What happens in your brain when you pay attention? w/ Dr. Sasha Hamdani | from TED Health

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Maybe you have a coworker with boundary issues or you want to know how to inspire and motivate your team. No problem is too big or too small. Give us a call and we'll help you solve the problems you're stuck on. Find Fixable wherever you listen to podcasts. Hi, everyone. Sherelle here. Today, we're sharing an episode of a podcast we think you'll love. It's been handpicked by the TED staff, and we think as a TED Tech listener, you'll come away with a fresh idea and a totally new perspective. Enjoy and head to the link in the description for more. This is TED Health, a podcast from TED, and I'm your host, Dr. Shoshana Ungerleiter. I'm going to be honest with you. Sometimes I wonder if my brain has a mind of its own. I'll sit down to answer an email and suddenly I'm shopping for new running shoes, half reading a news headline, and then remembering I never texted my sister back. Does that sound familiar? That's the strange thing about attention. We know it's important. Our health, our work, relationships, and even our safety depend on it. But we also live in a world where a mini computer in our pocket can ping and buzz and pull us in a dozen different directions all at once. And while we might laugh out loud about having the attention span of a goldfish, the truth is that it's important to nurture our ability to focus. Because it's one of the most powerful tools we have for making healthier choices, building habits and actually living the lives we want. Think about it. Eating more mindfully, sticking with exercise, remembering to take medication. All of those start with attention, the ability to notice and to filter and then choose where our mental energy goes. And when that filter isn't working well and the distractions constantly win, that's when life can feel chaotic and overwhelming. The good news is that attention isn't just some fixed trait that we're stuck with. Neuroscience is showing us that it can be trained, supported, and even reimagined with the help of technology. And the implications for our health are huge. In today's talk, computational neuroscientist, Mehdi Ordi Kani Seidlar invites us to look more closely at what our brains are really doing when we pay attention and how that knowledge might transform the way we approach everything from daily tasks to complex medical challenges. Then I hope you'll join me after the talk for a conversation with Dr. Sasha Hamdani, a prominent psychiatrist specializing in ADHD and digital health. She's also my friend and colleague. It's an enriching addition to this episode's big ideas. But before we dive in, a quick break to hear from our sponsors. And now, Mehdi Ortikaini-Sidlar takes the TED stage. Paying close attention to something, not that easy, is it? It's because our attention is pulled in so many different directions at the time, and it's in fact pretty impressive if you can stay focused. Many people think that attention is all about what we are focusing on, but it's also about what information our brain is trying to filter them out. There are two ways you direct your attention. First, there's overt attention. In overt attention, you move your eyes towards something in order to pay attention to it. Then there's covert attention. In covert attention, you pay attention to something, but without moving your eyes. Think of driving for a second. Your overt attention, your direction of the eyes, are in front. But that's your covert attention, which is constantly scanning the surrounding area, where you don't actually look at them. I'm a computational neuroscientist, and I work on cognitive brain-machine interfaces. or bringing together the brain and the computer. I love brain patterns. Brain patterns are important for us because based on them, we can build models for the computers. And based on these models, computers can recognize how well our brain functions. And if it doesn't function well, then these computers themselves can be used as assistive devices for therapies. But that also means something. because choosing the wrong patterns will give us the wrong models and therefore the wrong therapies, right? In case of attention, the fact that we can shift our attention not only by our eyes but also by thinking, that makes covert attention an interesting model for computers. So I wanted to know what is the brainwave patterns when you look overtly or when you look covertly. I set up an experiment for that. In this experiment, there are two flickering squares. One of them flicker in a slower rate than the other one. Depending on which of these flickers you are paying attention to, certain parts of your brain will start resonating in the same rate as that flickering rate. So by analyzing your brain signals, we can track where exactly you are watching. or you're paying attention to. So to see what happens in your brain when you pay over attention, I asked people to look directly in one of the squares and pay attention to it. In this case, not surprisingly, we saw that these flickering squares appeared in their brain signals, which was coming from the back of their head, which is responsible for the processing of your visual information. But what I was really interested in, to see what happens in your brain when you pay covert attention. So this time I asked people to look in the middle of the screen and without moving their eyes, to pay attention to either of these squares. When we did that, we saw