ADHD In Women & Girls with Dr. Jennifer Gierisch & Dr. Julia Schechter

Summary

Podcast Summary: ADHD In Women & Girls with Dr. Jennifer Garish & Dr. Julia Schechter

Podcast Information:

• Title: Laugh Lines with Kim & Penn Holderness
• Hosts: Kim & Penn Holderness
• Episode: ADHD In Women & Girls with Dr. Jennifer Garish & Dr. Julia Schechter
• Release Date: March 4, 2025

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Introduction

In this enlightening episode of Laugh Lines with Kim & Penn Holderness, the hosts delve deep into the complexities of Attention Deficit Hyperactivity Disorder (ADHD) as it uniquely affects women and girls. Joined by esteemed experts Dr. Jennifer Garish and Dr. Julia Schechter from Duke University's Center for Girls and Women with ADHD, the discussion sheds light on the often-overlooked nuances of ADHD in females.

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Understanding ADHD in Women & Girls

Dr. Jennifer Garish ([04:19]):
"When you think of ADHD, you generally think of this little rambunctious boy literally running into walls... But we're starting to learn that females can have ADHD, and it might look a little different than the typical male presentation."

Dr. Garish emphasizes that the traditional perception of ADHD is heavily male-centric, leading to the underdiagnosis of ADHD in women and girls. She highlights that ADHD in females often manifests as inattentive symptoms rather than the hyperactive behaviors typically associated with males.

Dr. Julia Schechter ([07:13]):
"A lot more boys and men have been diagnosed than women and girls, but there is some evidence to suggest it might be more even across genders."

Dr. Schechter points out the disparity in diagnosis rates between genders, suggesting that ADHD may be equally prevalent in females but remains underdiagnosed due to differing symptom presentations.

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Challenges in Diagnosis

Kim Holderness ([16:26]):
"Women being diagnosed as adults now, because there's more awareness, are going through perimenopause. So is it hard to distinguish what's anxiety, what's ADHD, what's perimenopause?"

The conversation explores the intricate interplay between ADHD, anxiety, and hormonal changes in women, particularly during perimenopause and menopause. This overlap complicates the diagnostic process, making it challenging for both patients and clinicians to identify ADHD accurately.

Dr. Garish ([19:28]):
"Even with all my resources and being embedded here at Duke, it took me two and a half years to find a provider who would listen to me and diagnose me."

Drawing from personal experience, Dr. Garish illustrates the difficulties women face in receiving timely and accurate ADHD diagnoses, even within top-tier medical institutions.

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Symptom Presentation in Females

Dr. Schechter ([27:39]):
"Girls and women with ADHD tend to have more inattentive symptoms compared to hyperactive, impulsive symptoms. We're talking about things like being easily distracted, having difficulty sustaining attention, and being disorganized."

The experts discuss how ADHD in females often presents internally, with symptoms such as distractibility and organizational challenges, rather than the external hyperactivity seen in males. This subtlety contributes to the underrecognition of ADHD in women and girls.

Dr. Garish ([30:26]):
"Women tend to be sort of internally hyperactive and externally inattentive. Their brains are racing, but outwardly they might seem calm or just unfocused in non-disruptive ways."

Dr. Garish further explains the "internal hyperactivity" prevalent in females with ADHD, where the constant mental activity isn't always visible, leading to misconceptions about their behavior and capabilities.

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Impact of Undiagnosed ADHD

Dr. Schechter ([41:03]):
"Women and girls with ADHD are at higher risk for negative outcomes such as self-harm, suicide attempts, and unintended pregnancies. ADHD impacts every facet of life, from relationships to financial management."

The discussion highlights the severe consequences of undiagnosed or untreated ADHD in females, including heightened risks of mental health issues and impaired life management skills, ultimately contributing to reduced life expectancy.

Dr. Garish ([42:27]):
"Individuals with ADHD are more likely to engage in substance use or smoking, especially if their symptoms are not well managed. There are also connections between ADHD and cardiovascular health."

Dr. Garish underscores the broader health implications associated with unmanaged ADHD, emphasizing the urgent need for comprehensive support systems and effective treatments.

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Personal Stories and Advocacy

Dr. Garish ([58:26]):
"First of all, you are not broken. You are perfect just the way you are. You are not alone. Embracing your ADHD means recognizing your strengths and understanding your needs."

Both Dr. Garish and Dr. Schechter share heartfelt personal anecdotes about their journeys with ADHD, advocating for self-acceptance and resilience. Their stories serve as a beacon of hope for listeners grappling with similar challenges.

Kim Holderness ([63:54]):
"Knowing that it took you two and a half years to get diagnosed, don't give up. Start with your primary care physician and go from there."

Kim emphasizes the importance of persistence in seeking diagnosis and support, encouraging listeners to take proactive steps in their mental health journeys.

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Strategies for Management and Support

Dr. Schechter ([61:07]):
"If you think you might have ADHD, continue to advocate for yourself and educate yourself. Utilize resources like the Duke Center's website for vetted information and tools to prepare for medical appointments."

The experts offer practical advice for women and girls suspecting they have ADHD, including self-advocacy, education, and leveraging specialized resources to facilitate effective diagnosis and management.

Dr. Garish ([64:01]):
"Don't give up. Start with your primary care physician, go from there, and utilize available tools to organize your thoughts before appointments."

Dr. Garish reiterates the importance of seeking professional help and using structured methods to communicate symptoms and concerns effectively during medical consultations.

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Conclusion and Call to Action

The episode concludes with the hosts expressing their deep appreciation for the work done by Dr. Garish and Dr. Schechter. They highlight the critical need for increased awareness, funding, and research to bridge the gaps in understanding and supporting women and girls with ADHD. The hosts advocate for widespread acknowledgment of ADHD's unique manifestations in females and encourage listeners to support initiatives that promote comprehensive education and resources.

Notable Quote:

• Dr. Garish ([42:27]):
  "Not only are women and girls with ADHD experiencing the usual challenges, but there are unique additional burdens that make the difference in mortality not surprising to us at all."

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Key Takeaways

• Underdiagnosis in Females: ADHD in women and girls often goes unnoticed due to predominantly male-focused research and differing symptom presentations.

• Symptom Differences: Females typically exhibit more inattentive symptoms, such as distractibility and disorganization, which are less conspicuous than male-associated hyperactivity.

• Consequences of Undiagnosis: Untreated ADHD in females can lead to severe mental and physical health issues, contributing to reduced life expectancy.

• Importance of Advocacy and Education: Self-advocacy, education, and utilizing specialized resources are crucial for women and girls seeking diagnosis and support.

• Need for Research and Support: There's an urgent need for targeted research and comprehensive support systems to address the unique challenges faced by females with ADHD.

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Additional Resources

• Duke Center for Girls and Women with ADHD:
  Access extensive resources, educational materials, and support tools at Duke ADHD Center.

• ADHD is Awesome Book:
  For more insights and strategies, consider reading "ADHD Is Awesome: A Guide To (Mostly) Thriving With ADHD" by Kim & Penn Holderness.

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This episode serves as a critical conversation starter, urging both the medical community and the public to recognize and address the distinctive ways ADHD impacts women and girls. By fostering understanding and supporting targeted initiatives, society can better support females navigating the complexities of ADHD.

Transcript

[Kim Holderness]

Hey, Penn, have you ever had this conversation? You meet someone, they say, hey, how you doing? And without thinking, you just reply, I'm good. You?

[Penn Holderness]

Yeah, of course. Right.

[Kim Holderness]

Well, I decided when I say I'm good, I want to meet it. That's why I'm using Headspace.

[Dr. Julia Schechter]

Great.

[Penn Holderness]

So Headspace is the app that helps me and 100 million people with their mental health and well being with guided meditations, mindfulness practices, breathing and calming exercises, and so much more.

[Kim Holderness]

It reduces stress, boosts your mood, and helps you sleep better. By combining scientifically proven benefits of medit and mindfulness with modern practices.

[Penn Holderness]

The app has these customized personalized approaches to help you navigate through all of life's moments, whether they're big or small.

[Kim Holderness]

If you're a total newbie or have been meditating for years, there's always content for what you're going through.

[Penn Holderness]

And if you're short on time, Headspace has these quick on the go programs that help you get in the right headspace in just a few minutes.

[Kim Holderness]

With more than 1000 hours of mindfulness exercises, it's got the most complete meditation library I've ever seen. I can feel my mental health getting a boost by taking a few minutes minutes every day, listening to the programming, and reframing my relationship with stress and anxiety.

