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Why ADHD in Women Gets Missed | The Original Self Podcast · The Original Self Podcast

0:00
A client told me, everyone thinks I have it together,
0:05
but they have no idea what it takes. She has
0:09
three calendars of which she checks twice before
0:13
every appointment because she's terrified of
0:16
forgetting an appointment. She can manage a completely
0:20
complicated day for everyone else, yet leave
0:23
a simple email or text unanswered for days. When
0:29
a deadline gets close, she gets the work done.
0:32
And then she wonders why she just couldn't start
0:35
earlier. From the outside, she knows she looks
0:39
capable. Inside, she's tired of being at war
0:44
with herself. Years later, after these patterns
0:49
have just persisted, her child's assessed for
0:53
Attention Deficit Hyperactivity Disorder, or
0:57
ADHD. Around the same time, Changes in her sleep
1:03
and hormones made the systems she relied on less
1:08
dependable. And she's learned more. She's asked
1:12
herself for the first time. What if I haven't
1:15
been lazy, scattered or preoccupied all of these
1:19
years? Hey everyone, it's Evet and you're listening
1:28
to The Original Self Podcast: Lessons From Behind
1:30
The Chair. My client's question is where I want
1:34
to start. Why is ADHD easier to miss in girls
1:39
and women? What does it take to appear fine while
1:43
working twice as hard to keep up? And why might
1:49
midlife make those difficulties harder to manage?
1:53
And by the end of this episode, I hope you'll
1:56
be able to separate a difficulty you've lived
1:59
with from the judgment you've learned to attach
2:03
to it. If this brings up an old story you've
2:07
told yourself, You don't have to sort through
2:09
it alone. I do offer a free discovery call to
2:13
talk about what's coming up for you and whether
2:16
coaching might be a good fit. There's no pressure,
2:20
no pitch, no commitment required. You'll find
2:24
the link for me in this episode's notes. So for
2:29
a long time, many people pictured a child with
2:33
ADHD as a little boy who just couldn't stay seated
2:37
or who constantly interrupted. That picture describes
2:42
some kids, but it missed many others. What about
2:47
that girl staring out the window? Or forgetting
2:51
an instruction halfway through? Or working late
2:55
to finish her schoolwork that many completed
2:57
at school? Or the one that felt restless while
3:01
sitting quietly? In one experiment, researchers
3:08
took parents and elementary school teachers and
3:12
read them descriptions of children with ADHD.
3:16
All the descriptions were identical, but some
3:20
had typical boys' names attached to it and some
3:23
had typical girls' names. Parents and teachers
3:27
alike were less likely to seek or recommend services
3:32
for the child with a girl's name. Not every girl
3:37
was overlooked, but it shows that Expectations
3:41
can influence whether a child gets referred for
3:43
help or before an assessment can actually take
3:46
place. A large Swedish study found that females
3:53
reached their first recorded ADHD diagnosis or
3:58
were prescribed medications at an average age
4:01
of over 23 .5 compared with an average age of
4:07
19 .6 for males. That's about four years in
4:12
age at recognition across the groups. Not the
4:17
length of time every woman spent seeking a diagnosis.
4:21
Those two findings leave me with a question.
4:25
If someone sees a girl who is struggling, but
4:29
doesn't think about ADHD, what explanation does
4:33
that child receive instead? She may hear that
4:39
she's careless, too emotional. or capable of
4:44
so much more if she would only try harder. Then
4:49
she may learn to believe those descriptions long
4:52
before anyone asks what's actually making school
4:55
or even everyday life difficult for her. Anxiety,
5:01
depression, trauma, sleep difficulties, those
5:05
can all affect attention. That's why a careful
5:09
evaluation matters. A girl deserves an investigation
5:14
of what she's experiencing. rather than a judgment
5:17
about her character. One of the most striking
5:24
things about adult ADHD is that somebody can
5:28
be doing really well and also struggling at the
5:32
same time. In a qualitative study, adults with
5:37
ADHD describe the systems they develop before
5:41
diagnosis, checklist and reminders written on
5:45
paper, saved on devices and sometimes on their
5:49
own hands. Other people saw the completed task,
5:55
but rarely saw the effort put forth behind it.
