Latest / Hook,Line,&SinkHer / Season 1 Episode 3 Casting in Different Waters: Why ADHD Looks Different in Girls

Transcript

Season 1 Episode 3 Casting in Different Waters: Why ADHD Looks Different in Girls · Hook,Line,&SinkHer

• Jayson St.Croix: Welcome back to Hook Line and SinkHer, the podcast where we cast out big questions, real and honest conversations, and occasionally get distracted by whatever shiny object just floated by. I'm Jayson, and joining me, as always, is Dr. Amy St. Croix. Dr. Amy S. L. St. Croix: Good morning. I'm Dr. Amy St. Croix. My work sits right at the intersection of education, ADHD, medicine, and legal analysis. And I, as we've said before, these are four worlds that overlap far more than people realize. And today I'm super excited to talk about the conversation that we have ahead. Jayson St.Croix: And we saw that last episode when we talked about some of the biggest myths and misconceptions surrounding ADHD. And while those myths affect everyone, today's conversation focuses on something that has been overlooked for decades. When most people picture someone with ADHD, they often imagine the stereotypical kid bouncing off the walls, interrupting class, forgetting their homework. But what happens when ADHD doesn't look like that at all? Today we're diving into why ADHD often presents differently in girls and women and why so many people go undiagnosed for years and what happens when an entire generation grows up wondering why life seems harder for them than everyone else. So when we were sitting at the conference room table this summer strategically planning out our episodes and our topics, you strategically wanted to put this episode third, and you said to me that this was the episode that you're most looking forward to. Why was that, Dr. St.Croix Dr. Amy S. L. St. Croix: Well, besides I mean, i it's honestly not even that I'm a girl. Or that we have a daughter that's, you know, significantly affected by ADHD. I love the research behind it. I love being able to bring that knowledge to the forefront. And it's even, you know, as I talk about those four worlds that collide, you know, regardless if I'm working with a pediatrician or you know, we're doing a legal analyst situation with a student with an IEP, it's it's embedded in that. I mean, sometimes in IEP, I can literally just go down and see almost these check boxes of accommodations and they don't fit the characteristics of you know some of the symptoms or some of the challenges that girls are facing. Jayson St.Croix: You mentioned the research and I had a feeling you were gonna bring that up. So I actually had to do some homework on this one because it's Dr. Amy S. L. St. Croix: Ha ha. Jayson St.Croix: a little out of my wheelhouse and it's more up your alley. But historically boys were diagnosed with ADHD more than double the rate of girls. It was a two to one ratio. But recent CDC D C data shows that that gap's narrowing. It's down to like one point eight to one. So I'm gonna ask you this. We used to think of ADHD as a boy's condition, but recent numbers show that the diagnostic gap is shrinking fast. Do you think this is because girls are developing ADHD more, or are we simply catching what we missed for decades? Dr. Amy S. L. St. Croix: Yeah. I have to be honest, I'm not sure that it's either. I think that we're in a really precarious spot right now. And I think that, you know, part of this is all historical, as you said. For a really long time, we recognized ADHD that was shaped, you know, by children that were getting noticed, right? They they're referred to in studies as disproportionate. They're disproportionately boys, exactly as you just said. And if you think about how a child gets diagnosed with ADHD. It typically, not always, but it typically will come once they're in a school setting. And I think that one of the things that we have to acknowledge is is our children are going to a school setting earlier and earlier and earlier, right? We're really promoting preschool within our society. But preschool doesn't start the year before children start kindergarten, right? We have we have three-year-old preschools and then we have Programs for students or children that are as young as two that you know really set up that schedule or that routine that we see within a school setting. So I think it's really important to acknowledge that most students often get diagnosed within a school setting. And historically, it's really because that child is constantly moving. They're interrupting, they're interrupting instruction. If that's appropriate for the grade, they're really impulsive or they've created some type of behavioral concern that gets the attention of adults. And statistically, boys were likely to present with these obvious externalizing behaviors. And I think that's the really, really important part of this discussion is to be aware of externalizing behaviors versus internalizing behaviors. And I really think it's just important to notice how it happens. You know, if you're in a classroom and you have 25 kids and you know, one of those students is a distraction to the educational process, regardless if it's to themselves or to others, then you know, that's what we notice. That's where the quote unquote problem lies. So I think that our system is becoming better at detecting ADHD. But when it creates a challenge or when it creates a problem. So one of the things that you had said was that ADHD had gone undiagnosed. And I think there's another important piece to that. ADHD has gone misdiagnosed. So sometimes you know people will, you know, think that ADHD is potentially a behavioral