Podcast Summary: What Your Therapist Thinks

Episode: Is it Anxiety or ADHD? Understanding Women’s ADHD Experience

Hosts: Felicia Keller Boyle (B), Kristie Plantinga (C)
Guest: Dr. Rebecca Lyles, Psychiatric Nurse Practitioner (A)
Date: February 25, 2026

Episode Overview

This episode investigates the experience of ADHD in women with Dr. Rebecca Lyles, a psychiatric nurse practitioner and founder of the Mind Medicine Clinic. The conversation delves into why ADHD is underdiagnosed in women, how symptoms often present differently than in men, the impact of societal pressure, masking, medication, and the complexities of modern diagnosis. The team also unpacks real questions from Reddit about generational coping, masking, and the controversy around the surge in ADHD diagnoses among adult women.

Key Discussion Points & Insights

1. Why ADHD Is Underdiagnosed in Women

• ADHD presents differently in girls:

  • Girls are often socialized to "behave" (03:21) and suppress outward hyperactivity.
  • Symptoms may manifest as quiet daydreaming or dissociation (04:19), leading teachers and adults to overlook them.

• Quote:

  • “We are taught to behave, and we're usually pretty good at behaving really well, even when we don't feel like it... So oftentimes, young girls will spend a lot of time in the classroom daydreaming, and maybe that's something someone on the outside wouldn't pick up on.” — Dr. Rebecca Lyles (03:21)

2. The Overlap: ADHD, Dissociation, and Anxiety

• Dissociation as a Symptom:

  • Daydreaming in girls is often dissociation, which is very common in ADHD (04:31).
  • Personal Insight: Rebecca ties her own experience of dissociation in childhood and public speaking to her ADHD.

• Quote:

  • “Dissociation is extremely common... If you're picturing this little girl in the classroom... that is a form of dissociation, which is very common in ADHD in women, girls, AFAB people.” — Dr. Rebecca Lyles (04:31)

3. Adult ADHD in Women: Unique Pressures & Presentations

• Symptoms become more similar across genders in adulthood (07:59), but social expectations result in unique stress:

  • Adult women feel pressure to ‘do it all’—career, motherhood, household—leading to more burnout, depression, and anxiety.
  • Many women aren’t diagnosed until parenthood, when their children are assessed for ADHD.

• Quote:

  • “The pressure that adult women feel to do it all... oftentimes, when this pressure... is really hitting women, they get to a breaking point of stress and burnout... those can cause depression, anxiety, burnout.” — Dr. Rebecca Lyles (07:59)

• Subtle Signs in Women:

  • Internal symptoms: Perfectionism, chronic anxiety about being “good enough”, self-criticism, and feelings of “not enoughness.”

  • Difficulty keeping up with daily tasks/organization is often attributed to personal failings rather than ADHD (13:41).

  • Quote:

    • “A lot of worry about how one will be perceived. A lot of planning or trying to stay organized and feeling like you're failing at it... these outside expectations... and yet they're having a lot of difficulty doing that.” — Dr. Rebecca Lyles (13:41)

4. ADHD “Superpowers”

• Reframing ADHD Traits:

  • Hyperfocus, rapid idea generation, connecting disparate concepts, and thriving under sprint-like deadlines can be viewed as strengths (16:31).

• Quote:

  • “The speed at which folks with ADHD can skip around different ideas can be very cool... If there's something that is a special interest... I can go deep for a very long time.” — Dr. Rebecca Lyles (16:31)

5. The Problem with Masking

• What is Masking?: Adapting behavior to meet societal expectations (30:13).

• Agency is Key: Using masking as a tool can help in challenging situations, but constant masking leads to invisibility and loss of self.

• Unmasking: Vital for authenticity and healthy relationships.

• Quote:

  • “Masking as a tool, if you have agency around it, can definitely help you get some things done. If you don't have access to your authentic, genuine self and no one else around you knows what that looks like, that means you're invisible.” — Dr. Rebecca Lyles (31:42, 00:00 repeated)

6. Long-Term Effects of Undiagnosed ADHD in Women

• Consequences: Chronic depression, anxiety, underemployment, missed health appointments, deteriorated self-esteem (20:45).
• Cascading Impact: ADHD can start a negative feedback loop affecting all areas of life, from career stability to health outcomes (22:25).

7. Accommodations & Diagnosis

• Importance of Diagnosis:

  • Enables access to school and workplace accommodations, which can be transformative (23:21).
  • Systems should adapt to the individual, not the other way around (24:53).

