as a kid, I was never hyper, I was never fidgety or anything of that sort, but I would make a lot of careless mistakes in my schoolwork. Yeah. I would be very forgetful. I would always get low marks.

Because I would forget half the things that I had studied the previous night, because obviously I'd be studying last minute.

Yeah.

Just it would never stick with me. But as I've grown older, the reason how I got diagnosed is that I actually messaged my psychiatrist and I asked her, I said, I'm very forgetful and I'm very absent-minded.

Is this like a heritable trait? Is it a personality thing? Why am I like this?

And her prompt response was, have you been screened for ADHD? I was like, no. I thought that was a hyperactivity thing. I honestly, I didn't know much about ADHD at all until that moment in my life.

And then of course I went, I got screened.

She said, you definitely don't have the hyperactivity part of it. So you do have ADHD, but it's

inattentive type, which is, could you also go through the types of ADHD?

Dr Supriya Malik: So there are three types that we know now. One is of course the inattentive type.

Which is what you were describing, right? Where you don't feel the energy or the need for movement as much. But keeping focus for a long duration is problematic sometimes, or, it's just managing attention.

Because things can come up and what happens with people with ADHD is they don't know what to pay attention to.

So if something comes up, they start paying attention to that. Thing, not realizing that it might not be the most salient, salient thing that they need to pay attention to. So it's more about what we choose, and that's why we call it, as part of the neurodivergent spectrum, because it's a difference in the way we are paying attention to different material.

I know I can tune out the sounds that might be there in the background. But for some of the people with ADHD, that tuning out is very difficult and that's what makes it difficult to then focus on what's there in front of you.

Abhijit: Yeah. I look at it from the perspective of it actually being less of a physical hyperactivity and more of a hyperactivity of the mind brain.

Where the brain is just bouncing around between different topics, between different things

Dr Supriya Malik: Yeah.

Abhijit: And not really being able to focus on one thing. But The point also becomes, in not being able to focus on that one thing, we also have another problem of hyper focus.

Dr Supriya Malik: Yes. Let stop extreme, which

Abhijit: so this is more like a dysregulation of your attention.

Dr Supriya Malik: Yep.

Abhijit: Instead of a deficit of attention. We've got lots of attention. We just don't know where to put it.

Dr Supriya Malik: Exactly.

Abhijit: And then all of a sudden we settle on this one thing.

Dr Supriya Malik: Yep.

Abhijit: And we focus on it so much that then, like next thing you know, I know everything I need to know about bacterial lum all of a sudden the next day.

But yeah. A lot of people look at ADHD having ADHD and this hyper hyperfocus as a form of a superpower.

Is that something that you would claim it to be?

Dr Supriya Malik: I think yes and no. Like you said that it allows you to then get absorbed in one topic and know everything about it, which actually is really useful.

But also sometimes it takes away from the person, because you are so hyper hyperfocused, you are not able to switch off and move on to something which might need actually focus for you. So for example, it could be simple things like this topic has got you so involved and you had planned a date.

With a friend or someone, and you've just missed out your time, timelines, and everything is off.

Abhijit: Yeah.

Dr Supriya Malik: So you couldn't make time for your date. And then obviously people are upset, whatever, and then you also feel bad because you wanted to be there, you wanted to socialize, but because you've gotten sucked in and you just forgot about the time, things happen.

Abhijit: Yeah, that's very true actually.

Dr Supriya Malik: it's a double-edged sword Yeah, absolutely.

Abhijit: And that of course, also, there's another aspect involved in the time blindness

Dr Supriya Malik: timelines is, yeah. So

Abhijit: I don't know if you've seen this but it was viral a couple of years back where there was this woman who is crying on camera saying that, I was late for something and my boss told me.

That, you shouldn't be late, et cetera. She got told off by her boss. She's but I have time blindness. And the boss says that, who the hell do you think you are with time blindness? Your kids just think of all sorts of random things nowadays. As an excuse for not being on time or not doing your work.

And there was a lot of hate for that woman as a kind of, something new Gen Z that is, that Gen Z is thinking up all sorts of excuses to not work and all this is nonsense and stuff like that.

Dr Supriya Malik: Make a

Abhijit: But I have procrastinated for so long that it is now no longer viral and nobody remembers the video anymore.

Have you seen that video by any chance? No, I haven't. It was really painful. Because time blindness is a thing.

Dr Supriya Malik: Yeah.

Abhijit: Honestly I have a watch, I have a phone, I have reminders and I have to-do lists and I have things buzzing constantly just to make sure that I am on time for things

Dr Supriya Malik: Yeah.

Abhijit: If I have to be somewhere, I have to calculate backwards. Make sure that I am in my shower at a particular time and I'm ready by a particular time, and I have to leave the house by a particular time so that I can be on time.

Dr Supriya Malik: Yeah.

Abhijit: But if I don't do that, it's not an instinctive thing. Half an hour before I'm supposed to be somewhere, I'm like, ah, now it's time for a shower.

And then all of a sudden I find out, oh my God, I should have been there by now.

It's horrendously tough.

Dr Supriya Malik: Yeah.

