ADHD in Women

What if the true face of ADHD isn't the hyperactive boy disrupting the classroom, but the quiet girl lost in her own thoughts? Uncover why girls are often overlooked in ADHD diagnoses during childhood, leading to a later-life reckoning where rates between genders even out.

We peel back the layers of societal expectations and biological nuances, revealing how inattentiveness in girls leads to underdiagnosis—and the significant impact this oversight has on their lives, from self-worth to increased chances of physically abusive relationships.

Our conversation explores the complex world of ADHD as a manifestation of chronic stress adaptation. We highlight how misattributions to hormonal factors and rigid school systems ignore the ADHD diagnosis, exacerbating the challenges faced by women who internalize rather than externalize emotions. Listen as we dissect the intricate interplay between dopamine, sensory inputs, and diet, offering insights into managing ADHD symptoms and understanding its comorbidities.

Join us in shedding light on the unique struggles of women with ADHD, where societal judgments add an extra layer of burden. From the challenges of parentification to the role of estrogen, this episode opens the door to a more nuanced understanding of ADHD in women, paving the way for an ADHD survival guide designed with women in mind.

ADHD Test website:
https://wisey-adhd.com/adhd-quiz?

Chapters

• 0:35 Understanding Gender Discrepancies in ADHD
• 16:40 Gender Discrepancies in ADHD Diagnoses
• 22:11 ADHD as Chronic Stress Adaptation
• 39:31 Challenges of Women With ADHD
• 51:39 Understanding ADHD in Women

Transcript

Speaker 1: 0:35

Thank you, hey everybody, and welcome back to another episode of the Speak Blangly podcast, where we speak plainly about things that matter. I'm your host, owl Medicine, and today's podcast is why women with ADHD are just bad women. If you've been listening for any length of time then you understand that I don't mean you're actually a bad woman, but that's the way we label things. So in this podcast I'm going to walk through a few variables that explain this stat that I don't like. A lot of good inquiries begin with a question. Podcasts, I think, are the same. They begin with a question, and my question here was why, in childhood, like before the age of 13, in childhood, like before the age of 13, why do boys have an ADHD diagnosis rate of 3 to 1 to women, and in adulthood it's basically 1 to 1. So what I mean by that is in childhood, as a boy, you were three times more likely to get a diagnosis of ADHD than you are if you're a girl. And in adulthood, you have basically the exact same diagnosis rate across the board for women and men, and I want to know why. That's a very weird statistic and I want an explanation for it. So that's why I did a bunch of research for this podcast and I found some really cool crap that I want to share with you guys.

Speaker 1: 2:10

I've tried hard. I've taken two days of notes and I'm going to try my best to get a straight line through all of this and include all of these pieces. There's a lot to cover. This won't be the last time that I do this, but it did inspire me to create something an ADHD survival guide. I'm going to do an owl medicine ADHD survival guide and I'm going to do a survival guide specifically for women as well. So, without further ado, what we're going to do today is look at why ADHD is different in women. But before I get started I know I just said without further ado, but before I get started, I apologize. If there's any weird staticky kind of sound things, I will do my best to edit them out. Will do my best to edit them out. However, I am house-sitting and I am having a hard time being able to provide power to my podcast machine. That isn't making it super staticky. I'm getting like weird hums and buzzes and statics and all kinds of weird crap. So if you hear any of that, I apologize. I'll do my best to edit it out.

Speaker 1: 3:24

So why is ADHD different in women? Why are boys diagnosed at a 3 to 1 rate to girls in childhood, but there's a 1 to 1 ratio in adulthood? So what we're going to look at is we're going to look at diagnostic factors, we're going to look at the criteria to get an ADHD diagnosis and we're going to look at the presentation of those diagnoses in men versus women and we're going to look at the diagnostic track how you actually go about getting a person diagnosed because all of those things add up to this really big discrepancy, along with things like societal expectations on women and one of my favorite things to talk about parentification. So we're going to talk about how hormonal changes in puberty make it hard and more dangerous for women. We're going to talk about why medication is less effective on women with ADHD than it is for boys ADHD than it is for boys. Also, we're going to talk about how there are two primary types or forms of ADHD an inattentive and a hyperactive and how that affects diagnosis and how that also leads us to this really big discrepancy. And we're going to look at brain development as well and see if and why there might be some discrepancies in our diagnostics because of brain changes between boys and girls. So if we're gonna talk about all this stuff, it needs to matter, right? Why does this matter? Why is why does ADHD matter in women? Why does this deserve its own topic outside of?

Speaker 1: 5:05

There's a big discrepancy in diagnosis from childhood to adulthood and that's interesting enough in and of itself for me to want to deep dive. But the reality is it is profoundly impactful. It is much more impactful, I believe, on women to have ADHD than it is for boys. One way to show that is that girls with ADHD were five times more likely to be the victim of physical intimate partner violence than non-ADHD girls. They were five times more likely. So it's already bad enough. We have like a six point something percent chance if you are a woman to experience intimate partner violence in your life. If you have ADHD, that number goes from 6% to 30%. That's a one in three chance. That's a one in three chance that if you have ADHD as a woman and with this stat that we're looking at of a one to three ratio for girl diagnoses in young life, that's a lot of undiagnosed ADHD. That puts women in this chance of being one out of three to experience intimate partner violence. That's like that's crazy, that's mad. You add that to all the other comorbidities of ADHD and it's that's really rough. You add that just to the fact that ADHD makes any person, male or female, five to ten times more likely to develop alcoholism and you have a recipe for disaster.

