HealthyGamerGG - How ADHD is Different for Women

Episode Date: September 30, 2024

In this video, we learn how ADHD affects women differently and why it often goes undiagnosed and misunderstood. Check out more mental health resources here! https://bit.ly/3xsk6fE Learn more about your ad choices. Visit megaphone.fm/adchoices

So the first thing that we tend to see, which is very, very common, is we tend to attribute certain features of ADHD to sort of feminine failings. And this even gets worse during puberty when we'll oftentimes see the manifestation of ADHD more. And one of the key manifestations of ADHD is actually emotional dysregulation. Ha! She's menstruating. She's on her period. It's her time of the month. So we tend to dismiss these symptoms of emotional dysregulation. And at this point, the concept of ADHD has been removed from most people's brains. Right, so your parents aren't really looking for a brand new ADHD diagnosis when you're 15. Today, we're going to talk about ADHD in women.

And this is an incredibly important topic because when we think about ADHD, we're all aware of certain impairments. So we know that kids with ADHD may need a little bit more time to take tests or maybe a little bit distractible. They may be hyperactive and fidgety. But it turns out that the manifestation of ADHD in women is actually quite different. And furthermore, there are so many different. that women with ADHD face that we don't think of as parts of ADHD. In fact, we as a society tend to judge these women very, very harshly for being a bad woman. So just as an example, we know that people with ADHD struggle with organization, right?

So like we know that if you've got ADHD, it's hard to stay organized, it's hard to stick to a plan, you're always running late. And so that's a common problem that everyone with ADHD faces. Now, when you look at someone who's a woman, this person, has additional expectations in life. So mothers are expected to pack their kids lunches, make sure their school forms are assigned, make sure their kids are always on time to school.

There are so many maternal or female specific duties that we expect of women that we don't really accommodate for if you have ADHD. So it turns out that ADHD is very, very devastating in women. Women with ADHD are much more likely to suffer from domestic abuse. they're much more likely to suffer from or struggle with divorce or single parenting. And so there are so many manifestations of ADHD that are gender specific that we absolutely have to dive into them. Hey, y'all, if you're interested in applying some of the principles that we discuss to your life to actually create change,

check out Dr. Kay's Guide to Mental Health. The guide synthesize my years of training as a monk, along with years of clinical experience as a psychiatrist to cover common topics like meditation, ADHD, and trauma. The guides include over 100 additional videos that can be navigated based on your needs or interests or in a more open choose-your-own-adventure format. The guides are now available in the YouTube store below. And if they're a little bit outside of your price point, you can check out a piece of them with our free resource packs, which are also linked below. So definitely check them out.

So if we want to understand this, we have to start with the original diagnosis of ADHD. So this is kind of crazy. but when we first developed diagnostic criteria for ADHD, this was in the DSM, the original diagnostic and statistical manual, basically a group of people sat down and figured out, okay, what are the diagnostic criteria for ADHD? And this original study where they were figuring out what are the diagnostic criteria for ADHD

was done exclusively in European boys. So from the get-go, in our diagnosis of ADHD, it is biased towards men. And we see that because boys are, three times as likely to be diagnosed with ADHD as girls. The diagnosis is so much more common in boys. And why is this? It's because hyperactivity is one of the key features that leads to diagnosis. So let's take a step back and think about how does a kid get a diagnosis of ADHD? It's not like you wake up one day and you're like, let me take my kid to get a neuropsychological

evaluation. That's not what happens. So what happens is you start with parents or teachers who are frustrated with a kid because the kid won't sit still. The kid is disruptive. The kid won't sit down at the dinner table and actually eat their food. The kid won't sit there and pay attention in class. So we get complaints. So there's some kind of difficulty that usually starts the path of diagnosis. And most of this difficulty relates to hyperactivity. So this is a kid who literally won't still so their physical manifestations of ADHD make it difficult to do whatever we're supposed to be doing. Now this is the first big difference between boys and girls. So girls tend to not be nearly as hyperactive.