diagnosis. That's not true. True, or a personality diagnosis. We know someone personally who in third grade was not initially diagnosed with ADHD solely, there was the potential for a personality disorder, and we were like, Whoa, what what what do you mean a personality disorder? And then obviously, as time has evolved, there's no personality disorder. It's it's definitely ADHD. So I think. I think it's really important to also acknowledge the misdiagnosis of ADHD. And I think we're getting better at, you know, on both parts being able to diagnose what it is for really what it is. Jayson St.Croix: Yeah, some of the symptoms that and I say symptoms not in a negative connotation, but some of the are more observable. Some of them are hidden, Dr. Amy S. L. St. Croix: Mm-hmm. Jayson St.Croix: right? Some of them are sleeping. so like the one that you just mentioned, you No, they're Dr. Amy S. L. St. Croix: they're not sleeping. Jayson St.Croix: they're they're not sleeping within. No, I agree. But the the two Dr. Amy S. L. St. Croix: Right. They're they're just internal, right? Jayson St.Croix: and correct me if I'm wrong, because this is your expertise, not mine, but the two that I hear often associated with ADHD and misdiagnosed with women, females, girls are anxiety and depression. Dr. Amy S. L. St. Croix: absolutely. Absolutely. And when we talk about medication, regardless if that's right for you or your child, or it's not right for you or your child, very often before we put kiddos or even adults on ADHD meds, often they're prescribed an anxiety med first. And I really love you know, kind of getting into this conversation and how that misdiagnosis can come about just because of what's being internalized and what's being externalized. But I do have to say that I think that it's really, really important to indicate that there's not a male ADHD and a female ADHD. That's not true at all. Girls can absolutely be impulsive, girls can absolutely be hyperactive. It's just that we're talking about patterns of research, not rules. So I really do want to clarify that for our listeners. There's not a girl ADHD. There's not a boy ADHD. It's just the symptoms that we see are based on patterns of research. It doesn't mean that you know one is categorical to the other. So I just want to be super super clear about that. So that you know if you do have a hyperactive girl you say it can't be ADHD because that's that you know, is usually symptomatic as far as, you know, anxiety in a girl, let's say. So I think that's really important for us to to really separate that for listeners. Jayson St.Croix: Two things. One, you don't have a copy of my notes, right? For the listeners? You don't you no, you don't have my my edited version of my notes. Okay. Because you just you Dr. Amy S. L. St. Croix: No. No. I'm like looking for it. Jayson St.Croix: just teed this up perfectly for me. You talk about boys' ADHD and girls' ADHD. Why do you think people still have such a narrow picture of what ADHD looks like? Dr. Amy S. L. St. Croix: 'Cause it's what we see. Right? It's what we see. It's just exactly what we talked about last session. We see challenges in behaviors. We see disruptions. We see interruptions. we see meltdowns or dysregulation, right? We don't see daydreaming or inattention, right? We don't we don't see that. So we could have a student, I say a girl, but you know, again, we could have a student that looks completely compliant, always is following the rules, doing what you're asking them to do. Because she's seated or he's seated quietly. And what you don't notice is that they're actually struggling to sustain attention that entire time. And they're not following along with the lesson, and they're not following along with the reading. And because of that anxiety, they're also not asking questions. They're not the student who's, you know, raising their hand and screaming out and saying, I don't understand how to do first outside, inside, last. You know what everybody else appears like they know what they're doing. So we don't ask questions because we don't want attention brought to us. So, you know, it's those things like daydreaming and inattention that that is really, really you know, it's quiet. That's that's why it goes unnoticed. We talk about anxiety, right? Or emotional sensitivity. And when we think about these things, it's really emotional dysregulation, but we can't see it. So it goes under the radar. We can see behavioral dysregulation, and that's why it's at the forefront. And nobody really identifies you know how do you unless someone is is externally melting down how do you know that they're anxious you don't have any idea right Jayson St.Croix: Yeah. Dr. Amy S. L. St. Croix: and I know we see so many memes about this on the internet. Maybe it's or Tik Tok maybe it's just the Tic Tok that I'm in, but they talk about that, you know, people who see the most anxious part of their childhood is popcorn reading. Do you remember what popcorn reading was when we were kids? Jayson St.Croix: Is that where the teacher went around the room and called on individual students? Dr. Amy S. L. St. Croix: Yeah, or the reader did. So like the teacher Jayson St.Croix: okay. Dr. Amy S. L. St. Croix: started, right? And and then the reader would then call on another student in their class. And regardless if it was their friend or another student or whatever, but you didn't know when your time to read was coming. It was popcorn reading, right? Pop, pop, pop, pop, pop. You didn't know. So Jayson St.Croix: Yeah, I was the kid that was sitting there in class, please don't call me, please don't