Episode 1
Episode 1: Deep dive into ADHD and Emotional Dysregulation with Henry Shelford and Dr. Shyamal Mashru
Henry and Shyamal looking at the link between ADHD and Emotional Dysregulation. Dr. Shyamal is a consultant psychiatrist practicing both in the NHS in Adult ADHD service and in his private clinic, ADHDHealthClinic. You can contact him through his website: adhdhealthclinic.co.uk. The clinic also has its own page on ADHD and emotional dysregulation.
TRANSCRIPT:
Henry Shelford: Welcome. My name is Henry Shelford. I’m CEO and co-founder of ADHD UK. And I have ADHD. This is the first in a series of deep dives. Today we’re deep diving into an area of major impact for many with ADHD, emotional dysregulation, starting with the key question of what it is and how it impacts.
And before we start, I’ve got to do the disclaimer, and I got to introduce Dr. Shyamal Mashru, who is our expert and is going to be my partner in crime on this. So disclaimer first, there’s no formal advice here, no medical advice, and you should always refer directly to your relevant qualified medical professional. Right, that’s it. And to say hello to Dr. Shyamal.
Dr. Shyamal Mashru: Hi, Henry. Thanks for the introduction. For the audience out there, my name is Dr. Shyamal Mashru. I’m a consultant psychiatrist practicing both in the NHS in an adult ADHD service, as well as in private practice doing adult ADHD. So I guess my only disclaimer to the audience is that my main area of specialism is with adults with ADHD and comorbid disorders.
Henry Shelford: Fantastic. Well, thank you for doing this and many more of these. So I’m looking forward to this. And this is our first. One of my main goals is to make Dr. Shyamal not have a terrible time. Awful, awful. We’ve obviously spoken a lot and he’s absolutely great and extremely impressive individual with a very high depth of knowledge.
Right. Okay. First off, big question. Because I think this is one of the tortures of ADHD that almost every aspect of it has some fairly complex name that doesn’t really communicate well. Like even our name ADHD, attention deficit hyperactivity disorder, like it’s just a mouthful and not particularly useful when we’re trying to talk about it.
So what is emotional dysregulation? How does it impact people?
Dr. Shyamal Mashru: Right. So Henry, look, I think I want to pick up on the first thing that you said about the name, the misnomer that we’re really seeing, attention deficit. Let’s first pick up on that. Really, it’s not a deficit of attention, in my opinion, from what I see in adults. A deficit of attention, that terminology almost makes you sound like there’s a vacuum of thoughts, there’s a lack of thought.
Henry Shelford: I totally distracted you, and I think we wanted to go straight into emotional dysregulation, not the ADHD one. This bit is getting edited out, I hope, if I don’t forget.
So, I’ll do my last, my end bit again and then, I just got to put you back to that side. Yeah, so, first big question is what is emotional dysregulation? How does it impact people with ADHD?
Dr. Shyamal Mashru: Right, so emotional dysregulation is essentially the difficulty of an individual to modulate or regulate their emotional responses to a situation. The emotion is congruent with that situation. What that means is, if there is a sad situation, something that would make anyone feel sad, for example, the emotional response in an ADHD individual would appear extremely amplified. This can present in other ways, for example, with anger outbursts or irritability.
So it’s not that if another individual without ADHD was viewing that situation, they would say, yeah, I can understand. Well, you know, that this individual has become angry, but that particular individual with ADHD cannot regulate the intensity of that emotional response, and that’s really the best definition I can give of emotional dysregulation.
Henry Shelford: And so that means, like, in a given situation, the ADHD’s reaction is going to be bigger. That’s if I summarize that. And like, how’s that differ from, let’s say, a toddler? What’s the difference between an adult and emotional dysregulation and a toddler? Cause obviously we are operating in the day-to-day world like.
Dr. Shyamal Mashru: Absolutely. So I think one of the key sort of in terms of adult maturity and emotional maturity, one thing that most people can do is situations gone wrong. Something’s something unpleasant. I mean, they don’t like, they will have an emotional response to it. But there will be a pause at some point or a point of reflection where they will say, okay, fine, let me bring myself down, calm down and think about what can be done. In an adult with ADHD, which is sort of maybe undiagnosed, untreated, etc.
Those emotional responses will be huge. And they will have a lifetime history of this type of emotional responses. So when they were children, it would have looked like temper tantrums, which were just uncontrollable. So I’ve had, you know, parents say, one of their children, they just could not console them, for example, very different to their sibling as an example.