Abhijit: Sorry, I digress as usual. but the thing, and also there is a huge overlap between ADHD and a lot of aspects of ADHD

Dr Supriya Malik: with

Abhijit: people who have autism spectrum disorder.

Dr Supriya Malik: Yes.

Abhijit: And there is something called a DH adhd, which is Autism Spectrum Disorder and A DH adhd. So how does one really separate those. But how does one separate that? What are the differences and similarities?

Dr Supriya Malik: So autism and ADHD are actually quite different.

Abhijit: Ah, okay.

Dr Supriya Malik: Because autism is a disorder of social skills and communication. that's the largest part of what is considered in an autism diagnosis so when we say social communication challenges, what we mean is being able to understand social intent, being able to take perspectives, being able to communicate non-verbally.

So I'm, you and I are using gestures, we are nodding our heads. So it's more about the social and communication challenges. Along with that, the next aspect that we check for or look for is repetitive behaviors or stereotypic behaviors, which means basically behaviors or actions that people will take, which are very structured and repetitive in nature.

And it's a need for them. It's not so much about drilled because of a thought that has come into my mind, for example, in OCD or something like that. So it's just the body's need to be able to engage in those repetitive actions.

Abhijit: It can be comforting, like stimming.

Dr Supriya Malik: It's comforting.

Yes. It is comforting for most of them. They will say that. Some of them find it more anxiety provoking, but, it's an interesting one on that. But with people with ADHD most often we will not see social challenges of the same kind.

Abhijit: I see,

Dr Supriya Malik: With people with ADHD, the social challenges do come up.

But they're more about not, it's not about not being able to take perspectives, not understanding social intent. Those are not the challenges that people with ADHD have. It'll be more on not being able to think through what the consequence will be of my action. Ah, because futuristic planning is something that I'm not able to do.

They'll be very good with friend, going into a room and, saying hi and hello with a lot of people. And just that basic social chit chitchat. A lot of people with a ADHD are able to do and actually are really good at. But those are differences that we will see in people with autism.

And they struggle with that quite a bit. They're the ones who are nervous. They're the ones who are not sure how to go up and engage with people. So those challenges are more autism related, but some people can have the mix. Whereas autism and ADHD and then those challenges then have a very different way in which they'll come up.

Because a lot of people with autism, with ADHD will have the social communication challenges. And the inattention, the impulsivity saying the wrong things, getting embarrassed because they've said something wrong, inappropriate in front of others. Those kind of challenges come up more for them.

Abhijit: And there's the overlap that happens, and I've heard this from friends who have. Autism and ADHD together where they have this compulsion to be extremely organized, but their minds are very chaotic.

And it's very hard. I can't imagine what it's like to have both those living.

I'm very disorganized.

My room is an absolute mess. It has been for my whole life.

My parents have called it a pigsty, as many parents do. But I for example, books, if I'm setting up books and stuff like that, I do want to organize them.

According to author names.

Okay. Just one things, the inside of my cupboard is extremely organized, which is also weird. Interesting. Yeah. But there are, so there, there's that overlap. It makes things very, I'm sure very difficult for people who have to deal with that.

Dr Supriya Malik: Yeah.

Abhijit: On top of that, do both conditions have an emotional regulation problem as well? Yes.

Dr Supriya Malik: Yeah,

Abhijit: both of them do.

Dr Supriya Malik: Both of them would

Abhijit: Okay.

Dr Supriya Malik: The, again it'll come up in different ways sometimes. But both of them have regular, actually the thing is in people with autism, in people with ADHD emotional regulation in general is a challenge. It's regulating myself, regulating action, regulating thought regulating emotion. So regulation of any sort is a challenge in ADHD. Whereas in autism, the emotion regulation piece comes up because I have challenges with social regulation.

Abhijit: Okay. That's very interesting. And what exactly is so now there is on social media? There is so much content, which is about people with ADHD about people with autism. But there are also, there's also a lot of a term being thrown around a lot called neurodivergence, which is something I have had a little trouble in nailing down exactly what it means.

I've Googled it and it apparently encompasses quite a wide range of conditions.

Dr Supriya Malik: But

Abhijit: how would you term neurodivergence in the context of ADHD and autism and what it encompasses? What defines a neurodivergent person?

Dr Supriya Malik: So I think Neurodivergence, the way it was coined was to say that there are differences in neural structures in the human being.

The idea was to help people understand that there are differences and differences need to be accepted, just like any other differences in the human body that are there. Some people have long hair, some people have short hair, some people go bald, some people don't after a particular age.

So there are differences that happen in human beings. And the same way there are neural differences that we are going to see and those differences are natural. In the context of autism and ADHD, that's actually how we understand it. Literally, where we have seen study after study now, which has shown that there are neural differences for people with autism and for people with ADHD as we compare it to neurotypical population.

The way I have often talked about neurodivergence is where I've said that we need to, in the spectrum that I often show, I include neurotypical over there. Because that is part of the difference.

Abhijit: Yeah. It is all a part of the same spectrum. I go of human brains.

Dr Supriya Malik: Human brains, exactly.

So it's more to understand the differences in the brain and then I start accepting that behavior resulting from that does not mean that it's disorderly or it is deficit.

