The Truth About Female ADHD, The Invisible Struggle (Leading Psychiatrist Explains)

0:00Propel Fitness Water. With Gatorade electrolytes, zero sugar, and vitamins. Propel hydrates better than water to help you get the most out of your workout and get back to your best self. What propels you? Propel with Gatorade electrolytes. We've let women down in both the diagnostic stage of ADHD, but also in the support that we offer them. We're looking in childhood for very clear symptoms of an impairment with hyperactivity or inattention. Girls are more likely to develop emotional maturity and make efforts to conform to social norms during their childhood. That invites itself for masking to start taking place.

0:38Dr. Yath Ramesh is an ADHD specialist psychiatrist with a unique twist. He's treated people with ADHD from ages 18 all the way to 100. So, with regards to ADHD, he's seen it all.

0:49Dr Yath Ramesh:With ADHD, people often gravitate to fast reward, fast feedback mechanisms in order to help cope and regulate your emotions. It could be alcohol, cannabis, shopping, various things that ultimately could lead to an addiction. Do you think if left unchecked and that propensity to seek the low hanging fruit, the quick dopamine, can that lead to a dangerous path of crime perhaps for somebody like that? I think that... Can I have just a second of your time? If this podcast has helped you understand your brain or made you feel less alone, can you do me one favour? Can you hit the follow button? And I'll repay the favour by continuing to book the best and most exclusive conversations on this topic.

1:29Please enjoy the episode and always remember, you're not broken, just different, and you have always been enough. Dr Yath, welcome to the ADHD Chatter podcast. Thank you for having me. It's such a pleasure to have you here. the patients that you've treated for adhd they range from 18 years old to 100 years old is there anything that still shocks you about adhd so there are so many things uh that shock me about adhd um but i should start off by saying that i guess the reason why i treat people within the within that range is I'm a dual trained general adult and old age psychiatrist. And as I went through my training, I essentially developed skills with treating neurodivergence in both the adult population, but I also took those skills into the work that I was doing in the older adult population.

2:29I think what shocks me about ADHD at the most is the fact that the symptoms can still persist over the different age groups. And in particular, I think what I've learned from working with people across those different age groups is that although the symptoms themselves can sometimes go away for some people, actually as life gets more complicated, things can get more complicated for older adults. So yes, yeah. So the symptoms of ADHD can stay consistent throughout someone's life, all the way from 18 to 100, but the way they manifest and show up and cause challenges, does that change as you go through life and get a bit older?

3:15Absolutely. So let me talk you through the different life stages. Okay, so we're going to start with children. Now, I'm going to call this the dependent stage, because at this stage, what we're looking at is the amount of dependence that you have on your parents or your teachers or whoever it is that provides support around you. Now, with children, when it's obvious that you're requiring more dependence on those people compared to others, then we start to notice problems with ADHD. But therein lies the challenge, because if you're very good at masking your symptoms, if your symptoms were there, but you had a sibling who had, let's say, hyperactive symptoms that were more obvious, if there were symptoms that were happening, but there was something else going on like parental divorce or conflict, and they could be rationalized or justified in another way.

4:13For all those different reasons, it's very possible to get through childhood where you have symptoms, but they haven't manifested into something that we might consider ADHD. So then we go on to your early adulthood. And in this stage, I'd call this the independent stage because in the independent stage you're trying to become self-sufficient but you might find manifestations of ADHD there where you can't so I'm talking about the people who do really well academically at school but then they go into their university years and everything falls apart their grades fall they struggle with making making friends or they struggle with being able to prioritize the differences between prioritizing school, prioritizing work, prioritizing friendships, relationships, and the old self that used to jump from thing to thing, excitement, one excitement to the other, struggles with handling this sort of stage of life.

5:19And then we go on to the next stage, which is the integration stage. So let's say that you managed to get through life and you learned skills of independence, but when you get to actually trying to bring those skills together, so let's say you're a parent, you're juggling responsibilities with childcare, with aging parents, or you're taking on a leadership role at your work. At this stage, you can struggle with trying to bring all of those different skills together. Why? because you don't have the opportunity to mask in the same way that you did before all those times that you used to give yourself that downtime gone all those times where you used to be able to prepare for conversations prepare for those situations that you knew were going to be anxiety provoking for you gone and at this stage adhd can manifest rather than with symptoms but with a difficulty with managing the complexity of life.

