Shadowing Practice: What Makes ADHD in Women Different - Learn English Speaking with Video

So the first thing that we tend to see, which is very, very common, is we tend to attribute certain features of ADHD to sort of feminine failings.

And this even gets worse during puberty when we'll oftentimes see the manifestation of ADHD more.

And one of the key manifestations of ADHD is actually emotional dysregulation.

Ha!

She's menstruating.

She's on her period.

It's her time of the month.

So we tend to dismiss these symptoms of emotional dysregulation.

And at this point, the concept of ADHD has been removed from most people's brains.

Right, so your parents aren't really looking for a brand new ADHD diagnosis when you're 15.

Today, we're going to talk about ADHD in women.

And this is an incredibly important topic because when we think about ADHD, we're all aware of certain impairments.

So we know that kids with ADHD may need a little bit more time to take tests

or maybe a little bit distractible.

They may be hyperactive and fidgety.

But it turns out that the manifestation of ADHD in women is actually quite different.

And furthermore, there are so many difficulties that women with ADHD face that we don't think of as parts of ADHD.

In fact, we as a society tend to judge these women very, very harshly for being a bad woman.

So just as an example, we know that people with ADHD struggle with organization, right?

So like we know that if you've got ADHD, it's hard to stay organized.

It's hard to stick to a plan.

You're always running late.

And so that's a common problem that everyone with ADHD faces.

Now, when you look at someone who's a woman, this person has additional expectations in life.

So mothers are expected to pack their kids' lunches, make sure their school forms are signed, make sure their kids are always on time to school.

There are so many maternal or female-specific duties that we expect of women

that we don't really accommodate for if you have ADHD.

So it turns out that ADHD is very, very devastating in women.

Women with ADHD are much more likely to suffer from domestic abuse.

They're much more likely to suffer from or struggle with divorce or single parenting.

And so there are so many manifestations of ADHD that are gender specific that we absolutely have to dive into them.

Hey, y'all, if you're interested in applying some of the principles that we discuss to your life to actually create change, check out Dr. K's guide to mental health.

The guide synthesized my years of training as a monk, along with years of clinical experience as a psychiatrist to cover common topics like meditation,

ADHD, and trauma.

The guides include over 100 additional videos

that can be navigated based on your needs or interests or in a more open choose-your-own-adventure format.

The guides are now available in the YouTube store below, and if they're a little bit outside of your price point, you can check out a piece of them with our free resource packs,

which are also linked below.

So definitely check them out.

So if we want to understand this, we have to start with the original diagnosis of ADHD.

So this is kind of crazy, but when we first developed diagnostic criteria for ADHD, this was in the DSM, the original Diagnostic and Statistical Manual.

Basically, a group of people sat down and figured out, okay, what are the diagnostic criteria for ADHD?

And this original study, where they were figuring out what are the diagnostic criteria for ADHD, was done exclusively in European boys.

So from the get-go, in our diagnosis of ADHD, it is biased towards men.

And we see that because boys are three times as likely to be diagnosed with ADHD as girls.

The diagnosis is so much more common in boys.

And why is this?

It's because hyperactivity is one of the key features that leads to diagnosis.

So let's take a step back and think about how does a kid get a diagnosis of ADHD?

It's not like you wake up one day and you're like, let me take my kid to get a neuropsychological evaluation.

That's not what happens.

So what happens is you start with parents or teachers who are frustrated with a kid because the kid won't sit still.

The kid is disruptive.

The kid won't sit down at the dinner table and actually eat their food.

The kid won't sit there and pay attention in class.

So we get complaints.

So there's some kind of difficulty that usually starts the path of diagnosis.

And most of this difficulty relates to hyperactivity.

So this is a kid who literally won't still, so their physical manifestations of ADHD make it difficult to do whatever we're supposed to be doing.

Now, this is the first big difference between boys and girls.

So girls tend to not be nearly as hyperactive.

They're far more inattentive, so they have sort of inattention in their brain, which the boys will have too, but you won't see external signs.

So young girls with ADHD won't be disruptive because we're also socialized

or y'all are socialized as girls to not be a nuisance

and be polite and be respectful of others

and be a good little girl and sit in your chair and do your work.

So these girls tend to experience a lot of inattention.

And they also get described as things like spacey, right?

So there are some girls, oh, she's a little bit of an airhead.

She's forgetful.

Ha, ha, ha.

Little clueless girl.

Little blonde, right?

Like, oh, my God.

Like, it's not that big of a deal.

She's just spacey.

So the first thing that we tend to see, which is very very common, is we tend to attribute certain features of ADHD to sort of feminine failings.

And this even gets worse during puberty when we'll oftentimes see the manifestation of ADHD more, and one of the key manifestations of ADHD is actually emotional dysregulation.

But hey, guess what?

If you're a 14 year old girl and you're going through puberty and your emotions are dysregulated, Are people going to say,

oh my God, this girl is honestly suffering from a lot of problems.

Maybe she needs mental health support.

That's not what we say at all.

Ha, she's menstruating.

She's on her period.

It's her time of the month.

So we tend to dismiss these symptoms of emotional dysregulation, which is absolutely what we see in women with ADHD.

So let's take a quick look at some of the literature, and we'll kind of see this firsthand.

How are the symptoms of girls with ADHD or women with ADHD different?

So such as hyper-talkativeness, high arousal, fidgeting, flight of thoughts, internal restlessness, and emotional reactivity.

So if you see a girl who talks a lot, is very interested in things, is a little bit fidgety, her thoughts bounce all over the place,

and she's emotional, would we say, oh my god, this young girl is struggling with ADHD.