call me, please don't call on me. Dr. Amy S. L. St. Croix: Right, right. So what was happening is is teachers at the time thought this was a great classroom management skill because it kept everybody attentive or so that they thought, right? Because you never knew when your time was gonna come to read. But what was happening is the students that were having that internally ang you know anxiousness about either reading out loud or not knowing when their turn was going to come, what would happen is you never paid attention to what your classmates were reading. reading, You were always reading one paragraph ahead to make sure that you were potentially prepared. Or there was the student who just wasn't paying attention at all because they weren't engaged because they weren't involved. So then it would get to them. They wouldn't know where you were, and they'd sort of you know get corrected, so to speak, to pay attention. So it's about, you know, the stuff that we don't see. I think another really, really important space that we have to talk about with girls in ADHD is this internal perfectionism, and it's not even about being perfect. It's about compensation. Almost. So I know you're gonna be able to lock into this immediately when I say it to you, that sometimes what looks like perfectionism is really compensation for in executive functioning. So for example, if someone goes over the top in let's say note-taking, and out comes the graph paper, out comes the colored pencils. Jayson St.Croix: Who do you have in mind? Dr. Amy S. L. St. Croix: Out comes the, you know, colored markers because bold markers represent something different. Bold markers represent something different than thin lined markers, right? And this particular student will often, you know, spend copious amounts of hours doing note taking. And it appears that they're extremely organized and they have stuff together. When in reality, they're compensating for an executive function that if they were just to sit down and read the you know, the research, the paper, whatever assignment they were given, they would not be able to comprehend it to its entirety because they're either losing focus, they're anxious that they may not understand what they're reading, there's some bit of you know nervousness, inattentiveness going on. So they overcompensate for a weakness in the executive functioning. But it appears on the outside that this is some type of perfectionism or extreme organization and that's just not true. Jayson St.Croix: So you're popcorning a lot between home and school. So I got a question for you. What role do teachers and parents play in identifying their child with ADHD? And specifically girls and females? Dr. Amy S. L. St. Croix: I I think Th this is a great question. And I and I'm gonna be honest. This is completely my professional opinion. I have no research to back this up. But what I think happens with girls, my perspective is that parents often take the lead on the diagnosis of girls versus often the educational setting takes the lead on the diagnosis of boys. And you know, I'm I'm just gonna keep repeating this: internal versus external, right? So moms and dads see a student that comes home, completely melts down, can't keep it together, you know, cries throughout homework, you know, doesn't want to participate in family events right after school or really struggles in the social aspect. And when I say struggles, you know, you notice that other kids are having play dates, but maybe your child is not, or your child may not be getting invited to birthday parties at the at the same rate that maybe their classmates are. Those kinds of things. Moms and dads notice that. But often what happens. is because of this compensation, these particular students are great all day in school because they're compliant. Not because they're not struggling, because they're compliant. So very often when we're talking about these internalizing characteristics, the things that are happening internally, I see that moms and dads usually take the lead on those diagnosis versus teachers, where teachers are much more apt, or schools, not just necessarily teachers, because we have some. wonderful social workers and school psychs that are really astute to this kind of thing. And what happens is is I think we have that split ratio just of the way the symptoms present themselves. Jayson St.Croix: So how do you think our understandings of ADHD have changed over time? Dr. Amy S. L. St. Croix: Well You know, I I struggle with that because I don't know that they have. I you say this constantly, those that know know, right? And I think that it's all about education. The more that we can educate people, regardless of what their role is in a child's life, it could be from their pediatrician to their parent to their tea, it doesn't matter what their role is. You know, it could really honestly even be like a dance instructor or a piano teacher or a coach. I don't know if you remember this or not, but do you remember when our son was playing hockey? It was actually his coach that came to us and said, you know, you got a great hockey player here, but he can't focus to get through my direction of a drill. And do you also remember that when he would stand for the Star-Spangled Banner when they did the national anthem, right? He was the only kid in that line that was constantly moving. He was moving in in in place. His skates were c and I used to always say to you, look at him. He doesn't sit still. So I think that sports and coaching is an another space that's a great outlet for these kids. But I think the more that we educate, it can also be a