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

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 second of a two-part special on Women and ADHD, and Blandine is joined by Dr. Jo Steer, a clinical psychologist, and Emily, Anita, and Firdawsi – three young women with lived experience of ADHD.

To set the scene, Emily begins by discussing her ADHD journey, with Anita then sharing how, as a young woman, ADHD has impacted her life. Firdawsi follows this by sharing an overview of her diagnosis timeline.

Jo and Blandine then discuss what the other common co-occurring conditions are that women with ADHD struggle with and comment on the risk of untreated ADHD.

Emily then shares her thoughts on how her ADHD affects her as a woman and Firdawsi provides further insight into her own ADHD lived experience, including problems with sleep.

Emily also comments on her experience of being diagnosed with ADHD, including the difficulties she faced in getting her diagnosis, with Anita then sharing her own diagnosis journey.

Jo then explores how societal expectations of gender play a role in the misdiagnosis of women and girls before sharing her key message that women need to know about the effects 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.

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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 – Episode 4 ‘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

Emily
Emily

Hi, I’m Emily and I’m 22. I’m currently in a gap year doing volunteering before starting psychological and behavioural science at Durham University. I was first diagnosed with ADHD in November of 2021 during college studies, and I also have a diagnosis of PTSD and experience with child and adult mental health services.

Anita Salimi
Anita Salimi

Hi my name is Anita, I’m 22 years old. I’m a biomedical science undergrad student at the University of Warwick and I was diagnosed with ADHD over a year ago. I have also had a lot of experience with CAMHS as I was under their care between the ages of 13-18 years old.

Firdawsi

Hi, my name is Firdawsi. I am a Nigerian. I’m currently studying law at the University of Abuja. But I’m also studying software engineering on ALX.

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 second of a two-part special on women and ADHD. The first part was with Dr. Jo Steer, who we welcome back today. And we also say hello to three young women who will be sharing their experiences on diagnosis, how they manage their ADHD, the differences they face from men with ADHD, and also giving you their advice. Welcome, Jo, and could you give us a brief introduction of who you are and what you do?

[00:01:56.770] 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.

[00:02:23.972] Dr. Blandine French: Emily, can you start with an introduction, please?

[00:02:27.000] Emily: I’m Emily. I’m 22, and I am currently taking a gap year, but I plan to study psychological and behavioural science.

[00:02:35.460] Dr. Blandine French: Thank you. Anita, can you start with a brief introduction of who you are and what you do, please?

[00:02:40.320] Anita: Hi, Blandine. I’m 22 years old, and I’m about to start the second year of my university in September.

[00:02:46.377] Dr. Blandine French: Fifi, can you tell us a little bit about yourself?

[00:02:49.850] Firdawsi: Hi, my name is Firdawsi. I am a Nigerian. I’m currently studying law at the University of Abuja. But I’m also studying software engineering on ALX. That’s an online school. And, yeah. It’s going great.

[00:03:05.400] Dr. Blandine French: That’s great. Thank you all so much. Emily, can we start with you? Can you tell us about your ADHD journey?

[00:03:11.190] Emily: In terms of actually becoming diagnosed, there was quite a delay. And obviously, I didn’t find out until adulthood, which I partially put down to being female. Because I think, more based on my own research, this is like– symptoms don’t necessarily present in the same way. So, it was like it was never to an extent where people would look at me and say, oh yeah, she has ADHD. And I think there was such a– well, there is still such a stereotype that is particularly difficult, because it meant that I was not able to learn in the most effective ways or understand myself better.

And I don’t think that would have been the case if I wasn’t a female. But then just in terms of actually having ADHD and how it affects me, I would say it’s just a lot more unpredictable. And I think especially when it comes to periods and menstrual cycles– you know, PMS is a nightmare as it is. And I feel like often those– people experience quite difficult mental health as well during that time. And if your hormones are all over the place, and– it basically just exacerbates everything about the ADHD. And so, everything just becomes a lot harder in terms of controlling yourself, your emotions, and thinking things through properly. And I think it’s just something that is only applicable to people who have menstrual cycles. So, it’s quite an individual thing, I suppose. It just depends on people’s experiences. But I know for me that definitely it’s made the symptoms of ADHD even worse.

[00:05:00.833] Dr. Blandine French: Thank you, Emily. Really interesting to hear what you have experienced. And I can certainly empathize with it. Moving on to you, Anita. Can you explain how, as a young woman, ADHD has impacted on your life?