She needs our help.

No, that's not what we're going to say.

What we're going to say is, in women, these symptoms are often interpreted as signs of emotional difficulties.

Yeah, she has difficulty during the time of her menstruation.

You know, it's just her time of the month.

Disciplinary problems and learning or attention difficulties rather than symptoms of ADHD.

Yeah, she's not just as good of a girl as all of the other girls.

100

And yeah, it's just her being spacey.

101

This is literally what we see in ADHD.

102

So we also see that girls or women with ADHD manifest different kinds of symptoms.

103

So let's take a look at another paper that sort of highlights the gender differences in phenotypic expression.

104

Identify that girls with ADHD are less likely than boys to manifest a comorbid disruptive behavior.

105

So this is oftentimes what leads to diagnosis.

106

Girls with ADHD aren't as disruptive.

107

They're less likely to have a learning disability, less likely to engage in rule-breaking or externalizing behaviors, because this is how boys with ADHD get diagnosed.

108

And so if girls aren't exhibiting this, the likelihood that they get diagnosed is way less.

109

So what we find in girls is that they may exhibit higher levels of inattentiveness, internalizing symptoms, or comorbid conditions.

110

Separation anxiety, general anxiety, eating disorders, and depression, right?

111

So let's think about that for a second.

112

When girls have ADHD, they are more likely to manifest with other kinds of comorbid conditions.

113

So boys are more likely to have disruptive externalizing behaviors, oppositional defiant disorder, conduct disorder, rule breaking, this kind of stuff.

114

Whereas girls are more likely to have problems like eating disorders, more likely to have separation anxiety, right?

115

And if there's like a 10-year-old girl who doesn't want to go to school, we don't say, oh my God, this girl may be struggling with ADHD.

116

We say, oh my God, she's such a soft-hearted little soul.

117

Look at how much she loves her mommy and daddy.

118

You got to be a strong girl to go to school.

119

We have to be big grown-up boss babes.

120

Let's go.

121

You can do it, my darling.

122

I love you.

123

And this is what leads to crippling self-esteem.

124

Because just like boys with ADHD, girls with ADHD who struggle get told that if you work harder,

125

if you expend more effort, if you just apply yourself a little bit more.

126

If you do all of these things that are effort-based, then these problems would not exist.

127

But the whole problem with ADHD is that they aren't effort-based.

128

There is neurodiversity at play.

129

So the way that this girl's brain is wired is different,

130

which makes it impossible or very difficult to do things that neurotypical girls can do.

131

But we don't treat girls that way, which is why one of the reasons, one of the manifestations that we see with ADHD is crippling self-esteem.

132

And that too, we sort of, is like a more of a feminine characteristic.

133

In society, we sort of acknowledge, right, that like girls sometimes have self-esteem problems, and it's because of things like the way that they dress

134

and because of thigh gaps and because of makeup and because of Botox.

135

And we have all this crap that gives girls self-esteem problems.

136

And so then we are doing these girls with ADHD a huge disservice.

137

Because when they have self-esteem problems, we don't consider that it's ADHD.

138

We consider that it's this pile of other stuff, like unrealistic feminine beauty standards.

139

Which I'm not saying that those aren't real problems.

140

My issue is that as a clinician, when I work with women with ADHD, it's that so many features of the ADHD get attributed to other things

141

because we don't take this as a clinical concept in women seriously.

142

And so let's take a quick look at some of the consequences of misdiagnosis or misdiagnosis or misdiagnosis on young women, okay?

143

So we see a diminished self-image and self-esteem.

144

We talked about that.

145

less developed or underdeveloped interpersonal sensitivity skills and awareness of relationship dynamics.

146

We're going to dive into relationships a lot.

147

Decreased information processing skills, inability to plan and organize effectively without feeling overwhelmed, and increased emotional reactivity.

148

Now we're beginning to see that if you are a woman with ADHD, it isn't just the standard stuff that we're aware of, like difficulty at school or difficulty at work, where people may give you accommodations.

149

The real struggle with women with ADHD is that there is a societal set of expectations, which ADHD makes it almost impossible to achieve.

150

And so we're going to focus a little bit more on that.

151

So I kind of got off track.

152

Let's go back to why diagnosis is different.

153

So let's dive into the biology of ADHD in women, because this is also different.

154

So we have to understand this, okay?

155

So let's go back to this concept of misdiagnosis, right?

156

Because this leads to a lot of the problems that women face.

157

So why is diagnosis so different?

158

So hyperactivity is a huge piece of it.

159

But another piece is that girls do mature faster than boys.

160

So if we look at sort of gray matter studies in the brain, so these are studies that are looking at brain volumes and how capable boys versus girls are,

161

what we see is that the maturity of an 11

162

and a half year old boy is something that a girl achieves around age 10.

163

So we're sort of looking at the bar for what a kid should be able to do, like how long should a kid be able to sit still.

164

A 10-year-old boy will say, okay, they should be able to sit still for an hour.

165

The challenge is that since all of our diagnosis is based on male standards, what happens is we have girls who are one year older in terms of brain development,

166

but they're with a group of kids who are all like 10 years old, right?

167

So you have a girl who has an 11-year-old brain who is in a group with all of these 10-year-olds.

168

So this is why we miss ADHD, because this girl should be operating at an 11-year-old level, but that's not the way that we judge her.

169

We judge her as if she's one year younger because that's like her brain is supposed to mature faster.

170

I don't know if this kind of makes sense, but basically what goes on is since girls mature faster than boys do,

171

since their brain literally develops more rapidly in some ways than boys do, they're effectively one year older.

