Abundant Practice Podcast: Episode #679

Why Are We STILL Missing ADHD In Women?
Host: Allison Puryear
Guest: Dr. Jennifer Dall
Date: August 20, 2025

Episode Overview

This episode dives deeply into the ongoing issue of missing ADHD diagnoses in women, especially those who are adults or late-diagnosed. With Dr. Jennifer Dall, an expert with lived experience and professional expertise in ADHD, Allison Puryear explores why stereotypes persist, the impact of misdiagnosis, evolving diagnostic practices, and actionable insights for therapists to better serve their clients. The conversation is candid, practical, and full of both personal stories and clinical wisdom.

Key Discussion Points & Insights

1. Origins & Lived Experience with ADHD in Women

• Dr. Dall’s Journey:
  Dr. Dall explains her late-in-life realization of having ADHD, despite decades in education and psychology, highlighting how stereotypes misrepresent ADHD as just "rambunctious 8-year-old boys."
  Quote:

  "What people think about as ADHD is like the 8-year-old boy who's just... all over the place... I have a doctorate in educational psychology. I should have connected the dots." (03:08)

• Personal Identification Through Teaching:
  Dr. Dall only recognized ADHD traits in herself after teaching more girls and seeing herself in their behaviors, underscoring the subtlety of symptoms in women.
  Quote:

  "I started to... see myself in [my female students] in certain ways, like some of their behaviors. And I would think, oh, that's me in middle school..." (03:45)

2. Stereotypes and Shifting Understanding

• Generational Blind Spots:
  Both host and guest, as Gen Xers, share how their education and training framed ADHD as a "male disorder," leaving women and girls overlooked, especially those who internalize, mask, or overachieve.
  Quote:

  "When I was coming up, like in grad school... ADHD, it was always like a rambunctious eight-year-old boy. Always." (04:38)

• Developmental Differences & Hormonal Impact:
  The discussion notes how ADHD changes over the lifespan, especially for women experiencing puberty, pregnancy, perimenopause, or menopause, making diagnosis even trickier.
  Quote:

  "As our hormones shift, we can't mask and fake it in the same way... there's an uptick in diagnoses among us Gen Xers..." (11:35)

3. Masking, Misdiagnosis, and Internalized Stigma

• The Challenge of Masking:
  Many late-diagnosed women spent years rationalizing struggles or overcompensating, and were often misdiagnosed with depression or anxiety due to difficulty with emotional regulation and burnout.
  Quote:

  "You may have been misdiagnosed with depression or anxiety or something else because... you're tired because masking and doing all this stuff is very hard." (06:09)

• Stigma and Self-Criticism:
  Both articulate the burden of being told (by self or others) that ADHD-related challenges are moral failings.
  Quote:

  "It's easy to fall into this trap of believing it's some moral failing... that's what our culture has told us forever." (09:32)

• The Necessity of External Supports:
  Dr. Dall references the importance of hiring help and creating external structure as healthy accommodations, not failures.
  Quote:

  "I hired a house cleaner. I live alone. But you know what? I had to do that... And getting past that, 'oh, you should be able to do everything yourself.'” (10:07)

4. Routine, Resistance & The Irony of Structure

• Structure as Freedom:
  Many with ADHD resist routine but ultimately find structure liberating.
  Quote:

  "People with ADHD resist routine... and it is the thing that tends to free them the most. It just doesn't sound like it will." (10:54)
  "Don't tell me what to do, but please tell me what to do." (11:10)

5. Why ADHD is Still Missed in Women

• Diagnostic Tools Are Gender-Biased:
  Dr. Dall critiques the DSM and standard surveys as male-centric, designed for and by men/boys, lacking nuance for how ADHD presents in adult women.
  Quote:

  "The DSM and a lot of the things... were created by men, based on studies on men and boys—not us." (13:04)