[00:05:14.820] Anita: I think the main way my ADHD affects me as a woman is that I don’t fit the typical stereotype or expectations of what society thinks a woman should be. I think most people believe or expect women to be clean, tidy, organized. When in reality I’m a huge mess. I can’t keep on top of any schedule. Sometimes I go days where showering requires too much effort for me, or I forget to brush my teeth. I have a slightly– well, I have a highly addictive personality, which I think most people would typically associate with men.

Like, I’ve had a nicotine addiction since I was 15. I’ve been addicted to caffeine since a really young age. And I could fully get sucked into a video game or a TV show to the point where I don’t realize there is another world around me. I think the hardest part, though, is that I’ve really struggled to meet the beauty standards that are unfairly expected of women. I mean, you look at all the beauty upkeeps that women can go through– hair care, skin care routines, makeup routines, body hair removal, going to the gym and dieting to get the ideal body. There are so many things women feel the need to do to keep up their regular appearances. And that feels impossible to keep up with as a woman with ADHD when you’re struggling with basic hygiene or just the smallest responsibilities in life.

[00:06:30.983] Dr. Blandine French: Thank you, Anita, for that honest description. I think many of our listeners would be able to relate to what you’re describing. Fifi, how about you? Can you give us an overview of your diagnosis timeline?

[00:06:42.360] Firdawsi: I was diagnosed early this year. I saw a therapist and they said I had anxiety, and depression, too. But I wasn’t satisfied, so I went back, and I asked for an ADHD evaluation. Yeah, it was difficult to get a diagnosis, because where I’m from, people don’t really know ADHD. And the person I was seeing at the time was online. So, I had to ask for a diagnosis. And while I waited, I did research on ADHD.

[00:07:12.002] Dr. Blandine French: Thank you, Fifi. I find it very interesting that the difficulties and similarities of trying to get an ADHD diagnosis are mirrored in Nigeria. So, you mentioned briefly anxiety as often overlapping with ADHD. What are other common co-occurring conditions that women struggle with?

[00:07:30.763] Dr. Jo Steer: So, what I’m picking up is also something about self-esteem and those messages that you have about yourself. You know, and often these girls and women are told that they’re lazy. They’re ditzy. They’re stupid. And actually, they’re not. They have ADHD. And it makes it much more harder to do some of these tasks, doesn’t it? And as you say, that kind of making sense of your forgetfulness in the context of ADHD is very different from just feeling like you’re a forgetful person. And there’s nothing you can do about it.

[00:08:03.377] Dr. Blandine French: Oh, absolutely. Yes, this is exactly that. And I think this leads to our next point of the risk of untreated ADHD. If you have such low self-esteem– you know, I remember sitting at school and my friends would say, oh, I did three hours of homework last night. And I remember thinking, how? And then I would go home from school and say, I’m going to do three hours of homework tonight. And I couldn’t go past 20 minutes. And I was thinking, well, obviously I’m not trying hard enough. I’m not good enough. And this had a really strong impact of how I dealt with everything.

For me, the risk associated with untreated ADHD means that I didn’t believe I could study. I didn’t believe I was good enough. I believed I had to stay in careers such as hospitality where I didn’t have to concentrate in the same way. And it had a strong impact on my quality of life in terms of careers, in terms of everything. And in fact, not understanding what I was dealing with really impacted every single aspect of my life. Jo, can you tell me a bit more about what we know the risks are if ADHD is not picked up?

[00:09:05.320] Dr. Jo Steer: So, I think the biggest risk is, linking to what you said, is around mental health. And we know that often women are actually coming through to services because of their mental health. Potentially anxiety difficulties, depression. And they present for counselling or therapy for their anxiety or depression, and actually have unidentified ADHD. So sometimes this is how people are getting to that point of diagnosis, because things are so difficult and stressful for them in their lives.

And they haven’t been aware that they have ADHD, that it’s causing these additional mental health difficulties. And that can sometimes lead to really significant other issues like substance abuse, as well. So actually, it is really, really important that we try and identify this early, so that people can be aware of it and make sense of it rather than having this real negative self-image, this low self-esteem, which then goes on to lead to these mental health difficulties. Because so often, there’s these repeated childhood experiences of not feeling good enough, and failing, and struggling in all the different areas you’ve described. And these can then go on to be factors in developing these mental health difficulties. So, for anxiety, as an example, if you’re constantly forgetting things and finding things quite difficult, then you inevitably begin to feel quite anxious about different scenarios, whether that’s meeting up with people, or going to school or into the workplace. So that then leads onto the anxiety. And that can really spiral out of control and be quite a challenge for people to manage. Often, we see anxiety alongside ADHD, but it can also be the flag comes up in order that sometimes these women are diagnosed through those adult mental health services, really.