172

And that one year of additional brain development masks the impairments of ADHD

173

because we're comparing an 11-year-old brain with ADHD to a bunch of 10-year-olds, and that kind of balances out.

174

So we see a big misdiagnosis there.

175

Now, there's also a huge hormonal and biological component.

176

So this is a huge tragedy in psychiatry that we tend to think of mental illness as static, right?

177

Depression is depression is depression.

178

Anxiety is anxiety, anxiety.

179

ADHD is ADHD is ADHD.

180

But the more that we're learning about the biology of mental illness, the more we're realizing that there is a hormonal component.

181

So whereas a man may experience ADHD uniformly all 30 days of the month and 365 days of the year,

182

there is a baseline fundamental fluctuation in women's attentional symptoms and experiences like emotions and things like that, that are hormonally based.

183

So we're going to dive into that a little bit, okay?

184

So the first thing to understand is that when women go through puberty, we see a surge of estrogen.

185

Now, this is what's really interesting.

186

When we see a surge of estrogen, what we also see is an upregulation of dopamine receptors and sensitivity in other parts of the brain.

187

So a young girl has less dopamine sensitivity than a girl in puberty, and this is an estrogen effect, which is why we see something that's really, really interesting.

188

If you look at the rates of adult diagnosis between men and women, it is one to one.

189

But boys to girls is three to one.

190

So why the difference?

191

Why is it that an adult woman is just as likely to be diagnosed with ADHD as an adult man?

192

And that's because as we actually go through puberty, that estrogen increases and we see more dopamine sensitivity.

193

Once we see dopamine sensitivity, then we see the emergence of a lot more classical ADHD symptoms.

194

So we'll see things like more impulsivity, right?

195

So remember, young girls are inattentive or spacey, whereas once they start hitting puberty, they become more impulsive.

196

They're more likely to engage in high-risk sexual behavior.

197

They're more likely to be sensitive to dopaminergic things like substances and stuff like that.

198

So it seems like something happens during puberty where the brain increases its sensitivity to dopamine, which in turn creates a lot of the more traditional ADHD symptoms.

199

Now, this doesn't quite work itself out beautifully because at this point, right, you're like a 13-year-old, 14-year-old, or even 15-year-old girl,

200

and there are studies that show that girls with ADHD start to hit puberty later or they develop more slowly.

201

So now we're talking about a 15-year-old who's like really starting to hit puberty.

202

And at this point, the concept of ADHD has been removed from most people's brains, Right.

203

So your parents aren't really looking for a brand new ADHD diagnosis when you're 15.

204

So there are a lot of other challenges that lead to misdiagnosis.

205

The other thing that tends to happen around the time of puberty is

206

that estrogen also increases the sensitivity to our internal emotional state.

207

So women are more likely to experience internalizing symptoms.

208

They're more likely to experience things like anxiety, depression, eating disorders, which we already looked at.

209

Right.

210

So we see a lot of these things start to emerge.

211

And once again, if you're a 15-year-old girl going through puberty

212

and you start to get concerned about your body

213

and you're not happy with your appearance and you're anxious about going to the beach, how are most people going to judge you?

214

Are they going to say, oh my God, this is a girl with ADHD who needs our help.

215

She needs help and support.

216

No, it is just the standard experience of being a young woman in the world, which is tragic in and of itself.

217

But now we're setting ourselves up for a huge failure because we are not intervening in the right way.

218

We are just saying this is the vagaries of the world that we live in.

219

This is a misogynistic society.

220

This is a feminine beauty standard.

221

These are all these kinds of things.

222

And when we say these massive, grandiose, systemic problems, how does that result in helping an actual girl who's struggling?

223

It doesn't.

224

So this is a huge problem that we see in ADHD.

225

Next thing that we're going to talk about is that there are some brain differences.

226

So we know that, for example, the splenium, which is sort of the rear part of the corpus callosum in girls is actually different compared to boys.

227

So this is a part of the brain that involves information processing and sort of awareness of your current state.

228

So this kind of once again leads to this spaciness that we see.

229

A lot of girls also start to struggle with ADHD during their teen years because when you're a teenager, we expect girls to do a better job of staying organized,

230

you know, doing well in school.

231

You got to be able to pack your bag.

232

You got to be able to go to your extracurriculars on time.

233

This is when girls start to become women.

234

And when girls start to become women, we expect them to be organized, helpful, and all of this kind of stuff.

235

And so we run into problems here, which result in this person not having ADHD, but being a bad woman, which is a huge part of ADHD.

236

So once we end up with adult women, what we tend to find is that we judge these women incredibly harshly for failures of being a good woman.

237

We don't even think about ADHD.

238

I tried to plan ahead and get things started earlier, but I just couldn't do it.

239

It was as if I needed the panic of not understanding something

240

and knowing that I would get a test in it to get the adrenaline going so that I could get it done.

241

It's extremely stressful, especially since you're also beating yourself up because you're thinking, how dumb, and here I did it again.

242

Why can't I just do it ahead of time?

243

Now, any person with ADHD will empathize with this experience.

244

Why do I need this adrenaline and last minute panic to really just get started?

245

The challenge with women is that they have an additional layer of this.

246

It's not just about the test.

247

It's about planning your birthday party, planning your friend's birthday party, making sure that my divorced parents, my dad's fridge is stocked, right?

248

Because we see a lot of parentification of girls into women, especially in single-parent households, where there's an adult male who is incapable of taking care of themselves.

249

So these organizational difficulties start to pile on.

