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You are listening to the Navigating Adult ADHD podcast with your ADHD coach and expert, Xena. Hello, hello, hello, my friend. Welcome back. Today we are navigating adult ADHD together. You know the drill. I am so happy you are here. Thank you for choosing to push play on this episode and on this podcast I really, really appreciate. So today we are talking about five things that doctors still get wrong about adult adhd. Now, before anyone starts to sharpen their pitchforks, this episode is not called, you know, doctors are terrible and know absolutely nothing. No, like I want to be straight, because doctors are expected to know a shitload about thousands of different conditions and many GPs receive very little, very limited training when it comes to adhd, and specifically adult adhd. I remember a GP friend of mine and actually my own personal gp, they both told me how they received approximately one hour of training when it came to menopause and hormones. And I thought, one hour? Omg, that is not enough. So we can only imagine the limited amount of training that they have received about adult adhd. Okay? And there are some really incredible doctors, psychiatrists, psychologists, ADHD specialists, who really do understand this condition deeply and continue to update their knowledge and as the research evolves, so shout out to them as well. But there is still a really significant gap, very big gap, between the clinical description of ADHD and what it actually is like to live with adhd. The messy, complicated, full, complex colour reality of having adult adhd. And when medical professionals rely on these outdated ideas about what ADHD looks like, people can spend a long time being misunderstood or misdiagnosed or told, no, you cannot possibly have adhd. Okay, so perhaps you have heard things like, you did well at school or you have a successful career, you're not hyperactive or you can focus when you want to, you're just really anxious and everyone struggles with those things. Now, while none of those statements automatically prove that somebody has adhd, they certainly don't rule it out either. Okay, so today, my friend, we are going to look at five things that the medical model can still miss or mess up about adhd. And for each one, we're going to talk about some of the things that we are commonly told. Why it maybe can sound plausible, but we're also going to look at what the research and the lived experience tell us and what a better question or a better response may be if this is something that you encounter. Okay, now, of course I'm going to remind you before we dive in, this is an episode for educational purposes only. I am Not a medical expert. I am not a doctor. I cannot diagnose you or any other condition, my friend. But I am an expert on all things adhd. And I want us to get into this, all right? So, number one, the number one thing that so many doctors can still get wrong about adult ADHD is overlooking emotional dysregulation. Okay? Emotional dysregulation is a major part of adhd. However, it is not currently listed. Listed as one of the core diagnostic symptoms or the kind of core criteria in the DSM 5 when it comes to ADHD. Now, when I say DSM, that means the Diagnostic Statistic Manual. So that is the most recent and updated version of the manual that is used to diagnose somebody. So in that criteria, emotional regulation doesn't even feature. It doesn't even make the list. Okay? That diagnostic criteria primarily focuses on symptoms of inattention, of hyperactivity and impulsivity. But if you were to ask any adult with ADHD what affects their life the most, emotional regulation is likely to enter that conversation very quickly, my friend. For many of us with adhd, the hardest part is not losing our keys. It is losing our shit. Okay? It is the speed and the intensity of our emotional reactions. It is going from mildly frustrated to completely overwhelmed. Throwing your toys out of the cot in 30 seconds. Right? It is feeling criticism throughout your entire body like you're crippled and held by it. It's knowing that your reaction is bigger than the situation and still being unable to turn that down or dial it back. So maybe this looks like becoming intensely frustrated when something small and tiny goes wrong, or reacting impulsively before you've even had time to think. Feeling crushed by the thought of being rejected, Becoming overwhelmed and shutting down. Struggling to calm yourself down once you have been triggered and experiencing emotions so intensely that they take over your ability to think and act clearly. And yet the research consistently shows that emotional dysregulation is quite common in adults with adhd, and it can cause significant challenges and impairments for us. So the problem is that when emotional dysregulation is overlooked, it can be labeled as being too sensitive or immature or dramatic or angry or unstable or difficult or just simply, you know, unable to control themselves. So sometimes we see that our emotional challenges or our emotional reactions and responses are attributed to something else entirely. They might be attributed to anxiety or depression or trauma or bipolar or a personality disorder. Now, yes, those conditions can absolutely coexist with adhd, and some, yes, they have similar symptoms, but we can't rule out ADHD when those, when these things are present, okay? Emotional challenges should not automatically be treated as evidence that the problem is something other than adhd. Okay? So the myth is ADHD is only about focus, organization and hyperactivity. Whereas a more accurate way to understand it is ADHD can also affect a person's ability to respond, regulate and recover from emotional reactions. So the dsm, that Diagnostic Statistic manual, may describe what ADHD looks like from the outside, but emotional dysregulation often describes what it feels like for us from the inside. All right, Number