Women and ADHD – Episode 4 ‘ADHD, A Young Person’s Guide’

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Hosted by Dr. Blandine French, this podcast series focuses on attention-deficit/hyperactivity disorders (ADHD) and is designed to help young people and their families. We are delighted to produce this podcast series in partnership with Clinical Partners, the UK’s largest private mental health partnership.

This episode is the first of a two-part special on Women and ADHD, and Blandine is joined by Dr. Jo Steer, a clinical psychologist.

Blandine and Jo begin by discussing how ADHD can look so different in different people and explain the gender differences in the presentation of ADHD, before turning to explore why women and girls are more commonly missed than boys in terms of diagnosis.

Blandine and Jo provide insight into why it is so important to get a diagnosis, and comment on how female hormones can affect ADHD, with Blandine sharing her own lived experience perspective.

With women with ADHD more at risk of teenage pregnancy, unplanned pregnancy, and more likely to engage in risky sexual behaviour, Blandine and Jo look at what women with ADHD need to consider in planning and managing their physical health.

Blandine and Jo then turn to explore what they think is different of ADHD in women as opposed to men, with Blandine commenting that, for her, the main difference lies in how people see ADHD and how people see you with a diagnosis of ADHD as a woman.

Furthermore, Blandine and Jo share their key takeaways that women need to know about the effect of ADHD on them.

This podcast series for young people is supported by Clinical Partners. With the UK’s largest network of senior mental health professionals, Clinical Partners can help ensure your child has fast-tracked the right diagnosis and optimized treatment plan. For further information and advice for families and carers, search for Clinical Partners ADHD or visit their website.

Subscribe to ACAMH mental health podcasts on your preferred streaming platform. Just search for ACAMH on; SoundCloudSpotifyCastBoxDeezerGoogle Podcasts, Podcastaddict, JioSaavn, Listen notesRadio Public, and Radio.com (not available in the EU). Plus we are on Apple Podcasts visit the link or click on the icon, or scan the QR code.

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Other episodes in the series

Getting the Right Support – Episode 1 ‘ADHD, A Young Person’s Guide’

Adjusting to Change – Episode 2 ‘ADHD, A Young Person’s Guide’

ADHD and Sleep – Episode 3 ‘ADHD, A Young Person’s Guide’

Women and ADHD: Diagnosis & Management – Episode 5 ‘ADHD, A Young Person’s Guide’

Managing Impulsive and Risky Behaviour – Episode 6 ‘ADHD, A Young Person’s Guide’

Dr. Blandine French
Dr. Blandine French

Blandine has worked with parents of children with ADHD and adult patients for the last 8 years. She also received a diagnosis of ADHD as an adult which enabled her to go back to university to gain a degree in child psychology. Blandine’s main research interest in neurodevelopmental disorders, most specifically ADHD and Dyspraxia. Bio and image via The Institute of Mental Health Nottingham

Dr. Jo Steer
Dr. Jo Steer

I am a Chartered Clinical Psychologist and I specialise in working with children, young people and their families. I graduated from the University of Kent at Canterbury with a BSc (Hons) in Psychology.  I subsequently went on to the University of Surrey and completed my Clinical Psychology doctorate in 2004.  The focus of my thesis was looking at the attachment relationships of children with a diagnosis of ADHD.

I lead the Emotional Health Service (CAMHS Team) in Kingston and Richmond in South West London based within Achieving for Children.  Alongside this work I operate an small independent practice providing consultation and training to professionals, particularly school staff, and expert media consultation. Bio via drjosteer.com

Transcript

[00:00:30.360] Dr. Blandine French: Hello, and welcome to ‘ADHD, A Young Person’s Guide’. This podcast series focuses on Attention-Deficit/Hyperactivity Disorders, referred to as ADHD, and is designed to help young people and their families. It is produced by the mental health charity, the Association for Child and Adolescent Mental Health– ACAMH, for short. In partnership with Clinical Partners, the UK’s largest private mental health partnership. Search for Clinical Partners ADHD or visit www.clinical-partners.co.uk for more information.

I’m Dr. Blandine French. I am a researcher at Mindtech at the University of Nottingham. My main research interests are on neurodevelopmental disorders. But more specifically, ADHD and dyspraxia. I work with young people and parents of children with ADHD. And I myself received a diagnosis of ADHD as an adult, which helped me make sense of my life as a child and adolescent and helped me go to university and put the right support in place.

This podcast is the first two-part special on women and ADHD. In the second part, we will be talking to three young women about their experiences.

