ADHD in Women Symptoms: Why Success Can Hide the Signs

25:36And what happens is that then it starts to fall apart because you can't maintain it. It's exhausting. You burn out and then it falls apart. And for a lot of girls, you know, if they think that, oh, you're just so ditzy, then you try to have this mask of then being overly present, hyper vigilant, needing to be the perfectionistic straight A student who is involved in all these sports and athletics and extracurriculars and doing well in school. And so then, well, you can't have ADHD. Look how great of a student you are. And so that's when I think then things can fall apart because then you can't maintain that level of masking after a while.

26:12Before we shift, so I want to let everyone know we have a whole episode coming on burnout. But before we shift, you just explained the good student. So I don't want a parent right now being like, wait, I have the good student. Does she have ADHD? See, what are the subtle things parents should be tuning into? Looking at that fine line between what is causing impairment in that functioning. So maybe you have that student who does well in school, but at what cost? They're perfectionistic and they're not getting enough sleep and they're getting sick all the time. They have headaches. They have stomach aches, back aches all the time.

26:44They're always going to the doctor for some psychosomatic issue. They're, oh, they're just making up this symptom. But it's causing impairment. You know, going back to the self-diagnosis, everything can look like the same thing, but it's really also about the impairment piece. And so thank you for that reminder, one mom, you know, over here. Dr. Simone, I want to not go high level, but really specifically, what do you see in your patients? What is the masking that they describe? Working so hard to function day to day. I've told many, many women what you're doing every day sounds so incredibly exhausting.

27:19And they're like so validated. They're like, yes, it has been exhausting. I'm so tired. I don't understand why my peers do other, why they can do things so easily. And I have to try doubly hard, triply hard my whole life. I have a million calendars, reminder systems, post-its everywhere. I take longer to do simple tasks and just everything is just so exhausting. And we also talked about rehearsing conversations ahead of time, feeling like you have to actually plan socialization. You are constantly monitoring yourself. Am I saying the weird thing? Am I interrupting? I need to hold the thought and not interrupt this person.

28:00Am I talking too much? And that can sometimes look like going home at the end of the day, feeling like you TMI'd through an entire conversation, hating yourself for it, ruminating on all these thoughts, and then promising yourself it's going to be different the next day. So for the women listening, this is the how I compensate. The masking is how I compensate. So if you recognize yourself in any of these things, I would write that down in your section. Like, am I constantly worrying about being organized? Am I always arriving early? Am I, you know, the person who at the end of the day, I'm completely exhausted and burnt out doing the same level of things that everyone else is doing.

28:41Now, one of the things that people like to say about ADHD is that everyone does that, but everyone's a little bit ADHD. Dr. Lockhart, what do you say to that? Ha ha ha. But you know, is there some truth to that? I mean, I hear that and I cringe every time someone says, well, everybody's a little autistic. Everybody's a little bit bipolar. Everybody's a little ADHD. No, they're not. So yeah, maybe you're a little unfocused, maybe you're a little disorganized, maybe you have a hard time getting motivated, but does that cause an impairment on your functioning where you're so, it is so difficult to initiate a task that it's been six years since you've been to the dentist, right?

29:22That you, it's hard to get motivated. And so you're routinely late on filing your taxes and now you're paying more in penalties because that's an impairment on functioning. So I think people need to realize that it's not hard for everybody. So I think we have to stay away from not everybody has ADHD. Not everybody is impacted by the executive dysfunction that people with ADHD actually have. And this is exactly what goes into the frequency and the cost section of people's columns right now. It's like, you know, are you forgetting things? Sure. How frequently do you forget things and what is the cost of that?

29:55So I want to move into our protocol playground now. And these are real questions that our listeners need answered. So I'm going to start first with Dr. Simone. I've been diagnosed with anxiety. How do I ask someone to evaluate me for ADHD without sounding like TikTok diagnosed me? I think what you have been talking about throughout this series, writing things down, being prepared for the evaluation, come in with a note. say, I understand that I have anxiety, but I'm also still struggling with these tasks, time blindness, procrastination, rehearsing conversations before I meet people. What does a thorough assessment actually look like?