two, the second thing that our medical professionals and our doctors can often get wrong, and I have seen, seen this firsthand, my friend is ruling out ADHD due to success, assuming that success means that somebody cannot have adhd. So this might sound like you did well at school or you went to university, you have a successful career or you run a business. So how could you possibly have adhd? And the problem here is that this really focuses on what someone achieved while completely overlooking or completely ignoring what it took for them to achieve it. Because success does not mean ease, right? People with ADHD can be incredibly intelligent, ambitious, creative, highly capable people. And we can also rely on and run on perfectionism, anxiety, a fear of failure, people pleasing that last minute panic, pulling all nighters over, preparing external accountability, and a constant pressure that we put on ourselves. So those strategies, they can help us to produce some pretty impressive shit, but they can also lead to chronic stress. Stress. Chronic stress, right? They can lead to exhaustion and to burnout. Some of us may do well at school because our parents provided structure and kept us organised. Alright, let's be honest, that was not me. Okay? But some of y', all, that is true for you, right? Some of us can thrive in a stimulating career, but struggle when it comes to paying bills or cooking meals, or just managing home life in general. Right? You may appear productive and capable in public and then completely fall apart in private. You may be succeeding because you're incredibly talented. And then you might also be still working three times harder than everybody around you trying to keep your shit together. So imagine two students, both receive an A. Okay? One student studies steadily over a two week period. They sleep well and they hand in their assignment calmly. Then the other, the second student, avoids it for 12 days, writes the entire thing overnight, submits it at 11:59pm and then spends the next day completely exhausted, absolutely wrecked and stressed out. The result is the same, they both got an A. But the process is not the same. And ADHD often lives in the Process. That's where it shows up. So the myth is that people with ADHD can't succeed academically or professionally. That's such bullshit. A more accurate understanding of this is people with ADHD can be incredibly successful, but that success can come at an enormous cost. So instead of only asking, well, what have you achieved? We need to ask the question, what? What has it taken you to achieve that? Because a degree successful. I can't say successful today. Oh my God. My friend, Hello. Let me try this again. Because a degree, a successful career, or a color coded calendar does not rule out adhd. Okay? Sometimes having that color coded calendar is part of the evidence, right? Can we just take a moment to acknowledge that I said successful successfully? Yes. Thank you. Winning at life today, my friend. All right, number three. The third thing that our doctors and our medical professionals are still getting wrong with ADHD is how ADHD presents in women. Okay? The third thing is still getting it wrong and failing to recognize how ADHD presents in women. It can hide behind anxiety and depression and competence. For a long time, the understanding of ADHD was shaped around the presentation that most commonly was seen in young boys, right? We all know this story. The little boy who can't sit still, he interrupts the teacher. His behavior then impacts everybody around him. He can't sit. You know, I already said he can't sit still, right? But that presentation, that naughty little boy at school, okay, ADHD does not walk into the room carrying a giant megaphone. Sometimes it is quiet, sometimes it is internalized. Sometimes ADHD looks more like daydreaming, forgetfulness, chronic overwhelm, perfectionism, people pleasing, anxiety, low self esteem, emotional sensitivity, struggling to begin tasks, working incredibly hard just to appear as though everything is fine. That is not as loud or as obvious as that naughty little boy at school. So girls and women are more likely to be described as chatty or dreamy, scattered, sensitive, messy, lazy, not living up to their potential. And because our symptoms do not always cause problems for other people, they can be missed. Many women also become incredibly good at masking or compensating for their adhd. Adhd, okay, we might become hyper organized because we are terrified of forgetting something. Or maybe we arrive to every appointment 15 minutes early because being late feels unbearable. That is so me. The idea of being late, like, just is so anxiety inducing that I will be early to everything. Okay? Maybe we set dozens of alarms or write endless lists and constantly double or triple check all of our work. So maybe we even appear calm or capable at work, and then we collapse and everything falls to shit the moment we walk in the door and get home. We may use anxiety as fuel to get things done. And this is one of the reasons women are often diagnosed with anxiety or depression before the ADHD is recognised. And to be clear, anxiety and depression, they can absolutely coexist with adhd. But what is fueling the anxiety? What is fueling the depression? Sometimes, and I've used this example before, or this analogy rather, if you were to imagine, like a layered cake, sometimes the layer at the bottom is the adhd and then above that might be depression and the top tier of the cake might be anxiety. If you strip away the layers, what's at the bottom of the cake? Anxiety might be something that we have because of the untreated, undiagnosed, unrecognised ADHD at the bottom of our layer cake. So rather than simply diagnosing anxiety and depression, sometimes we need to look a little deeper at what could be driving them. Are you anxious because your brain never stops scanning for what you might have forgotten? Are you