You, me, and ADHD

Summary

Podcast Summary: Today, Explained – "You, me, and ADHD" (March 1, 2026)

---

Episode Overview

This episode of Today, Explained (Vox), hosted by Jacqueline Hill, explores the realities, myths, and evolution of Attention Deficit Hyperactivity Disorder (ADHD) in the US. It features clinical psychologists Dr. Laura Knauss and Dr. Julia Schechter, as well as first-person stories from listeners and therapist Molly Schmerling, who has ADHD herself. The episode focuses on how ADHD presents and is diagnosed, the impact of social media, how gender plays a role, and the current state of diagnosis and treatment options.

---

Key Discussion Points & Insights

1. Personal Experiences with ADHD

• Opening Stories: Listeners and Molly Schmerling share their early struggles—difficulty paying attention, social confusion, and the sense of always being “too much” ([01:09], Molly Schmerling).
  • Quote: "Just this constant feeling of being too much, too kinetic, too loud, and just really feeling like people got some kind of social rule book that I never got." — Molly Schmerling [01:11]
• Adult Diagnosis Realization:
  • Quote: "We were talking about a client, but it could have been like she was talking to me." — Molly Schmerling on her "aha" moment during grad school [02:03]
  • Half of the 15.5 million US adults diagnosed with ADHD were diagnosed after childhood ([02:46], Jacqueline Hill).

---

2. What is ADHD? Definitions and Challenges

• Diagnosis Complexity:
  • Quote: "ADHD can be a really challenging condition to diagnose if you’re a clinician." — Dr. Laura Knauss [03:24]
  • ADHD centers around issues with self-regulation, distractibility, organization; symptoms can overlap with other mental health or lifestyle issues.
  • ADHD is defined by age-inappropriate, impairing inattention and/or hyperactivity/impulsivity ([03:24], Dr. Knauss).
• Impact Areas: ADHD affects school, work, relationships, self-esteem, and increases risks for comorbidities like depression, anxiety, and even incarceration ([05:12–07:01], Dr. Knauss).

---

3. Trends, Social Media, and Misinformation

• Diagnosis Rates: More people are being diagnosed, but prevalence doesn’t appear to be rising. Notably, under- and over-diagnosis co-exist due to access disparities ([07:08], Dr. Knauss).
• TikTok & ADHD Online:
  • Quote: "Basically, like 50% of what’s on hashtag ADHD TikTok videos is not accurate." — Dr. Laura Knauss [08:28]
  • Much online ADHD content is personal anecdote rather than clinical fact, leading to both increased visibility and misinformation.
  • Caution advised: “Why not say, ‘I’m having trouble resisting distraction’ instead of ‘I’m so ADHD right now.’” — Dr. Knauss [09:43]

---

4. Historical Perspective on ADHD

• Origins: ADHD traits date back centuries; first clinical description surfaced in 1775 ([12:38], Dr. Knauss).
  • Early 20th-century terminology: "Hyperkinetic reaction of childhood" (1968 DSM), focusing on hyperactivity ([13:46]).
  • Recognition of adult ADHD is a relatively recent development—from the 1990s onward ([14:40]).

---

5. Causes and Treatments

• Nature and Nurture:
  • ADHD’s core symptoms are ~80% heritable (“about as heritable as differences in human height”) ([14:47], Dr. Knauss).
  • Environmental modification—skills, support, feedback—can reduce impairment even if core traits persist ([15:39]).
• Treatment Modalities:
  • Medications: Stimulants (e.g., Adderall/Ritalin) are standard, but don’t work for all. Non-stimulants like Strattera/atomoxetine exist but are generally less effective ([16:07], Dr. Knauss).
  • Therapy: CBT tailored to ADHD helps with inattentiveness, impulsivity; skill-building is crucial.
  • New frontiers: Transcranial magnetic stimulation shows promise ([16:07]).
  • Quote: "Whatever tool in the toolbox." — Dr. Laura Knauss, on individualized approaches [16:07]
  • Caution: Many "treatments" lack evidence—use reputable sources (e.g., CHADD, NRC for ADHD).