[Penn Holderness]

So feel good and mean it when you say it. For a limited time, get Headspace for free for 60 days. Just go to headspace.comholderness Yes. H E A D S P A C E.comholderness to unlock all of Headspace. Free for 60 days.

[Kim Holderness]

Headspace.comholderness hey, Penn, have you ever had this conversation? You meet someone, they say, hey, how you doing? And without thinking, you just reply, I'm good. You?

[Penn Holderness]

Yeah, of course. Right.

[Kim Holderness]

Well, I decided when I say I'm good, I want to meet it. That's why I'm using Headspace.

[Dr. Julia Schechter]

Great.

[Penn Holderness]

So Headspace is the app that helps me and 100 million people with their mental health and well being with guided meditations, mindfulness practices, breathing and calming exercises, and so much more.

[Kim Holderness]

It reduces stress, boosts your mood, and helps you sleep better by combining scientifically prov benefits of meditation and mindfulness with.

[Penn Holderness]

Modern practices, the app has these customized personalized approaches to help you navigate through all of life's moments, whether they're big or small.

[Kim Holderness]

If you're a total newbie or have been meditating for years, there's always content for what you're going through.

[Penn Holderness]

And if you're short on time, Headspace has these quick on the Go programs that help you get in the right headspace in just a few minutes.

[Kim Holderness]

With more than 1000 hours of mindfulness exercises, it's got the most complete meditation library I've ever seen. I can feel my mental health getting a boost by taking taking a few minutes every day, listening to the programming, and reframing my relationship with stress and anxiety.

[Penn Holderness]

So feel good and mean it when you say it. For a limited time, get Headspace for free for 60 days. Just go to headspace.com holderness yes H-E-A--S-P-A c e.com holderness to unlock all of headspace.

[Kim Holderness]

Free for 60 days headspace.com holderness Penn. You feeling that spring travel itch?

[Penn Holderness]

Oh, you know it. I'm looking outside, the sun is shining. It's perfect out. I'm ready to head to the beach.

[Kim Holderness]

Vacation season is almost upon us and this year I'm treating myself to luxe upgrades I deserve with Quince's high quality travel essentials at fair prices.

[Penn Holderness]

Yeah, like the lightweight European linen styles from $30, washable silk tops and comfy lounge sets with premium luggage options and stylish tote bags that carry it all.

[Kim Holderness]

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[Penn Holderness]

And Quint only works with factories that use safe, ethical and responsible manufacturing practices and premium fabrics and finishes, which we both love.

[Kim Holderness]

I'm definitely going to be grabbing an Italian leather pouch travel set to upgrade my makeup for our next vacay.

[Penn Holderness]

And I may need to grab like a new toiletry bag as well. For your next trip, treat yourself to the luxe upgrades you deserve from quints. Go to quince.comholderness for 365 day returns plus free shipping on your order.

[Kim Holderness]

That's Q U I-n c e.comholderness to get free shipping and 365 day returns. Quince.comholderness and you are not alone.

[Dr. Jennifer Garish]

I might start crying like it took a long time for me to get to that point for myself personally. And I feel like that is such a gift for my daughter now that I can have her grow up to be a strong, confident girl woman with adhd.

[Kim Holderness]

Hi everyone, I'm Kim Holderness.

[Penn Holderness]

And I'm Penn Holderness and this is the Holderness family podcast.

[Kim Holderness]

Podcast.

[Penn Holderness]

Did I, did I use the right accent? Podcast?

[Kim Holderness]

Yeah, hot tub makes it sound French. Welcome. Thank you for hitting Play. Yeah, this is a good one. I say that about everyone, don't I?

[Penn Holderness]

But it's not a good sign if you say this one's kind of eh.

[Kim Holderness]

And this one.

[Dr. Jennifer Garish]

I don't know.

[Penn Holderness]

No one's gonna listen to that.

[Kim Holderness]

No, this is great. Okay. Last week it was so fun to announce that we were working on a children's book about adhd. We've been working with our publisher. Contract's not totally been signed yet, but it's happening. It's happening. But it is. So we are expediting this to get it out into the world and we wanna take you along with the process. But we are working so quickly on it. I'm trying to document it, but then things have to be made. Like, we had to agree on a title in a day.

[Penn Holderness]

Yeah.

[Kim Holderness]

We had to interview illustrators over a weekend.

[Penn Holderness]

I mean, it's happening quickly.

[Kim Holderness]

Yeah.

[Penn Holderness]

And the book is essentially a. A children's version of our central messaging in our first book, ADHD is Awesome that we wrote that did quite well. But we had a lot of people asking, is there a. Is there a younger version of this? And always wanted to do that. I want to talk more about that first book. We're very proud of that book. I. I have very few regrets on that book. I have one little splinter in the back of my mind of that book. And I learned about it by going and meeting you. You who are listening, you who came to our book tour, to our book signing, you who stopped us in the airport and on the street and told us how much this book meant to them. And so many of you were women and girls who. Some of them had felt seen for the first time. And so many of them did not realize that they had ADHD until they read the book. Not to say, I'm a doctor, I didn't diagnose anybody. But when we wrote the book, which was meant to be a catch all textbook, we wrote one paragraph about how women were under diagnosed. And there are so many more things to learn about this and to be said about this.

[Kim Holderness]

I think that is. I'll name it as a regret. I'm very proud of the book as well. It was not meant to be a. For one specific group.

[Penn Holderness]

No, we didn't talk about men either.

[Kim Holderness]

We didn't talk specifically about men or children. It was very general. That was the purpose of it. I do regret that we didn't include more research about girls and women. But guess what, guys?

[Penn Holderness]

Yeah, we're about to learn something.

[Kim Holderness]

We didn't include it because Much of it, it doesn't exist, which is so a disappointing. But I think if we had more time in that book or more space, I would go back and add at least just acknowledging how different ADHD is in girls and women.

[Penn Holderness]

You're going to hear me audibly stunned when this doctor we're about to speak to told me that pretty much all ADHD research, and guess what? Medicine, diagnosis, it's all based on research, is based on boys. Not men, not women, not girls, just boys.

[Kim Holderness]

According to attitude.com, which we love and we've worked with them, women with ADHD have routinely been dismissed, disregarded, misdiagnosed, or just simply not diagnosed because the symptoms of ADHD in females often gets conflated with anxiety, mood disorders, or even hormones. So a lot of doctors have traditionally written off girls and women because they're like, ah, that's just anxiety, because it looks, look so different.

[Penn Holderness]

The CDC says that 12.9% of men and boys live with ADHD compared to 5.6% of women and girls. I want to just quote them again, live with adhd. I think that also means are diagnosed with adhd. So the point there is that a lot more boys and men have been diagnosed than women and girls. But there is certainly some evidence to show, especially after people that we talk to, that could actually be more even across both genders. How stunning is that, that so many millions of women and girls have been undiagnosed?

[Kim Holderness]

We're going to talk more about this, but medical news today. Inattentive adhd. They say that inattentive ADHD is the most common form of ADHD in women and girls, which means there's distractibility, difficulty concentrating, difficulty remembering things, but not the outward hyperactivity we see as, you know, typical in boys.

[Penn Holderness]

Can I say something interesting that I think I've finally realized? I profile more as a stereotypical female diagnosis of adhd. I wasn't particularly hyperactive, right in school. The inattentive part really got to me. I had a really tough time with the emotional side of it, and I was internally hyperactive, but not necessarily externally. And these doctors you're about to talk to make a really interesting point about the fact that hyperactivity usually exists somewhere. You just can't always see it.

[Kim Holderness]

We wanted to dive into this more with doctors who are doing research and education and outreach right in our backyard at Duke University, at the Duke center for Girls and women with ADHD.

[Penn Holderness]

Dr. Jennifer Girish is a behavioral scientist and health services researcher. She's an associate professor in the Department of Population Health Sciences and the Department of Medicine at Duke University. Dr. Gerrish is a core investigator with ADAPT, where she serves as the leader of the partnered research methods corps. Her research focuses on complex health behaviors, evidence based interventions to improve patient and health system outcomes, and community engaged research approaches. Man, that's an impressive bio.

[Kim Holderness]

She has an impressive bio. And she also acts as a human chat in her office.

[Penn Holderness]

And she has ADHD.

