Mental health in the workplace

(upbeat music) Sometimes life takes really unexpected turns, and I've always been passionate about talking men's health, and you don't know what's around the corner.

Back in 2018, I went on This Morning to undergo a live testicular examination to discuss the importance about men checking themselves and how to do that correctly.

It's really given me the drive to keep talking about this important topic.

It's around 95% curable if diagnosed early.

So today I'm joined by Dr.

Naveen to unpack this important topic.

So Dr.

Naveen, thank you very much for joining me.

Thank you for having me, Chris.

And welcome.

And we are in a changing room.

I think the important thing around this is the fact that you know, as men in changing rooms, in sport teams, we do a lot of talking, but it's not necessarily on the topics which are actually important within our lives.

You know, it's quite a stigmatised subject, talking about testicular, how we all shower together, as we know.

But I feel for like women, it's a lot easier to do.

They go down to the park, they go out for drinks, and they'll talk about those important subjects.

But as men, we don't necessarily do that.

Yeah, I'd fully agree Chris.

I think it's one of those rare places that men are actually vulnerable, isn't it?

As you say, we shower together, we talk together.

This is like one place we can truly be open.

So let's see if we can replicate some of that banter, and.

Absolutely.

And well, the first thing, checking your testicles.

It's the easiest thing to do in the world.

Is it not?

It really is.

And that would be easy for me to say as a doctor, but honestly speaking, a testicle is really a small structure to check.

It takes literally seconds.

And if we're asking you to check both your testicles once a month, which is the frequency we recommend, it shouldn't take very long at all.

And we've got some props.

We do indeed.

So out comes the satsuma.

Right.

Show me exactly how you should do this correctly.

All right.

So a satsuma, as most men will know, is much bigger than their actual testicle is, but this is a little bigger just so we can demonstrate to our audience how to do an examination.

The first thing is you wanna stabilise your testicles.

So if you take the finger and thumb of one hand and just hold your testicle or satsuma like this.

Yeah.

Your other hand is free, and you've got your finger and thumb on that hand, and all you want to do is just make sure you run around the entire smooth surface to make sure there's no lump on there.

Your fingers have hundreds of nerve endings, in fact millions of nerve endings, so that if there was a lump on there, you'd pick it up really easily.

So stabilising the testicle, all you wanna do is take your finger and thumb and just run them entirely around your testicle to make sure it's smooth, from one end down to the other.

So maybe start at the top and work down, or start at the side and work to the other side, whichever is easier for you.

Is that easier to do when you've, I know when we have a bath as men, everything relaxes.

Yeah.

So it gives you a more kind of, Spot on.

full on approach to it, I guess.

Yeah, absolutely.

That's a great tip.

So when you have a bath or a shower, the testicle actually falls down from the body because the testicle has to be slightly cooler than the body temperature.

So having a bath or a shower, or even just some kind of workout, when you're hot and warm can lower the testicles and make it much easier to examine your testicle as well.

I like you just mentioned that you're touching it.

So we are literally looking for any kind of lump or anything what doesn't feel natural.

Yeah, absolutely.

So as I said, it should be completely smooth.

Just like that satsuma surface is.

If there was a lump or a projection on this, so let's take, for example, a pea.

If there was a pea stuck on that or a lentil stuck on that, hopefully, your finger would pick that up quite easily.

But you have to be feeling to know it's there.

The body gives you no warning signs, so unless you're feeling, you're not gonna know one is present.

And that is essentially what happened with my brother.

So I did the live examination that day.

I went home, I went to bed as you do, and three o'clock in the morning, he knocks on my door.

And I did say to him, I was like, Ben, what are you, what are you doing?

It's three in the morning.

He goes, I think I've got a lump on my testicle.

I said, well I'm not getting up at three o'clock to check it right now.

It can wait 'til the morning.

Yeah.

And then he showed me in the morning and obviously, there was a lump there, which he then went and got diagnosed.

But what would you recommend for people if they found a lump on their testicle?

How would you then go about the secondary approach to that?

Yeah, well thank you for sharing your story, Chris.

And I think your brother took exactly the right approach in checking himself, and well done for having done so.

What I'd say to anyone that feels a lump is don't be alarmed.

There can be many things that can cause a lump, but we have to be concerned to rule out a possible cancer.

In young men in particular, there are very few things that cause a lump.

And so if you've got one, let a doctor do the work for you.

And so you need to take yourself to the doctor so that they can do the next stage of investigation by referring you on to a specialist.

And I think what you just touched on there is very important.

I mean, a lot of people don't necessarily want to put themselves through the anxiety of going and getting themselves checked out.

They might kind of, I think a very common thing we do as men is like bypass the situation.

Yeah.

And put it to one side and think, okay, there's a slim chance it might be cancer, so I'm okay, I can deal with that.

Yeah.

Because with testicular cancer, it is a pain-free situation, isn't it?

It's not something which is physically gonna give you pain or any feeling to kind of alert you in that respect.

Yeah, absolutely.

And I feel like men, we can ignore that.

We can put that to one side, and that's not a good approach is it?

Yeah, no, spot on.

I mean, I think as men, we tend to bury our heads in the sand, don't we?

And unless there's a symptom such as pain or a rash or something which you can see or feel, you're not inclined to want to go and see a doctor.

I'd say a couple of things.

One is that testicular cancer actually affects younger men more than it affects older men.

So men that are the age that you're in Chris, and your brother, will certainly be affected more than say the men in my age group.

And so it's very important that you do recognise that.

The second thing to say is that when you go to a doctor, I know for a patient or for a gentleman like your brother, it's the most daunting thing.

But for a doctor, we probably see several a week actually.

And it really is just run of the mill, another gentleman with a testicular lump, let's refer onwards to a specialist.

We'll do our best to make you feel as comfortable as possible.

But it is important you get through the door, because if you don't, no help is available to you.

Yeah, and I know why we are in a rugby change room, It's quite a fitting setting.

'Cause I was chatting to Gareth Thomas about this similar situation when we were doing some filming together, and he was essentially saying he doesn't want to, or he didn't want to check himself, because he feels like what he doesn't know can't hurt him.

Right?

Yeah.

And I'm sure his approach would've changed in that respect, but the way I see that, I feel like if you do check yourself, and you don't find a lump, Yeah.

or if you do find a lump, and then you get it cleared as being fine, you can continue to check yourself every month, which you'd probably recommend.

You can tell us a timeframe in a minute.

But if you check yourself then, going on every month after that, it gives you that security in your head that if you then do find something afterwards, you've caught it early and at a good stage.

Yeah.

That is spot on too.

So in terms of frequency, I would say do a check once every month.

A good time as you've recommended is when you're just out of a bath or a shower 'cause the testicles are slightly lower in the body.

Even after a workout, you're a lot warmer.

And so doing it then is a good time as well.

It takes literally seconds.

So if you, the first time you do it, you may wanna take a bit longer just to, you know, sort of get a real feel for how you do it.

I'd also say to men, get to know your testicles.

We always tell our female patients to get to know their breasts when they do a breast exam, and the same applies to us as men as well.

Get to know your testicle, get to know what normal for you feels like.

And if you do it month on month on month, if there ever then is a change, you'll think, oh, hang on, that's not normal for me.

Let me go and take myself to a doctor.

And you can see it much clearly.

Yeah, absolutely.

Whereas if the first time you do a check, like your brother perhaps, and that's the first time you pick up a lump, you may then wake up your sibling at three o'clock like your brother did with you and you know, raise the alarm, which is absolutely fine to do, but you may also just think that's normal, and that would be really disastrous.

But it's literally 10, 15 seconds, that's all it is.

It takes no time to check yourself.

If you do that 10, 15 seconds on each testicle once a month, that's 30 seconds of your life.

Yeah.

Thank you for that.

Which could save your life.

Yeah, it really isn't that big an ask, is it?

But yeah, as long as you make it a routine, make it a regular thing for yourself, that's all we're asking you to do.

So why do we feel embarrassed about it?

What is the problem?

You know, it's hard to pin down, Chris.

I mean, there's a couple of things that I speak to mine, based on the patients that I've seen.

I think one of the biggest things is an embarrassment about seeing a doctor and getting naked in front of them.

But as I've said, doctors see naked people all the time.

It's a part of our routine.

We'll do our best to make you feel as comfortable as possible and just talk you through the process so you know exactly what's going on.

I think another thing is the fear of the unknown.

I think some patients come to us and recognise that they may have something wrong but don't want to know what's gonna happen next.