And that would have been a pattern that goes throughout their lifespan because ADHD has been there throughout their lifespan. And then in many ways, people will say, Oh, they’re just a child. So that’s fine. So that will be kind of missed and then move into adulthood. And those emotional outbursts are so strong that they’re actually affecting people’s relationships, both at home with their children at work.
And I think where it becomes significant is where it causes this functional impairment in different areas of people’s lives. Now, if we look at the term ADHD, the last D is not a nice term, I guess, but it’s a medical term and it says disorder. Disorder means that your symptoms are impacting, functioning in multiple areas of your life.
Everyone will have a sense of an emotional response. We’re not robots right to any situation, but if you can’t bring yourself back to equilibrium and you’ve gone out and say, for example, at a total anger outburst with your partner, said some foul things, which we, you know, can happen to everyone, and you, and you constantly are doing this, then it’s a problem. A part of emotional dysregulation then also leads to what has been referred by some researchers as emotional incontinence. Again, it doesn’t sound like a nice word. It doesn’t sound like names keep
Henry Shelford: No, no, no
Dr. Shyamal Mashru: incontinence. Yeah.
But if you think about what that really is, and it’s really brutal sense, it’s all the emotional to flooding out, flooding out.
Henry Shelford: Right. So, and what does that metaphor gets worse? Okay, don’t worry. But essentially, what patients describe that as. is I feel overwhelmed with my emotions.
Henry Shelford: And that’s it. And it overwhelms where we started this conversation, which is overwhelmed is a really big aspect for many with ADHD, and it can be absolutely critical, particularly if it’s happening in work.
I mean, it’s the part that can get you fired pretty quickly and where you’re overwhelmed and then not outputting. I want to just quickly sort of summarize as I understood what emotional dysregulation is, is that essentially the emotional response is much bigger and much more latched into, and it overrides your intellectual response.
And so you’re just in there and then not only in there and then you’re unable to respond intellectually in the way that, you know, you can and otherwise, and being locked in there. So what is it like, I think, what is the definition, what’s overwhelm? Like when someone’s describing to overwhelm, what are you hearing?
Dr. Shyamal Mashru: I think the core feature of this is people are feeling out of control. It’s the lack of control. Yeah. So when you come back to dysregulation, another way of saying, I can’t regulate means I am not in control of my emotions at that point. So if we look at ADHD, and this is what I’m more and more seeing this as a problem with self-regulation in general, it’s actually a core feature of the condition.
If we even look at the attention deficit part of ADHD, it’s not a deficit of attention. It’s a lack of regulation of attention. So attention is being dispersed in multiple different things.
Henry Shelford: Yeah, when I’m talking about, yeah, I completely agree. The phrase we use, yeah, it’s not a deficit of attention, it’s like a control of attention.
Henry Shelford: And I thought your slightly more sophisticated regulation of it is really nice. When we were talking previously, something that I found really enlightening was when you compared it to a deficit, the difference between ADHD and BPD. And would you just talk to that for a moment?
Dr. Shyamal Mashru: Yeah. So just for the audience, when we say BPD, we’re talking about, well, the different things going on here. So there’s bipolar disorder. So there are some key differences in terms of what we call chronicity or time spans. First one is, as I touched on just before, People with ADHD have always had ADHD, whether they’ve been diagnosed or they haven’t been diagnosed. So they’ll have a history of childhood temper tantrums, which were far beyond many of their peers.
Bipolar disorder, the onset, is generally more towards early adulthood. So that’s one difference. Number two, is the length of time of onset and duration, right? So emotional dysregulation in ADHD is sort of zero to a hundred emotional response very fast. In bipolar disorder, you have episodes of what’s called mania or hypomania and episodes of depression that last at least a week at a time, normally longer weeks and weeks for the hypomania mania and months generally for depressive episodes.
The third difference is that the emotional dysregulation in ADHD happens following a trigger. The patient will be able to tell you, this is what happened. And that’s what led me to blow up in this way, or you did this. And that’s why I’ve responded in this way. They can tell you that. In bipolar disorder, there’s no obvious trigger.
I’ve had patients that can literally have a few nights of not sleeping very well and go into mania. Similarly, waking up, just coming out of mania, going into depression. There’s no obvious trigger that’s going on there. I think those are the differences between the two.
