Transcript | Ep. 113: ADHD All Grown Up
[CLIP - Ally Voice Memo]
There was that part of me that was so afraid that someone would look at me and go, no, you don't have ADHD, you are just looking for an excuse. And that fear kept me from addressing those and bringing it up to a doctor until I was twenty two and I was just crying on my kitchen floor because I, I couldn't get a grasp of my life. And that's when I finally called my doctor and we talked about it and she ended up agreeing to the diagnosis and start treatment. And truly, that was an amazing moment. It was really kind of life changing.
[Theme music]
Cristen: Hey y’all, and welcome to Unladylike. I’m Cristen.
Caroline: I’m Caroline
Cristen: And that was an Unladylike listener named Ally. Ally was one of dozens of unladies we’ve heard from about getting diagnosed with ADHD in adulthood. ADHD stands for attention deficit/hyperactivity disorder. And it’s one of y’alls’ most-requested topics. And from that clip of Ally alone, Caroline, I get why. She says it herself — “getting an ADHD diagnosis was life changing.”
Caroline: Cristen, you and I were also struck by how many other listeners had experiences similar to Ally’s. They grow up struggling with managing their schedule, meeting deadlines, staying organized etc. They finally hit a breaking point, like Ally crying on her kitchen floor. Then a professional is like, “Guess what? It’s not you. It’s ADHD!”
Cristen: A listener named Alison described it as getting an answer to a question she didn’t even know to ask. We heard from another listener named Katherine who said: “Getting diagnosed helped me lift a lifetime of shame for things that I thought just made me bad.” A lifetime of shame Caroline!! That is huge, C!!
Caroline: That’s huge. A listener named Frankie sent us a voice memo that perfectly illustrates that ADHD diagnosis before and after
[CLIP Frankie Voice Memo]
This has been such a huge life changing help for me. and I just like think about all the suffering I went through and all of the anxiety I went through and all of the pain and I describe it as being a car on ice so much of my life I've just been spending half the gas tank with my wheels spinning out, trying to go forward, and now all of the sudden, someone has salted the road and now I can just press the gas pedal and go forward.
Cristen: Caroline, just hearing the emotion in Frankie’s voice?
Caroline: I know. I think it’s easy for people who haven’t experienced that pain of undiagnosed ADHD to misunderstand and even side eye it. Which is exactly why we wanted to talk about the pattern of struggle, breaking down and breaking through with help from Unladylike listeners who’ve been there.
Cristen: So this episode, we want to find out what’s going on with women getting diagnosed with ADHD in adulthood and why CAN it feel so life changing?
[Sting]
Cristen: OK, Caroline, before we get into the gender of it all, could you please tell our dear listeners what is attention deficit hyperactivity disorder?
Caroline: Yeah well basically ADHD is a highly genetic disorder that interferes with how our brains regulate our behavior. Listener Ally, who we heard at the top of the show, describes it as a kind of constant mental gridlock.
[CLIP Ally Voice Memo]
So there's the executive dysfunction, which is when the part of my brain that knows what to do can't quite communicate with the part of my brain that actually tells me what to do. So simple tasks become these huge, undefinable hurdles for me. It's very frustrating.
Cristen: That sounds frustrating.
Caroline: Yeah, yeah, and that communication breakdown in the brain is why folks with ADHD often have a harder time with things like staying focused, alert and motivated. Which is also very relatable. Funny story Cristen, my therapist once told me I probably have some level of undiagnosed ADHD because of how my brain apparently decided to respond to Wellbutrin.
Cristen: Oh, OK.
Caroline: Yeah, so Wellbutrin is an antidepressant, which is why I am taking it, but it also targets the same brain chemicals that are affected by ADHD. And so when I started Wellbutrin, like all of a sudden I could focus, I could sit down and get my fucking work done, so I can attest to the importance of those little brain chemicals — and also should talk to someone about maybe actually getting a diagnosis
Cristen: Well, those little brain chemicals and the communication breakdown you just described can result in one of three different types of ADHD: hyperactive/impulsive type ADHD; inattentive type ADHD; and combination type ADHD. And since that’s all a bunch of fancy lingo I like to think of it Caroline like a neapolitan ice cream. Y'know, because it comes in those three different behavioral flavors.