that both of these flickering rates appeared in their brain signals. But interestingly, only one of them, which was paid attention to, had stronger signals. So there was something in the brain which was handling this information. So that thing in the brain was basically the activation of the frontal area. The front part of your brain is responsible for higher cognitive functions as a human. The frontal part, it seems that it works as a filter, trying to let information coming only from the right flicker that you're paying attention to and trying to inhibit the information coming from the ignored one. The filtering ability of the brain is indeed a key for attention, which is missing in some people, for example, in people with ADHDs. So a person with ADHD cannot inhibit these distractors, and that's why they can't focus for a long time on a single task. But what if this person could play a specific computer game with his brain connected to the computer and then train his own brain to inhibit these distractors? Well, ADHD is just one example. We can use this cognitive brain machine interfaces for many other cognitive fields. It was just a few years ago that my grandfather had a stroke and he lost complete ability to speak. He could understand everybody, but there was no way to respond, even not writing, because he was illiterate. So he passed away in silence. I remember thinking at that time, what if we could have a computer which could speak for him? Not after years that I'm in this field, I can see that this might be possible. Imagine if we can find brainwave patterns when people think about images or even letters. Like letter A generates a different brainwave pattern than letter B and so on Could a computer one day communicate for people who can speak What if a computer can help us understand the thoughts of a person in a coma? Well, we are not there yet, but pay close attention. We will be there soon. Thank you. Thank you. Hi, I'm Frances Frey. And I'm Anne Morris. And we are the hosts of a new TED podcast called Fixable. We've helped leaders at some of the world's most competitive companies solve all kinds of problems. On our show, we'll pull back the curtain and give you the type of honest, unfiltered advice we usually reserve for top executives. Maybe you have a coworker with boundary issues. Or you want to know how to inspire and motivate your team. No problem is too big or too small. Give us a call and we'll help you solve the problems you're stuck on. Find Fixable wherever you listen to podcasts. Thank you. She's a psychiatrist and ADHD specialist who herself was diagnosed with ADHD in the fourth grade. She's transforming mental health care for patients and families. Her book, Self-Care for People with ADHD, and her app, Focus Genie, are both designed as accessible resources for patients and families. Sasha's work has also caught the attention of the World Health Organization and the Biden White House, and she's collaborated with them on various global mental health initiatives. Here's my conversation with Dr. Sasha Hamdani. I know we've never talked about this before, but I used to joke that I have the opposite of ADHD because I can literally sit for hours in like this deep focus mode. And as I'm learning more about ADHD, because it's not what I do clinically, you know, it turns out that's not how it works. Can you talk a little bit about the different ways that ADHD shows up beyond sort of that stereotype of being, quote, distracted or hyperactive? Yeah. So I think that part of where that issue derives from is that the name for ADHD is so stupid. So ADHD is attention deficit hyperactivity disorder. And the reason why this is so problematic is that a lot of people don't present with what you would clinically think of right away as hyperactivity. And sometimes it's not actually an attention deficit. Really at its base, it's an attention regulation issue. And it's kind of an everything regulation issue. It's also an emotional regulation issue. It's an energy regulation issue. So there's a difficulty in regulating. And that's really where the crux is. So for some people, they have some difficulty with trying to stay on task. And some people kind of go the opposite way where it's impossible to pull them from the task. They just get so hyper-focused on what's going on that they're just in that moment. And it's like, that's their whole world. So you can have both. Is it possible that I only have that when I'm watching reality TV? I'm just kidding. Okay, so how do you distinguish between ADHD and maybe poor focus or short attention spans? Yeah, that's a question I get all the time. And it's actually really important because especially as ADHD is kind of having its cultural moment, or I mean, at least it definitely was during the shutdown and things like that. I think everybody was really keying in on, you know, there are times where I can't focus. The thing that distinguishes ADHD from those moments is, one, that it tends to be more continuous in nature. You're not having, like, these isolated moments. Usually it's across the board in many different fields. So it's affecting you at home. It's affecting you at school. It's affecting you at work. It's affecting your relationship. So it's showing up in many different presentations. As of right now, I think it's important to cling on to that word disorder because it has to cause a clinically significant derailment in your life in some capacity. So I think that's important to note. It's not really impacting all that much yet. And that can