They're far more inattentive, so they have sort of inattention in their brain, which of the boys will have too, but you won't see external signs. So young girls with ADHD won't be disruptive because we're also socialized or y'all are socialized as girls to not be a nuisance and be polite and be respectful of others and be a good little girl and sit in your chair and do your work. So these girls tend to experience a lot of inattention. and they also get described as things like Spacey, right? So there are some girls, oh, she's a little bit of an airhead.

She's forgetful. Ha, ha, ha, little clueless girl, little blonde, right? Like, oh, my God, like, it's not that big of a deal. She's just Spacey. So the first thing that we tend to see, which is very, very common, is we tend to attribute certain features of ADHD to sort of feminine failings. And this even gets worse during puberty when we'll oftentimes see the manifestation of ADHD more. and one of the key manifestations of ADHD is actually emotional dysregulation.

But hey, guess what? If you're a 14-year-old girl and you are going through puberty and your emotions are dysregulated, are people going to say, oh, my God, this girl is honestly suffering from a lot of problems. Maybe she needs mental health support. That's not what we say at all. Ha, she's menstruating. She's on her period.

It's her time of the month. So we tend to dismiss these symptoms of emotional dysregulation, which is absolutely what we see in women with ADHD. So let's take a quick look at some of the literature, and we'll kind of see this firsthand. How are the symptoms of girls with ADHD or women with ADHD different? So such as hyper-talkitiveness, high arousal, fidgeting, flight of thoughts, internal restlessness, and emotional reactivity. So if you see a girl who talks a lot is very interested in things, is a little bit fidgety, her thoughts bounce all over the place, and she's emotional. Would we say, oh my God, this is this young girl is struggling?

with ADHD. She needs our help. No, that's not what we're going to say. What we're going to say is in women, these symptoms are often interpreted as signs of emotional difficulties. Yeah, she has difficulty during the time of her menstruation. You know, it's just her time of the month. Disciplinary problems and learning or retention difficulties rather than symptoms of ADHD. Yeah, she's not just as good of a girl as all of the other girls. And yeah, it's just her being spacey. This is literally what we see in ADHD. So we also see that girls, women with ADHD manifest different kinds of symptoms. So let's take a look at another paper that sort of highlights the gender differences in phenotypic expression.

Identify that girls with ADHD are less likely than boys to manifest a comorbid disruptive behavior. So this is oftentimes what leads to diagnosis. Girls with ADHD aren't as disruptive. They're less likely to have a learning disability, less likely to engage in rule breaking or externalizing behaviors, because this is how boys with ADHD get to. diagnosed. And so if girls aren't exhibiting this, the likelihood that they get diagnosed is way less. So what we find in girls is that they may exhibit higher levels of inattentiveness,

internalizing symptoms, or comorbid conditions, separation anxiety, general anxiety, eating disorders, and depression, right? So let's think about that for a second. When girls have ADHD, they are more likely to manifest with other kinds of comorbid conditions. So boys are more likely to disruptive externalizing behaviors, oppositional defiant disorder, conduct disorder, rule breaking, this kind of stuff, whereas girls are more likely to have problems like eating disorders, more likely to have separation anxiety, right? And if there's like a 10-year-old girl who doesn't want to go to school, we don't say, oh my God, this girl may be struggling with ADHD. We say, oh, my God, she's such a soft-hearted little soul. Look at how much she loves her mommy and daddy. You've got to be a

strong girl to go to school. We have to be big grown-up boss babes. Let's go. You can do it, my darling. I love you. And this is what leads to crippling self-esteem. Because just like boys with ADHD, girls with ADHD who struggle get told that if you work harder, if you expend more effort, if you just apply yourself a little bit more, if you do all of these things that are effort-based, then these problems would not exist. But the whole problem with ADHD is that they aren't effort-based. There is neurodiversity at play. So the way that this girl's brain is wired is different,

which makes it impossible or very difficult to do things that neurotypical girls can do. But we don't treat girls that way, which is why one of the reasons, one of the manifestations that we see with ADHD is crippling self-esteem. And that too, we sort of, is like, more of a feminine characteristic. In society, we sort of acknowledge, right, that like girls sometimes have self-esteem problems, and it's because of things like the way that they dress and because of thigh gaps and because of makeup