6:21And there is a whole separate thing I can tell you about with the retirement stage, and perhaps we can talk about that later. I've never ever heard it explained in such a fluent way before, how it kind of can show up at various stages of one's life. So I suppose at different stages of your life, you have different support systems around you, your environment changes. And in response to the sort of ever-changing landscape of what you are in as a human being, how much your ADHD shows up changes depending on that too. Do you think as you grow up and you transition through these different stages, can ADHD get easier to manage as you as an individual become aware of your traits, your challenges, and you're able to self-reflect on them yeah so there are two arguments for why you might think that adhd can become easier to manage and i'd say for some people it absolutely is the case so first pattern recognition you start to be able to recognize those triggers before you let them get to the stage where it becomes a problem for you you know those people that if you spend time with are going to be triggering for you you know those situations those opportunities that if you say yes to they're going to completely override you and you know how to avoid those situations so yes for some people pattern recognition helps the second thing is emotional maturity so when you were younger your rsd may be driven by lots of perceived threats hypothetical scenarios about what could happen in the future but now as you get older you start to actually realize what does happen and that can help your rsd to have a more mature understanding about the difference between perceived and actual threat so this can be really helpful with being able to have the capacity to manage some of the adhd symptoms that you have but i would caveat that by saying that you've got capacity and you've also got demand.

8:28And as you progress through your life stages, the demands on you can also grow up and expand. And when they grow, if your capacity doesn't match the demand, then you personally might not find that ADHD gets easier as you age. So interesting being able to recognize your patterns and therefore it gives you the tools to mitigate and avoid perhaps an RSD trigger. Are there circumstances in someone's life as they get older, new experiences that their ability to see coming because of that pattern recognition isn't so useful because they have never experienced that life event before?

9:12Dr Yath Ramesh:Yes. So when we look at the experiences that you have as you age, so let's look at some of the most common scenarios here parenthood for women the menopause for both men and women the experience of progressing up the leadership ladder within your working environment for both men and women again the experience of complex physical health challenges as you age and again going through retirement at all of these life stages you're experiencing things that you never may have experienced before and one of the most difficult challenges with this and I'll give you an example of this okay so one of the things that people in their later stage of life tell me is that they look back at a certain period it's around middle adulthood where everyone is caught up in the thick of things and during that time what happens is that you don't have as many interactions with your friends and family around you but those interactions can be detrimental depending on how they play out and so something that I've heard time and time again is I never really had that good a relationship with my brother but that one Christmas in 1998 just completely ruined our relationship and they link it back to their experience of RSD that might have happened during that moment.

10:53Dr Yath Ramesh:And what it does is it reinforces to their RSD and to their ADHD brain that this is not a safe space and that you need to be careful with your social interactions. So as you go through the life stages, things can become more complicated, but also your RSD can become more sensitive to those situations from happening. what is rsd how would you describe it so rsd stands for rejection sensitive dysphoria um it is a concept and a term coined by the american psychiatrist william dodson who i know that you know very well you've interviewed him here and essentially what it describes is an intense physical and an emotional symptom or pain that you experience in the context of actual or perceived threats and it's disproportionate to what other people may presume to be a normal reaction to a situation and this is important because in the moment when you're experiencing rsd it's very possible that your emotions and experience are completely logical and justified for that situation based on what's going on in your brain you might regret it later yes but in the moment you will um it will make complete sense to you and one of the most painful things about rsd is that there is a self-perpetuating cycle between rsd and trauma so as we all know you know from from ADHD, you're more likely to experience trauma in the context of having ADHD.

12:42Dr Yath Ramesh:Now, unlike other experiences, so let's take alcohol. The more alcohol you drink, the more likely you are to actually dampen your responses to alcohol so that you don't become as sensitized to it over time. It's a complete opposite effect with ADHD and RSD. So the more traumas you experience, So if we imagine that RSD is this bubble that you have and it's a protective shield, it's a heightened fight or flight response that you have in order to protect you from trauma. Now, if you imagine that every time you experience a trauma, that bubble gets bigger. And with that bubble, it gives you a stronger response so that you protect yourself next time from trauma.