The other side of things is sometimes the impulsiveness can lead to quite risky decisions in people’s lives. So, whether that’s risky decisions around relationships, around criminality, substance misuse, all those sorts of different factors. And that can obviously, again, lead to some really tricky outcomes, where we know if women are diagnosed and accessing treatment, then actually some of those outcomes can improve quite significantly for women.

[00:11:30.755] Dr. Blandine French: So, Emily, do you have any thoughts on how does your ADHD affect you as a woman, perhaps seeing back to your diagnosis?

[00:11:38.170] Emily: Yeah, so I think in terms of actually becoming diagnosed, there was quite a delay. And obviously, I didn’t find out until adulthood, which I partially put down to being female. Because I think, more based on my own research, this is like– symptoms don’t necessarily present in the same way. And despite everything I’ve already talked about in terms of impulsivity and stuff like that, in the past it’s more like– it’s like it was never to an extent where people would look at me and say, oh yeah, she has ADHD. And I think there was such a– well, there is still such a stereotype. So yeah. It’s particularly difficult because it meant that I was not able to learn in the most effective ways or understand myself better. And I don’t think that would have been the case if I wasn’t a female.

[00:12:38.873] Dr. Blandine French: Thank you, Emily. Again, fascinating insight to how ADHD impacts on a young woman, and I can certainly relate to what you’re saying. We’ll hear from Fifi and Anita and then talk about the points raised. Fifi, would you like to explain a bit more about your ADHD?

[00:12:55.110] Firdawsi: Having ADHD as a woman– well for me, I’ve problem keeping to time, time management, and sticking to routines. I hardly stick to routines. My ADHD presents itself as being usually almost always restless. I also have trouble concentrating and acting on impulse. Yeah, I do that a lot. I find it really hard to stay organized. I do not keep a schedule because I do not follow it. Every time I write something down or I try to do this or plan my day, it always doesn’t end well because I will mostly actually just forget about the to-do list completely and just do what I feel like doing at the moment. And yeah, it also features a lot. And like I said, self-control and impulse behaviour.

Yeah, as a woman, my ADHD affects my sleep because there are times where I would be able to sleep for hours and hours, and then sometimes I won’t be able to sleep at all. I will literally be begging sleep to come. And then I just have to– sometimes I just close my eyes and think about some things or listen to light music. Sometimes I just pray. Most times I pray. Like after the whole thing, I just pray. And yeah, sometimes I just read a book and wait for sleep to come. Yeah.

[00:14:30.598] Dr. Blandine French: Thank you, Fifi, for that. Sleep is very much a key area, not just for ADHD, but for all aspects of mental health. In this series, we have devoted a whole episode to sleep with some great tips and advice. Emily helped us with that one, so do check it out. Emily, tell us of your diagnosis. How easy was that to actually get?

[00:14:49.080] Emily: Yeah, I’d say when I first had an assess– well, I suppose the idea of having ADHD only came into my head because I was in college, and because the learning support team brought it up to me. And they’d made some special arrangements for exams and stuff. And then I approached my GP. My initial appointment– now, I don’t have a specific GP that I see. It’s sort of like there’s lots of different ones. And the one I happened to pick was just not very happy about the prospect, or he didn’t really see it as being possible. He sort of said to me, he was like, well, you haven’t been in education for a couple of years now, so you sure you’re just not really able to manage the workload? And I remember thinking, like, so is that your really nice way of calling me lazy? But that was really horrible, basically. And I suppose this person didn’t really know me very well either. So it was almost like he was not just discrediting me and the problems I was having, but also the other people who had recognized it.

So yeah. And even my friends were quite surprised. Not that they didn’t think I could have it, but I think because there is such a lack of understanding in terms of who it can affect and how it can affect them. When I told them that I was being assessed for ADHD, it was almost this kind of shock of like, oh, I didn’t even think it was possible for adults to have ADHD. And also because I guess I’d done relatively well with my life in school and stuff. I’d done OK, so it was kind of like, yeah. They didn’t see it me as having any kind of particular issue. But yeah, I think a lot of people just need to learn a bit more about it, I suppose.

And I think as a woman, it’s definitely because you just don’t fit the stereotype as much as men might. And so, it can mean that people just immediately don’t see it as a possibility. But I know one thing was that as soon as I started to receive treatment, my friends were very appreciative that I was no longer interrupting them every five seconds. So that’s kind of a running joke now. And I’m glad that they’ve actually gone out of their way to understand it as best as they can, as well. So that’s positive.