250

One of the participants did not have academic problems, but struggled socially and particularly with regulating her emotions.

251

I remember having temper tantrums that would scare me because I realized that I couldn't control them, and I didn't even know why I was so upset.

252

Consistent with the literature on women with ADHD, inattention, disorganization, poor time management,

253

motivational difficulties, and problems with planning and structuring daily tasks have resulted in significant academic,

254

occupational, and psychological challenges for most of the women.

255

In the absence, this is the key thing, in the absence of a better explanation,

256

the women blamed their struggles on perceived personal flaws such as laziness, lack of effort, and capability,

257

which over time contributed to a negative self-image that followed several of the women into adulthood.

258

Now, this is going to become really important when we get to the treatment section, because it turns out evidence-based treatments of ADHD don't work so well in women.

259

And this is part of the reason, because the experience of women with ADHD is different.

260

They're perceived not only as like academic challenges and professional challenges.

261

Sure, we all are aware of ADHD, but there are so many personal failings, a lack of effort, a lack of organization.

262

There are so many gendered constructs that we have where we expect so much from women, and women with ADHD fail at this stuff.

263

So they conclude that they are not good women.

264

And one prime example of this is in relationships.

265

So it turns out that women with ADHD have specific challenges that are actually quite shocking in relationships.

266

So in relationships, we expect women to do things like be emotionally available, be the planners and organizers, be the caretaker of the household,

267

make sure our fridge is stocked, make sure the kids get to, you know, extracurriculars on time.

268

These are all gendered responsibilities.

269

Sure, things are moving in the right direction and things are more 50-50 now, but we still, generally speaking, expect women to be able to do these things.

270

And even I've worked with women who, because they have ADHD, struggle to do these things.

271

And even if they have a supportive partner who's willing to shoulder the load, it still doesn't shake the judgment, right?

272

So this is very important to understand.

273

I don't know if a lot of dudes are going to really understand this, but what I've observed when I work with women, even when I look at my own wife, is that even if you're in a relationship with a man who's like 50-50,

274

they help with the kids and stuff like that, it does not stop, especially the other women in your life for judging you, right?

275

So you have these like stay-at-home moms or trad wives or whatever, who like, if your husband does half the work, they're gonna look at you and be like,

276

this person can't even handle this kind of stuff, right?

277

This person needs help.

278

She's not a good woman.

279

The judgment is so cutting.

280

It's like death from a thousand cuts.

281

I've seen this crap.

282

It's so fucking toxic, right?

283

We don't ever consider that like, oh, like, and there's also some weird amount of like jealousy there where like, oh yeah, you managed to marry a guy who actually fucking helps out in the household.

284

I am so jealous of you, but I'm not allowed to be jealous of you.

285

So instead, what I'm going to do is I'm going to death by a thousand cuts

286

and I'm going to slightly insult you at every opportunity that I can.

287

And I'm going to shit talk you to all the people on our WhatsApp group

288

because that makes me feel better about myself.

289

It's so crazy

290

that even the women who managed to solve this problem by getting help from their partner are

291

so harshly judged by their mother-in-law, right?

292

It's like such a mess.

293

So let's take a quick look at some of the research that sort of highlights some of this stuff.

294

So another participant says that she began feeling the effects of ADHD-related challenges on self-esteem first as an adult,

295

largely due to her problems mastering many of the skills that are involved in maintaining and building a good relationship.

296

So we sort of assume that girls are capable of being good friends.

297

But women with ADHD struggle with this as well.

298

So we, women, been raised to take on a lot of responsibilities and make sure that things are okay, right?

299

So this is important to understand.

300

I want to pause here for a second.

301

See, another big problem with women with ADHD is that the default responsibility is usually the woman's, right?

302

So if you're a woman, like, and you're in a relationship with a man, you kind of know what I'm talking about, where, like, the man is going to be like, okay, I'm going to try to help out, right?

303

So we're going to, Like things are going to be 50-50.

304

But if something falls through, it is your job as a woman.

305

You take the cognitive responsibility.

306

The cognitive load is what you bear.

307

So even if you have a husband who goes to the grocery store, right?

308

Like the man of the house rarely goes through your fridge, goes through your pantry, thinks about how like what the menu for the school is going to be for the next week,

309

figures out which days your kids are going to eat school lunch

310

and which days they're going to eat home lunch there's all this cognitive load

311

that defaults to the woman and then gets passed on in some way to the man, right?

312

So then you do all this calculation as a woman, and then you like give your husband a grocery list, and then they'll go and help out.

313

So that's like, good job, bros.

314

Like, we're not saying that you're doing a bad job, but let's remember that a lot of this responsibility, the subconscious or conscious responsibility for staying organized falls to the woman.

315

If the man makes a mistake, like that's fair enough, they made a mistake, but that sort of defaults to the woman as a cognitive load.

316

So let's keep going.

317

And I think it can be extra challenging for women with

318

ADHD since women almost are expected to have an inborn ability to organize and maintain things in order.

319

When I drop my daughter off at the daycare, I'm always late, and I can see what the teachers are thinking.

320

People think you're a bad mother.

321

And this is absolutely the experience of women with ADHD.

322

Things became much harder for me when I became a mom because of the constant interruptions from my children.

323

I remember being exhausted by the end of the day, absolutely exhausted.

324

There are so many things you have to do when you're a mom.

325

At work, it was much easier because it was organized.

326

If I had a problem, I would just call someone and get it fixed.

327

While with kids, you can't do that.

328

So much responsibility lied on me as a mother, which was stressful.