space that we can have some, you know, we can have some knowledge of what what is happening in front of us. Jayson St.Croix: Yeah, I had the pleasure of coaching them for lacrosse all those years, remember? Dr. Amy S. L. St. Croix: Yeah, it was great. Jayson St.Croix: So for many years, girls flew under the radar because they weren't disrupting the classroom, and you've touched on a lot of these symptoms. Instead, they were air quotes daydreaming, overcompensating, or quietly struggling just to keep just to keep up with the class. But what are some of the signs that ADHD can look different in girls? And you've touched on a lot of these, and I want to just read them off to you, okay? You ready? Dr. Amy S. L. St. Croix: Yep, sure. Mm-hmm. Jayson St.Croix: Daydreaming and inattentiveness. Have you hit on that one? Dr. Amy S. L. St. Croix: Yep, yep, we talked about that. But but again I have to go back to typically that's girls, right? The day the daydreamer. But not always because I remember having a conversation before in second grade about a male student who would watch the squirrels out the window instead of you know looking at the teacher as she was teaching. Do you remember that? Jayson St.Croix: I do. Dr. Amy S. L. St. Croix: So date you know, again, I have to say this is about girls and these symptoms are are are per na you know, they're per they're They're typically what we see in girls, but not always. Again, not a male ADHD, not a female ADHD. Jayson St.Croix: I remember a director of special education who had a bird feeder outside of her window and I used to get updates on the birds that were coming to the bird feeder. Do you remember that person? Dr. Amy S. L. St. Croix: Do you remember? The principal Jayson St.Croix: Yeah. And the principal. Yep. Dr. Amy S. L. St. Croix: was actually the one that turned me on to that. That was all her. It was totally all her. Jayson St.Croix: Yeah. all right, this this next s symptom you've touched on perfectionism. What Dr. Amy S. L. St. Croix: Yeah. Jayson St.Croix: one that I don't think we have touched on yet. What about emotional sensitivity? Dr. Amy S. L. St. Croix: Ugh, if you have a teenage girl, man, and and people will say you know it it's that old cliche about you know she's a female she's you know no no no there's so much sensitivity emotionally as we go through those teenage years because it's naturally there right and then ADHD exacerbates it and it's tough man that is very difficult for a family to navigate. Jayson St.Croix: We have an episode coming up on hyperfixation and what I have learned and what my daughter has taught me is they have the ability to hyperfixate on one little nitpicking thing that you have said and whatever you have talked, and that's all that they can remember from that conversation. They just fixate and they nitpick that one cherry pick that one little thing. You know what mean? Dr. Amy S. L. St. Croix: Yeah. And and I think it's also important with this emotional sensitivity to talk about this because this is a strategy that I think could potentially help our listeners, which is which is always what I want to do. But if a difficult conversation needs to be had or a critic or you know, a construc constructive criticism, I think that having the ability to think about who the child is going to receive the message from most positively, regardless if that's the parent that is delivering it the most positively. Because I have to be honest, I feel like you're a much kinder human being than I am. You are much kinder in the sense that you don't dig deep and give the mmm like I do. But for whatever reason, I can say the exact same thing that you say, even in my mama bear tone, and it's better received than if you were to say the words more politely and more cautiously. Would you agree with that? Jayson St.Croix: Hundred percent. Dr. Amy S. L. St. Croix: Yeah, so I think a part of it is, is, you know, knowing the student and kind of knowing what causes those emotional dysregulations or emotional sensitivities. And then trying to to mitigate those, right? Trying to mitigate those a bit. So as parents, we often have conversations prior to conversations with our kids, and who's going to have that conversation just because of how it's going to be received. yeah, yeah. Jayson St.Croix: For the listeners that are listening and not watching us on YouTube, I'm currently holding my finger on my nose because Dr. St.Croix Dr. Amy S. L. St. Croix: It's usually not you. Jayson St.Croix: is much better at those conversations than Jayson is. So with our own kids you are. Dr. Amy S. L. St. Croix: But I'm not. I I'm very direct. I'm very direct and I'm very straightforward. And if I need to say to you, get it together now. There's no love there. It is get it together now. That is exactly what I say. I say, you need to pull yourself together. And and that is a those are my words. You know, but I do think it is a strategy to know, and and you know, we talk about other spaces, other places. I can think of a hockey coach off the top of my head that we have had conversation with to say, you say that to him, it will be better received by you. Or a lacrosse coach. I could think of a number three that didn't matter what he said, right? Our son would just do it. It could be the exact same thing you'd have told him for fifty-five practices. But when number three said it, it was Yeah. Jayson St.Croix: No, I know who you're talking about. All right. We talked about anxiety. we're still talking a little bit about the symptoms. What here's a good one. What about difficulty maintaining friendships? Dr. Amy S. L. St. Croix: Yeah, that's significant. Jayson St.Croix: How so? Dr. Amy S. L. St. Croix: That's significant. So you have to remember that the natural reaction for humans is to want to belong, right? To find a space. And if you can't find that space, it it's can you imagine that in every room that you sit in you don't belong? I I can't even imagine what that feels like. You make fun of me all the time because when I walk into a room, I take the room. That's my personality, right? I can't imagine not feeling like that. Imagine walking into a cafeteria and not knowing where you're gonna sit that day. So you don't know, I mean, think I want you to think about it from the perspective of these kids. You've got anxiety, so you're already concerned. But when you get up in the morning and you're on your way to school, who are you gonna sit with at lunch? Because you you have social anxiety, right? But as you say, they're the the whole situation, the social aspect of it. So you don't have a concrete friend group. You don't know, you know, who's g everybody else is getting notes on their lockers on their birthday. Kids just worry, is somebody gonna do that for them? Months in advance because you don't have that concrete friend group because it's very difficult and it's very difficult to make friends for several reasons. One of those reasons is because sometimes the impulsivity doesn't allow for what I refer to as a filter, right? So we can't always say what we're thinking. But sometimes with the impulsivity, we do say what we're thinking. And then that hurts people's feelings. So that can sort of, you know, be a tough challenge to go around. one of the challenges, I know you have experienced this as a teacher, because we've had conversations about this. We've experienced this as parents. Very often, ADHD kids are extremely cognitively intelligent. So, therefore, they're able to develop mentally do things prior to their peers. And I talk about things like sarcasm, right? Sarcasm isn't something that typically we pick up on until we're we we've grown a bit, right? Two-year-olds, three-year-olds, four-year-olds. 10-year-olds, they don't pick up on sarcasm, right? It's literal. But when you have that high cognitive function, you kind of start that sarcasm a bit earlier. And you come across as rude and you come across as disrespectful to your teachers and your peers. And that can be really difficult to navigate because others don't that they don't quote unquote get you, right? Jayson St.Croix: Right. Dr. Amy S. L. St. Croix: You appear to be mean or rude. Because you have that ability that others your age just developmentally don't have yet. Jayson St.Croix: All right, one more and then we're gonna bring it to this day and age. What about social masking, especially with social media? Dr. Amy S. L. St. Croix: Yeah. So in my opinion, social media is has a negative impact on these internalizing behaviors of ADHD. Because kids never have an opportunity to be off. Right? And because everybody is posting the positives that are happening, that is all that you're seeing. So both on the aspect of parents, then on the aspect of kids. So if somebody has a birthday party or somebody has a sleepover and your child didn't get invited, 15 years ago, you didn't know. Right? Now it's all over social media and everybody knows that you weren't invited, you weren't in the group, and you know you weren't invited. You know what I always think of when we talk about social media? When kids go to like homecoming and prom. So, you know how you see those large groups of kids in photographs in, you know, they're anywhere. They're at a park, they're down by the lake, they're, you know, around the local towns, right? Where the where the kids go, they all take their pictures, whatever. And you see groups of kids. There's a kid somewhere that's seeing these groups of kids, and you know what they're thinking? I I'm not part of that. Jayson St.Croix: Right. Dr. Amy S. L. St. Croix: I didn't get invited to that. Now those groups of kids aren't thinking like that. Of course they're not. They're not trying to be mean. They're not trying to be rude. They're not, right? They're all going in friend groups. They don't have any animosity. But I'm telling you, there's kids out there watching on social media that did not go to dinner. They did not go get their pictures taken with friends. They probably just went with either their date or themselves, right? So I really feel that social media is absolutely unequivocally not helpful with the challenges to ADHD. The part that I do think is helpful is getting the knowledge out there. but as far as the actual symptoms, I I don't I don't it's tough. It's tough when it comes to that social piece. Jayson St.Croix: So let's transition from the school years because for many women the diagnosis doesn't come in elementary school or even high school. Sometimes it happens in college or after becoming a parent or well into adulthood. What happens when someone spends years struggling without understanding why? Dr. Amy S. L. St. Croix: Well, you spend years struggling. There's significant aha moments. You know, as we've said in a previous episode, I'm that person, right? Like I didn't get diagnosed into adulthood. And there's so many things that I now look back on and say to myself, my gosh, I've been doing this forever. Or my gosh, I didn't know that everybody else saw it this way, and I see it this way. Like it it's it's double-edged because you feel wonderful that there's almost now an explanation, but you're frustrated that you didn't get that prior. Jayson St.Croix: Would they might experience self esteem