---

6. ADHD and Gender: Changing the Stereotype

• Historic Stereotypes: ADHD long seen as a “male” condition, with boys diagnosed 3x more in childhood ([18:14], Dr. Knauss).
• Research Gaps: Most studies skewed “male and white,” meaning girls and women were underrepresented and underdiagnosed ([21:11], Dr. Schechter).
• Symptoms in Girls/Women:
  • Girls tend to show inattentive symptoms—distractibility, disorganization, internal restlessness—rather than disruptive hyperactivity ([22:33], Dr. Schechter).
  • Quote: "Their symptoms tend to be more overt... compared to girls who have more of the internalized experiences." — Dr. Julia Schechter [22:33]
  • Girls/women often mask symptoms with coping mechanisms (to-do lists, over-reliance on structure/support) ([23:58], Dr. Schechter).
• Common Obstacles:
  • Medical bias—doctors sometimes disbelieve well-functioning adult women can have ADHD ([24:34], Listener story).
  • Quote: "You’re a 38 year-old woman who made it through engineering school. There’s no way you could have ADHD." — Listener reporting doctor’s reaction [24:34]
  • ADHD is not a reflection of intelligence or ability ([25:05], Dr. Schechter).
• Hormones and ADHD: Hormonal changes (puberty, postpartum, menopause) don’t cause ADHD but may exacerbate symptoms ([27:00], Dr. Schechter).
• Closing the Gap:
  • Diagnosis rates for adult men and women are now similar, though girls still underdiagnosed in childhood ([28:20], Dr. Schechter).

---

7. Living and Working with ADHD: Firsthand Reflections

• Therapist’s Perspective:
  • Quote: "For me, it kind of just tells them, hey, you’re in good company. It’s nothing to be ashamed of." — Molly Schmerling [29:41]
  • Lived experience provides empathy and practical advice for clients; community and unmasking are key for support ([29:41–30:30], Molly).

---

Memorable Quotes & Moments

• "ADHD symptoms as really problems in self-regulation, especially when there's like a lot of distractions." — Dr. Laura Knauss [03:24]
• "Basically, like 50% of what’s on hashtag ADHD TikTok videos is not accurate." — Dr. Laura Knauss [08:28]
• "ADHD is about as heritable as differences in human height." — Dr. Laura Knauss [14:47]
• "One of the things that it isn’t, it is not a disorder of intelligence, and it’s also not a disorder of what someone is capable of doing." — Dr. Julia Schechter [25:05]
• "I have found an enormous community of folks with ADHD across the US ... surrounding yourself with more people you can really be yourself and unmask with is just so helpful." — Molly Schmerling [30:14]

---

Timestamps of Important Segments

• 01:09–02:46: Molly Schmerling's ADHD journey and diagnosis as an adult
• 03:17: Clinical definition of ADHD, diagnostic challenges (Dr. Laura Knauss)
• 05:12–07:01: How ADHD impacts adults and comorbid risks
• 08:04–09:43: Social media’s influence, ADHD TikTok accuracy
• 12:38–14:40: The history and evolving understanding of ADHD
• 14:47–16:07: Causes (genetic/environmental), treatment strategies
• 18:14–19:09: Stereotypes, gender, and changing perceptions
• 21:11–24:26: Girls/women with ADHD: diagnostic gaps, symptom differences
• 24:34–25:05: Barriers in healthcare and common misconceptions
• 27:00–28:20: Hormonal influences and adult diagnosis parity
• 29:20–30:30: Living with and treating ADHD as a professional

---

Tone & Language

The tone is both empathetic and informative, with a blend of clinical expertise and lived experience. The episode gives a sense of validation to listeners who struggle with ADHD and pushes back on stereotypes and misinformation, all while centering voices of those most affected.

---

Use this summary to get a complete picture of the episode’s insights, findings, and key voices—whether you’re newly exploring ADHD, questioning a diagnosis, or supporting someone living with it.

Transcript

[Molly Schmerling]

5:00am I'm up with a crisp Celsius energy drink running 12 miles today. Grab a green juice, quick change and head to work. Meetings, workshops One more Celsius. No slowing down. Working late, but obviously still meeting the girls for a little dancing. Celsius Live Fit. Go grab a cold refreshing Celsius at your local retailer or locate [e-mail]

[Dr. Julia Schechter]

when things get hard. How do you talk to yourself? I'm Robinarsson, VP of fitness programming and head instructor at Peloton, and this week on my new podcast Project Swagger, I'm sharing my strategies for how to build better self talk. It's time to work on befriending yourself. Follow Project Swagger wherever you get your podcasts.