be internally or externally. I think that's important to note. So you've talked in the past about ADHD as more than just a disorder, but also a way of experiencing the world differently. Can you talk about some of the strengths that you see in your patients or even yourself that often go unnoticed? I was just talking about this this morning. So I think with ADHD, looking at how you interpret and process data, I think people with ADHD have processing errors where you can make careless mistakes or like you might not, you might jump to a conclusion or be a little bit more impulsive in that moment. But also you're able to pick up on stuff that a lot of times other people aren't picking up on. Body tone changes or shifts in conversation or just kind of like what the general crowd is doing. So you're seeing a whole bunch of data, whereas other people might be isolated on one facet of the thing. You're seeing kind of a big global picture. Another huge strength is I think that people with ADHD, they often have this ability just because of how their brains are wired. They have this ability to tap into this incredible creativity and ability to think outside of the box. And I think that when you're going through your schooling and more rigid paths, sometimes that can be a little bit difficult. But if you get on the other side of that, it's really nice to have that ability because then this ability to think outside of the box is rewarded because you're able to come up with unique solutions to things and actually push yourself further in a smaller period of time than I think a neurotypical brain could, which is really nice. And again, a lot of that happens to be like tapping into that hyper focus and things that you're interested in, you can just run with. I like what you said. If you can get on the other side of that, it can kind of become this superpower. Well, I didn't say that because I hate the word superpower. There are strengths for sure. I think there are. But I think that when I think of superpower, I think of like flying or becoming invisible or like doing something awesome. ADHD is like having that ability, but you can't choose when you tap into it. So it's like randomly just like shooting off into space. So there's things that you have as strengths and there's things where you can kind of try to use your skills to tap into, but there's other things that sometimes you can't tap into. Sometimes you can use your resources, but it's hard to get to that spot. And so for people that really struggle with that, sometimes I feel bad about calling it a superpower because I feel like it diminishes some of the struggle that other people have when they can't access that kind of stuff. Thank you for that distinction. I think that's so important. And I think for people who don't have ADHD, understanding that better is critical. And I feel like we're living in a time where so many people are being diagnosed with ADHD. What's driving that surge, would you say? Is it overdiagnosis or are we finally just getting better at recognizing it? I think there's a lot of things. I think there's a lot of things because there has been a huge uptake in that. Number one, I think that clinically and socially and culturally, we're talking about it more and it's less stigmatized. still stigmatized, but it's less stigmatized. So we're talking about ADHD more and people are starting to recognize it more. With that shift, people that should have been diagnosed when they were kids now are like, oh, okay, my kids have this. I just found out and I do the exact same things. And now they're starting to get diagnosed. So we're kind of making up for lost ground when we're kind of looking at those diagnoses retroactively and only diagnosing people now. I get the question all the time, is this overdiagnosed or underdiagnosed? I think it's both. I think there are some populations where people can be quick to jump on that diagnosis. And I think if you look at the actual breakdown in terms of socioeconomic status, even in racial status, cultural status, all of those things, you start to see disparities amongst all of those different groups. And in some groups, very quick to diagnose ADHD. And in some groups, it's extremely, extremely, extremely underdiagnosed. And instead, you're getting other diagnoses like oppositional defiant disorder in like kids, you're getting stuff like anxiety, depression, personality disorder, when really it's ADHD. So that sort of speaks to we need better education among clinicians right And teachers and across the board about like what this really is so people can get on the right path That really that critical I know a lot of people who gotten diagnosed as adults. What are the signs that often get missed in adults, especially women? And why does that under diagnosis matter? Let's talk about women specifically. Typically, women present with inattentive symptoms, which is a big distinction. Because if you're thinking about ADHD, there are three types. There's inattentive type, there's hyperactive type, and there's combined type, which is a combination of the two. Inattentive is the symptoms that you're thinking of with inattentive. They're the daydreamers, difficulty starting tasks. They get disorganized within conversation, hard to get from point A to point B. They lose stuff. It's just everything you kind of think about in that inattentive presentation. Hyperactive is more that physically and verbally impulsive. So where boys are presenting as more of this physically disruptive, verbally disruptive, those