Podcast Summary

I Have ADHD Podcast – Episode 298

Title: ADHD, Autism, and The Hidden Struggles in Women You Didn’t See Coming
Host: Kristen Carder
Guest: Dr. Priyanka Rao
Date: January 14, 2025

Episode Overview

In this insightful episode, host Kristen Carder sits down with Dr. Priyanka Rao, a licensed clinical psychologist and the founder of Asha Mental Health. Together, they unpack the nuanced experiences of women with ADHD and autism, discuss the underdiagnosis and misdiagnosis of neurodivergent women, and dive into the essentials of neurodiversity and culturally affirming mental health care. Drawing from both personal and professional experience, Dr. Rao highlights the importance of individualized, affirming assessment, advocacy, and the realities of being a woman of color navigating mental health.

Key Topics & Insights

Dr. Priyanka Rao’s Background & Lived Experience

• Dr. Rao is a licensed psychologist from Minneapolis, founder of Asha Mental Health, specializing in neurodiversity-affirming and multicultural care (02:45).

• Diagnosed with ADHD in adulthood after her first child; her late diagnosis journey sparked a passion for quality assessments and neurodivergence-affirming practice (03:42–05:13).

  “As a psychologist, I have a pretty high bar for what I think an assessment should look like... It felt very half-assed.”
  — Dr. Priyanka Rao (04:33)

• Experienced both relief and grief at her diagnosis—relief for making sense of long-standing struggles, and grief for not knowing sooner (05:36).

The Hidden Struggles of Women with ADHD

• Women are often overlooked or misdiagnosed due to social expectations and internalization of symptoms (09:16–10:13).

  • Societal norms teach women to mask, contain, and self-manage symptoms—leading to underdiagnosis.
  • ADHD in women often manifests as internal chaos, perfectionism, and constant overwhelm rather than external hyperactivity.

  “We’re socialized to contain our shit. For women, the ADHD is a lot more internal. And so it gets missed or it gets called anxiety...”
  — Dr. Priyanka Rao (09:19)

• Academic success or being ‘high-functioning’ can further obscure ADHD in women, as external accomplishments are mistaken for absence of difficulties (07:27–11:03).

  “You may have accomplished the thing... but at what cost?” — Kristen Carder (11:03)

• Common internal markers for ADHD in women:

  • Perpetual overwhelm (08:50)
  • Procrastinate–scramble–pull it off–crash cycle (07:24)
  • Planner and system “graveyards”—starting strong, unable to maintain (14:48)
  • Chronic lateness and difficulty maintaining time boundaries (12:40)
  • Sensory overstimulation and burnout—especially as mothers (15:24–17:07)
  • Intense perfectionism and rejection sensitivity, particularly in workplace and relationships (20:00)

  “We hyper fixate a little bit on some of the social pieces in a way that's different from how men do with ADHD.”
  — Dr. Priyanka Rao (20:13)

ADHD, Hormones, and Life Transitions

• PMDD (Premenstrual Dysphoric Disorder) and hormonal swings can intensify ADHD symptoms, and often intersect with neurodivergence in women (18:09).

  “There's a lot of overlap between the two [ADHD and PMDD]... That's also why a lot of women are getting diagnosed in perimenopause or menopause.”
  — Dr. Priyanka Rao (18:21)

Advocating for Yourself in Assessment

• Tips for women seeking accurate ADHD/autism assessment:

  1. Ask clinicians about their experience working with women and neurodivergent adults (22:01)
  2. Ensure the assessor values and listens to your internal experience—not just external behaviors or collateral reports (25:34)
  3. A good assessment should leave you feeling heard, supported, and provide tangible next steps—even if criteria aren’t fully met (23:06, 23:49)

  “If you don’t feel heard, you didn’t get a good assessment.”
  — Dr. Priyanka Rao (23:06)

  “Making sure the person assessing you is paying attention to your internal experience. Huge, huge, huge.”
  — Kristen Carder (25:34)

ADHD & Autism: Overlap and Distinctions

• There’s significant overlap; both can present with executive dysfunction, sensory sensitivities, and social/relational difficulties (26:14).

• Key distinctions:

  • ADHD: More about seeking stimulation (dopamine), impulsivity, and difficulty sustaining routines due to boredom and novelty-seeking.
  • Autism: Preference for sameness and routine for mental relief, not just organization; greater distress from sensory issues and social “masking” (28:00–29:28).

  “For autistic folks, routines and sameness provide mental relief... That preference, which gets pathologized as rigid, is actually just trying to give your brain a break.”
  — Dr. Priyanka Rao (28:46)

  • High masking is common, especially in women and high-functioning adults, making diagnosis more difficult.

• Assessment should screen for both ADHD and autism, as co-occurrence is high and their interplay creates unique challenges (35:45).

  “Most folks that have come to me have had both... A good assessment for ADHD should always include a screener for autism, and vice versa.”
  — Dr. Priyanka Rao (35:45)

  • Self-diagnosis is valid in the autistic community due to difficulty accessing competent, affordable care (41:40).

