Why do women get missed out?

The following text is a full, minimally edited transcript of the MNT In Conversation podcast episode titled: “ADHD in women: Breaking the stereotypes.”

Often they receive a misdiagnosis, such as anxiety or other mental health conditions, before a specialist accurately identifies ADHD. Many women with ADHD are missed altogether. Why exactly is that? And how can we improve our understanding of this often misrepresented condition?

I am Maria Cohut, Features Editor at Medical News Today.

And I am Yasemin Nicola Sakay, Global News Editor at Medical News Today.

Today we will delve into these and other questions around the difficulty of receiving an ADHD diagnosis as a woman on our latest podcast episode In Conversation.

You can listen to this episode in full below or on your preferred streaming platform.

Yasemin Sakay: So Maria, I know this is a topic you’ve been very keen to tackle on the podcast. Do you feel comfortable sharing why that is?

Maria Cohut: Yeah, that’s basically because to be completely honest, full disclosure, I’m one of the many women who received an ADHD identification as adults.

Yasemin Sakay: Did that come as a surprise to you?

Maria Cohut: Not really. I think I’d always realized that my way of being in the world of interacting with things was a little bit different. Plus, I’ve had people make comments about the way in which I do things that have really struck me. For instance, working in an office, we had this little snack table and I remember, I very specifically remember this moment when I got up from my desk carrying my laptop with one hand, typing with another, walking towards the snack table and talking to one of my colleagues.

And my colleague was like, how can you do that? I was like, do what? How can you do five things at the same time? How can you walk and type and talk at the same time? To me, I realized that is just how my brain works. That is just how I function normally.

Yasemin Sakay: So why would you say you only received your diagnosis so late in life?

Maria Cohut: Well, first of all, think when I was growing up, say ADHD or neurodiversity wasn’t really a thing. People weren’t very aware of what that might be and how it might manifest. And on top of that, I had this image of being a quiet, a shy kid. I did very well in school.

Insofar as the people around me were concerned, I guess I didn’t really fit that hyperactive jumping off the wall profile that people might expect with something like ADHD or that would catch somebody’s eye. That’s why probably because I didn’t fit the template. People weren’t necessarily aware of the hyperactivity that was going on inside my brain.

Yasemin Sakay: Interesting. So do you feel like you learned to hide this very early on?

Maria Cohut: For sure I did, because I think really early on I managed to get an understanding of what was deemed socially acceptable and what wasn’t socially acceptable, or what would get me in trouble, for instance.

So I wouldn’t, I was a daydreamer, I was struggling to pay attention in class, but I would never own up to that, right? Because I figured out that people would just think that I’m being a bad student. I would like perform focus, which is a very weird thing to say, but that’s what I did.

Yasemin Sakay: Yeah, and they will present differently. So on that note, I think it’s time to welcome our special guest who will help us unpick some of these issues further.

Joining us today In Conversation is Professor Davida Hartman, Chartered Educational and Child Psychologist with the Psychological Society of Ireland, Adjunct Professor in the University College Dublin School of Psychology, as well as Clinical Director at The Adult Autism and ADHD Practice, and Co-director and Principal Psychologist at The Children’s Clinic.

Prof. Davida Hartman: Thank you so much!

Maria Cohut: Do you mind if we start by asking you what got you interested in specializing in ADHD in the first place? Is it okay if you talk to us a little bit about that?

Prof. Davida Hartman: You know, it’s very interesting. It’s just, I often talk to a lot of my friends and colleagues who are working in this area and a lot of us that are currently working in this area have now discovered our own neurodivergence, have partners who are neurodivergent and children who are neurodivergent but when we started off at the beginning of our careers that wasn’t the case. None of us knew we were neurodivergent or had children at that stage.

And it really was just honestly, it started off by chance in that one of the jobs that I got was with, was supporting autistic children. Well, now I would know they were autistic and ADHD in schools and I really loved the work and then it flowed from there that I loved that work and then I sought out more experience in that area and then I focused on that in my college years. So it led on to that.

But what I would say is I think for a lot of us, what we realized was, well: Why were we drawn to that area? Why were we drawn to those children? And I always found that I really enjoyed their company. It never occurred to me at the time that I might be ADHD myself, but really enjoyed their company and I really enjoyed the, what I would say, the honesty in the interactions. And now I think, because what you see, I mean, what you see with neurodivergent people is, you know, they flock together, you know, once you see.