For some men, being medicalized can be quite scary.

Things like the fear of impotence and not being able to get erections, not being able to have children which are not the case, by the way, can often cloud their their ability to come and see us as well.

So there's many myths and wives' tales out there as to why patients don't see doctors.

But honestly, it's always the right thing to do.

So please do bring yourself to a doctor whenever you need to.

I think one important thing you said there, Dr.

Naveen, is you've seen everything as a doctor, and that is the thing for men to understand.

Yeah.

Especially people who want to go and get something looked at.

There's nothing you haven't seen.

So nothing's new to you guys.

So that embarrassment factor shouldn't really be there.

Should it?

Yeah, absolutely.

And I think it's important that we emphasise that.

For a doctor, we see these things day in, day out.

And really, a good doctor will make you feel comfortable around that.

We'll recognise the very brave step you've taken to come and see us.

But it's then for us to make you feel comfortable and take the next steps for you.

And in a very basic form, what is that next step?

So if you have got a lump, without x-ray vision, we can't tell whether it is a serious lump or a non-serious one.

So what we'll do is refer you to a specialist, and they'll do what's called an ultrasound scan.

This kind scan that pregnant women have over their tummy.

So you'll have some jelly applied to your scrotal sac, or your ball bag, we'll apply a probe over it, much like a deodorant roll on.

And that will give us a 3D image of your testicle.

Completely painless, takes literally minutes to do, and it gives us an image of what's going on, and we can then decide next steps from there.

And then after that, what would be the next stages of a cancer diagnosis?

Yeah, great question.

So as with any cancer, we then need to do something called staging to see how far the cancer has spread.

And the great thing with the testicular cancer is that if it's caught early, it is completely curable.

All cancers start off being contained essentially.

They're confined to a small area.

And unless they've spread elsewhere, all we have to do is simply remove that cancer, and you are completely cured.

Now, testicular cancer grows relatively slowly in the first few months, before it gets a lot faster and starts to spread elsewhere.

So if we catch it in the first few months of it being there, you are really in a much better position than if it's a bit more further afield.

I think that's why it's important to remember that 95% curable.

Yeah.

Is a great reason in itself just to get yourself checked.

Yeah, absolutely.

And if you consider a testicular cancer, it's so easy to pick up as well.

All you have to do is feel your balls through your testicular sac, and it takes, as we've said, about 30 seconds to do every month.

It really is a very easy one to pick up if you consider that other cancers that occur within the body can be much harder to pick up.

We really have no excuse for not detecting and then treating and curing testicular cancer.

is not a long time to put aside for what could save your life essentially.

Absolutely.

I mean, when you consider how much time we spend on social media or watching TV or even an advert between one of our favourite programmes, that's longer than 30 seconds.

Exactly.

If we can do all those things, there's no reason why we can't check ourselves as well.

A hundred percent.

So what things can we do to reduce our chances of getting testicular cancer?

Are there any lifestyle factors we can change?

Great question, Chris.

I mean, a lot of patients ask me what can I do to reduce my risk?

Because with the awareness, people are now looking to control their risk as well.

What I will say is that with all cancers, so let's speak generally, first of all, we know that there are certain things that certainly increase your risk of a cancer.

Things like being a smoker, things like drinking too much, things like being overweight and not exercising enough.

Those lifestyle factors certainly are cancer causing across the board.

I will also say, though, that testicular cancer, because it occurs relatively early in life, means that you've not always had enough exposure to the harms of cigarette smoking or drinking too much or other things that could cause a cancer.

And sometimes it is just bad luck that your testicles happen to develop a cancer in the circumstances that they do.

We know that some people have a genetic predisposition to that.

So sometimes you will hear about certain relatives in a family being affected, or certain relatives being affected when somebody else is diagnosed.

And so aside from being healthy and just being vigilant to the cancer being there by doing a self-examination, there probably isn't much else that I'd recommend people do at this stage.

Obviously, a subject I talk loads about, as well is my brother.

He was the one who had testicular cancer.

My cousin had it as well.

His cancer becomes secondary of the abdomen, but thankfully it was fully cured as well.

So again, it showcases the fact that testicular cancer is a hugely curable cancer.

Yeah.

Is it something which runs in the family?

Is it something that people should worry about in the family?

Is it genetically connected?

Yeah, let me be really honest with you.

I think medicine moves really, really fast, and we are constantly discovering new things about not just cancers, but all sorts of conditions.

But speaking about cancer in particular, there is a real knowledge base now around which cancers do have a very strong genetic link.

So there are certain kinds of breast cancer or bowel cancers that are very genetically driven.

We haven't discovered a one-off gene that causes testicular cancer, but we can't deny that there are clusters of testicular cancer that occur in families, and I think your family is one example, in point, with around that.

So we do know that there is some element of heredity in that equation.

What I'd say is that if you have got a first degree relative such as a brother or a father affected by testicular cancer, it does raise your risk quite considerably.

Okay.

If you've also got a second degree relative like a cousin, that also raises your risk, we're not sure by how much, but certainly does raise that concern there.

So I'd say for all men to be checking themselves regularly is important, but especially those men who have relatives who are affected as well.

Because if they've been affected, you may have a similar gene or genetic makeup which makes you prone to it as well.

Amazing, Dr.

Naveen.

That is very good advice for any man wanting to check themselves on how to do it correctly.

And if you find something, do something.

Perfect.

Simple as that.

Absolutely.

Though I think you've hit the nail on the head, Chris.

Being proactive is the most important thing.

And as long as you're doing that, you're good to go.

(upbeat music)

(gentle music) So I am genuinely so excited that today's guest is on the guest list.

Look at the size of that smile, because she's the guest that I wanted to be on the podcast before we even started putting together a list of people for the podcast.

I pretty much hounded her on Instagram.

(people laughing) To come on.

So today's guest has been on our TV screens for a number of different reasons, but more recently she received international acclaim for her documentary "Unmasking My Autism".

She's received international acclaim, she's been nominated for awards, and the National Autistic Society shared how incredibly brave she was to share her personal experience.

After watching the documentary, I felt the need to go on Instagram and message this person individually just to say thanks for teaching me so much about autism.

And I really hope that if every healthcare professional watched this documentary, I think it would make a big difference to people out there who, particularly those who have undiagnosed autism, especially girls and women.

So you've probably guessed who it is.

It's so lucky to have her here.

It's Christine McGuinness, thank you.

Thank you, that was an amazing intro.

Well it's from the heart, as you can tell.

I feel quite emotional, but I'm so lucky to have you here, Christine and I really, honestly, I'm a bit nervous about you.

I'm more nervous about interviewing you than I have been about anybody else.

'Cause I just think you're such an incredible woman.

Everything that you do, how brave you are.

You have three autistic children, you're autistic yourself, you have ADHD, and you know, I just really admire you.

So thank you for being here.

Oh, thank you.

No, thanks for having me.

I think it's important.

It's coming from a doctor to say, I've taught you something is pretty amazing.

Well, that's what this podcast is about.

As doctors, I think people sometimes assume we know everything and we know a lot, but we don't know what it's like to live with these conditions or to live with disorders or to live with Neurodivergence.

I'm not even sure we should call it a disorder, but we'll get into that.

Yeah.

The first question I want to ask you is, what is the one thing you should never say to somebody who is neurodivergent?

I think, I'm sure this answer would be different from everybody, but for me personally, it's one that I get all the time.

When you say that you're autistic or you've got autistic children, people go, oh, I think we're all a bit on the spectrum.

Right.

That, for me is the one thing that I don't like to hear, just because I think they're saying it to try and make you feel normal.

Yeah.

Whatever that is.

To try and make you feel like it's not too different and you're just like us.

But it also dismisses all of the assessments all of the time, all of the challenges, all of the struggles, things what people don't see.

It's kind of pushes that down.

Everything, what we've gone through as a family, as a mother, as a carer, me, myself, it sort of shuts that away as though, you're just like us, we're all a bit on the spectrum.

It's kind of like, no, you're not.

No, there are neurotypical people.

And there are neurodiverse people and they are completely different.

We very much know that the world is set up and designed for neurotypical people to thrive.

Maybe you can paint a bit of a picture for us.

So what has your day been like so far today?

Maybe you can talk us through it a little bit and maybe how do you think your day has been different to somebody who is neurotypical, having both autism and ADHD?

So today, I try to praise myself and recognise how far I've come with things now, I try and do that more often.

And I woke up in a different hotel that I hadn't stayed in before and I kind of thought, okay, I didn't sleep brilliant, but I don't sleep amazing anywhere.