Henry Shelford: I think that big piece around the difference of situational, like a situational linkage, like bipolar, not situationally linked and following those, those time patterns, ADHD, very situationally linked.
Dr. Shyamal Mashru: And there’s a fourth one actually, just to add, sorry, is a bit, which is an important one, which is called mood congruence and mood incongruence in medical terms. So in ADHD, what mood con so they will have a mood congruent response. What that means is if an external person witnessed this, they would say, yeah, I can understand that was an upsetting situation. So they got upset, but the intensity of the upset was very amplified. In bipolar disorder, it’s mood incongruent so that there might be potentially a tearful or sad situation, and if they’re in an episode of Hypomania Mania, they’re responding in a mood incongruent way.
They’re laughing, they’re finding it very funny or very excitable. It doesn’t make sense to the situation that’s going on around them. That’s a fourth big difference.
Henry Shelford: Well, thank you, Mike. And it’s, I think it’s interesting because in talking through different disorders versus ADHD, you actually learn quite a lot about ADHD. It helps understand us.
Henry Shelford: Can I touch on one thing before we move on from this topic, which is very important?
Dr. Shyamal Mashru: This is a really important one actually, is when we’re looking at treatment. If someone is presenting with these conditions, I just want to touch on this because this is a really critical thing. Actually, if you go for an ADHD assessment, in my view, the psychiatrist must review for any other potential comorbid disorders. The reason why is if you miss bipolar disorder and potentially misdiagnose it for ADHD, or there could be bipolar disorder and ADHD, but the bipolar disorder has not been treated by a mood stabilizer and you put that patient on a stimulant medication, there are 10 times the increased risk of developing a frank manic episode. So it’s critical for the person that’s assessing you to know the differences and be able to tease those out in an assessment.
Henry Shelford: Yeah, and I think obviously it is important to look at is it something else? Is it ADHD? Is it a combination? And I think one of the most tar like thing, it’s one of the things that it’s tested for, is whether or not you’re just of low IQ and I learned that and I just had to reflect for a moment how ADHD can present as be confused, as low, low IQ, potentially as a terrifying moment of realization.
You think that, and so emotional dysregulation and overwhelm, your view is it’s so significant, so prevalent, that you think it potentially could be part of the diagnostic criteria, is that right?
Dr. Shyamal Mashru: I am, I’m absolutely, you know, I’m 99. 99 percent sure of this. I go to a lot of research conferences, I’m sure you do as well, Henry. We, we, we recently. I’m going to say, but we also bumped into each other at the most recent large conference. Yes.
Dr. Shyamal Mashru: That’s working in this field. You’re, you see emotional dysregulation that the literature says in untreated ADHD, it’s 70 to 80 percent going to be present in someone’s lives. I think it’s higher than that. Actually. I hardly ever not see it. I think it’s more the rule really. The main reason, coming back to my last point, of why it will probably be put into the next DSM, the next diagnostic manual, DSM 6, is because of the fact that if it’s not put in there, it could be misdiagnosed for other conditions. And like I say, that’s where it becomes a problem. So I have patients who have had histories of initially presenting with essentially emotional dysregulation to their GP, not even with classic inattentive symptoms. And they’ll tell me a history of I’ve been put on all the different antidepressants under the sun for many years. And actually, either it made me feel a bit worse or I felt emotionally numb. And that’s because many antidepressants are working on a different chemical pathway to the pathways that are deficient in ADHD. And therefore if their outward presentation of their emotions are coming from undiagnosed ADHD, they’re actually being treated for the completely wrong thing. And that’s why it’s so important that it is actually put as a core feature of ADHD in.
Henry Shelford: Yeah. And when you’re saying, I think a lot of people think of, you know, I talk regularly to people with lost decades to treatment of anxiety and depression, not ADHD. Most people talk about it just as being lost time. You’re saying that misdiagnosing because it’s the emotional dysregulation that people are coming for, the treatment can have a negative effect. Can you talk a bit more to that, particularly around anxiety and depression?
Dr. Shyamal Mashru: Yeah, so the current thinking, and this is always evolving, right, because in terms of adult ADHD, it’s still a baby in terms of research but the current thinking is that there are, there’s a dysfunction in two chemical pathways in the brain, the pathway involving dopamine and the pathway involving noradrenaline, and that is thought to be contributing to many of these ADHD symptoms is actually still unclear exactly how that’s happening. So stimulant medication for ADHD looks to enhance the dopaminergic and noradrenergic pathways in the neurons in the brain. So if your emotional dysregulation is coming from deficient dopamine and noradrenaline, you need treatment for those two pathways.