and because of Botox and we have all this crap that gives girls self-esteem problems. And so then we are doing these girls with ADHD a huge disservice. Because when they have self-esteem problems, we don't consider that it's ADHD. We consider that it's this pile of other stuff, like unrealistic, feminine, beauty standards, which I'm not saying that those aren't real problems. My issue is that as a clinician, when I work with women with ADHD, it's that so many features of the ADHD get attributed to other things, because we don't take this as a clinical concept in women seriously. And so let's take a quick look at some of the consequences of misdiagnosis or misdiagnosis or

misdiagnosis on young women. Okay, so we see a diminished self-image and self-esteem. We talked about that. Less developed or underdeveloped interpersonal sensitivity skills and awareness of relationship dynamics. We're going to dive into relationships a lot. Decreased information processing skills, inability to plan and organize effectively without feeling overwhelmed and increased emotional reactivity. Now we're beginning to see that if you are a woman with ADHD, it isn't just the standard stuff that we're aware of, like difficulty at school or difficulty at work, where people may give you accommodations. The real struggle with women with ADHD is that there is a, societal set of expectations, which ADHD makes it almost impossible to achieve. And so we're going

to focus a little bit more on that. So I kind of got off track. Let's go back to why diagnosis is different. So let's dive into the biology of ADHD and women, because this is also different. So we have to understand this, okay? So let's go back to this concept of misdiagnosis, right? Because this leads to a lot of the problems that women face. So why is diagnosis so different? So hyperactivity is a huge piece of it. But another piece is that girls do mature faster than boys. So if we look at sort of gray matter studies in the brain, so these are studies that are looking at brain volumes and how capable boys versus girls are, what we see is that the maturity of an 11 and a half-year-old boy is something that a girl achieves around age 10. So we're sort of looking at the bar for what a kid should be able to do. Like how long should a kid be able to sit still?

A 10-year-old boy will say, okay, they should be able to sit still for an hour. The challenge is that since all of our diagnosis is based on male standards, what happens is we have girls who are one year older in terms of brain development, but they're with a group of kids who are all like 10 years old, right? So you have a girl who has an 11-year-old brain who is in a group with all of these 10-year-olds. So this is why we miss ADHD because this girl should be operating at an 11-year-old level, but that's not the way that we judge her. We judge her as if she's one year younger because that's like her brain is supposed to mature faster. I don't know if this kind of makes sense, but basically what goes on is since girls mature faster than boys do, since their brain literally develops more rapidly in some ways than boys do, they're effectively one year older. And that one year of additional brain development masks the impairments of ADHD because we're comparing an 11-year-old brain with ADHD to a bunch of 10-year-old. And that kind of balances out.

So we see a big misdiagnosis there. Now, there's also a huge hormonal and biological component. So this is a huge tragedy in psychiatry that we tend to think of mental illness is static, right? Depression is depression, is depression. Anxiety is anxiety, anxiety. ADHD is ADHD. But the more that we're learning about the biology of mental illness, the more we're realizing that there is a hormonal component. So whereas a man may experience ADHD uniformly all 30 days of the month and 365 days of the year,

there is a baseline fundamental fluctuation in women's attentional symptoms and experiences like emotions and things like that that are hormonally based. So we're going to dive into that a little bit, okay? So the first thing to understand is that when women go through puberty, we see a surge of estrogen. Now, this is what's really interesting. When we see a surge of estrogen, what we also see is an upregulation of dopamine receptors and sensitivity in other parts of the brain. So a young girl has less dopamine sensitivity than a girl in puberty, and this is an estrogen effect, which is why we see something that's really, really interesting.

If you look at the rates of adult diagnosis between men and women, it is one-to-one. But boys to girls is three-to-one. So why the difference? Why is it that an adult woman is just as likely to be diagnosed with ADHD as an adult man? And that's because as we actually go through puberty, that estrogen increases and we see more dopamine sensitivity. Once we see dopamine sensitivity, then we see the emergence of a lot more classical ADHD symptoms. So we'll see things like more impulsivity, right? So remember, young girls are inattentive or spacey, whereas once they start hitting puberty, they become more impulsive.

they're more likely to engage in high-risk sexual behavior. They're more likely to be sensitive to dopaminergic things like substances and stuff like that. So it seems like something happens during puberty where the brain increases its sensitivity of dopamine, which in turn creates a lot of the more traditional ADHD symptoms. Now, this doesn't quite work itself out beautifully because at this point, right, you're like a 13-year-old, 14-year-old or even 15-year-old girl. And there are studies that show that girls with ADHD start to hit puberty later or they develop more slowly. So now we're talking about a 15-year-old who's like really starting to hit puberty. And at this point, the concept of ADHD has been removed from most people's brains.