[Listener with ADHD]

I never paid attention in school.

[Dr. Laura Knauss]

I always doodled and everything.

[Listener with ADHD]

I was the only kid who couldn't sit in a circle and not get up during story time. That lack of concentration and the ability to focus has been detrimental to my career.

[Molly Schmerling]

School was complicated.

[Jacqueline Hill]

This is Molly Schmerling.

[Molly Schmerling]

So when I was really young, sort of in the elementary school age, it was a lot of meltdowns, a lot of coming home feeling really overwhelmed with assignments. Just this constant feeling of being too much, too kinetic, too loud, and just really feeling like people got some kind of social rule book that I never got.

[Jacqueline Hill]

Molly's mom saw her struggling and tried to give her tips, taught her how to do stuff like make lists so she could keep track of things. And it worked. Molly graduated from high school, college, and eventually she went to grad school to become a therapist. But that too much feeling, it wasn't going away.

[Molly Schmerling]

I was also balancing clinical work with my academic work. So I found myself just in a constant state of overwhelm.

[Jacqueline Hill]

One day she was sitting in her diagnostic assessment class.

[Molly Schmerling]

We would literally go through each of the criteria and sort of talk about what this would look like with a particular client. And I do remember that when we got to the ADHD diagnosis section, we're going through each of the symptoms and I just had this like, aha moment. We were talking about a client, but it could have been like she was talking to me. I really had thought, this is something that you get diagnosed with as a child and you know, that's it.

[Jacqueline Hill]

So.

[Molly Schmerling]

So being able to have her say, no, you'll have adults show up with all of these different symptoms. This is what that looks like. I was completely shocked and I was like, okay, I'm gonna make an appointment now.

[Jacqueline Hill]

It's not just Molly. Of the 15.5 million adults in America diagnosed with ADHD, about half got that diagnosis in adulthood. I'm Jacqueline Hill, and this week on Explain it to Me from Vox, we're talking about the fact and fiction surrounding attention deficit hyperactivity disorder, better known as ADHD.

[Dr. Laura Knauss]

I am Dr. Laura Knauss, and I am a professor of psychology at the University of Richmond, and I'm also a licensed clinical psychologist.

[Jacqueline Hill]

Okay, I'm going to start with what feels like a basic question. What is adhd?

[Dr. Laura Knauss]

I think this is maybe the most important question we'll talk about today, because I think a lot of the challenges when it comes to understanding ADHD kind of arrives from the idea that sometimes when the that term's being used, we're talking about different things. ADHD can be a really challenging condition to diagnose if you're a clinician, because if we think about the core features of adhd, so it's characterized by age inappropriate and impairing, either inattention, which is distractibility, difficulty organizing tasks and activities, and it can occur, inattention can occur by itself, or with hyperactivity, impulsivity. What we know about these kinds of symptoms that people have is that they can be because of adhd, but they could be the result of so many other either mental health conditions or other kinds of lifestyle factors. The way I like to teach people about it, though, is to talk about ADHD symptoms as really problems in self regulation, especially when there's like a lot of distractions. And so that's sort of one important way to think about adhd.

[Jacqueline Hill]

We heard from a lot of listeners who have adhd, and there was a real range of the way it impacts their lives.

[Listener with ADHD]

Growing up, I've had a lot of problems with school focusing, paying attention. I've always loved learning, but my grades never really matched. I made it through school, but I felt like it was a struggle to concentrate and to focus. I experience time blindness a lot, so if I have an appointment or something, it's my primary focus for the whole day to make sure I get there on time.

[Dr. Laura Knauss]

Yeah.

[Jacqueline Hill]

Is that typical of what you see in your patients with adhd?

