ADHD for Smart Ass Women with Tracy Otsuka

EP. 360: What Women with ADHD Are Really Feeling (Dr. Gilly Kahn Explains)

Date: November 26, 2025
Guest: Dr. Gilly Kahn, clinical psychologist

Episode Overview

This episode explores the nuanced emotional lives of women with ADHD, challenging stereotypes and shedding light on largely overlooked experiences. Host Tracy Otsuka welcomes Dr. Gilly Kahn, whose new book, Allow Me to Interrupt: A Psychologist Reveals the Emotional Truth Behind Women’s ADHD, focuses on the intersection of emotional regulation, neurodiversity, and gender. Together, Tracy and Dr. Kahn dissect common misperceptions, discuss trauma and misdiagnosis, and celebrate the strengths and resilience of women with ADHD, wrapping it all in honesty, warmth, and actionable advice.

Key Discussion Points & Insights

Dr. Gilly Kahn’s ADHD Diagnosis

• Late Diagnosis & Masking:
  Dr. Kahn received her diagnosis at age 33 after years of struggling with emotions, persistent depressive disorder, and PMDD (pre-menstrual dysphoric disorder). She shares how common it is for women to first be misdiagnosed with depression or anxiety, especially when they’re adept at masking symptoms (04:07–09:24).

  “I was a master masker... I worked really hard to make sure that no one saw I was struggling, but I knew I was.” — Dr. Kahn (08:56)

• Missed Red Flags & Research Gaps:
  She emphasizes that current diagnostic criteria don’t account for internalized symptoms or hormonal influences unique to women, leading to misdiagnosis and underdiagnosis (07:52–08:28).

ADHD, Migraines, and Hormonal Health

• Surprising Overlaps:
  Both Dr. Kahn and Tracy discuss the high co-occurrence of migraines, PCOS, and ADHD in women (35% overlap between migraine and ADHD), highlighting the lack of interdisciplinary understanding in health care (10:34–13:09).

  “A lot of women don’t know... Anytime I make a post about ADHD and migraine, the overlap is about 35%—it’s pretty high.” — Dr. Kahn (10:34)

• Medication Experiences:
  Dr. Kahn found new relief with gepants (Nertech ODT) for migraines; Tracy shares her own migraine triggers and remedies, underlining the need for individualized approaches (13:09–15:53).

• Cycle of Disability:
  Migraines amplify ADHD struggles by taking women out of commission, adding to emotional distress and logistical overwhelm (15:53–18:47).

Challenging Stereotypes: The Emotional Landscape

Social Labels & Internalized Criticism

• Both Tracy and Gilly dissect the derogatory labels applied to ADHD women (“snob,” “too much,” “too emotional”) and trace how these stem from misunderstood ADHD traits like niche interests and impulsivity (24:30–31:05).

  “When I think of 'snob,' I definitely tie it to special or heightened interests... I have been obsessed with very niche areas, and I think that can come off as snobby because we’re impulsive.” — Dr. Kahn (26:18)

Sensitivity to Both Rejection & Praise

• The episode introduces the concept that ADHDers aren’t just rejection-sensitive—they’re also deeply affected by praise, which can drive behaviors like people-pleasing and overachievement but also leave them vulnerable to burnout (31:05–34:08).

  “I have mixed feelings about it... It’s helpful to hang on to messages like that [praise], because I think we remember what our professor told us years ago, but we might forget what Tracy told us or what someone else we respect wrote.” — Dr. Kahn (33:21)

Literature, Role Models, and Breaking Norms

• Tracy and Gilly bond over their mutual, sometimes unexamined, love of Shakespeare—revealing that strong, nonconforming female characters resonated with their own experiences of “challenging the status quo” (34:08–38:19).

  “That’s why I like Catherine from The Taming of the Shrew—she’s misunderstood, but she says it as it is.” — Dr. Kahn (38:19)

Gender, Masking & The Diagnostic Gap

How Sexism and Social Roles Impact Women with ADHD

• The hosts unpack the impact of traditional gender roles, unacknowledged emotional labor, and the higher expectations placed on women. These societal pressures intensify struggles for women with ADHD, often leading to higher rates of depression and suicidality (43:03–45:38).

  “You put ADHD on top of that, we’re just set up to fail.” — Tracy (43:57)

The Science: Brain Differences & Masking in Girls

• Dr. Kahn shares that girls with ADHD often have a more developed amygdala and better behavioral regulation than boys, making them "model students" who can still be “crumbling on the inside” (47:21–48:41).

  “Girls are better able... to regulate their behavior, but that doesn’t mean they’re not crumbling on the inside.” — Dr. Kahn (48:28)

Emotional Dysregulation as Core ADHD Symptom

• Despite emotional volatility being central to the lived experience for many women, current diagnostic criteria still focus on externalizing behaviors rather than internal distress, perpetuating misdiagnosis (49:41–50:41).

  “Dr. Russell Barkley has been arguing for over ten years that [emotional dysregulation] should be included as a core symptom.” — Dr. Kahn (49:56)

Intelligence, Support, and "Adult Onset" ADHD

• "Flying Under the Radar" with High IQ & Support:
  Discussion centers on how girls with high intelligence and strong family/school support often aren't diagnosed until adulthood, when life structure falls away and challenges surface (51:20–55:21).