I also have insomnia.

But I was like, no, I've done it.

Because in the past, I would only ever stay in one particular hotel where I knew what it was like.

I was comfortable.

I knew what pictures were gonna be on the walls, what the curtains looked like.

And I like things to be the same.

Everything was very white.

So for years I would only stay in one hotel.

Now, the last two years, I've been trying to stay more in different places so that the location's closer to wherever I'm working that day.

And so, first thing this morning I thought, okay, woke up and I slept fine, I'm safe.

And I've done it again.

I've smashed, I've stayed in a different hotel.

Yeah.

Then I ordered breakfast and I know how particular I am with food.

Again, this is down to my autism.

It's nothing to do with body weight or image.

It's sensory for me.

I like everything to be beige and dry.

And again, still trying to stay positive.

I was thinking, okay, it's not gonna be the exact toast with the exact butter that I like and it's not gonna be delivered as I would do it myself at home, but I'm in a hotel, I'm trying to deal with changes, so I'll just order some scrambled egg on toast and a cup of tea and it'll be fine.

And then breakfast came.

(person laughing) What was it?

It was scrambled egg on toast, but it was on this sourdough bread, which has got a lot more going on than just normal toast.

And then the eggs were orange and not yellow.

And that took me forever to get my head round.

I kind of sat there looking at this plate of scrambled egg on toast thinking, how can it be so different to what I have every day?

Like it was a complete different colour, different smell, different texture.

And even though I know myself that it's kind of all in my head that it's so different and it will probably taste the same.

I just couldn't bring myself to try it.

I just kind of was like, I can't do it.

And it frustrates me.

Things like that really frustrate me that I can't just get my head around it and just try it.

I dunno what I'm scared of with it.

Did you order something else or did you go out?

So I got a croissant, 'cause they're just usually the same everywhere.

So that's a safer option.

Yeah, I remember, I don't know if it was on another podcast, and I remember you talking about taking your children to McDonald's, it's like a little treat.

It's something you do every week and that was right.

You'd been on your first holiday, I think.

Yeah.

And there was a McDonald's.

And that was, for your children and for you, 'cause McDonald's, wherever you go in the world, it's the same food, it looks the same, it tastes the same.

It's familiar, the smells are the same.

Yeah.

So that was like your little treat.

It's really common for autistic people, for autistic children and adults to really enjoy a McDonald's because it's the familiarity.

It's the same everywhere you go in the world.

That little red box, it's the same symbol and they usually taste the same.

So yeah, again, it's not that our children just love fast food at the weekend, it's that it's safe for them.

They know what it's gonna taste like and it's not scary for them.

Yeah.

You say, I think that's another thing that is misunderstood.

You talk about it in the documentary that you did experience an eating disorder, but that wasn't triggered by wanting to be a certain body type or body shape, it was actually the experience of going to secondary school.

Yeah, the school canteen.

School canteen, 'cause you very highly, your senses are very highly charged as well.

So the noises, the environment.

Yeah.

I think it's scary for anyone actually.

School canteen.

But if you have autism and then the foods as well, because you are particular about which foods you want to eat.

So therefore, you didn't eat for those reasons.

And then that ended up.

Escalated into a eating disorder.

Yeah, which took years to get over.

But once I understood it and I understood my reasons why I wasn't eating, it was because I was always being encouraged to eat foods that for me are not considered safe foods.

So of course I was under a doctor, I was under a dietitian, seen a nutritionist.

And they would always say, you can eat wherever you want if it's healthy, you can have your carrots, you can can have vegetables, you can have cucumber and you'll never put weight on.

And I remember sitting there just, I wouldn't vocalise it.

And that's part of the problem, I wouldn't say, it's not that, I'm not worried about my weight.

It's because it's, green and it's orange and it's got every colour of the rainbow and it's all these different textures and I don't know what it's gonna taste like and it smells too much for me.

And yeah, there was a lot, once I understood it, I've been a lot better.

Now I know we are uncomfortable.

I'll push myself more now than ever because of the children.

Yeah.

But I've learned from it and it's become a positive because when I took my children to school, one of the first things I spoke to the headmaster about was them eating in the canteen, if they didn't want to, if they couldn't cope with it, can you please provide a place for them that's quiet so that they will eat?

'Cause I don't want my children to be going without food all day.

And I was very, very fortunate that we've got a supportive school that allowed that to happen.

And it's taken a couple of years for them to be eating on their own to then slowly mixing with a group.

And now they do go into the canteen when it's quieter.

Great.

But that wouldn't have happened if I hadn't have had that bad experience at school myself.

Well I'm gonna ask you the questions we're planned, but I'm just gonna bit out of order because that just leads me into, do you think that, obviously you didn't know you were autistic when you had your children, and it was in the process of them getting their diagnosis, that it came to light.

That, actually when you're looking at the assessments and doing the questionnaires, it became apparent that you had autism yourself.

Do you think that having autism has helped you parent autistic children?

Yeah, definitely.

And I do because we're all very similar, obviously.

And that's kind of why I didn't even know they were autistic at first.

I didn't know much about autism before the children were diagnosed.

Even being autistic myself, I always felt different, but I didn't know what or why.

I just thought, like everyone had told me growing up, me teachers, family, oh, she's unsocial, she's just shy.

Or sometimes come off a bit rude because I wouldn't mix with people.

So I didn't understand why I was like that.

And when my children were just the same, I thought, well obviously they're just a bit like me.

But I didn't realise that was because we're all autistic.

And now, knowing everything that I know, I think knowledge is definitely power and it's key to improvement for all of us.

I'll push us all when it comes to socialising, when it comes to trying different foods, when it comes to going to different places, I'll push us all, but not too much to where it's gonna tip us all over and trigger meltdown and then that sends us 10 steps back.

Well, I guess that's the power in knowledge, isn't it?

Because you know what feels safe and what feels comfortable and you know why that feels safe and comfortable.

And once you have your kind of like safety circle, you can push boundaries a little bit.

Because you know you can just step back into the safety of the circle, if that makes sense, kind of as and when you need to so you can sort of push different boundaries.

And I know my children, like any parent does, I know them and I recognise when things are getting too much for them.

So I know to step back.

But they're doing incredibly well.

And I think it's a mixture of me understanding being autistic and also them having a good support system at school.

And that's how you managed to go on, was it your first family holiday?

Yeah.

You and the children.

You went on a plane and stayed in a hotel and 'cause that's so much change, that's so much.

The noise of being on a plane and how was it?

It was amazing.

They'd done incredibly well, it took a lot of prep.

We'd flown with them years ago.

It was before lockdown, but just to Southampton and that was kind of like a trial flight.

We just thought if it goes terrible, then at least we can get our car back if we need to.

So we'd done that to start with, and then the plan was to go away, but lockdown happened and then after that, it just took a long time for them to get comfortable going out and about, again, regression is quite common in autistic people.

So that happened and yeah, it's been months of visiting the airport, watching aeroplanes , going with the ear defenders on, and then slowly removing them so that they can get used to the noise.

And watching a lot of videos to the point where they were happy and excited about it and not scared.

And there was still moments where we kind of had to take one each and make sure they were nice and calm.

Yeah.

And they've done well.

They've done really, really well.

So yeah, hopefully more holidays.

Yeah, amazing.

So we know in your documentary you really did shine a light on autism, especially how it presents differently in women and girls and therefore it's not diagnosed.

But I think an area that we've heard less about is ADHD.

And you've also fairly recently received a diagnosis of that, haven't you?

Yeah.

How did that come to light?

So, it's quite common to get a double diagnosis when you're autistic.

You could potentially be autistic in ADHD or autistic and dyslexic or dyslexic.

It is quite common to get that double barrel.

For me, the ADHD is something I didn't understand how I could be ADHD because again, you Google or you see people and you have this image of what you think ADHD is gonna be like, and I didn't fit in that bracket.

But then when I researched it properly, spoke to a doctor, I am a different type of ADHD and I'm an inattentive ADHD, which is different to the typical hyperactive ADHD person that you might see and recognise more often.

So for me, where I'm inattentive, it's very much more, can be quite distant, do kind of live in my own little bubble quite a lot.

It goes quite naturally with my autism, it's kind of, it does overlap, it's quite similar.

But then I have my moments where I am extremely hyperactive in my thoughts, in my creative side, in my feelings, in my emotions.

I will be extremely hyper emotional if I'm sad, it can be the end of the world to the point where I'll think I can't cope, I can't do this anymore.