[Kim Holderness]

Dr. Julia Schechter is a child and family clinical psychologist with Duke Health who specializes in the treatment of psychiatric and behavioral disorders across the lifespan. She provides a range of clinical services, including training for youth and families impacted by ADHD and developmental disorders. Dr. Schechter also works in cognitive behavioral therapy for youth and adults with a wide range of psychiatric conditions, including adhd, anxiety and mood disorder.

[Penn Holderness]

Welcome to the show. Doctors Girish and Schecter. I am so honored to have you guys here. You're doing such important work, and it takes a lot of courage for me to say that because your basketball team regularly beats the crap out of my favorite basketball team. And it's particularly difficult this year because you're really, really, really good. So I'm gonna get that out of the way. But you're such lovely, smiling people and.

[Kim Holderness]

They'Re doing such important work. Honey, that has nothing, nothing to do with it.

[Penn Holderness]

Nothing. Yeah, but feel free to throw some barbs at me anyway. So I'll start with you, Dr. Schechter. Just quickly tell us about the work you're doing to study ADHD in women and girls.

[Dr. Julia Schechter]

Yes. Well, first of all, thank you all so much for having us. We are really excited to be here. And we are here representing the Duke center for Girls and Women with adhd. And the main type of work, actually, that we do is more focused on education and outreach, which is pretty unique. There's not a lot of centers that are focused on specifically on education and outreach, and there's really no other center that's really focused on this in girls and women with adhd. So the kinds of things that we really focus on doing is making information that is available about girls and women with ADHD accessible and understandable. We really see ourselves as kind of the bridge of how do we take the science that is out there and get it into the hands of the people who need it.

[Kim Holderness]

We were so excited to learn that in our area, there were people researching, promoting, educating ADHD in women and girls. We were thrilled to learn that. Tell us why. It's so. I know why, but tell the People listening why it's so important to have studies and have this education on just girls and just women around ADHD. Dr. Garish?

[Dr. Jennifer Garish]

Yeah, I mean, I think I'll start with the fact that when you think of adhd, you generally think of this little rambunctious boy literally running into walls, literally ants in his pants, can't stay still. That is a pervasive attitude in pediatricians, all sorts of healthcare providers, and also in the educational setting. And also it's important to say that most of the research on ADHD up until now has been on mostly male or all male samples. So even in the research world, when we think of adhd, it's grounded in this male presentation. What we're starting to learn is that females can have adhd. Let's first say that females, girls and adult women can have adhd. It might look a little different or very different than the typical male presentation that we have all in our brains. So I think for a variety of reasons, it's important to focus just on females and girls because for so long they have been overlooked by the research community, by schools and by pediatricians because we've centered so much on what ADHD looks like in boys.

[Dr. Julia Schechter]

I mean, I think the other thing, just to drive this home too, is that when I was being trained, I'm a clinical psychologist, right? And I was reading research studies in graduate school. I mean, those studies were based on the male presentation. So I kind of, you know, I entered my, my clinical work, really that was what I understood ADHD to be. And I, as, as Dr. Garish is saying, you know, so many well meaning pediatricians and primary care providers and, and, and mental health care providers still don't know that ADHD can look so different in girls and women.

[Penn Holderness]

I'm stunned by this. How old are these research projects? Like how is it that it's only boys and not adults, just boys?

[Dr. Julia Schechter]

You know, a lot of these studies are old. I think the good news is that there are more studies that are being done focused on girls and women with ADHD. But there is this catch 22, right, of to be in a research study, we really need a particular sample typically. And so we're using the DSM criteria that, that Dr. Gerrish mentioned to kind of figure out, okay, who's going to be in this study. But a lot of those criteria might not capture the experience of girls and women with adhd. And so that kind of impacts who's in these studies, I think another thing I hear from researchers who are often so eager to have more diverse samples and to have girls included in the sample or women include the sample say, it's really hard for me to find, you know, people who, you know, in quotes, just have adhd. Right. And a lot of times girls and women kind of either you collect other diagnoses along the way to their ADHD or perhaps their ADHD is co occurring with something else like anxiety or depression. And a lot of times research studies will kind of exclude for different reasons. Right. So I'll talk to researchers who say I really want to have girls with ADHD in my study, but for different reasons I can't include, you know, people who have co occurring anxiety or depression. And so that really limits their ability to include those folks in the study to include girls and women with ADHD who might have those co occurring conditions.

[Kim Holderness]

I want to talk about the misconceptions and how it looks different in girls and women. I want to get to that. But you just brought up a really important point. The women being diagnosed as adults now, because there's more awareness, are going through perimenopause, they're going through menopause. So is it hard to distinguish somebody my age because he's always been the one with ADHD and I've always been the more neurotypical. I have anxiety, but not adhd. Now with perimenopause, sometimes words, stuff. Now with perimenopause I'm like, maybe I have adhd. So tell us about the difficulty in sort of like peeling off the layers of what's anxiety, what's ADHD, what's perimenopause, what's ADHD?

[Dr. Jennifer Garish]

I want like $5 million just to study that. Because there are so many amazing research questions you just asked in that that we have very little evidence to answer. We have very little evidence to answer. And this is a question that we get asked all the time. Okay, is it hormones, is it late? You know, is it that I've always had this and then I'm losing that estrogen and now all my maladaptive coping strategies that I had, my timers, my hyper planning, the fact that I can get dressed in the dark because I've hyper organized my closet, because I would lose things if it wasn't right in front of me? Right. Is that challenge, that lack of estrogen then just amplifying all the things that were there before and challenging that person's ADHD in such a way that they can no longer cope effectively, or is it that it is something to do with menopause? These are questions we don't know. We do know from other conditions and cardiovascular disease and. And you name it, that women, as of our unique biology, have unique presentations of other disorders. It would stand to reason that because of our unique biology, we may also have a unique presentation for adhd. I'm going to clarify something. I'm going to out myself a little bit here. I am an ADHDer. I am one of those late in life diagnosed people. I wasn't diagnosed till my 40s after my. Oh, I wish I could remember. Remember. No good working memory. It was either my second or third child had gotten diagnosed. And I'm filling out those silly assessments and I'm like, oh, wow, this really sounds like me. This really sounds like me. This really sounds like me. But it's still. With all of my resources and being embedded here at Duke, it still took me two and a half years to find a provider who would listen to me and, And. And diagnose me. So even with all of my resources and my background in behavioral science, it still took two and a half years for me to get a diagnosis.

[Kim Holderness]

That makes me want to cry. Because you are.

[Dr. Jennifer Garish]

I did cry. Okay.

[Kim Holderness]

I mean, arguably one of the best, you know, medical institutions in the world. You have access to these people. You have access to all this care and the knowledge of your diagnosis. So what's it. What's a norm, like a. What's a normal person like, like me supposed to do that? That is shocking.

[Penn Holderness]

But you need. You need research and you need money. Like she. I love that she put a price tag on 5 million for that research. So let's. You know what, let's keep this rolling.

[Dr. Jennifer Garish]

I'll take.

[Penn Holderness]

No, no, let's. I want to keep this rolling. Let's go, finally, for that, how much do we need for a public awareness campaign and a way to communicate to doctors and clinicians about the best way to diagnose women? Dr. Schechter, how much money do we need for that?

[Dr. Julia Schechter]

Oh, this is a fun game.

[Penn Holderness]

Yeah.

[Kim Holderness]

I like this auction.

[Dr. Julia Schechter]

I like this option, too. I mean, let's just. Let's just put another. I don't know, let's put 5 million there.

[Penn Holderness]

So we're up to 10. Good.

[Dr. Julia Schechter]

Yeah, I think this is.

[Kim Holderness]

It is.

[Dr. Julia Schechter]

It is so critical and I think just a couple of things just to also clarify too, of, you know, this question you brought up, Kim. It's such an important one. It's such a timely one. I mean, at this point, you know, we are spending, you know, what, a third of our Lives in, you know, menopause, post menopause. And this is. More and more women are being diagnosed with adhd. And so they're entering this phase of life not knowing what to expect, not knowing the best way to support themselves, not knowing, like, how do they manage this? And we absolutely need studies to better understand this. I think one thing just to point out about ADHD that that may not be known is, like we mentioned earlier, it's a neurodevelopmental condition. So it has to do with how the brain is developing. And one of the things that. That we do need to see to make a diagnosis is that several symptoms need to be present in childhood. Now, what does that mean? You know, it means that you did not have to get a diagnosis while you were a kid, but we do need to see some evidence of this time when your brain was really developing, that there were several symptoms present. So that's tricky for a lot of reasons, right? When you're doing an assessment with an adult, they have to think back to when they were a kid or they have to talk to someone who knew them when they were a kid. And then if you layer on the kind of the female piece, right, because if we. If we're thinking about, you know, we know that. That. That females with ADHD tend to have more of those inattentive symptoms, those kind of fly under the radar, more internal symptoms, right. They're not being disruptive in the classroom. They're not typically having, you know, teachers send home emails with concerns. They're really masking a lot of these difficulties. So we're trying to get women to think back to when they were kids or have people remember. It's really extra hard to do. So there's a lot of complications when diagnosing in adulthood. It's still really important. Important and very possible to do, but it does. It does make it extra hard if you're an adult woman trying to. Trying to figure this out.