329

So we tend to see that women have an additional challenge

330

when they have ADHD when it comes to being a good mom, because you have to stay organized and it's not like anyone is gonna judge you less harshly.

331

There's no accommodation, right?

332

So if you're taking a test, cool, you get a letter from your psychiatrist and your school is like, you can have two extra hours to take the test.

333

Doesn't work for the rest of life.

334

You don't have two extra hours to make sure your kid is on time for swim practice.

335

You don't have two extra hours to make sure that your kids are organized and leave for school in the morning.

336

So this is where there are some accommodations which we offer society.

337

But these accommodations tend to be gender neutral, if not male favored.

338

And there's a whole host of other problems that women face.

339

So the next thing that we're going to talk about is relationships in ADHD.

340

So this is where like, this is some of the most shocking stuff that I have ever seen, like in scientific literature.

341

We know that people with ADHD have relationship difficulties.

342

The challenge is that the gendered expectations of men versus women

343

and the way that ADHD intersects with them are far more forgiving for men than they are for women.

344

Now, if you're a dude in the audience, chances are you will take issues with the statement.

345

You will say, Dr. K, how dare you say this because I am a man and I struggle in relationships with ADHD as well.

346

I'm not saying that you don't struggle.

347

I'm not trying to say that men have it easy, okay, by any means.

348

I have to fucking say this every time I make any video about a gender or any related thing.

349

We're going to look at the data.

350

So the challenge is that once again, the gendered expectations that women have of what they bring to a relationship, those expectations are far harder to meet.

351

There are gendered expectations that are hard for men to meet as well.

352

For example, ADHD leads to lack of professional success and men are expected to be the breadwinners.

353

So it exists in men too, but this isn't a video about men.

354

This is a video about women.

355

So let's look at the gendered expectations of women.

356

So women with ADHD really struggle in relationships because, first of all, they're expected to be emotionally available.

357

They're expected to be calmer.

358

They're expected to be the emotional caregivers in the relationship.

359

But when your brain is struggling with emotional dysregulation,

360

when you have an estrogen-based increase in intensity from the shame that you feel for not being a good woman,

361

when all of these things kind of pile on, and furthermore, when you do get emotional, it gets attributed to period, or she's so emotional, she's a woman,

362

or she's spacey, all this crap kinds of pile on, it leads to terrible outcomes.

363

Nadeau and Quinn reported that these women are often less able to be consistent parents, are less able to manage their jobs and households,

364

and are at higher risk for divorce and single parenting.

365

So this is shocking.

366

Nearly 60% of non-ADHD men had left their female partner with

367

ADHD compared to only 10% of non-ADHD women leaving their male partner with ADHD.

368

And male partners with ADHD compared to female partners of men with ADHD reported significantly lower overall functioning.

369

So what this means, if you're a woman with ADHD and you're dating a dude who doesn't have ADHD,

370

they're 60% likely to leave you in part because of your ADHD.

371

Whereas if you flip the genders around, it's only 10%.

372

Women recognize that dudes have ADHD.

373

They're hyperactive.

374

They can't sit still, whatever.

375

And for whatever reason, they're less likely to leave their partner.

376

But if you flip the scenario around, it's actually 60% of men who do not have ADHD will leave a partner in partially due to their ADHD.

377

Like that is staggering, right?

378

This is not a benign gender difference.

379

This is something that we absolutely have to consider, right?

380

This is a challenge that so many women face with ADHD.

381

It's not just that it's hard to succeed academically.

382

It's not just that it's hard to succeed professionally.

383

It's at the risk of divorce and single parenting are way higher.

384

And it is harder to be a good parent.

385

It's harder to be a good mother because you struggle with organizational skills.

386

But this is just, this isn't the end of it, right?

387

So this is the most shocking statistic.

388

So if you look at women, if you're a woman who's born today or alive today, you have a 6.3% chance to suffer from intimate partner violence, okay?

389

Just so there's like it's bad, right?

390

It's like men are I think less likely to suffer from it

391

But the key thing here is that you have a six percent chance

392

So that means that 94% of women are gonna be okay

393

when it comes to intimate partner violence Like that's not a good statistic.

394

It should be zero, but like it is what it is Here's the crazy thing.

395

If you're a woman with ADHD 30.7%

396

30.7% It is a five-fold increase one out of three women with ADHD suffer from intimate partner violence.

397

This is insane Women with ADHD are more likely to get pregnant, more likely to have STIs, right?

398

Because like, let's be honest, boys don't like to use condoms.

399

Boys with ADHD especially don't like to use condoms.

400

Women with ADHD, it's difficult to remember to use a condom, right?

401

And this is the key thing is we'll tell, we'll tell women, just use a condom, bruh.

402

But the whole point is that the neurodiversity, the deficits that we see in ADHD make it harder to remember.

403

Remember that dopamine sensitivity, that increased during estrogen.

404

And when you're like, you know, getting into stuff, like I'm sure that the hormones are flowing there too, right?

405

So we have an increased sensitivity to dopamine, which means we don't really think about the consequences of our actions, creates such problems.

406

So this is a huge challenge that women with ADHD really struggle with relationships.

407

And now y'all are probably wondering, okay, Dr. K, what do we do about this?

408

And this is where I'm sad to say that I don't have like four tips, right?

409

I can't say, oh, just sign up for coaching and everything will be fine.

410

Just get Dr. K's guide to whatever the fuck, and then you'll be okay.

411

No, there is no easy answer to this.

412

And not only is there no easy answer, the answers that we have don't work well for women.

413

So this is a paper that is looking at female-specific concerns in ADHD, okay?