Speaker 1: 6:54

So let's look at what are the symptoms of ADHD Like. If you are going to go get a diagnosis, what are the symptoms, what are they looking at? And the way that we get this is from the DSM. Right now we're on the DSM-5. And that book tells mental health practitioners what all of the agreed upon parameters are to diagnose any given person with one of these disorders personality disorders or mental health disorders or whatever you want to call them. So for ADHD, a person must have several symptoms of inattention and or hyperactivity and impulsivity that are persistent for at least six months and occur in two or more settings. All right, so let me say that again, several symptoms of inattention or hyperactivity slash impulsivity. They would kind of lump those together hyperactivity, impulsivity they're pretty closely related and you have to have several of those symptoms that are present and persistent for at least six months in two or more settings. For the age part of this diagnosis, symptoms must have been present before the age of 12. And here's a key to the reason that women don't get diagnosed as much as men. The next is disruption Symptoms must significantly disrupt functioning at work, school, with family or socially.

Speaker 1: 8:26

Other conditions concerning ADHD for the DSM-5 is the symptoms must not be better explained by other psychiatric disorders, such as anxiety, or occur exclusively during a psychotic disorder such as schizophrenia. Right, okay, that's basic. We're differential diagnosing here and saying, well, if a person shows signs of ADHD, but only when they're in a psychotic episode, that's probably not ADHD, which seems a bit like duh. But we have to put those well does in there, because even doctors are idiots. So, and the number of symptoms that are required for a diagnosis changes depending on the age of the person being evaluated. Up to the age of 16, a person requires at least six symptoms, and from 17 and up, they require at least five symptoms. And it's your healthcare professional that's going to use a variety of tools to help you find your diagnosis for ADHD. If you're getting evaluated for one, they'll have a symptoms checklist, rating scales and other tests. They'll also usually ask for input from family members and teachers and check around to see if maybe there's things that are falling into things like depression or anxiety or sleep disorders or thyroid disorders, seizure disorders. All of those things need to be ruled out and evaluated, and that whole differential diagnosis thing along with schizophrenia, right.

Speaker 1: 9:58

So there's two main types of ADHD. There is the hyperactivity part and there is the inattentive part. Now this is pretty obvious for me, because I happen to be the appropriate age that when I got my diagnosis as a kid it was just ADD and they had just been adding the H. This was the early 90s VH this was the early 90s or mid 90s, I guess. And I got my diagnosis from a doctor. That was fantastic. But my mother was like no, you're not putting him on medication and didn't put him on any meds. Didn't put me on any meds and we kind of went on with our life and my mother stopped going to that doctor. But we didn't really go to doctors anyway, unless it was forced by our pediatrician or for vaccinations for school. So that's fine, it is what it is. But the two main types are inattentive and hyperactivity, and with the inattentive this is part of why women don't get diagnosed as much, because inattentive is what women get and the hyperactivity is more of what men get. Obviously there's like either can get both and many of us have a combined form. So technically there's three there's inattentive, there's hyperactivity and there's mixed. No fucking shit, well duh. But there's two basic types and then there's a mixed type.

Speaker 1: 11:26

I took a test while I was doing all of this because I'm super ADHD, so I got distracted while taking all these notes and finding studies and all this stuff and I found there was an advertisement for a. Take our little test and see what type of ADHD you are. It just gave me a 1 to 20 score ADHD you are. It just gave me a 1 to 20 score. The average was 9.5 and my score was 19.4 or 3.4 or something like that, but it was 19 out of 20, which is hilarious and my score was mixed. I have a combination of inattentive and hyperactive, but with inattentive, the actual things that you're looking for is an inattentive ADHD person or must have six or more before the age of 12.

Speaker 1: 12:12

Often fails to give close attention to details or makes careless mistakes in schoolwork, at work or with other activities. Often has trouble holding attention on tasks or play activities. Often does not seem to listen when spoken to directly, often does not follow through on instruction and fails to finish schoolwork, chores or duties in the workplace, eg loses focus and gets sidetracked. Or this person might often have trouble organizing tasks and activities. They could often avoid or dislike or is reluctant to do tasks that require mental effort over a long period of time, such as schoolwork or homework. Often loses things necessary for tasks and activities school materials, pencils, books, tools, wallets, keys, paperwork, glasses, mobile phones. They often easily get distracted or is often forgetful in daily activities.

Speaker 1: 13:10

Something interesting I see in here is we have schoolwork mentioned in number one. We have schoolwork mentioned in number three. We have organizing tasks and activities as number four. Then we have a long list of reluctant to do tasks that require mental effort over a long period of time. It mentions schoolwork or homework. The next one again mentions things that are related to school, is often easily distracted or is forgetful in daily activities. The overwhelming majority of these issues that are listed are do you have a problem in school? Now I have a theory on ADHD. I'll save until the very, very end because I don't want to get distracted. I want to really cover this with as much breadth and depth as I can and I don't want to ADHD myself onto some rabbit hole that you all have to listen to because I will be too confused to edit it. But that is the inattentive side, right, women are more associated with the inattentive side of ADHD.

Speaker 1: 14:15

The hyperactivity and impulsivity type of ADHD looks more like often fidgets with or taps hands or feet or squirms in seat. Often leaves seat in situations when remaining in seat is expected. Often runs about or climbs in situations where it is not appropriate. Often unable to play or take part in leisure activities quietly. Is often on the go, acting as if they were quote, driven by a motor. They often talk excessively, blurts out an answer before the question is completed. Often has trouble waiting their turn, often interrupts or intrudes on others, butts into conversations or games, that sort of thing. So those are the hyperactivity part. Now. Usually a person will have a combination of hyperactivity and inattentiveness and, depending on what that mix is, you'll be either more one way, more the other, or if you're an even split, like me, then they'll consider you a mixed type. And before the age of 12, you need six. After the age of 12, you need five. No-transcript right, we just covered all those. I wanted to cover them one more time.

