跟读练习: What Makes ADHD in Women Different - 通过视频学习英语口语

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.

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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.

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And yeah, it's just her being spacey.

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This is literally what we see in ADHD.

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

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

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

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So this is oftentimes what leads to diagnosis.

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Girls with ADHD aren't as disruptive.

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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.

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

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

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

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So let's think about that for a second.

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

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

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

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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.

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

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Look at how much she loves her mommy and daddy.

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

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We have to be big grown-up boss babes.

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Let's go.

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You can do it, my darling.

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I love you.

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And this is what leads to crippling self-esteem.

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

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

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

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

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There is neurodiversity at play.

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

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

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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.

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

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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

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

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

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

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

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

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

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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

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

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

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

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We talked about that.

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

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We're going to dive into relationships a lot.

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

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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.

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

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

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So I kind of got off track.

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Let's go back to why diagnosis is different.

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

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So we have to understand this, okay?

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

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

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So why is diagnosis so different?

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So hyperactivity is a huge piece of it.

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

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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,

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what we see is that the maturity of an 11

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

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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.

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

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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,

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

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

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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.

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

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

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

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

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

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So we see a big misdiagnosis there.

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

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

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Depression is depression is depression.

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Anxiety is anxiety, anxiety.

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ADHD is ADHD is ADHD.

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

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

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

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

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

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Now, this is what's really interesting.

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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.

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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.

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

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But boys to girls is three to one.

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So why the difference?

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

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

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

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

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

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

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

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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.

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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,

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

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

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

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

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

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

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

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So women are more likely to experience internalizing symptoms.

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

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Right.

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

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

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and you start to get concerned about your body

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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?

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

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She needs help and support.

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

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

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

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This is a misogynistic society.

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This is a feminine beauty standard.

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These are all these kinds of things.

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

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It doesn't.

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

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

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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.

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

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

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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,

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you know, doing well in school.

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You got to be able to pack your bag.

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

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This is when girls start to become women.

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

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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.

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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.

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We don't even think about ADHD.

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

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

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

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

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

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

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

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

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It's not just about the test.

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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?

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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.

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So these organizational difficulties start to pile on.

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

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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.

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

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

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occupational, and psychological challenges for most of the women.

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

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

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

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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.

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

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

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

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

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So they conclude that they are not good women.

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And one prime example of this is in relationships.

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

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

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

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These are all gendered responsibilities.

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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.

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

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

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So this is very important to understand.

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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,

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

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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,

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

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This person needs help.

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She's not a good woman.

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The judgment is so cutting.

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It's like death from a thousand cuts.

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I've seen this crap.

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It's so fucking toxic, right?

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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.

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

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

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

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

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because that makes me feel better about myself.

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It's so crazy

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

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

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It's like such a mess.

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

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

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

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

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But women with ADHD struggle with this as well.

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

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So this is important to understand.

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I want to pause here for a second.

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

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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?

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

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

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You take the cognitive responsibility.

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The cognitive load is what you bear.

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

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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,

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

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

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

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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.

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So that's like, good job, bros.

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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.

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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.

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So let's keep going.

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And I think it can be extra challenging for women with

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

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

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People think you're a bad mother.

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And this is absolutely the experience of women with ADHD.

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

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

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

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

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

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While with kids, you can't do that.

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

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So we tend to see that women have an additional challenge

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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.

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There's no accommodation, right?

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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.

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Doesn't work for the rest of life.

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

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

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

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

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

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

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

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We know that people with ADHD have relationship difficulties.

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The challenge is that the gendered expectations of men versus women

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

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

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

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

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

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

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We're going to look at the data.

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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.

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

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

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

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This is a video about women.

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

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

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They're expected to be calmer.

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

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But when your brain is struggling with emotional dysregulation,

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

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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,

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

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

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and are at higher risk for divorce and single parenting.

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So this is shocking.

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

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

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

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

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

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

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Women recognize that dudes have ADHD.

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They're hyperactive.

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They can't sit still, whatever.

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

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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.

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Like that is staggering, right?

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This is not a benign gender difference.

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

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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.

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跟读法 (Shadowing) 是一种有科学依据的语言学习技巧，最初开发用于专业口译员的培训，并由多语言者Alexander Arguelles博士普及。这个方法简单而强大：您在听英语母语原声的同时立即大声重复——就像是一个延迟1-2秒紧跟说话者的影子。与被动听力或语法练习不同，跟读法强迫您的大脑和口腔肌肉同时处理并模仿真实的讲话模式。研究表明它能显着提高发音准确性，语调，节奏，连读，听力理解和口语流利度——使其成为雅思口语备考和真实英语交流最有效的方法之一。

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什么是跟读法？