Even having suicidal thoughts, it can go that far.

And that's where the hyper side for me is.

But then also on the plus side, if I'm happy, it's the best thing in the world and nothing can ruin my day.

And it can be from the tiniest little thing, and that's where the ADHD affects me.

But if you met someone with ADHD or spoke to somebody about it, they might assume that you're hyper and you're all over the place and you're full of energy and all of this, and that's not the type of ADHD that I am.

I think, well this is a lot of the issue I think, certainly within healthcare services.

And this is the thing that really struck me when I watched your documentary and there were certain parts in that documentary where you had guests on there as well and they hadn't, especially as girls and women, we are taught at medical school, we're always taught the stereotype.

So we are taught ADHD, I mean, it's quite a while since I was at medical school and I'm sure it's improved.

But I had Dr.

Alex George on the podcast recently.

He's much younger than me.

And it seemed that it hadn't improved all that much.

We were talking about eating disorders and how you very much taught the stereotype is a young girl who's very underweight, who's at school and stresses of exams.

And I think when we're taught about ADHD, it does tend to be more both in the general population and within healthcare professionals tends to be, we think of a boy who's very hyperactive and sort of running around.

And I think, again, autism we tend to think of boys.

And we have that definition in our brains.

And because we learn by pattern recognition, that's how we learn when a person is sat in front of us who is presenting with issues, but don't fit that pattern.

And we're trying to find what the answer is.

It was evident in your documentary, there was one girl in there who was doing some boxing.

Leanne.

And she received so many different diagnoses throughout her life, anxiety to bipolar, to personality disorders.

Yeah.

And the relief that she shared when she found out actually, she discovered autism.

And it was like, kind of, it just all makes sense now.

Yeah, again, unfortunately it's extremely common, from the documentary, I've had thousands if not hundreds of thousands of messages off women in particular, older women that watched it and said, I've been diagnosed with depression, with bipolar, with everything, and I've watched a documentary, I'm almost there and I'm autistic and I'm none of these other things.

And if you are diagnosed with any of those other things, I think it's still important and you get the help and support that you receive.

But if you're actually autistic and not that, then whatever treatment you're being given is not gonna work.

And the thing is, as Leanne you said, as she rightly highlighted, a lot of the medications and treatments for conditions like bipolar, whilst if the person does have bipolar and they're effective are worth it.

Yeah.

They have a lot of side effects as well.

She described having it put her heart into an abnormal rhythm and she had to go to hospital multiple times.

So it really is important that as healthcare professionals, we are always thinking about autism in women and girls.

Yeah, definitely.

In the same way perhaps we do men and boys, I think not only the treatment and like the medication or the therapy, whatever help and support they can give, that's extremely important.

But also the environment and the place that it's given, for a lot of the ladies that I spoke to, Fe was another one, she had anorexia.

Yeah.

She'd always struggled to get better.

And now she's on this other programme where the food is more suitable for her.

She's treated in a place that's more suitable for her.

She's seen at home, instead of in hospital where for someone who's autistic, she was struggling with the change, with being in a different environment, with different nurses coming in and out, not seeing her family.

She was away from home, and the same for Leanne.

Again, it's just gonna make them worse.

Yeah.

But you can't blame the doctors and nurses if they didn't know, that they've gone along with the normal programme that they've been told to follow for somebody who's got an eating disorder or somebody who's got bipolar.

Not for somebody who was autistic, which is why unfortunately, they were failed until they got the diagnosis and now they're doing really, really well.

Yeah, because I guess it's the same as what you experience.

We make assumptions about people with eating disorders and we maybe encourage them to eat a range of foods that are low calorie, but highly nutritious.

And actually it's not about that.

It's not about the weight, it's about actually the textures that foods have and the colours of foods and therefore actually, there's certain range of foods that you may be happy to eat, but they're not always available.

And that's what, as in your case, that's how it started.

But then it can become a more significant issue when phobia of food.

Yeah, you lose control of it and you know, your tummy does shrink and you get used to eating less and then it becomes such a big issue.

The more people mention it kind of doesn't help either.

So it did spiral for me, but again, it led to a positive with my children where I had this different outlook on, well as long as they're eating, as long as they're healthy, that's what's more important.

And I remember having health visitors, professionals, paediatricians, even family saying, oh, well, you're letting them eat what they want.

Why are they gonna go and eat what everybody else is eating if you are allowing them to eat breadsticks for breakfast and not you know a porridge.

But I saw my children getting smaller and my son in particular really, really struggled.

He was in the hospital far too often when he was three, four, extremely underweight.

We spoke about putting a peg in his tummy to feed him because he was so underweight.

And it was all because I was following advice of what professionals had told me to do, was to only offer him food what all the other children were eating at nursery.

And he wouldn't touch it.

He wouldn't eat it.

And because I understood that, 'cause I would sit there and look at this bowl of bolognese and go, well, I'm in thirties and I wouldn't eat it.

It's far too sloppy, it's wet, it's got all these different colours.

It smells and I wouldn't touch it, so why would I expect my children to eat it?

Yeah.

So I kind of ignored their advice and gave him anything beige, lots of high calorie stuff to get his weight up.

I got him milkshakes that had vitamins and extra calories in to make sure he was getting some nutrition in him.

But ultimately, it comes down to just being healthy enough to survive, to live and to thrive, of course.

Not just sticking to what people will say, you must eat five a day, five a day's amazing if you can.

But if you have got a sensory eating disorder.

Yeah.

It is literally, it's a matter of life or death when it comes to it.

You've gotta just let your children eat what they will eat.

Yeah, well obviously, you're an absolute picture of health, we spread this message that we have to have this widely varied diet and eat the rainbow and all these colours.

But you've said actually, your preference is, you mostly eat beige food that's dry in texture and obviously you can thrive.

What sort of things do you eat and do you take vitamin supplements?

I do, of course I do.

So for me, of course I wish I could eat the five a day I really do, it looks lovely on a plate when I see it all like a rainbow, it looks pretty.

Yeah.

But I've just accepted that right now, that's not gonna happen, I wanna keep pushing myself, but I just wanna stay healthy and keep my weight up.

Yeah.

So I'm on quite a high calorie diet.

I have lots of carbs.

I have lots of pasta, lots of bread, protein.

I have a lot of chicken.

So although it's very like beige and bland, for most people, really boring, for me it works and I'm a healthy weight.

And I've got enough energy to keep going and look after my children, and right now that's my focus.

And I admire you 'cause you're a fitness bunny as well, aren't you?

You train practically every day.

Not anymore, three, four times a week I try and train, yeah, do something.

I'm struggling with my motivation.

Someone who's always trained at the moment I'm really struggling with motivation.

So it's another reason I admire you.

(people laughing) So I guess bringing it back to the ADHD, we sort of went back into autism there and getting away from this, I think we do need to get away from this stereotype.

This image that we have.

And we do have a professional who's gonna join us in a little while to share a bit more about us.

But in your scenario, do you feel that the autism and the ADHD go hand in hand then?

Yeah definitely, for me it does anyway.

And I can kind of tell now when I'm having more of an ADHD day.

Yeah, I can kind of separate it days where I'm feeling extremely autistic.

My autistic days are more so when I'm working or if I'm going to an event where it's a busy environment or if there's been a big change in life or if I'm doing something that I'm not quite prepared for.

My autism kind of takes over and I do go very insular, very into myself, very quiet, kind of hide in a corner.

Whereas when I'm having quite an ADHD day, that's when I'll kind of notice more like details and things will make me a bit more, like more anxious and more on edge and more, I feel everything a lot more than on my typical autism days where I'm very much like, just keep yourself to myself and nice and quiet.

So do you feel like if kind of the situation feels comfortable for the autism, that's when the ADHD can sort of bubble up?

Yeah, yeah.

I think the ADHD is triggered more by things that they're gonna give me, like anxiety and stress and things.

And then I'll be more hyper, more vocal, more on edge.

It's, yeah, I don't really like that side as much as the autism.

I kind of keep myself quieter and yeah.

Which is today?

(person laughing) Today, just more calm, more autistic.

This is, I was prepared for today.

I got the questions, the call sheets.

I knew where I was going.

Yeah, I'm having quite a calm day today.

I'm feeling all right.

Another thing, just sat here having this conversation.

People watching and listening won't know.

But we're in a studio.

There were quite a few people around.

We did just before we started recording where everybody introduced themselves a little bit.

And you mentioned about your short term memory.

Yeah.

That that's another side of autism that people might not realise.

Yeah, it's awful.