Caroline: Genius, ok. What is our first ADHD flavor?
Cristen: I think the predominantly hyperactive, impulsive type of ADHD is our chocolate because it's the stereotypical ADHD. You know, it looks like restlessness, fidgeting. You know, it's the kid who can't sit still in class and you probably don’t want to give them too much ice cream.
Caroline: So what's vanilla?
Cristen: I would say our vanilla is gonna be inattentive type ADHD. Because really your vanilla is the quiet hero in the neapolitan trio is vanilla. So inattentive type is often less noticed than our hyperactive chocolate. It tends to look like daydreaming, disorganization, forgetfulness. And that leaves us, of course, with strawberry. And for that, we'll let unladylike listener Kathryn give us ...the scoop.
Caroline: Oh, Lord.
[CLIP - Katherine Voice Memo]
I have combination type, which means that I'm a mixture or a combo of inattentive and hyperactivity type. So that means that most of my ADHD happens in my head. So it's more inattentive. Spacey, thoughts racing, distraction, with a little bit of physical hyperactivity too, I do fidget a lot.
Cristen: So to recap, we've got our hyperactive/impulsive chocolate. Our inattentive vanilla. And our combined type strawberry, which is a mix of those impulsive and inattentive behaviors.
Caroline: Mm, but here's the … meltdown?
Cristen: You’re getting the hang of it, Caroline!
Caroline: ADHD is THE most commonly diagnosed neurodevelopmental disorder in children. So Cristen why are we hearing from folks like our listener Ally who spent years feeling too scared to ask for help? Why was Ally worried that she’d be dismissed as just looking for an excuse for not working hard enough?
Cristen: Because stigmas and stereotypes Caroline, and I do not have an ice cream analogy for this one because it just stinks! So as far as stigmas goes...Ever since the rate of kids getting diagnosed with ADHD began rising in the 1990s, critics have called it fake news. Like, oh, this is just an excuse for lax parenting and kids who don't want to behave.
Caroline: Now for the gender stereotyping. ADHD was first clinically defined just based on BOYS’ hyperactive / impulsive behavior. Like Cristen, we didn’t even GET the first long-term study on girls diagnosed with ADHD until 2002!!! So until relatively recently, ADHD was stereotyped as just a disruptive boy thing.
Cristen: But in fact our gender stereotyping continues when we break down those different types of ADHD. So take the hyperactive type. In girls, those behaviors as them just being overdramatic and too emotional. She’s just so hormonal, right? But when it comes to our inattentive vanilla, that type
Of ADHD is much harder to diagnose because it’s more internal, the symptoms are more internal. And also, girls are the ones who are likelier to get diagnosed with that. But unfortunately, the forgetfulness and spaciness associated with inattentive type ADHD tends to get written off in girls as them just being airheads and ditzes. Like, Caroline as if we needed sexism sprinkles on top of our neapolitan ADHD ice cream
Caroline: I don’t want it. I don’t want it.
Cristen: Me neither. And this reminds me of an email we got from a second listener named Ali. She wrote, “It took me until I was 20 to realize I had ADHD. Everyone down to my family members thought that when I couldn’t filter what I was saying or when I fidgeted, that I lacked self-discipline.”
Caroline: Yeah, that notion that kids like Ali are too lazy, you know, and just need more self-discipline is one of the most harmful ADHD myths, especially when you factor in race. These days, I think that it's accurate to say that ADHD is stereotyped yes as a boy thing, but even more so as a white kid thing. Because regardless of gender, white English speaking students are way likelier to get diagnosed with and treated for ADHD. Meanwhile, students of color exhibiting ADHD symptoms are likelier to just get labeled as bad kids.
Cristen: Now let's also talk about age. We know that boys outnumber girls when it comes to childhood ADHD diagnoses. But that’s not the case when it comes to adult ADHD diagnoses. In fact… are you ready for a staggering statistic?