It actually is showing a difference in behavior and it might need a different way of thinking, approaching learning environment, context, so it's more of that.

Abhijit: And so what are the other conditions one could say are included in that term? Is all mental illness neurodivergence?

Dr Supriya Malik: So that's been a bit controversial because sometimes people have included all mental health challenges in it. It initially, when the term was coined, it was largely to do with neurological or neurodevelopmental disorders, so things like dyslexia.

Dyscalculia, all the learning difficulties and disabilities ADHD, autism Tourette syndrome, the different syndromic populations that we have, because that we knew was coming from neurological differences. But now, there is now some research to suggest that yes, of course some mental health challenges are coming because of neurological differences as well.

But it's controversial, that evidence, we don't have conclusive evidence till now.

Abhijit: Okay. Just to understand this from the scientific perspective you're talking about neurological differences. Have we managed to nail down exactly what the neurological differences are in, for example aDHD and autism?

Dr Supriya Malik: Yes, absolutely. We have certain areas of the brain, for example, we know that the frontal cortex, which helps us with a lot of these executive functioning skills. There are differences in the way that fires for people with a as compared to neurotypical people.

Abhijit: I see.

Dr Supriya Malik: So there are a lot of studies which talk about the prefrontal cortex, which is responsible for working memory, like some of these skills which are really important and people with ADHD actually struggle with. And there are real differences that have been spotted.

I was actually going through a BBC video recently where they had mapped out a brain of, an adult who has ADHD and compared that to a neurotypical adult. And it was an EEG study. That was being done at University of Sheffield, if I'm not wrong. It was fantastic to see what the ADHD brain looked like the EEG of that brain looked like compared to a neurotypical.

It was very interesting because you could see just how one would imagine the firing was all over. It was some of the areas for the neurotypical that didn't even fire when they were looking at, their screen and they were so different tasks that they were performing. So some of those areas didn't fire for the neurotypical, but for the ADHD person, they were constantly firing.

Abhijit: Wow. So that, from some of the studies that I've looked at and some of the resources that I've looked at, The actual neurological difference, especially with people with autism, is that the pruning of neurons that happen early on in life that pruning hasn't taken place appropriately or has taken place at a different rate.

Is that a legitimate scientific finding? Is that the cause of autism?

Dr Supriya Malik: Because we don't know the cause for autism, ADHD, dyslexia, we have no idea what is the cause till now.

Abhijit: Okay.

Dr Supriya Malik: There are multiple theories around it.

There's a very interesting one that is now got a lot more support, which is about how at the time

when the embryo is growing. And the way at that time when the neurons are to be formed and the, there is a difference in the timing apparently, and there's a difference in the number of neurons that are actually at that time getting formed. So it's very interesting. There are a lot more things that we are now discovering and trying to understand autism.

But yes, there are studies that have shown that there are differences in pruning that happen for people with autism. And that's the reason why early intervention was stressed. Because what we have also seen is that when we are picking up kids early, which is below six years of age, because at six is the, that's the time when the first big, chunk of pruning happens in the brain.

So that below that's the time where we can actually make some changes and some real changes, that's why early intervention at that age has actually shown that the way the brain develops changes. So the firing is different.

my PhD research was, on this. So we do know that early intervention can change the trajectory of the brain.

Abhijit: Interesting. I wish I knew this stuff when I was growing up, when I was a kid. 'cause of course I was born in 1980. And back then there was. Practically nothing known, especially in India.

Nothing known about autism or my parents had no idea that, this is even possible. There is a very strong genetic component to Neurodivergence as well. Is it?

Dr Supriya Malik: Yes.

Abhijit: Yes. To neurodivergence as general or just specifically autism and ADHD?

Dr Supriya Malik: Again, neurodivergence in general as well.

Like we know that people when there are people in the family who have dyslexia for example, or learning disorders, mental health disorders that The susceptibility to developing that in the offspring increases. So it's not to say that a hundred percent you're going to have it.

If you have ADHD, then your child is definitely going to have ADHD. That has not been proven till now. But yes, it increases the chances that the offspring might have ADHD or autism or dyslexia or any of the other challenges. Interestingly, it is more so we have more conclusive evidence for ADHD autism, schizophrenia than some of the other disorders.

Abhijit: do you think there would be the screening would happen early on around the age of six, but do you think there are. Possible genetic tests that one could, you can probably happen in the future.

That would determine even earlier, if a child is prone to any of these disorders,

Dr Supriya Malik: We'd love for science to go there.

Abhijit: We love it.

Dr Supriya Malik: We don't have it right now. Do you know it, it's interesting, which a lot of families have come and asked me about this very question because they want to plan a second child

Abhijit: Yeah.

Dr Supriya Malik: their child has been diagnosed with autism.

And they want to know that, can a test be done to check whether the next one is going to have autism or not. And we don't have anything like that. There's nothing if there are people who are claiming that, I'm sorry.

They're trying to make money and there's nothing really around there

Abhijit: absolutely.

Dr Supriya Malik: So we do now have very good. Early markers for autism, We can pick it up as early as anywhere between 12 to 18 months for some of the kids. So we want to pick them up very early so that the debilitating effects that we see don't actually come up.

for ADHD, it's harder. Because ADHD till now, we know that a lot of kids are going to be very restless. They are going to have poor attention spans till that age of five or six. so it's very difficult for us to surely say that this is ADHD or not.