Speaker 1: 15:50

Again, I find it very interesting that this number four bullet or number three bullet here says there is clear evidence that the symptoms interfere with or reduce the quality of social, school or work functioning, or reduce the quality of social, school or work functioning. Again, all this ADHD stuff is pointed at do you work well in school and do you work well at work? Those are the only things that we actually seem to give a shit about. The ADHD diagnosis doesn't have anything to do with that child or the child's betterment or the child's enjoyment, or anything about the child's betterment or the child's enjoyment or anything about the child's life. It's only about is that child fitting into the expectations that we have in order to be able to go through school without disrupting things?

Speaker 1: 16:40

And this is why girls have way lower diagnosis in early life, because women girls have inattentive versus hyperactivity. And why does that matter? Because we have the checklists right. The checklists are there, we can sit down and we can ask our boys and our girls all of these same questions, and that should theoretically get us to an equivalent number of diagnoses. But it doesn't. And why is that? The reason is because inattention isn't disruptive. You have to actually go to the doctor to get a diagnosis, which means you need a reason to go to the doctor, especially in America, because it is so damn expensive, it is such a waste of time Most of the time. You need a damn good reason to go to the doctor, and if your boy has hyperactivity or if your girl has hyperactivity, that's going to lead to all the fidgeting and the tapping and the outbursts and all the things that are disruptive in school and therefore are going to get the attention to say, hey, this kid needs a problem, because what we're looking at with this stuff.

Speaker 1: 17:53

One of the main, one of the key pieces of ADHD is emotional dysregulation. That's why kids are blurting out and unable to control themselves and fidgeting, because they have these emotions inside and they're not regulating them very well. Go figure, they're a child, but with emotional dysregulation. We see that acting out in boys through hyperactivity. But girls, especially around the age of puberty, would get a dramatic increase in estrogen as a result of puberty. What estrogen then does is it sensitizes female bodies to be more interoceptive and more self-focused. Now, that means their type of emotional dysregulation is not going to disrupt a classroom, which makes it harder to go to the doctor. Why would they go to the doctor? Because emotional dysregulation in the boy versus emotional dysregulation in the girl.

Speaker 1: 18:50

When a boy is emotionally dysregulated, he acts out. When a girl going through puberty is emotionally dysregulated because of the sensitizing effects of estrogen, they're actually going to act in, they're going to self-blame, they're going to look at themselves and see themselves as the problem and they're going to freeze. And when you have that kind of thing as a child, let's just think about what a boy looks like emotionally dysregulated and what that girl looks like emotionally dysregulated. The boy is easy. We just covered that. He's going to act out. And he's going to act out. He's going to have the impulsivity. He's not going to be able to sit still, he's going to answer questions before they're asked. He's going to be running around and climbing things and being very physical, because that's the way boys are more wired to deal with emotional upheaval and the girls are going to internalize their emotional upheaval.

Speaker 1: 19:43

And so if we have a girl who is being inattentive and a girl who is losing her train of thought, that is a bit flighty. What do we call that girl? We call her a space cadet. When a girl gets overwhelmed by school and says I don't want to go to school, I want to stay home with you, mom. We don't go. Oh, like that's probably ADHD. We go oh, she's so sweet, she's so loving, she's so kind, she wants to stay home with mom. Well, you got to put your big girl pants on and we got to go be big boss girls and we got to go to school. You got to be strong to go to school.

Speaker 1: 20:18

We don't think of it as ADHD. Especially once you get past the age of 12 or 13 and you're getting into 15, 16 years old, when you have emotional dysregulation and you internalize all of that stuff, what happens is you start getting a very low sense of self-esteem and then that low self-esteem doesn't reflect back on ADHD either, does it? It kind of does a little bit. In boys, we think of that a little bit. With boys not much, but we do think of it a little bit. We don't think about that at all. With girls, we go oh well, that's because of the unreasonable beauty standards in the world, that's because of TikTok, that's because of Instagram and Botox and fillers and plastic surgery and all this stuff on the media and all of those things are true. They're all very, very true and they're very real. All very, very true and they're very real.

Speaker 1: 21:07

But this is the differential diagnosis that we're missing here is the self-blame and this poor self-concept. Is this an issue of this external societal stuff or is it a combination of that, with ADHD and these kids having a lack of focus and a lack of attention, because we call those girls flighty? Another really, really big factor I must cover, because I see this all of the time. We see ADHD showing up and inattention showing up in certain realms of life and we see hyperattention in other realms of life and we see hyper attention in other realms of life. Right, like this is not one or the other. Where a person is hyper all of the time or they're inattentive all the time. There will be certain environments or certain situations that make a person check out and the inattention is the same way It'll make a person check out, just as hyperactivity We'll check out of what's happening in our body and we just respond with hyperactivity, with the inattention we freeze and we check out that way.

Speaker 1: 22:11

Yeah, when girls are being inattentive or are lacking organizational skills and they're having emotional dysregulation, we blame it on their hormones, we blame it on their menses, we blame it on their cycle. When they get dysregulated, we blame it on that, we blame it on being women. We just we're like, oh well, that's the plight of being a woman in the world, which is screwed up in and of itself, right, but it doesn't address the fact that these women have ADHD. Ah, and the parentification of women. Let me talk about the parentification of women, the parentification of young girls, especially young girls who are like being raised by a single parent who is incapable of taking care of themselves in one way or another.