13:24but as the bubble gets bigger and bigger the problem is that it becomes easier and easier for things to actually hit the bubble so now you get this very heightened response that's also much easier to be able to hit and that can cause you to want to curl up into a ball and avoid all trauma and that's why it can be so painful William Dodson he theorized and we speak a lot about it on this podcast is is those horrible comments that many of us experience in our early years because of our differences but what other trauma could a child with adhd be exposed to that perhaps someone who didn't have adhd might for various reasons avoid yeah so as a child with adhd you are more likely to go through life being told things that are a different narrative

14:20Dr Yath Ramesh:to why you're experiencing life the way that you are. So let me just get this out from the start as well, because some of these listeners of this podcast will have gone through generations of life where we didn't even have the culture or language to express neurodiversity. So what does that actually mean? So what that means is that inattention wasn't even considered a possibility to be something that was wrong with your brain. These children were probably told that you're not listening, you're not paying attention, there must be something that's wrong with you because other children are not like this.

15:07Dr Yath Ramesh:You're messy, you're disorganized, you misbehave. Why can't you just be like your sibling or someone else. So these are ADHD specific traumas that you can have. But then there's another problem that happens. Children with ADHD who are exposed to the same traumas that someone without ADHD doesn't have, so let's say parent or divorce for example, they not only experience the worries that they might have caused it because of all the things that they were told about themselves. But for their RSD, suddenly you go from having a perceived threat to confirmation that there is an actual threat here. This event actually happened in your life and maybe you might have had some contribution to it.

15:56Dr Yath Ramesh:And I find this one of the most painful experiences to hear about when people carry that. So yeah, childhood trauma has a very, very strong role to play and how ADHD develops in children. Gosh, it's heartbreaking. If a child experiences those traumas you were just mentioning, and they're in their really early stages, they're developing years, and they are on the receiving end of all of those horrible comments, or they witness this event like a divorce, and they internalise it and think that it's their fault. What does a child do? How do they react? How do they respond to those messages? Do they change who they are?

16:35Dr Yath Ramesh:A child tries to make sense of this by building a narrative about themselves. So that narrative might be that there's just something that's fundamentally wrong or flawed or different about me. And that narrative then can cause a reaction. so for some it might make them withdraw it might make them want to spend more time with themselves and not with other people because they worry that about what other people are going to say or how other things might play out in future relationships that withdrawal for some people could look like an anxiety so you may see a child you know diagnosed with social anxiety as a result.

17:24Dr Yath Ramesh:Some children withdraw so much that they stop doing things and they stop gaining pleasure in things and that again could cause issues with their mood and again that could play out as a depression. Other children, especially when going through adolescence and learning about how to regulate emotions, can have difficulties with identifying with what's safe and what's not safe and that can very strongly contribute to emotional dysregulation all of that I guess could lead to a child presenting with different mental health issues but also as you get older you start to learn different coping strategies now with ADHD one of the things that we know that people often gravitate to are fast reward fast feedback mechanisms in order to help cope and regulate your emotions what that could involve is it could be alcohol it could be it could be cannabis and it could progress to other substances like cocaine or it might not be drugs at all.

18:39Dr Yath Ramesh:It could be shopping, gaming, various things that ultimately could lead to an addiction. So these are just different ways that trauma can have an impact on children. I asked Dr. Ned Halliwell what ADHD, if it's not recognised and managed, can turn into, and he summarised what you just said, it can turn into addiction and compulsive spending. And it explains a huge percentage of the prison population. Do you think if left unchecked and that propensity to seek the low-hanging fruit, the quick dopamine, can that lead to a dangerous path of crime perhaps for somebody like that? so I actually simultaneously worked in the NHS in a specialist ADHD service within our local area and I also worked in a drug and alcohol addiction service at the same time and essentially what I was doing was seeing ADHD presenting in two different populations.

19:50Dr Yath Ramesh:Within the addiction service, we actually had a specific sub-team called the criminal justice team because of the propensity of crimes that were committed by people within that service. But what you could actually see was that the exposure to traumatic life experiences, the combination of not having the resources to be able to support those people through the education system, through the social care system. And inevitably, what happened for some of those people is that they experienced an addiction, but without the financial resources to be able to manage the addiction, you end up trying to fund it.