Because I have seen, and honestly it's been very interesting for me to see some kids who, where preschools have referred saying, oh, ADHD, please assess her DJ and all of that. And then we have said, we've looked at the chat and I'm like, yeah, gosh, the hyperactivity is real.

But then you see them at age six and you're like, what? Not the same child.

Abhijit: Oh, wow. That drastic.

Dr Supriya Malik: Yeah, that drastic. Geez.

Abhijit: But yeah and of course, because children are developing at such a tremendous pace at that age. Yeah. And of course, our criteria for establishing a diagnosis and screening is much, much better and is growing better all the time.

Yeah.

And just for one thing about, for our American viewers and listeners. It is not caused, none of these things are caused by vaccines or by paracetamol or Tylenol or whatever else you have. It's just that really grinds my ears. Yeah. That really gets on my nerves. No there has been absolutely no evidence found for any connection between vaccines and autism or a DH ADHD or any other neurodivergent condition.

Dr Supriya Malik: Yes. Please get the MMRs vaccine.

Abhijit: Absolutely. Get the vaccine, get every vaccine you can possibly get. I get the flu shot now.

Dr Supriya Malik: Yeah. Yes. Yeah.

Abhijit: And I haven't gotten the flu yet.

Dr Supriya Malik: Yeah. Touch would knock on

Abhijit: Yes. one thing that I have grown up with, unfortunately, as a person with ADHDbecause there was no understanding of this when I was growing up, when I was in school.

There was constant that my teachers would always say that my handwriting looked like it was a doctor's handwriting because I was going above the lines and below the lines and I had misspelled something even though I knew the spelling. And I'd have to scratch it out and restart again. I was make careless mistakes as usual.

I would fall asleep in class, which happened all the way up to my MBA.

Dr Supriya Malik: Wow.

Abhijit: I would be sitting in class and I just doze off.

And I recently discovered on Instagram which brings me to my next question. There are lots of things that are being told on Instagram. For example, the connection between ADHD and sleep, not only at night, but when one is not being constantly stimulated like in a class, which is relatively boring.

Is there a genuine connection between having ADHD and getting so bored that you fall asleep in an office meeting or in a class?

Dr Supriya Malik: Is that a genuine, for some people, I wouldn't say general thing, but it happens. Yes. there is good amount of evidence to suggest that Yes. Sleep regulation again, is problematic for some people with DH adhd, but again, it's not for all.

So we can't say that. All people with ADHD are going to have sleep issues. I know a few of them who sleep really well. I've had a lot of teenagers who I've worked with who can easily, regulate their sleep patterns.

But on other areas, there are issues with regulation, but yes, it can happen for a lot of people that, when it's not stimulating, the brain shuts down.

Interesting.

Abhijit: And I used to always especially in office meetings that kind of stand up and kinda stand against a wall or something of that sort while listening to it just to keep my brain awake.

There's another thing that I've heard on social media. Echo Lilia.

So echo is the Repetition of certain words or sounds or songs inside one's mind, is that associated with neurodivergence at all or is that just something that people do anyway?

Dr Supriya Malik: So echolalia is in the scientific way, the way we define it is repeating this words or the phrases in exactly the same tone and intonation as the other person out loud.

Abhijit: I see.

Dr Supriya Malik: Okay. And this is a characteristic of autism

more than any other disorder

Abhijit: I see. Okay.

Dr Supriya Malik: So I wouldn't generalize it to neurodivergence.

It is something that we see quite specifically in autism.

Abhijit: And there's another word that I want you to comment on, which is inner dialogue.

Or monologue.

For that matter. Is that also a feature of certain neurodivergent conditions or is that also something that is more generalized amongst most people?

Dr Supriya Malik: So it's more generalized amongst most people. Everyone has an inner dialogue, we have a voice that is there. With people who are neurodivergent or people with a DH, D and autism specifically there are two challenges that they will often talk about. One is that voice, it's very difficult to keep it internal. They're gonna say things out loud. talking to themselves

Is something that a lot of people will talk about, but it's because they haven't been able to internalize that voice. And that happens in, usually most kids will, talk to themselves.

And it starts happening again at that interesting time of around 6, 7, 8 years, where they're now starting to internalize it.

I see. And they recognize that, oh, I can, do it in my mind. I don't have to always say it out loud.

Abhijit: Okay.

Dr Supriya Malik: So I was

Abhijit: hoping that there would be some explanation to why I make extremely inappropriate jokes, very inappropriate types, but I guess not, that's just me.

and one more thing I really wanted to touch on is, the importance of having awareness. And therapy and help for people with ADHD and autism for that matter, or any other neurodivergent condition, is the amount of self blame shame that one has in regards to these conditions, especially with ADHD.

I can speak to that because as I mentioned just being careless, making careless mistakes in exams, in essays, in presentations, and being a messy person on the whole, because I've realized recently that I'm messy because I need to have things visible because object permanence is a thing.

It's like I, is that the term that to use?

Dr Supriya Malik: Yeah.