[Kim Holderness]

We're coming right back.

[Penn Holderness]

This show is sponsored by Better Help.

[Kim Holderness]

All right, Penn, let's talk about your support system. Who do you reach out to when you need help?

[Penn Holderness]

Honestly, like, 99 of the time, it's you. Maybe like, the other 1% would be my brother. He's great at that. Or if I have, like, a weird thing on my elbow or whatever, I have a doctor friend that I can call.

[Kim Holderness]

Yeah, that's. That's really great. Very sweet.

[Penn Holderness]

So when you think about your mentors and supports, you realize that they don't have all the answers, but they do know when to ask questions or seek support from their community.

[Kim Holderness]

In a society that glorifies hyper independence, it's easy to forget that we're all better when we have a support system behind us, and therapy can be a.

[Penn Holderness]

Source of support for any area of your life. It's time to shift the focus from doing it all to knowing that we're better when we ask for help.

[Kim Holderness]

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[Penn Holderness]

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[Kim Holderness]

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[Penn Holderness]

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[Kim Holderness]

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[Penn Holderness]

No, I remember just this weekend carrying all the bulky jackets up to stor.

[Kim Holderness]

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[Penn Holderness]

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[Kim Holderness]

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[Penn Holderness]

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[Kim Holderness]

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[Penn Holderness]

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[Kim Holderness]

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[Penn Holderness]

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[Penn Holderness]

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[Kim Holderness]

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[Penn Holderness]

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[Penn Holderness]

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[Kim Holderness]

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[Kim Holderness]

That's Holderness to 64,000. Message and data rates may apply. See Terms for details. I skipped a question in the sequence here because I think it's important to just reiterate that ADHD can and often does look different in girls and women than it does in little boys. Can you tell us some ways in which it shows up differently?

[Dr. Julia Schechter]

So what we tend to find is that girls and women with ADHD tend to have more inattentive symptoms compared to the hyperactive, impulsive symptoms. Or like that's more what is prominent. And when I say inattentive symptoms. I'm talking about things like being really easily distracted or having difficulty sustaining attention on one task or being really disorganized. Things that have to do with, you know, kind of, you know, regulating your attention in such a way that you are able to stay focused and accomplish those kinds of tasks. Hyperactive and impulsive behavior tends to be more. More overt.

[Dr. Jennifer Garish]

Right.

[Dr. Julia Schechter]

These are things like fidgeting, having trouble staying seated, running and climbing. Oftentimes, you know, we're thinking about things like, you know, being really verbally impulsive, like calling out or being intrusive into conversations. And so what our data shows tends to show is that. That girls and women have more of those inattentive symptoms compared to hyperactive, impulsive symptoms, interestingly. Well, first of all, girls and women can absolutely have the hyperactive, impulsive symptoms, too. I'm not saying they can't have them, but they sometimes look different. There was actually a paper that just came out this month that was actually looking at the different symptoms and how they might differ between females and males. And they were able to look at this across multiple studies. And really, interestingly, what they found was that girls and women did tend to have more of those inattentive symptoms than the boys, in particular, difficulty sustaining attention and distractibility. And boys were more likely to have those overt symptoms that I mentioned earlier. However, girls were. Females were more likely to have that talkativeness, which is a piece of the hyperactive and impulsive behavior. And so, you know, there's, you know, kind of that name Chatty Cathy. Right. That's very typical to see in girls and women with adhd. More so than that kind of ants in your pants sort of hyperactivity that we think about with. With boys with adhd.

[Penn Holderness]

One of the. One of the biggest advancements in ADHD study and in conversation in the last five years for sure, has been acknowledging the emotional component of adhd. Right. And a lot of times that's probably why boys get diagnosed more. Right. They are releasing their energy and their dysregulation presents itself in a more obvious way. But I don't think there's anyone I've talked to with ADHD who doesn't experience some part of this emotional component. And a lot of the women I've talked to have said that that is transl into shame because they've internalized their difficulties. I want to know from Dr. Girish what she's experienced personally and also those that have come through this center have experienced.

[Dr. Jennifer Garish]

Yeah, thank you for letting me answer this. Question. I have so many thoughts and emotions and science to share with you about this, but I do want to share one amazing thing that one of our patient advocate advisors told us. And you know, we, we have a strong orientation at the Duke center for Girls and Women for AD with ADHD about leaning into experiential wisdom because we know that the science is so far behind on girls and women that we really do lean into what people are experiencing as truth too. And one of our lived experience experts, an adult woman with adhd, told us, you know, the way I see it is that women tend to be sort of internally hyperactive and externally inattentive. And I just love that because you, you do see the, the, the, the fallout of that inattention, which can look like being super anxious because they've forgotten an appointment or they can't remember their grocery list or they're late on a deliverable for their boss. And so all of that swirl around lack of executive function and time management is what you're observing. But it's almost like late, a latent sort of thing from what they're actually feeling. And then in their brain everything is racing around. Like right now I'm like thinking about, I mean I'm totally focused on you all, I promise I'm totally focused on you, not I'm thinking about like what am I going to make for dinner and oh my gosh, did I forget to do something else? And oh, did I, I like, doesn't do my kids, did I pack lunch for my kids? Like I like I always have a fast brain, right. My brain is very much going in a thousand different directions. It can also look a lot like a lot of. I, you know, researchers generally are very laser focused. You know, I tend to have a lot of different interests in a lot of different areas. I need to stay really stimulated and activated and I get bored really easy doing the same thing. And that might be a way that ADHD might look differently for girls too, or women is that we might just be over scheduled or over committed. Right. Because we want that stimulus coming in. And I would say that another thing that Julia talked, Dr. Schechter talked a little bit about too, was this idea of not only the unique biology aspect of this, but then there's this whole gender aspect with girls and women. You know, there is a real expectation that as a girl and as a woman, I am supposed to act a different way.

[Penn Holderness]

That's where the shame comes from. Right? Because you're expected to do this. Things start falling through the crack Executive functioning is difficult. Women stereotypically are expected to do all of this crap that is not conducive to executive functioning. And they end up asking themselves, is there something wrong with me? Why is this so difficult?

[Kim Holderness]

The first we. Our book, ADHD is Awesome came out a year or almost a year ago. And in effort, you know, you go talk about it and you go promote it in. In every single audience after the talk, there was a line of crying women and just needing to be heard and acknowledged. And in the first audience, we were at south by Southwest and this couple had driven in and she. So in our dynamic, he has the ADHD and I'm more neurotypical.

[Penn Holderness]

This was opposite.

[Kim Holderness]

Yeah, this was opposite and very loving husband, but he more nerd. Like, why, why can't you, like, balance the sign up? Genius. And why can't like, he's very loving and very supportive. He was there, but it was so eye opening for him to learn. Like, oh, she's actually, she is trying. Like, she. But she simply couldn't. And she was just sitting there like white knuckling it. So I just think, do you find Dr. Geirish just having a diagnosis, even though it came late, was helpful to you?

[Dr. Jennifer Garish]

It was as if a weight had been lifted. I can't explain to you what a sense of relief it gave me to understand it wasn't that I wasn't smart enough. I was already, you know, an associate professor at Duke, but that I wasn't smart enough or wasn't working hard enough or wasn't a good enough mom, that I couldn't remember all the commitments that I had for my family or for my husband or for my career, and that things just were falling through the cracks. I will be very honest with you. I was doing one of those emotional, emotional intelligence 360s that they do sometimes when you're getting, you know, executive coaching. And this was before I got diagnosed and I was knocking it out of the park on everything except for two things. And my executive coach was sitting down with me and saying, oh, you know, there's. You're doing great in all these, except for this, like, follow through on commitments and time management. And she said, what do you see in that? I said, I see DSM criteria for adhd. What do you see? And she's like, well, that's one interpretation. And I think you might be onto something. And that was like, when I started this, like, journey towards thinking about ADHD as a way of having some kind of, like, framework to understand why I act the way I act, why I behave the way I behave.