[00:17:32.790] Dr. Blandine French: Thank you, Emily. I’d be interested to know, have any of our young people had any experiences where you’ve been told that you can’t have ADHD because you’re a woman?

[00:17:41.862] Anita: I’ve never been told I can’t have ADHD because I’m a woman. However, I did notice that a lot of the initial screening and self-survey questions they gave me at the GP before they referred me were related to behaviours that a young boy with ADHD might display. I mean, the questionnaire is even called “Conners Scale for ADHD Assessment.” And there’s questions like, do they disturb other children in the classroom? And as an adult or a woman, these sort of questions can really throw you off or make you question yourself, or make GPs question you if you don’t answer them even though they’re not relevant in any way.

[00:18:17.250] Dr. Blandine French: Yes. Exactly right, Anita. That’s a great example of the types of male-female differences. Jo, how do societal expectations of gender play a role in the misdiagnosis of women and girls?

[00:18:31.563] Dr. Jo Steer: I think for women, one of the biggest challenges is that there is often an expectation that they do it all– that they have a full-time job, that they look after the children, that they organize the children’s lives, but that they also cook the meals and clean the house and manage things. Now, that’s not in every family. I absolutely acknowledge that. But it often is an expectation, and actually often an expectation that women put on themselves more than perhaps even men.

I think we know that if you have ADHD, it can be a struggle at times to manage yourself. So, when you have all these other factors that you also need to manage, and your children’s lives, and perhaps also the home and work, it can be quite tricky. And I think there’s something there also about women– there’s an expectation that women are nurturing, emotionally available, stable, kind, and caring. And we know that ADHD often means that women can be quite emotionally dysregulated at times. So, they can really struggle to manage their emotions sometimes. And that’s part of ADHD. But it’s not listed as a core symptom. But it’s very well recognized that it is one of the core areas of difficulty with ADHD, is that managing emotions.

And being a parent is often very emotionally charged. And it can be quite challenging for anyone without ADHD, let alone throwing ADHD in the mix. So, I think there’s something there about just this huge level of expectation from society, but also from women themselves.

[00:20:15.860] Dr. Blandine French: As we come to the end of the podcast, thinking about our listeners, if there are any people out there who are connecting with what we are saying and perhaps recognizing traits in themselves, or indeed in friends or family, what would you recommend they do? Fifi, would you like to say anything?

[00:20:31.363] Firdawsi: Yeah. My advice to them is they should probably just get tested, yeah. Shouldn’t rule out the possibility of any other thing, but they should just get tested, because once you do that– and also your research. Research is really good because it helped me a lot. So, once you do that, once you get your research and get tested, I think that’ll work.

[00:20:52.313] Dr. Blandine French: Thank you, Fifi. Anita, would you like to comment?

[00:20:55.940] Anita: I think it depends on the age. If you’re still under your parent’s care, I definitely think you should express your concern with your parents, do some research with them, and they can back you up when you decide to go to the GP or something. If the GPs are being dismissive, if your parents truly also believe that you have ADHD, then they might take it a lot more seriously.

But if you’re an adult woman, then I think the thing to do is to do a lot of research and associate what you think you could relate to with the symptoms you see. And so when you go to the GP, it seems to them like you know what you’re talking about. It’s not just a hunch, and they can’t just easily dismiss you. I mean, it sucks that you even have to do this, and you’re not just believed. But I often find that if you know what you’re talking about– because I don’t think GPs have a lot of training on ADHD anyway. But if you often know what you’re talking about, you can’t be as easily dismissed, and you’re more likely to go through the screening and then through the referral.

[00:22:14.323] Dr. Blandine French: Thank you, Anita. Jo what would your key messages that women need to know about the effects of ADHD on them?

[00:22:21.990] Dr. Jo Steer: So, I think the first one is actually that it’s not about attention deficit, it’s– 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 themselves 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 access 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.

[00:23:39.978] Dr. Blandine French: Thank you, Jo. Really interesting. Thank you. Also, our thanks go to our three young women who have joined us today– Emily, Fifi, and Anita. I’m sure your examples will be both inspirational and enlightening to our listeners. As we mentioned, this is the second part of a two-part special. In the first part, myself and Jo talked about a whole range of different issues that having ADHD as a woman brings. So please do check that. Other topics in this series include sleep, adjusting to change, getting the right support, plus 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 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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