Abhijit: So if I don't see something. It ceases to exist out of sight, out of mind. And then I'm running around like a crazy person trying to find it. And I can't find it. So everything has to have a perfect place for it to be.

But there can be many multiple things in that place. So there's a pile of stuff. I know exactly what's in that pile, but to any other normal person, it'll look like a mess.

So my entire room is essentially like that, especially my bedside table, which is it's got TV remotes, it's got my C Pap machine.

It's got five different medicines. It's got five different lotions. It's got all sorts of things. Things that don't belong in a bedroom are on my coffee table. Or my bedside table. So there's a lot of, there are all these little aspects of being a person who has been dealing with ADHD that have been associated with me being messy, being forgetting.

Certain engagements not turning up, remembering at the last minute being late. And one thing in particular is double booking things. So I end up making an appointment for one thing and then forgetting that I have already made an appointment for another thing. And when those two clash, it's usually last minute on that day, on that morning when I'm like, oh crap.

Like I've got to tell one of these people that I can't make it. And that always leads to a lot of shame and then there are certain friends who are totally cool with it and say, ah, don't worry about it. We'll meet next time or something other, and some friends get very upset.

But, that has all built up through my life and has become. A part of a very, has basically contributed to me having a very low level of self-esteem. And I know that there are a huge number of, several of my friends definitely. But is that low self-esteem, that shame associated with these conditions, is that something that a lot of people with ADHD suffer from?

Dr Supriya Malik: Yeah, absolutely. So I had actually just recently written a book chapter in a scientific publication on exactly this, on a theory on how these early childhood challenges lead to this narrative of, someone who is not good enough, someone who is lazy. Someone who is careless, forgetful, and these are just, words that are thrown around, but we don't realize how those words stick for that person as that identity that they're starting to build.

And then there's a lot of shame and guilt that come with it. So what can we do to change some of this in order to break this cycle? Because what happens is when I work with the adults with ADHD, it's exactly this that I start off with. Do you know the ADHD cycle, and how depression or anxiety or some of these mental health challenges that you come with.

Are actually associated with the ADHD that was unnoticed in childhood.

Abhijit: Yeah. I have depression.

So that's been dealing with it.

Dr Supriya Malik: Yeah.

Abhijit: But could you take us through the cycle a little bit? Yes,

Dr Supriya Malik: So we know that, children who have dysregulation in early childhood and who are going to have high impulsivity, for example. As well as increased distractibility or, lack of focus. They're the ones who will be struggling with also parental relationships. So it's very interesting, Abhijit, how one thinks of human beings learning some of these skills.

Because actually it's in the parent child interaction that the child is learning how to regulate themselves. No, typical child also will be able to regulate themselves independently till age six or seven because that's the time when the, brain is developing and they are also learning how to do it on their own without the mother or the father.

But for children who have ADHD, because they haven't their brain is developing much later.

And it's developing in a different way. They don't develop the regulation strategies, and that is hampering the parent and child relationship anyways. So the parent is constantly at them, come on, why can't so they are not get, they're not learning regulation from the parent because the parent is also getting dysregulated because of the child's dysregulation. So there's a breakdown that is happening in that frame where actually regulation can be taught. So school also, they're getting the same feedback.

What it does is social difficulties. And social issues around how am I supposed to interact with others, which will be acceptable. What will make me not get into trouble?

Abhijit: There's a lot of that lead to masking

Dr Supriya Malik: Yes. There's a lot of putting a mask of being sociable. I try to be sociable in different ways, like I might lie.

I might hide things because I don't want my parents to find out, About this. 'cause I'm gonna get scolded again for it. Oh my God, I forgot my bottle again. I don't know how, but I will have to try and get it somehow, because again, I'll be in trouble or my teachers are gonna put circles around my paper So those kind of lived experiences then are contributing to what I was saying, the constant guilt and shame that the person, and as a teenager when you're reaching that age, you start experiencing a lot of it. That's when a lot of, now when I speak to parents, a lot of them will come at age 10 and say, he or she is saying, why am I different?

I thing is also the times are changing, which is really good in our time. We don't even, I don't think we had the courage to even tell our parents, why am I different? It was something that was far more internalized. Yeah,

absolutely.

Than us being able to voice it.

Yeah. Whereas as parents now, we are evolving and more self-aware, so we are trying to give our children also platform to start, expressing some of those challenges. But then as adolescents, when they're, experiencing anyways, the disintegration, which they're not managing hormonal changes, are adding up all of the Oh, absolutely.

Challenges. Yeah. And there is, social difficulties that are coming up more and more now. Acceptance is becoming a harder issue at home with peers and in school.

Abhijit: And, but the thing is that, when I try to explain to someone

And I would imagine that kids are also, in that stage, right?

Yeah. Now, earlier on, because only now people my age are starting to figure out that we have a DH adhd. So we start trying to explain to someone, it's like I can't be attention and boring meetings. Like I need to be constantly stimulated. I get obsessed with certain things and I dive into it and everybody says, ha, maybe Ong.

And it's like it, so it becomes very hard initially for me, like now I have found better ways to explain it, but initially it was very hard to explain to someone how this is a disorder and not just because that there is a fine line Yeah. Between it, between a normal person being bored and between ADHD.