are the people that are getting caught earlier in classrooms because it's like, this is a problem. We need to get this classroom going. And so teachers are very quick to kind of put out that fire, whereas girls, they don't want to get in trouble. They're towing the line. So we're just kind of, and part of that is societal. Honestly, there's different expectations, even at a very young age. And so they're getting passed from class to class to class to class, because they're the pleasure to have in class. They're never disrupted. The only people they're really disrupting are themselves. So I want to ask you about early diagnosis, because I imagine it's better when kids are identified earlier on in life and get the support that they need. So for parents listening, what should they be paying attention to in their kids behavior that might signal ADHD without immediately pathologizing every distraction that they have? So I think as a parent, number one, you're going to be the best first line of defense, because you're the one who really knows your kid. Genetically, you know yourself probably and your spouse. And so you know where some of these symptoms may be coming from. It's a little bit difficult in terms of like, what's normal? What's not like kids aren't supposed to be like little robots. It's normal for a kid to be distractible and have difficulty completing tasks. But if you get to a spot where you're like, well, the school is starting to notice things, you know, that's a really good assessment in terms of because they're being compared to their peers. Then one of the things that I tell people is like, that should be a time where you should start asking questions. And again, the question might be with that, you go to your doctor and say, is this normal? And And the doctor might say, yes. But what you're looking for in early childhood kind of things is, again, if you go back to that inattentive, hyperactive, and combined type difficulty, focusing on a task. So like what I typically see with parents, they're like, I have asked my kid no less than 10 times to do something and it doesn't get done. Difficulty staying still in a seat. Difficulty with keeping their hands to themselves. Difficulty with playing loudly. It's like, we're in a library, man. like difficulty regulating your noise or just kind of being unaware of the circumstance or situation that you're in. And again, a lot of that is so hard to tell because a lot of kids are naturally kind of boisterous and joyful and exuberant in their presentation. But I think what we really start to look at, and again, this is what distinguishes normal behavior from disorder is how disruptive is this? You know, one of the things that I love about what you're doing is that you've been so open about your own ADHD diagnosis. And you, of course, also treat patients with ADHD every day. How does your personal experience shape the way that you show up as a clinician? I think I understand what most of my patients are going through. I've been a patient, I've been a provider. I've seen both sides of that. So I think that makes me able to understand not just on like an academic level, but a lived level what they're experiencing. I also think that it helps me prioritize things a little bit differently. Tell us what the DSM is for folks who maybe aren't familiar. So the DSM, Diagnostic Statistical Manual, is basically the way that we categorize psychiatric illness. And that is kind of where people look to like, what criteria do you fit in to match a diagnosis? I have some significant beef with the DSM because I feel like it's way too narrow and limited. It's built to monitor observable symptoms and who would you observe symptoms in with young boys. So we're still going to be in a hole in terms of diagnosing people assigned female at birth and people who have had these profound struggles, but aren't displaying this subset that you have to kind of display. The other reason I have problems with the DSM is unlike other countries like Europe reevaluated their criteria pretty recently in 2019. Almost everywhere else has emotional regulation as part of the criteria for ADHD. And that is nowhere in the US in terms of the DSM criteria. And that's a huge, huge, huge limitation. I mean, that is going to continue to be problematic because for a lot of people, the emotional regulation is the hardest part of ADHD. And that's why people are getting hit with these incorrect diagnoses of anxiety and depression, but really it's the ADHD that's causing those. Fascinating. Yeah. And so I don't know if it was this way for you with your own personal journey, but in talking to some colleagues and friends, I understand that there's a grief that can come with diagnosis, sort of looking back at your life and realizing, and this is for adults who get diagnosed. And they look back and they say, Oh, that's why I struggled so much. That's why my parents yelled at me all the time. How do you talk with patients about that sense of mourning of what could have been different had they been diagnosed earlier? Does that come up? It comes up all every single day, every single day. I think first to understand and to accept kind of there is a place for that grief. That's OK. It's OK to feel like maybe there was time lost during that time and that maybe life could have been different. And it's OK to feel that way. I think what is really important is looking at, OK, that was then. And during that time, you were probably doing the best you could and building skill sets that now with this new