[Kim Holderness]

Well, we get a lot of emails and again, every book signing we went to, women just like, what do I do? I mean, there's only so many planners you can buy and there's only so many post it notes you can do. Right. So obviously you can still be a very highly successful person. There's so many examples of highly functioning successful people. But what are the sort of things you're coaching these women and girls in your center?

[Dr. Julia Schechter]

Yeah, so it's a great question. And you know, I think there's a couple things. I mean, one just to circle back to this point that we're making is that I think just starting with knowing that you are not alone. For so long, women with ADHD and girls with ADHD were not, they weren't understanding what they were experiencing and they didn't know who could really get them and understand them. And it is, it's really wonderful to see this movement that's really started to help people realize again that they are not alone. Their brain is not broken. Right. And I think that is definitely one of the goals of the center, to help people understand that they are not alone in their experiences. That's step number one. I think the next step is, you know, we do recommend, you know, talking to your doctor, right. And this can be your pediatrician if you have a kid, or it's your primary care if you're an adult and talking about your experiences. One thing that could be helpful, especially if you're really early on this journey and just starting to think, maybe I have adhd. I'm not sure we actually have on our website, everything's free on our website. A free sort of tool for kind of collecting your thoughts and thinking about your questions ahead of your appointment with your pcp. Just so that when you go in there, you really feel like you really feel prepared. Right. You know what you want to ask, you know what information you want to convey. And you know, at the end of it, if you haven't figured out what the next step is, we give you some sample questions to help you figure that out. Primary care providers and pediatricians sometimes are able to clarify whether or not there's a diagnosis, but they may want you to see a specialist. So this might be like a psychologist or it might be a psychiatrist or a mental health provider that can really dive in a little bit more deeply to better understand if that's there. If you do get a diagnosis. The good news is that there are interventions that are out there that can be really helpful. And right now we, we don't have data to suggest that our interventions work any differently if you are a man or a woman or. And, and so those interventions typically are, are thinking about medication. So stimulant medication is a really strong evidence base to, for helping manage ADHD symptoms. And we also have behavioral therapy as well.

[Penn Holderness]

As you guys are research based, I want to bring up a study that you, you're nodding your head, Dr. Schechter, because, and I am too. I'm just going to give you space for this because it scares the, the heck out of me. The British Journal of Psychiatry found that women with undiagnosed ADHD can die up to 11 years earlier due to a lack of appropriate support and treatment. And I just want to know more about this.

[Dr. Julia Schechter]

Yeah, it's, it's alarming. Yeah. And the truth is, Pen, it's not the first study to find this and it's. So, so ultimately what did the study do? So this particular study that just came out, I mean this was looking at it, you know, huge population based sample in the UK and they identified individuals who had ADHD and compared them to individuals who didn't have adhd and they found that, yeah, individuals, adults with ADHD were more likely to die earlier. And then like you said, women were significantly earlier than men with ADHD. And yeah, it was, it was up to 11 years on average. It was around nine years earlier. And it's, I mean that is tremendously frightening. We don't have a clear reason of why this is. It's not just having ADHD that's gonna know, lead to this finding, but it's probably all the other stuff that comes along with having adhd. Right. So it is things like, you know, we do know that individuals with ADHD are more likely to, to use substances or to smoke. And this is particularly by the way, if their, their symptoms are not well managed. We know that if we get some good treatment for ADHD, we're less likely to see substance use. We also know that there are other health conditions that come along with ADHD too. So for example, data suggesting a connection between cardiovascular health and adhd. And then just generally there's just a lack of unmet needs for this population. Right. I mentioned a moment ago about finding a specialist that can help you. But the truth is that's really hard to do. It can be really hard to find clinicians that really understand adhd, period, and that understand ADHD in girls and women specifically. And certainly that's one of our missions at the center is how do we, we help support clinicians who really want to help this population and better serve them.

[Penn Holderness]

What was the response in your group when you saw that study, Dr. Gerrish?

[Dr. Jennifer Garish]

Not surprised, really. Just, I mean, sad, but super duper sad, but not surprised. I mean, just to build a little bit off of what Dr. Schechter said too, that girls and women with ADHD be are also at higher risk for additional negative outcomes such as self harm, suicide attempts, unintended pregnancies. And also, just having ADHD also impacts the way every factor of your life. It's not a learning disability, though. People notice in school settings that it does impair your ability to learn. It impairs your ability to have lasting, loving relationships, manage your finances, take care of your own health, remember to get your mammograms and all of those things. All of that is executive function, and all of those are life stressors. Right. And that impacts your health and well being as well. So not only are women and girls with ADHD experiencing sort of the normal bad stuff that happens when you have ADHD that is either undiagnosed or undertreated, but there are unique additional burdens for girls and women with ADHD that makes that 9 to 11 year difference in mortality not surprising to us at all.

[Kim Holderness]

Also, when we went and talked to people, I remember very specifically there was a pharmacist who came to one of our talks and she probably in her 50s, and she said, I live with ADHD, I've been diagnosed, but I will never tell anybody I work with because I have adhd, because I'm afraid they're gonna think less of me in such an important, impactful job. Right. So, Dr. Girish, when you were diagnosed and what you'd do specifically, was it sort of like a hey, high five, I got you and everybody understood, or were you afraid to walk into the office and say, actually, guys, it's me.

[Dr. Jennifer Garish]

Wow, that is such a good question. And I want to roll it Back to when Dr. Schechter and I started working together. One of the things that we wanted to talk about was this sort of different way in which men with ADHD and women with ADHD are sort of held at a work site or viewed at a work site. Right? And we were going to talk about me as a person in the work site as a female with adhd. And then we're going to have another sort of man and we're going to compare and contrast. And I must have talked to half a dozen people my Husband, my colleagues, my mentors, Dr. Schechter about whether I should out myself. I mean, this was going to be out in the universe and I was really nervous. It wasn't high fives. It was really scary. It was scary because, again, there are so many misconceptions, including that ADHD means you're not as smart. By the way, there are lots of misconceptions around what ADHD is, what it means. And also, I will say this, that, oh, now it's this thing like, oh, everybody has a little touch of ADHD that drives me crazy. It's like, oh, everyone's a little bit pregnant, like. Or like, you're just a little bit pregnant. You know, it's not quite the same thing. To have adhd, you have to have functional impairment. There has to be functional impairment going on. So it's not this. All of us get a little distracted, right? All of us feel like we need to move our bodies a little bit more if we've been sitting all day. That is not adhd. ADHD comes with real impairment and consequences for those of us who have it.

[Kim Holderness]

Did you. What was the end of that? I mean, did you find a difference between how? Because I feel like men are just treated differently in a workplace. We can just say that and he will agree because he has seen it happen with his own two eyes. So did you notice a difference? Did you find a difference?

[Dr. Jennifer Garish]

Well, I mean, we did this amazing compare and contrast of this guy who had ADHD at his work site. And then me, like, I walk into a meeting, five minutes, and people are like, wow, look at she again, can't get her act together. She can't get anywhere on time. Like, why can't she do it? The guy walks in the meeting five minutes later, like, oh, my gosh, I'm so glad he made time for us. It's like, he's so important, you know, that was kind of like that. We were comparing and contrasting. This was not a study. This was just us talking about anecdotally.

[Kim Holderness]

Anecdotally?

[Dr. Jennifer Garish]

Yeah, anecdotally. Perceptions of, like, how my ADHD shows up at the work site and the perception that comes with it. It. And how his ADHD shows up at the work site and how it is perceived. Like, when I interrupt someone, I'm being rude or aggressive. When he interrupted somebody, he's being a boss and taking control.

[Penn Holderness]

Oh, Tim doesn't call me a boss when I interrupt her. I'm just going to make that super clear.

[Kim Holderness]

Well, I'm. I'm cringing. Myself.

[Penn Holderness]

But it's a good point. No, it's a really good point.

[Kim Holderness]

No. And I'm sure you, you probably have more examples of this. This too, right? I mean, my fists are in balls right now and I'm trying not to like air punch because this is so infuriating. Because oftentimes when. And Pen knows this, he is the most self aware man there is. He knows that when he interrupts, he's. He's being perceived in a meeting as charming and so creative. And he's so creative, he just can't stand it. And he has to say what? What? It's on his mind. I. If I did that, I would be discounted and called rude. And it is. And he is. He has seen it happen. He's noticed. He's. He's very aware of it. But perhaps by having this conversation and the ones you're having in your work, we can all acknowledge that there is a way we treat women with adhd. And there's a way we just accept. Accept men and boys, I mean, also.