How would you help us explain that line and what happens when we've crossed it?

Dr Supriya Malik: I think the language is very important to help other people understand, because you're right. All of us are going to, at some point lose focus and get distracted and things like that. the way I usually explain it is by saying that everyone loses focus.

I understand that you are saying that this is something that you go through as well. However, for me, it is far more extreme. For me, it is something that actually interferes with my day-to-day. that's why it becomes a disorder. It's impacting daily functioning.

Something is not, it's making sure that you're not being able to achieve what you do want to.

Abhijit: That's

Dr Supriya Malik: why we are calling it a disorder. Otherwise, why would it be?

Abhijit: Exactly. That's exactly the kind of strategy that I've started using. When it starts affecting your quality of life

Dr Supriya Malik: Yeah.

Abhijit: And strongly affecting it. That's when you understand it as a disorder.

Dr Supriya Malik: Exactly.

Abhijit: It's just something that needs to be understood. that's why people who might have ADHD, but they don't feel that it's really affecting their lives. Because ADHD is also a spectrum.

Dr Supriya Malik: Yeah.

Abhijit: it's like autism spectrum disorder.

ADHD also has a spectrum. Like I could swear that my brother is the hyperactivity side of it. But he's also extremely focused. He's very disciplined. He's very organized. And at the same time, he can't sit still. He needs to get something done.

He needs to always be up to something. And he told me during COVID, he was grinding his teeth. Because he was so restless that he needed something to do and he couldn't just sit around in the house.

So I know that there is, if he's on the ADHD spectrum it's on one side.

But it's just a little bit like, it just affects a little bit of his life and it doesn't affect his life in general. Whereas on, and of course, since there is a strong genetic component, I'm sure my parents have it, but they've managed to cope with it in very different ways. And they've managed to get through life without any problems.

But I'm having a really big problem with it.

So I think that understanding it, putting a label on it is not a bad thing. If you identify it, you can figure out for yourself whether it's affecting your life or not, and seek help if you need it.

Yeah, I agree.

But there's the one problem with India especially, is the shame involved in actually seeking therapeutic help?

What is it that you would like to tell people about going and finding therapeutic help? Talk therapy, psychiatric therapy, psychiatric medical interventions.

Dr Supriya Malik: So I agree with everything that you've said till now.

I think sometimes labels help. It is important for me to know what I have.

Only if I know what I have, will I be able to find a solution. Of course if I don't know what I have, I'll be constantly confused and worried. So for internal clarity, I think getting the diagnosis is very useful.

The other be on therapy. So there are in India, I know there is a lot of stigma around therapy still.

Abhijit: Yeah. That is huge amounts,

Dr Supriya Malik: which is my experience because if I have to compare from 2008 to now, the change has been that people are more accepting of therapy. It's a medication piece that still there is a lot more stigma.

Abhijit: Yes. There's a very, there's a very strong stigma. Especially even in the US. Even in the West, generally they say that, the Ritalin and Concerta and all the other medications which are all stimulants.

Dr Supriya Malik: Yes.

Abhijit: Which have analogs in the. Illicit drug market. Yeah.

Dr Supriya Malik: Yeah.

Abhijit: They're also looked down upon.

It's oh, you're giving my kids drugs. Yes. But they are the most evidence-based in the right dosages to actually help significantly. Yeah. It helps, even though I have high blood pressure, so I've had to like, done a lot of balancing acts with my health to be able to, get on a Concerta regimen and enough for it to actually make a significant difference in my quality of life.

It's the most evidence-based stuff that we have.

Yeah.

And yet people are still because there's a lot of people who think that these kind of medication make you dull, make you not so creative.

Is that true? The creativity part especially,

Dr Supriya Malik: So actually it came, there are two different notions. One is that it will make you dull and it makes you drowsy. And that does happen with some of the other psychiatric medication which has been prescribed for say, phobias or like for anxiety and different other disorders.

Which is bipolar, all of those medications will make you. Calm down.

Abhijit: It's

Dr Supriya Malik: now for some people that calming down, they say it kills their creativity. But on the other end, we do also have, drugs where you, because you've mentioned stimulants we also have non-stimulants.

Abhijit: Indeed.

Dr Supriya Malik: And they also are doing pretty well. There's a lot of good evidence, especially in the adult population for non-stimulants to say that they work. There are options that are now available. It's about, educating the person in front of us And seeing how, and I think that's what happens with a lot of the clients now.

The thing is, what they want is more information. Yeah. And in India as doctors, people don't have enough time to sit and explain everything.

Abhijit: Indeed. Huge. We have a huge,

Dr Supriya Malik: we have a huge population. I mean if you look at, the way we work in the government hospitals, they have a hundred people who are coming in to then sit with each of those patients or clients and explain for a full hour what it does.

Which we have the luxury of doing, when we go into private practice.

That doesn't happen so easily. So it becomes, and there's a lot of fear then that's generated. But at the same time, therapy also, it was earlier we were termed as the doctors for people who are mad or people who are cuckoo.