And it's always been there, it's always been an issue.

And again, growing up people are just, oh, she's really forgetful.

It's Christine, she's forgotten again.

But yeah, it is actually very, very common.

The more I speak to autistic women in particular, their short term memory is not great.

But then I can repeat a whole conversation with every single detail, what I had last week.

And I'll go over and over it.

I talk to myself a lot anyway.

Yeah.

And I always have done and I didn't realise that that was something that not everybody's done.

Yeah.

Until I started talking to more autistic people.

But yeah, I'll remember things from years ago, from months ago.

But yeah, my short term memory is yeah, not great.

'Cause I think I've been thinking this morning, I've been sort of preparing to have this conversation with you and I think trying to figure out perhaps a little bit more, 'cause the world is just, it's slightly different.

Your experience of where we are right now I'm aware is different to mine.

So I think just being a bit more aware today when I walked into this room, I was aware that it does smell.

I wouldn't have even noticed, there is a smell of food.

It's food, yeah.

Actually, I walked in with a poke bowl and thought, actually I'm not gonna eat that, it's in the fridge.

I thought I'll eat it afterwards because the last thing you need to be hit with is a smell of raw fish.

But even, I noticed when you came in the room and I kind of, I guess I don't take that much notice of things, but you really do take notice.

Yeah, yeah, and because I'm more aware of it now, I'll try harder.

So throughout this I've tried to really keep good eye contact.

Yeah.

But with you, it's quite easy 'cause you've got dark eyes.

If you are bright blue eyes.

Okay.

I probably will keep looking away and having a glance.

I still do look away, but I'll be more subtle.

But I'm choosing to look that way and not that way.

Because that way there's a shelf behind you full of plants, so I would start counting.

I already have, I know there 10 on there.

Yeah, well I was wondering, 'cause when you were saying also with the ADHD and it's the sort of inattention, but in that moment you said that I thought, but I feel like I've got your full attention.

So we've been chatting for, I don't know, maybe 20 minutes and I felt like I've had your full attention.

Is that work for you?

Are you having to really work hard to do that?

Yeah, no, you haven't had me full attention at.

Have I not, you fooled me?

No, I'm really trying and I've always try when I'm talking to someone, I wanna be present and I wanna listen and I wanna take it in and I wanna enjoy the moment.

But I'm always, no matter what, I'm always having five or six conversations in my head.

Right.

It's like there's a radio on and I can't switch it off and it switches between the channels.

And I'll start thinking about things that I've done last week or what I'm doing next week, and it's hard.

It's hard to really stay focused.

But when I'm talking about autism or ADHD or my children, that's when I can hold a conversation compared to if we were just out now chatting, like we met at an event recently.

If we stayed chatting around a table about anything other than this topic, I'd probably left by now 'cause I'd have struggled to have kept that going.

But talking about things that I know about, I'm quite comfortable.

Good, okay, well, I'm glad we're talking about that.

(people laughing) What changes would you like to see when it comes to neurodivergence generally around people's ability to get a diagnosis?

Yeah, I would say that.

Yeah, the diagnosis for children, I think it's so important.

It makes a huge difference.

If they're diagnosed preschool, that's incredible.

They're gonna get help and support early when they need it.

But unfortunately for a lot of children, that diagnosis isn't common until later on in life.

It can be when they finished school, a lot of the waiting lists now are between four and seven years, which means, hundreds of thousands of children all over the country going without support that they need.

And it's a lack of funding.

It's a lack of doctors being able to actually give that diagnosis.

Even doctors that recognise it and they can say to the parents, yes, we believe your child is autistic.

They're not actually able to go and do the whole assessment and give them a formal diagnosis, therefore they might not get the support that they need.

Yeah.

So I think somehow that does need to be brought right down.

You know, nobody should be waiting for support, especially children.

And it's the same, it's even worse for adults, isn't it, because at the moment, you've had all these women reaching out to you after you've made the documentary probably saying, I'm pretty certain that I have autism.

And it'd be a similar scenario for ADHD.

What have you advised them.

To keep going, to keep pushing, don't leave it.

I think, again, one of the worst things someone can say to a woman in particular who's going for a diagnosis later on in life is, oh, well you've got this far, so you must be fine.

Do you really need that diagnosis?

Does it matter if you're in your thirties and you've had a job and you've had a family, you've been married, does it make any difference?

But it really, really does, from my own experience, it's completely changed my life.

I'm doing so much more now since my diagnosis.

I understand myself so much more.

I understand people in the world so much more than I ever did.

And I didn't get it before I stayed in, I was a recluse for almost eight years.

I barely left the house.

I wouldn't be doing the events and the jobs and the stuff that I'm doing now if I did not have that diagnosis.

So it is very, very important.

It doe matter.

It's the quality of life thing, isn't it?

Yeah.

The quality of life you can have it sounds like can be completely different.

Yeah.

Just knowing and understanding, having that diagnosis so you can sort of reevaluate everything, I guess.

Yeah, definitely.

I'd say to anybody to just keep pushing.

I know it's hard, but just don't give up because you deserve that clarity.

Yeah.

You deserve to know that you're not going mad, you're not overthinking anything here.

If you're feeling that you fit that bracket, then go for it and get it clarified completely from the doctor.

Sort of stepping out of that for a moment, thinking about public health and public health strategies, what do you think fundamentally, what do you think needs to change when we're talking about these types of topics?

I think a lot of it is quite simple changes and not expensive.

Like we're going into work or going into a family function anyway.

Even coming in here today, you quite simply second can everyone introduce themselves.

And for me, it's nice to know who's in the room and what everybody does, that costs nothing.

It took two minutes of your time to do that.

But it made me feel a lot calmer and I know what's going on and getting the information before I got here, things like that is really, really helpful.

But that could happen in everybody's everyday life.

If there's somebody working in a job where they don't want to eat in the canteen, for them to be able to just speak to the boss and just ask is there somebody else that, can I eat me my lunch away from everybody?

I'm not being rude, but that could really help someone's mental health to just have that time away to just breathe, to step away and be allowed to do that without feeling rude or like they're being difficult, it's a simple ask, but it's a really, really big difference for somebody who may struggle in that kind of environment.

It's that understanding, isn't it?

Again, it's what about was podcast is about, you know, what we are all learning from you.

Having that understanding and therefore empowering somebody who is affected to ask for just these simple things.

Yeah.

Please don't assume I'm rude, just because actually I feel more comfortable sitting in a different room to eat on my own.

I just need to take 10 minutes out just to sit myself.

But again, it was only after my diagnosis that I felt confident enough to do that 'cause I'd got to the point where I was turning down work, I was turning down birthday parties, wedding invitations, everything.

I wouldn't go to anything.

And it was after my diagnosis that I'd done a TV show called "The Real Full Monte.

" And that was the first time where I felt extremely autistic.

I felt everything was overwhelming.

It was all too much.

I stayed in different hotels for the first time.

I stayed with people I'd never met.

Everybody seemed to just be chatting away and eating together and spending all day night together.

And I was sloping off to my room whenever I could.

And it was kind of bubbling inside me, and just went to one of the other cast members, Duncan from Blow.

Who's your bestie now.

Yeah, we're very close.

And yeah, it was him that I spoke to and I just said, look, I'm autistic.

I'm really struggling to fit in here.

I don't know what to do.

And he was amazing and took me under his wing.

And then from there I went on to do another TV show, which was a bigger group of people a bigger challenge.

It was for ITV called "The Games".

Honestly I don't know how you're so brave.

With that one, I just went into the canteen on the first day everyone was eating and I just went, I'm not being rude with everyone, but I'm not going to eat with you at all.

I'm autistic, I love you all, but I'm gonna take my food and go eat in my car.

Were like, oh fine.

Yeah, do what you want.

And by the end of it, we were all eating together.

That's amazing.

But the difference in the first time you felt so uncomfortable and afraid you needed a Duncan there to sort of, I guess have those conversations for you to being so empowered to go in and say, this is me, this is what I'm doing.

It's not got anything to do with you actually.

And that's that.

Yeah, and everyone's great.

It is amazing that when you do speak up and you ask for those little bits of help and explain, everyone's so understanding and so kind.

I think it's more in your head the worry and the fear of making yourself seem difficult or coming across as being rude or on social.

It's more up there, you know, when you just say, actually everyone doesn't really care and they're just like, yeah, do what you want.

Everyone's in their own world to some extent, aren't they?

But it is that thing of fitting in.