[Penn Holderness]

Treat women in general.

[Kim Holderness]

I mean, I mean, that's a whole other podcast.

[Dr. Jennifer Garish]

Can I get an amen?

[Kim Holderness]

Yeah.

[Penn Holderness]

And hey, I want to. I also want to give you flowers here, Dr. Gerrish, because you are talking about all of these things and how difficult it is to live with adhd. But you're the person that we called of anybody in the country when we wanted to talk about the best way to learn about ADHD in girls and women. You are a PhD at Duke. You're a badass. So ADHD does have its upside. And I do believe that some of your creative problem solving probably got you to where you are today. That other side of the same brain. And I, I'm always. I always. You're saying no or you're saying yes? You're saying yes.

[Dr. Jennifer Garish]

Okay. And I, And I appreciate you stressing the Duke affiliation, Pen, but I do want to say I'm a thrice Carolina graduate, not a girl.

[Kim Holderness]

Okay.

[Penn Holderness]

I like to hear that too. That's good.

[Dr. Jennifer Garish]

Okay, so I. I do accredit some of my amazing achievements to UNC Chapel Hill as well, so. Great.

[Kim Holderness]

All right, so I do wanna hear. This is big on Penn's. Sort of. It's very exciting because we have just signed to do a children's book based on ADHD is awesome. We're so excited. But part of Penn's mission is yes, we all know it sucks. Everybody knows it sucks. There's a million, not a million. There's a lot of Books that talk about how it sucks, but there are some awesome things, things that come with it. So this is a question for both of you. In your research, anecdotally, tell us what are some of the awesome things you've seen from women and girls who have adhd?

[Dr. Julia Schechter]

Yeah, I'll jump in here and say that. Yes, we, we love that you highlight that because I think you're right. I mean, I think it's. It's both. Right. It's both having a conversation about people literally dying earlier because of ADHD related impairment. And at the same time, it allows your brain to work in this very amazing way. Actually, the tagline at the Duke center is thinking differently about different thinkers. That is, that was what we want. That's what we came up with, actually. First of, like, that is our mission is how do we think differently about these brains that are different? They are not bad, they are not broken, they are different. And differences come with just really exceptional strengths as well, I think. Yeah. Anecdotally, I am a psychologist that also works with, with kids and with families, and I get to hear all the time about just the wonderful things that parents talk about with their kids. These are oftentimes they're talking about just an immense amount of creativity. Right. These are the kids coming up with the most creative school projects, or they are passionate about social justice and they are speaking their mind and standing up for their friends. Those are the kinds of things that, that I often get to hear about. And, and when I actually, when I work with teens, we have a list at the center that we've been collecting just of famous people with adhd. And if you look at that list, I mean, it's inventors, it's actors, it's athletes, it's people who have to do things differently, have to think differently. And so it really does come along with all these just really, it can come along with all these exceptional strengths, especially when we can manage it well. And so we can really limit that impairment that can also come along with it.

[Dr. Jennifer Garish]

Yes, I absolutely echo everything Dr. Schechter said. I see it in myself. I see it in my three children. They're absolutely incredible and creative and weirdos all in their own right. And just so amazing in what they come up with. My daughter currently has green hair because we decided she want to do that and express it. But for me, it's interesting. Again, in our field, you're either a quantitative scientist or a qualitative scientist. That means you either deal with numbers and stuff or you talk to people and do focus groups or in depth interviews and deal with textual information. I'm weird in that I do both. I run a meta analytics center, so I deal with very quantitative things. I also love that gooey qualitative work and I love when I can can bring those patterns together and see something that somebody hasn't seen before. Dr. Schechter works maybe too closely with me. And I have a nickname. Nickname in the office is called the Human chatgpt.

[Penn Holderness]

Oh, wow, that's great.

[Dr. Jennifer Garish]

I will just. When I'm on fire, I will just like sometimes people just record me because my brain is moving so fast and I'm turning so many out that like literally people will just record me because also I'll brain dump and I won't remember any of it. So I have to record myself. But that's part of it too, is I can be super generative super fast.

[Kim Holderness]

I love this.

[Dr. Julia Schechter]

That's.

[Penn Holderness]

This is so great. Okay, so we just talked about all of these wonderful qualities for women with adhd. Just about five minutes ago, we were talking about how you're undiagnosed. You can die up to 11 years earlier. I want to focus on the word undiagnosed though. Okay.

[Kim Holderness]

Or maybe under supported.

[Penn Holderness]

Well, that's what undiagnosed is. I mean, you're look, you're not aware.

[Kim Holderness]

Or both.

[Penn Holderness]

Or both. Either one. Okay, well, either one of those issues, you are not being supported. You're not. You don't have the awareness of the things that you need to work on. Right. And the fact that there are those things. So I want to get back to the diagnosis at least and ask you, Dr. Schechter, diagnosis is nothing more than asking the right questions. Are we missing some questions in the clinician's room? Are there questions that you would ask.

[Dr. Julia Schechter]

To really do a proper evaluation? We need some things, right? We need to have some rating scales completed so that we can really get a sense. Does somebody's presentation differ from what we'd expect in the kind of typical population? Right. Because, you know, as we mentioned earlier, you know, it's not just sometimes needing to move your body or not just losing your key sometimes, or not just, you know, forgetting an appointment or running late sometimes. Right. These things are happening more often for people at a level that really differs from what we'd expect from their age or developmental expectation. Right. And so, you know, how do we figure that out? We need people to answer some questions and to compare their ratings to other ratings. Right. And we do this a lot through, you know, Screening measures and assessment tools. One tricky thing about that is a lot of those measures where come back to the research. Right. A lot of the research, again, was, was done with male samples. And so sometimes we're missing, right. Some of those measures are really missing a comparison group to look at girls and women and, and, and with adhd. So we're comparing, you know, these, these rating scales to, to girls and women compared to boys and men. There are rating scales and assessment tools.

[Dr. Jennifer Garish]

That do do that.

[Dr. Julia Schechter]

They have norms that were that. So we can compare, you know, kind of apples. But those often are not used in kind of just the regular day assessments in pediatricians, offices or potentially in schools. They typically are more expensive. They're in more specialty clinics. So that's just one issue that gets in the way. In addition to rating scales during this evaluation process, we also have to do a really good clinical interview. Tell us about how have these symptoms been impacting you over time and across settings. Tell us about other things going on in your life. Life, Right. Like, tell us about were there certain events that happened or have you been feeling really anxious or depressed? We have to tease apart the ADHD symptoms from other things to make sure that those are really kind of standing alone. And that takes time. That takes a lot of time. Right. And sometimes these evaluations don't have the luxury of time. And so I think to get back to your question, what kinds of things would I want included in that assessment measure? I think what I really want to do is we need to get rating scales, but can we explore some of those ratings a little bit more to better understand what might have been going on or what people might have been thinking as they were completing the scales? Can we also dive in and get a better sense of, you know, the impairment that people might be experiencing? So an example of this is a lot of times we ask, you ask people, you know, how, how did you do in school as a kid if you're an adult? Or how does your daughter do in school? And they might be getting good grades, straight A's. ADHD is not a disorder of intelligence.

[Dr. Jennifer Garish]

Right.

[Dr. Julia Schechter]

You look at Dr. Gift, she got, you know, strong grades throughout school. But then if we dig in a little bit more and say, tell us a little bit more about that, like, what is the process? Then we start to learn. Oh, well, I, I pulled all nighters throughout middle and high school. That was the only way.

[Kim Holderness]

Dr. Gears, by the way, is just nodding aggressively. Yeah, exactly.

[Dr. Julia Schechter]

I go, oh, I had to get extensions on everything. Or oh, I like you Know, I, I never turned in my homework on time, but I'm a great test taker. And so I think once we start to dig in a little bit more and ask more questions about the process and experience, that's where sometimes we get to kind of that impairment that's not so apparent on the surface. Again, those inattentive symptoms might be a little bit more impacting the process, not necessarily what we see on the, you know, on the report card.

[Kim Holderness]

Okay, Dr. Gerrish, you got.

[Dr. Jennifer Garish]

Shaking my head, yes, yes.

[Kim Holderness]

You're like, yes and yes.