You know, there’ll be groups of friends and they’re all neurodivergent and neurodivergent people marry each other and all of this kind of thing. So I don’t think it was coincidence, but that’s how it happened. It was mostly my early career was very much in the area of autism and autistic children and then later autistic adults with the Adult Autism and ADHD Practice.

For years I’ve been working with ADHD children, but without realizing it because a huge amount of the kids that I look back now, I wouldn’t even know. And that’s part of one of the issues around ADHD experience and people not being identified as ADHD is that we don’t recognize it, we’re not identifying it enough as professionals. Like it wasn’t even until 2013 that you could be recognized officially as both autistic and ADHD, which really isn’t that. It’s so, so recent history. So ADHD is relatively new for me.

I mean, I was late identified as ADHD myself maybe 4 or 5 years ago. So I think my real interest started then. And also just seeing because my work was so much in the area of autism or autistic experience, more and more realizing that these kind of binaries between autism, ADHD and various different types of neurodivergence are so unhelpful.

It’s helpful to recognize these things as individuals so that people can understand themselves. But actually, there’s massive overlap between all these things and realising that, you know what, this is something I actually really need to understand both personally and professionally.

Maria Cohut: That makes a lot of sense and we’ll come back to some of what you said just now as well. But I also just wanted to say, first of all, you took the words right out of my mouth with the birds of a feather flock together. And I’m so glad you said it because that’s also been my experience. And I’m also somebody who got a late diagnosis of ADHD. In fact, mine came last year. I’m not going to give you my age.

Prof. Davida Hartman: Congratulations!

Maria Cohut: Thank you! But it came last year and it took me… literal decades to obtain a, well, first of all, I guess, to think about asking for a diagnosis and then again, to obtain a diagnosis. And so that brings me to, I guess, the topic at hand. And I find it very striking that it takes so long for people to get a diagnosis of ADHD in adulthood and particularly for women, a diagnosis of ADHD. And my question to you is, why do you think, or why would you say, based on your experience, that is, why does it take so long for women to receive a correct diagnosis of ADHD?

Prof. Davida Hartman: You know, I think that there’s so many factors going on there from the very, very broad that our systems are medical systems, because unfortunately, I mean, we see like in our practice, we see ADHD as we’re neurodiversity affirmative. So we don’t see it as a disorder. We see it as a natural brain variation part of neurodivergence, not that it comes without its difficulties, of course, like every different neurology does.

But what I would say is that, unfortunately, ADHD is kind of housed and owned within this very medicalized, very medical model, disease disorder that was developed by white middle-aged cis men. And the DSM [Diagnostic Statistical Manual of Mental Disorders] and the ICD-11 [International Classification of Diseases 11th Revision] are based on white cisgendered children, young boys.

And so it looks at this very small, narrow way of being ADHD, which doesn’t encapsulate all the different ways that people can be ADHD and that people assigned female at birth and nonbinary people can experience being ADHD.

So we have this system that only thinks that’s hyperactive boys who can’t stay in their seat. And so there’s these kind of perceptions of being ADHD that didn’t fit how many people, not just women but many people were presenting and experiencing life. So people just literally weren’t thinking of it. Professionals weren’t thinking of it and women and girls weren’t thinking of it.

There’s also a huge amount of, I mean, listen, this is a whole other podcast, but there’s a huge amount of misogyny and distrust of women’s experiences. And so within the medical system, not just around ADHD, with anything, so that when women bring certain things to doctors or psychologists or any of that kind of thing, that their experiences would have been invalidated as, you know, and a lot of stuff would have put down to, you know, women issues and anxiety and all that kind of stuff.

And we see that across the board, not just with ADHD. So, but I think that the reason that it took decades, but I’m not sure that starting from now, it’s going to take decades because now, because the good part, I mean, there’s so many negatives about social media, but now with social media, there’s so many people talking out about their experiences.

There’s a lot more research from a personal perspective of this is me, I’m ADHD, this is how I experience the world. And so women are seeing that and are seeing other people and they’re recognising themselves, I experienced that, maybe I’m ADHD. And we’re talking more vocally, we’re going to the professionals and we’re saying, no, I think that I might be this, I want this looked at.