depressed because everyday life feels like it is 10 times harder for you than it is for everyone else? Is your perfectionism a personality trait? Or is it like a strategy that you developed because you just cannot trust yourself to remember or organize or follow through? For many women, ADHD is not suddenly just appearing in adulthood out of nowhere. It is becoming visible because our coping strategies that kind of once held everything together for us are no, long enough. And this often shows up. And this is why so many women are diagnosed later in life during times of, you know, hormonal changes. It can be during big life events, whether that be having a child or chronic stress, burnout, those sorts of things. Losing a loved one. And hello, the ADHD was there the whole time, but the scaffolding that was holding it all together just gave way. So the myth that we see here is if someone is quiet or capable or anxious, ADHD is unlikely. No, not at all. A more accurate way to understand this is ADHD can definitely be hidden beneath the surface of things like anxiety, perfectionism, masking and years of overcompensating. Competence does not always mean that someone is coping. I want to say that again. Competence does not always mean that someone is coping. Sometimes it just means that they've become exceptionally skilled at hiding how hard everything is or how hard everything is feeling to them. Right, my friend? Number four. The fourth thing doctors can still get wrong is treating ADHD as though it exists separately from hormonal challenges. Okay? Hormones can and do change Our ADHD symptoms and our treatment response. So how effective our medication can be. Okay, throughout our cycles, throughout different hormonal changes that we go through. So many women specifically report in their ADHD symptoms that across the menstrual cycle or during pregnancy or after giving birth, during perimenopause, throughout menopause, they have changes to their ADHD symptoms and how their ADHD presents and what areas are challenging for them. Now, there is still a lot of research that needs to be done here that is, you know, there's a lot of research also underway. I do want to acknowledge that. But the evidence that we do have does show that hormonal changes affects attention, motivation, working memory, emotional regulation, and executive functioning. So that helps to explain why some women notice predictable changes throughout the month or throughout certain periods of their life in areas like focus, memory, motivation, sleep, impulsivity. Right, Emotional regulation, and also how effective our medication is or is not. Some women find that their medication seems way less effective during particular parts of the menstrual cycle. This is something that so many of our doctors and our medical professionals have no idea about. They don't understand this, they don't even know this. And yet the research, which, yes, is still coming, but it clearly does show that this is a pattern, that this is something that is going on. There's other research that shows how perimenopause, right. Women in perimenopause often describe how their brain has just suddenly stopped cooperating. So you might say things like, oh, my memory has disappeared. For me, I think the headline they printed in the, in the newspaper was, 35 year old woman thought she had dementia. Obviously I said that to the reporter who interviewed me, but I did, I truly worried that I might have dementia because I could not remember the most basic things. Right. We might also say things like, I can no longer rely on the systems that used to work. Right. My strategies aren't working anymore. I feel more scattered, more emotional, more overwhelmed than ever before. I feel like my medication has stopped working. And because these symptoms, the symptoms of hormonal changes can also overlap with things like anxiety and depression and stress. There's poor sleep. Because of that, ADHD often gets overlooked. And we might be told things like, oh, you're just stressed or you're just getting older or, you know, this is just part of the hormonal changes. It's probably just anxiety, you know, or you might even hear, ADHD doesn't suddenly get worse. No. Hormonal changes can and do impact our sleep, our mood, our energy, our Brain's ability to function. Hello. Right. That's hormones. But also ADHD impacts all of those things as well. So, yes, it can be really difficult if you're getting diagnosed to know what's what and what's going on. That's why we need to approach these things together. We need to talk about hormonal changes throughout our cycle, throughout our lives, alongside our ADHD treatment and support. Okay. And also to address the medication element here. You may notice that throughout a certain part of your cycle, or as you enter into perimenopause, you might find that your medication becomes less effective at certain times or just in general. Now, there are many reasons that medication, our response to medication, can change, but hormones deserve to be part of that conversation. Okay, so the myth here is that ADHD symptoms should remain the same regardless of what happens, hormonal wise. But a much more accurate understanding of this is hormonal changes can and do affect our ADHD symptoms. It impacts our emotional regulation and the way in which we respond to our medication. So we can't fully understand ADHD in women without considering the role it hormones can play. That needs to be part of the conversation. Okay. All right, my friend. I'm feeling a little fired up. Number five, the fifth thing that our doctors can still get wrong is assuming that having ADHD means we cannot pay attention. That is such bullshit. Unfortunately, this misunderstanding is built into the name Attention Deficit Hyperactivity Disorder. It sounds as though people with ADHD simply have less attention or a lack of attention, right? But we all know that ADHD is not necessarily a lack of attention. When we're