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ADHD LOOKS DIFFERENT IN WOMEN · ADHDtime On Air

• Daniella karidi: Hi everyone, thank you so much for joining me today at ADHDTime on Air. I'm going to be talking with someone that wrote amazing books that have been sitting on my bookshelf for years. And today I'm hoping to talk with her about one of her new book, which I'm gonna tell not only show. and she is an award winning clinical psychologist and an amazing woman that. elevates women with ADHD and I am very proud to have a conversation with Dr. Nadeau Kathleen Nadeau: Thank you so much. Very kind words. And and as always, I am very happy to talk about girls and women with ADHD. It's something that has been on my mind for a long, long time. I am a woman with ADHD. I am the mother of a woman with ADHD. I am the grandmother of two young women with ADHD. I'm the sister. of a woman with ADHD. So it's very personal. I've got lots of lived experience. And if you met me and my sister and daughters and granddaughters, you would see very different people. Very different people. We've been impacted in different ways. And I I think that if there's one thing I hope to get across to your audience is that I'm very opposed to these little diagnostic boxes that we're trained to put people in. that ADHD is very nuanced and very complex. And the reason it's very complex is A, not only does it impact every aspect of our lives, it's not just school, it's not just work, but also that ADHD, and especially in women. is related to so many other issues. And what what I try to get across is just that we need to look at the individual in front of us and really try to see what is impacting her, what is her environment, what is her world, and not stick all these different labels. I don't think there are all these different diagnostic categories. I mean we're we're trying to comprehend the complexity of the human brain and so we have artificially created these little boxes. But I really think that a better analogy is a tapestry. There's just so much interwoven complexity that we need to understand with whatever person and especially whatever female is sitting in front of us. Daniella karidi: I I love that as a a starting point. I I've been talking a lot about your books. anyone that works with me knows that I'm obsessed with still distracted after all these years because I work with ADHD adults that try to retire. And that book is the only book that we have out there that talks about anything related to my audience and that I work with a lot. so thank you for writing that book. And I really appreciate the focus on that the those individuals and the fact, but today, even though I love that book, I'm not gonna ask you any questions about it. I'm gonna put Kathleen Nadeau: Yeah. Daniella karidi: it aside because and I'm just gonna tell people go read it if you're interested at all about your ADHD aging with you, because it's not going anywhere. but today we're gonna talk about the clinician's guide to ADHD in women. And I'm gonna start with why do you think we need a clinician guide? Why did you write the book? Kathleen Nadeau: Well, I think I need to start way back when, because Pat Quinn is my second author on the book, and Dr. Michael Morse, who worked for me at my clinic as a younger psychiatrist, joined the project. He wanted to support women. He wanted to promote himself as a male psychiatrist who is actually very interested in women's ADHD issue, so I appreciated his joining us. But Pat Quinn and I started talking about girls and women in the mid-90s. So we're talking 30 years ago, more than a generation ago. And looking back, it was just humorous. I mean, Pat Quinn and I would go to conferences and people would tease us, male, ADHD researchers and specialists that we were ADD, we called it ADD back in the day, ADD wannabes, like you just want to join the boys' club, but we've got the real deal. And they considered the way women were affected to be ADD light. Well, you don't really have it, but I guess you have few of the characteristics. And and the reason for that And it's something that women really need to understand, we women about ourselves, is we work so darn hard to mask it, so hard to compensate for it, that we made it a lot harder to notice. and the way that I sort of the phrase I use to explain it is that boys with ADHD were bothersome. They bothered their teachers, they bothered their parents. Let's do something about that kid that is driving me crazy in the classroom. Whereas girls with ADHD were bothered, it was internal. We knew Daniella karidi: Mm. Kathleen Nadeau: we were struggling. We knew we were hurting. And but we tried very hard for nobody else to know what was going on. We wanted to fit in with the other girls. We didn't want the teacher to be mad at us. And so we were a lot harder to spot. And we still are. And in fact, I