Right. So your parents aren't really looking for a brand new ADHD diagnosis when you're 15. So there are a lot of other challenges that lead to misdiagnosis. The other thing that tends to happen around the time of puberty is that estrogen also increases the sensitive. to our internal emotional state. So women are more likely to experience internalizing symptoms. They're more likely to experience things like anxiety, depression, eating disorders, which we already looked at.

Right. So we see a lot of these things start to emerge. And once again, if you're a 15-year-old girl going through puberty and you start to get concerned about your body and you're not happy with your appearance and you're anxious about going to the beach, how are most people going to judge you? Are they going to say, oh my God, this is a girl with ADHD who needs our help? She needs help and support. No, it is just the standard experience of being a young woman in the world, which is tragic in and of itself.

But now we're setting ourselves up for a huge failure because we are not intervening in the right way. We are just saying this is the vagaries of the world that we live in. This is a misogynistic society. This is a feminine beauty standard. These are all these kinds of things. And when we say these massive, grandiose, systemic problems, how does that result in helping an actual girl who's struggling? It doesn't. So this is a huge problem that we see in ADHD.

Next thing that we're going to talk about is that there are some brain differences. So we know that, for example, the splenium, which is sort of the rear part of the corpus callosum in girls is actually different compared to boys. So this is a part of the brain that involves information processing and sort of awareness of your current state. So this kind of once again leads to this spaciness that we see. A lot of girls also start to struggle with ADHD during their teen years because when you're, you're a teenager, we expect girls to do a better job of staying organized, you know, doing well in school. You got to be able to pack your bag. You got to be able to go to your extracurriculars on time. This is when girls start to become women. And when girls start to become women, we expect them

to be organized, helpful, and all of this kind of stuff. And so we run into problems here, which result in this person not having ADHD, but being a bad woman, which is a huge part of ADHD. So once we end up with adult women, what we tend to find is that we judge these women incredibly harshly for failures of being a good woman. We don't even think about ADHD. I tried to plan ahead and get things started earlier, but I just couldn't do it. It was as if I needed the panic of not understanding something and knowing that I would get a test in it to get the adrenaline going so that I could get it done. It's extremely stressful, especially since you're also beating yourself up because you're thinking, how dumb and here I did it again, why can't I just do it ahead of time? Now, any person with ADHD

will empathize with this experience. Why do I need this adrenaline and last minute panic to really just get started? The challenge with women is that they have an additional layer of this. It's not just about the test. It's about planning your birthday party, planning your friend's birthday party, making sure that my divorced parents, my dad's fridge is stocked, right? Because we see a lot of parentification of girls into women, especially in single-parent households, where there's an adult male who is incapable of taking care of themselves. So these organizational difficulties start to pile on. One of the participants did not have academic problems, but struggled socially and particularly with regulating her emotions. I remember having temper trantrums that would scare me because I realized

that I couldn't control them, and I didn't even know why I was so upset. Consistent with the literature on on women with ADHD, inattention, disorganization, poor time management, motivational difficulties, and problems with planning and structuring daily tasks have resulted in significant, academic, occupational, and psychological challenges for most of the women. In the absence, this is the key thing, in the absence of a better explanation, the women blamed their struggles on perceived personal flaws, such as laziness, lack of effort and capability, which over time contributed to a negative self-image that followed several of the women into adulthood.

Now, this is going to become really important when we get to the treatment section because it turns out evidence-based treatments of ADHD don't work so well in women. And this is part of the reason because the experience of women with ADHD is different. They're perceived not only as like academic challenges and professional challenges.

Sure, we all are aware of ADHD, but there are so many personal failings, a lack of effort, a lack of organization. There are so many gendered constructs that we have where we expect so much from women and women with ADHD fail at this stuff. So they conclude that they are not good women.

