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Abundant Practice Podcast
Episode #679: Why Are We STILL Missing ADHD In Women, feat. Dr. Jennifer Dall
00:28:28
to talk about the often-overlooked signs of ADHD in women and why so many are diagnosed later in life. They unpack how ADHD can show up differently as we age, especially when it intersects with things like eating disorders and the hormonal shifts that...
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- [00:00]
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Foreign.
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Hi, welcome to the Abundant Practice Podcast. I'm Alison from Abundance Practice Building. I have a nearly diagnosable obsession with helping therapists build sustainable, joy filled private practices. Just like I've done for tens of thousands of therapists across the world. I'm excited to help you too. If you want to fill your practice with ideal clients, we have loads of free resources and paid support. Go to abundance practice building.com Links all right, onto the show. So I've talked about therapy notes on here for years. I could talk about the features and the benefits in my sleep. But there are a couple things I want you to know about therapy notes that doesn't typically make it into an ad script. First is that they actually care if you like their platform. They don't only make themselves available on the phone to troubleshoot so you don't pull your hair out when you get stuck. They also take member suggestions and implement those that there's client demand for. Like Therapy Search, an included listing service that helps clients find you internal and external secure messaging. Clinical outcome measures to keep an eye on how your clients are progressing. A super smooth super bill process. Real time eligibility to check on your client's insurance. In my conversations with the employees there at all levels, they all really believe in their product and they want you to love it too. Second, they are proudly independently owned. Why should you care about that? Because as soon as venture capital becomes involved, the focus shifts from making customers happy to making investors happy. Prices go way up. Innovation plateaus. Making more money with as little output as possible becomes the number one focus. With over 100,000 therapists using their platform, they've been able to stay incredibly successful and they don't have to sacrifice your experience to stay there. You can try two months free@therapynotes.com with the coupon code Abundant. Welcome back to the Abundant Practice Podcast. I'm your host Alison Parear. I am here with Jen Dahl and we are going to be talking about ADHD in women, how it gets missed, what we need to be looking for, all of it. Thank you so much for being here. I appreciate it.
- [02:13]
C
Thank you for having me on. I'm so excited to meet you and talk to your people and just talk about this topic.
- [02:19]
A
Yeah, yeah.
- [02:19]
B
Can we start with maybe origin story of like why is this important to you? Why is this an area of focus?
- [02:25]
C
Why is this an area of focus? Well, my origin story is as a Gen Xer, I did not know until fairly recently what was going on. I feel like I should have known. I was in education for 25 years, a lot of it in special education. Teacher coordinator. I have a doctorate in educational psychology. I should have connected the dots. I think there was a point I started connecting the dots. But as you know, what people think about as ADHD is like the 8 year old boy who's just, it's an all over the place. And I would say things to people sometimes who should know, like, do you think, no, you, you have a doctorate, you have a master's degree, you, you do all these things, you hold yourself together. No way. And I'm like, okay, okay. But then I would just still keep thinking. And the more I learned, the more I learned. And then I think what really started to happen was when I started I had mostly boys, you know, back then. And over time I got more and more girls in my classes and I started to not relate to them, but see myself in them in certain ways, like some of their behaviors. And I would think, oh, that's me in middle school, you know. And so I just, I just kept thinking that way. And then, you know, the pandemic hit and we all went home and we all had a lot of time at home and more and more information kept coming out and I started bringing it up more and more and finally I was at a psychiatrist and we, we went through it and yeah, and by that point I already knew. And I think the main reason I was really pushing it with them was trying to decide if perhaps medication was something I wanted or just being able to look at it in a more authentic way. So that is basically it. Just over time, learning, learning more, seeing myself meeting other people who are realizing that they have ADHD and how we have in common. I love teaching because I wanted to really work with people outside of the school district to be able to create and do my own things without, without all the policies and with, with you know, all that stuff that's going on.