Today, I’m delighted to be joined by Dr. Jo Steer to talk about this very important topic. There’s evidence that women are poorly served group, and there are unique aspects to being a woman with ADHD. We’ll be talking about how ADHD can present differently, how societal expectations of gender play a role in the misdiagnosis of ADHD, how hormones affect ADHD, and what do we need to consider in planning and managing their health? Most importantly, we’ll be offering tips, advice, and strategy to help you and your families. Welcome, Jo. And could you give us a brief introduction of who you are and what you do?

[00:02:16.180] Dr. Jo Steer: Yes, thank you. Thank you so much for having me today. So, I’m a clinical psychologist, and I specialize in child and adolescent mental health and have worked in this area for 17 years now. So, I currently work in South West London for Achieving for Children and deliver ADHD and autism assessments alongside running a very busy child and adolescent mental health service. Over the years, I’ve really become very interested in ADHD. And more recently, in ADHD in girls and women. And that’s become a particular area that I’m very, very interested and focused on. And as a result, last year, I published a book called Understanding ADHD in Girls and Women. So, I edited that and also was one of the contributors. But it has many contributions from different professionals across the field in adult and child ADHD expertise. And so, really excited to be here today to talk a bit more about ADHD in women and how it affects them.

[00:03:27.900] Dr. Blandine French: Thank you very much, Jo. As a woman with ADHD, I am really also very passionate about this topic and understanding how it affects us differently. So, I’m just going to talk about my experience. I think having ADHD as a woman created lots of barriers, especially in the diagnosis. I wasn’t diagnosed until my late 20s. And I think it’s because of the type of ADHD that I had, which is very inattentive. But also the fact that I didn’t cause much trouble at school. I was quite bright in terms of education. And I was never really behind. I was just always more my head up in the clouds. But my parents didn’t really worry about that. I mean, and also, this is a few decades ago, and ADHD was a lot less known. But especially in women and girls. And I strongly believe this affected how late I got diagnosed and how early I could get support for my ADHD.

But since my diagnosis, I really have been really looking into obviously how my ADHD affects me. But also the different parts of my life as a woman that are impacted because of my ADHD. So, for example, when I got pregnant, no one ever told me when I got an ADHD diagnosis that pregnancy would mean I would have to stop my medication. Breastfeeding would mean that I would have to stop my medication. I’ve spoken to lots of women as well about how menopause can affect ADHD symptoms. And all different slight subtleties into what makes your ADHD worse. And very slightly different than if I was a man, for example. So, Jo, can you talk to us a little bit. How can ADHD look so different in different people? Can you explain the difference between men and women?

[00:05:18.875] Dr. Jo Steer: Yeah. I mean, I think it’s so valuable to hear about your experiences, Blandine. And I think what you’ve said describes such a common experience for girls and women on their ADHD journey. And really, I suppose it’s important to remember that ADHD looks different for every different person. And we say if you’ve met one person with ADHD, you’ve met one person with ADHD. And it is really important to hold that in your mind. And particularly I think for teachers and other professionals working with people who have ADHD actually to not make assumptions and to not jump in there because they have had an experience with one person with ADHD. To assume that the next person will be the same and will benefit from the same strategies and support. They may do, but they may not.

And it can be quite confusing, really. And I think those core symptom areas of inattention, hyperactivity, and impulsivity can be present. But as you’ve just mentioned, what’s really important to know is that there are different subtypes of ADHD. So, you can have ADHD combined type, which means that the person meets the criteria for inattention, hyperactivity, and impulsivity. But you can also have ADHD inattentive type, which is what you’ve just mentioned. And ADHD inattentive type is where you meet the criteria for inattention and the difficulties in that area, but not for hyperactivity and impulsivity. Although often, we still see some low-level hyperactivity or hyperactivity presenting in a slightly different way. But not classic and not able to sit down. Running around, jumping all over the place hyperactivity that we commonly associate with boys and ADHD. And we know that that looks really different in the inattentive type.

You can also have ADHD hyperactive impulsive type, where the young person or the adult may not have the inattention symptoms but does have the hyperactive and impulsive symptoms. So, there are three different categories. And actually, ADHD inattentive type, that’s what we used to call ADD. So, missing the H. Missing the hyperactivity. But we’ve moved away from that now and we talk about ADHD inattentive type. Girls and women are much more likely to present with inattentive type ADHD than boys and men. And this is often where things are getting missed. Because actually, as you said in your experience, Blandine, you weren’t behaviourally causing trouble at school. People weren’t really worried about you and you weren’t disruptive.