Yasemin Sakay: Yeah, no, you’ve touched on a great point there. You were about to come to how it presents differently maybe in women and girls. And I thought, how about let’s talk about the symptom differences? Like how does ADHD present in girls and women versus boys and men?

Prof. Davida Hartman: So the way that we approach ADHD, we come out from a neurodiversity-affirmative a perspective. So we don’t actually use the language of symptoms. Now I know everybody does. ADHD is very much owned by most of the researchers coming from the medical community. So it’s very much symptoms, diagnosis, all that kind of thing. But we don’t actually use symptoms because if you think about it, symptoms is the language of disorder and disease. So we use traits instead. And it’s a really helpful way of, yeah, it’s really helpful.

We don’t even use diagnosis. If you hear me saying identified and that I’m formally identified because diagnosis again we diagnose disease and disorder and look the thing is we are like officially you know people are like well you are diagnosing you are making a formal identification but you know language matters and we’re trying to shape the future and all that kind of thing.

But anyway so what I would say about the I know I talked about how it can present differently but actually I don’t know personally that it does actually present differently because I think that what we’re getting into there is, and people would have said that about being autistic also as well as ADHD, that it’s kind of buying into this idea that there are two different ways, that there is one way of being ADHD, but actually ADHD can look so, different whether, depending on where you live, depending on your culture, depending on your personality, depending on what’s going on in your life.

And I don’t necessarily think that there is, I don’t think ADHD itself presents differently in men and women. I think that men and women can be different and see we have to take into account nonbinary people as well of course and trans people and how does that fit then if you’re trans or nonbinary into that. So I think that notion that it can look different stops people from receiving the correct identification if you know what mean because I think there’s lots of women that do actually present in that how people would say a typical boys presentation but that it’s just not picked up because we’re not expecting it to be ADHD.

And then also you can’t get away from the societal expectations put on women to be good and to sit and be nice and to not say what we’re thinking and to manage everybody’s feelings and all that kind of stuff. And so we don’t even know how much of that cultural conditioning is going on in terms of how much. Possibly because of cultural conditioning it can look different.

Yasemin Sakay: You touched on a great point again, speaking of cultural conditioning and hiding. So a term that I’ve come across is masking. So do you think people who have lived with ADHD for longer, but they haven’t known it, do they learn to mask this better? And does this kind of further impact the likelihood of them seeking out medical help or like a diagnosis?

Prof. Davida Hartman: There is emerging research around masking, but a lot of is it within the autistic community, not as much within the ADHD community, because there’s a much more organized autistic community that are doing a lot more advocacy work in this area, whereas the ADHD advocacy community is smaller. It’s getting bigger, but it’s smaller and a bit less vocal around stuff like language and things like that, whereas with the autistic community, it’s a lot stronger. But again, it’s because ADHD is so significantly linked to medication. And so again, it’s housed within the medical community.

Okay, so masking is a huge issue. So for example, an example might be talking less, for example, you know, and again, there’ll be some situations, I mean, as you can tell already, I am a talker, so, you know, an example of me masking would be in some situations where I would have to really be working on talking less, you know, not saying every thought that came into my head, all of that kind of stuff.

And in some situations that’s actually helpful and I need to do that. But in other situations where someone might do that in social situations, so they might be around friends, like it’s supposed to be a situation where they’re enjoying themselves and getting support from their community of friends, but instead they’re working really hard on acting a certain way, communicating in a certain way, and actually that just causes significant stress on the person.

And also that leads to feelings of shame because usually they get it wrong or they might say things, blurt out and then they’re going home and they’re thinking about the things that they said and they wish they hadn’t said that. But there’s a lot of emerging research that masking is really significantly negatively impacts people’s mental health. And it gets to a kind of breaking point where people don’t even really know themselves because some masking is conscious and a lot of masking is unconscious. Like we were talking about how women learn to be nice and manage feelings and all that kind of stuff. A lot of that is unconscious.

I think that sometimes it just gets harder as we get older and then if we’re talking about women here, when perimenopause hits and when the demands increase, that it becomes harder and harder for people to mask and that’s when they start to think, okay, this is actually becoming a little bit untenable and what’s going on here.