[Dr. Laura Knauss]

Yeah, certainly. So the studies show that difficulties in, like, educational settings are one of the biggest places that these symptoms show up. And certainly, like in kids, that's how children get identified a lot of times. And then when you're thinking about adults, the second place where the impairments show up most commonly is in the workplace. So, you know, what do we know about these settings? Well, there's settings where you really do have to sit down, concentrate on one thing for a long period of time. There's not a lot of physical movement or changing of activities really happening a lot of the time. And so these kinds of environments tend to really put a strain on kind of self regulation resources for people with adhd, but it really goes beyond that. So I hear adults talk a lot of just struggling with adulting, right? Like pay our bills on time, keep up with kids activities and all that stuff. And then relationships is another tough thing, right? In order to be in relationship with other people, a lot of times it requires a lot of kind of regulating your emotions, which can be challenging for adults with adhd. And also like keeping your promises to other people and you know, doing the things that you need to do to kind of fulfill your end of the social bargain. And that really affects people's self esteem. So that's something we really have to work with in therapy. We also know ADHD does put people at risk for other mental health diagnoses, so from like depression, anxiety, substance use. So we know that kids with ADHD are at greater risk in adolescence and adulthood for accidental injuries, becoming the victim of violence, you know, those problems with educational attainment and becoming incarcerated. So actually the place in society where the rates of ADHD are probably the highest are in our prisons and jails. And so I think it's really important that we strive for access, for quality assessment and treatment for all that have adhd, not just the folks that kind of make it into private treatment.

[Jacqueline Hill]

Are you seeing an increase in people who have adhd? Like, is that something that's happening? And if it is, why is that?

[Dr. Laura Knauss]

That's such a great question. And I think to answer it you have to draw a distinction between an increase in the people getting diagnosed with ADHD versus is it a true increase in what an epidemiologist would call the prevalence of ADHD in the population? So there's a clear increase. In fact, I was reviewing some papers right before I came on here for people getting diagnosed with ADHD more commonly, but they really still can't find solid evidence that the prevalence of this well defined kind of neurobiologically related trait of ADHD is increasing. However, the thing I get concerned about as a clinician is there's clear evidence that for certain populations, ADHD is still vastly underdiagnosed and undertreated. And these are the people that probably also have the least access to care. So they can be simultaneously maybe over and under diagnosed, depending on who you're talking about.

[Jacqueline Hill]

I think we've seen a real rise in people talking about ADHD on social media and there are even ADHD influencers.

[Molly Schmerling]

As a full time content creator with adhd, here are five tips that I use to make my life easier.

[Jacqueline Hill]

There are two types of ADHD anger.

[Molly Schmerling]

I have adhd, but I'm like really good at it.

[Jacqueline Hill]

I have literally mastered having adhd. How accurate is what we're seeing online?

[Dr. Laura Knauss]

So I had a lot of fun looking up the very recent research studies on this that are like fascinating. Okay, so a couple of studies have taken the top videos, the top adhd videos on TikTok and then had experts kind of rate the quality of the information that is in these videos. And what? There's only a couple studies, but they all kind of land around that like, basically like 50% of what's on hashtag ADHD TikTok videos is not accurate. So there's a lot of what I would call like maybe misinformation, you know, not that people are necessarily trying to spread misinformation, but I think a lot of the content tends to communicate personal experiences and there's nothing inherently wrong with that. But if it's not accurate, it could point people in the wrong direction when looking for ways to better live their lives. So I think as a clinician, a researcher, I treat the term ADHD with a lot of gravity and a lot more than I see it being used in daily life. I think this is true for other terms like OCD or how we use the term autistic. So why not say I'm having trouble resisting distraction instead of I'm so ADHD right now.

[Jacqueline Hill]

The way we think about ADHD has changed a lot over the years. How did it become the disorder we know today? That's next.