have written in the past year a questionnaire for elementary classroom teachers to better identify girls in the classroom. There's still a need for that because girls just go under the radar. So why the need for a new book? Because the books that Pat Quinn and I, we wrote those in the mid-90s, a generation ago. And our books were called Understanding Girls and Understanding Women. And you've there we go. Daniella karidi: Yep. I think I have I actually have a nice new copy because my copy was was disappeared. So understanding Kathleen Nadeau: I know. Daniella karidi: girls with ADHD. I remember when it came out. Kathleen Nadeau: Yes. And so finally, I said to Pat Quinn, Before we retire, we have got to write an update. It's been an entire generation. And you know, what excites me today is that suddenly I would say in the past ten years and less, there's a whole cohort of female researchers. And interestingly, they're almost all females. maybe not surprisingly, that are looking at how we experience ADHD. Many of them are in Europe. Sandra Kuey is MD PhD in the Netherlands. She's been a powerhouse in doing research and training, and she has a whole team under her. And there are women researchers in Scandinavia, in the UK. Not so many here. It's interesting. Not so many here. Daniella karidi: Yeah we have where to grow, room to grow. Kathleen Nadeau: But there was so much to talk about because, you know, joking back about ADD light, you know, you just wanna be part of the club. what we've discovered in all those years is that women really are more seriously impacted by ADHD than males are. I mean, women with untreated ADHD are more likely to make suicide attempts. They're more likely to be psychiatrically hospitalized. They have a much greater family of medical conditions that often accompany their ADHD. And in spite of all the progress we've made in terms of equality of the sexes, we've still got a long way to go. And so not only are we women. struggling with emotional regulation issues and executive functioning issues and anxiety very often, much more often in women than men accompanies ADHD. We're still the ones expected to work full time, run the family, raise the kids, cook the supper. I mean, it's like this insane juggling act that we're Daniella karidi: Yeah. Kathleen Nadeau: expected to do. And then you add ADHD on top of it. So That's why we needed to write this book because we really need clinicians to understand those differences and take them seriously. Daniella karidi: So if someone went and was considering getting the book, what would be the one thing you'd say is the biggest takeaway you want them to get? Kathleen Nadeau: Well, the parts of the book that I wrote, earlier parts of the book focus on medication, which is certainly very important, on diagnosis, which is complicated, on co occurring medical conditions, but the parts of the book I wrote are really written in such a way that women with ADHD can get just as much out of them as a professional can. They're not written in technical arcane academic language and because my job is to communicate and so I I'm a great believer in plain English. And so what I tell women who come to me for treatment is my job is to help you do anything and everything that is going to help you feel calmer, more focused. and lead a more authentic life. I mean women have spent decades hiding and apologizing and feeling terrible. I forgot the birthday card. I forgot to thaw the chicken for dinner. I you know, I'm terrible at this job of being a woman. You know, and I I think if anyone wrote the job description, nobody would sign up for that job. Daniella karidi: Yes, for sure. and and and and definitely not for the salary. I Kathleen Nadeau: Right. And so the the part that I want women to get out of it is that there are many different ways to lower your stress level, feel more focused, calmer, able to really do what matters to you instead of just being a gerbil on a cage, more, more, more, more, more I'm late, I'm late, I'm late. and so I write chapters about way beyond everybody says medication CBT T, like that's the magic combo. That's not the magic combo. medication can be helpful, but the secret is if you look at the stats, many adults don't stay on medication very long, one, two, three years because they don't like the side effects. it's it's not the perfect answer. And there are many other things Whether or not w and I'm certainly not anti medication, it it can be very helpful for people. but we really need to find ways to change the way we think about ourselves, and that's where C B T comes in very handily. But we also need to become really good problem solvers because ADHD is so exacerbated by or calmed by the environment that we're living in. And I think so many women are just running so hard and so fast to just try to keep up with the demands of daily life that we never have the time