- [04:39]
B
Yeah, absolutely. Yeah, it's interesting. So I was having a conversation about ADHD actually earlier today and as a fellow Gen Xer, I said exactly what you said of like when I was coming up, like in grad school when we talked about adhd, it was always like a rambunctious eight year old boy. Yeah, always. And I think about like some context is I have a tween, one of my daughters has adhd, very severe adhd. And also seeing the difference not just between like typical presentation of boy versus her, but also developmentally, how it shifts and morphs and changes as she gets older. You toss some hormones on top and like we see what happens and it's, I think about all the friends I have who are late diagnosed clients I've had who are late diagnosed and how developmentally it's shifted and changed and how it shows up now, you know, amongst some of my peers with kids and like I can't juggle their schedule and my schedule and like my executive functioning can't stretch that far. Like it's stretched far enough for me to do school or do work and all those kinds of things. But like I hit a limit.
- [05:48]
C
Definitely, definitely. I, I know what you're saying and I know a lot of people end up really finding out when their own kids become heard or somebody starts talking about it with them because there's that whole component. And back when, when we were young, you know, it was just personality things. You're, you're this, you're that and so smart. So why do you do this sometimes? And so it was never really looked at. And I think that that's one thing also for, for especially women, but even men who are finding out later, having to relook at those stories, relook at what you've been told, what you told yourself. All that stuff you've internalized. And I know a lot of times, and I can speak for this, you may have been misdiagnosed with depression or anxiety or something else because you show up and you know, your emotional regulation is hard, difficult and you're, you're tired because masking and doing all this stuff is very hard. Oh well, you must be depressed. So here, have some, have some antidepressants, which whole nother thing.
- [06:48]
B
Yeah, it's interesting. I've been an eating disorder therapist for 20 years. So I also look back and I'm like, how much did I miss like how many of my clients who were perfectionistic and like basically spending all of their, I think about that internal adhd, right. Like they were spending all of that energy doing things that they needed to do to be as perfect as possible that couldn't succeed all the time. And like how much of that might have been wrapped up with ADHD and I missed it or my clients with binge eating disorder and the co occurrence of binge eating disorder and ADHD is something that like I had no idea about for most of my career because you know, adhd was for 8 year old boys and so it's astounding.
- [07:33]
C
And eating disorders were different. Like, oh, that, you know, the way everybody, doctors, parents, everyone related to it. Yeah, yeah, that's, that's actually so interesting because I hadn't. It makes complete sense, but it was not something the penny just dropped for me. I mean, no, it's a binge eating and that's the thing. But like really looking at. Wow. Women with eating disorders and adhd because just the control and the masking. And I know that I think I did well when I taught especially I taught a lot of English and so I could be creative. Said I taught high school mostly. So like, you had bells. This. Eat your snack. Yep. This is your prep period. These are the days you work. This is when grades are due. And when I left, there were other things going on. It was post pandemic, my husband had died, all these things. But like, wow, it has taken me time to figure out how to run a day.
- [08:34]
A
Yeah, yeah.
- [08:35]
B
Because we all need structure whether we have ADHD or not, but especially if we have adhd and when it's formed for you, it's much easier to follow.
- [08:44]
C
And then if you don't like it, you don't like it. Has nothing to do with you. Exactly. There's the bell. Or yes, we go back on August 10th or whatever we do. Grades are due this day. That's just simply the way it is. And, and I think people who don't struggle with it don't know how hard it is. Well, just, just do it. So.
- [09:03]
A
Yeah.
- [09:04]
B
And I, I fall into that category. I think I fell into that for a really long time as somebody who, like, if I have something on my to do list, I just do it. And it's easy for me in a way that I thought was just normal for me, not easy for me. But having an ADHD daughter and other people in my family with adhd, I'm like, oh no. Because I know them and they're not like willfully not doing, they're not avoiding just to be an asshole, you know, like they just, they can't do it right now.
- [09:29]
C
How many times are you told? I mean.
- [09:31]
A
Yeah, yeah.
- [09:32]
B
And so it's the stigma that goes along with the symptoms of adhd. Like each of the symptoms, from the impulse control to the executive functioning struggles to the emotion regulation problems. Like it's, it's easy to fall into this trap of believing that it's like some moral failing in some way. Because that's what our culture has told us forever.