[Podcast Announcer/Host]

Support for Today explained comes from growth therapy. Every chapter of life brings new challenges and growth therapy can connect you with someone who's equipped to help you navigate them. Whether it's your first time in therapy or your 50th. Gros says that they make it easier to find someone who fits you. From a network of thousands of independent licensed therapists across the United States, you can search by what matters like insurance, specialty, identity or availability and get started in as little as two days. You can cancel up to 24 hours in advance at no cost. GROW says that there are no subscriptions, no long term commitments, and you just pay per session. Whatever challenges you're facing, Grow Therapy can help. Grow accepts over 100 insurance plans. Sessions average about $21 with insurance and some pay as little as $0 depending on their plan. You can go to growththerapy.com explain today to get started. That's growththerapy.com explain growththerapy.com explained availability and coverage vary by state and insurance plan. Support for Today Explained comes from Samcera. A lot of companies have to get product from point A to point B. That means hiring drivers, which in turn means insurance dash cams and accepting the fact that accidents can happen. That's exactly where Samsera comes in. Samsera brings AI dash cams, vehicle tracking and asset visibility together in one simple platform. Samsera says that they want to help you protect your drivers, cut costs and operate smarter. Their AI dash cams capture real time video that can help prove when your drivers aren't at fault, which might help protect them from false claims. Samcera's data shows companies that use their system have reduced fuel costs and improved driver retention thanks to better visibility and coaching. You don't need to wait for the next accident to take action. You can go right now to samsara.com explain to request a free demo and see how Samsara brings visibility and safety to your operations. That's samsara.com explained samsara operate smarter Foreign.

[Jacqueline Hill]

I'm JQ back with more Explain it to me. ADHD is definitely having a moment right now, but Dr. Laura now says it goes back, way back.

[Dr. Laura Knauss]

The traits we associate with ADHD probably have existed in humans as long as there have been humans. But in terms of like the medical literature, we can rewind the clock all the way back to 1775. A German physician named Melchior Adam Weickard is now the first documented kind of like clinical case description.

[Jacqueline Hill]

A young chaplain, for example, is supposed to meditate about the Savior's sufferings.

[Podcast Announcer/Host]

Every humming fly, every shadow, every sound.

[Jacqueline Hill]

The memory of old stories will draw

[Podcast Announcer/Host]

him off his task to other imaginations. Even his imagination, if and when it is copious, entertains him.

[Jacqueline Hill]

With a thousand minor subjects.

[Dr. Laura Knauss]

The case description kind of pops up in different languages. So it was sort of independently discovered in different spots kind of all the way through the 1800s. And then kind of in the early 1900s is where we start to see mental disorders in general. They're becoming kind of diagnostic criteria for things. And ADHD didn't become part of the diagnostic system that's used in the United States until 1968.

[Jacqueline Hill]

Oh wow.

[Dr. Laura Knauss]

It was referred there to hyperkinetic reaction of childhood. This disorder is characterized by overactivity, restlessness, distractibility, and short attention span, especially in young children so as you can see the emphasis there being on the hyperactivity kind of piece of it. And then kind of Moving into the 70s and 80s, it evolved a little bit to not just kind of focus on the behavior, but also the cognitive processes. So that's where we get a name change to Attention Deficit Disorder. So notice we're adding that attention piece there. Yeah, yeah. So a number of name changes. And then it wasn't really till like the 90s that even in clinical spaces, the idea that ADHD persists into adulthood became a prominent thing for a long time. It was like, well, this kid's just gonna outgrow this, so we don't have to worry about it in adulthood. But now we know that is not the case.

[Jacqueline Hill]

Do we know what causes adhd? Like, is this environmental, is this genetic?

[Dr. Laura Knauss]

Yeah.

[Jacqueline Hill]

What causes this?

[Dr. Laura Knauss]

So what we find when we're talking about the core ADHD symptoms, right? So the inattentive and or hyperactivity impulsiv. The extent to which this varies between people is about 80% heritable. So it's about as heritable as differences in human height. The place where the environment becomes exceedingly important is in the extent to which somebody with these ADHD traits experiences impairment. We do know that modifying the environment in particular ways, helping clients learn new skills, giving frequent and really helpful feedback, like, these are ways that adults with ADHD can, you know, they still have adhd, but they're going to function better with their symptoms. And so that's what I get really jazzed up as a clinician is like, helping people figure out how to, like, hack their lives. Right. To succeed more even in the presence of adhd.

[Jacqueline Hill]

Okay. One of the well established ways to treat ADHD is with certain stimulants like Adderall or Ritalin, but those don't work for everyone.

[Listener with ADHD]

I don't like stimulants. I think they do a great job for everyone, but I just do not like how they make me feel. In middle school, I was prescribed Ritalin, but it only lasted for three hours and I would get in trouble when it would wear off before the next dose kicked in.