Speaker 1: 22:52

This child will find themselves horribly inattentive, painfully, really cripplingly inattentive in spaces in which nothing needs to be done. Nothing must be done, because they live in a world where the things that need to be done actually need to be done. Mom or dad needs to be put to bed because they drank too much, or food needs to be made for themselves or for their younger siblings. They have to be the ones to organize stuff because mom or dad is not available, especially when this happens when there is a single father, or just any male in the family who is incapable of taking care of themselves. The women, young girls 12, 13, 11 years old are the ones who get parentified to such a degree they feel they have to engage in the world by fixing their parent and doing all the things that must be done in order to get through the day.

Speaker 1: 23:57

But what that leads to is tons of good and useful focus for other people's stuff and no focus left for things like menial bullshit homework. Because, again, all of these diagnoses that we're looking at, all of this list of stuff it all focuses on do you fit into our school system? Do you fit into our work system? Are you a good little cog? Can you sit down, shut up and do what you're told to do? A good little cog? Can you sit down, shut up and do what you're told to do? And if you had a easy coasty life then, yeah, you probably can, because humans are infinitely adaptable and that's what we have been forced into. That's the pigeonhole that we've been forced into. But for those of us with chronic stress and trauma in our early lives, we don't do well with that, because we've experienced real threats, real problems and we know experientially what actually matters and what's actually important. So we don't care about schools, nor does the school care about us, because school systems were not designed to help the human animal. School systems were not designed to help the human animal School systems were not designed with us in mind. They were designed with making good little obedient workers.

Speaker 1: 25:15

And this is where I have to talk about ADHD. For me, 80, 90% of the time is actually chronic stress adaptation, and you've heard me talk about this a lot on the podcast, because it is my, this is this is my, this is my wheelhouse, and I will be screaming it from the rooftops until people start paying fucking attention, because everything about chronic stress adaptation lines up with ADHD perfectly. You can inherit it from your parents. That's obvious. If a parent has ADHD, you're going to have ADHD and it looks a lot like chronic stress adaptation. If your parent was adapted to chronic stress, you will be adapted to chronic stress psychologically as well as biologically. We're going to pick that up from our parents. But if our parents aren't CSA or chronic stress adapted but we go through chronic stress or traumatic situations, then we are going to wind up chronic stress adapted as well. There's not really any way around it.

Speaker 1: 26:21

There is actually a lot of good science that I found now that is finally tying ACEs to ADHD, and there was a study I found published in 2017, where they looked at 58 million children and they looked at those who had socioeconomic hardship and they looked at the ratios of all those and they looked at confidence intervals for all of these and they looked at familial mental illness. They looked at incarceration and neighborhood violence all the questions that are covered in the ACE score and it turned out that there was a graded relationship or there was a dose-dependent relationship that was observed between ACE scores and ADHD severity, like I'm glad that there was. Finally and it's a huge, absolutely massive, massive study and when they looked at adverse childhood experiences that's the ACE study and the number of those adverse childhood experiences in those different categories of familial mental illness, divorce, incarceration, physical or sexual violence, neighborhood violence, all that crap when they looked at it and then they looked at ADHD, it scaled evenly. So for me, adhd is calling. That's the name of the flower, that's the name of the like in Chinese medicine. We talk about the root and we talk about the branch. Adhd is the branch.

Speaker 1: 27:57

The actual root of ADHD is chronic stress adaptation. To me. To me, it's unfreaking, deniable. There's no way that it's not the same thing in the overwhelming majority of people, to chronic stress during development, those changes to the reward system, the threat evaluation system, to the vagus nerve, to myelination in the brain, to the prefrontal cortex and the dorsolateral prefrontal cortex. When you look at all of these changes in the memory system, it's the exact same stuff. It explains everything about ADHD. If you look at even just those four places, it explains nearly everything about how we struggle as ADHD people. So for me, I want people to recognize and there isn't enough science to back this up fully, but there's finally enough science that's pointing in that same general direction that I've been saying for years. So you're hearing it right now from me ADHD is actually chronic stress adaptation and the funny thing is that's not even the biggest hot take that I have on this. It ought to be, but it's not. I've got one more that's even a little further and even a little crazier. I think ADHD is functional. I don't think it's a disorder. I think school is a disorder. I think work is a disorder.

Speaker 1: 29:44

I think those things are so far removed from the species expected stimuli that we have as biological beings. Every single species is born with expecting certain types of input, like I mean, even just something as simple as like a giraffe or horses being able to wake up and run running as a part of their stimuli, or fish being in water. That's a species-expected stimuli. We have these species-expected stimuli that have all been. They grew together from our evolution with our environment. Our environment is what provided all of those species-expected stimuli and we have changed them. Our biology is what provided all of those species expected stimuli and we have changed them.

