Navigating ADHD with Girls and Women - Episode 2

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Transcript

SPEAKER_01 0:00

Welcome to My Medicine. And today we are continuing our talk with Chastity Simmons Tablet on ADHD among girls and women. Before we begin, here are a few important CME announcements. This episode is accredited for AMA PRA Category One credits for full accreditation, designation, and disclosure information. Please refer to the show notes. And now the show.

SPEAKER_00 0:51

Okay. So I think in a situation like that, one of the best things that the clinician can do is to, you know, just to be aware of how much education they have around what ADHD looks like in females first. I mean, and just being honest with, you know, have I had very much information or very much education on ADHD specifically in females, so that I have a good baseline understanding of it so that when I'm as I'm hearing things, I can consider how this symptom might be related to to ADHD when I'm looking at the broader picture. And clinicians may have to seek it out because it may not be a requirement. It may not be readily available information. They may have to take the initiative to be really intentional about getting this information in order to provide the best care. Okay, so that's just a first. Okay. The second thing is because we know that ADHD is commonly thought about as presenting as it would in young boys, that hyperactive disruptive piece. So it's generally based on hyperactivity as it presents in males. So having that awareness that whatever screener they may be using may be tailored more towards the presentation of symptoms in males versus how it appears in women. So you will have to look at um look at other aspects of what's going on with this female in front of you. Okay. So we need an ADHD model that shifts away from behavior and more towards impairment. So for clinicians specifically when they are diagnosing that shift from behavior to an impairment model, considering the hormonal, how the hormones are affecting her, where she is in her menstrual cycle, or perhaps is she in perimenopause? Has she gone through menopause? You know, considering considering how estrogen in that moment may be impacting what's going on, considering the later appearance of symptoms. I know that for some of the criteria for an ADHD diagnosis, some things need to have been present earlier in life, but because ADHD looks different in women, in females versus males, that may not have been picked up earlier in life. And because estrogen and those hormonal shifts really impact a female's ADHD, those symptoms may not have been as apparent until puberty, which um happens a little bit later. Okay, so there may have been minimal childhood symptoms for for um the female. Looking at how impairments worsen over time, okay, there will be subtle, less impaired presentation. Um, you're gonna be looking for things like um anxiety, depression. Is this primary or secondary to ADHD? You know, looking at a sexual history, is there an impulsive sexual history? Um considering comorbid uh conditions secondary to ADHD instead of thinking of them uh initially as primary conditions. Um consider how women motivate how they masks they mask symptoms, okay? And they spend a lot of time overcompensating. So they might not have the kind of struggle that um a male is having, but they may be expending an enormous amount of energy masking and overcompensating, which in itself is making them more unable to focus and concentrate on the things that they need to be getting done. Do not discount the fact that there is not hyperactivity and impulsivity presentations as they would be in males. Okay. You know, um, that's really, really important to just have that understanding and education about what the more nuanced symptoms look like. Like what does that inattention look like? And to consider those things and also how girls also internalize because of the social aspect, they internalize a lot of what's going on. And inner restlessness, maybe hyperactivity, being hyperverbal can be an expression of um hyperactivity. Um it can be there, it just may not look like it does in males. They can also consider, you know, like how is school being affected? How are their social relationships being affected? You know, just so just broadening the questions that they're asking and the information they're looking for when they're making a diagnosis.

SPEAKER_01 6:06

So let's say, okay, we got the diagnosis. We uh, you know, especially since you mentioned earlier, like one in 20 um adults are diagnosed, I believe you said, and then you know, probably more carrying it than than we think. But let's say we we we uh we we got a proper diagnosis, we nailed it. This person, this lady walked in, ADHD. Okay, we're on it. What what are some treatment options? Um I mean, of course, I'm imagining, you know, medication, of course, but you know, let's let's talk about the game. But what how would we how would we build a service plan for this person?