• Quote:

  • “Systems should be adjusting to people, not the other way around.” — Dr. Rebecca Lyles (24:53)

8. Medication: Controversy & Clarification

• Reddit Critique:

  • A Redditor raises concerns about overdiagnosis, pharmaceutical profits, and the pathologizing of women’s stress (37:24).

• Rebecca’s Response:

  • Acknowledges societal pressures, rejects the notion that prescribers profit from ADHD meds (44:13).
  • Stimulants often serve as diagnostic tools—paradoxically calming and focusing for those with genuine ADHD (42:20).

• Quote:

  • “If you take a stimulant medication... and you are helped, meaning it doesn't make you anxious and in fact, it calms you down... you likely have the neurodivergence that is benefiting from an ADHD medication.” — Dr. Rebecca Lyles (42:23)
  • “I don't benefit if someone is on meds... I prescribe a medication, and then someone goes to the pharmacy and then they get their meds. I have got nothing to do with that.” — Dr. Rebecca Lyles (44:13)

9. Systemic Issues and the Value of Help

• Medication as a Tool:

  • For some, medication lifts the floor enough to allow therapy, behavioral change, and daily life participation (47:17).
  • Not prescribing won’t remove the systemic pressures women face.

• Quote:

  • “Sometimes you need a medication... to get to the point where you can do the things that will help you long term, like exercise.” — Dr. Rebecca Lyles (47:54)

10. Generational Differences and Agency in Coping

• Older Generations:
  • Gen Xers recall ADHD being ignored; today’s climate is more open, but there’s pushback against unreserved “unmasking” (30:13, 36:42).
  • Masking isn’t inherently good or bad—key is having the choice.

Notable Quotes & Timelines

• On Underdiagnosis:

  • “Oftentimes, young girls will spend a lot of time in the classroom daydreaming... that's one of the very common reasons that little girls are missed...” (03:21)

• On Perfectionism and Anxiety:

  • “A lot of planning or trying to stay organized and feeling like you're failing at it... and attempting to do it brings this sense of not enoughness, anxiety, and anxiety of perfectionism...” (13:41)

• On Superpowers:

  • “The speed at which folks with ADHD can skip around different ideas can be very cool... If there's something that is a special interest, I can go deep for a very long time.” (16:31)

• On Masking:

  • “Masking is sometimes good so that we can perform in ways in order to get what we need to get out of a situation... However, knowing yourself, at least unmasked for yourself, you know, and knowing yourself and also knowing that you have a choice around how you want to behave... is really important.” (31:42)

• On ADHD Diagnosis & Medication:

  • “If you take a stimulant medication... and it calms you down, helps you concentrate... you likely have the neurodivergence that is benefiting from an ADHD medication.” (42:23)
  • “I don't benefit if someone is on meds. I don't get money from that.” (44:13)

• On Systemic Support:

  • “Systems should be adjusting to people, not the other way around.” (24:53)
  • “Sometimes you need a medication. We're talking about antidepressants now. But sometimes you need something to help you get to the point where you can do the things that will help you long term...” (47:54)

Memorable Moments

• Rebecca’s Humor & Transparency:

  • Admits to being on Adderall during the interview and shares her personal ADHD journey (02:25).

• Hosts Self-Reflecting on Symptoms:

  • Felicia & Kristie both connect to described symptoms, showing how pervasive and underrecognized these experiences are (05:39–06:48).

• Exploring Reddit's Skepticism:

  • Dr. Lyles robustly addresses the controversy about overdiagnosis and profit, providing nuanced context (40:00–45:31).

• Closing Thoughts on Healing:

  • Diagnosis and treatment allow intergenerational healing—ADHD help increases “presence” for mothers and their children (49:04).

Timestamps for Key Segments

• ADHD in Girls and the Role of Masking: 03:01–05:12
• Dissociation & Adult Symptom Differences: 04:31–07:59
• Internalized Symptoms in Women: 13:41–14:51
• Superpowers of ADHD: 16:31–18:27
• Impact of Masking: 30:13–36:24
• Long-Term Effects of Undiagnosed ADHD: 20:45–22:25
• Diagnostic Value of Medication: 42:20–43:30
• Societal Pressures & Systemic Solutions: 24:53–28:14
• Medication Misconceptions Addressed: 44:13–45:31
• Presence & Intergenerational Healing: 49:04–50:56

Final Thoughts

This candid episode not only demystifies why ADHD is often missed in women but also advocates for nuanced understanding, personal agency, and systemic adaptation. With warmth, humor, and clinical clarity, Dr. Rebecca Lyles and the hosts encourage listeners to consider their own experiences, rethink assumptions about medication, and seek supportive care tailored to authentic needs.