issues? Dr. Amy S. L. St. Croix: Yeah, possibly. And you know, I think about success. I I think we might have talked about this on the first episode. How I have a group of, you know, I don't know, a circle of friends or girls, whatever you want to say. And we're we're all fairly successful, right? We're all pretty intelligent and we kind of got it going on and every one of us has ADHD. And we're now medicated as adults, and it's been diagnosed and those kinds of things. And we talk about how it can be a superpower. And for me, that's worked out great. But what about the other side that isn't able to manifest it into a superpower. And it actually is destructive, right? I think about those people who are diagnosed later in life and what it could have meant for them if they had been diagnosed earlier. Yeah. Jayson St.Croix: Destructive like burnout, anxiety, imposter syndrome, feeling different, r Dr. Amy S. L. St. Croix: Yes, yeah. Jayson St.Croix: relationship challenges. Dr. Amy S. L. St. Croix: Yeah. I think relationship challenges is a big one, is a huge one. And you feel like a failure when in reality that's not true at all. So you you have this different perception of yourself than than what it really is. And I think other people have a different perception of you. Yeah, I could probably speak from my own perspective with that. I think that, you know, before I was diagnosed and kind of do what I do, you know, people thought I was rude or that I, you know, was I don't want to say mean, but because they didn't understand that, you know, being in a room with 20 people was just that I was giving it all I had. To do that. Jayson St.Croix: As girls grow into women, society often places a tremendous number of expectations on them. They're expected to remember birthdays, manage schedules, maintain relationships, juggle careers, organize households, and somehow keep everything running smoothly. Did I leave anything out of your pink job list? Dr. Amy S. L. St. Croix: No I don't think so. Jayson St.Croix: How okay, how does ADHD how does ADHD intersect with those expectations? Dr. Amy S. L. St. Croix: Well you know, I'm I'm it there's just so much here with what you talk about. I mean, think about I'm gonna I'm gonna give you a perfect example. Birthdays. Right? You love the people in your life, obviously, your friends. y It seems pretty simplistic to be able to pick up the phone and shoot a text or a phone call out or send a quick birthday card. Because you know, you love that person and you and you think highly of them. But think about the executive functioning skills that go into that. You have to, first of all, remember it's their birthday. I usually write it down, put it in my phone calendar, actually. And then you have to remember to look at the calendar where it's put in, where you're supposed to remember that the birthday is there. You then have to, in some way, not become distracted to either pull out the phone or to you know whatever it make contact with them. There's then this social anxiety of making that contact. Now you say people who don't understand this do not understand this. It's your friend, it's your family member, it's your mom. What is what anxiety could possibly be there to reach out? A lot, a lot, and then you start to wonder, what if what if they want to start a conversation with me? What I don't want to talk right now. I don't have time to talk right now. Maybe I should wait to tell them happy birthday until I have a moment in case they want to start a conversation with me. But what if they don't start a conversation with me? If they don't start a conversation with me, does that mean we're not as good a friends as I think that we are? Should I post this on social media? Because if I put it on social media, does that then everybody knows that I wish them happy birthday? Maybe I could do that. Like there's just so many random thoughts that go into it that unless you understand, you just don't understand. And that is just the most simplistic thing. Right? Wishing someone a happy birthday. How can that take that much thought? But it does. And that's the role often of a girl. And I'm going to give you the perfect example. Sitting on my desk right now is a card. That card is filled out. It is ready to go for a friend of ours whose daughter graduated. And this friend is actually my very best friend. You know exactly who I'm talking about. And her daughter graduated in June. It's sitting on my desk. It's all ready to go. Is it because I don't have great thoughts of this individual or I want success for the daughter? None of those things. I have not been able to bring myself to the point to put the gift card in that card and mail it out. it's real. It's real. So managing all of those things, there's so much more that's involved than just a checklist. Jayson St.Croix: And the mental load that it puts on you doesn't just affect you mentally, it affects you physically as well. Dr. Amy S. L. St. Croix: Yeah. I would love to know, and I do not know the answer to this, but I would love to know if there's any research out there that connects ADHD and autoimmune. Jayson St.Croix: Interesting. Dr. Amy S. L. St. Croix: Because once you know, autoimmune diseases are often caused by or triggered by a a stress or a traumatic incident or some I would love to know if there's any research that connects those two. Because the physical toll is astronomical. Yeah. Jayson St.Croix: Yeah, that'd be interesting to find out. Do you think women with ADHD become good at hiding their struggles? Dr. Amy S. L. St. Croix: Absolutely. Absolutely and I think it's po it's part of the