SPEAKER_00 6:41

Let me speak to this part first. There's a there's a little a little side note here in addressing this. So for for females who are looking for treatment, looking for diagnosis and treatment, it is really imperative and can be can be difficult to find someone who has some experience working with women or females with ADHD and treating them. Okay. Um that that's gonna be really helpful because they're gonna have that information that they need to move forward with the diagnosis and the treatment, okay? Um so medication can be very helpful, incredibly helpful, and stimulants are the best treatment option, although there are others. However, I think sometimes when um women are being treated, they may not be always, they may not always be being offered the best option. Maybe there's a lot of worry about um addiction to stimulants or something, but it really is the best the best medication for women. Also, um because of the hormonal shifts, um sometimes in that second half of the menstrual cycle during the luteol phase, um even adding a little bit more of just slightly increasing that dosage of the stimulant can help manage those symptoms that get so much worse during that time. You know, so that hormonal stuff has to be considered in the management. Um family psychoeducation, being sure to give information that is written in a way that she can best consume so that she can take it home and understand the impact of ADHD, what it looks like, the symptoms, how it will affect her, can affect her both at school and socially, how it can affect her health. Um it's really important to be able to walk out with that information so that if they're unable to focus really well while in the doctor's office, they can take it home when they have more attention, maybe more time, more quiet, less distraction to really focus on it so that they themselves can be educated about what's going on with them. And that's a really important piece. Um there are coaches that can help women and girls develop um skills to manage things like organization, to help with focus, to help with um time management. Um, and then support groups are also an important piece because because of that social aspect that takes place in females' lives, you know, it can be really helpful to be with other women who might be struggling with the same issue and to be able to come together and connect with people in that way, because so often women, females with ADHD can feel so isolated and alone as they're trying to navigate the social um environment. So having that support group and not feeling isolated can be really, really important in increasing mental health, which can just positively affect so many other aspects of that female's life and health and well-being.

SPEAKER_01 10:23

Interesting. So, you know, I I know we talked a lot about you know ways of approaching, uh, ways of diagnosing ways of approaching, particular uh to girls and women with ADHD. But you know, sometimes, you know, the mat we have masking, but and ways to cover up the the negative, I guess, side of ADHD. But I mean, many people like to embrace their ADHD-ness, their neurodivergence-ness. Um what what are some benefits of of you know being being an ADHD? Especially particularly for women and girls.

SPEAKER_00 11:00

Yeah, so um one of the um ways that the way that I like to think of ADHD is that it's um, like I said, a bit of a superpower, but you have to manage, you have to learn how best to manage um some of the symptoms, okay? So um people with ADHD, some of the positives benefits can be can be that hyperfocus. I mean, um I was reading and I think that there was um a little blurb about Edison and invention of the light bulb, and that it took 3,000 tries, and that the suspicion is that perhaps he had ADHD and his he was using his hyperfocus to keep at it, which allowed him to do those 3,000 attempts. And so thus we had the light bulb, right? So the hyperfocus, you can do a really deep dive into some information, which can be really helpful in in certain for certain positions, jobs. Resilience. Um, things can be a lot harder for folks with ADHD. Um being neurodivergent and living in a neurotypical world can be really difficult. And so you sort of develop a resilience of to keep trying, keep to get to stand back up, to keep going, you know. Um ADHDers are often people people, if that makes sense, you know, like they're they're warm, genuine. Um, there's there's generosity, empathy. Um, they care about fairness because they've spent some time in a world that where things are not equal. Um they often have a great sense of humor. There can be a lot of compassion because, again, you know, that struggle can can sort of really build in that compassion piece. They are persistent, which is really wonderful, especially with problem solving. ADHDers can be really wonderful problem solvers and very have a hopeful, positive, oh, I can figure something out attitude, you know. Um and incredibly creative, the ability to think about any idea from like multiple perspectives, out really outside of really outside of the box thinking, if that if that makes sense, and really being able to turn it around and look at it so that you can figure out how to tackle it, how best to understand it, how to represent it, you know, um in any music, art, you know, whatever you want to do. There's just so many positives that go along with ADHD. And I really hope that that stigma that's uh surrounds it, um, and the feeling that um people with ADHD can get about themselves and their self-esteem and self-worth because of the lack of education out in our world and in clinicians, um and the difficulties that can be in navigating that social environment, um especially during middle school, how that can decrease our self-worth and self-esteem. But really, there's just so many positives. And um, I hope that we can get to a place where people are embracing those more, and um it's just seen as something that is giving versus deficits, if that makes sense.