  “Having an accommodating environment means you may not need an evaluation—or the label—until you hit a wall in adulthood.” — Dr. Kahn (51:20)

• Masking as a Protective, But Damaging, Adaptation:
  Social skills and masking let women evade detection but fuel shame and emotional exhaustion (55:21–56:33).

Practical Insights: Memory, Coordination, & Workarounds

• Working Memory & Math:
  ADHD-related working memory deficits explain inconsistent math performance ("great until word problems"), fostering unhelpful self-labeling and avoidance (56:33–58:08).

• Physical & Emotional Balance:
  The cerebellum’s role in both physical and emotional regulation is highlighted—activities like dance can improve attention and emotional steadiness (59:22–63:38).

• Workarounds:
  Dr. Kahn’s top workaround is writing everything down, fighting the ADHD urge to “trust” your memory unnecessarily (92:41–93:43).

  “If your brain tells you, ‘Don’t worry, you’ll remember this later’—just write it down anyway.” — Dr. Kahn (92:41)

Addiction & Reinforcement

• Gaming & Addiction in ADHD Youth:
  Dr. Kahn shares a powerful case of a teen whose video game addiction—and his family’s well-meaning but counterproductive attempts at reinforcement—illustrate behavioral addiction’s grip on ADHD brains (64:22–71:41).

  “When you’re addicted, for some people, it’s like...they’re giving him alcohol, right? Or cigarettes.” — Dr. Kahn (71:14)

Hormones, Estrogen & The Female ADHD Brain

• Estrogen's Role:
  High estrogen (such as during pregnancy) can improve ADHD symptoms for some women; both Tracy and Gilly discuss the frustrating lack of clinical knowledge, research, and support regarding hormonal management in ADHD women (73:09–80:04).

  “I’ve been searching far and wide trying to find an expert, but I don’t think there is one...” — Tracy (75:35)

• Anecdotes & Advocacy:
  Experiences with PCOS, menopause, and hormone replacement therapy expose a major health care blindspot for women with ADHD (80:04–81:13).

Trauma, Resilience, and Validation

• Trauma vs. Neurobiology:
  Dr. Kahn confronts the stereotype that trauma “creates” ADHD, emphasizing that while trauma worsens any condition, it does not “cause” ADHD—a crucial distinction for therapists and sufferers alike (88:24–89:38).

  “To say my mother’s death is why I struggle with everything in life is not correct.” — Dr. Kahn (88:59)

• Empathy, Creativity, and Ownership:
  Both speakers (and many ADHD women) wouldn’t trade their brains for a non-ADHD version, underscoring the creativity, empathy, and authenticity that ADHD can foster—even if it comes with pain (91:13–92:01).

  “There are amazing things about having ADHD too... I wouldn’t trade it.” — Dr. Kahn (91:13)

Notable Quotes & Moments

• On Masking & Misdiagnosis:
  “That explains why many of us are diagnosed with depression and/or anxiety beforehand and why suicide attempts are so much higher in this population.” — (08:57)

• On Sensitivity to Praise:
  “It’s helpful to hang on to messages like that...because we remember what our professor told us years ago, but we might forget what Tracy told us.” — (33:21)

• On Challenging Authority:
  “I corrected a professor...and when we had our break, she walked by me and said, ‘Gilly, can you please stop by my office after class so we can have a conversation?’...and then criticized me for struggling in interpersonal interactions.” — (29:31)

• On Emotional Exhaustion:
  “It’s hard to manage emotion when your brain is already exhausted by other things...ADHD is hard.” — (18:47)

Key Timestamps

• Introduction & Diagnosis Story: 03:32–09:24
• Migraines, PCOS, Estrogen and ADHD: 10:34–17:42
• Social Labels & Rejection Sensitivity: 24:24–34:08
• Love of Shakespeare & Female Role Models: 34:08–39:55
• Masking & Emotional Regulation in Girls: 47:21–50:41
• "Adult Onset" ADHD & Environmental Buffering: 51:20–56:33
• Math, Working Memory, & Writing as a Tool: 56:33–59:22
• Cerebellum, Coordination, and Emotional Balance: 59:22–63:38
• Addiction, Reinforcement, and Video Games: 64:22–71:41
• Estrogen, PCOS, HRT, and Clinical Gaps: 73:09–81:17
• Trauma, Validation, and the Power of Resilience: 88:24–92:01
• Favorite Workaround: 92:41–93:43
• Finding Dr. Kahn & Her Book: 94:06

Resources & Where to Find More

Dr. Gilly Kahn’s Book:
Allow Me to Interrupt: A Psychologist Reveals the Emotional Truth behind Women's ADHD
[Find via Dr. Kahn’s website, major booksellers, or linked in the episode description]

Connect with Dr. Kahn:

• Website: drgillykahn.com
• Instagram: @drgillykahn

Tracy Otsuka’s Resources:

• Website: adhdforsmartwomen.com
• Book: ADHD for Smart Ass Women
• Academy: Your ADHD Brain is A-OK

Episode Tone

Warm, supportive, and honest—with both Tracy and Dr. Kahn modeling the vulnerability, humor, and candor they champion for ADHD women. The conversation is dense with personal anecdotes, validation, and a persistent focus on hope, optimism, and falling in love with one’s ADHD brain.

Summary by Podcast Summarizer AI