Maria Cohut: Hold that thought, let’s come back to that because we have some questions about that as well. I just wanted to be very vulnerable here and interject and say this is genuinely bringing tears to my eyes. I think that is so true, the emotional and mental health toll that forcing yourself to fit a certain image when that is not the way in which you naturally interact with people and I think you know there’s obviously value in being a socially conscious person and knowing when to take space and when to give somebody else space to talk and talk about their experiences and whatnot.

If it crosses a certain line where you feel like you’re constantly holding back, that’s when it becomes really hard on the individual. I love what you said about how people assigned female at birth or people who, you know, have an experience of girlhood like me perhaps learn how to mask really early on because thinking very far back into my past, to my childhood, I am very aware that I was very conscious very early on that there were certain things I shouldn’t do and I shouldn’t say because people expected me to behave a certain way.

And so I learned very quickly not to do and not to say those things. But you mentioned perimenopause, making it harder to mask, to pretend that you don’t have these traits and this way of interacting with the world. I’m going to start broad and then maybe zoom in a little bit.

When you’re thinking of perhaps women who seek a diagnosis later in their adulthood, in their thirties, in their forties, maybe later, why do you think that is? And obviously perimenopause appears to be a factor. So how does that specifically affect how ADHD presents and how we’re able to manage it? And are there, you think, other factors, maybe?

Prof. Davida Hartman: There’s a bit of emerging research, again, we’re very early days in terms of research in this area, there’s very small studies, and very small studies in perimenopause as well as ADHD, you know, a lot of the research into ADHD is very deficit-focused and not focusing on women also.

There is research that’s kind of indicating that it’s possible that ADHD people, experience perimenopause earlier and certainly have more significant perimenopausal symptoms than people who are not ADHD. And I also think on top of that, and even anecdotally, what I would say is anecdotally and from a personal perspective, for me, I am ADHD, it did affect me. I didn’t realize. Looking back, it was very clear, but I had very scaffolded… So I think this is also the thing.

People who are very supported in earlier life, who have supportive parents, they’re able to manage that because ADHD, while it’s described at the moment in the DSM as this very deficit-based problem with attention, what we know is that there’s no… ADHD people have loads of attention. It’s just a difference in the way that we attend. So it’s very much based on novelty and it’s based on interest and it’s based on all of those kind of things. So there’s this abundance of attention that we can give to things. And creativity.

I had friends. I did fine in school. But it was only later in life when I had children. And then really it was when perimenopause hit that I thought, actually, I can see, I actually received my identification before I went through perimenopause. But that was only because colleagues of mine, friends and colleagues would say to me, you know, you’re very ADHD. And then I went to a psychiatrist and did the assessment and he was like, yeah, you’re ADHD.

And honestly, I was surprised at the time. I didn’t even, I had worked in the area for years. I was like, really? I am. Oh, okay. And again, not to go too broad with this, but where we are in society at the moment in terms of we’re losing our communities. We’re talking about women here, but middle-aged women previously would have had a community of support and even and would have been able, a lot of women would have been able for example to not be working two jobs now with the state of the economy.

Yasemin Sakay: So what I’ve kind of understood from what you’ve been telling me basically perimenopause dialed up a lot of your ADHD traits or made them more apparent. Is that correct?

Prof. Davida Hartman: Did it dial up or was it, do know what, was more, I don’t think, no, I don’t think that they dialed up, but it was more the difficult, because as I said, there’s massive strengths to being ADHD. And I wouldn’t say that my strengths are dialed up as in I don’t think I talk more than I used to, or I don’t think when I hyper focus, I hyper focus more than I used to.

But I would say in terms of my forgetfulness and in terms of say executive functioning, it’s just too many tasks. I think with perimenopause, as well your emotions are all over the place. It’s more your emotional reaction, your kind of emotional bandwidth to handle stress I would say gets harder.

Yasemin Sakay: So yeah, okay, so I’m gonna draw on something else you said. So you were talking about executive dysfunction and I’m thinking of brain fog, for instance. These perimenopause symptoms can look a lot like ADHD. How can we actually tell them apart if they’re perimenopause symptoms or ADHD?

Prof. Davida Hartman: Oh yeah, they’re very similar. But the thing is that to be ADHD, you have to have shown traits before the age of 12. To do an assessment, it has to be a really rigorous, in-depth assessment. And I know that there’s a lot of talk on social media, oh, everybody’s being diagnosed as ADHD and… ADHD and private companies.