30:37So let's go through what you do in your practice. I always start with childhood history. So tell me about your childhood. Tell me about school. Tell me about relationships, your family life. Was there any pattern of behaviors written And on your report cards, like you are smart, you have potential, but you're not applying yourself or you talk excessively, you're disrupting the classroom. So tell me more about your childhood. What has your partner told you about your personality traits? Just tell me everything about your life. And then, of course, we'll go through the actual diagnostic criteria for ADHD.

31:09Yeah. And I want to follow up with this because I get this question all the time from people. What's the value of getting a diagnosis? I've made it this far in life. What's the point? I think emotionally it's very validating for a lot of people. A lot of my patients say they finally understand what is going on, why they have felt different from other people their whole life. Now, I want to shift the conversation to a different question. Dr. Bornemann, this person says, my partner doesn't believe that my struggles are ADHD. How can I explain to them what is happening in my brain and be able to ask them for the help I need?

31:46This is a really heartfelt question and also really hard because if your partner doesn't believe that your struggles are ADHD, I think the first part is asking why. Leaning in and understanding what barriers they're having to understand or accept that it's ADHD. Because that can be a helpful starting point of where you want to go with that conversation. Because in order for someone to understand ADHD, you have to be educated. And we were just talking about it. So much to know about ADHD. And when we're trying to have our partners understand our experiences, it's so hard for a person to understand if they're not educated and they're coming to the conversation with their own assumptions.

32:31So that's why I say start there. And then once you know where they're at with their understanding of ADHD, it's now important to say, okay, this is my experience. If your ADHD feels different across your cycle, postpartum, or in perimenopause, ADHD in Women explains why hormones can change your brain and what you can do about it. Pre-order now and for a limited time, get the first chapter audio read by me, Dr. Jolene Brighton, for free. Plus a bunch of other bonuses like a free recipe guide and a PMDD workshop. Claim your bonuses at drbrighton.com slash ADHD in Women. That's D-R-B-R-I-G-H-T-E-N.com slash A-D-H-D and women.

33:40listen. Live your story with Coach. Learn more at coach.com.

33:48In a similar vein, but a different relationship dynamic, Dr. Lockhart, this person says, my daughter was recently diagnosed with ADHD. She has her IRB, but the teachers keep telling us, why don't you just get her on a medication? And they're not willing to meet her needs and her accommodations. How can I have a successful conversation with teachers and advocate for my daughter? Great question. What the evidence has shown is kids are going to be more successful who have an ADHD diagnosis if you approach it from a variety of perspectives. It needs to be a holistic perspective. So parent training and education is vital because the way you parent an ADHD kid is different than the way you parent another child who does not have ADHD or any other a neurodevelopmental disorder.

34:34Teacher education and accommodations are going to be important because some accommodations will need to be made, whether it's untimed tests or reduced homework or one-on-one testing, anything like that. Also teaching the child. So educating the kid on their diagnosis, helping them understand what ADHD looks like, how it shows up for them, where their strengths are and where their challenges are. They're like, yeah, maybe medication is going to be helpful, but also these are the other things that I need. What are you going to be doing in the classroom for my child as well too?

35:17Yeah, I think that first asking the student, your child may not want their teacher to know that they have ADHD. It is personal information. So first asking your teenager, your kid, like, this is a new diagnosis. This is the medication that you're on or we're thinking of. How do you feel about the principal or your teacher, teachers knowing about this first? And then, okay, so how would you like to go about talking to them about it? You know, would you like me to initiate the conversation for you? Would you like to go along, initiate it for yourself? And then speaking to the teacher once you get the, okay, that, you know, my kid recently got an evaluation.