[Jacqueline Hill]

What are some of the other ways ADHD is treated?

[Dr. Laura Knauss]

Yeah, first of all, I think people do not need to feel that if a medication is not the right choice for them, that it's some sort of moral imperative. Right. I'm like, whatever tool in the toolbox. You know, there are non stimulant classes of medication. So Strattera, which is a brand name Atomoxetine from The research overall, they don't tend to be as effective as the stimulants. And they have a different side effect profile though. So the other thing is everybody's brain is a little bit different. And so it'd be so nice if we could just say, well, everyone is gonna respond to this drug, but if the caller doesn't like how a stimulant makes them feel, that's totally fine. And they totally should talk to their doctor about trying some of these alternatives. Therapy for specifically for ADHD works best when it is really tailored to the problems that people with ADHD face. So where we really see like the big effects or the larger effects right now for adult ADHD is these treatments like CBT for adult ADHD where you're working on skills that address the inattentive symptoms, the impulsive symptoms and that sort of thing. In the more kind of biological therapy space, there is some exciting stuff going on with something called transcranial magnetic stimulation. So this is, and I'm not an expert on it by any means, but it's a way of kind of stimulating the brain in certain ways that is showing some signs of being able to relieve symptoms, you know, at least for some limited periods of time. And finally, I guess I would say there's a lot of exciting things, but there always with this disorder have been a ton of unproven or disproven treatments out there. So I just encourage kind of buyer be. I am on the professional advisory board for an organization called CHAD Children and Adults with adhd. And I would just encourage listeners to go to chad's website and the National Resource center for ADHD if they have a question about like, what's the evidence for this kind of treatment?

[Jacqueline Hill]

Has the profile of who we think of as a person with ADHD changed over time?

[Dr. Laura Knauss]

I hope so, because I hope that's where we're going that we can recognize that ADHD affects all different kinds of people, regardless of socioeconomic status, race, gender. One of the prominent stereotypes has been that ADHD is a male only disorder. Now, it's certainly true that ADHD is more likely to be diagnosed in males, but there are plenty of women and girls with ADHD that are very affected by the disorder. And it's possible that because of our stereotypes about what ADHD is and who has it, that especially in the past, some girls might not have been diagnosed even when they needed help.

[Jacqueline Hill]

Coming up, how those girls and women are finally getting the help they need.

[Podcast Announcer/Host]

Hey everybody. Astetted hernton here. I wanted to let you know that Vox Media is returning to south by Southwest in Austin for live tapings of your favorite podcast. Join us from March 13 through March 15 for live tapings of Pivot, Teffy Talks, Professor G's Markets. Where should we begin with Esther Perel and the special live taping of Today Explained, hosted by yours truly. The Vox Media podcast stage will also feature sessions from Brene Brown and Adam Grant, Marcus Brownlee, Keith Lee, Vivian2, Robin Arzon, and more. Visit voxmedia.com southbysw to preregister and get a special discount on your south by Southwest innovation badge. That's voxmedia.com south by Southwest. Hope to see you there.

[Dr. Laura Knauss]

What are the main takeaways of the foreign policy section from Donald Trump's State of the Union address? I do think they've made a decision to elevate domestic issues.

[Podcast Announcer/Host]

As we head towards the midterms, we'll see if that that sticks because he

[Dr. Laura Knauss]

keeps getting drawn back to the foreign policy issues.

[Podcast Announcer/Host]

I'm John Finer.

[Dr. Laura Knauss]

And I'm Jake Sullivan, and we're the hosts of the Long Game, a weekly national security podcast. This week we'll react to President Trump's

[Molly Schmerling]

State of the Union address, the situation

[Jacqueline Hill]

with Iran, and the eruption of violence

[Dr. Julia Schechter]

involving cartels in Mexico.

[Podcast Announcer/Host]

The episode's out now.

[Molly Schmerling]

Search for and follow the Long Game

[Dr. Laura Knauss]

wherever you get your podcasts.

[Jacqueline Hill]

We're back with Explain it to Me. I remember back in elementary school, it seemed like ADHD was something only boys had. But that's changing, thanks in part to Dr. Julia Schechter.

