ADHD Experts Podcast Episode 546

"Living with ADHD: It’s Different for Women – an Expert Roundtable"

Date: March 11, 2025
Host: Annie Rogers (Attitude Magazine)
Panelists:

• Dr. Ellen Littman (Clinical Psychologist, pioneer in gender differences in ADHD)
• Dr. Lada Borg Skogland (Associate Professor, Uppsala University; hormone research in ADHD)
• Dr. Andrea Chronis Toscano (UMD ADHD Program Director; family/parenting research)
• Dr. Diane Miller (Clinical Psychologist; adult ADHD, race and sex therapy)
• Dr. Maggie Sibley (Seattle Children’s Hospital, diagnostic research and APSARD guidelines chair)

Episode Overview

This roundtable explores why ADHD is experienced differently by women and girls, what barriers exist to diagnosis and care, the role of hormones across the lifespan, the mental health consequences of late diagnosis, and how research and treatment must adapt to address these disparities. The discussion emphasizes real-life experiences, systemic challenges, intersectional issues (including race), and concrete strategies for advocacy and self-care.

Key Discussion Points & Insights

1. Historical Neglect and Misdiagnosis of ADHD in Women

• The Chasm in Diagnosis Criteria
  • Dr. Littman describes the "chasm" between diagnostic criteria based on observable behaviors in boys and how girls/women often mask symptoms (06:20–11:20).
  • Quote:

    “Women put tremendous time and energy into masking and in some way hiding those behaviors... so if you’re looking for hyperactive or other behavioral symptoms, you’re not going to see them that way.”
    — Dr. Ellen Littman (08:00)

  • Women internalize symptoms, often present with anxiety/depression—misdiagnosis is common.
• Diagnosis is often delayed until adulthood, leading to years of self-blame and isolation.

2. Why Are More Adult Women Being Diagnosed Now?

• Increased public awareness via online platforms and magazines; self-referral is rising (12:34–16:54).
• Clinicians still may dismiss women’s self-reported struggles if they don’t fit traditional (male-based) symptom profiles.
• Consequences of Late Diagnosis
  • Decades of untreated symptoms can severely erode self-esteem, result in maladaptive coping, and intensify isolation.
  • Quote:

    “The better that you look in your presentation, the more likely you’ll be among the last to be diagnosed. So what happens if they're diagnosed later? They’ve spent a decade or two...having no overarching understanding of what’s going on.”
    — Dr. Ellen Littman (15:00)

3. The Hormonal Dimension: Puberty, Menstrual Cycle, and Menopause

• Cycle Effects
  • Estrogen and progesterone fluctuations significantly impact ADHD symptoms for many, but responses vary individually (18:09–23:36).
  • Women may feel more “together” in the follicular phase (high estrogen) and less control or increased symptoms in the luteal (premenstrual) phase.
  • For some, stimulants are less effective during certain cycle phases.
  • Quote:

    “Women with ADHD often report less control over their ADHD symptoms and some may even experience that their ADHD medication may be less effective during this premenstrual period.”
    — Dr. Lada Borg Skogland (19:53)

  • Individual ADHD profiles (impulsive vs. inattentive) interact differently with hormone changes.
• Perimenopause & Menopause
  • Cognitive complaints can be due to hormonal shifts, undiagnosed ADHD, or both (24:10–27:59).
  • HRT may help some women with ADHD, but far more research is needed.
  • The “why now?” of midlife diagnosis often relates to hormone-driven loss of compensatory abilities and increased life stress.

4. Motherhood: The ADHD Parent–Child Dyad

• Many women realize they have ADHD when their child is assessed for it.
• Two Major Challenges:
  1. Executive Function: Planning, organization, oversight—especially hard when both mother and child have ADHD.
  2. Emotional Regulation: Staying calm/patient with a child who “pushes buttons.”
  • Quote:

    “Parenting requires a great deal of executive functioning…and when the parent also struggles in this area, it can be really tough to maintain things like calendars or to-do lists.”
    — Dr. Andrea Chronis Toscano (28:45)

  • Self-care, prioritization, and giving oneself “grace” are critical, as is integrating parental ADHD management with child-focused interventions (32:07–36:18).