SPEAKER_01 14:52

Absolutely. And that all those positives, you know, as they do definitely contrast with the negatives. I mean, I remember in in yeah, we've heard all these stories about these like super ADHDers that get into positions of power influence and creativity, and you know, this is success, and and they do credit their uh ADHD superpowers for uh being able to get them. Of course, having worked in uh a jail, I can also tell you there's a lot of ADHDers that ended up in a different direction, you know, and their symptoms definitely drove them in that direction. So it is very interesting how sometimes the uh same similar set of symptoms can can yield a high proportion of them on either end of the bell curve when it comes to social success, CEO or prisoner, you know. Yeah, yeah.

SPEAKER_00 15:40

I think that can um have a lot to do with where it's focused, you know. You can you can focus, um, you can hyper focus on um how to how to steal that thing, you know what I mean? You can hyper-focus on that and get really good at it, or you can hyper-focus on, you know, the come coming up with a new idea, opening a new company, you know. I think a lot of that has to do with to some degree, it can be influenced by, you know, the opportunities that we have, the people that surround us, um, and then probably a little bit of larger society knowing how to focus our strengths, you know, how to guide us towards focusing our strengths, you know. And if you're hearing, if you were um not diagnosed and your behaviors, this presentations of ADHD were seen as problematic and you were labeled as such and treated as such, then you know, that might be a natural outcome sometimes from from that, you know, which is just another reason that for us to increase our education and knowledge about ADHD and to be able to develop organizations and systems that really offer helpful supports that channel the strengths.

SPEAKER_01 17:04

So, where would we find out more? Where can we, as we're wrapping up today, where you know, we need more awareness, and this podcast will get us started here, but where else can we find more information on this? Uh uh, particularly for you know women dealing with ADHD.

SPEAKER_00 17:18

Additude magazine, A D D I T U D E magazine, has so many wonderful resources. You can go online, you can look, you can read articles. There are um lots of trainings that you can get um certificates for um through Attitude magazine. In fact, I spent my entire morning listening to yet another one this morning. Chad chadd.org. You can go there. Uh Canada has a really great ADHD website. Um, some of some and some of the other countries out outside the US have some really great and more in-depth information. I think maybe they've taken their understanding and education of ADHD a little more in-depth than the United States currently has. So um going to those places. Uh let's see. Duke has a um girls and women's ADHD center where they're doing research. So you can um that's that's a really wonderful resource that's pretty close to our our area, I think. You know, it's not it's not too far too much of a drive. Um ADHD network is a great place to go um for information. And I was yesterday I was listening to a presentation, and there's um there's a a woman, her name is Margaret Sibley. She's actually working on um gathering information and putting stuff together for training for clinicians. So actually looking her up and um what she's doing would be really helpful. Um Ellen Littman also is a really she's a clinical psychologist. She has wonderful, wonderful information on ADHD and women. So anything that you can listen to podcasts, anything she's written would be really helpful. Excellent.

SPEAKER_01 19:38

Just I think that wraps us up for today. Any parting words?

SPEAKER_00 19:42

So ADHD in women and girls is really important. We really need to increase our research, our education, um, and we really need to shift from thinking about the behaviors to the impairments. And then we also really need to embrace the positives that are so many and figure out ways that we can channel those positives in ways that help all of us.

SPEAKER_01 20:09

All right, well, thank you so much for coming on today.

SPEAKER_00 20:11

All right. Thank you for having me. It's been wonderful.

SPEAKER_01 20:15

You've been listening to Mind and Medicine, a Sentera podcast. As a reminder, please check the show notes for details on how to claim your continuing education credits, as well as any resources mentioned in the episode. That's it for now, but keep an eye out for another episode and more evidence based education for healthcare providers on the go. You will.