[Dr. Jennifer Garish]

And yeah, I'm getting too old, old to pull all nighters, but I still do occasionally pull them because again, I had 40 some years of maladaptive coping strategies. Right. Because I didn't know that I had adhd and I just thought everybody pulled all nighters to like, be a professor at Duke and to get through college. I just thought that was normal. Right. And didn't know that there was another way. So unlearning, that is a really hard thing to do. Again, I have boy, girl, twins, both have adhd, and it couldn't express more differently in the boy versus, versus the girl.

[Kim Holderness]

What a fun experiment to just be living with.

[Dr. Jennifer Garish]

Yeah, they hate that their mom's a behavioral scientist. I see that you're exhibiting.

[Penn Holderness]

Mom, I'm trying to eat nachos. Stop.

[Dr. Jennifer Garish]

I'm just eating my oatmeal. No, but you know, just how my daughter expresses things more relationally, Right? Yeah, it's how she's relating to her, her like, peers. And my son is, is delightfully clueless about what his people think of him. Right. And again, that's maybe gender, that's maybe sex, social norms, we don't know. Also, if my boy goes out and is, you know, his clothes are a little messy, or his hair is not done, or you might have his shirt on backwards. You know, his teachers don't really think that much of it. But if my daughter's hair is not combed or if my daughter has stains on her shirt or if she looks unkept like she. There is more social fallout from that. So I think asking about sort of hygiene as well might be some of the things that I don't think. Dr. Schechter, I don't think you all think about hygiene as a part of exploring something around inattention.

[Dr. Julia Schechter]

It's not in our typical, you know, kinds of questions that we typically think to ask, but it's a great one. I think you're getting to like the, the social part of this Too. We do find that, you know, girls with ADHD tend to have pretty unique social difficulties. Again, I, I think, but hygiene social, those aren't always top of mind. I think when providers are thinking about impairment, I mean, again, we're oftentimes thinking about school performance or as an adult, we're thinking about work performance, and we aren't always thinking more broadly about the ways that ADHD can impact across different contexts.

[Kim Holderness]

Okay, a woman or a girl is listening to this, thinks they might have adhd. Where do they start? How can they learn from you? Tell us, where do they start this journey?

[Dr. Jennifer Garish]

Just say, first of all, you are not broken. You are perfect. You know, and. And you are not alone. I might start crying like, it took a long time for me to get to that point for myself personally. And I feel like that is such a gift for my daughter now that I can have her grow up to be a strong, confident girl. Woman with adhd. Embracing Penn, what you said, her crazy, weird, different thinking brain. And know that it's a strength, but also know that she needs scaffolding and support to reach her full potential. And that's not a weakness. That is not a weakness to need a different type of educational support. To ask your boss, hey, can I have an agenda so I can stay on task? Those are things you might just need to reach your full potential. So that's the first thing I would say if you're thinking about it. You're not broken, you're not bad. You are perfect just the way you are. The other thing that I would say is, hey, there's the Duke center for Girls and Women with ADHD Plug. And what we do is we try and take the best available science and make it so people can understand it. Everything on our website has been vetted and is the best available evidence that we know around girls and women with adhd. So I would start with us. I would also just start doing some thinking about what. What is leading you to think about ADHD and talk with your significant other or your best friend or your partner and just have them be that mirror to you to see, like, what are they seeing in you? And then I think Dr. Schechter already mentioned we have some beautiful tools around how to sort of scope that conversation out with your primary care provider so you can organize your thoughts. I'm sure you've been able to notice that Dr. Shekht is way more organized in the way she's presenting things than I am. So having something where you can go into your physician's office and have some of those thoughts laid out can be very helpful in helping you get what you need from your medical care team. I'm going to pitch it to Dr. Schechter to add.

[Dr. Julia Schechter]

Yeah, I think that was well said, Jennifer. I think, yeah. The only other things that I would mention are that I think just one is clarifying again that our center is very education and outreach focused. We at the center don't offer clinical services. So for example, at the center we don't do therapy or do evaluation or do med management. Our goal is to really equip people to go back into their communities to find those kinds of services. We also again are providing, we hope some of the resources on our website people will find really educational and they are giving geared towards the public. But also we have resources that are geared towards providers as well. Because obviously when we send people back to their communities, we want their providers to feel like they know what they're doing as well. We mentioned on our website that tool to help adults track share their conversation with providers. I also want to make a plug. There is a child focused version that's from Understood.org it's called take Note. Very similar in that it just helps helps collect information into one place so that you just feel like you're going into that appointment with all of the data that you want to convey. So I think those are great resources to start with. The other thing I'll say is on our website we keep a running list and e a curated list of electronic resources from across the web. So some of the stuff is ours that we've developed. But we also again, we really believe in collaboration and partnership. And so we kind of put things on there that we just think are good, good podcasts, good videos, research, research studies, things like that. And so we call them our electronic libraries. And so that might be a good resource for people to start with as well.

[Dr. Jennifer Garish]

Can I add one last please?

[Kim Holderness]

No. Yeah.

[Dr. Jennifer Garish]

Because I will say that for girls and women there's a lot of parental advocacy for girls and for women, a lot of self advocacy that needs to happen to get to that diagnosis of an ADHD. I think Dr. Schechter talked a lot about how people might be picking up diagnoses along the way, whether that's anxiety or bipolar disorder or depression, which may or may not be those things. It may just be a manifestation of undiagnosed untreated ADHD that is causing this. Or they might truly coexist together, complicating things. Things I would also say, and this is not the scientist in me. This is the lived experience in me. Saying, listen to yourself. Like if you, if somebody's saying something to you and it does not live up to your truth of how you are experiencing your life, be true to your true north. Right. If you think that what you're experiencing aligns with what you believe ADHD is and that, that we know we're underrepresented, girls and women are underrepresented in sort of the conventional knowledge around adhd, the scientific knowledge, the knowledge that providers have, then continue to advocate for yourself, continue to educate yourself. That's what I would also say.

[Kim Holderness]

That is very powerful and very true. And just knowing that it took you two years to get diagnosis, don't give up.

[Dr. Jennifer Garish]

2.5.

[Kim Holderness]

2.5. Start with your primary care physician. Go from there. That, that's the advice. Okay, thank you so much.

[Penn Holderness]

And before you go, just very quickly, we've got to do our top five. And you guys can stick around for this. It'll be fun. We, we like to end with the top five.

[Kim Holderness]

Yes.

[Penn Holderness]

And we were just talking about making sure that there's resources. One of the resources is hearing about awesome famous women with ADHD. So I've got my top five famous women with ADHD. Oh, you guys ready?

[Kim Holderness]

Okay. You have top five?

[Penn Holderness]

Yep, I got top five. Five.

[Kim Holderness]

You have top five here? Okay, I've got top five. And are we going to ask Dr. Garris?

[Penn Holderness]

I think they should hang out for this and see if they have comments, if they have thoughts.

[Kim Holderness]

I thought I was on your top five. You are.

[Penn Holderness]

I don't want to give it away, but.

[Kim Holderness]

Oh, okay, great.

[Penn Holderness]

Guys. Number five, Dr. Jennifer Gar. Yeah, that was, that was the whole setup for this.

[Dr. Julia Schechter]

I'm so sorry.

[Dr. Jennifer Garish]

Goes wild.

[Penn Holderness]

Yeah. None of these other women that I'm aware of have PhDs.

[Kim Holderness]

I mean, so boom. Take that, take that number.

[Penn Holderness]

Take that. Number four. Mel Robbins.

[Kim Holderness]

She has a podcast and a best selling book.

[Penn Holderness]

She might even have a PhD. I'm not really sure.

[Kim Holderness]

But she did get diagnosed with ADHD later in life. I've heard her tell her story around this and how impactful. Just having a diagnosis was like this. Aha. And it's allowed her, I mean, obviously she's incredibly successful.

[Penn Holderness]

Found out by a fluke at the age of 47. And her, I think her superpower really, if you want to call it that, is her curiosity. I think the, the rabbit holes she likes to go down. So number. Wait, was that number four?

[Kim Holderness]

That was.

[Penn Holderness]

Number three is Emma Watson.

[Kim Holderness]

Emma Watson.

[Penn Holderness]

Emma Watson. And look, you can argue that who goes where in this list? But I'm just a huge Harry Potter fan. And also, she's. She's a pickleball player now, so I put her a little bit higher.

[Kim Holderness]

I. So that's. She's an actress, and I only know her as an actress. I'm like, hermione doesn't have adhd, but she's an actress.