Every so often there’ll be something about private companies and they’re just… handing out ADHD diagnosis willy nilly you know but actually it’s so not the case you have to go through a very rigorous assessment process where there has to be signs before you were 12 there has to be an impact on functioning and all this kind of things.

Maria Cohut: First of all, let me just confirm everything you said about how rigorous the assessment is. It really goes into a lot of details about just your life’s history and all of that. I find it very difficult to believe that people are just handing out these diagnoses or identifications like that.

But the difficulty that I have also found, and I think other people have also found with this has to have been present in your life before the age of 12 is that there are people who don’t have somebody in their lives who was present during their childhood, for instance.

Or maybe they do, but they are one of those people who are like, what, what’s ADHD? It’s not real. Everybody’s got ADHD these days. That’s just normal. Why are you, why do you think, why do you think you’re ADHD? I wonder how we can square up and deal with that difficulty. I don’t know there’s an answer to that question.

Prof. Davida Hartman: No, yeah, it’s really hard and we, like in the Adult Autism and ADHD Practice, we gather information and sometimes, because a lot of the time people remember, you know, again, it goes back to this mistrust of people. I really hate that culture not trusting people to talk about their own experiences. I really trust people.

So if they’re talking about their early experiences, and they’re saying, I struggled with this is what happened in school, this was me when I was younger. That’s all really valid and sometimes it just happens that the person can’t remember, there’s nobody there that does remember or the person that does remember as you say, because obviously this is all massively genetic and so if you’re ADHD it’s exceptionally likely at least one of your parents is ADHD as well. Of course they’re like, it’s all not… ah sure everybody, that was completely normal. Everything was, you know, normal in inverted commas. And it was normal and isn’t that great? I mean, at the same time, it’s wonderful because it means that…

So unfortunately that can happen though, because there are professional standards. So we really support self-identification. Like there’s no reason why, you know, if somebody wants to investigate the traits of ADHD or various neurodivergences, they can’t self-identify because we can have this conversation with somebody who comes into us. Okay, there’s no evidence from before the age of 12. However, from all the information you provided to us, it’s really looking likely.

You know, you have all these traits, your friends are all ADHD, your children have been identified ADHD, let’s face it, you know, you’re most likely ADHD even if we don’t have this evidence. And I have seen very good psychiatrists do situations where, okay, we don’t have that evidence, but we can still, with the psychiatrist’s support, we can still trial medication and see if it’s supportive.

You’re not going to get that everywhere because there’s a lot of bad practice out there. But yes, it is an issue.

Yasemin Sakay: Does everybody that has ADHD need medication?

Prof. Davida Hartman: No, it’s so individual. It’s so individual. I think that you see, it’s a funny one because we come from a neurodiversity affirmative framework where we reject a medical model of disorder. But yes, we’re still within a system where people genuinely do get benefit from medication.

And I do know a lot of people that have come through us have really been very well supported by stimulant medication. But a lot of people aren’t. And I think what’s really unfortunate is there’s a lot of people who really pin their hopes on… I’m going to get this ADHD identification and then I’m going to get medication and my life is going to be perfect because they see all these people online.

There’s a lot of videos online, people saying, I took the ADHD meds and my mind suddenly went quiet and I didn’t hear voices and I was able to get everything done. But it doesn’t work for everybody. It doesn’t suit everybody. It’s very individual about whether a medication is going to support or suit somebody or whether they like it or whether they want it. So it’s certainly not to be all and end all.

But loads of people find it very helpful. And you know, it’s something that I’ve had to learn, you know, like, it’s one of the areas where, what we always talk about this as a team, that we need to remain open and curious and not kind of stake a flag in this is what we believe right now. Because earlier on in my career, I would have been very anti-medication. And now I think back and go, I really didn’t have a clue. Because I’ve seen now the benefit that it can have, and I’m just more knowledgeable about the area. But I think it’s really individual to the person.

Maria Cohut: What you just said makes a lot of sense to me because there’s no one size fits all approach, right? For this kind of stuff, everybody needs to find what suits them best for the life that they live and who they are as a person. But I was just going to go briefly back to this notion of obstacles.

So we’ve talked about why people might choose to seek identification later in life. But I was going to ask what obstacles, what are some obstacles that women in particular face when it comes to accessing identification?