Speaker 1: 30:31

Our biology is still mostly that of a hunter-gatherer, and in a hunter-gatherer it's a pretty good idea for you to be able to sit and doodle while the geometry teacher is going on, because really you're just waiting to hear the piece that you don't already know, right, and you need to occupy your time in the meantime because you're a little bit amped because there are actual life threats out there, like things that are threats to your life, and we need to be able to like kind of chill and have one ear to the world around us to see is anything changing? That is a threat and that's the equivalent to me of doodling in geometry class, because you're listening for the one thing that's going to pop up on the test, the one thing that's the threat, and you're keeping your. You're keeping your body engaged and your brain engaged in some way, and enough that you have enough resting neurotransmitters in your body that you can respond appropriately, that you can ramp up if you need to, quickly. That makes perfect sense to me. What makes sense is that we have, as a species, have needed to be able to access both our task-focused network or the task-oriented network and our default mode network simultaneously. Imperialization and colonization, and the removal of basically anything that is a threat to us other than ourselves. We no longer need that, but that's what our body expects. We no longer actually need to keep an eye out for the things that are going to kill us, but that is what our body naturally does.

Speaker 1: 32:23

And I think, for those of us who were raised in environments that exposed us to a lot of threats, we got used to being able to activate this default mode network and the task-focused network at the same time, and we do know that this is what happens in ADHD. There are two basic modes in the brain the default mode network, which is, go figure, the default, and there is a task-focused or a task-oriented network, and each one is for something different. In the default mode network, we're in our horizon view. Visually, we're looking at everything all at once, our eyes relax and we take in lots of stuff, whereas in a task-focused network our vision shrinks, we go down into more of a tunnel vision and we're looking at one thing in higher detail because we're typically evaluating is that a threat or not, and or is that it's something that we need to focus on, like food processing. And so it wasn't until we eliminated all of our basic threats which was very recently and created schools to be able to create obedient workers, that we were able to separate our default mode network tasks and our task-focused network tasks. And we were able to really fully separate them because we hyper-specialized as a species.

Speaker 1: 33:50

But I don't think that that's the actual baseline. I don't think that being able to sit down in a classroom and do menial work for hours and hours and hours and hours is a natural process for the human animal. That makes absolute zero sense to me and I don't know why no one is talking about it. It blows my mind. Does that make any evolutionary sense to you?

Speaker 1: 34:16

Think about what it takes for a child to be a good student. We're looking at the extremes here. So take the idea, your concept of the best student. Take your best male student, your best female student. Think about how they act and how they behave, how they move through the world. And now imagine them in a jungle. Do you think they would survive? Right, I laughed too. Now picture your most disruptive, chaotic, adhd, hyperactive boy. And what do you think about that kid surviving in a jungle? Much better chance, right? Much better chance.

Speaker 1: 35:03

So, frankly, I really believe that ADHD is the. That's the baseline. I think that that is the baseline on a biological level and I know that I'm biased because I have ADHD and I also know that I am far more productive than the average human being is. Between going around and doing my patient care and my client work and writing articles and writing the book and doing this podcast and playing gigs and learning new instruments and like doing my solo shows and singing with another group and starting a whole nother one and building out a show now for April, I do obscene amounts of crap, and it's not because I'm a good little obedient worker and I can sit down and force myself to do stuff. No, that's not the way I go about doing these things, and I don't think that's the way you should go about doing these things either is to recognize exactly which way you are. What I mean by that is back to my favorite little saying know thyself Because ADHD not useful. And the reason I say that is because the term ADHD is a diagnosis and diagnoses are a thing because they help us to understand and inform us how to treat a person.

Speaker 1: 36:32

But here's the thing If you go to a doctor, as a male or as a female, and you say evaluate me for ADHD, they say you have ADHD, congratulations. What are they going to do for you? They're going to give you stimulants because that's all that they can do for you. There is like community integration stuff in really fancy places, but 95% of the time they're going to give you a stimulant and send you out the door.

Speaker 1: 37:01

And another very interesting little factoid about women with ADHD is stimulants don't work. Factoid about women with ADHD is stimulants don't work. There's a wide, wide range on the studies to see if stimulants work for females and the range was somewhere between 20 and 70%, like that. 20%, only 20% was found effective in some studies, up to 74 or 75 or something like that. These don't work for women because the expectations for women are different. The manifestations of ADHD are different. We've covered that. It's more inattentive stuff. But the problem is, I can give you like as a male, if you're hyperactive. The biggest problem that you typically have is being hyperactive and being disruptive. And once you get medicated you're less disruptive and you can focus and you're good to go.

Speaker 1: 38:02

For women, especially women who are getting adult diagnoses, you've had ADHD for a long time, which means you've been chronic stress adapted for a long time for your whole life basically, at least to me and when you go to get on that medication, you have a one out of three chance of having an abusive partner. No stimulant's going to solve your abusive relationship. That's not going to solve it. And the meds might help you focus a little bit more and that's great and it does work for some people. I'm not saying that meds don't work for women. They absolutely do. They absolutely do, but not all the time, not even most of the time.

Speaker 1: 38:47

We know that it takes a multi-pronged approach for women to suffer less from their ADHD. Now, for me, I think, if you want to suffer less from your ADHD, just stop engaging in the world that is designed not for you. That's what I've done. I stopped engaging in the world that isn't designed for me, not for you. That's what I've done. I stopped engaging in the world that isn't designed for me. They've designed our entire capitalistic world around being a good little obedient follower, and that's not me. I'll never be able to be that because of my chronic stress adaptation and I don't want to be, and I'm proud that I am who I am and I'm really proud that I've learned to leverage my own ADHD to be a freaking superpower for myself.

Speaker 1: 39:31

But women are not going to have your problems solved by meds because they can't take care of your spouse, your abusive spouse. And one of the main things that women suffer with from ADHD is judgment and it's self-judgment, partially because of the sensitization of estrogen and we talked about that making us more interoceptive and making us look more inward and be more inward blamey rather than externally blamey. Men have it easier in being externally blamey. Women get self-blamey. And then inattentiveness is really hard to cope with as a woman, because when you are inattentive it's hard to focus on all the little things that you're supposed to be doing. And we expect women to be the subconscious organizers of the world, and they are the subconscious organizers of the world.