to step back and say, is this the life I want to be leading? And is there a different and better life that I can be leading? And so A lot of what I've written about in the book is that we really need to make pragmatic changes in our environment to really look Daniella karidi: Mm-hmm. Kathleen Nadeau: at what are the stressors, what are the things that keep frustrating me, annoying me, overburdening me every day of my life, and do a lot of pragmatic problem solving. I mean, I actually Daniella karidi: Yeah. Kathleen Nadeau: met a woman who announced to her family, I no longer cook. Figure it out. Daniella karidi: I there's there's a woman on social media these days that she's saying she's doing a dad summer. She's doing all the jobs that the dad does and nothing more. That's so she's not doing Kathleen Nadeau: Mow the line. Mow the line. Yeah. Daniella karidi: she's doing dad summers. she's not packing the lunches for the beach. She can come to the beach, but she's not doing like and I laugh about it, but on the other hand, I do know that some of my listeners are saying, Okay, how do we do that? And I know you use a fr a phrase about We talk about the fact that we should be simplifying, simplifying, simplifying, simplifying. So Kathleen Nadeau: Yes. Yes. Daniella karidi: give me some thoughts and examples of how we do that, how us ADHD women can simplify some of our life. Kathleen Nadeau: Well, I'll tell you some of the things that I've done and Daniella karidi: Yes. Kathleen Nadeau: I'm always problem solving with women. One of the things I did a long time ago is I decided that I was going to limit my wardrobe to only things that would go with black. 'Cause then I didn't ha I mean, if it goes with black, okay, I've got five pairs of black pants and I've got a two black skirts and I got a bunch of tops. I don't have to think about it. I can and I I don't it's not that I don't care what I look like, but I don't have half an hour to scratch my head and think of what am I gonna wear to work today. That greatly simplified. I worked with a woman, and she actually lives in the same building that I do, who has a daughter with ADHD, and she bathes her daughter in the evening gets her daughter dressed in her school clothes for the next day and puts her to bed. She said, You can't believe how much calmer our mornings are. All she has to do is put on her shoes when she gets out of bed. And fortunately these days, you know, kids just wear jeans and t-shirts and it's perfectly okay to do that. So really doing some creative thinking about what's gonna make my life simpler. I try to cook meals in batches. Cook once, serve dinner three times. I mean I don't mean that we eat the same thing three days in a row. I just freeze it. But that means I really only need to cook a couple of times a week. And we still eat perfectly healthy, you know, reasonable home cooked meals. so just looking for different ways to do it. And I I love your example about, you know, I'm gonna have a dad summer and not a mom summer because I think we train people to take us for granted. I mean, we just jump into things and do them reflexively and then of course everyone expects us to and then it's what's wrong with you? Why aren't you whatever it is we've trained our family to expect us to do? Daniella karidi: Yeah. I I appreciate all those examples. I think my sister, she has four boys and she all her life made you never bought pajamas. You always put the clothes from the from the night before to wear to school the next day. That's a thing she always done. So I'll tell her I'll tell her she's not alone. Kathleen Nadeau: Perfect. Brilliant moment. Daniella karidi: and I I like those examples. I tell a lot of my clients that whenever we find ourselves saying, I need to do it this way, is where we can ask. why and who said so. I think that that's like a a an insight that we can kind of put that lens. And talking about lens, I really appreciated in the book that you emphasize that we should be addressing s basically quality of life and not list of symptoms. The whole idea of of of the that we're treating, we're helping, we're working with individuals and not with list of simple symptoms. Kathleen Nadeau: And a list of symptoms is a list of what's wrong with you. Well, but but they don't put in this circumstance. and Daniella karidi: Whoa. Kathleen Nadeau: I've often said I love to read, I'm a good reader, I learned to read very young, I've been a reader all my life. But I would be willing to bet that I would be completely dyslexic had I been born in Japan or China because I'm not very visual. And all those tiny little distinctions and these complicated symbols that mean words and ideas, my brain would be terrible at that. So do I have a disability? I mean, it could be a disability if I live there, but thank goodness I don't. I tell people, you know, in Italy there's almost no