414

So let's look at treatment.

415

Although boys showed better response to a combined behavioral and medication protocol, or medication-only protocol compared with community care,

416

only the combined treatment was more effective than community care for girls.

417

Thus, although medication alone may be an effective treatment for boys, girls seem to need behavioral interventions as well.

418

So when we think about evidence-based treatment for ADHD, we tend to think medication, right?

419

So I have ADHD.

420

What should you do?

421

Go see a psychiatrist, get started on a stimulant and you'll be golden.

422

So there's a lot that needs to go into this.

423

We got to understand why this is.

424

So we have to understand how does a medication, how do we determine that a medication is effective for an illness.

425

So what is the most hallmark feature of ADHD that leads to diagnosis in boys?

426

Hyperactivity, right?

427

The kid won't fucking sit still.

428

And so when I'm a drug company and I'm thinking to myself, I'm going to make a medication and I want people to be on it for their whole fucking lives.

429

What am I going to do?

430

I'm going to treat the thing, focus on the symptom that causes problems for teachers and problems for parents, right?

431

Like makes sense.

432

What are drug companies in the business of, making the world a better place.

433

And I don't say that facetiously.

434

They're like, we're here to try to solve problems.

435

It's not an evil drug company.

436

Okay.

437

But we got to think about this.

438

So they came up with stimulants and what are stimulants really good at?

439

Reducing hyperactivity, right?

440

So you start the kid on a stimulant, they sit in their chair and they pay attention.

441

They finish their food.

442

They're able to read.

443

Hallelujah.

444

This has fixed the problem.

445

Except remember, girls don't experience a whole lot of hyperactivity.

446

They have attentional problems and the medications help with that some too.

447

We're not saying medication isn't effective.

448

So the context of this is stimulant treatment for ADHD symptoms in women, okay?

449

A large variation has been reported in response to treatment with efficacy ranging from 25% to 78%,

450

which is much different than the fairly consistently reported 70% range of response rate in children.

451

When we look at medication and we think about what is the expected gain, right?

452

How much better are things going to be.

453

When we look at these trials in children, we see, okay, things are going to get 70% better.

454

Parents are like, hallelujah.

455

Teachers are like, thank God.

456

But when it turns to ADHD treatment in women, the range is 25 to 78%.

457

Doesn't work for all women.

458

It isn't like what it is for boys.

459

And there are contrary studies that show that it's effective in women.

460

So I'm not saying that it isn't effective.

461

But the key thing to understand is that medication is very good at hyperactivity.

462

Boys tend to have more hyperactivity.

463

Stimulants have been sort of very effectively used in men, but stimulants alone seem to be in some cases insufficient for women.

464

This is very important to understand because even the standard, you know, psychiatric institutional juggernaut is going to try to prescribe you stimulants,

465

which I'm not saying it isn't effective.

466

We see that the range is 25 to 78%.

467

It may not be as effective and you probably need some other kind of support as well.

468

I don't know that a stimulant is going to help you with an abusive partner, right?

469

Like that's not, it's not going to fix that.

470

And the whole point is that if we look at the challenges that women with ADHD face, they aren't as simple as things that can be solved by a stimulant.

471

Their organizational difficulties, their expectations, their judgment, their low self-esteem, their things like intimate partner violence, more likely to be divorced,

472

all these kinds of challenges a stimulant cannot fix.

473

We're not saying that it isn't effective in studies show that it can be even up to 78% effective, but it depends on the person.

474

So what's the point of this video?

475

I mean, I was looking at this and to be perfectly honest with y'all, it's taken me months to make this video.

476

And the reason it took me months to make this video is I wanted to end it by saying, hey, ladies, if you're out there, just do A, B, and C and we'll be able to help.

477

Every time I try to prepare some kind of lecture, I try to leave y'all with something that says, do this thing and it will improve your life.

478

The challenge that I faced with this video and why it took so long is I did research and research and research.

479

And I worked with so many women with ADHD.

480

There is no simple answer.

481

I wish I could say, take this supplement and your life will be better.

482

I wish I could say, just do this thing before you go to bed and your life will be better.

483

So the purpose of this video, then why did I end up making it?

484

Because I wasn't even sure I wanted to make it because I don't like have an answer for y'all.

485

The reason I made it is because y'all need to know this.

486

The whole world needs to know this, right?

487

You need to understand that first of just

488

because you made it to puberty without being kicked out of class

489

and getting straight A's does not mean that you don't have ADHD, right?

490

So the first thing to be super aware of is that if you are an adult woman who is struggling today, and this fits the bill where you have difficulty with relationships, you're basically like a bad woman.

491

You're not organized like the other women.

492

You get super emotional.

493

You have separation anxiety.

494

Like you can't maintain friendships, like all this kind of stuff.

495

You have a lot of these internalizing symptoms.

496

You just think you're an airhead or spacey or people have judged you harshly.

497

If you're a single mom, like there's a good chance that you've got ADHD.

498

So the first thing is get support, right?

499

So we don't want to misdiagnose.

500

We don't want to miss the diagnosis.

501

So that's the first reason is if this kind of tracks for y'all and y'all don't have a diagnosis, by all means, get evaluated.

502

Second thing, if you do have a diagnosis, recognize that the majority of the literature on ADHD does not focus on gender specific issues,

503

that your providers may not be aware of some of these things.

504

If they're good providers, they picked it up, right?

505

But it's not like I had a lecture on ADHD-specific issues for women when I was training in residency.

506

We had gender-related issues.

507

We had ADHD-related issues.