Speaker 1: 40:22

It's not your husband who plans your best friend's birthday party, is it? No, it's the woman who plans the best friend's birthday party, is it? No, it's the woman who plans the best friend's birthday party. It's the woman who plans the kids' meals or plans out the grocery list and say you're a man and you go and you pick up the groceries and you do all that great, wonderful. But don't forget that cognitive load still rests on the woman most of the time. Things are getting better, but the cognitive load still rests on the woman. Most of the time. Things are getting better, but the cognitive load still rests on the woman.

Speaker 1: 40:52

And if that woman can't focus on that cognitive load, we don't say oh, she has ADHD. We say she's a bad woman. We say she's a space cadet. So if you have trouble with your emotional regulation and you've been called a space cadet or a spacey, then you probably have ADHD and you might want to go get evaluated as an adult. If you think medication and those sort of things will help you, I think that's great. Go get the diagnoses if you want, but remember the diagnosis. They're just going to give you meds and the meds aren't going to solve the biggest part of the problems. They will help solve some of the root and if you think that they will help you with that, you should ought to go do that, or just go do it and give it a try and see if it helps. But medications don't solve the problems for women like they do men.

Speaker 1: 41:44

Before I go any further, I just want to give a quick recap. We're looking at why it sucks more to be a woman with ADHD than it does as a dude with ADHD and I'm a dude with ADHD and it sucks. But it's also pretty freaking awesome once you get out of the self-judgment. And that's what's so hard about with women, because if you get out of that self-judgment, you still have all of the judgment of other women, because I don't know if you know this, but women are judgy AF Like men. If men don't like you, they will let you know.

Speaker 1: 42:19

You think about the most toxic classic male environment. A new guy comes in and they just tease the new guy over and over and over and over and over and over again. They prod him and poke him to see if he's willing to like, deal with the crap and be a part of the crew. And if they like you, they'll tease you like. Whatever, whatever little bit of of of friction is there is externalized and brought out to the light and made and made light of through the jokes and the poking, whereas women, if there is any amount of friction, typically women won't say anything about it at all. They will not externalize it. They will talk shit about you behind your back. They will text everybody on the WhatsApp group to talk shit about you and why you don't have this and why you don't do that and all the things that are wrong with you. And that's super fucking toxic. It is so toxic but that's the reality that women have to deal with, that other women are being extremely judgy and that's really unfortunate, especially with how hard women are judged in our society, and I firmly believe it's mostly by other women. More than anything else, women hold women to ridiculously high standards. So we've covered that.

Speaker 1: 43:33

Women have inattentive forms of ADHD. Men typically have hyperactive forms of ADHD. Women get way less diagnoses early in life because they have that inattentive form and that's less disruptive, and it's usually the disruption that pushes a person or a family to a doctor to get a diagnosis, because most of us don't just wake up and be like, oh okay, well, they're 11 years old, it's time to go get an ADHD diagnosis. That's not the way that it works. We typically have to wait for a problem and a disruption and when we look at the problems that boys have versus girls have with ADHD, it's far less obvious that much more dramatized to externalization because of their testosterone, women more prone to internalization because of the estrogen, and then they get into more self-shame and they get into a terrible self-concept and that's the immediate following thing that's the next emergent phenomenon is this terrible sense of self that we don't attribute to ADHD, the way we attribute the disruptiveness and going to detention or getting kicked out of class or whatever. We look at those and we go, okay, that's the cost of the ADHD, so let's go get an evaluation, whereas the cost of the ADHD for the girl is a crippling sense of self-doubt or self-hate or whatever. And then we don't contribute that to ADHD either. We contribute that to all of the impossible beauty standards and the Instagram and the Botox and the fillers and all that crap, all of which are real but all of which are reasons that women go underdiagnosed in childhood. This really matters because we have a five-fold increased chance for domestic partner violence as a result of ADHD. It's a 30% chance a one in three chance that a woman is going to experience intimate partner violence because of ADHD. There's other stats that I didn't write down that were about divorce rates. Women are way more likely to be divorced by a spouse without ADHD because they have ADHD than men are. If you flip it, it's not okay. It's very difficult to be a woman with ADHD and I really want you to get that as a woman.

Speaker 1: 46:28

If you have the crippling self-doubt and all of that stuff, if you can find inattentiveness in your life, there's a good chance that you have ADHD. But for me, that's the ADHD portion. But for me, what I want you to understand is that what ADHD actually is is it is a form of chronic stress adaptation. You are addicted to chronic stress because that is the only environment that you knew. Therefore, that is the environment that your body adapted for. Your body doesn't adapt to the things that you hope for. It adapts to the things that you hope for. It adapts to the things that you experience and if you experience chronic stress, you will be adapted to chronic stress and when you move from an environment that is chronically stressful to an environment that is inherently monotonous, like school or work, and you work on stress adapted you're going to run into problems. As a male, you're going to be constantly looking for that threat and for that fight.