20:39Dr Yath Ramesh:So how do you do that when you don't have the skills or resources to have a job that's going to help you you need to find other ways so you end up in the criminal justice system then what happens there doesn't fix the problem and so when you're out of the criminal justice system you start looking for a way to cope again and then there's a cycle that happens between being in trouble with with the criminal justice system the addictions and it's very difficult to break that cycle and that's fundamentally what we try to do within within our service so yes criminality and adhd definitely have have a commonality and it's sometimes just your life experiences early on that can shape which direction you go it's such a big motivator for me like as someone myself who's an addict and an alcoholic like i've been in the hospital wards with tubes hanging out of me i've been in the back of police cars i've been down an alleyway with someone calling an ambulance because I just can't stop drinking.

21:42And then I got my diagnosis of ADHD. I got sober. And suddenly I realized that so much of what was holding me back was my not being aware of my addiction and how much ADHD played into that. And with awareness, I was able to manage that challenge, which was my addiction, get that under control. And then afterwards, you can really lean into the many strengths that come with being different. and that led on to the podcast and sat here today interviewing incredible people like you and it's such a passion project of mine and to hear similar stories of people having that moment where they get a diagnosis and so much makes sense and they're able to turn their challenges and confusions into strengths.

22:29Out of the patients that you've seen, Yath, do you have any stories of somebody getting a diagnosis and it being totally transformative to their life?

22:39Dr Yath Ramesh:I have many stories about that. So what I'm actually going to tell you about is, and I guess this comes from my experience of working with people across the lifespan, is I had the pleasure of actually treating three different generations of one family and seeing how ADHD changed things for them. So I'm going to start off with my original patient. So she was a 19-year-old young woman who was struggling with transition to university. Again, she did well academically, but really struggled with how to navigate everything in her first year. and what became apparent when we actually started to unpick her symptoms and she had a lot of inattentive symptoms that she was masking was that at a certain age around 15 or 16 she stopped pursuing the things that she was actually good at and pursued the things that she felt she needed to be good at so there was a lot of masking that was happening around that time She picked subjects not based on her strengths, but again, based on a narrative that she was playing.

23:57Dr Yath Ramesh:Perhaps there's a bit of people pleasing in there. And it progressed into university. So for her, when we made an ADHD diagnosis, what she actually benefited from was understanding herself, understanding where she was masking. and through coaching she realized that perhaps actually the choice that she made in terms of the degree wasn't the right one for her and she actually changed her course and thrived in what she did what was interesting was that during the diagnostic assessment process so her mum completed an informant questionnaire and and we see this a lot where parent completes the questionnaire and the parent identifies with a lot of the symptoms and the child herself said my mum has undiagnosed ADHD when I asked about the family history.

24:52So mum herself was going through a difficult time so mum was in her 50s and she was experiencing a recurrence of

25:00Dr Yath Ramesh:problems that she used to have in her 20s. Again, inattention based but more recently she was also having short-term memory problems as well and when we unpick things from mum it wasn't just a case of diagnosing ADHD it was also recognizing that she was going through the menopause and the impact that ADHD and the menopause can have on each other in terms of symptoms so with mum what she actually benefited from I mean she had a choice of what to do but she lived life up until that point without ADHD medication so she decided to try hormone replacement therapy and it worked wonders for her but the insight into her diagnosis also helped her too.

25:46Usually that's where the story ends but in this case during mum's assessment process so my original patient's grandma helped mum with the diagnostic assessment and grandma identified with a lot of the symptoms not just of inattention but also of hyperactivity as well.

26:07Dr Yath Ramesh:A lot of people in a later stage of life don't necessarily pursue an ADHD assessment, even if they know that information. But interestingly, grandma was actually already under mental health services. She had a diagnosis of generalized anxiety disorder and she was seeking treatment. She was trying medication after medication. Nothing was working for her and she also had a small stroke a couple of years ago and was riddled with health anxiety since then so we went through the assessment process with grandma we had to get lots of background information in order to confirm the diagnosis but once I made a diagnosis of ADHD in her case actually we did talk about starting medication and we started her on ADHD medication but we also thought about the fact that her health anxiety was very understandable in the context of what she was going through we actually found out that she almost died when she was a small child and that really had an impact on her when she was going into her later life and it brought back those memories and thoughts about death again so with a combination of adhd medication and also anxiety-focused therapy, she did really well.