And one prime example of this is in relationships. So it turns out that women with ADHD have specific challenges that are actually quite shocking in relationships. So in relationships, we expect women to do things like be emotionally available. Be the planners and organizers. Be the caretaker of the house. Make sure our fridge is stock. Make sure the kids get to, you know, extracurriculars on time. These are all gendered

responsibilities. Sure, things are moving in the right direction and things are more 50-50 now, but we still, generally speaking, expect women to be able to do these things. And even I've worked with women who, because they have ADHD struggle to do these things, and even if they have a supportive partner who's willing to shoulder the load, it still doesn't shake the judgment, right? So this is very important to understand. I don't know if a lot of dudes are going to really understand this. But what I've observed when I work with women, even when I look at my own wife, is that even if you're in a relationship with a man who's like 50-50, they help with the kids and stuff like that, it does not stop, especially the other women in your life for judging you, right?

So you have these like stay-at-home moms or trad wives or whatever who, like, if your husband does half the work, they're going to look at you and be like, this person can't even handle this kind of stuff, right? This person needs help. She's not a good woman. The judgment is so cutting. It's like death from a thousand cuts. I've seen this crap. It's so fucking toxic, right?

We don't ever consider that like, oh, like, and there's also some weird amount of, like, jealousy there. We're like, oh, yeah, you manage to marry a guy who actually fucking helps out in the household. I am so jealous of you, but I'm not allowed to be jealous of you. So instead, what I'm going to do is I'm going to death by a thousand cuts and I'm going to slightly insult you at every opportunity they can. And I'm going to shit talk you to all the people on our WhatsApp group because that makes me feel. better about myself. It's so crazy that even the women who managed to solve this problem by getting help from their partner are so harshly judged by their mother-in-law, right? It's like such a mess. So let's take a quick look at some of the research that sort of highlights some of this

stuff. So another participant says that she began feeling the effects of ADHD related challenges on self-esteem first as an adult, largely due to her problems mastering many of the skills that are involved in maintaining and building a good relationship. So we sort of of assume that girls are capable of being good friends. But women with ADHD struggle with this as well. So we, women, been raised to take on a lot of responsibilities and make sure that things are okay, right? So this is important to understand. I want to pause here for a second. See, another big problem with women with ADHD is that the default responsibility is usually the woman's, right? So if you're a woman, like, and you're in a relationship with a man, you kind of know what I'm talking about, where like the man is going to be like, okay, I'm going to try to help out, right? So we're going to like, things are going to be 50-50.

But if something falls through, it is your job as a woman. You take the cognitive responsibility. The cognitive load is what you bear. So even if you have a husband who goes to the grocery store, right, like the man of the house rarely goes through your fridge, goes through your pantry, thinks about how, like what the menu for the school is going to be for the next week, figures out which days your kids are going to eat school lunch and which days they're going to eat home lunch. There's all this cognitive load that defaults to the woman. and then gets passed on in some way to the man, right? So then you do all this calculation as a woman, and then you, like, give your husband a grocery list,

and then they'll go and help out. So it's like, good job, bros, like we're not saying that you're doing a bad job. But let's remember that a lot of this responsibility, the subconscious or conscious responsibility for staying organized, falls to the woman. If the man makes a mistake, like that's fair enough. They made a mistake, but that sort of defaults to the woman as a cognitive load. So let's keep going.

And I think it can be extra challenging for women with age. ADHD, since women almost are expected to have an inborn ability to organize and maintain things in order. When I drop my daughter off at the daycare, I'm always late, and I can see what the teachers are thinking. People think you're a bad mother. And this is absolutely the experience of women with ADHD. Things became much harder for me when I became a mom because of the constant interruptions

from my children. I remember being exhausted by the end of the day. Absolutely exhausted. There are so many things you have to do when you're a mom. At work, it was much easier because it was organized. If I had a problem, I would just call someone and get it fixed. While with kids, you can't do that. So much responsibility lied on me as a mother, which was stressful.