5. Intersectionality: ADHD in Black Women

• ADHD in Black women is often overlooked or misdiagnosed; symptoms may be mistaken for mood disorders or, more stigmatizing, bipolar disorder (38:07–44:24).
• Cultural and societal pressures encourage masking, overcompensation, and self-reliance; seeking help may be seen as weakness.
• Mistrust in healthcare and concern about being dismissed or mischaracterized as “medication seeking” are very real.
• Quote:

  “Many of us grew up hearing that we had to be twice as good to keep up...When executive function issues make it hard, instead of seeking help we internalize it as a personal failure.”
  — Dr. Diane Miller (40:45)

• The “Strong Black Woman” stereotype can make it even harder to access care and express need for help.
• Reframing strength, building community, and increasing representation among clinicians are urgently needed.

6. Diagnostic Systems and Guideline Reform

• DSM-5 criteria lag behind clinical realities—especially regarding female presentations (45:31–51:42).
• APSARD is developing new U.S. clinical guidelines to help clinicians recognize diverse presentations, particularly in women.
• Provider education is essential—many are hesitant to diagnose ADHD in adults, particularly women who didn’t have classic “childhood” histories.
• Stigma against “overdiagnosing” leads to women being missed.

7. Self-Esteem, Imposter Syndrome, and Reframing the Narrative

• Years of “flying under the radar” while struggling can produce imposter syndrome and relentless self-criticism (52:58–58:20).
• Reframing is possible: understanding ADHD as neurodivergence, not a moral failing, and challenging negative self-talk with CBT can be effective.
• Quote:

  “What we can do...is help them reframe the way they understand how they function in their lives…to view themselves in a more forgiving lens.”
  — Dr. Ellen Littman (54:22)

8. Practical Strategies & Support

• Cognitive Behavioral Therapy (CBT) is effective for changing unhelpful thoughts and behaviors (58:20–63:56).
• Programs teach organizational, self-care, and emotional regulation skills.
• Encouragement to build in small moments of joy and self-prioritization.
• Sleep, self-compassion, and mindful relaxation are cornerstones.

9. Advocacy and Navigating Healthcare

• Women often need to self-advocate, track symptoms, and demand holistic evaluation—especially as comorbidities (anxiety, depression, etc.) are the rule, not the exception (65:20–70:01).
• Quote:

  “We have to expect that [comorbidity]. Try to bring in this holistic perspective…otherwise you will miss essential pieces of the puzzle.”
  — Dr. Lada Borg Skogland (65:20)

• Special challenges for those with fewer resources or who are marginalized; privilege and education make self-advocacy easier, but all face difficulties.

10. Changing the System: Research, Representation, and Community

• How to find an open-minded clinician: ask about experience with women/adult ADHD, willingness to discuss rationale, and openness to feedback.
• The need for diverse participation in research to improve diagnostic criteria for women and minorities—patients are encouraged to get involved (80:30–83:40).
• Lived experience is valid and valuable even before research catches up; community support is vital in the meantime.
• Community-building efforts are under way (85:36); resources and upcoming research projects were highlighted.
• Quote:

  “We need to crowdsource what some of those new, better defined symptoms of ADHD for women would be...it's not just about what do most people with ADHD experience.”
  — Dr. Maggie Sibley (81:31)

• Rejection of “pride in the struggle”—true strength is in seeking help and reforming self-concept (79:19).