And so perhaps you flew under the radar, and nobody noticed that you were daydreaming, distracted, struggling with organization and forgetting things. Some of those symptoms are much harder to spot for teachers and for parents. That’s often why we’re really struggling and missing some of these girls and women when we’re diagnosing.

[00:08:20.800] Dr. Blandine French: So, are women and girls more commonly missed than boys in terms of diagnosis?

[00:08:27.405] Dr. Jo Steer: It’s definitely a trend that girls are being missed. So, they’re often being picked up now in adulthood. So that is absolutely a trend. But I think it’s also fair to say that inattentive boys are also being missed. So those boys that don’t present with the hyperactivity are also not being diagnosed in childhood in the same way.

[00:08:47.365] Dr. Blandine French: Thank you. I mean, some people might say, well, if it’s not causing problems and you might go under the radar. But why is it so important to get a diagnosis then?

[00:08:56.650] Dr. Jo Steer: Yeah, I think that’s a really good question. And I guess it would be good to hear from you in a minute about why it was important for you. But what people say to me is that the process of having an assessment and getting a diagnosis has helped them to understand themselves better and to feel understood and to feel heard. Certainly, the process of writing the book and lots of the feedback I’ve had from the book from adult women is that they felt heard for the first time in their lives having read the book, that someone actually was understanding their experiences.

Now I think we know diagnoses can lead to that improved understanding for the person themselves and understanding themselves better. But also, from those people around them. So that could be their family. But also, it could be at work, it could be at school obviously if it’s in younger years. And that then that understanding can also lead to support. And that support obviously varies from person to person. But it can mean access to treatment, which can mean medication for ADHD. Which we know can have a really positive impact on someone’s life.

[00:10:10.510] Dr. Blandine French: Thank you, Jo. And I think that reflects a lot about my experience as well. Where I think once you know what you’re dealing with, you can put strategies in place. If you know you’re forgetful, which is a big trait of ADHD, then you set reminders. You ask your husband to remind you to do that. You put it in big Post-Its everywhere. You find strategies. If you don’t really know what you’re dealing with and you just think you’re not good enough, then you’re trying to implement all the wrong strategies. And this is where I think for me. A diagnosis made all a difference. Because it wasn’t that I wasn’t good enough, it was that I learned differently. And that opened so many more doors for me. I spent my whole life believing that I couldn’t study. I wasn’t good enough. I couldn’t focus. The narrative that I heard is that I wasn’t trying hard enough.

But once I understood that I had a problem with attention and I couldn’t focus, then it allowed me to think, well, OK, so how can I learn? If I can’t learn like everybody else, how can I do it? And I learned to put things in place to allow me to learn as well as possible. But not in a typical way. And that allowed me to go back to university. And that allowed me to get my degree, which allowed me to get my PhD, which allowed me to be sitting with you right now. So, for me, my diagnosis had a huge positive impact on my life.

I was a restaurant manager before. Drifted between jobs and living in different countries and a bit purposeless. Because I thought there was no other options. Another career couldn’t happen to me. Because it was always so difficult. But understanding why I found it so difficult and what I could do differently to change that just changed my life. Basically, I know this sounds a bit corny, but it did. Because it said, OK, well you don’t fit in that box, but you can still do things if you do them differently. So, you talked about the emotions. And I know for me, the female hormones really affect my ADHD. So, for example, puberty as well is very problematic. So how do female hormones affect ADHD?

[00:12:27.560] Dr. Jo Steer: So, I think many girls and women with ADHD are affected by the changes in their hormone levels within the menstrual cycle. And also, in the perimenopause phase as well, actually. So, we know that in the week before a woman has her period, actually that is when there will be a worsening of the ADHD symptoms. So increased irritability, increased forgetfulness. Perhaps more impulsive. But also, that heightened emotional dysregulation that we were talking about. So really struggling with some of those big emotions. And women with ADHD seem to actually experience premenstrual syndrome much more acutely than women who don’t have ADHD. And that’s something that we see in clinical practice.

I think the research is still catching up in this area, to be honest. It feels like at the moment, a lot of the talking and the thinking is what’s being seen. And the research is following alongside. Actually, it’s really important, I think, for girls and women to track their menstrual periods and track their ADHD symptoms. So, to try and make sense of what they’re noticing and what patterns they’re seeing over time. And that might be able to help them understand, OK, that’s why this week, I’ve been really quite forgetful more than ever. Actually, it’s because I was premenstrual and about to have my period. And over time, being able to develop that pattern and knowledge and then feel more understanding towards themselves.