- [09:57]
C
Yeah. And you should be able to do it all yourself.
- [10:00]
A
Yeah.
- [10:01]
C
You know, now a widow, there's, there's so many things that just other people did that.
- [10:06]
A
Right.
- [10:07]
C
So fine, I hired a house cleaner. I Live alone. But you know what? I had to do that.
- [10:12]
A
Yeah.
- [10:13]
C
It's done. I've hired somebody to help with certain things. And getting past that, oh, you should be able to do everything yourself. Just schedule it to death and do it. And I'm in a workspace, I'm in a little office in a co working space and I finally started going there and I have finally come to accept it and love it because yes, lots of people who are entrepreneurs. Oh, I can work at home. I can't work at home. I don't get it done. And also having the boundaries. So like for the most part I leave my work stuff here. This is work. My brain says work and when I leave, but that's taken a long time.
- [10:51]
A
Yeah.
- [10:52]
C
To get to.
- [10:53]
B
Absolutely.
- [10:54]
A
Yeah.
- [10:55]
B
And I think about how a lot of people with ADHD resist routine.
- [11:00]
C
Yes.
- [11:01]
B
And like there's such a, like, please don't make me do that routine thing. And it is the thing that tends to free them the most. It just doesn't sound like it will.
- [11:10]
C
Yeah. Similarly, a friend was reading, they'd seen something. Somehow they have been getting ADHD stuff probably because of me. And it was don't tell me what to do, but please tell me what to do. Yeah, yeah, totally. It is a deadline, but it has to be a real deadline because I know if it's a BS deadline. I know. But like if this is the deadline, it's done and it's there and it's good.
- [11:35]
A
Yeah.
- [11:36]
B
It's interesting too. I've been paying attention recently to how many women in perimenopause and menopause are being diagnosed with ADHD for the first time. And like, as our hormones shift, we can't mask and fake it in the same way that we might have been able to because we hit that like, I don't give a shit button. That is so valuable and I love so much. But like there's an uptick in diagnoses amongst, you know, us Gen Xers that I think goes beyond like it just got missed. It's like with these hormone shifts we're just not able to function that way.
- [12:12]
C
The more information that's there now.
- [12:14]
A
Yeah. Oh yeah.
- [12:14]
C
Our moms. Was it there? No. They were probably self medicating on whatever.
- [12:19]
A
Yeah.
- [12:19]
C
You know, so it takes so long for research to come out, you know that like you have to do the studies, do the studies, get it peer reviewed, get it published, get people to read it, get it out. It takes so long. And so there's this chunk of us who are just going through this and, and even women who knew, like maybe they had heard before their 20s were in school, oh, you have ADHD. But I don't think anybody really knew what that meant. It was really looking it and looking at it, what it means for you and how to, how to work with yours and your life.
- [12:48]
A
Yeah.
- [12:49]
B
So if we're coming at this from like, how do we as therapists improve our diagnostic accuracy? Like what can we be looking for, screening for assessing to make sure we're not missing women.
- [13:04]
C
So the diagnostic part of that, that is me, you know, that, you know, the DSM and a lot of the things that are out there, I would think look at it through a lens. Right. They were created a certain way by a certain group of people for a certain group of people. I think it's probably gotten better. But so much of it. Right. Was created by men based on studies on men and boys and not us. I would really listen to your clients and see what their story is and see what they're really saying their whole history. Because you know, this didn't. They may just be finding out about it or realizing it, but it's been their whole life. So what are those stories they're telling about things that people say. Said to them, ways that they felt about things, things that they struggled with. You know, there's the whole interspace, hyper focused. Were they really good at something and they would just deep dive into it? And like we were talking about, you're not being defiant, you're not being a jerk. But like these other things you just can't do and people don't understand that that's all about, you know, the, the emotional dysregulation, getting really upset about certain things that other people, you don't know why you're so upset about or why it's just such like an intense kick in the heart or the gut. And so looking at those things and I, and I think that the more we can develop other tools. I've told this story several times. I hope the friend doesn't mind, but she has adhd. But she was also going through some testing for autism because there's a huge. We're finding this huge overlap. Had asked me to, as a friend, as a good friend to fill out one of those surveys. It brought me back to the days when I was teaching and so many of the questions I just didn't felt were appropriate. Like the things they were asking. You know, first of all, it's often in that range like never to always ADHD Hate things like that because it depends. But I told her, like, you're an adult here, Gen X, You've had jobs, you've had kids, you're married, you mask. So some of these questions, like, do you remember to bathe? Like, I mean, maybe for a young kid, that's a more appropriate question, looking at those kinds of things. But she knows how to mask. She knows how to do it.