Prof. Davida Hartman: Well I think there’s obstacles for everybody at the moment in terms of the waiting lists are absolutely huge. know even if you know that you want an assessment and you’re trying to get one, the waiting lists are absolutely enormous and then to go privately obviously costs money. We did talk about it before but people seeing and professionals seeing this you know that ADHD is one specific way and that maybe a lot of women don’t necessarily come in presenting in that one specific way.

I think that a lot of professionals don’t really realize that ADHD can look so different for different people and can be so much about internal experiences. And a lot of professionals don’t realize, for example, that you can be successful in some areas. A lot of people that come through our practice are doctors, psychiatrists, and also artists and people that are employed and people who find it very difficult to hold down a job. But there’s also, you know, it’s such a wide variation of people. And I think that there really needs to be more education around what ADHD can actually look like.

Also I think that the fact is that because usually at that stage there is mental health issues, for example depression, anxiety are all linked and so everything gets this kind of that overshadowing where people think well they’re anxious and depressed. And that’s why all of these things are happening.

And it’s literally people, think the professionals just literally aren’t thinking about the possibility that this woman might be ADHD. I mean, I personally think that in all mental health services, there needs to be screening for neurodivergence, ADHD and autism across the board, even just to get professionals starting to think that this might be a possibility. I think that’s the biggest obstacle probably.

Maria Cohut: It makes a lot of sense to me again because I suppose a lot of the time, the longer that you’ve gone through life without identifying your specific flavor of neurodivergence, that can cause a lot of anxiety, a lot of depression-like symptoms, that can cause a lot of mental health and emotional struggles because you might not know why it is or like you might struggle again to fit this mold that people around you have created for you.

Prof. Davida Hartman: And it’s so important because in order to support anxiety and depression in all those different areas, we have to have an understanding of ourselves. that, for me, that’s the most important. And then it gives this permission to be yourself.

And that’s not to say that anxiety and depression goes away. Of course, it doesn’t. But it’s the start of, I think, people living much more authentic, happy lives is to truly understand themselves and why they do things in a certain way. And that’s the biggest benefit I would see of a of an identification, formal identification.

Yasemin Sakay: So, Davida, what would you say is a constructive way for us to think about ADHD or neurodiversity?

Prof. Davida Hartman: Well, in terms of ADHD, I think that the really constructive way is to think about it not as a deficit of attention, like I said, but a variability, just a different type of attention. We talk about biodiversity in the natural world. To think about neurodiversity as there’s just different types of brains.

Each type of brain has different strengths and different challenges. And that ADHD can be seen as this variable attention, different types of attention, because in the world that we live in, in kind of Western civilization, let’s say, there’s a real emphasis on behaving neurotypically and what I call selective attention. Andso, which is basically being able to pay attention to one thing and one thing only.

So, you know, in school, for example, stop fidgeting because they’re not paying attention. Whereas with ADHD, there’s this variability of attention. So there’s an ability to pay attention to loads of different things at the same time. And there is very much interest based so if I’m really interested in that, I can pay attention to that so well. If I’m completely uninterested, then we’re going to see problems, then I’m going to really struggle. And that’s the case for me. It’s the case for like it’s one of the core kind of basis of ADHD.

But if you think about it, there’s nothing in itself wrong with that. We need lots of different brains. We need people who pay attention in different ways. And again, there’s going to be challenges with that because obviously in life there’s going to be, we’re going to have to do boring things sometimes. And so there’s going to be challenges there.

But then if you think about say a neurotypical brain that’s very good at selective attention but maybe isn’t so great in a crisis or maybe isn’t going to sit and really hyperfocus to the extent that they become absolute, you know, professional, like a lot of professional athletes, for example, are ADHD. Or if you read, like any time that you read about where there’s been massive discoveries made, for example, of our inventors, they’re often, when you read the stories about them, they’re clearly neurodivergent, like they’re clearly autistic or ADHD or usually both.

With neurodiversity, we really need to move to a place where we’re not saying this is the best way to be is the person that can sit down in a classroom or in a work place, in a work office and do their work. We need all those different types of brains in order to progress as a society.

Yasemin Sakay: On that note, I want to know as a person with lots of neurodivergent friends, what can I and what can we do to better support people, especially women in our lives who have or suspect they have a form of ADHD?