[00:14:04.562] Dr. Blandine French: Thank you, Jo. That’s really insightful. How hormones play a role on a monthly basis as well as how hormones play a role in the big hormonal changes that women go through their lives. So, whether it’s puberty then pregnancy and then menopause, which really affect women– all women, but especially ADHD symptoms when you have ADHD.

So, there’s a really famous saying of when woman is pregnant or after she’s given birth of having a baby brain. You forget things and you’re putting your phone in the fridge or whatever. And actually, the baby brain phenomenon is really similar to ADHD. So, when you have ADHD and baby brain, which I experienced with my two children, it just really, really aggravates ADHD symptoms. They’re just so similar, and it just makes everything worse. And obviously on top of that, when you are pregnant or when you’ve just given birth, you’re not allowed to be on your medication. So, you’re struggling even more. And it’s understanding that there will be changes in your symptoms and throughout your life. The fact that you are a woman with ADHD will create this extra layer of difficulties.

[00:15:21.883] Dr. Jo Steer: So, I think it’s really important that when girls or women are diagnosed with ADHD, that the clinicians diagnosing them give them this information, actually. So that you are ready and armed for those really big hormonal changes in your lifetime. So that you’re aware, actually, this is going to be important that I think about my ADHD, as well as thinking about having a baby or going through the menopause, definitely.

[00:15:46.958] Dr. Blandine French: Jo, we know that women with ADHD are more at risk of teenage pregnancy, unplanned pregnancy, and more likely to engage in risky sexual behaviour. So, what do women need to consider in planning and managing their physical health?

[00:16:00.190] Dr. Jo Steer: Big question, isn’t it? [LAUGHS] I think what’s important is that women and their GPs actually take account of their ADHD when they’re thinking about their physical health and any treatment and management of that. So, whether that’s the contraceptive pill or hormone replacement therapy or actually their asthma medication– whatever it might be. That they are thinking about the challenges that people with ADHD face when managing some of these daily situations.

So regularly remembering to take medication. It can be a real problem. So actually GPs talking with women about how to set this up so that they can remember. Obviously, we have the wonders of technology which helps us with lots of reminders and alarms that we can set for things. And ways to manage that. But I do think also attending appointments we know can be something that cause difficulties, can be forgotten about, can miss appointments. Then get discharged because they didn’t turn up. So, trying to build in strategies around some of these health aspects to their care is really important.

[00:17:17.540] Dr. Blandine French: So, what do you think is different of ADHD in women as opposed to men?

[00:17:22.592] Dr. Jo Steer: So, I think one of the big differences is that we’re missing it often. And therefore, we need to get better at picking it up in the younger years. So, get better at schools identifying ADHD in girls. But also, as a society, I suppose putting the information out there. Making it much more of a public health campaign around ADHD in girls and women and what it looks like and encouraging people to seek support and advice around that.

I think that’s one of the big things is those differences in being identified, really. I think another factor is the mental health side of things that we’ve talked about. And how often girls and women struggling with their mental health. When actually, it’s as a result of their undiagnosed ADHD. And so that feels really important, and that we need to encourage clinicians who are working in the field of mental health but also even the physical health to be more mindful of potentially identifying ADHD in women and girls.

And certainly, I’ve heard of women who have been identified as potentially having ADHD through their asthma clinic, through their hearing check that they’ve been for, and other physical healthcare where you wouldn’t expect them to be talking about ADHD. But actually, that has come to the fore. And that feels really powerful and important as a way forward.

[00:18:52.220] Dr. Blandine French: I’ve seen the way my ADHD affects me. And I see a difference between male friends, for instance. I do think that there’s a lot of stigma around ADHD in women. I’ve heard quite a few times that I couldn’t have ADHD because I was a woman. Because I don’t show it as well. How can you have ADHD if you’re an academic? Or how can you have ADHD? You’ve been managing quite well in this meeting. So, I think there’s a lot of more stigma also even from– I mean, even from healthcare professionals.

I had a GP, for instance, who told me once I couldn’t have ADHD because of my gender. And it didn’t exist in women. So even from the professionals that you expect to know a lot about it, there is still a lot of awareness raising to be done around ADHD in women. And for me, that’s where the main difference lies, is how people see ADHD and how people see you with a diagnosis.

[00:19:51.295] Dr. Jo Steer: I think that point about, well, you can’t have ADHD, you’ve been to university, is terrible. And we hear that so often that women are told that by their GPs. And we really need to work on that. That ADHD is not connected to IQ. And I think the other thing that’s really important to mention is that ADHD isn’t about being deficit of attention, so not being able to pay attention. It’s about difficulties regulating attention.