  “If somebody comes to you and says, ‘I think I might be autistic,’ they probably are.”
  — Dr. Priyanka Rao (37:01)

The Flaws in Mental Health Professional Training

• Dr. Rao discusses the alarming lack of ADHD and autism education in clinical psychology programs (38:14–39:24):

  “I did not know anything about ADHD and autism. I had one hour in a course that covered both as neurodevelopmental. Unless I was a specialist in neuropsychology, there wouldn’t have been more coursework.”
  — Dr. Priyanka Rao (38:14)

Neurodiversity-affirming & Multicultural Care

• Neurodiversity-affirming care: Centers the diversity of brains as equally valid, focusing on differences not deficits (43:27).

  • Looks for context and support rather than pathologizing symptoms
  • Should be reflected in language, approach, and accommodations in care

  “You’re not looking for deficits, you’re looking for differences. You’re not helping people understand where they’re problematic, but instead asking them, how would you like to be?”
  — Dr. Priyanka Rao (45:23)

• Red flags: Deficit-focused language, use of the puzzle piece icon, insistence on collateral over self-report, “person with autism” language (46:03).

  “If the puzzle piece icon is there, go another direction... If they’re saying ‘person with autism’ instead of ‘autistic person’, they’re not affirming.”
  — Dr. Priyanka Rao (46:28)

• Green flags:

  • Telehealth options for sensory/comfort needs (47:05)
  • Intake questions about sensory and scheduling needs and communication preferences (47:05)
  • Openness to adapting for accessibility

  “You don’t have to look at me ever. How do you answer questions best?... What can help us make this accessible for you?”
  — Dr. Priyanka Rao (47:07)

Ableism & Context

• Ableism: The privileging of neurotypical, non-disabled standards as defaults or ideals (48:13).

• The “double empathy problem”—miscommunication occurs both ways between autistic and non-autistic people; it’s not a lack of empathy from autistic people (49:20).

• “Disabled” is contextual: the right support and environment decreases disability and distress (50:57).

  “The folks who are disabled are disabled because the context they’re in doesn’t work for them...you wouldn’t feel disabled in that context. You would feel seen and valid and understood.”
  — Dr. Priyanka Rao (51:12)

Cultural Contexts: ADHD in Indian/BIPOC Communities

• Mental health stigma, limited awareness, and strict cultural/familial expectations make identification and acceptance of ADHD/autism challenging in many communities of color (53:34–56:14).

• Rao shares her own family’s skepticism and the lack of cultural representation in mental health professions.

  • “Cultural competence” is not a finish line—practitioners must exercise humility, curiosity, and inclusivity (56:51–59:28).

  “Culturally inclusive care means understanding that the American white way of doing things is not the only way…You’re helping somebody feel good about the life that they’re living, the way they’re living it, versus the way you think they should live it.”
  — Dr. Priyanka Rao (57:57)

• The relief of finding a practitioner who understands both neurotype and cultural context cannot be overstated (58:30).

Notable Quotes & Memorable Moments

• Dr. Rao on relief and grief in late diagnosis:

  “There was a lot of grief for, like, oh, my goodness, what could I have done had I known this sooner?... When I started meds and my brain felt like it turned on, I remember being, like, devastated that night.” (05:36)

• Kristen Carder on achievement and struggle:

  “You may have accomplished the thing... but at what cost?” (11:03)

• On internal experience in assessment:

  “Making sure the person assessing you is paying attention to your internal experience. Huge, huge, huge.” (25:34)

• Dr. Rao on diagnosis access:

  “If somebody comes to you and says, ‘I think I might be autistic,’ they probably are.” (37:01)

• On neurodiversity-affirming practice:

  “If the puzzle piece icon is there, go another direction.” (46:28)

• On context and disability:

  “The folks who are disabled are disabled because the context they’re in doesn’t work for them.” (50:57)

Timestamps for Key Segments

• Dr. Rao’s diagnosis journey: 03:42–06:18
• Why ADHD in women is missed: 09:16–10:41
• Signs of ADHD in women: 13:58–15:25
• Hormones & ADHD (PMDD): 18:09–19:21
• Perfectionism and masking: 20:00–21:25
• Advocacy in assessment: 22:01–25:34
• ADHD vs. Autism overlap: 26:14–29:28
• Flaws in professional training: 38:11–39:24
• Why self-diagnosis is valid: 41:40–43:09
• Neurodiversity-affirming care explained: 43:27–45:23
• Cultural context and mental health: 53:22–57:22

Where to Find Dr. Priyanka Rao

• Asha Mental Health (for ADHD/autism assessment): ashamh.com
• Asha Coaching (support groups, coaching): asha-coaching.com
• Licensed via PSYPACT — able to work with clients across many U.S. states.

Tone & Takeaways

This episode shines with empathy, candor, and practical wisdom. Both Kristen and Dr. Rao blend humor, validation, and lived expertise, making complex neurodivergent realities accessible and relatable. Listeners—especially women, people of color, and high-maskers—will find new language, evidence-based advice, and hope for better care, advocacy, and self-acceptance.