6:00
That's why someone saying, but you've always
6:03
been so organized, may not feel like the compliment
6:07
it's meant to be. She is organized. She's worked
6:12
hard to become that way because she knows what
6:16
can happen without those systems she's put in
6:18
place. So I think there's two different questions
6:22
worth asking. Did she remember what she was supposed
6:26
to remember? And then what did it take to remember
6:30
it? A yes to the first question doesn't answer
6:35
the second. Psychologists use the term executive
6:39
functions for processes involved in holding information
6:43
in mind, planning, starting a task, controlling
6:49
impulses, and shifting between activities. Knowing
6:55
what needs to be done isn't always the same as
6:57
being able to begin it when you want to. So a
7:02
five-minute reply may require her to stop what
7:04
she's doing, recall the conversation, then decide
7:08
what to say and shift into writing it. Simple,
7:12
right? She may know exactly why the message matters,
7:17
yet still struggle with those transitions. And
7:22
that's why When she finally sends that reply,
7:26
no one will know all the work she did before
7:29
the words actually were written down. Research
7:33
on adult ADHD suggests that both cognitive control
7:37
and motivation very much matter. In one small
7:43
experiment, changing the reward attached to a
7:46
task changed some aspects of performance. That
7:51
doesn't mean a reward fixes ADHD. But it does
7:56
help explain why the conditions surrounding a
7:58
task can affect when someone begins. Many women
8:04
with ADHD that I've spoken to regard urgency
8:08
as the condition that most fuels them to start
8:11
today what they couldn't start yesterday. But
8:16
here's where the gears catch. If she was taught
8:20
that the only explanation for that inconsistency
8:23
was laziness. she turns that into judgment about
8:28
herself. And that can lead to a social cost.
8:35
Overcommitting, apologizing before anyone is
8:37
upset, or working late so nobody knows how long
8:41
that ordinary task took. We all know that everyone
8:46
is different and doesn't operate in the same
8:48
way. But ADHD has certain operating patterns
8:52
that are very similar. Let me ask you this. How
8:57
much of your energy goes toward doing the task
9:01
and how much goes towards hiding the effort it
9:05
takes? That's an important question to ask yourself
9:08
if you suspect that you may have ADHD. Some of
9:14
that effort may begin before the day even starts.
9:19
Sometimes it's with a night spent trying to fall
9:22
asleep. Sleep timing is the physical piece of
9:27
this picture that rarely comes up when a woman
9:29
says she can't focus. Research reviews find that
9:34
ADHD is associated with a later chronotype. Chronotype
9:39
is a tendency toward later sleep and waking times.
9:43
There's also a delayed signal from the body's
9:46
circadian clock. So one of those signals is melatonin.
9:53
As evening light fades, the brain begins releasing
9:57
melatonin to help prepare the body for sleep.
10:01
It's called dim light melatonin onset. That's
10:05
how the body should work. Many adults with ADHD
10:09
have difficulty falling asleep because their
10:12
internal evening signal, that melatonin, arrives
10:16
later. In studies of adults with ADHD, melatonin
10:21
onset has an average delay of about 90 minutes
10:25
compared with others in the study without ADHD.
10:29
Imagine going to bed at 10, because you need
10:32
to be up at six, but your body is completely
10:35
alert. But the next morning, your brain feels
10:39
foggy, you're irritable. Or worse, you miss the
10:43
alarms, the meetings, or scheduled events, because...
10:47
your body's not awake, you're asleep. By afternoon,
10:53
it's hard to hold the thought together. But then
10:56
nighttime comes and you feel completely wide
11:00
awake again. You know, some will say to you,
11:04
oh, you need to be more disciplined about bedtime,
11:08
work on your sleep hygiene. Yet for many people,
11:12
there's a genuine timing mismatch that's not
11:17
always understood. Sleep. loss itself can worsen
11:22
attention and emotional regulation. That creates
11:26
a difficult cycle. My friend Silvina, who has
11:30
ADHD, describes another part of the nighttime
11:33
that matters very much to her. She says it's
11:36
the only time when no one expects anything from
11:39
her. The day's demands have lifted. She can breathe
11:45
and choose how she spends her time. Sometimes
11:50
that means that she's organizing her closet at
11:53
1130 p .m. She told me that once she's started,
11:58
she wants to finish because going to bed early
12:01
feels like giving up the first quiet hours that
12:04
have belonged entirely to her. Silvina's experiences
12:11
doesn't mean every late night has the same explanation.
12:15
A delayed body clock, the pleasure of uninterrupted
12:19
time, and difficulty stopping an absorbing task
12:23
are Definitely reasons to stay up late. For some
12:28
though, all three play a part. Obviously being
12:33
a night owl doesn't mean you have ADHD. Sleep
12:37
timing, insomnia, sleep apnea, or anxiety and
12:42
medications, those can all affect whether you
12:47
go to sleep on time or whether you sleep at all.