internalizing, right? And then I think the other part of it is is because you don't wanna be embarrassed, then you suffer in silence. And it doesn't mean that you just don't say anything. I'm talking about the mama who goes upstairs and takes a shower and and cries in the shower and then gets out of the shower and nobody knows that it happened, right? Or the mama that, you know, goes up to her room and hides in the bathroom for 10 minutes and then comes out a different, you know, re-regulated kind of a thing. So I think that it happens so often that people suffer in silence. And you also don't want to bring it up because you don't want people to think differently of you, right? Because since I've been diagnosed and our family is very, very knowledgeable about the symptoms and the challenges. When I do have a squirrelly day, what is the first thing every one of you says to me? Jayson St.Croix: Did you take your medication? Dr. Amy S. L. St. Croix: Did you take your medication? Now, I joke it off because it's true, right? When I don't take mine, I can't even, it's not happening. But at the same time, do you know what that feels like to have your own family look at you and be like, did you take your medicine? So there's a part of the reason that people suffer in silence because of the embarrassment of it. Jayson St.Croix: Right, because someone on the outside because from the outside someone might appear incredibly organized and successful while internally they're working twice as hard just to keep everything afloat, right? Dr. Amy S. L. St. Croix: You you got it. You got it. And and it's there's guilt there, right? There's guilt. you spend a significant amount of time being a perfectionist because you're making up for those executive functioning challenges. So you what somebody else, and this is it doesn't matter if you're in kindergarten or you know, you're in the professional world, what it's not about necessarily the quality of work that you perform, but If it takes someone else 30 minutes to do the same thing with the same quality that it takes you three and a half hours, there's a problem. That's a challenge. And that's what people don't realize. They're only looking at the end product and not what got us to the end product. And if we could really take a look at that, I think that diagnosing females would increase. Because it's not just about is the paperwork, is the work sloppy? Or, you know, are they missing parts? Or were they misbehaving? Or was there not attention? It how long did it take you to complete that? If it's double the time that it takes someone else, there's a problem. There's a problem. You are working way too hard to complete this task to the same ability that someone else can do it. Jayson St.Croix: Yeah, that's another episode for another day. We can talk about you and me in Google Sheets or in Canva. And that's a whole nother episode between the two of us, right? Dr. Amy S. L. St. Croix: Yeah. Jayson St.Croix: All right. One thing that I hope people take away from today's episode is that ADHD doesn't have a single look, a single personality, or a single story. For listeners who are hearing pieces of themselves in today's conversation, what would you want them to know? Dr. Amy S. L. St. Croix: It doesn't mean you have ADHD. So that's the biggest thing here is that you can't take one snippet of like one part, like, man, I couldn't focus during that movie. I kinda I have to have ADHD. That is not true. That's not true. But sharing these pieces with people just brings about awareness, right? So it's about. different pieces put together within a puzzle to then be able to provide a whole that could potentially identify that there's, you know, there could potentially be some challenges that we can introduce strategies to in order to make things better. Jayson St.Croix: Yeah, I think you summed that up good because one of the most important lessons to learn is this. Understanding how your brain works isn't about making excuses, right? Dr. Amy S. L. St. Croix: Yeah, ADHD should never be an excuse. Jayson St.Croix: No. It it's about building systems, maybe extending yourself some grace, realizing struggles that you've carried for years may finally have an explanation. Dr. Amy S. L. St. Croix: Right. And I think it's really important to make sure that our listeners understand that the diagnosis of ADHD is not a negative thing in any capacity. Like if you can put the systems in place and you know you can get the right strategies going, it is a superpower. And, you know, though I get very, very frustrated with myself sometimes, every once in a while I'll look at you and I feel a little disappointed for you because you're never gonna get the chance. To like really dive in. Like we do. Like you're missing out. It's so great if you can harness it. Jayson St.Croix: You have said that to me on multiple occasions. And there's support groups. I mean, interact with us on any of our social channels and some strategies work. Some for it just depends on the person. Some strategies what will work for you might not work for our daughter. What works for our daughter might not work for you. Or, you know, but Dr. Amy S. L. St. Croix: Yep. Yep. It's just throwing out as many strategies as we can and finding something that works for us. we're definitely out of the boxers, right? If you have ADHD, you're definitely not inside the box. So if you're already outside of the box, who cares? Give a bunch of you know, give some strategies and some tries and see what works for you and then stick with what works for you. But definitely, you know, our listeners should reach out to us. Our