So we tend to see that women have an additional challenge when they have ADHD when it comes to being a good mom. Because you have to stay organized and it's not like anyone is going to judge you less harshly. There's no accommodation, right? So if you're taking a test, cool, you get a letter from your psychiatrist and your school is like you can have two extra hours to take the test. Doesn't work for the rest of life. You don't have two extra hours to make sure your kid is on time for swim practice. You don't have two extra hours to make sure that your kids are organized and leave for school in the morning. So this is where there are some accommodations which we offer society, but these accommodations tend to be gender neutral if not male favored.

And there's a whole host of other problems that women face. So the next thing that we're going to talk about is relationships in ADHD. So this is where like this is some of the most shocking stuff that I have ever seen like in scientific literature. We know that people with ADHD have relationship difficulties. The challenge is that the gendered expectations of men versus women and the way that ADHD intersects with them are far more forgiving for men than they are for women. Now, if you're a dude in the audience, chances are you will take issues with the statement. you will say, Dr. Kay, how dare you say this because I am a man and I struggle in relationships with ADHD as well. I'm not saying that you don't struggle. I'm not trying to say that men

have it easy, okay, by any means. I have to fucking say this every time I make any video about a gender or any related thing. We're going to look at the data. So the challenge is that once again, the gendered expectations that women have of what they bring to a relationship, those expectations are far harder to meet. They're gendered expectations. that are hard for men to meet as well. For example, ADHD leads to lack of professional success and men are expected to be the breadwinner. So it exists in men too, but this isn't a video about men.

This is a video about women. So let's look at the gendered expectations of women. So women with ADHD really struggle in relationships because, first of all, they're expected to be emotionally available. They're expected to be calmer. They're expected to be the emotional caregivers in the relationship. But when your brain is struggling with emotional dysregulation, when you have an estrogen-based increase in intensity

from the shame that you feel for not being a good woman when all of these things kind of pile on. And furthermore, when you do get emotional, it gets a tribute to your period or she's so emotional, she's a woman or she's spacey, all this crap kinds of pile on. It leads to terrible outcomes. NATO and Quinn reported that these women are often less able to be consistent parents

or less able to manage their jobs and households and are at higher risk for divorce and single parenting. So this is shocking. Nearly 60% of non-ADHD men had left their female partner with ADHD compared to only 10% of non-ADHD women leaving their male partner with ADHD. And male partners with ADHD compared to female partners of men with ADHD reported significantly lower overall functioning. So what this means, if you're a woman with ADHD and you're dating a dude who doesn't have ADHD, they're 60% likely to leave you in part because of your ADHD, whereas if you flip the genders around,

it's only 10%. Women recognize that dudes have ADHD. They're hyperactive. They can't still whatever. And for whatever reason, they're less likely to leave their partner. But if you flip the scenario around, it's actually 60% of men who do not have ADHD will leave a partner in partially dudes. to their ADHD. Like, that is staggering, right? This is not a benign gender difference. This is something that we absolutely have to consider, right? This is a challenge that so many women face with ADHD.

It's not just that it's hard to succeed academically. It's not just that it's hard to succeed professionally. It's at the risk of divorce and single parenting are way higher. And it is harder to be a good parent. It's harder to be a good mother because you struggle with organizational skills. But this isn't the end of it, right? So this is the most shocking statistic. So if you look at women, if you're a woman who's born today or alive today, you have a 6.3% chance to suffer from intimate partner violence.

Okay? So there's like, it's bad, right? It's like men are, I think, less likely to suffer from it. But the key thing here is that you have a 6% chance. So that means that 94% of women are going to be okay when it comes to intimate partner violence. Like that's not a good statistic. It should be zero, but like it is what it is. Here's the crazy thing.

If you're a woman with ADHD, 30.7%. 30.7%. It is a five-fold increase. One out of three women with ADHD suffer from intimate partner violence. This is insane. Women with ADHD are more likely to get pregnant, more likely to have STIs, right? Because like, let's be honest, boys don't like to use condoms. Boys with ADHD, especially don't like to use condoms. Women with ADHD, it's difficult to remember to use a condom, right? And this is the key thing is we'll tell women, just use a condom, bruh. But the whole point is that the neurodiversity, the deficits that we see in ADHD make it harder to remember. Remember that dopamine sensitivity that increased during estrogen and when you're like, you know, getting into stuff, like I'm sure that the hormones are flowing there too.