508

But we don't tend to combine the two.

509

And so as a woman, be aware that this disorder will affect every dimension of your life.

510

And many of the dimensions that we don't think of, we think of school.

511

We think of work.

512

We don't think about home.

513

We don't think about birthday parties.

514

We don't think about divorce.

515

We don't think about parenting.

516

But it absolutely affects those things.

517

Another thing is, unfortunately, you're going to be judged a lot.

518

Like, I wish it was different.

519

And this is where we get to the actual treatment, right?

520

So there's a lot of stuff here that needs to be done.

521

So by all means, see a professional.

522

But what we also know is that combined treatment is very important.

523

So it's not sufficient to just get a stimulant.

524

Maybe you're one of the lucky ones and that does it for you.

525

Fine.

526

But chances are, one of the other things

527

that you need to work on in therapy is the consequences of being a woman with ADHD

528

and all of the harsh judgment because they internalize, y'all internalize all of that shame.

529

That happens in men too.

530

Everyone with ADHD internalizes that shame and then you carry it with you.

531

This manifests things like depression.

532

It manifests things like anxiety.

533

It manifests things like lack of confidence.

534

So that must be addressed.

535

And the last thing, which I want all y'all to hear from the bottom of

536

my heart as a dad of a daughter who may have ADHD is that you're awesome, right?

537

This is not your fault.

538

You are not a bad woman.

539

You're not a bad parent.

540

You're not sure you struggle ensure there are many outcomes that are not going your way.

541

And I totally get this, including things like abusive partners.

542

Like that's crazy, right?

543

Your life has been very, very difficult because this thing has been impairing it.

544

We don't really consider or accommodate for the fact that your neurodiverse brain has difficulty fulfilling the duties of a woman, the expectations of a woman.

545

And I have faith that y'all can get there, right?

546

It's going to be your own journey.

547

You're going to have to walk it.

548

We're going to do our best to help you.

549

We're not done with this topic, by the way right?

550

So we're just getting started.

551

This isn't the end.

552

This is the beginning.

553

And so have a little bit more faith in yourself if you can.

554

Be a little bit more forgiving of yourself and try to get the support that you need.

555

Because there are studies that show that combined treatment is effective.

556

Women do get better.

557

I've seen this myself in my clinical practice where we've helped them sort of, you know, start on stimulant medication because that's what I did at the time.

558

And then we help them build the things that are necessary, repair their self-esteem, learn how to set limits, be more selective with partners, you know, prepare things a little bit better,

559

and then their lives can absolutely turn around.

560

And if you're a woman with struggling with ADHD, yours can too.

561

We do have a guide to ADHD and doing stuff.

562

So there's a lot of practical stuff in there, but that stuff is not gender specific.

563

It does not address many of the issues that we talked about in this video, but I still encourage y'all to check it out because it'll help with things like organization,

564

planning, motivation, these core features of ADHD that everyone struggles with are addressed there.

565

And chances are you're going to need all the help that you can get.

566

So ladies with ADHD, I'm so sorry

567

that your experience has probably been incredibly harsh and I hope things that will get better.

568

And we here at the HE community are here to support you.

569

Thank you.

📺 Same Channel

The Best Solution to Video Game Addiction

Business EnglishUniversity StudentsWorking Adults

Your Imagination Won't Fix Your Life

Business EnglishUniversity StudentsWorking Adults

Psychiatrist Explains Why You Feel Tired All The Time (No Matter What You Do...)

Daily ConversationUniversity StudentsWorking Adults

✨ Recommend Video

164 sentences

World Leading Physician View On ADHD: Gabor Mate

Daily ConversationUniversity StudentsWorking Adults

849 sentences

Feminist vs Anti Feminist Women | PART 1

Daily ConversationUniversity StudentsWorking Adults

918 sentences

Adulting in Our 30s - New Habits, Values, & Life Lessons We’ve Learned | AsianBossGirl Ep 291

Business EnglishDaily ConversationUniversity Students

267 sentences

Every Type of Depression Explained in 16 Minutes

Daily ConversationUniversity StudentsWorking Adults

276 sentences

Signs Your Mother Is A Covert Narcissist & How To Recover

Daily ConversationUniversity StudentsWorking Adults

154 sentences

Why you procrastinate even when it feels bad

Business EnglishDaily ConversationUniversity Students

83 sentences

How to Deal With ADHD BURNOUT

Daily ConversationUniversity StudentsWorking Adults

169 sentences

The Male Reading Crisis

Business EnglishDaily ConversationUniversity Students

184 sentences

People Really Hate New Dads With Depression

Daily ConversationUniversity StudentsWorking Adults

49 sentences

Don't Put Women on A Pedestal | Sadia Khan

Daily ConversationUniversity StudentsWorking Adults

22 sentences

ADHD Is Not A Superpower | Mel Robbins #shorts

Daily ConversationUniversity StudentsWorking Adults

207 sentences

Being Married To Someone With ADHD

Daily ConversationUniversity StudentsWorking Adults

Vocabulary and speaking notes for this lesson

This video has 569 sentences and 7625 words to shadow. The speech runs for 39:24. The speaker talks fast, about 194 words per minute, so expect linked and reduced sounds. 84% of the words are among the 3,000 most common in English; the rest is worth studying before you start.