35:52It looks like there's ADHD and attentive type. This is how it shows up. These are the accommodations that were recommended. What reasonable accommodations can you provide for our kid? What does that look like? They're concerned about being pulled out of class or they're concerned about being seen as a favorite or they're being seen as different. How can we work together so that they don't feel like they're the odd one out? I really appreciate that you centered the child back into the conversation. I think that gets missed so often. So often. Yeah. So far, we have covered the where. So we've talked about relationships, school, work, home.

36:24So if you haven't noted where yet your symptoms show up and where they're affecting you most, I would definitely encourage you to do that. One question that I had that I think is really important is, Dr. Simone, how do I find someone qualified enough to evaluate me? What credentials are we looking for? What should we ask before booking? And what are the red flags? Most of my patients come through direct referrals. So people who already have worked with me. So family and friends of current patients, therapists that I work with, therapists who trust me. So first, ask your community. If you're comfortable with sharing that you're seeking this out, ask your friends, ask your family, ask your co-workers if you're comfortable with that.

37:07again. Google online psychiatrist, specifically women's mental health, reproductive psychiatrist, female psychiatrist, and on their website specifically, see if they talk about working with women. I think in general, psychiatrists who have a particular interest working with women will say that on their website. If you have to use insurance, I guess the easiest way would be to look through your insurance panel. It's not the best way, but I think that's one of the easier ways. I want to ask outside of psychiatry because some people live in rural areas. Are there other providers, maybe social workers or other people that they could see that would be able to do an assessment?

37:46Psychologists and psychiatrists are trained to do evaluations and assessments and some primary care providers actually like pediatricians and family medicine doctors, internal medicine doctors are also comfortable with doing this. Okay, I'm going to ask a kind of loaded question here, but if your PCP says there's no way you could have ADHD, they say they gave you an evaluation, but you were like, something else is going on. Would you recommend a second opinion? A hundred percent. All right. What are the red flags to avoid? If you're in a visit and this pops up, the doctor only spends 15, 20 minutes with you on the first appointment.

38:19An ADHD evaluation cannot be completed in 15, 20 minutes. That's literally impossible. Two is you bring something up and they just dismiss it and move on to something else. Clearly like they don't want to talk about it or dig deeper. Three, they don't ask you about your childhood history. Four would be they only look at your online forms and they say you do or you do not have it without asking any sort of question about it. And I would say five is they say, everyone thinks they're ADHD these days. It's so true though. That would be so offensive. I would never say that to a patient. I had a client that came in and stated that they definitely didn't have ADHD because they got assessed.

38:57And I was like, okay, where did you get the assessment? I always like to collaborate and better understand. And they said they didn't even meet the qualifications to do the proper assessment. I do think that's a red flag. And also, too, what I hear often is that when kids or teens get diagnosed by their primary care physician, it is just a screener. They're doing a Vanderbilt, for example, and they're just like, oh, oh, no, you definitely have it or you definitely don't. It's like, well, again, it's a rule out diagnosis. So there's things that could be popping up as concerns that may be concerns because of something else completely, a learning challenge or a math disability or something else.

39:34Or a nutrient deficiency. Right, exactly. And so I always make sure that kids, like you said, is making sure they have a medical evaluation because maybe they're iron deficient. That's why they can't focus in school. Maybe there's a thyroid issue. There can be so many other things going on. Yeah, it goes back to the clinical assessment piece. It's not just one piece of paper. Exactly. Yeah, if it was, it would be that easy, right? We would love that. Right. Yeah, I want to go into other things that should be ruled out with ADHD. But what I do want to say about that is that one of the biggest problems, someone might be like, what's the big deal if my kid doesn't have ADHD, but they get these accommodations?

40:09The medications that we use in animal models have been shown that in a non-ADHD brain, they can actually induce issues in the brain, like inflammation, reactive oxygen species. And that, I think, is something that should give us all pause. We want to be certain that the person that we're medicating, their brain needs that medication. I'm sure Dr. Simone would echo that as well. Now, we've offered up hypothyroidism, iron deficiency, anemia. What other things should we rule out before diagnosing ADHD? Dr. Simone, do you want to start? Anxiety. Anxiety can definitely look like ADHD. The lack of focus because you're worrying so much.