Notable Quotes & Memorable Moments with Timestamps

• "Women put tremendous time and energy into masking...so if you’re looking for hyperactive symptoms, you’re not going to see them that way."
  — Dr. Ellen Littman (08:00)

• "They’ve spent a decade or two...having no scientific understanding of what’s going on. They fill in the blanks...with their own character."
  — Dr. Ellen Littman (15:00)

• "Women with ADHD often report less control over their ADHD symptoms and...their medication may be less effective during this premenstrual period."
  — Dr. Lada Borg Skogland (19:53)

• "Parenting requires a great deal of executive functioning...when the parent also struggles in this area, it can be really tough."
  — Dr. Andrea Chronis Toscano (28:45)

• "Many of us grew up hearing that we had to be twice as good...instead of seeking help we internalize it as a personal failure."
  — Dr. Diane Miller (40:45)

• "If the task looks daunting and is riddled with high probability of rejection or harm versus help...usually we don’t [seek help]."
  — Dr. Diane Miller (43:22)

• "We need diverse, shared perspectives of your lived experience…to crowdsource what some of those new, better defined symptoms of ADHD for women would be."
  — Dr. Maggie Sibley (81:30)

• "Women are not volunteering the pain they're experiencing."
  — Dr. Ellen Littman (57:39)

• "There’s pride in the struggle...It’s not great to work on hard mode constantly; there’s no prize at the end for that."
  — Dr. Diane Miller (79:19)

Important Timestamps for Key Segments

| Segment | Topic/Quote | Timestamp | |---------------------------------|---------------------------------------------------------------|-------------| | Opening & Panel Introduction | Host welcomes and introduces the roundtable | 00:14–06:20 | | The Diagnostic "Chasm" | Dr. Littman on masking, internalized symptoms | 06:20–11:20 | | Rise in Adult Female Diagnoses | Why self-referral now increases; impact of late diagnosis | 12:33–16:54 | | Hormones & The Menstrual Cycle | Dr. Skogland on cycle effects, perimenopause, menopause | 17:28–27:59 | | ADHD & Parenting | Dr. Chronis Toscano on generational ADHD, parenting challenges| 28:45–36:18 | | Black Women & ADHD | Dr. Miller on racial barriers, stereotypes, misdiagnosis | 38:07–44:24 | | Diagnostic Guidelines | Dr. Sibley on new approaches to adult/female ADHD care | 45:31–51:42 | | Self-Esteem, Reframing | Dr. Littman, Dr. Chronis Toscano on internal narratives, CBT | 52:58–63:56 | | Comorbidities & Holistic Care | Dr. Skogland, Dr. Chronis Toscano on anxiety/depression | 65:20–73:25 | | Reducing Barriers/Advocacy | Dr. Miller on “Strong Black Woman,” system changes | 74:20–79:19 | | Research & Community | Dr. Sibley and others on research participation, need for community support | 80:30–85:36 |

Takeaways for Listeners

• ADHD in girls/women remains underdiagnosed due to outdated criteria and societal expectations; internalized, masked symptoms are missed.
• Hormonal changes at puberty, menstruation, and menopause critically affect ADHD symptoms and treatment efficacy.
• Having a neurodivergent family is common—parenting with ADHD is uniquely challenging; organizational and emotional strategies plus self-compassion are vital.
• Black women face distinct and compounded barriers: stereotypes, misdiagnosis, systemic mistrust, and cultural expectations around strength and self-reliance.
• Clinician education and diagnostic guidelines are evolving, but self-advocacy, persistence, and support networks remain critical.
• Community and research participation are essential to improve care—sharing lived experiences will shape future understanding and guidance.

Resources

• ADDitude Magazine’s ADHD Expert Webinars
• Upcoming Women’s Issue
• Slide presentations & research participation opportunities to be linked online

Final Thought

“It is more imperative than ever for those of you who are listening to participate in the research...It is really up to this community to push forward...there’s a lot of work remaining.”
— Annie Rogers, Host (86:00)

This summary was compiled to offer a comprehensive guide to the episode’s essential ideas and strategies for listeners and advocates—especially women navigating ADHD in their own lives or supporting others who do.