And I think, this is, I think it's one of many, many plausible reasons why girls and women are so much better at masking when they have autism, being very little as girls, we're trying to fit in, we don't wanna be the one necessarily standing out.

We're trying to conform to what society tells us we should be.

Yeah.

Which is usually perfect.

Boys are brought up to be brave and girls are brought up to be perfect.

There's a really great TED Talk on that.

And I guess as somebody with autism, that's been your life, hasn't it?

You've been constantly trying to.

Trying to fit in.

And never quite fitting in.

(person laughing) Yeah.

There was some of the language in the documentary where both you and is it Fi, the girl who had the eating disorder.

You often spoke about trying to get it right, like, having a conversation, you'd rehearse a conversation and if you felt like you didn't get the conversation right, then it would ruminate in your mind.

And for me, as somebody who doesn't have autism, I don't necessarily think about getting a conversation right.

I can have a good conversation or a bad one and come away and think, oh, I wasn't on form or I wish I hadn't said that, but to define a conversation as right or wrong.

But that's been your experience.

Yeah, forever.

I've always wondered, right through school, I've always gone over questions and conversations I've had, I always wondered if I've answered something correctly as in not like as though I'm being interrogated and I might have said it wrong.

It's more just simply, did they say a joke and did I laugh at the right time or did they mean it sarcastically or were they being serious?

So it's things like that that I struggle to understand and yeah, I misunderstand quite a lot but now again, now I understand myself, I can kind of laugh at it and go, oh, well I didn't hear it like that.

It was completely different how I processed it.

But yeah, it's hard to understand people.

I don't get that gut feeling on how somebody may be.

And I try and take everybody at face value and I see everyone for the best and yeah.

And that's just me how I am.

Well I guess the different, we were talking about this again before we started recording and we talk about often, that gut feeling or I've been told before that I'm a good sense of character because I can, I don't know, the stuff that you a person presents you with a certain amount of evidence, but being a good sense of character is almost when you can read between the lines and figure out who a person is beyond what they're presenting with you.

How do you do that?

And you were saying that, you know, a gut feeling, you don't even know what that really is.

Because that's just something that you don't have.

Yeah, I don't get it.

And people often say to me, well, just go with, surely you must have like a good judge of character or something, well, no, not really.

I've never really kept a lot of people in my life.

My circle's very, very small.

I've only got like two or three very, very close friends and I rely on them a lot, and it's not really their job to do what they do.

But me closest friend in particular, Kath is usually one, the one to say, just watch out for that or just be careful of that.

I don't ever see people's intentions and that's something that I really don't like about myself because things can happen over and over again and I don't see it coming and then I'll get annoyed with myself that I should have learned by now.

But it's again, unfortunately quite common for autistic women in particular to be that bit more vulnerable, a bit more innocent, easily led, a bit green, and sort of believe anything.

And I am very much that person.

Yeah.

Yeah, it's frustrating because still in my thirties, I don't learn and I don't see it coming when I might have seen it 100 times.

Yeah but it's like you say, that's part of what being autistic is, isn't it?

Yeah.

And you shared in the documentary that like you say, in some ways it can make you more vulnerable.

Because you don't necessarily see those warning signs, those red flags.

But also, you mentioned you separated from your husband now.

Yeah.

But perhaps it's one of the reasons why you felt safe.

And that's why perhaps you stayed in a marriage that maybe other people wouldn't have done for a very long time because that safety, you don't like change and it's difficult.

Yeah, and also believing that somebody would change and believing it and believing it and then they don't.

And it's kind of, like I said before, that frustration within myself for believing in it.

But I still always wanna believe that there's good in everyone.

Yeah.

And I wanna believe when people say that they'll change.

But yeah, I was married for 12 years, with Patrick for 16 years.

So from when I was 19, that's been my whole life.

And that's where I know.

So of course changes with that are petrifying.

Yeah.

We're doing everything very, very slowly.

Not just for me, but for the children as well.

Yeah, of course.

We still live together.

Yeah, and eventually it is gonna change.

'Cause that's not a long-term plan, but the thought of it does petrify me.

It doesn't excite me, I think most people think, well, surely you must be ready to move on now.

I get asked all about dating and things like that.

And I'm like, no, absolutely not.

I'm petrified.

Oh God, I don't like eating in restaurants.

I don't want food's on the menu.

Don't really want talk to someone that I don't know.

(person laughing) Dating is absolutely petrifying.

I've so totally rehearsed conversations back the days of dating, I hated it.

So yeah, slow changes are good.

Yeah, and there's no need to rush that stuff.

Yeah, I'm not in any rush.

I'm really not.

Although I bet there's a lot of people interested.

(people laughing) But I think, I mean, sort of, towards the end of the documentary, the bit, there's one scene of you where I think having the diagnosis and being able to look back and reflect on life differently, there's one scene where there's a particular sequin dress that you're getting rid of and you're going through your wardrobe and realising, actually, I didn't wear that because I wanted to wear that.

That's actually not me.

I wore that because I was trying to fit in and I think the sequin dress, you were going on to Strictly and you wanted.

Yeah, I wanted to look like everybody else.

Yeah, you wanted to fit in where actually you don't like scratchy textured clothes.

So that journey of before moving on and being in another relationship, it's really about discovering the relationship, I think with yourself, isn't it?

Yeah, yeah, I've got out to.

Figuring out, now you're not pretending anymore.

Well, we all pretend, but you know, now you're focusing on discovering who you really are.

How's that going?

I'm trying to not pretend, but I still do it.

Well I think we all do to be honest.

Yeah.

But you obviously have done in a different way.

Which I'm not doing anymore, but I still do tend to try and fit in with wherever I'm going or whoever I'm with.

But yeah, I'm not really sure.

It's very contradictory being autistic because a lot of the things I do where it's trying to be like everybody else and trying to copy, although that's not my authentic self, it is.

Your whole life.

So trying to stop that would not be me being myself.

Yeah, yeah.

I see what you mean.

Yeah, so it's hard, I'm getting more comfortable in my own skin.

Yeah.

I'm doing a lot more, I'm pushing myself a lot more.

I'm saying yes to opportunities and I'm trying to not be so scared of change.

Yeah.

And know that everything will be fine.

And I'm trying to just set a good example for my children.

You know, I want them to grow up and be social and go to work if they want to and have families if they want to.

And I wanna show them that mommy does all of these things and a little bit silly sometimes I usually ends up in tears if I push myself too much.

But I usually end up feeling proud and I want them to go and do all of that.

Well I honestly, I just think you're so brave.

You're such an incredible mother, that your children are so, so lucky.

Oh, thank you.

To have you as their mom and I am in admiration, but one thing I'm desperate to ask you about and I've wait till the end is yeah, so you did "The Real Full Monty", which is show I did as well, which was kind of terrifying in so many, they made us do it on ice though, that made us ice skate.

So my fear with that, people misunderstood.

It wasn't so much taking the clothes off.

Yes.

Of course that's petrifying.

Yeah.

My problem was the audience and the noise and the lights and the smell.

It was performing in front of a huge audience for me.

That's what I found petrifying.

Yeah, 'cause I remember, you went on "Loose Women" and spoke about it and Brenda Edwards, who's just lovely.

Yeah.

And her fear and lots of the women who do that show, it's about actually bearing yourself to an audience.

But for you it was terrified.

Just being in a room with people.

(person laughing) Yeah.

So you did that, then you did the games, which involved you diving from a high board and you were scared of heights.

Oh gosh, yeah.

Again, I'm scared of heights, that terrified me.

But you've just done "Celebrity Hunted".

I have, yes.

How was that?

It was amazing.

Honestly, the best thing out of everything I've ever done, it's where I've been my most comfortable, my most confident.

Even though I was petrified of everything, because I'm in this mindset now, I've really wanting to push myself.

I said yes and I just went for it.

I went for it.

I enjoyed it.

I was with Duncan, thank God, who I'm very close with.

And that helped massively.

I think what I've learned about myself is that if I'm with someone that I know, that I trust, that I'm comfortable with, I can do so much more than if I'm on my own.

Or if I'm with people that I don't know, then I'm definitely more likely to kind of sit in the corner and take myself away and stay quiet.

So yeah, having that right support system is really, really important for me.

Yeah great.

And what have you got coming up?

Obviously please tell us about your book as well and anything else you've got coming up.

I am writing another children's book.

Are you, fantastic.

My last one went to number one on World Book Day.

It done really well.

So I've just started writing again for the second one, which will be out next year.

And then I'm just trying to think if I'm allowed to say anything.