There are all kinds of words that were being thrown around, but. Therapy also has evolved. We've evolved and said that, it's far more structured. It's not always about going back into your childhood as what people would think. it's about problem solving.

It could be about better decision making. So it's more about how we can do more dialogues like this. Make people aware and start helping them see that things. There are, a lot of change in movement that has happened in the field. There are a lot of possibilities that people have.

Abhijit: And along with that, so if people are still hesitant to start with medication

Are there things that, especially with ADHD, we keep a focus because otherwise we can go on for days. Especially with ADHD, are there certain interventions that they can look at from a lifestyle perspective? To start helping themselves a little bit before going into further interventions.

Dr Supriya Malik: Lifestyle perspective. See, there are executive functioning training

Abhijit: Which

Dr Supriya Malik: I will definitely encourage anyone who's been diagnosed with ADHD. That's because those are areas that have, that are. Challenging for people. And that needs support. Of course.

It's harder for people with a issue to do it alone, I'll be honest.

Yeah.

So some ones, like a coach or a therapist, is required to get you onto that track. Then to see when you are ready to do it independently is obviously between the therapist or the coach. But I do think that some support is going to be required.

So when I say support and interventions, executive function training is, something that we definitely recommend. If someone has higher needs, then it would be cognitive behavior therapy. That one would, consider if there are other challenges that are mixed up with ADHD like autism or depression or anxiety or substance issues, because there are whole gamut of issues that will come with ADHD.

Then we have different lines of work that will, go on and try and use. Apart from that on daily way, how one can manage. I have very simple three things that I usually recommend. One is routines. Which is so hard for people with adhd. But I do think that, getting myself forcing, like literally it sometimes for people I know some of my clients are like, how do I force myself, Dr.

Like, how do I get this? And I was like, okay, we'll come up with different ways. But it is really about having a. Brief, like a three or two step morning routine and it could be whatever morning looks like for you.

It could be at 6:00 AM if you are an early riser, or it might be 12:00 PM but when you do wake up, what are the three small things that I can do?

That just, and if I do it repetitively, it helps anchor. So

Abhijit: could you give us an example?

Dr Supriya Malik: So something like, as simple as I will wake up in the morning, I will go brush my teeth first.

I will have a coffee or a cup of tea and I will do a crossword puzzle.

Or I will watch a BBC podcast or I will listen to something.

It could be something as simple as that, but just, I'm saying simple, but it's not easy. Very hard. Yeah. I know. It's very difficult to implement and just doing just these couple of steps on a daily repetitive basis really helps people. It could also be in, if mornings are tough, I start with night routines.

I say, okay, just before winding down, do three simple things. It could be simple things like for girls, I, often say, just put cream on your hands. just put hand cream before sleeping for so many guys that, they'd be like, no, I don't wanna do creams or anything.

Okay, fine. Just go wash your face. Brush your teeth, change your clothes. Make sure that the, what it does is it gives the brain a signal that it's time to either wake up or it's time to sleep. It's time to calm down. And that signaling is really important in the morning or in the evening.

Interesting. For regulation.

Abhijit: Yeah. one of the biggest interventions I have done in my own lifehas been to set an iron clad sleep routine.

Dr Supriya Malik: Yeah.

Abhijit: So that every day of the week, including weekends, which everybody goes, oh, let's party on the weekends.

We'll go to bed at 3:00 AM and Monday is gonna be fine. And Monday's never fine. But the most important thing is I have those couple of things that I sort out before I go to bed and a couple of things that I sort out when I'm waking up, I have that little routine, whether it's just playing with my cats or whether it's just changing clothes and playing a word game before going to bed.

Dr Supriya Malik: Exactly.

Abhijit: It just, those little things just happen like clockwork and just signal that it's time to pass out and off I go.

Dr Supriya Malik: Yeah, that's it.

Abhijit: And it's really, it really does help. Alsoa lot of the misconceptions that are circling around ADHD, especially in the West nowadays is that.

DHD is being overdiagnosed. There are too many kids. Everybody wants to be on Ritalin, everybody wants to be on Concerta. Everybody's getting drugged up and just because kids are hyper and stuff like that, what do you have to say to people who claim this?

Dr Supriya Malik: There is some truth to it, but not a hundred percent.

I have also had a lot of cases actually recently where people want the medication and therefore they have come trying to look as if they have ADHD. But they don't. Interesting.

Abhijit: Oh.

Dr Supriya Malik: So we have had that, and some of it is true. There's also this idea about over-diagnosis which is also true.

Where there people, a lot of professionals don't have the depth of understanding of the disorders and lot. Actually, the thing is that people, it's lot of times autism, anxiety, DHD, they overlap.

And someone who might be very anxious will also not be able to focus.

Abhijit: That's true.

Dr Supriya Malik: And they will look like very similar to what a person with ADHD has or looks like.

The same thing happens with autism. It's very important for whoever the professional is, for them to have a very good understanding of what ADHD is. Indeed. And so sometimes it does happen where we have had people who've come in and they said that I, my therapist has said that I have ADHD can you give a diagnosis because I wanna take it back to university, or I need to tell my employer about it, and things like that.