• Subtle or Internalized Symptoms:
  Symptoms in women may be inward (racing thoughts, hyperfocus, emotional lability) and easily masked. Standard checklists (e.g., "Do you remember to bathe?") are not nuanced for adult life.
  Quote:

  "She knows how to mask. She knows how to do it." (15:06)
  "If a lot of it's hyperactive in your mind... that doesn't come out." (15:18)

• Assessment Limitations & Adult Life:
  Questions about punctuality or organization (“Is it hard to get to appointments on time?”) ignore the invisible extra effort required for women with ADHD: alarms, arriving very early, extensive reminders.
  Quote:

  "They may say, like, no, it's not hard because I got there. But it took considerably more effort..." (19:08)

6. Therapy, Self-Advocacy, and the Therapist's Role

• Therapist's Awareness:
  Therapists must recognize when homework or therapeutic assignments consistently "fail," and approach with curiosity and compassion, not criticism.
  Quote:

  "What is holding you back from doing this? Not like, why didn't you do it... but trying to be like, okay, I hear that you care and you're really asking..." (22:04)

• Task Analysis for Clients:
  Help clients break assignments into component steps, seeking small, attainable wins for confidence and progress.
  Quote:

  "Even having... a task analysis and seeing what's missing and where they get lost... we need to move it back. We need a smaller task, a smaller goal first..." (23:02)

• Accommodations in the Workplace:
  Dr. Dall advocates for proactive workplace supports, noting many professionals have little ADHD training.
  Quote:

  "I've seen workplaces that don't work... They get like one little hour or one day in all of med school on it. That's nothing." (25:40)

7. Resources & Closing Guidance

• Continuous Learning:
  Dr. Dall encourages therapists to keep learning—from podcasts, books, clients, and each other—and to understand there is no one-size-fits-all solution, even among people with ADHD.
  Quote:

  "To whatever level you want to learn more... listen to your clients, like, to the extent that you can actually listen to them and maybe get some information out of them... it's going to take time, because it's been there forever." (26:11, 27:40)

• Dr. Dall’s Tools:
  She offers practical tools on her website, such as a quick hack list and an ADHD SOS card deck to help break down challenges into manageable steps.
  Resource:

  ADHDholistically.com (27:44)

Notable Quotes & Memorable Moments

• On Masking and Diagnosing:

  “We can know how to game the system. We can know how to show up at an intake, mask and not show. You know, you go in and you get these surveys to fill out, even for yourself... well, it depends what mood I'm in that day.” (15:18)

• On Gender Bias and Generational Gaps:

  “We're Gen X. They're in some basement that probably got flooded. You know, they probably say, ‘Oh, she was too quiet, or she talked to her friends too much…’” (17:38)

• On The Therapy Relationship:

  “Try to be really open and honest and listening and asking in a non-critical way…because you build up all these walls like, 'oh, I'm just stupid or I'm just lazy.'” (22:04)

Timestamps for Key Segments

• Origin Stories & Gen X Blind Spots: 02:19 – 06:47
• Stereotypes, Misdiagnosis, Stigma: 06:47 – 11:34
• Hormones & Adult Diagnosis: 11:35 – 13:04
• Improving Diagnostic Accuracy: 13:04 – 19:08
• Therapist Role & Homework Failures as Red Flags: 19:33 – 24:15
• Workplace & Systemic Issues: 24:15 – 26:11
• Final Advice & Practical Takeaways: 26:11 – 27:52

Conclusion & Takeaways

This episode underscores the urgent need for therapists, educators, and health professionals to update their mental models of ADHD—especially as it presents in women. Accurate diagnosis depends on going beyond standard checklists and truly hearing clients’ life stories. Therapists are urged to learn, listen, and adapt, knowing that ADHD in women is nuanced, masked, and often deeply internalized. Small, compassionate changes can make a transformative difference for clients who have gone unseen for too long.

Find more resources from Dr. Jennifer Dall at ADHDholistically.com