The majority of antidepressants work on what’s called the serotonin pathways. Now, there is a very complex link between serotonin and dopamine and noradrenaline, but it’s very indirectly linked. So what patients will often describe to me is I’ve taken these antidepressants and I just felt a sense of numbness as opposed to a sense of well-being, and if you treat the emotional dysregulation that’s coming from ADHD with ADHD medication. The interesting part that I found in my work is that patients will tell me, doc, the biggest benefit that I had was I just feel emotionally much calmer than before. I’m not even bothered anymore about the attention and concentration. I mean, you know, that’s almost a secondary benefit. The main benefit that’s helped my life is that I feel this sense of emotional calm and I can better regulate my responses to situations.
And my partners noticed that people at work have noticed that. It’s quite a profound difference of effect.
Henry Shelford: Thank you. It’s great you’re reinforcing that and talking to it. It’s obviously the reason we chose this as the first deep dive. You’ve talked already earlier about how it impacts one of the most impactful parts of ADHD, impacting personal relationships, work relationships with children and sleep. What about gender? But how does gender make a difference here?
Dr. Shyamal Mashru: So, again, looking at the research and again in my own clinical experience as well, the emotional dysregulation component of ADHD seems to be most prominent more in women than in men. Now, just for the audience out there, I don’t want to, you know, any of the men jumping up and down saying, no, this is a big problem for me. It definitely is. It affects both genders, but I have had many female patients come to me saying that this is their primary problem. And actually when they were researching more about their difficulties with their emotions, ADHD. So it’s not that they came across ADHD because their primary problem for their life was actually about attention, concentration, and fidgetiness. It was actually their emotional dysregulation. The second effect where there’s still very limited research, but there is more and more research coming out, is the impact between female sex hormones and the menstrual cycle and emotional dysregulation, as well as other ADHD symptoms. Would you like me to talk a bit more about that, Henry?
Henry Shelford: Absolutely. That’d be great. Yeah, I think it’s important.
Dr. Shyamal Mashru: Okay. So if we, well, there’s different elements in the menstrual cycle. So for, for a female that’s having regular periods. So having regular menstrual cycles in the few days or week leading up to the period, estrogen, which is a female sex hormone falls, it reduces. If it didn’t, you wouldn’t have a period. We are now can see that there is a link between reduction in estrogen and dopamine and noradrenaline pathways. Okay. Where a reduction in estrogen further impairs those dopamine and noradrenergic pathways that are already deficient in that female with ADHD. So they will describe a history of feeling far more emotionally dysregulated in those few days or week leading up to periods. And many of them might get diagnosed with PMDD, separately. And then what they will say is when they go towards ovulation in their cycle, where the estrogen levels are at their peak, they feel a bit more in control of their emotions.
Take that forward. As you go towards perimenopause and menopause, you’re essentially going into states of lower and lower estrogen across the whole cycle until you’re eventually not having periods. Many women will say, look, I was struggling with my emotions before, but now I’m just finding I absolutely cannot cope and it doesn’t just affect the emotional element. It also causes other symptoms of heightened ADHD, inattentive symptoms where they’ll describe things like brain fog, increased forgetfulness. Some people have actually thought they’re developing early stages of dementia. They’ve gone for memory tests, etc. And, and that’s the link that we can see there in women, with estrogen lowering of estrogen and ADHD symptoms, including emotional dysregulation. In men, this is sometimes displayed more as irritability and anger symptoms. And it’s very, very new research, but they’re now looking into the impacts of the, over the lifespan of lowering of testosterone and similar impacts on, on these types of ADHD emotional symptoms.
Henry Shelford: Thank you. I think, and I think that obviously in ADHD, the, the discussion between gender differences and, and, and, frankly, any difference beyond male, like, so when we’re looking at ethnic diversity and the, research this has a lot of catching up to do.
And so I think it’s important we try and talk about the information we have and so thank you for doing that. Now, I think we’ll be good to talk a bit more about, well, you talked previously, we were talking about the lack of the pause, the lack of inhibition means losing the pause. No, no gap between thoughts and speaking that lack of inhibition, slightly different part of emotional dysregulation. And tell us a little bit more about that.