- [15:18]
B
Right.
- [15:18]
C
And so I think that they aren't looking at other details, things that aren't as obvious. Right. If. If a lot of it's up here, if a lot of it's hyperactive in your mind, your thinking, that kind of stuff that doesn't come out. 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. And it's just like, well, it depends what mood I'm in that day left. It depends if I ate. Depends how comfortable I feel.
- [15:52]
A
Yeah.
- [15:52]
B
And as the parent of a kid with adhd, when filling out those forms, it's like, how aggravating has today been? Because if it's been a really aggravating day of trying to, like, get her on task and get out the door and all those kinds of things, and everything's going to be elevated versus if it just happened to be a smoother day like I prevented.
- [16:12]
C
Have you had to fight doctors? Have you been told you're wrong? You know, what are the implications of going there and being there and either hearing yes or no? You know? Yeah, that's part of it, too.
- [16:25]
A
Yeah. Yeah.
- [16:26]
C
I mean, I've seen things where, you know, just put two people with ADHD in a room together and you'll figure it out. Like, when I started taking my puppy to this daycare thing, the first step they do is they put him in a room with another dog to see how those two went. Like, it was like, put this person in a room with somebody else with adhd.
- [16:45]
A
Yeah.
- [16:46]
C
How the conversation goes and see what happens. And, you know, that kind of thing. I think listening, listening to their stories, how they do things, how they think about things, things that have happened to them. And then, you know, getting diagnosed officially can be kind of a privilege, too. It can be very hard to find doctors. It can be. Depends on your insurance, how much you have to pay, where you go from that. Are they gonna push meds on you? Is that what you want? Is that what you don't want? Are you not sure? Because if you're going in and you're confused and you're just looking for some help. It's really easy to say, okay, you know, give me the pills and we'll go from there. But I mean, that's true for so many things, you know? Right, right.
- [17:30]
B
Your point about, like, the assessment. The assessment is not just the questions. Right. It's the listening.
- [17:39]
C
Right. Often, like, they want to know, oh, well, when you're in elementary school, what did your record say? We're Gen X. They're in some basement that probably got flooded. You know, and know that they probably say, oh, she was too quiet, or she talked to her friends too much or she stopped passing notes or, you know, she gets silly. Right.
- [17:57]
B
And the expectations were different then, too. Right. Like, I remember my report card said a few times, like, talks too much in class when, like, I was not. I was a rule follower. I was not trying to, like, break the rules and chat with my friends. But, like, probably asking for a pencil got me written talks too much in class because it was still more of a scene and not heard by.
- [18:21]
C
Or somebody said something that made you think, and then you just had to, like, Right, somebody. Which comes across as rude to some people.
- [18:29]
B
Right, right.
- [18:31]
A
Yeah.
- [18:32]
B
And I think, like, I was talking to somebody else about adhd, the same person I was mentioning earlier, and she. She was saying, like, there's a question that's often on these assessments of is it hard to get to appointments on time? And for a lot of women, it's like, well, no. I mean, I always get to appointments pretty much on time, but they had to set eight alarms to do it.
- [18:55]
C
Yeah.
- [18:56]
A
Or.
- [18:56]
C
Or really early. Like, yeah, yeah, you can't be late. But really realizing that figuring out that actual time is hard. So getting really early.
- [19:06]
B
Right.
- [19:07]
C
Oh, I brought a book. I don't care.