Right. So we have an increased sensitivity to dopamine, which means we don't really think about the consequences of our actions, create such problems. So this is a huge challenge that women with ADHD really struggle with relationships. And now y'all are probably wondering, okay, Dr. K, what do we do about this? And this is where I'm sad to say that I don't have like four tips, right? I can't say, oh, just sign up for coaching and everything will be fine. Just get Dr. K's guide to whatever the fuck. And then you'll be okay.

No, there is no easy answer to this. And not only is there no easy answer, the answers that we have don't work well for women. So this is a paper that is looking at female specific concerns in ADHD, okay? So let's look at treatment. Although boys showed better response to a combined behavioral and medication protocol or medication-only protocol compared with community care, only the combined treatment was more effective than community care for girls. Thus, although medication alone may be an effective treatment for boys, girls seem to need behavioral interventions as well. So when we think about evidence-based treatment for ADHD, we tend to think medication. right so i have ADHD what should you do go see a psychiatrist get started on a stimulant and you'll be

golden so there's a lot that that needs to go into this we got to understand why this is so we have to understand how does a medication how do we determine that a medication is effective for an illness so what is the most hallmark feature of ADHD that leads to diagnosis and boys hyperactivity right the kid won't fucking sit still and so when i'm a drug company and i'm thinking to myself i'm going to make a medication and I want people to be on it for their whole fucking lives. What am I going to do? I'm going to treat the thing, focus on the symptom that causes problems for teachers and problems for parents. Right? Like, make sense. What are drug companies in the business of making the world a better place? And I don't say that facetiously. They're like, we're here to try to solve problems.

It's not an evil drug company, okay? But we got to think about this. So they came up with stimulants. And what are stimulants really good at? Reducing hyperactivity. Right? So, So you start the kid on a stimulant, they sit in their chair and they pay attention. They finish their food. They're able to read. Hallelujah. This is fixed the problem. Except, remember, girls don't experience a whole lot of hyperactivity.

They have attentional problems. And the medications help with that sum, too. We're not saying medication isn't effective. So the context of this is stimulant treatment for ADHD symptoms and women. Okay? A large variation has been reported in response to treatment with efficacy ranging from 25% to 78%. which is much different than the fairly consistent, consistently reported 70% range of response rate in children. When we look at medication and we think about what is the expected gain, right?

How much better are things going to be? When we look at these trials and children, we see, okay, things are going to get 70% better. Parents are like, hallelujah, teachers are like, thank God. But when it turns to ADHD treatment in women, the range is 25 to 78% doesn't work for all women. It isn't like what it is for boys. And there are contrary studies that show that it's effective in women, so I'm not saying that it isn't effective. But the key thing to understand is that medication is very good at hyperactivity. Boys tend to have more hyperactivity.

Stimulants have been sort of very effectively used in men, but stimulants alone seem to be in some cases insufficient for women. This is very important to understand because even the standard, you know, psychiatric institutional juggernaut is going to try to prescribe you stimulants, which I'm not saying, it isn't effective. We see that the range is 25 to 78%. It may not be as effective. And you probably need some other kind of support as well. I don't know that a stimulant is going to help you with an abusive partner, right? Like, it's not going to fix that. And the whole point is that if we look at the challenges that women with ADHD face, they aren't as simple as things that can be solved by stimulant. They're organizational difficulties. Their expectations, their judgment, their low self-esteem. There are things like intimate partner violence, more likely to be divorced,

all these kinds of challenges a stimulant cannot fix. We're not saying that it isn't effective and studies show that it can be even up to 78% effective. But it depends on the person. So what's the point of this video? I mean, I was looking at this and to be perfectly honest with y'all, it's taken me months to make this video. And the reason it took me months to make this video is I wanted to end it by saying, hey, ladies, if you're out there, just do A, B, and C and we'll be able to help. Every time I try to prepare some kind of lecture, I try to leave y'all with something that's

says, do this thing and it will improve your life. The challenge that I faced with this video and why it took so long is I did research and research and research and I worked with so many women with ADHD. There is no simple answer. I wish I could say, take this supplement and your life will be better. I wish I could say, just do this thing before you go to bed and your life will be better. So the purpose of this video, then why did I end up making it? Because I wasn't even sure I wanted to make it because I don't have an answer for y'all. The reason I made it is because y'all need to know this. The whole world needs to know this. Right. You need to understand that. that first of all, just because you made it to puberty without being kicked out of class and getting straight A's does not mean that you don't have ADHD, right?