Dr. Shyamal Mashru: Yeah, yeah, absolutely. So if we look at Russell Barkley, a very famous sort of American psychologist regarded as one of the godfathers of ADHD and Russell Barkley talks a lot about the emotional dysregulation being part of almost impulsivity symptoms of ADHD and what is going on behind impulsivity? What does impulsive mean? Impulsive means disinhibition, a lack of inhibition. So when, when we break down what’s going on in really simple format, we said that there is a trigger, a situational trigger, and then there’s this emotional response. What’s going on between that trigger and that emotional response between someone with ADHD and someone without ADHD potentially. In that process, the patient with ADHD has a very pronounced loss of inhibition. They are not able to inhibit that response. We see this with other impulsive symptoms of ADHD, where people will say, I keep interrupting in conversation. It’s the loss of inhibition, almost like a lack of patience, and that produces that emotional response. If you have a loss of inhibition, don’t take any second to reflect on does or appraise, does this situation actually require this level of emotional response? There’s a loss of rationalization of what’s going on. This is, if you’re really breaking down what’s happening there. And that’s what I mean by loss of inhibition. It’s obviously a very important point.
Henry Shelford: You know, that lack of the pause. And so how does something like rejection sensitive dysphoria fit in with this?
Dr. Shyamal Mashru: So rejection sensitive dysphoria, again, is not part of the diagnostic criteria. It’s not a formal symptom.
Henry Shelford: But it’s again, it’s something you think might be included in the future, which is, which is, which is a big deal, right? Because at the moment it’s, it’s got very low levels of research backing, but it’s something that you say to people and it resonates with them instantly. I’m really keen to learn more from you on this.
Dr. Shyamal Mashru: So rejection sensitive dysphoria. Essentially, so dysphoria comes from the Greek word, which means intense pain or suffering and rejection sensitive part is talking about the fear of failure or rejection. And the emotional response is almost felt like the patient will almost say I felt wounded. It’s so potent. And that’s where that dysphoria word comes from. So this again has been shown to be more common in women than men, but I’ve certainly seen this in men as well. And this has huge impacts in different people’s lives in different ways. And I’ll give you some examples of this. I’ve had patients tell me that I didn’t apply for that job, even though I was, I was more than qualified to apply for it. So scared of the fear of not getting that job. In other ways where it’s impacted is people have developed very strong defense responses. So your employer or your partner or someone has given you some feedback and then the response has been very defensive. And they were trying to sort of, and they all have to say, hang on, like I don’t, I’m not trying to be offensive here. I’m just trying to give some constructive feedback.
Henry Shelford: But it’s not been, I think when you talked earlier when you said it’s painful like a wound. Like that. I have to say that hit home for me, like I know that I’ve had those feelings of rejection and failure and it really, it hurts.
Dr. Shyamal Mashru: And where it has other impacts? I’ve even had patients who told me that they stayed in relationships that were really not good for them and that they shouldn’t have stayed in because of fear of rejection. They’ve been people pleasers. They’ve tried to make everyone else happy around them at the sort of cost of their own happiness, actually. So they’ve not had that boundary of saying no, they’ve become more, you know, other patients have said they’ve become more perfectionist, but not in a productive sense.
Henry Shelford: Perfection’s hardly ever like it’s, it’s normally like nothing’s perfect, right? Like, so it’s pretty much, but
Dr. Shyamal Mashru: I’ve had patients who tell me their perfectionism actually stopped them from starting certain complex tasks. And what’s that called? Perfectionism. Procrastination. That’s a symptom called procrastination. When you really dig into procrastination, many times RSD, reject centered dysphoria is playing a role here because subconsciously the person is so worried about getting it absolutely right because of a fear of failure, a fear of rejection, etc, that they don’t even start it.
Henry Shelford: And are you saying that the essential rejection sensitivity dysphoria is a part of emotional dysregulation, and what you’re saying is that people from learned experience of the feeling they get, the wounded feeling from failure of rejection, they then quite rationally, knowing that level of pain that they then don’t do things that they stop, they won’t do it. They don’t stay in a relationship. They won’t start a major project. They won’t apply for a job out of fear of that.
