ADHD Psychiatrist Explains NEW Hidden Signs of ADHD

[00:00:00]You went to a doctor, maybe more than one, got a diagnosis, anxiety or depression or borderline personality disorder. Or you know what, maybe you didn't even get a diagnosis and you just left [music] knowing that you needed to try harder or stress less and some of it, yeah, maybe you know what, some of it maybe fit, but the parts that didn't fit kept not fitting despite how long you stayed on the medication or how many times you redid this worksheet. I'm Sasha Nani.

[00:00:26]I'm a board-certified psychiatrist and an ADHD clinical specialist and I have ADHD myself. And here's what I want you to know. The diagnostic criteria for ADHD was made by studying hyperactive young boys in classrooms. What gets flagged is what a teacher can observe from across the room. External, behavioral, visible. Researchers now believe that those criteria capture somewhere around what a third of ADHD actually looks like in the population.

[00:00:54]The other two/3s happen on the inside, which is exactly why they keep getting missed. And this is why so many people spend years being handed explanations that almost fit. These are the signs that nobody's been looking for. Let's get into it. Sign one. Let's talk about interosception. This is when your body stops sending you mail. Most people feel hunger, exhaustion, stress building.

[00:01:18]With ADHD, those signals can run late or they can be quiet. You crash before you ever really got a warning. And that has a name, interosception. This is your brain's ability to receive signals from inside your body. Last year, researchers at Oregon Health and Science University published the first ever systematic review on this in ADHD. Last year, like what have we been doing this whole time?

[00:01:42]Basically, it was showing that the higher the in attention, the more muted the internal signals. By the way, as I'm going through this, I know a lot of you are nerds like me. You're welcome. Um, and so I'm going to put journal articles. If you want to read more, I'm just going to put them on the screen so you can screenshot [music] or you can figure out what to do with them. Anyway, let's go back to interception. This is what gets called as bad self-care, [music] but it's not that. It's a sensory difference in how your brain receives its own signals. Sign two is cognitive disengagement syndrome, which is basically a fog that looks like laziness. I'm actually really excited to talk about this. So, this is for people like, let's take off the hyperactive component. This is the opposite. Foggy, daydreamy, mentally feeling sluggish even when you're rested, trouble holding information, always feeling a step behind. In 2023, I know this is a lot of history, but I think it's important. In 2023, an international research work group, including Dr. Russell Barkley and Dr. Steven Becker at Cincinnati Children's Hospital, published a consensus statement in the journal of the American Academy of Child and Adolescent Psychiatry. They're saying that this cognitive disengagement syndrome happens co- occurs with ADHD in roughly half the cases. And so when we see this, your brain isn't checked out.

[00:02:56]It's just running a different process.

[00:02:58]And yet our criteria has no language for it. This one kind of hits home for me because I feel like so many people that I see when I'm hearing about this phenomenon and they're describing to me all of these kind of buzzwords. I feel foggy. I feel sluggish. I feel like I'm one step behind. The thing that I almost inevitably hear is that I'm being lazy.

[00:03:21]And so there I mean this is just without understanding the words and the verbiage and the diagnostic nature behind it. We are so quick to blame ourselves and I do that too. But hopefully this video will give you a little bit of understanding.

[00:03:35]There are words for what you're experiencing. Sign three, rejection sensitivity. This is all about the nervous system that refuses to stand down. I want you to think about the last flat text or neutral email you got that you ended up chewing on for hours and hours and hours cuz like listen same.

[00:03:52]The fact that you're getting stuck on that is not a personality flaw. That's your threat detection system running on hot always. The same dopamine and norepinephrine systems that regulate ADHD attention also regulate how the brain interprets social threat. We're lucky because we're talking about this a little bit more and there's like little bits and pieces of information coming in and more research being done about rejection sensitivity as a neurological phenomenon. So there was work cited by the British Psychological Society in 2025 that was actually showing rejection sensitivity in relation to cortisol and talking about that perceived rejection firing a stress response as if the threat was real. We build entire lives based on not disappointing anybody. Let me overexlain a situation. I don't want to apply for this cuz I might get shut down, but I'm going to constantly apologize. This is something that I feel like is so worth introducing into the conversation because so many of us experience that rejection sensitivity, that constant I'll do whatever it takes so that I am not rejected or criticized in this situation impacts and fuels a lot of our behavior. So, if the part wrecking you isn't the focus itself, it's this this and the emotional sensitivity component of it, I've wrote a whole book on that. It's called Too Sensitive, and it it really does get into the reasoning why you feel things so much harder. It's out for pre-order, and it's officially out on August 25th.

[00:05:20]Sign four is misdiagnosis. I will tell you that usually when people are seeing me, they've already seen a couple of other doctors and they're coming to me for a second opinion, sometimes third opinion. I have had numerous patients, especially female [music] patients, who come in and they have been on upwards of 10 different anti-depressants hoping to treat depression and anxiety. And when you actually get to the bottom of it and you ask them about their depressive criteria, and you ask them about anxious criteria, you screen them for bipolar, you screen them for underlying medical conditions, it becomes very obvious that depression and anxiety aren't the primary issue. No, they're results of this underlying ADHD being mismanaged.

[00:06:01]One of the easiest ways to figure this out is when you look at historical data about their response to these anti-depressants. They don't respond to them or they have a very partial response, but things aren't any better.

[00:06:14]Sometimes when you see this, especially repeated in nature, it should encourage a provider to look deeper. There might be something that we're missing. Cuz when the diagnosis is wrong, the suffering is real. Okay, the last one is not something that is hard and fast across the board, but we're getting an increasing amount of data about this and I get questions about this all the time.

[00:06:34]So, let's jump into joint hypermobility.

[00:06:36]So, in 2021, a Swedish paper presented their initial research that joint hypermobility was significantly over represented in ADHD and autism communities. Then, a 2025 meta analysis, like a grouping of a whole bunch of review of studies, confirmed the same pattern. Over 50% of people with ADHD or autism show elevated joint hypermobility versus roughly 20% in the general population. I'm look at this like I'm there. [laughter] Bendy is going to be and nobody actually fully understands the full mechanism about this yet, right? We're still getting data about this coming out every single day. Right now, the current hypothesis is that shared genetic pathways between connective tissue regulation and ADC neurotransmitter systems. That's kind of where we are.

[00:07:23]And to be clear, hypermobility doesn't mean that you have ADHD. And ADHD doesn't necessarily mean that you will be hyper mobile. This is a correlation that researchers just keep finding. And it's not a diagnostic sign. Clarifying.

[00:07:34]When you look at all of this, this is stuff that you are going to consistently miss. Why? Because the criteria was never built to focus on what was happening underneath. Every sign we just covered has one thing in common. Years without the right explanation doesn't just delay the diagnosis. It teaches you that the problem is you. And shame does something really specific to the ADHD brain. It triggers emotional flooding that shuts down executive function. So now you [music] can't focus, not because of ADHD, but because of what you were taught to believe about yourself. So if that sounds like it applies, this next video gets into exactly that. It talks about what focus actually looks like [music] when you have ADHD, the systems that I actually use myself, and why self-compassion isn't just this soft add-on. It's the thing that makes the rest of it possible. Not one's linked right