- [19:09]
B
Right. And so they may say, like, no, it's not hard because I got there. But it took considerably more effort than it would take for somebody who's neurotypical.
- [19:18]
C
Huh. And remembering things, you know, I put something away. You know, you've got the doomboxes and stuff. I put something away, it is gone. But then if I have everything I need to remember out, it's a mess.
- [19:33]
A
Yeah.
- [19:34]
B
Well, I think you mentioned earlier about, like, being misdiagnosed or. Or maybe the ADHD diagnosis being missed amongst anxiety, depression, these kinds of things, which, I mean, I personally think anxiety, having anxiety and depression makes sense if you have been trying so hard to function in a world that is not set up for you and you Think it's your fault.
- [19:59]
C
Yeah. But you just have anxiety and depression. Hairs of hell.
- [20:04]
B
Right. Or like, let's just keep doing therapy. But you're still gonna feel like shit about yourself because you still can't keep up, so to speak.
- [20:11]
C
Yeah. And. Cause your therapist doesn't know, just like your doctor doesn't really know. Right. They know very, very little unless they've gone out to learn about it or experienced it.
- [20:21]
B
And so it sounds like you self advocated, like you, you self diagnosed essentially and came into like mental health professional and said here's everything going on.
- [20:31]
C
Yeah.
- [20:31]
B
And I talked about it for a.
- [20:33]
C
While and part of it was first of all, I don't think these antidepressants are right for me and I don't think they're helping and I don't think we looked at the right thing. And so this whole process of what's really going on, wanting, you know, just being tired of all of that. And then my husband died suddenly and I, I have since found a great therapist and she knows so much about grief and trauma, but there are so many times where I'm actually teaching her about adhd or she'll say something and be like, okay, so that might work for some other clients, but let's just be honest, this isn't going to work. Or this is how I think I know doing. I mean I have, I have a master's in school counseling. I know this stuff. But I'm telling you that from my lens, this is something else you should know and think about.
- [21:18]
B
And so I think about somebody in the same position that doesn't have your background and doesn't have your assertiveness skills.
- [21:24]
C
Yeah.
- [21:25]
B
And how in that same.
- [21:27]
A
Yeah.
- [21:28]
B
And great therapist and you know, yeah, but feeling like, okay, now I'm failing at therapy because I'm not able to do this stupid homework assignment that I'm supposed to do or whatever, you know, and how as therapists we need to be really mindful of like are there certain tasks or homework assignments or ways of processing or thinking about a thing that we are asking people to do and the same person is having like a thematic issue with getting some of it done, in which case that could be a great red flag for you. Maybe this is a neurodivergence of some sort or ADHD or something, you know.
- [22:04]
A
Yeah.
- [22:04]
C
I would think trying to be really open and honest and listening and asking in a non critical way what is holding you back from doing this? Not like why didn't you do it? Like what's the problem? Like, but trying to be like that and getting to the relationship where they accept that and they're like, okay, I hear that you care and you're really asking and I may not know, but let's talk about it because you know, you build up all these walls like, oh, I'm just stupid or I'm just lazy. So taking that time to. Okay, so what really is it too many steps? I mean, a lot of the times something that neurotypical sink is easy to do. Like we talk about the laundry. Oh, just do the laundry. But when you think about it, there's a lot of steps to do in the laundry that you've got to plan and do and remember and keep. Got that interest based thing. Keep interested in from getting it from the dirty clothes to put away. And it's a lot.
- [23:01]
B
So what are the steps?
- [23:02]
C
Like you could ask a client if this is the task, whether it's a homework assignment for English or it's something for your job or something you're trying to do for your family yourself. What are the steps? Even having, you know, listed that out, a task analysis and seeing what's missing and where they get lost in there because maybe they're jumping from A to F and that's where they get hung up because then none of this was accounted for. Or then you just see that this project has 200 steps and we need to, we need to move it back. Like we need a smaller task, a smaller goal, a smaller project first and just a little win. Because that's something that I really like is just subtle shifts, little wins just to make this a little bit better and then just went a little bit better because we can, we can dive in. Like yes, I have a doctorate and. But that's very directed. You know, it's like it is step by step, whereas I'm trying to write a book much more out there, you know, and so that kind of thing. Yeah, kind of on a tangent, I think.