Prof. Davida Hartman: I think the most important thing is really just accepting people how they are. If you’re friends with someone, not getting angry with them for things like not texting or being late or forgetting your birthday. If you know they love you, you know that they care about you and they’re showing up for you in all these other ways, those are the things that people can feel really ashamed about.

Like what kind of a friend, because there’s this expectation if you forget somebody’s birthday, they don’t really care about you. If they haven’t texted you in two weeks, they don’t care about you, they don’t want to talk to you about it. And often it’s times it’s really not the case. It’s just issues with time perception and executive functioning and all those kind of things.

Because it’s something that they’ve done in the past they feel shame about, then they go into a shame spiral and then they don’t text at all. So I think as a friend, if you’re just kind to people and don’t take those things as signs that they don’t like you or care about you, that it’s just their neurodivergence and that, you know, that we show up to our friends in different ways. I think that it’s around that acceptance and normalization and not shaming that’s the most important thing from friends.

Maria Cohut: Once again, you’ve brought tears to my eyes, I have to say, because I recognize myself in some of the things that you described, and I have a huge problem with remembering dates, and particularly birthdays. And I have a list that I’ve written down of the birthdays of every single important person in my life, family, friends, chosen family, if you like. But the problem is I have to remember to look at it, which I sometimes don’t if I’ve had a bad day.

And then I remember the next day and I’m like, oh no, and I feel so bad about it because it’s actually important to me to remember and to make those people feel loved and to demonstrate that I care. And sometimes it just doesn’t work out that way. And it’s what you’re talking about, the shame spiral that really gets to you in the end.

Prof. Davida Hartman: It’s so important because people do hold such shame about it and it’s really not. It’s like expecting somebody in a wheelchair to walk at all. You know, it really is a difference in their… I forget people’s names. Sometimes I forget my friends’ children’s names. And these are people I care about. I care about so much. You know, I meet people I’ve forgotten their names and I know that society sees that as a sign of that I didn’t care about them or I didn’t like them or I weren’t interested in them. And it’s so not the case.

So, and I think that it’s really helpful when you are ADHD to be able to say that to your friends. Look, I know that I forgot your birthday, but you know, it’s not me, it’s my ADHD. But then we have bit of a laugh about it. But I do try and I, you know, I put in, I put it, but I think it’s going easy on yourself. You know, us going easier on our friends helps them be easier on themselves as well.

Maria Cohut: Thank you. And I’m going to be very annoying now. have, before I say goodbye, I have one final question and I think it’s going to be an annoying question because we just discussed how there’s no one size fits all approach for people. But based on your experience, professional and personal, if you like, if you had to give ADHD women, some tips or advice on how to manage themselves better, how to manage those aspects of ADHD that show up for them that interfere with their quality of life, what would you suggest?

Prof. Davida Hartman: I think that women, I think we take on a lot. I think, you know what, I think it depends on the life setup of the person. So what I would say is for women who are in relationships with children, with men, in straight relationships with men, with children, what I would say is to really work on not taking on everything.

I think that we’re kind of culturally conditioned and also we’re just very caring but we take on a lot and we do a lot and there’s a lot of expectations around we have to do the tea morning in the school and we have to do all the costumes for Book Day and we have to, I suppose actually it’s broader actually I think that’s a broader point it’s not just about women in straight relationships there’s a broader point around we don’t actually have to do everything, you know.

We don’t have to bake the cupcakes and we don’t have to sew all the things and we don’t have to do all the school activities. I think it’s moving away from these societal expectations of how we’re supposed to show up and how we’re supposed to look perfect and be on time and figuring out what’s too much because there is that idea of the mask, the oxygen mask on the airplane that we can’t if we’re not looking after ourselves and our health and getting exercise and doing the things that give us energy that it’s impossible for us to keep going. So we need to also think about ourselves, not just be caring for everybody else and looking after everybody else.

Maria Cohut: Thank you so much, Davida. This has been such a fabulous discussion, so important. I feel like we’re going to come back to it in the future. If you’re happy to rejoin us on the podcast in the future, I’m making this official right now, live on air. We would love to welcome you back because there’s just so many follow-up questions that I now have. But thank you so much. This has been absolutely fantastic. Really appreciate it.