such thing as dyslexia. Why? Because it's an entirely phonetic language. If you can say it, you can spell it. That's not true in English. So it's really where are you planting yourself? And I think we don't pay nearly enough attention. In fact, we pay hardly any attention to what's my brain good at? Where should I plant myself? What am I naturally good at? And This debate, is it a gift? Is it disorder? I think that's a ridiculous debate. I mean that's very black and white thinking. We're all complex human beings. And so I have sensory sensitivity, which many neurodivergent people have. So I like to live in a quiet house. I I couldn't tolerate living in a house where the television was going all the time. It would just make me feel kind of a little bit frantic all the time. And so knowing that about myself, I feel better when I can see nature. And so I live in a place where I can look out every window and see trees. That calms my brain. That we really need to pay attention to what can we do in our environment? to feel well and function well. Not what's the matter with me. I mean, we all have brains that are very complicated and are very good at some things and very bad at others. Daniella karidi: hundred percent. I very much agree. I also found the whole superpower challenge because I think every person that comes in my office has some power that's super with or without ADHD, it's it's just finding ways to use it in a super way. and and I think that that is kind of my perspective about it. I will add that sometimes we make suggestions like add nature and unfortunately Some of our clients can't go and live surrounded by trees. And then I said, you know what? You can buy a mint plant that costs a dollar to ninety nine and fill your window slowly with mint. there I think that there always is a solution to bring those strengths into our life. But sometimes we need help of a professional to help us a coach, a clinician, a therapist, a support group. And that brings me to my next question. You you in the book, you guys talk a lot about the power of connection and community and being seen and support and support groups. Tell me a bit your perspective about that. Kathleen Nadeau: I think it's so important and I think what's hard for women with ADHD is we're expected to be, you know, the social planner, the social organizer, and that's just one more task. You know, am I supposed to call somebody up and decide that I'm free on this night and okay, am I supposed to cook something or go out and frantically buy a lot of, you know, hors d'oeuvres or you know, it it becomes a job. And I think that we need to arrange our way of being in the world so that it's kind of organic. And I'll give you an example from my own life. my husband and I decided to sell our house because we just we didn't need a house anymore. Our kids were long grown and it was becoming burdensome to maintain it. And so we've moved into an apartment. And in this community of apartments, there is an amazing walking group. There's a walking group of sixty two and counting. More women keep joining women that belong to this walking group that walks every morning of the week at 8 a.m. And you don't have to go every day, but as you walk with a group you get to know more and more people, you get to know their stories. So you are getting exercise, you are socially connected, and you're out in nature all at the same time. And that gets me to the chapters in the book about how do you reduce the negative impact of ADHD? And that has everything to do with a healthy lifestyle. I mean some of your listeners may be aware of the very troubling research that came out of the UK a little over a year ago in which they basically discovered that people with ADHD, especially untreated ADHD, lose close to a decade of lifespan. Not because Daniella karidi: Mm-hmm. Kathleen Nadeau: the ADHD directly kills us, but because having an ADHD brain makes it so much harder to fall asleep at night, so much harder to get up in the morning, so much harder to plan healthy meals and prepare them and clean up after them, so much harder to find the time to exercise. I mean it sounds like an unachievable dream to lead the healthy lifestyle that we know our brains need and that will reduce our ADHD symptoms. And so I'm always trying to help people find, just like I said, the walking group takes off three of the most important healthy lifestyle boxes. And if you've been on a long, brisk walk every day, you're more likely to be able to fall asleep. And if you can learn efficient, easy ways to cook nutritious meals, I mean all of those things combine so that we feel better and we function better and that's so critical. and it's it's hard to do. It I remember talking to my college roommate and she is a little bit older than I am and unfortunately has Alzheimer's disease at this point. And I was visiting with her when she was