I don't think I'm allowed to say anything else.

Okay, fab.

Well I can't wait for that.

Thanks again, so we're gonna take a short break now, and then we're gonna be joined by our expert and we're gonna dig into things a little bit further.

(gentle music) So we're now very lucky to be joined by Dr.

Rajeev Dhar, who is a consultant psychiatrist who actually runs an ADHD clinic and is based at the Cromwell.

So thank you so much for joining us.

Thank you.

Tell us a little bit about your experience first, if you wouldn't mind, with psychiatry and autism and ADHD.

Well, I've been a consultant psychiatrist for 20 years almost.

And what we do is we treat all types of mental health problems actually.

So we start with a mental health issue and then we drill down into what type of disorder it might be.

So in the course of my career, depending on the environment I've worked in, it could be PTSD, it could be schizophrenia, it could be ADHD.

So we really specialise in actually diagnosing, we're diagnosticians, I work in the private sector, I work with a lot of corporate patients.

I also deal with a lot with individuals who are transitioning from child service to a adult services, to university because it's a lifelong process.

Yeah.

Getting a diagnosis, the journey of an ADHD patient is very similar actually across the world.

So I deal with patients all over.

So my job now is to make sure that we are able to diagnose people who suspect they may have it, either because their children have been diagnosed or because they've always wondered whether there's something else going on.

It's not just depression or anxiety disorder or any of these other conditions.

So my job is to try and like a detective, work that out.

Okay, and I guess one of the things that's just sprung to mind is when we talk about autism or we talk about the autistic spectrum disorder and we know that it is a spectrum and people can be affected to different extents.

How do you feel about that word disorder?

I mean, obviously for some people it's a very, very disabling condition for other people like you, Christine, you know, you live a really, a life that many people would look up to and admire and love to have your life.

But you've spoken about how actually every day has additional challenges.

Yeah.

It's hard work.

It sounds like everything is a lot of additional work, but do we think disorder is right?

I personally prefer condition, but yeah, it's different for everyone.

And if you've met one autistic person, you've met one, like you said, there are those where it does affect them physically, therefore it will be, have disabilities as well.

Yeah.

Lots of people like to go with the abilities that they get.

Instead of, but yeah, for me, it's simply that I am an autistic person, I'm just a person who happens to be autistic.

Well sometimes people talk about that, don't they?

The abilities, sort of the super abilities that can come with it.

How often Dr.

Rajeev, do you come across patients who have neurodivergent conditions that sort of see it as a benefit?

It's a really good point, an important point.

Without a doubt, I will see an individual who has a condition, like we said, there has to be a way of describing the pattern.

So I agree with you completely.

Conditions is a better word, that has dysfunction in some areas.

So I use the word function for that individual, but also hyper function and whether you want to call it genius or abilities or whatever, it's the ability of that individual in that particular context to over perform.

Yeah.

But the flip side, I guess in terms of why we're trying to get people the support they need is that it'll often go with an area that they don't perform as well in.

Yes.

And that fitting in, I mean, you both did a fantastic job.

It was inspirational to listen to the conversation because you tapped on into all the areas as a senior consultant, I have to communicate with patients because that's what we see.

We see this challenge of fitting in.

So I agree that yes, no, it's definitely about encouraging people to develop the areas that they're already brilliant at.

And there's definitely individuals that have that, but it's also making sure the other areas don't cause suffering.

Yeah.

So, yeah, Rajeev, would you reflect on the conversation that Christine and I had and were there any specific points that when you were sat listening, you thought, oh, I'd love to interject and add this or mention that.

A fantastic conversation, I mean, listened to people talking about their mental health issues for 30 years now, and I thought that you described it just beautifully.

The notes are too extensive, I would say there's two or three things I think need to come out from a professional is that you, I think you start at the beginning about talking about parenting and learning about yourself.

First of all, learning that you may have a ADHD and autism because your children, which is really interesting, isn't it?

Because it's almost the gift that the children have given you is some insight into yourself.

And then you've taken that and you'd be able to create an environment which has allowed them to flourish now.

Yeah.

So we don't need to medicalize things.

We don't need to make these psychological, we need to create environments, that minimises the impact of any mental health condition.

Your journey really started with the diagnosis.

Yeah, oh yeah, definitely.

Which is what I've always said, that without that diagnosis being there and getting of the bow of seeking a diagnosis, you wouldn't have had this journey.

No, I think you go through instantly, it's almost like a grieving process or for me it was, you kind of grieve for the life what you could have had or might have had and you sort of realise that things happened certainly in my teenage years that might not have happened if I'd have had the help and support at the time, but it didn't.

So you have a bit of a grieving period, but then you, you get this rebirth, it's like you have got this whole new life where you suddenly understand it a bit more and you understand yourself more.

And it's incredible.

For me, it's been a huge positive getting that diagnosis.

So I think we're all agreed that the diagnosis bit is absolutely crucial.

But then we have an issue, don't we?

Because I think, through your documentary alone, it's raised a lot of awareness and we know that there are many, many women and men, adults out there who will now be thinking that they have autism.

But as an NHS GP, when patients come to me and ask me to help them get the diagnosis, we're a bit stuck.

We're not able to essentially, for adults, it may depend on where you are in the country, but where I work in Central London, we're not able to refer for that.

So what do we do?

So I guess what can people do?

Obviously there's the option of seeing somebody like yourself, Rajeev, privately, which I think perhaps for a lot of people it is worth it, if they can.

But for people who absolutely can't, you can go online.

There are these self-assessments that you can do online.

But what would be the pros and cons of doing that?

Well, I think lets distinguished self-assessment from self-diagnosis.

That's an important distinction isn't it, so self-assessment could lead to self-diagnosis.

But if anything, it should lead to a diagnostic process that is valid.

If you have self-assessment and then self-diagnosis, then obviously we're gonna have false positives, false negatives, and that's not gonna help anything 'cause you're creating a whole new set of health economic issues.

So if we use screening tools correctly, then we can get that first step where people are filtered a bit before they go on to the diagnostic step.

The diagnostics step is a problem, as you say, as a GP, I've always said that, when I was a clinic director, we always had this challenge, what can you do in a five or 10 minute consultation?

Keeping the private sector aside, we can do a more on understanding that consultation better for people who have mental health problems because we need to be efficient with it.

And then I think, as you said, how do you then get that valid diagnosis in place?

'Cause it has to be a psychiatrist and it has to be a psychiatrist who's had specific training in making these diagnosis.

And there's really important reasons because as we've said, there are two bits of ADHD that go together.

One is ADHD itself and how it manifests, and you've said it very well actually, about the overlap with other conditions like autism.

And there's a 40% chance that a person will have autism as well as ADHD.

Yeah.

And if you add dyslexia into that and dyspraxia, you've got that mix and then you've got very high morbidity connected to ADHD, so social anxiety, we're talking 80% and then disability.

So it's a complex disorder whenever anybody presents.

That's why it has to be done by diagnostician who understands all those different conditions.

And then the pathway can be set, the pathway can include other people and it can be more efficient.

But I think that first step is important.

That diagnosis has to be a proper formulation.

So what needs to happen then, I guess from, I asked Christine this question, kind of looking at it more from a public health perspective, from a government perspective, from NHS England, commissioners, what do you think needs to happen to better support people in this very, but then this is just getting the diagnosis.

I mean, I think we're at a point where if we have, across medicine, if we have conditions that we think are root causes, we invest in that.

Yeah.

So if you take ADHD as being one of those root cause conditions that has secondary conditions, and there are other ones in medicine, as you'll know, we invest in that and we prioritise.

It takes time to build a system around we prioritise that because the secondary effect will be cost saving anyway.

Yeah.

So I think yes, that's gotta be the post.

The interest isn't gonna go away because ADHD and autism is out there now.

Yeah.

We know globally, anything between four and 7% pre COVID, and I would say COVID is because of, for lots of reasons, but we don't have time to discuss it.

But COVID has also probably increased the symptomatology with ADHD.

It's untapped it a bit, so you've got a higher percentage, so it's not going anywhere.

So we do need to find a solution to this.

Yeah, fine.

So yeah, so at that point about the primary care, how can we be more robust in finding a pathway for patients?

Yeah.

So I think, like I said, the initial consultation has to be I think one that includes, its in the GPS mind, all the possible diagnoses.

So without any stereotyping or, 'cause as you said, it's exactly the same thing we had with long COVID where GPs would often find it difficult to think this could be long COVID.

So it would delay the diagnosis, it would delay the process.

So with ADHD is exactly same.