understanding and with this new diagnosis, you can use those skill sets to build and to compound and to kind of move forward in a very meaningful way. Whereas maybe if you had gotten that diagnosis earlier, you wouldn't have built those skill sets and you wouldn't have figured out those kind of ways that your brain works. So it isn't truly lost time. You were working and building and understanding your brain. And now with this diagnosis, you can continue that work in a very meaningful way. But I completely understand that feeling of like, God, where did the time go? Things could have been so different because I think everybody feels that way when they have a diagnosis that is seemingly late. But there's still such a beautiful span of time where you can continue to expand and learn and change things, not only for you, but generationally. I really like how you reframed how we think about that struggle. I want to talk a bit about treatment. So I feel like medication gets all the airtime when it comes to that. Are there other options like behavioral therapies, coaching, mindfulness, even shifts in lifestyle, like what's showing promise? So I feel when we have this conversation about ADHD management, it is so common for people just to assume like, I thought that a stimulant was the only thing that could treat ADHD. When really there's, number one, there's a huge wide array of medication, but there's also incredibly powerful tools for behavioral modification that you could do. And I think that that is so incredibly vital to talk about because access to care is such a nightmare. So finding things that, number one, will help you understand your brain, because I think that's absolutely the most important step. Number two, understanding your own patterns. Like, what do I do? How do I solve problems? How do I approach tasks? Where are my holes? Because that tells you like where I need to fill in the gaps. And then using specific tools to kind of get through and help you build habits. Okay, this is how my brain works. And so now I'm going to start to fix this problem with the solution actually built for how my brain is wired instead of trying to get my brain to fit into a solution that it's not meant for it. And the great thing about this new era that we're in is that we're surrounded by information. So then the question becomes, how do you get good vetted information? And for that, if you don't have access to a clinician that has a wide breadth of knowledge on this, which again, I understand it's an absolute luxury, then it could be going online and looking at some of the materials that other people that have specialized in ADHD, have worked on, but I feel like I only want to get medical information from a credentialed physician I want someone who has been trained and who understands that and who can break down those complicated topics in a way that I can digest it I had my son a couple of days before shutdown happened in 2020. So I was hormonal. The world had literally no structure anymore. It was like one prolonged maternity leave. I had no way to tether myself to the things that previously kept me afloat. And so that's when I really started thinking like, what do I need? That's when I created that app, Focus Genie, so that I could track, there's a focus tracker, which every day I can go through and be like, okay, I drank my water. This is what my mood is doing. This is what I've eaten. This is how much I slept. And so as you kind of gather that information, it graphs it for you. And that's when I started to realize when I started to track it more regularly, like, okay, I have a pretty strong hormonal variation that happens with this and everything gets affected by that and thrown off kilter. And oh my God, I can see very clearly that my day is worse if I'm not getting restorative sleep or if I'm not hydrating appropriately or things like that. So I think that part is important. And then in terms of the actual behavioral techniques, everybody's brain is totally different. Even within that context of ADHD, everyone's brain fires a little bit differently and the things that help you might not look the same. So for a lot of people with ADHD, people need external or some sort of motivation to complete the task because just getting it done or prioritizing the thing isn't enough. And people are like, that's not, I recognize it's on my to-do list, but I don't feel like doing that. And I cannot force my brain into it. And that's why like for Focus Genie is everything is gamified. You put something on your to-do list, you click it off, you get points for that, you win badges for that. So it's helping you kind of get through your day. If breaking down a task is too difficult, you give it to the genie, the genie breaks down five easy to digest steps. So everything is just kind of fun and interesting. Outside of an app, I just recommend finding things that really truly work for you. Some people, they really respond to timers. Some people respond to just having like alarms in their phone. Some people respond to just having someone accountable with them, like having someone who are like, check on me at 12, make sure I've done this. So I feel like it's just a matter of, number one, if you understand how your brain works, and you understand what you're hoping to do, you can start to fill in those gaps with specific tools. I love that you designed something based on your own experience. And you're such a credible voice because you're personally going through this. And this is your professional expertise. I want