Key vocabulary in this video

15 less common words from the video, with pronunciation and meaning:

diagnosis /daɪəɡˈnəʊsɪs/ (noun) — The process of, or an instance of, identification of the nature and cause of a medical condition or illness.
difficulty /ˈdɪfɪkəlti/ (noun) — The state of being difficult, or hard to do.
symptom /ˈsɪm(p)təm/ (noun) — A perceived change in some function, sensation or appearance of a person that indicates a disease or disorder, such as fever, headache or rash; strictly, a…
medication /mɛdɪˈkeɪʃən/ (noun) — A medicine, or all the medicines regularly taken by a patient.
anxiety /æŋˈzaɪ.əti/ (noun) — An unpleasant state of mental uneasiness, nervousness, apprehension and obsession or concern about some uncertain event.
expectation /ˌɛk.spɛkˈteɪ.ʃən/ (noun) — The act or state of expecting or looking forward to an event as about to happen.
sensitivity /ˌsɛn.səˈtɪv.ə.ti/ (noun) — The quality or state of being sensitive; sensitiveness.
esteem /ɪˈstiːm/ (verb) — To set a high value on; to regard with respect or reverence.
divorce /dɪˈvɔːs/ (noun) — The legal dissolution of a marriage.
disorder /dɪsˈɔɹdɚ/ (noun) — Absence of order; state of not being arranged in an orderly manner.
suffer /ˈsʌfɚ/ (verb) — To undergo hardship.
feminine /ˈfɛmɪnɪn/ (adjective) — Of or pertaining to the female gender.
household /ˈhaʊshoʊld/ (adjective) — Belonging to the same house and family.
shock /ʃɔk/ (noun) — A sudden, heavy impact.
whereas /(h)wɛɹˈæz/ — In contrast; whilst on the contrary; although.

Phrasal verbs you will hear

look at (verb) — To observe or watch.
think about /ˈθɪŋk əˌbaʊt/ (verb) — To ponder.
go through (verb) — To travel from one end of something to the other.
talk about (verb) — Used to draw attention to the speaker's characterization of someone or something.
see in (verb) — To show (someone) in: to introduce (someone) to the inside of a place.
turn out (verb) — To end up; to result.
figure out (verb) — To come to understand; to discover or find a solution; to deduce.
pile on (verb) — To jump on top of someone or something quickly.

Pronunciation to watch

The speaker uses 204 contractions and reduced forms, such as you're, don't, we're. Say them the short way, as you hear them.

The “sh” and “zh” sounds: medication /mɛdɪˈkeɪʃən/, expectation /ˌɛk.spɛkˈteɪ.ʃən/, shock /ʃɔk/, emotion /ɪˈməʊ.ʃən/, separation /ˌsɛp.əˈɹeɪ.ʃən/
Long words — get the stress right: difficulty /ˈdɪfɪkəlti/, medication /mɛdɪˈkeɪʃən/, anxiety /æŋˈzaɪ.əti/, expectation /ˌɛk.spɛkˈteɪ.ʃən/, sensitivity /ˌsɛn.səˈtɪv.ə.ti/

How to practise with this video

Listen to the whole video once without speaking and note the words you do not know.
Start at 0.75× speed, shadow it sentence by sentence, then go back to normal speed once it feels easy.
Record yourself and compare with the original, paying attention to words like diagnosis, difficulty, symptom.

Grammar in this video

The structures the speaker uses most, with the exact words from the video:

Structure	In the video
Present perfect have/has + past participle — a past action that still matters now	has been removed · have resulted · I've worked
Passive voice be + past participle — the focus is on what happens, not who does it	has been removed · are expected · can be navigated
Relative clauses who / which + clause — extra information about a person or thing	see, which is · teachers who are · kid who literally

What is the Shadowing Technique?

Shadowing is a science-backed language learning technique originally developed for professional interpreter training and popularized by polyglot Dr. Alexander Arguelles. The method is simple but powerful: you listen to native English audio and immediately repeat it out loud — like a shadow following the speaker with just a 1–2 second delay. Unlike passive listening or grammar drills, shadowing forces your brain and mouth muscles to simultaneously process and reproduce real speech patterns. Research shows it significantly improves pronunciation accuracy, intonation, rhythm, connected speech, listening comprehension, and speaking fluency — making it one of the most effective methods for IELTS Speaking preparation and real-world English communication.

Shadowing technique: read the full step-by-step guide →

Shadowing Practice: What Makes ADHD in Women Different - Learn English Speaking with Video

The Best Solution to Video Game Addiction

Your Imagination Won't Fix Your Life

Psychiatrist Explains Why You Feel Tired All The Time (No Matter What You Do...)

Happiness is a Skill (And You’re Missing It)

How To ACTUALLY Stay Mentally Healthy

A Guide To Living Without Regret (Using Science)

Is gaming a form of art?

Why Overthinkers Make No Progress (Rumination)

Self Loathing Man of Inaction

We Need To Talk About Ozempic

What Makes A Relationship Great?

World Leading Physician View On ADHD: Gabor Mate

Feminist vs Anti Feminist Women | PART 1

Adulting in Our 30s - New Habits, Values, & Life Lessons We’ve Learned | AsianBossGirl Ep 291

Every Type of Depression Explained in 16 Minutes

Signs Your Mother Is A Covert Narcissist & How To Recover

Why you procrastinate even when it feels bad

How to Deal With ADHD BURNOUT

The Male Reading Crisis

People Really Hate New Dads With Depression

Don't Put Women on A Pedestal | Sadia Khan

ADHD Is Not A Superpower | Mel Robbins #shorts

Being Married To Someone With ADHD

Vocabulary and speaking notes for this lesson

Key vocabulary in this video

Phrasal verbs you will hear

Pronunciation to watch

How to practise with this video

Grammar in this video

What is the Shadowing Technique?