Dr. Shyamal Mashru: Absolutely. And this touches on another, I’m going into segues a little bit here. I appreciate. But in an ADHD environment, it’s something that we are very comfortable with. I think there’s been a lot of mention around trauma and ADHD, right? So if we look at rejection sensitive dysphoria, why is that there? If you think across the lifespan of an undiagnosed person with ADHD, why have they developed a fear of failure and rejection because throughout their life? They have essentially found that despite their best efforts or that they’re working so much harder than the people around them to achieve and still might not be achieving as high as the people around them, they then get labeled. So if they’re procrastinating because of, you know, they’re like, well, I got it wrong last time. So I don’t know where to start with this task. How do I, what do I do? They’re deemed as lazy.
Henry Shelford: Or they’re deemed as well, you know, I just don’t understand, you know, Charlie’s a bright kid. Why is he not getting top grades? Why is he not fulfilling his potential? Over time, that starts impacting your self-esteem because you, those are little, little traumas that you’re experiencing from society around you. Maybe even also from your parents. And so that gets into your psyche. And as you get older, you develop low self-esteem and then you start to doubt yourself. And then you start to say, am I good enough? When you start to say that a lot, am I good enough? That will impact you in so many ways, because if I’m not good enough, then I’m going to potentially fail this task. So what do I need to do? I need to make sure it’s perfect. I’ve got to make sure it’s perfect this time because it’s never perfect. And actually coming back to emotions, you get emotionally overwhelmed. So what do you do as a natural human response? You push back that task, you push back that task. I know I’ve got to do, I’ll do it tomorrow when I’m in a better state of mind until there is absolutely no choice. The deadline is tomorrow morning and you’re frantically doing it at that point. And at that point, your noradrenaline levels, which have been low, shoot up, your adrenaline shoots up, and then people will say, they’ll almost think of it as well, I needed the threat of that deadline to get it done. You hear this all the time. So coming back to where does the rejection-sensitive dysphoria come from? Well, it’s because those repeated traumatic messages that you are getting since you’ve been a child all the way going through when you go to uni, when you go to jobs. Kills your self-esteem and then you develop rejection-sensitive dysphoria. That’s what I think is the pathology of what’s going on.
Henry Shelford: It’s pretty painful listening to that. It does hurt a bit inside. Okay, what can we do? Let’s talk treatment and what makes a difference.
Dr. Shyamal Mashru: Yeah. So coming back to our topic, which is obviously emotional dysregulation, even RSD as a part of that broad brush speaking, there are really two real forms of treatment, like in most elements of mental health, medication and therapy. Now, in terms of medication, there are really no licensed medications that specifically are treating emotional dysregulation. And rejection says it is phoria. However, there are some treatments that have shown some promise. So what’s known as non-stimulants or alpha agonists, that’s a medical term. So medications like Guanfacine, or potentially Atomoxetine have shown some promise in helping reduce or dampen the emotional response that people are having to certain triggers.
The other side, so nowadays what many psychiatrists are doing is they’re combining stimulant medication, which is very good for traditional executive dysfunction, and it can also have a benefit in terms of emotional regulation as well. And also using a non-stimulant alongside that if the emotional dysregulation is a very prominent feature in that patient’s symptoms. Now I have to caveat this by saying this is definitely not licensed in the NHS, for example, in the UK, because there’s still not enough research to really prove how beneficial this is. In terms of non-medical treatments, so these are certain types of therapies like coaching ADHD coaching. So a good coach, when we go back to when we said there’s a loss of that pause or a loss of inhibition, a good coach will work on your cognitions. So we’ll introduce a form of CBT therapy, cognitive behavioral therapy into their practice, which essentially forces that patient to keep practicing, reflecting on that situation before responding.
So it’s a learned practice that they have to keep consciously doing until it becomes automatic. Other techniques, very similar things like mindfulness. Mindfulness is essentially taking a time out and saying, right, let me just pause and stop. Okay. What’s the situation that we’ve got here? Are there any practical solutions? What’s the implications and essentially taking a step away. from that situation so that there’s less emotional overwhelm.
So in an ideal world, you would want to have a combined treatment of both medication and therapies. Medication might help, I would say more in the short term, but the therapies definitely developing techniques can help in the longer term. And whilst I’m not a child specialist, I know one of the techniques that they use for children, for example, is distraction, distraction techniques. So child doesn’t want to go to school. They’re really kicking off rather than spending an extra five minutes, forcing them into the car, take them to the side, maybe play with them for a few minutes. Yeah, you’re going to be a few minutes later, but you distract the child, put them into a better mood. And then try taking them to school. So, these are the different types of techniques. But broadly speaking, you’re talking about medication and therapy.