27:24And so, I mean, this is just an example how even within one family, you can approach ADHD in completely different ways. And that's actually how to deliver individually tailored support for someone. What a story. What a story. What a fantastic argument as well for some of the naysayers who might say that it's not genetic. Do you mind me asking how old the grandmother was? Yeah, so the grandmother was in her late 70s. Do you think there is, I want to get to the age in a bit, but just rewinding a tad, do you think there is a general grieving process that someone goes through when they get an ADHD diagnosis?

28:02Oh yes.

28:03Dr Yath Ramesh:So I have met people who have accessed so much content that's out there for ADHD. I've had conversations with people at the assessment who can tell me so much of the information that you put out through this podcast because they identify with so much of it. They identify with having ADHD. But when they hear the words from my mouth confirming that they have the diagnosis, usually the first reaction is still shock. because despite all of the times that they thought that they must have ADHD, there was also always that little voice, the RSD, that was saying, you might not. Yeah, it might not be you.

28:54Dr Yath Ramesh:It might be everyone else, but just not you. So there is a big shock when people can get the diagnosis. But then what happens is when you let that ride out, there's another emotion that comes in and it's relief because once you start realizing that actually all along that narrative that you held that you were flawed that there was something fundamentally wrong with you wasn't actually as true as you thought it to be because there is an explanation you were reacting in a predictable way based on the way that your brain was hardwired you can start to understand yourself in the past but it also gives you a clarity to be able to understand yourself in the present and to look to the future so there is a grieving process but fundamentally at the end of it when it works you come out with more clarity than you had before so interesting and just circling back to the age you said she was in her late 70s that's right Do you think the older someone is when they get that ADHD diagnosis, is the grieving, is that a bigger process, the older you are?

30:16So, the older you are, the more likely you are to have lived life by writing your own narrative and your own autobiography. So I guess let's start off with, we are all, all the time, writing our own autobiography in our heads. and when you're much older you've already written many of the chapters so when you get this diagnosis often one of the first questions you ask yourself is how am I going to fit this into my book how am I going to make sense of everything that I've written before all the conversations that I've had with people in the past about myself how's it all going to fit together and with that

31:00Dr Yath Ramesh:comes another question which is would this book have looked different if I was diagnosed earlier and that contributes certainly to the grieving process as well and what I would say is that I always ask people this and it doesn't matter what age you are but I always ask people to think of three priorities that they have that they would like to improve as a result of having the diagnosis because it helps people to narrow it down. I don't think it's helpful to have the ADHD diagnosis and then feel like you've got nowhere to go and reflect back and think, I wish my life was better. You need to have a clear direction of what you want out of this.

31:48And that's where we can help. So that often usually helps people to get through. I suppose it's the ultimate twist in the tale, isn't it? if you get a diagnosis in your late 70s that perhaps nobody saw coming in their story. If you're in your late 70s, is there a chance that that particular woman, that particular grandmother was masking her entire life without knowing about it?

32:12Dr Yath Ramesh:Absolutely possible for that to happen. And if we think about what that actually looks like, so first of all, ADHD symptoms, if you don't have another explanation for them, become embedded into what you think is your personality so when you think about the fact that I'm not able to you know spend time with other people without having energy for myself if you don't have ADHD as an explanation what might you label that as being an introvert I need that downtime for myself before spending time with other people is what you think you need what is actually happening is you're rehearsing conversations before you meet them you're trying to remember all those things that they told you last time so that you don't come across as being inconsiderate when you see them so many people with old age are masking and they have no idea because they think it's their personality but then there's a second bit and I think this is almost sort of the ultimate mask is aging.

33:20Dr Yath Ramesh:So you go through many stages in life and you try and find different ways to rationalize your symptoms. But then all of a sudden, as you get to a certain age, you can actually justify what your executive dysfunction problems by talking about the fact that you're getting older. And society accepts that as well. So I meet a lot of old people who what they tell me is that they're going through aging and they tell me that this is all something that's new but when you actually hear the story the problems have been there all along it's just got a new name for it now my sincerest apologies for interrupting your hyper focus but a quick word from our sponsor like many in the new year we want to turn over a new leaf looking to be more productive more organized and never late well timo app is here to help Timo wasn't named App of the Year in 2025 for no reason.

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