40:46Depression. One of the symptom criteria for depression is poor concentration. and OCD, again, being distracted by your own obsessive thoughts, intrusive thoughts. So a lot of poor focus there too. Anything you would add? Yeah. Learning challenges. You might have dyslexia, dyspraxia. I mean, there's all kinds of different speech and language and academic challenges that can come up. And so you're not focusing on math because maybe you don't understand what you're seeing. You're flipping numbers and letters and that kind of stuff. I also think other types of events going on at home, like social divorce, families, domestic violence, a lot of the adverse childhood experiences, a parent that's incarcerated, abuse in the home, alcoholism, those things can take away your presence in the classroom or because you're focused and thinking on what just happened.

41:38My dad just got arrested last night kind of thing. So I think we have to also pay attention to the psychosocial factors as well as could it be ADHD or maybe is there something else that's going on with this kid. And all of these things can also go along with ADHD, which is why you have to meet with the professional. I do want to talk about specifically in childhood experiences, there are disparities when it comes to getting a diagnosis. So we were on a previous podcast episode together and you shared with me that it's, and correct me if I'm wrong, but black boys are often diagnosed as having oppositional defiance disorder rather than ADHD.

42:19I recently read another study where Black and Latina women, if they're diagnosed with ADHD as adults, if, right, they have a bigger delay, but they're less likely to be offered medication. If they are offered medication, it's a shorter period of time and they are not given other things like cognitive behavioral therapy or occupational therapy. They're just told like, this is the way it is. So can you speak a bit to that? Because we've been talking about getting diagnosed and here's the things that you can track and look for red flags, but there is inherent bias in the system that I want people to know that's not a them problem.

42:55It's a systemic problem. Yeah. This is a tough conversation for a lot of people because you have people on opposite ends of the spectrum who think that there's no such thing as systemic racism and disparities in medical care and psychological care. What a wonderful world to live in. I would like to be the reality. That's the past and that's not true. And there's so many things that people are, how they're treated differently and how they're diagnosed differently. And so it is true that we do see that young black boys compared to white boys are diagnosed at a different, different ways for the same behavior.

43:27And a lot of times little black kids are seen as oppositional for that same behavior you're seeing from a white child. So we do see that and that's pretty consistent over the spectrum of development. But same thing with women and how women will come in, but they're seen as medication seeking or being overly dramatic or being dismissed. We've seen so many videos recently with hospital care and how women are treated and for pain and that kind of stuff. So there is a reality of that. And I think that we have to be aware that when our kids are telling us, like, my teacher treats me differently or that I got in trouble for this, but the other kid doing the same thing didn't get it, that we need to listen and we need to pay attention to it because I hear that quite often.

44:10And as I like to always say, for my haters, I will have all the research studies linked in the show notes so that you can see the evidence of what people are facing because it's not just our clinical opinions. It's not just our observations, but studies have been done because these disparities are causing significant harm. And when we talk about ODD, that is something that that child often gets labeled. And for the rest of their life, that label follows them. Can you talk about like, why is that such a problem? That's why people cite the school to prison pipeline, because if you are treating a kid like they are the problem and that they're getting in trouble, they're getting kicked out, there's suspension, detention, getting sent to the principal's office, being written up.

44:55Your parent has to leave work to come pick you up. So now they're missing out on work. and this then you are becoming the problem child for the same behavior maybe other kids are doing you can see how then there's this self-fulfilling prophecy that well I'm just a bad kid and I remember there was a movie years ago that we watched um Zootopia the first one and there uh there's a fox in it and he's just seen as a sly fox and I remember he's speaking to the bunny and he's like you know I remember early on people always just saw me as a sly fox and if I was just nothing but trouble. Why should I be anything but?