Henry Shelford: Thank you. And obviously, like, for the actual medication part, people need to talk to their practitioner. I have to put that. I just always feel like you’ve got to say that multiple times. You’re giving rounded advice on what sort of options are available.
Dr. Shyamal Mashru: Absolutely. I really want to caveat and say the non certain non-stimulants are definitely not licensed yet in the UK for these types of treatment. You’re seeing this a lot in the US and Canada. I think probably more advanced if I can say so. We are seeing this being tried out more, a lot more in sort of non NHS practices and showing good promise actually.
Henry Shelford: Great. Well, thank you for sharing that. I think it’s obviously very important. I think, look, in this area we’ve covered, gone into emotional dysregulation, covered how important it is, how significant it is. I think one of the really big takeaways for people is, like, this is one of the really big deal aspects of ADHD. with and I had to hold myself back when you’re talking about the sort of knock-on impacts around, you know, procrastination, working to deadlines and using deadlines and how they impact, because those are all things that people talk to quite directly, because they’re the sort of more tangible elements that then that they know of the step back is it’s all coming out of this emotional dysregulation. So this lack of pause, it’s this challenge we have. And it’s been great. And thank you for all your time and in talking through it and giving us this deep dive, which has been wonderful. I think this is where we sign out. If you just check, there’s nothing else you want to cover this particular thing.
Dr. Shyamal Mashru: Well, I guess there’s only one last thing I would actually touch on.
Henry Shelford: Is it that I’m wonderful? Because that’s a good topic.
Dr. Shyamal Mashru: Yeah, you can do a whole, a whole other deep dive about you, Henry. One thing I think that I want to touch on just because I think the audience might be quite interested in this. Cause I get this asked a lot is when we, when we were speaking about the impact of female sex hormones, on ADHD symptoms and emotional dysregulation, many, many people are now starting to wonder about other treatments alongside their ADHD medications, targeting hormones. So there’s very little data about this. In fact, the, the attitude magazine did, did surveys about this and very recently about the impact of HRT. On emotional dysregulation. And what they found was that in about one in four cases of people that are using HRT, that significantly improved the emotional dysregulation many women were experiencing during perimenopause and menopause. So I think that’s just something. I mean, that’s an area that’s going to be probably researched a lot more into, but that’s something to bear in mind, actually, as well.
Henry Shelford: Thank you. Extremely important point. I mean, I was talking with someone doing some ADHD research right now and discovered that every single one of their participants was male. I honestly couldn’t believe it. I was like, you’re kidding me. Like, just that sort of need to do more female based research and more diverse research is massively important. And what you’re talking about is that as people are starting to do it, they’re finding very, very important findings and potential to make a very big difference for people underlines the importance. Right. We’ve got to sign out. I need to thank you Dr. Shyamal Mashru. You’ve been wonderful. I’m looking forward to doing more of these with you. I’m going to put at the bottom. So for people, there is the link to Dr. Shyamal Mashru’s private clinic. He also works within the NHS. If you’re lucky enough to be in his area. And his ADHD health clinic uk. And if you’re watching, if you’re seeing this on the website, it’ll be, there’ll be a link in his bio as well. That’s it. Thank you so, so much. Thank you, Dr. Shyamal Mashru and yeah, it’s been wonderful. I’ve learned a lot and frankly, like in some parts, frankly, hurt a bit like, you know, when you’re hearing the reality of your own life. And I think just to end on a positive note, being more aware of this can then open the door for treatment.
Dr. Shyamal Mashru: Right? Absolutely.
Henry Shelford: No, that changes it because it means, you know, you know, what actually you’re trying to target and challenge. Thank you. Thanks very much. And I just need me to sign out, say thank you very much. Obviously got to do the bit where we’re a charity, right? I can’t tell you how tight money is and all donations or fundraising are essential. We receive no government funds. It’s the only way we do everything we do. And, we can’t, we can’t do anything without. So thank you. And it’s harder for us. ADHD is a stigmatized condition. Lots of people don’t want to shake it in, go out and talk about it. And so the people who do it, it is, it is, incredibly important. Thank you. Well, again, thank you to Dr. Shyamal Mashru for doing this. He’s wonderful and hugely appreciated and hopefully he had a good time. We’re going to do it again and again. So thank you. Okay. Goodbye.