So the first thing to be super aware of is that if you are an adult woman who is struggling today and this fits the bill where you have difficulty with relationships, you're basically like a bad woman. You're not organized like the other women. You get super emotional. You have separation, anxiety. Like, you can't maintain friendships, like all this kind of stuff. You have a lot of these internalizing symptoms. You just think you're an airhead or spacey or people have judged you harsh. if you're a single mom, like there's a good chance that you've got ADHD.

So the first thing is get support, right? So we don't want to misdiagnose. We don't want to miss the diagnosis. So that's the first reason is if this kind of tracks for y'all and you all don't have a diagnosis, by all means get evaluated. Second thing, if you do have a diagnosis, recognize that the majority of the literature on ADHD does not focus on gender-specific issues, that your providers may not be aware of some of these things.

If they're good providers, they picked it up, right? But it's not like I had a lecture on ADHD-specific issues for women when I was training in residency. We had gender-related issues. We had ADHD-related issues, but we don't tend to combine the two. And so as a woman, be aware that this disorder will affect every dimension of your life. And many of the dimensions that we don't think of. We think of school. We think of work.

We don't think about home. We don't think about birthday parties. We don't think about divorce. We don't think about parenting. But it absolutely affects those things. Another thing is, unfortunately, you're going to be judged a lot. Like, I wish it was different. And this is where we get to the actual treatment, right?

So there's a lot of stuff here that needs to be done. So by all means, see a professional. But what we also know is that combined treatment is very important. So it's not as sufficient to just get a stimulant. Maybe you're one of the lucky ones and that does it for you. Fine. But chances are one of the other things that you need to work on in therapy is the consequences of being a woman with ADHD and all of the harsh judgment.

because they internalize, y'all internalize all of that shame. That happens in men, too. Everyone with ADHD internalizes that shame and then you carry it with you. This manifestses things like depression. It manifests things like anxiety. It manifestses things like lack of confidence. So that must be addressed. And the last thing, which I want all y'all to hear from the bottom of my heart as a dad of a

daughter who may have ADHD is that you're awesome, right? This is not your fault. You are not a bad woman. You're not a bad parent. you're not sure you struggle and sure there are many outcomes that are not going your way. And I totally get this, including things like abusive partners. Like, that's crazy, right? Your life has been very, very difficult because this thing has been impairing it.

We don't really consider or accommodate for the fact that your neurodiverse brain has difficulty fulfilling the duties of a woman, the expectations of a woman. And I have faith that y'all can get there, right? It's going to be your own journey. You're going to have to walk it. we're going to do our best to help you. We're not done with this topic, by the way. Right. So we're just getting started.

This isn't the end. This is the beginning. And so have a little bit more faith in yourself, if you can, be a little bit more forgiving of yourself and try to get the support that you need. Because there are studies that show that combined treatment is effective. Women do get better. I've seen this myself in my clinical practice where we've helped them sort of, you know, start on stimulant medication because that's what I did at the time.

And then we help them build the things that are necessary, repair their self-esteem, learn. learn how to set limits, be more selective with partners, you know, prepare things a little bit better, and then their lives can absolutely turn around. And if you're a woman with struggling with ADHD, yours can too. We do have a guide to ADHD and doing stuff. So there's a lot of practical stuff in there, but that stuff is not gender-specific. It does not address many of the issues that we talked about in this video, but I still encourage y'all to check it out because it'll help with things like organization, planning, motivation, these core features of ADHD that everyone struggles with,

are addressed there. And chances are you're going to need all the help that you can get. So ladies with ADHD, I'm so sorry that your experience has probably been incredibly harsh, and I hope things that will get better. And we here at the H.E. community are here to support you.