listeners should c start conversations on social. Like we're in those worlds, we're having those conversations, we're trying to share those strategies that we have and that we know, and you know, that we really promote with our clients. And I think that it's really important to get support so that you can manifest into a superpower. Jayson St.Croix: Yeah, I don't know if you'll remember this because we have a different genre of movies that we like. But do you remember the Truman show with Jim Carrey? Where he lived Dr. Amy S. L. St. Croix: I can Jayson St.Croix: in a bubble and it was a controlled bubble, and everything that happened to him during the day was under controlled situation and controlled circumstances. Dr. Amy S. L. St. Croix: Yes. Jayson St.Croix: So there was no chance for him to live outside the bubble. That's Dr. Amy S. L. St. Croix: Yeah. Jayson St.Croix: what I picture inside the box people like. Everything everything Dr. Amy S. L. St. Croix: Yeah, so Jayson St.Croix: is always controlled, everything's always constrained. Whereas if you're outside the box, You got freedom. Dr. Amy S. L. St. Croix: Yeah, so this reminds me of, this is how different we are. You bring up the Truman show, right? I'm gonna say to you, do you remember the novel, The City of Embers, or the novel The Giver, where they lived, right? They were in a controlled environment trying to create this almost a utopia. Not fully understanding that not that's not everybody's utopia. That's that that The Giver, Lois Lowry, that that that could be our own our own ADHD series right on that novel. Jayson St.Croix: Yeah, she won an award for that. And because both of those books used to be in the middle school curriculum, I read both of those books, so it looks like you you owe me a Truman show. Dr. Amy S. L. St. Croix: Nice Night no way, I'm never watching No, I'll lose brain cells. Haha Jayson St.Croix: Yeah, that's what you always say. Okay. Before we wrap things up, it's time once again for our tangent of the week, and this one's a good one. Every episode we'll share one of those moments that perfectly captures the wonderful, unpredictable nature of ADHD and Dr. St. Croix. So let's talk about just yesterday. It's finally fall decorating season, which means the harvest trees are coming out. The porch is getting a makeover. And somewhere in the middle of all of that, you got a sticky note listing everything you need to buy as you are getting everything out of the garage. And we both know there's only one place to go for those things. Where is it? Dr. Amy S. L. St. Croix: Yeah. Jayson St.Croix: Where is it? Dr. Amy S. L. St. Croix: Well I can't go there on Sundays. Jayson St.Croix: It's Hobby Lobby. So you head out with your sticky note. Your your list is clear. Your mission's simple. You're just Dr. Amy S. L. St. Croix: Yep. Yep. Yep. Jayson St.Croix: there for a few small garlands, maybe a few small items for the tree, some ribbon, maybe some new, Dr. Amy S. L. St. Croix: I just needed four things. Jayson St.Croix: maybe some new lights for the front porch. But then you see the other aisles in the harvest section. And then suddenly you might need three more hard harvest trees, a garland you didn't know existed until 30 seconds ago. A centerpiece that would be perfect for a table that you actually don't have space for. And now we have new couch pillows that say something to the effect you are the pumpkin to my pie or something like that. True? Dr. Amy S. L. St. Croix: Well, i maybe, maybe. But w just one, just one. Jayson St.Croix: Do we have new couch pillows? Okay. Dr. Amy S. L. St. Croix: I haven't brought the other ones home yet, in yet. Yeah. So I actually this happened twice and you didn't even know about it. So Jayson St.Croix: Dr. St.Croix I'm not done yet. there's more to this. Ready? No, Dr. Amy S. L. St. Croix: Yeah, I'm ready. Jayson St.Croix: I I bet. And here's the part that really gets me is you forgot the golden rule, right? So for anyone that's tuning in, we have a rule in our house. If it's a non-pay week, it's a basket. If it's a pay week, she shops with a shopping cart. If you know that, you know, right? If you go to Hobby Lobby. And somehow, sticky note in hand, non-pay week, very much in effect, you come home with a receipt that very clearly required a cart. Did that recently happen? Dr. Amy S. L. St. Croix: No, that's not true. Jayson St.Croix: No. Dr. Amy S. L. St. Croix: No, I did not use a cart because I went to Hobby Lobby three times this weekend. So I was able to do it with a with a basket because I went three times instead of one time and used a cart. I've been to Hobby Lobby three times this weekend. Jayson St.Croix: So you so you circumvented the system? Dr. Amy S. L. St. Croix: Correct. I'm an out-of-the-box thinker. Jayson St.Croix: There you go. Right it couldn't have drawn it up any better, right? Dr. Amy S. L. St. Croix: Yep. Jayson St.Croix: All right. You got anything else you'd like to add? Dr. Amy S. L. St. Croix: Yeah, there's one bag in the truck underneath the seat that I haven't brought in yet. Jayson St.Croix: Oh my god. Alright. Thanks for joining us for another episode of Hook Line and SinkHer. If today's conversation resonated with you, be sure to subscribe, leave a review, share this episode with someone who may have spent years wondering why their experiences never seem to match the stereotypes. So next time we'll dive into practical strategies, routines, and productivity hacks that actually work for people with ADHD. So until next time, keep casting, keep learning, and remember, sometimes the best catches happen when you least expect them.