45:31And I always, I was like, wow, that is deep and so powerful. And that's the danger in labeling a kid with this ODD who's the problem child, because now what is going to happen is that's who they're going to be. And I would see like these ODD kids and then they would come and I'd be like, okay, they are not showing any signs of ODD with me. Like they're playing, they're not like, and I would purposely try to beat them in games and, you know, and I would like trash talk. And they were just like, that's okay, Dr. LaCarte, next round. I'm like thinking, how is this kid, this dysregulated kid that they keep talking about?

46:02And I would ask them, I'm like, you know, your mom, your sister, your teacher keeps saying that you're so like pushing back and you're mad when you don't win games. But in here, you're like, like no problems. And they're like, what's because I know you like me. Oh my gosh, my heart. Yeah. I know you like me and I want you to want me to keep coming back. It is a self-fulfilling prophecy. Maybe they're getting beat up at home. Maybe they're getting bullied. Maybe they feel stupid. Maybe they're, you know, being challenged in academics in ways that no one is finding. So I think we've got to be careful with the ODD diagnosis.

46:37That's a tough one. How do you see that play out in adults? Women coming to your practice. I mean, I know you primarily see women, but I'm just wondering overall, like, what does this do when the child's brain has developed under this kind of pressure? How does the adult show up in life? Women tend to internalize things, right? They're being told this their whole life. They're ditzy. There's something wrong with them. They're late. They're lazy. They internalize it. And so a lot of downstream effects actually of ADHD can be depression and anxiety. And what you said earlier about the child kind of becoming who they are, I think that's so true.

47:12Like if you're constantly told something about yourself, you become that just like a self-fulfilling prophecy. If I could give parents one tip, one thing that I do with my sons before they go to bed every night is I tell them, I'm so proud of who you are in this world. And I'm just in awe of like watching you. And then I go through the things that are their talents and the things I know they feel good about. And my husband said to me like, I love that. Like, I wish someone would have said that to me as a child. And I'm like, that's exactly why I say it. Yeah, I was actually late diagnosed with ADHD and misdiagnosed as bipolar in childhood.

47:48I was struggling keeping friends. I was impulsively lying all the time. I was dysregulated. I was screaming. And I went to the therapist. I got diagnosed with bipolar. They gave me medication. I became a zombie. And then around the age 15, I actually advocated. Looking back, I advocated for myself. I was like, I don't want to take medication anymore. I don't like this. My mom, thankfully, was like, okay, that's fine. And my mom did everything that she could. But when growing up, I was literally told every single day I wasn't the proper person, that I'm incapable, that, I mean, in high school, they didn't even give me a language because I was too stupid.

48:35That's what they told me. I couldn't do it. I was forced into what was called a focus program where I had three periods and then I was released from high school. And it was the place that all the kids that needed to graduate for the district to look good, but couldn't do it. And it was because we weren't understood. We weren't supported. They become imprinted on you. Yeah, absolutely. That's awful, by the way. Yeah. I think that's why I really appreciate you sharing that because I see 15 through adults. And And when I work with ADHD, women and men, one of the things that I make sure that I do is when we work on executive functioning and they come back, even if there's movement toward the thing we're working on, I talk about, I'm so proud of you.

49:18You should be so proud of yourself. Look at how this was so hard for you, but you even just thought about it. And to be able to just praise yourself for those small things, that it's not an expectation that you should always meet all the time, that you can celebrate those little wins. So I think that's so important. So even as a psychologist, to be able to do that for your client, I think is so helpful. Well, thank you all for helping us answer the question for those listening. Now, for you listening, if you felt seen in this, understood for the first time, recognized, could you share this episode?

49:46Coming up in the series, we're going to be talking about perimenopause, cyclical hormones, how those impact ADHD. We're going to take a deep dive into medications for ADHD, for PMDD, and otherwise. We'll also be talking a lot about relationships and what it looks like to maintain pain friendships, romantic partnerships as an ADHD-er, and providing you tips along the way on things like what you can do nutritionally, what you can do with your lifestyle, and what you can do to partner with a provider to make medicine work for you. As always, I appreciate your time. I know it's your scarcest resource and you chose to spend it with us today.

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