to talk about something that you mentioned, you're certainly the world that we live in is not designed for narrow divergent people, right? And so when we think about human influences and support, what role does community play in helping people manage ADHD? How can families and friends or teachers or workplaces even better support someone living with this? I think the biggest and most important thing about ADHD management that a community can provide is just like that emotional support for it. Because, you know, when you are going into a situation and people are either unaware or if they're aware that you have ADHD and maybe there's like a negative stigma associated with it. Like I could tell you going through medical school, the difference between my medical school training and my residency training where I was surrounded by psychiatrists who love talk about ADHD is in med school. I just felt like I was incapable and lazy and behind all the time. I mean, I felt like that for the entirety of med school from literally my first neuro exam till the day I walked out of there. and then when I shifted into this other environment the people around me were like instead of being like this was wrong do it better they were like this is how your brain works let's figure out a solution so we can get to where we need to go and it was the first time that that had ever been posed as like this isn't your fault let's figure out together how to solve it and it it changed my entire number one relationship with myself, but it also kind of invigorated me from a professional standpoint to help other people do that because not everyone's going to have the opportunity to be surrounded by psychiatrists all the time. So Sasha, for people listening who suspect they might have ADHD, but aren't sure what's the first step, because we both know how hard it is to get access to mental health support or a clinician that is experienced in diagnosing ADHD? So what I'm going to say is a teeny bit controversial, but I stand by it. I feel like there is a lot of validity in self-diagnosis. And I think there's an upper limit of that, and I'll go into that. But I think that for people to look into their own symptomology and find something that resonates with them and actually explore it and dive into it and be like, yes, this sounds like me. This resonates with me. Number one, it's so validating. Number two, it gives people the vocabulary for what has been going on internally that they weren't taught. And number three, I think it opens the door to dialogue and helps them access care that they want. Now, I have lots of issues when that translates into getting like a specific treatment for it because in terms of like medication and things like that, you have one brain. If you're wrong with this diagnosis, like you don't want to try medications and they impact other things. But if it comes to, I think this is what's going on, then I say research it, look into it, dive into it, see if this actually meshes with you. Once you get to a spot where you're like, I think I do have it, or I think with some likelihood, it could be that I'm looking around. Other people think I have that, but I'm not 100% sure. If you can't find someone who is able to diagnose you, and that could be through a therapist, it could be through a primary care doctor, it could be through a psychiatrist, then the next step is what do I do about it? And that's when I feel like the behavioral stuff really comes in handy. Because even if you don't have ADHD, it is not going to harm you. It's only going to help you to figure out how do I plug these holes? And how do I make my brain work better. Yeah. No, it's so true. This was fascinating. Thank you. I so appreciate your time. Of course. We're focused on making the end of life a part of life. That's a topic that I care a lot about, and you've probably heard me talk about it on this show. So I want to personally invite you to join me for the End Well Summit, streaming live and for free on November 20th. It's a day that's unlike any other conference I've ever been a part of. It's focused on how we live, care, and connect through life's most universal experiences. The day features powerful voices and stories that challenge how we think about mortality and meaning. And one of those voices is Emma Hemming-Willis, who's opening up about caregiving and courage. There'll be researchers, patients, artists, and so many others who are reshaping how we think about the end of life. Register to tune in from anywhere at endwellproject.org. That's E-N-D-W-E-L-L project.org. I'd love to hear from you on this, truly. When you think about living and ending well, what matters most to you? Send me a DM at ShoshanaMD on Instagram and let me know. This episode was produced by me, Shoshana Ungerleiter, and Jess Shane. Edited by Alejandra Salazar and fact-checked by Vanessa Garcia-Woodworth. Special thanks to Maria Lages, Farrah Degrunge, Daniela Balarezo, Constanza Gallardo, Tansika Sangmarniwang, and Roxanne Heilash. Thank you. podcast called Fixable. We've helped leaders at some of the world's most competitive companies solve all kinds of problems. On our show, we'll pull back the curtain and give you the type of honest, unfiltered advice we usually reserve for top executives. Maybe you have a co-worker with boundary issues, or you want to know how to inspire and motivate your team. No problem is too big or too small. Give us a call and we'll help you solve the problems you're stuck on. Find Fixable wherever you listen to podcasts. Thank you.