12:51
But they could also mean that you may need different
12:54
types of support. So if falling asleep has been
12:58
very difficult for years, speak to your doctor.
13:03
Tell them what's going on. Like I said, a difficult
13:08
night can affect how you feel the next day. But
13:13
Sylvina's experience also raises a question about
13:15
the feelings that come from being misunderstood
13:18
for years. Attention deficit is in the name of
13:23
ADHD. But Sylvina and many like her feel that
13:28
The label describes her mind only by what it
13:33
supposedly lacks. In her experience, her divergent
13:38
thinking moves quickly through many possibilities,
13:42
making connections and seeing options that other
13:47
people may possibly miss. She sees all the puzzle
13:52
pieces, their shapes and edges, and then connects
13:57
them into one cohesive picture. For Silvina,
14:03
the harder part can be convergent thinking. So,
14:06
narrowing those options, choosing which one to
14:10
pursue, and then moving forward. Seeing the possibilities
14:15
can be a strength, even when choosing among them
14:19
takes considerable effort. All of that has an
14:24
emotional side. A study that followed young adults
14:30
in daily life found that changes in emotion helped
14:34
account for the relationship between ADHD
14:37
symptoms and symptoms of anxiety or depression.
14:43
There is not yet concrete proof that one condition
14:46
causes the other, but it does show why feelings
14:50
deserve a place in the conversation that often
14:54
focuses only on attention. Many with ADHD recognize
15:00
in themselves something called rejection -sensitive
15:04
dysphoria, or RSD. That is a feeling of intense
15:09
pain after criticism or perceived rejection.
15:14
Because rejection sensitivity can have several
15:16
origins, I think it's useful to ask ourselves,
15:22
what happens inside when feedback lands? And
15:26
what do you do next after receiving it? A short
15:33
message from a friend may possibly lead to an
15:37
evening of wondering whether she's angry at you.
15:42
Maybe a reasonable correction at work turns into
15:46
you telling yourself, I never get anything right.
15:51
Or you make one mistake, and it feels so much
15:55
bigger than it is because it lands on years of
16:00
being told that you're careless. The feeling
16:04
can be real even when you're uncertain about
16:07
what the other person meant. There's room to
16:11
take the emotion seriously and still examine
16:14
the conclusion you drew from it. A qualified
16:19
doctor can help someone assess ADHD, anxiety,
16:23
and difficulties with emotional regulation. In
16:28
coaching, we can look at the story the person
16:31
tells themselves in those moments and consider
16:37
how they want to respond. There are turning points
16:43
in our lives, and hormonal changes may affect
16:48
ADHD symptoms. For some women, pregnancy and
16:55
the postpartum period bring those questions into
16:58
focus years earlier. So here's a... piece worth
17:03
understanding before I speak about percentages.
17:07
Estrogen appears to enhance dopamine activity
17:10
in the brain. The same dopamine system is involved
17:15
in attention, motivation, and focus. See where
17:20
I'm going? When estrogen rises or falls, the
17:25
system doesn't stay still. The dopamine system
17:29
doesn't stay still. That's why ADHD symptoms
17:33
and their severity isn't fixed. It can shift
17:39
across the menstrual cycle, across pregnancy,
17:44
through the postpartum period, and then later
17:47
through perimenopause. Researchers are still
17:53
working out how hormonal changes at different
17:56
stages in life may affect ADHD symptoms. Pregnancy
18:01
and the months after are one of the clearest
18:05
examples that they have so far. In a Swedish
18:10
register study, almost 17 % of women diagnosed
18:14
with ADHD received a postpartum depression diagnosis
18:20
compared with about 3 % that didn't have ADHD.
18:27
That is a five -fold difference in the population.
18:32
Postpartum depression deserves care on its own
18:35
right. And an ADHD diagnosis is also an important
18:40
part of the history a clinician should know about.
18:44
But pregnancy and postpartum are only part of
18:48
a woman's reproductive history, right? Researchers
18:52
are now asking how ADHD may overlap with other
18:57
conditions. Questions that have definitely received
19:02
far less attention than the familiar conversation
19:04
about hormones and focus. In a nationwide Swedish
19:08
study, women with endometriosis were more likely
19:13
to receive a later ADHD diagnosis. The researchers
19:18
also compared sisters, which helps address some
19:22
shared family factors. The association remained.