Because there's something in your mind saying, almost like your aim is to prove that it's not that thing, rather than looking to prove that it is that thing.

It is.

And I think ADHD and autism in females, your brain, you're not choosing to, but your brain automatically for some reason as a doctor is thinking, well, it can't be that, so let's disprove it.

It's quite hard, I mean, this is a difficult one, you don't wanna necessarily show this, but it's difficult in 10 minutes to explore something that you know you can't possibly.

It is, but we always have the benefit we can bring people back.

So I think, the 10 minute consultation general practise is restrictive.

That's the issue.

And we've got a real shortage of appointments.

But I think sometimes, certainly what I may have done with patients is say, go away, have a little read of that, do the self scoring and then come back.

Come back and we look at it.

Sometimes keeping a little diary.

Yeah, you can do serial kind of consultation.

So if it's 15 minutes or whatever, 10 minutes.

10.

But we can a double as well.

(people laughing) But if you do it over three, four months, this is a person who may, who's had this for 20 years.

Yeah.

On average, plus.

if they know there's a process by which we're gonna get a bit closer to identifying.

And then, what we then need is a diagnostic assessment in place.

Yes.

But it's not going there.

Because also as you said, there is still this idea that people carry with them an idea.

So it's the same with all conditions, but cancer, unless somebody looks like their weight loss and all the rest of it, you will kind of look at things that simpler.

Yeah.

With ADHD, you will generally not think about somebody as ADHD if they've got an attention problem.

Because the attention problem is, like you said, you have to share how you process information.

Yeah.

If you are hyperactive on the seat, it would be a bit more obvious.

Yeah.

If you were interrupting the GP every second, the GP would say, well actually possibly this is ADHD.

So it depends on what type of ADHD you have.

Yes.

And that's a challenge with this, 'cause doctors are just human, they'll have their own template in their mind.

Yeah.

They'll be thinking, well that's ADHD in my mind, this can't be ADHD.

When we take adults, we know that hyperactivity reduces over age.

When you're a little child, you'll have hyperactivity, inattention, impulsivity is norm because the frontal lobe of the brain hasn't developed, as you get older, the hyperactivity for those who are ADHD will eventually wear down, it'll wear off.

What you'll get more of is inattention.

Yeah, that's where I'm at now.

(people laughing) When you get to GCSEs and A levels and university, so wherever the structure starts to go around you, the attention problem becomes more.

So that's why we see adults with inattention who didn't necessarily have the hyperactivity.

The impulsivity is interesting one, so for most people with ADHD, children, it will lessen.

But there's a group, unfortunately a group that will go into adulthood still with impulsivity.

Okay.

So the majority are gonna be inattention as adults.

Some with impulsivity, but far less with hyperactivity.

That's really damaging.

Yeah.

So that's why it's very hard to be a detective and tease out that inattention because someone says, oh, I did reasonably well at university.

I'm working here, I'm working in a bank, or whatever.

You say, well, how can you possibly have an intention?

But you described those type of inattention issues, that you have to stay very focused.

It takes you 150%, which means you're more pro to burnout.

Yeah, definitely.

That's kind of what I've got from Christine is just hearing an account, even just staying in a hotel room, everything requires a lot more effort.

Is a lot more work.

Yeah.

It sounds exhausting to be honest.

It is but again, because I understand it now, I'll plan better so I know if I've got a busy run, for example, if I'm on a promotion run, if I'm promoting a children's book or my documentary, for example, I know I've got a busy week full of interviews and podcasts and I know now that after that I will burn out massively.

Then I've got no patience.

I don't wanna speak to anyone honesty very much, it's not good for no one.

it's not good for me, it's not good for anybody else.

So now, I space things out a lot more.

I manage my time better.

I make sure that I give myself quiet time after I've done a job.

Yeah.

And it just means I can function better because if I shut down, then I'm no good to know one.

You know, so it's, yeah.

It's just managing better now that I understand it.

But yeah, when you don't know what you're dealing with, then you're gonna keep, I used to have burnouts and meltdowns all the time, and I still do, but since I understand it, I'm managing it a lot better.

You could anticipate more now.

Yeah, definitely.

Well, I think, what we're doing right now, Christine's documentary, this sort of stuff that just raises awareness generally and helps people understand a bit more and hopefully be kind and more sympathetic or hopefully also helps raise the profile of how important it is, it's not really ethical that people are unable to get a diagnosis for these conditions.

Do sometimes people challenge you and say, yeah, but you can't be autistic and have ADHD because look at you, you've got it all together and you live in this, what appears to be like such a wonderful life and it is a wonderful life, but obviously with all these additional challenges and how do you respond to that?

I still think it's amazing how people don't get that what I show is a vision that I'm presenting.

Yeah.

I still don't get it.

And when people look at me Instagram, they'll see a one second photograph of me on a red carpet where I might be smiling and they'll go, oh, well, she's fine.

Yeah.

But they haven't seen the five hours before that of me having a meltdown or pacing up and down my room going, I'm not sure if I should go or can anyone tell me what anyone else is wearing?

The millions of questions that I've asked before I've even got there.

And then they haven't seen me in a room where I'm stood looking over the balcony, just seeing where the chair is and who I'm next to and leaving every 20 minutes 'cause need time out.

No one sees all of that.

Yeah.

Even though I spoke about it so much, people will still go, but you went to that event and you smiled.

Yeah, but I like to portray that I'm fine and I like to act comfortable and I like to not stand out.

So I'm gonna go and give my best acting I can.

And try and fit in with everybody else.

Yeah, there's a bit in the documentary, the bit I thought, oh, I wish I could see where you said, your happy place is actually when you're completely by yourself.

Yeah.

And even your husband, who you've been married to for many years, would be surprised if he saw who you were when you're just being you.

Yeah.

And I wish, oh, I wanna see, but obviously I'm not gonna get to see.

I rearrange things a lot.

That's what I tend to do when I'm on my own, even in my bedroom at night or if I'm in a hotel certainly, I will rearrange stuff a lot.

I'll be moving plant pots around and pictures and moving blankets and cushions and hiding them in a cupboard.

And I tend to do a lot of rearranging of places even in my own home when I'm on my own.

Love it, Rajeev, back to you.

We've got a few minutes left.

Is there anything else you, can see you've got loads of notes on your page there.

Oh it was your conversation.

Anything else that you'd like to pick out from what we were talking about that.

I mean, I think, so from a clinical perspective, you've raised quite a few symptoms I think, which again goes back to the conversation about when people present with something to their GP or to their psychiatrist.

And could it be connected to ADHD, autism?

So you mentioned something about sleep.

Yeah.

Which is what I'm quite interested in the moment.

Which is connected to overthinking.

Yeah.

So there's a vicious cycle where you said that maybe when you're younger, something might happen.

There might be an explosion, then you regret it 'cause you didn't really mean it.

Yeah.

And then it plays in your mind.

Yeah.

For the rest of the day, when nighttime happens, we've evolved to always be more hypervigilant at night since we were in the jungles because that was when we were most at risk as human beings.

So our neurobiology is it designed to be more vigilant.

So when everything's quiet and calm, we'll focus on things that bother us, where we feel stressed.

So these events then for someone with ADHD will result in them overthinking.

So how do I solve that?

'Cause my insomnia's been going on.

Yeah, it's lifelong.

30 years.

But I think again, 'cause we're going around with the same issues, I suppose, it's that diagnostic, it's that understanding of, well first of all, well you are not sleeping because you can't switch your mind off, and then from that onwards, you then have a plan that solves that bit.

If you could put your mind, it would be that.

The over thinking.

Yeah.

Well, can I just say that every single word that has come out of your mouth today does not need to be analysed or I know you'll still doing it, but it doesn't need to be analysed or ruminated on because you know, as Rajeev said, like the way you've just described and explained to me and everyone listening, just a little bit of what it's like to be in your shoes, in your life.

It's really, really helpful.

And I'm sure there'll be lots of people listening who have ADHD, who have autism who will just feel seen and heard as well.

So thank you so much.

Thank you for having me.

Oh good.

And Dr.

Rajeev, thank you so much as well.

Just absolutely fascinating.

Thank you.

To hear a bit more about the science and a clinician's perspective on it, and again, even though you haven't solved the problem of my issue as a GP, knowing how to help people quite, hopefully we will see change and I think conversations like we're having right now and your documentary, Christine, literally as a single entity on its own will really, really, hopefully help with that.

So thank you both.

Oh, thank you.

Thanks for having us.

(gentle music)