[Dr. Julia Schechter]

I am a clinical psychologist and an associate professor at the Duke University School of Medicine, and I also lead our Duke center for Girls and Women with adhd.

[Jacqueline Hill]

Why'd you choose to focus specifically on girls and women with adhd?

[Dr. Julia Schechter]

So, as a clinician, what I was seeing is that girls and women who were coming into the clinic were just a little bit more complicated, and they didn't seem to fit the description of ADHD that I had learned about in graduate school or kind of saw more often in the clinic. And the vast majority of research has used predominantly male samples. So our research understanding of ADHD is based on mostly male, mostly white samples. Right. And so that has really centered our clinical understanding of the condition on this more male presentation. Also, what we know is that this kind of trickles into the way that the public understands adhd. This myth of it being a boy disorder is really pervasive and continues.

[Jacqueline Hill]

Yeah, I, I definitely encountered that myth, and we heard from a lot of listeners who did Too.

[Listener with ADHD]

As someone who grew up in the 90s and early 2000s, it seems like most people who were diagnosed with ADHD or ADD at the time were boys who were hyperactive or super disruptive in class. I wasn't diagnosed with ADHD until my twenties, and when I was, I learned that early indicators in girls often look really different. Things like being bossy or prone to interrupting.

[Dr. Julia Schechter]

So we often do see differences in the way that ADHD presents in girls compared to boys or men and women. One of the main things that we see as differences is that girls and women tend to have more of those inattentive symptoms of adhd. So things like a lot of distractibility or having trouble staying focused on a task or disorganization, those kinds of things. Boys often have more of those hyperactive and impulsive symptoms that we can see with adhd. So things like a lot of difficulty remaining seated, a lot of restlessness, running and climbing. Their symptoms tend to be more overt. That is not to say that girls cannot have those hyperactive, impulsive symptoms, but we tend to find is that they're kind of less of the ants in your pants kind of energy level and often have more kind of hyperverbal behaviors. They're more talkative. So that's kind of one of the main things is that these boys tend to have more of those kind of in your face kinds of symptoms compared to girls who have more of the internalized experiences. The symptoms that girls often experience aren't leading teachers to call home. Other people are not noticing as much as those kind of more overt, hyperactive, impulsive symptoms.

[Jacqueline Hill]

Do girls manage those symptoms differently when they pop up?

[Dr. Julia Schechter]

They certainly can. They often will mask their symptoms, so kind of hide them from other people. And that might look like coming up with these elaborate coping mechanisms to manage their symptoms. So this is a really common thing that we also hear from girls and women that they've come up with many, many to do lists or these really elaborate spreadsheets, or they're really relying on a lot of other people to help them manage their symptoms.

[Jacqueline Hill]

You know, there's another roadblock we've heard about, and I want to play you a message from a listener who was having trouble focusing at work.

[Listener with ADHD]

I approached my doctor about this and told them about the struggles that I was having and told them that I thought it might be related to adhd. And I was honestly really surprised by the lack of, of support from him. He was like, you're a 38 year old woman who made it through engineering school. You know, there's no way you could have adhd.

[Jacqueline Hill]

It's really frustrating to hear stories of when doctors don't take you seriously. And I wonder how common this kind of story is when it comes to adhd.

[Dr. Julia Schechter]

I would say what that that person just described is so incredibly common at what we hear about at the. At the Duke Center. And it is. It's heartbreaking. I think that experience also speaks to some additional obstacles to understanding ADHD and what it is and what it isn't. One of the things that it isn't, it is not a disorder of intelligence, and it's also not a disorder of what someone is capable of doing. So for clinicians, one of the challenges that they have to think through is to kind of dig a bit more below the surface. So on the surface, we often hear about women saying, but I did really well in school as a kid, and that's great, and probably took a lot of extra effort, but during evaluations, to be able to dig in a little bit more and say, okay, tell me a little bit more about that process, what was that like for you? Were you pulling all nighters on a regular basis? Were you asking for extensions from your professors? And then when we start to realize, okay, there is impairment, but it probably is just below the surface, not necessarily above the surface. From what we can see, is there

[Jacqueline Hill]

any connection between hormonal changes and adhd? I ask because we got this call from a listener.