interested in something, we can hyperfocus on that for hours. It is a difficulty regulating that attention. It's a difficulty putting that attention where I want it to go. So this means we may struggle to direct our attention towards something that's important but really fucking boring. And we may struggle to pull our attention away from something that's really interesting, like, hello, my most recent puzzle. Something. But it could also be something urgent or something really rewarding. We might be unable to begin a simple email or make a simple phone call, but we can spend six hours researching the perfect storage container to go into our cupboard. It's true, isn't it, that inconsistency can really confuse our medical professionals, right? It might lead a doctor to say, well, you can't have ADHD because you can read books or you can play video games for hours, or you. You're able to concentrate on that work, or you clearly have no problem focusing. But the question is not simply, can you pay attention? The question we need to be asking is, can you control where your attention goes? Can you control how often you do the thing that you need to do and how easily you can shift that attention? Because people with ADHD may focus incredibly well when something is interesting, novel, urgent, challenging, immediately rewarding or emotionally meaningful. Those categories, they motivate our ADHD brain. They help us to produce the dopamine that we need to get the thing done. They help us to shift our attention. But we often struggle when something is repetitive or boring. Vague. Vague is another one. Oh, my God. If you give me vague instructions, I'm lost, I'm out, I've tapped out, I'm gone. If something's low stimulation, right? That is such a ick for us. If it's missing a deadline, oh, good luck. Or even if the reward feels way too far away. This is why someone can perform brilliantly during an emergency. Right? Some of us are fcking great under pressure, myself included. When there is a crisis, you want me there? But then we can completely struggle to complete routine paperwork. Ugh. Can you feel me? I know you can. This is also why we can become completely absorbed in something we really, really enjoy. Hello. I did just tell you about my puzzles. Yes, I'm obsessed with was jigs, and I've got a stack of like 25 of them sitting in the corner right now. Yes, I do. I'm absorbed in them. But at the same time, we can really struggle and be completely unable to start a task that we do care about but just is really boring or really hard. And hyper focus, like that is something that a lot of our medical professionals don't necessarily understand. We know as ADHD is that when we get into hyper focus, we can lose hours, we can lose track of time. We can get eight hours worth of work done in 20 minutes when we're in hyper focus. Okay, but also that can be very confusing for our medical professional, for the doctors to understand because they think, well, if you can do that, then you can definitely focus on something else. And that's not always the case. This is not I can't focus. This is I can't always choose what my brain focuses on. So the myth and the problem here is that the idea that if you can focus intensely on one thing, then you can't have adhd. Whereas a more accurate understanding is, hey, ADHD affects our ability to direct our attention, to regulate it, to shift our attention, and therefore can impact our lives, our ability to get things done. ADHD is not simply a shortage of attention. It is kind of like attention. Without a reliable steering wheel, we can't seem to choose the direction it goes in. So, alright, my friend, to recap, the five things that doctors can still get wrong about ADHD are. Number one, not including emotional dysregulation and emotional challenges as a major part of adhd. Right? Seeing them as completely separate issues. Number two, assuming that success rules out adhd, Failing to realize that achievement tells us nothing about the effort, the stress, or the coping strategies it took to get there. Number three, being very quick to discount or dismiss ADHD in women. Not realising that it can and often does hide behind things like anxiety or depression or perfectionism or even complete competence. Number four, lack of understanding and consideration around how hormonal changes can affect ADHD symptoms and how they can also affect emotional regulation and how well our medication works for us. Number five, assuming that ADHD means an ability to pay attention. Sorry, an inability to pay attention. Okay, Assuming that if you have adhd, you can't pay attention to anything. Failing to take into consideration the difficulty we can have directing our attention where we need and want to put it. Now, none of this means that our doctors are deliberately getting ADHD wrong. It means that their understanding of ADHD is still evolving, especially as it comes to adults. And sometimes the lived experience is moving much faster than the medical model. And that is for sure when we talk about that diagnostic and statistic manual, that shit is so far behind. So, my friend, if you have ever felt dismissed because you were successful or emotional or anxious or capable or just able to focus on things that you enjoy, please know that none of those things automatically rule out adhd. You are allowed to ask more questions. You are allowed to explain more what your functioning costs you. Right? You are allowed to seek out someone who understands adult ADHD more deeply. And you're allowed to trust that your lived experience matters even when it does not fit neatly into some diagnostic checkbox, please, please continue to advocate for for yourself, my friend. Huge, huge love to you. Take care. I'll speak to you next week. Hey friend, if you want some more help navigating and thriving with ADHD and some help applying everything that you're learning here on the podcast, then head over to our website, navigating adultadhd.com.