- [24:11]
B
No, that's good, that's all good. It's all relevant, right?
- [24:15]
A
Yeah.
- [24:15]
C
I was in an interview with somebody. I'm going to start doing some webinars, teaching through some entrepreneurs and HR and stuff like that. And the person, she's. Don't take this the wrong way, but I can tell you of adhd. Yes. And I promise I can also show up and I can pull it together and be very, very pulled together.
- [24:37]
A
Yeah.
- [24:37]
B
Because you've done it your whole life. You've had to. Right. And I think that's the interesting piece is like there's masking and there's figuring out what works for you to get shit done.
- [24:48]
A
Yeah.
- [24:48]
B
And whether that's accommodations or alter or however you need to make it happen. There's clearly a lot of work you did in your schooling.
- [24:59]
A
Yeah.
- [24:59]
B
At all different points. To make things happen. Because while it's directed, doesn't mean you always wanted to do what they said to do.
- [25:05]
C
It wasn't right.
- [25:06]
B
I know I was barely interested in a lot. There was very little that I was interested in in some of my grad school classes. It took a lot for me to make myself do it. And I don't have adhd, so there's some way that you accommodated that on your own through probably a lot of.
- [25:22]
C
Hard one error and just. Yeah. White knuckling it through.
- [25:26]
A
Yeah. Yeah.
- [25:28]
B
And I think that's some of the beauty of getting diagnosed and getting accommodations in certain circumstances. Probably some of what you're working with HR on in different places to help them make it a more accessible workplace for folks.
- [25:40]
C
Because I've seen workplaces that don't work and I've seen nothing against them, but they just. They don't know. I think I've heard, you know, things like, oh, they get like one little hour or one day in all of med school on it. You know, that's nothing.
- [25:56]
A
Yeah.
- [25:56]
B
It's not enough.
- [25:57]
C
And the research probably kind of old.
- [25:59]
A
Yeah.
- [26:00]
B
So I appreciate you talking to us.
- [26:03]
C
Yeah.
- [26:04]
B
You've got an audience of therapists listening to you right now. Is there anything specific you want to leave them with?
- [26:12]
C
I would just like to say we all have so much to learn. I would suggest to whatever level you want to learn more, whether it's talking to people, listening to. There's some really great podcasts out there, like this, reading books, just doing some own thinking or workshops on your own, and then listening to your clients, like, to the extent that you can actually listen to them and maybe get some information out of them and just keep thinking and that we want to just keep moving forward. And like many things, it'll show up in different ways to different people. So, I mean, that's something else that we can sometimes hear is, oh, well, my sister does this. This is the calendar my sister uses. This is what you should use. And great. It might work, it might not. Because it shows up both in how it shows up and in our lives. Getting to this point have been different.
- [26:58]
B
Yeah, absolutely.
- [26:59]
C
So some of the stuff that I pull together is I have some stuff on my website, like quick and easy hacks. I have a an SOS ADHD card deck that I pull together that gives little scenarios and some suggestions and then like a main idea about what's going on behind that. Just trying to work through things like that. Let's not tackle all of this. Let's tackle something, whether it's a low hanging fruit or your boss or your partner or something is really, really impacting your life and that's where you want to start. And still we're not going to tackle all of that. We're going to take one little bit and work through it and see what works and see what we can add on to and then go from there.
- [27:39]
A
Yeah.
- [27:40]
B
Love it.
- [27:41]
C
Because it's going to take time because it's been there forever.
- [27:44]
B
Awesome. Well, thank you Dr. Jindal. Y' all can find her at ADHD holistically.com I'll put that in the Show Notes to make it easy to click. And thanks for your time today.
- [27:53]
C
Thank you so much.
- [27:54]
B
Take care.
- [27:55]
C
Bye.
- [27:58]
B
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