Speaker 1: 47:30

And as a female and that's what you're going to do, with all of those emotions and as a female, we wind up being spacey and being able to just shut down our brains for a little bit, because you're always considering so many things and so many variables from so many angles. They're just like so much more thorough thinkers. Women, I feel, are much more thorough thinkers than men are and it's nice to be able to just shut that down for a bit. And it's only when you were in a safe environment that you get to shut that down. And if your home was not a safe environment all of the time, the safest environment you found was school. So no wonder you went to sleep at school, no wonder you were tired there, no wonder you didn't pay attention there, because it was the only time that you could afford to not pay attention Like immediately I just heard my mother's voice pay attention when I'm talking to you.

Speaker 1: 48:26

I couldn't not pay attention to her, I couldn't pay, I couldn't not pay attention to that anger? There was no way. So what I didn't pay attention to was my monotonous home ec teacher. Oh my God, she had the most monotonous voice ever. I actually liked her, but Jesus, that voice was monotonous. I don't wow, but I couldn't bring myself to pay attention to her.

Speaker 1: 48:46

And women might. But your brain, because you, because you're much more thorough thinkers I feel like women's brains just shut down, girls brains shut down and boys brains get overstimulated and they gotta. And their version of shutting down is to go, is to go, act out, we, we, we resolve this inappropriate level of neurotransmitters and hormone cascades and all that crap. We resolve them differently as males and females. But I thought this was really important to talk about because women suffer differently and to a more extreme level.

Speaker 1: 49:20

If you have ADHD and most don't get diagnosed when you're young, it might really do you some good to go out and get a diagnosis. But again, if you do go get a diagnosis, remember you're going to need more than just the medications, because the unfortunate reality for women with ADHD is you carry a much larger burden than the men do with ADHD, because less is just expected of us, period, less is expected of us. We're allowed to be dumb, we're allowed to be spastic, we're allowed to be impulsive, we're allowed to be like all those things. It's great when we don't, right, like people love the stoic man and whatnot in concept, but boys will be boys, that's the phrase, right? I don't really hear people saying girls will be girls, but they'll definitely say boys will be boys. And what do they mean by that? They mean that boys will act pretty ADHD from time to time.

Speaker 1: 50:20

I think it's a form of chronic stress adaptation and I think that is a very new thing that the baseline is supposed to be not chronic stress adapted, because the baseline for our biology is alone and naked, afraid in the jungle. That's our biology, that's our expectation, like mom is there to hold us as infants and that sort of thing. But our basic, our baseline is there are threats that we must stay alive through, so we have to be on. I should have covered this in the beginning and I totally forgot because I didn't put it in my notes. But I wanted to talk about the low dopamine theory, the theory that explains a lot of ADHD stuff. It's an incomplete theory. They came out with it and everybody loved it and ate it up. And now people are saying that people, other scientists are saying that it oversimplifies. But here's what's going on with the low dopamine theory. And when I was actually talking to chat, gpt about this and was like, yeah, but what happens when you take into consideration chronic stress adaptation with low dopamine theory, and when I, when you do that, everything clicks perfectly.

Speaker 1: 51:39

So low dopamine theory is that there just isn't enough dopamine in the brain for the body to function. In an ADHD person that's the theory which, yes, that's true, but why person experiences a lot of stress during those developmental windows of childhood that body releases stress hormones as well as dopamine all at the same time. It releases cortisol, dopamine, epinephrine, norepinephrine, all these things. If it's important enough, acetylcholine, your body produces massive amounts of these things. And if you are exposed to chronic stress, then you are going to get an upregulation in the number of receptors that you have, because there's a bunch of the transmitters floating around in the system, so you need more receptors to be able to pick up all of those and use them right. So you get an upregulation.

Speaker 1: 52:41

And in chronic stress adaptation and in ADHD, what we know is happening in ADHD is that you are getting a cross wiring of the default mode network and the task mode network. The task mode is to get you to focus to do a thing and the default is all of the rest of the time, the default you're in parasympathetic state. And the task you're in a more sympathetic state. And the idea is that, because of the level of chronic stress and not actually getting to fully rest in your default mode, the kind of floor of the default mode got raised to where your default, my default as ADHD people the resting threshold is higher than the resting threshold for a person without ADHD, and because you have more cortisol receptors and more dopamine receptors in all these different parts of the brain, what happens is because your default is still, your default is still.

Speaker 1: 53:49

There's a higher floor to the default mode network. It consumes more calories. It is less energy efficient because it is doing more, so it burns more calories, it consumes more, it demands more, including more dopamine. And you add that with the task focused network and there are dopamine receptors all over the place in both of these networks, both of these systems you also need enough dopamine to be able to fill the dopamine for your default mode network and for your task-focused network simultaneously, because typically what we expect is that the brain is in task mode network or it's in default mode network and the two don't get cross-wired. When one is activated, the other is unactivated. But in ADHD we see that you're actually stimulating both simultaneously in a lot of situations. That's what I mean by like the floor being the floor being higher in the default mode network. What this leads to is more receptors in the brain, so it takes more dopamine to fill the receptors in order to be able to function. So we actually need more dopamine to function than the average person because of the cross wiring of our default mode network and the task focused network. Which is why the things that work for ADHD people so we can get stuff done is more sensory input. We have everything from fidget spinners and textured putties to listening to binaural beats, to smelling essential oils.

Speaker 1: 55:28

There's a lot of ways that we can make our lives easier as ADHD people. For me, I know that I have to have a certain level of dopamine in my body in order to even just sound or like sound, engaged or interested in just about anything. And I get a lot of that from coffee, because I love coffee and coffee releases dopamine, but really good. Coffee releases that much more dopamine. So it's not even me drinking three or four or five cups of coffee. I'll try to limit myself to two or maybe three. But I go to my favorite coffee shop that has absolutely exquisite coffee with beautiful latte art and perfectly textured milk and really nice mugs that feel good in your hands, because I get so much dopamine out of that and what that's doing is it's supplying enough dopamine to be able to run my task focused network and my default network simultaneously, because that's the way that the two are wired in my brain. Whether I like it or not, that's my reality, that I have to, that I have to deal with.