And we have diagnosed, we have assessed and recognized that it's not ADHD but it is some of the other mental health issues that are coming up as ADHD. So you know that understanding is is something, but having said that, awareness has improved. So a lot more people are coming for diagnosis and we love, and honestly, it's really great about the fact that people are coming and asking for it.

That's wonderful. Because it's important for people to know what they have and what, how they can actually help themselves.

Abhijit: Absolutely.

Dr Supriya Malik: So awareness has made a huge difference. We also know that we are becoming better at diagnosing.

Abhijit: Yeah.

Dr Supriya Malik: As professionals, we have better understanding.

So what we were overlooking, it's fine. This is what happens at boys are always like this, ah those sort of notions. Now we don't have, as professionals, we want to understand and have a different lens, scientific lens to now when people come up with those challenges.

So I think it's both, that awareness and improved understanding of the disorder has led to an increase in the number of people getting diagnosed.

Abhijit: And as a closing question, what are these certifications that one can look for, especially in India, to ensure that the person who you're going for therapy, who you're going to, of course with a psychiatrist, because they're doctors of medicine, they, it's relatively easy for that.

But in terms for a therapist, what is the certifications that one should look for, to verify that therapist is certified, qualified, educated, not just educated, ob obviously educated, but somebody who is knowledgeable about the conditions that they are seeking help with. What is it that one can look for?

Dr Supriya Malik: I'm gonna take a deep breath here because it's a bit complicated in India

We have so master's in psychology is a minimum degree that we will have for anyone to be a counseling psychologist. Okay. And that's the world over. Mostly that's how it is defined. Some countries it might be different, but that's generally the case.

Now in India, after that, we had the mfi and then we have a doctorate program. These are all qualifications that are valid that will help you determine whether the therapist has enough experience, have enough training in order to work with this sort of a population. Having said that. Both you and I know that some of these conditions require specialization.

Some of the, because they are so nuanced in the way they show up and the way they actually impact life, that people need to have advanced trainings. I see. An ad advanced work experience in order to be able to provide the right support. It's the same case actually with psychiatry.

We have of course people who are general psychiatrists but not everyone would have had that experience with adult ADHD

To be able to confidently decide whether this is adult ADHD or not. So what you want to go and ask the therapist is of course what you work with people with ADHD.

If so, have you got any specialized training in that or how many people have you worked with still now who have ADHD that you feel comfortable and confident of working with me?

I do think that the more people ask us questions, the more we will be responsible in getting ourselves trained and experienced.

Indeed. It's really important for our clients to ask us these relevant questions and challenge us because only when we are challenged will we do more. Absolutely. So please look out for people who have the training, not just the minimum qualifications, but some of the advanced training or have actually gone ahead and worked with a large number of people who've experienced that condition.

then they have specialized in it. I see. Then they have enough experience to say, yes, I can support you. Otherwise a lot of people are saying it not actually doing it. Yeah. Yeah.

Abhijit: Thank you so much. This has been an absolutely fantastic conversation.

I couldn't even go through half of the questions I had. Hopefully we'll have you on again.

Dr Supriya Malik: Yes.

Abhijit: Could you please tell us where we can get in touch with embrace and where people can go to, get themselves screened or get therapy, Tell us more about Embrace and how we can get in touch.

Dr Supriya Malik: We are in Delhi. We are based out of three places right now in Delhi. There's Wassan, Kun, and Rebo Children's Hospital, as well as you can find us on our website, www.embracelives.com. We do work online globally. So we have clients from across 12 countries now. And we do offer both in-person and online support.

We offer support for children, teenagers, and adults.

And we have a team of clinical psychologists, psychiatrists, occupational therapists, psychologists, speech and language pathologists, special educators, all under one roof. Because the idea was to be able to create a one stop shop and people don't have to go from place to access services.

Like you said, we do offer assess. And our assessments are internationally standardized global standard assessments. So any report from us is accepted right now, the world over, and we have experience of that. So our reports have gone to Ireland, us, uk, Germany, Japan. You are, say everywhere. Wonderful. So that's been good.

And if anyone's looking for therapy as well. As we have licensed qualified therapists, we will be able to provide all therapeutic support.

Abhijit: Thank you very much.

Dr Supriya Malik: thank you.

Abhijit: So therefore, there is wonder reliable place that you can definitely go. I'll put all the links, et cetera, in the description.

Dr Supriya Malik: Yeah.

Abhijit: Thank you so much Dr. Malik for joining us. This has been very enlightening indeed.

Dr Supriya Malik: Thank you so much for having me. It was lovely.

Abhijit: It was a pleasure.

Dr Supriya Malik: ours. Great conversation.

Abhijit: thank you guys for joining us for this podcast episode with Dr. Malik. Please go check out embrace the link is in the description.

If you think that you might have ADHD autism or some of these other related conditions go have a look at the website, reach out to them, try and get the help that you need. There's nothing to be ashamed of. There's nothing wrong with getting therapy. There's nothing wrong with any therapeutic intervention for mental health.

It's, you are just human and sometimes we just need a little help. To live a little bit better. So keep that in mind. if you like this conversation, please give us a like, please subscribe to our channel and support us in any way that you possibly can.

We are on Patreon at Rationable as well. And until next time, be Rationable. See ya.