[Listener with ADHD]

I was diagnosed as an adult after I had my first child. I had a lot of, like, symptoms of just, like, not being able to pay attention. Like, I couldn't even get through a movie. I was finishing my master's degree, writing my thesis, and it just, like, took a really long time for me to figure out. And I was sleeping all the time. They said I had postpartum, put me on Wellbutrin. Long story short, didn't work. I've been on Adderall ever since, and it's been the greatest experience.

[Jacqueline Hill]

You know, I'm thinking about the times in your life where hormones are just raging, like puberty or pregnancy or menopause. Can that trigger this?

[Dr. Julia Schechter]

So hormones themselves, we don't yet see that as the triggering factor to causing adhd. ADHD is a neurodevelopmental condition, which means that it has to really do with how the brain is developing. And certainly hormones are a part of that. But we don't yet kind of see that connection of you have a big sort of hormone shift and that causes adhd. But when we do have emerging research to suggest is that hormonal shifts may exacerbate these kinds of symptoms. And so now we're seeing them differently or they're causing impairment in such a way that would make someone then meet criteria for adhd. And this is still an emerging literature. It's really exciting literature. Some of what we're seeing is that, yeah, across the menstrual cycle in young adult women, we're seeing that. That at certain points in the menstrual cycle, particularly when estrogen is low, we're seeing that ADHD symptoms seem to be exacerbated. We also have some of this indication kind of in older women and seeing some similar changes there in fluctuating hormones. And so this is definitely an area that is really needed in terms of more science.

[Jacqueline Hill]

So are we seeing the gap in diagnoses starting to close?

[Dr. Julia Schechter]

Yeah, we absolutely are. In fact, what we're finding is that in adulthood, men and women at this point are diagnosed largely at the same rate. There's been a really big kind of pendulum swing, and women have been diagnosed much, much more in adulthood. Girls are still less likely to be diagnosed in childhood. So boys are around three times more likely to be diagnosed in childhood. But absolutely, once we get to adulthood, we are. We're seeing women having a lot more conversations with their providers. They are much more likely to be diagnosed and treated. But again, this is after a lifetime of not being identified or being misidentified and not getting the treatment that they really deserve to get.

[Jacqueline Hill]

Remember Molly, who we heard from at the beginning of the show? After 20 some years of struggling, she. She finally got her diagnosis, and that shaped her professional life, too.

[Molly Schmerling]

So I'm a licensed clinical psychologist, I'm in private practice, and I see individuals with adhd. That's a specialty of mine.

[Jacqueline Hill]

So as a therapist with ADHD who's helping patients with adhd, how do you think your firsthand experience shapes the way you do care?

[Molly Schmerling]

Yeah, I mean, it's a huge part of the work for a lot of them. There may be a lot of shame and stigma attached to the diagnosis. So for me, it kind of just tells them, hey, you're in good company. It's nothing to be ashamed of. It's one thing to read the criteria or the symptoms on a piece of paper. It's another to really be able to share, hey, this is what this actually looks like in real life. And here's some things that I've tried or the research shows to be helpful. I have found an enormous community of folks with ADHD across the US through school, through different groups, social connections. So surrounding yourself with more people you can really be yourself and unmask with is just so helpful.

[Jacqueline Hill]

And that's our show. A big thank you to everyone who wrote in and called in with your stories of adhd. We really appreciate them. We're working on an upcoming episode about the delights and the dangers of sugar. How do you manage your sweet tooth or do you just go for it? Give us a call at 1-800-618-8545 or email askvoxox.com if you like this podcast. One great way to support us is to become a Vox member. You'll get access to our Patreon, which has cool stuff like videos hosted by your favorite Vox journalists, including me. Go to Vox.com members to learn more. This episode was produced by Avishai Artsy. It was edited by Ginny Lawton and fact checked by Melissa Hirsch. Engineering was by Patrick Boyd and our executive producer is Miranda Kennedy. I'm your host, Jonquin Hill. Thank you so much for listening. I'll talk to you soon.

[Podcast Announcer/Host]

Bye.

[Dr. Laura Knauss]

Sa.