19:28
It's not evidence that endometriosis causes ADHD,
19:31
but we don't yet know why the conditions overlap.
19:38
Endometriosis can involve severe menstrual or
19:41
pelvic pain, Fatigue, pain with sex, and fertility
19:46
difficulties. Consider how it might feel to have
19:50
years of physical pain explained away while your
19:55
difficulties with attention are dismissed as
19:59
a failure of discipline. For those of you with
20:03
both, you don't have to imagine because that
20:07
repetitive dismissal might make you stop trusting
20:10
your own experience, because different parts
20:13
of it are repeatedly minimized. However, I must
20:18
say that this is only something to consider.
20:22
It's not a description of every woman with a
20:25
diagnosis. Another condition that researchers
20:31
have examined is polyendocrine metabolic ovarian
20:36
syndrome, or PMOS. Most know that as PCOS, but
20:42
now they're saying that PMOS is the new name.
20:47
The question I have here is: are children born
20:50
to mothers with PMOS more likely to be diagnosed
20:55
with ADHD? Some studies have found an association
21:01
between a mother's PMOS and ADHD in her children.
21:06
And then researchers have explored possible explanations.
21:10
but they haven't yet established that PMOS or
21:13
a particular hormone level during pregnancy causes
21:17
ADHD in a child. But there's a reason why researchers
21:22
are trying to find a connection in all of this.
21:25
I just want women hearing this to leave feeling
21:29
curious, not with a checklist of conditions
21:34
that she has to have, just bringing it to her
21:38
attention. A good explanation should account
21:42
for the whole person without claiming more than
21:45
the research can tell us. And something tells
21:49
me that Gen X and all the generations that
21:52
follow will keep asking those questions until
21:56
we have much better answers. These questions
22:00
become especially pressing in midlife. What happens
22:05
when the tools a woman relied on for decades
22:08
become less reliable? Sleep changes. More responsibilities,
22:16
Menstrual cycle shifts. Perimenopause itself
22:21
can bring difficulties with memory, attention, and
22:25
mood to most women, whether they have ADHD or
22:28
not. A 2025 review describes plausible interactions
22:33
between estrogen and dopamine systems and reports
22:37
worsening symptoms for some women during the
22:40
hormonal transition. Researchers are still testing
22:44
those mechanisms. In one population study in
22:48
Iceland, 54 % of women who reported an ADHD diagnosis
22:53
also reported more severe perimenopause symptoms
22:59
compared to 30 % of women without ADHD. That
23:05
means women with ADHD are about twice as likely
23:09
to experience severe perimenopausal symptoms
23:12
as women without. Broken down further, 30 % of
23:17
women with ADHD reported more severe hot flashes,
23:21
joint pain, and sleep issues compared to 14 %
23:26
of women without. 58 % reported severe psychological
23:31
symptoms like depressive mood, anxiety, and irritability
23:35
compared to 36 % without ADHD. And 43 % reported
23:41
the rarely spoken-about urogenital symptoms of
23:45
bladder issues and related concerns compared
23:48
to 28 % without ADHD. What catches my attention
23:54
is the broader picture. Someone could arrive
23:58
at a doctor's appointment with poor sleep, anxiety,
24:02
changes in concentration, and a sense that she's
24:05
suddenly become a lot less capable. If each concern
24:11
is put in a different folder, she may never have
24:15
a conversation about how they interact. And if
24:19
she had a highly effective coping system at 30,
24:24
the loss of that system at 50 may be the first
24:29
time her long-standing difficulties became visible
24:32
to anyone else. When those difficulties finally
24:38
become visible, and you bring them to the doctor
24:42
hoping for an explanation, what happens if her
24:46
account is dismissed? Another term for that is
24:52
medical gaslighting, and it's usually a very
24:55
painful experience for the one who's experiencing
24:58
that. I know many symptoms overlap. Evidence
25:03
can be incomplete. Science changes. We get that.
25:10
But when a person's account is repeatedly given
25:13
less weight because of assumptions about who
25:15
she is, we can begin to ask other questions
25:19
about credibility. There's a philosopher named
25:24
Miranda Fricker. She calls this testimonial injustice.