Speaker 1: 56:33

Treatment is stimulants. That's all that they give you, and there's a few kinds of stimulants that they have that they offer for ADHD people, and try them out, give them a shot if you want. But there are other ways as well, and most of these ways increase dopamine. We have physical exercise, we have meditation, we have yoga. There are actually computer-based interventions now, programs that can target ADHD symptoms like inattention and distractibility, because the computer can provide enough color and light and sound and all of this stuff to give us enough dopamine.

Speaker 1: 57:16

Then there's also diet, because dopamine is not the only neurotransmitter associated with ADHD. We also seem to have a lack of enough serotonin. That makes us just kind of feel okay. So we can do a lot with our diets, because 90 something percent of all of the serotonin in the body is made in these chroma something cells in the stomach. So diet is a really big way to help, specifically omega-3 and omega-6 fatty acids, which are found in flax seeds, and there's a meta-review study that found that it helps even in children. Omega-3 and omega-6 fatty acids help even in children. Low zinc levels have been associated with cognitive defects and some studies have found that zinc supplements can improve ADHD. And then again back to the dopamine stimulation. We have music and nerve stimulation. Interventions based on music and nerve-specific stimulations improve attention, memory and executive function.

Speaker 1: 58:20

I wanted to cover comorbidities as well. It's important to look at these, especially for me, looking at it from a chronic stress lens, because these are the comorbidities associated with ADHD, and comorbidities is the fancy word for other crap that comes along with a diagnosis or disease or disorder. Diagnosis or disease or disorder. And we have anxiety disorders, depression, bipolar disorder, substance use, personality disorder, learning disabilities, oppositional defiance disorder, obsessive compulsive disorder, sleep disorder, obesity and even borderline personality disorder. All of these things are comorbid with ADHD and we have science behind all of them, just saying that and explain exactly how these things, how they arise from chronic stress, adaptation and from those specific brain changes I mentioned earlier in the reward system, memory system, threat evaluation and response system and the vagus nerve and the prefrontal cortex and the dorsolateral and other things too, but those four especially.

Speaker 1: 59:52

So remember that for women, if you were listening to this and you have ever thought that you were a bad woman, you probably have ADHD. If you have been called a space cadet and have struggles with emotional dysregulation and people have just called you spacey or called you emotional or hysterical or spent all of this time chalking all of your personal problems up to existential things like Botox and plastic surgery and all of that, you might be struggling with ADHD. And the consequences of this are very real Because, as a woman, you are struggling with more judgment, more internalized judgment and judgment from other women. That can't be easily fixed by medications, and we see that in the studies as well. Boys are much more easily resolved from the things that have been disruptive in their life by just putting them on meds. It's much more effective to do meds and community care. Even in boys and women, it is very rarely is just medication enough to relieve the symptoms, because by the time women are getting diagnosed, it seems like we've got a long history of bad decisions that come from being chronic stress adapted and choosing decisions that put us into situations of chronic stress because we thrive there.

Speaker 1: 1:01:25

So, if you're unsure, take an online test. I'll include one. I'll include the one that I took from YZ. I'll include the one that I took in the podcast notes so you can go into the notes and you'll be able to take your little test and you can leave a comment and tell me what your number is, and mine was 19. But I hope that this helped. I really do. I think I got most things covered. There was a handful of things that I didn't get covered, that I wanted to get covered, and that's fine. That's the way these things go.

Speaker 1: 1:02:00

I'm trying to distill a lot of information from a lot of places and give like why ADHD is different for women up front as a this is, this is a very real problem and it's harder for women than it is for men. But also get in my own two cents about what I think ADHD actually is, because that's where I think the rubber really, really truly meets the road, because having the label of ADHD is great, but all that's going to do is get you in a different rabbit hole on Instagram or on TikTok, because, as a woman, the medications aren't going to be the solve-all for you like it is for men. You have to do something different, and that do something different for me is to know thyself, because you are chronic stress adapted, but you need to find out what way you are adapted. What are you good at? What types of automatic responses to stress do you have that are useful? Learn to leverage those things and your ADHD can be a superpower, unlike anything that these normal people quote unquote are capable of, because we're basically still incredible, wild machines compared to their docile, perfectly conformed neuro-normality docile, perfectly conformed neuro normality. So I really tried to cover as much as I could today. I wanted to give you pieces of information that you can work with. I want to let you know that you are not alone as a woman with ADHD, that you are suffering, and that it is worse in a lot of ways than it is for men. I'm not saying it's easy for men with ADHD, but I'm saying it probably is easier just because of the way things shake down. It's not fair, but that's the reality that I see.

Speaker 1: 1:03:54

So thank you for listening to this podcast. Thank you very much for joining me and for spending your time with me today. If you enjoyed this episode, consider leaving a comment. Please leave a rating. The more engagement people have with the podcast, the better off it is. For me, nothing there's literally nothing that you can do, including buying me a coffee. That will be more beneficial than sending this to your friends and sharing it with other people I deeply appreciate that and engaging with the content by leaving reviews and leaving comments on whatever platform that you have. Thank you for spending your time with me. I hope you got something out of this and remember Stay curious and stay uncomfortable. We'll be right back. Thank you, you Bye.