And so, as you say, there could be a meeting that was really interesting and that you were really engaged in. And maybe it short and you had done a bit of exercise beforehand. And so actually, you focus really well in that meeting. And that doesn’t mean you don’t have ADHD. It just means you are having a good meeting.

And it’s that difference. And that’s so often what we see, that people say, oh, you can’t have ADHD, because, oh, you can do this activity. You can read books for hours on end. Well actually, maybe they’re hyper focusing, and maybe they are really engaged and interested in reading a certain book on a certain topic. But that doesn’t mean that they don’t have ADHD, because they struggle to focus in lots of other ways and to shift their attention and to manage their attention in really, really difficult situations and tasks that are boring. They just can’t regulate up their attention.

It’s quite confusing for people. And I think this is particularly for that inattentive type in girls and women. That’s so often what we’re seeing, that people make an assumption that they saw them focus on something, and therefore, they can’t have ADHD.

[00:21:32.632] Dr. Blandine French: So, as we bring the first of our two-part special on women in ADHD to a close, I would like to ask you, what are the key things that women need to know about the effect of ADHD on them?

[00:21:44.220] Jo Steer: So, I think the first one is what we were just saying, that actually, that it’s not about attention deficit or being deficient in paying attention. It’s actually about attention regulation difficulties. And it’s really important to remember that. I think there’s something for women about understanding that actually many of their childhood experiences that they’ve had may well be down to their ADHD. And therefore, some of these perceptions and views that they’ve developed about themself are very much as a result of their ADHD.

So, these feelings of being lazy and stupid and potentially their anxiety or mental health difficulties that then run alongside that are very likely to be as a result of ADHD. And that’s important to remember and have that context. And I think finally, I suppose ending on a positive, that we know that once you have identified your ADHD and hopefully accessed some treatment and support, that actually it can be life changing and really can improve things no end. And so, it’s so important to come forward for that help and support where you can.

[00:23:03.348] Dr. Blandine French: Thank you, Jo. I have very similar key messages. Actually, my first one was about understanding how ADHD affects you. And really similar to that, once you have the diagnosis and you understand, it doesn’t have to be a negative thing. There’s some things you will struggle with. And there’s loads of positive about having ADHD as well and really understanding how your ADHD affects you on a daily basis really helps you put strategies in place and communicate with people and understanding what you might have difficulty with, and then trying to put things in place to minimize the impact it can have on your life.

But also understanding the key role of changes in life. Any big changes will affect your ADHD symptoms, whether they’re hormonal or not. We’ve talked about pregnancy or menopause and puberty. But also, big things, like going to university, getting your first job, all of these affect how your ADHD affects you. And I think it’s really important. I wish someone had told me that when I got my diagnosis, that the way my ADHD was 12 years ago is very different than it is now. And I’m sure it will be very different in 10 years’ time as well. And that’s OK. My attention demands are different now than they were 10 years ago and 20 years ago. And my ability to grasp attention is also different. But the strategies I’ve put in place are different as well. And you’re constantly learning. And there will be new challenges what life throws at you. That hormones throw at you. And that’s OK. I think just accepting that it’s very important, and also accepting that not everybody will get it. That you will get some colleagues and friends that say, well, I’m going to be forgetful, too. Or everybody can look at the window and don’t pay attention sometime when it’s a bit boring. And some people would just try to normalize your ADHD because it’s not as obvious as hyperactivity, for example.

People can more easily see hyperactivity than they can see inattention. But just accepting that you know you have ADHD, you know the struggles that you have, and it’s OK for those who don’t get it. It’s not your battle to fight. I think it’s also quite important. Just because you can’t see, doesn’t mean you’re not struggling.

So this is the end of our podcast. Really interesting. Thank you very much, Jo, on your expertise on ADHD in women. I can highly recommend your book. As we mentioned, this is the first of two specials. In the second part, we’ll be talking to three young women about their experiences. So do please subscribe to our podcast. Other topics in this series include sleep, adjusting to change, getting the right support, and risky and impulsive behaviour.

Once again, our thanks go to Clinical Partners for supporting this ADHD podcast series. With the UK’s largest network of senior mental health professionals, Clinical Partners can help ensure your child is fast-tracked to the right diagnosis and optimized treatment plan. For further information and advice for families and carers, search for Clinical Partners ADHD, or visit www.clinical-partners.co.uk. For more details, please visit the ACAMH website, www.acamh.org. And Twitter at @acamh, A-C-A-M-H. And don’t forget to follow us on your preferred streaming platform. Let us know if you enjoyed the podcast with a rating or review, and do share with friends and colleagues.

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