[Penn Holderness]

Right? She. She has apparently been typecast in Kim's head as Hermione.

[Dr. Julia Schechter]

She doesn't have adhd.

[Kim Holderness]

She's fine.

[Penn Holderness]

Number two is Greta Gerwig, who has crossed my radar in the last couple of years. And, man, I'm not surprised if you watch that movie Barbie. It is so whimsical and creative and bold and all of those things that women with ADHD are.

[Kim Holderness]

Yeah, I'm seeing some nods here.

[Penn Holderness]

You guys. You guys want to give Greta some flowers? I'll. I'll lay out.

[Kim Holderness]

Yeah.

[Dr. Jennifer Garish]

Are we allowed to say.

[Penn Holderness]

Oh, yeah, Absolutely.

[Dr. Jennifer Garish]

Yes. Total, like, cool brain on her.

[Kim Holderness]

I know. I love listening to her talk and the way she, like, sees the world. I didn't know she had adhd. And now it makes perfect sense because she sees the world and just a different, more beautiful way than my brain. So. Yay.

[Dr. Jennifer Garish]

I like that you said different instead of weird, but. Yes.

[Kim Holderness]

No, no, nothing. None of it's weird. It's just, like, it's special. Like, I kind of want to get a little of it. Like, can I get a little of that ADHD? Okay.

[Penn Holderness]

And number one, I'll let Dr. Schechter comment on her because there is no way you guys aren't impressed by what she has done for mental health awareness in the world. Is Simone Biles.

[Dr. Julia Schechter]

Oh, yeah. I knew that was going to be your number one. I think she's my number one, too. She's Jennifer, just phenomenal. And. Yeah. And such a wonderful advocate for mental health and just. Yeah, a true. A true incredible athlete. Probably, you know, the best in the world.

[Penn Holderness]

If you guys have a chance to watch the documentary on her. I don't remember the name. Rising Rise. I can't remember what it was. It takes. It takes you through her rise to dominance.

[Dr. Jennifer Garish]

Her.

[Penn Holderness]

Her mental health, her twisties, her mental health. Break, like, very open about all of her mental health issues and then. Then kind of climbing back. It is awesome.

[Kim Holderness]

I know. I. I had our kids. I didn't have to force them to watch it. They watched it, and it was so good for me as an adult woman who's way older Than someone biles be like, you know what? I can take a break. She's the best in the world on the world's biggest stage. And she honored what was going on in her head. Like, I'm good. I can do this. And I love what an advocate she has been for adhd. Yeah.

[Penn Holderness]

Just watching her, I was fascinated by her in the Olympics, how her demeanor and confidence changed when she became aware of her mental health issues. And she credited. Remember Dr. Schechter, she credited therapy. Like, how come you won this gold medal? Because I went to therapy every Thursday.

[Dr. Julia Schechter]

Yeah, amazing. Yeah, yeah. Making that public is on that stage. I mean, it's just. Yeah, that's transformative. I mean, you know, that was, that was really transforming lives.

[Penn Holderness]

It's the same woman, but she's been diagnosed and she is aware of what's going on in her body. Body.

[Dr. Jennifer Garish]

I love this idea that, like, you think about ADHD as something that is a, a disorder of not being able to focus. But sometimes it is that hyper focus that gets you to that excellence in, in, in whatever it is, whether it's acting, writing, science, gymnastics, it, it is that can be that hyper fixation and focus that gets you to that next level. That is that sort of, of secret, I like to call it a secret power of adhd.

[Kim Holderness]

That's one, that's the part of ADHD that I want a little bit of. Like, if I can get a little bit of that hyper focus, that'd be awesome. You are lovely. I love, I'm obsessed with the work you're doing. I'm so glad that a center like this exists. If anybody's listening, has $10 million and they would like to give it to the Duke center for Girls and women.

[Penn Holderness]

With age 5 million for the studies between ADHD and menopause and women. And then the other 5 million was to.

[Kim Holderness]

What was the other 5?

[Penn Holderness]

We were going to educate some people just for us. Some physicians, maybe. We were going to educate. Yeah, we were going to. There was, we had another one for five. So 10 million.

[Kim Holderness]

Just a cool 10.

[Penn Holderness]

Yeah.

[Dr. Jennifer Garish]

Could we, could we get two more million to do a really good study to develop some new tools that would be more sensitive to the way ADHD shows up in girls?

[Penn Holderness]

So look, if anyone has $12 million, unless. Should we ask, add some more for the questions like, like getting better questions for clinicians?

[Dr. Julia Schechter]

Probably, yes.

[Penn Holderness]

How much for that?

[Kim Holderness]

How much for that?

[Dr. Jennifer Garish]

I, I, I could do that for a million.

[Penn Holderness]

If anyone has $13 million, yeah. It would be well spent.

[Kim Holderness]

But seriously, the Duke center for Girls and Women.

[Dr. Jennifer Garish]

It's worth those 11 years that women might be dying soon.

[Penn Holderness]

No bleep. Yeah.

[Dr. Jennifer Garish]

Yeah.

[Kim Holderness]

We need to have a telethon. Okay. We're doing it. We were. We will be putting your website in our show notes in the blog that supports this. We'll put it on Instagram. We'll make sure people have access to this. Thank you so much for the work you're doing. Anywhere else that people can find you in the work you're doing.

[Dr. Jennifer Garish]

Instagram.

[Dr. Julia Schechter]

All over social media.

[Dr. Jennifer Garish]

Yeah.

[Dr. Julia Schechter]

Yeah. All over social media. So, yeah. ADHD girls, Duke on Instagram and Facebook and LinkedIn. And so we're all over there. So any of those places you can.

[Dr. Jennifer Garish]

Find us at the Harris Teeter.

[Kim Holderness]

Just walking around.

[Penn Holderness]

Also find you at the Harris Teeter. You guys are the best. Thanks so much for joining us.

[Kim Holderness]

Thank you so much.

[Dr. Julia Schechter]

Thank you.

[Kim Holderness]

I loved every minute of that.

[Penn Holderness]

Same. They're great.

[Kim Holderness]

They're great.

[Penn Holderness]

They're. They're great for their own reasons, too. They're kind of a dynamic duo.

[Kim Holderness]

Perfect.

[Penn Holderness]

It's good to have sort of a, you know, actual clinician who's in there doing the diagnosis and then someone who understands the emotional side on a professional level and is also a lab rat with ADHD. It's perfect.

[Kim Holderness]

Mean 10 out of 10, and they're doing such important work there. And if we got another chance to write ADHD is awesome or do an updated version. Sometimes they do that. Right? There'll be an updated version.

[Penn Holderness]

Or we could write a whole book on it.

[Dr. Julia Schechter]

Yeah.

[Kim Holderness]

Are you the person to do that?

[Dr. Julia Schechter]

I don't know.

[Penn Holderness]

Maybe.

[Kim Holderness]

No, I mean, because you'd have. I mean, I want somebody to write a book about ADHD in girls and women. I'm just thinking, you going on the Today show to promote it, and you're like, hi, here's this dude.

[Penn Holderness]

Well, I would love to champion anyone who wants to try to put it together. I. To me, of all the things that I heard on that interview, most of it I already knew, and some of it I just should have known. Like, I didn't really think about the fact that when women with ADHD occasionally interrupt or lose focus in a professional environment and you're. You're already oomphing, and I understand why they are treated generally differently from if men do it. I think when she said that, you know, in one way you're. You're rude, and in the other way, if you're a man, you're a boss. If you're doing that, holy crap. We've got some work to do. Right. And that part should be in the book, so.

[Dr. Julia Schechter]

Yeah.

[Penn Holderness]

Why would a white dude write a book about women with adhd? I don't know. But you know what I want to do is support anyone who wants to do it.

[Kim Holderness]

Absolutely. If you want to write a book about women and girls adhd, we'll have you on the podcast and provide whatever help we can. And maybe the center for Women and Girls, because we'll have new $13 million. Okay. We love you so much. Bye bye. Hey folks, it's Marc Maron from wtf.

[Dr. Jennifer Garish]

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[Penn Holderness]

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[Dr. Jennifer Garish]

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[Kim Holderness]

There are thousands of Peloton members whose.

[Penn Holderness]

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[Kim Holderness]

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[Penn Holderness]

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[Dr. Jennifer Garish]

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[Dr. Julia Schechter]

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[Kim Holderness]

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[Dr. Jennifer Garish]

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[Dr. Julia Schechter]

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