first diagnosed, which was a number of years ago And I asked her, have you read about the research about healthy lifestyle having a huge impact on cognitive functioning? And she just said, y don't tell me about that. I mean her immediate attitude was, I can't do that. I can't change everything in my life at this point. That she'd never been an exerciser. She didn't like to cook. She was on the introverted side and didn't know how to have social connections readily. And she says, I can't do it. And so I think we really need to create communities. I mean, I have the great good fortune of just living in this community where somebody initiated this walk-in group. It's been going on for over 20 years. And women leave it as they age out of it and women join it. But it's an amazing supportive phenomenon that Here are all these women and many of us are older women getting out there and walking and socializing and connecting first thing in the morning. It's a great way to start a more calm, focused day. Daniella karidi: I I think they understanding how everything is intertwined is really important. When I meet with people that are late diagnosed and they ask me like where to start, I always say start with movement. Add medication, add therapy, add coaching, but start with movement. That would be my first prescription. Like and I don't care if movement for you is walking in the mall as long as you're really moving or jumping on a trampoline if it's it movement is what it will help, especially your ADHD brain. And talking yeah, sorry. Kathleen Nadeau: But we also we also know that that movement does us much more good if we're out in nature. They did an interesting study at the University of Michigan in which they took students with ADHD and they gave them memory tests after half of the students walked down a path in a public park for I don't know how long it was, mile and a half or so, and the other cohort. walk down the busy streets of Ann Arbor, Michigan with cars honking and stores and that sort of thing, and then they convened at the end. And there were measurable differences in their ability to attend. And the ones that it's the Japanese have a phrase for it called forest bathing, but that's where the human race evolved. We evolved in nature and we've created these very brain unfriendly environments. That we live in. Daniella karidi: So if you're listening to this go outside afterwards and if you're putting this in your podcasts and your earbuds and you're walking outside, you're winning. and talking about winning, please tell us about your new institute, where I think is it's a major win for clinicians, and I will put the link to it, but tell us about it. Kathleen Nadeau: I'm so glad you asked. This is a project that I've been thinking about for a long, long time. it is the Institute for Lifespan ADHD training. Why have I wanted to create this institute? Because your listeners may or may not be surprised to learn that we do not receive good training. As physicians, as psychiatrists, psychologists, social workers, we do not receive good training in how to diagnose, much less how to treat ADHD. And ADHD is such a common phrase. I mean, it you can hardly run into anyone on the street that's, I know about ADHD. And what they know about ADHD is a very superficial, narrow and often inaccurate notion. that just means you're hyper, means you can't pay attention. So my vision is there is nowhere to get really comprehensive in-depth clinical training. And my vision is to bring together the best clinical faculty that I can find. globally, and when I say clinical faculty, this is not going to be more talking heads and PowerPoints. This is going to be experienced clinicians talking about how do you understand this complex human being in front of you that among many other traits has a set of traits that we call ADHD. How can I help them? How do I create a treatment plan? I mean so many therapists Just say, well, tell me what's Daniella karidi: Wing it. Kathleen Nadeau: going on, you know, tell me what's on your mind. They have no treatment plan. They have no sense of how can I help this person feel and function better in their daily life. That's that's our job. Daniella karidi: Yes, yes, a hundred percent. You you also somewhere brought up in the book something about taking an inventory of of what people are do are doing Kathleen Nadeau: Stress inventory. A stress inventory. Daniella karidi: a st but also wait, my brain is like blanking and it's gonna come to me. It's when you kind of ask ask them if if they're if the therapy's working. If you ask them like Kathleen Nadeau: absolutely. Feedback all the time. Are we working on what you want to be working on? And let's Daniella karidi: Right. Kathleen Nadeau: think about and sometimes that almost draws a blank from the person I'm working with. Well, I'm not sure what I want to be working on or should be