25:30
A person receives an unfair deficit of credibility
25:33
because of prejudice. Was the woman's description
25:38
explored? Were possibilities investigated? Or
25:43
are you just stressed? End the conversation
25:47
before any questions began. We can't know the
25:53
reason behind every delay, but we must remain
25:57
curious about whether our listening habits make
26:00
some experiences easier to overlook. If you notice,
26:06
I've shared findings from Sweden and Iceland
26:09
today, but not from the United States. I think
26:15
the questions that researchers have posed to
26:18
Icelandic and Swedish women are kind of foreign
26:24
to American women. Researchers in those countries
26:28
have helped reveal patterns that we should be
26:32
asking here. If we had a more connected healthcare
26:37
system in this country, we could begin to see
26:40
patterns that are harder to follow when care
26:44
and records are spread across separate systems.
26:49
Hmm...Imagine if there was only some way. The research
26:55
and the evidence I've shared from other countries
27:00
need to happen here. We need to keep asking questions
27:04
here. When a girl says she's trying as hard as
27:07
she can and hears try harder, whose account becomes
27:11
the accepted one? When an adult says that her
27:14
concentration and sleep have changed and that's
27:19
just your age, what else might go on an exam?
27:23
Listening carefully doesn't mean accepting a
27:26
self -diagnosis without assessment. It means
27:31
taking your experience seriously enough to find
27:34
out what is truly happening. When a woman's difficulties
27:41
go unexplored for years, she probably comes up
27:45
with her own explanation. And many times, it's
27:50
pretty harsh. In a 2025 study that asked 28 women
27:56
that were diagnosed with ADHD later in their
27:58
life to describe their experiences before diagnosis.
28:04
Many, many spoke about absorbing criticism and
28:08
feeling shame. Some felt relief when they finally
28:13
had an explanation. Some grieved what might have
28:18
been different had they known. After I read that
28:21
story, I asked my friend Sylvina if she felt
28:25
angry about her late diagnosis. She told me she
28:29
ultimately felt relief. It was that missing puzzle
28:34
piece that had finally fallen into place for
28:36
her. She could see why she spent years building
28:42
so many ways to cope. That speaks to the part
28:46
of the story that really interests me. How a
28:50
woman comes to understand herself. My whole podcast
28:53
is that. Psychologists use the word schema for
28:58
a pattern of belief that shapes how we interpret
29:01
experience. Imagine hearing careless for years,
29:08
for 50 years. And then there's The examples of
29:13
that. You forget to pay your child's tuition
29:15
on time. That word comes back. You lie awake
29:20
worrying that you'll miss a meeting, oversleep,
29:22
arrive late. And there's that word again. Careless.
29:29
The bills you paid on time? They don't count.
29:33
Neither does the meeting you led brilliantly
29:36
the week before. The moments that fit the old
29:40
belief feel like proof. The moments that challenge
29:44
it? are easier to just dismiss. Learning that
29:51
ADHD may be part of the picture offers a new
29:55
explanation, but it takes time to stop hearing
29:59
careless every time something goes wrong. Missing
30:04
a deadline describes something that happened.
30:07
It doesn't describe who you are. A diagnosis
30:12
opens the door to treatment, to support, to accommodations.
30:18
and a language for an experience that has been
30:23
years of hard to explain. It doesn't automatically
30:31
erase a lifetime of self -criticism, but relief
30:35
can sit alongside anger and grief. I think back
30:40
to that woman in my chair who told me nobody
30:44
knows what it takes. Again, she knows she's capable.
30:51
What? she maybe wants is room to tell the truth
30:56
about the effort behind the capability and then
31:00
reconsider the explanation she was giving for
31:03
needing to work that hard in the first place.
31:09
I'd like to leave you with a couple of questions
31:11
to ask yourself. What have you called the flaw
31:15
in yourself that deserves a closer look? What
31:22
coping strategies have you built that nobody
31:26
else notices? The answers to those questions
31:31
may help you find precise words for the questions
31:34
you bring to an assessment. In the next episode,
31:40
I will sit down with my friend, Jen Walters.
31:43
We will hear what these questions mean inside
31:47
her actual life. What does it take to cope? What
31:52
changed? What she understands about herself right
31:55
now? Her experience will be hers, of course,
31:59
but I hope it helps you feel free to be curious
32:01
about your own. If this episode found you at
32:05
a point where you're reconsidering an old story
32:08
about yourself, I would welcome a conversation.
32:12
You don't need to have it figured out first.
32:15
You can book a free discovery call through the
32:17
link in this episode's notes, and we could talk
32:21
about where you are, what matters to you now,
32:24
and where do you want to go to next. I'm Evet
32:29
DeCota and I thank you for listening to The Original
32:31
Self Podcast. I hope you have a beautiful day.