working on. And then then it's very appropriate for me because I've been down this road a thousand times. To say, well, let's think about it. Let's think about what are the daily stressors that are making you always feel tense and inadequate and frustrated. Let's do some problem solving together. Not just thinking about how you feel, but doing about how you live. Because doing differently Yeah. Daniella karidi: I love that phrase, doing about how you live. I will add that I find that some of my clients with ADHD struggle using their backwards lens. They k struggle like remembering. And this is where as a professional we have the opportunity to say, okay, I'm looking at my notes or my recordings or my things, and this is the topics we've been talking about. How do you feel about them now? Like sometimes we have to be their memory considering their challenges. Kathleen Nadeau: That's right. Daniella karidi: And I love the the idea that you're developing an institute that will be designed for clinicians, that will allow us to have these kind of conversations, that will be available for people to continue with training and learning about ADHD, because I have no doubt that a lot of the psychologists and psychiatrists that I interact with know nothing about women with ADHD. Kathleen Nadeau: That's right. And w one of the things that I hope that ILAT will become is a place where we clinicians can come together in small groups and talk about complex cases and learn from one another. I don't think anyone has all the answers, but together we've got a lot of the answers. Daniella karidi: I love that one too. So before you leave, I like to ask this question to my guests. I like to ask, now that you're at this point where you wrote, I think 18 books, don't, don't, don't cat catch my number. But what would you wish some you tell young you? What you would you now that you have all this ADHD knowledge, what would you wish you could tell young yourself? Kathleen Nadeau: Well, that's a good question, but I would tell my young you you're gonna have a good time because I had the great good fortune I have a DHD but I have hyper focus and I had the great good fortune of becoming absolutely fascinated by learning, thinking, writing about what I do. so I think I've really been blessed in stumbling into it. I mean, I tell people I have an accidental specialty in ADHD, and that really is the truth. I had a general practice, and the public law changed, which required schools to provide accommodations for students if they had the diagnosis. And suddenly my phone was ringing off the hook from pediatricians from parents, can you diagnose this? We need that. And so I thought this is going to get awfully redundant. I too thought it was just hyperactive eight-year-old boys. And I thought, boy, how long did I? And I soon learned it wasn't that at all. And I soon learned that the parents had it too. And the siblings had it too, even though they looked very different. And so it's just been a fascinating life. So telling I would tell the younger you you're you're really gonna enjoy your career 'cause it's gonna mean a lot to you and it's gonna fascinate you for decades, which it has. Daniella karidi: That's amazing. And what would you tell future you? Kathleen Nadeau: Future me. Well, everyone around me tells Future Me that I should slow down. but what they don't realize is I have, if anything, I would call it the blessing of hyperactivity. I am the still the ever-ready bunny. I just passed my 80th birthday and I'm Daniella karidi: Congratulations. Kathleen Nadeau: still going strong. And so What I really try to help people in in my book on older adults with ADHD is it's a time if you weren't as fortunate as I was to have time to focus on things that are meaningful to you, that allow you to express your creativity or allow you time to connect with the world in ways you never had time to during your working years. But for Daniella karidi: Yeah. Kathleen Nadeau: me that means staying busy. Daniella karidi: A lot of my clients we we we don't call we they might be retirement retiring from official job but then they start their life passion or they start their their second job or they start their in some cultures it's called the age of gold, so the golden age. So this is the opportunity to make gold of your life and and make it to be what you want it to be. Kathleen Nadeau: Absolutely. Daniella karidi: if you're fortunate enough to be healthy enough to do that. And I wish you a lot of many more healthy years. And I look forward to sharing this book with other professionals and to maybe having more opportunities for conversations in the future. Kathleen Nadeau: Thank you so much. And just to remind your listeners again, the Training Institute is ILAT dot org, I L A T, the Institute for Lifespan ADHD training. And I hope you check it out. Daniella karidi: Thank you so much.