Caroline: I hope
Cristen: I feel like this could be a whole new segment of the show: Staggering Statistics with Cristen.
Caroline: Is Caroline Ready?
Cristen: lol Ok, here we go. According to the CDC, between 2003 and 2015, the rate of ADHD drug prescriptions rose 700% for women between 25 and 29 years old! Again, that’s the rate of ADHD drug prescriptions for women in their late 20s. Up 700 hundred percent!
Caroline: Seven HUNDRED percent?
Cristen: Seven HUNDRED!
Caroline: Seven HUNDRED
Cristen: Yes Caroline, would you call that a staggering statistic?
Caroline: Yeah, that statistic is fucking staggering Cristen. Clearly, there have been a LOT of girls who've struggled and coped with undiagnosed ADHD. So what happens to them as they grow up, and what does it take for their ADHD to finally get recognized?
Cristen: We'll get to the bottom of that when we come back from a quick break.
[Sting]
[CLIP: Alexa voice memo]
A big part of my ADHD has just been an imposter syndrome. So I've always done well in school. I was always, always written on my things like, oh, a pleasure to have in class and stuff like that. But like inside, it just felt like I was always like two disasters away or two mess-ups away from catastrophe kind of thing. So just not really feeling on the inside what people were telling me on the outside.
Cristen: We're back, and that was an unladylike listener named Alexa. Also apologies to everyone whose Alexas we just set off
Caroline: When we left off, we raised the question of what happens to girls with undiagnosed ADHD as they grow up. And long story short: ADHD symptoms are not like a fine wine, y'all. They do not magically get better with time, especially when they've gone unrecognized. Instead, ADHD can become a BEAST to live with...
[CLIP: Sindia voice memo]
There was some point that I felt I couldn't execute anything. I couldn't write as a copywriter or as a, you know, paid blogger. I couldn't do my own projects that I wanted to do. And I felt I was I was getting in my 30s, like mid to late 30s, that I was not reaching any anything. And I was still, you know, under poverty levels and trying to live my life month by month. My house was a mess. And it was very overwhelming.
Cristen: That was an Unladylike listener from Puerto Rico named Sindia. And Caroline not to be too on the nose about this, but living with undiagnosed ADHD as an adult tends to look very unladylike you know? Think: messiness, constantly running late, just being generally unable to get your shit done.
Caroline: Yeah and that means that a lot of women spend years relying on coping mechanisms as a way of masking their ADHD. So for instance Alexa, who we heard from earlier, mentioned that she's had to keep a day planner since she was 10 years old. And all of that coping and masking can get really exhausting. Here’s Alexa
[CLIP - Alexa voice memo]
It's hard when my perfectionist brain says you should never make any mistakes, so there's a lot of internal pressure, I really pushed back in my brain on the idea that like like it was very much like, oh no, you don't struggle enough to have ADHD. What if what if you go through the process and they tell you actually you're just making it all up and you're just looking like you're just attention seeking and stuff like that. So like I didn't feel like I deserved it.
Caroline: In fact, women ARE more likely than men to internalize their ADHD behaviors — and that internalizing comes with self-criticism, self-doubt, AND something called rejection sensitive dysphoria.
Cristen: Caroline, I had never heard of rejection sensitive dysphoria until literally unladylike listeners told us about it .
Caroline: Yeah same. But a lot of the folks we heard from identified it as the WORST part of living with ADHD. Listener Ally who we heard at the top of the episode described it this way:
[CLIP - Ally Voice Memo tape]
I had been experiencing this for years and it was terrifying because I didn’t know what it was. Essentially, it's a deep, visceral aversion to the feelings of being rejected. But even wording it like that doesn't do it justice because because it comes across as very sensitive, takes things personally, doesn't like rejection. And all of that is normal. But when I would feel rejected or even when I would just feel a bit out of place, a bit socially anxious, it's as though like it is as though my tether to reality snaps. And it was horrifying. And I and I would wind up in these awful, truly unbearable mental health spirals, and I would just feel so weak and so pathetic.
Caroline: Cristen, hearing Ally describe rejection sensitive dysphoria honestly left my feeling a little guilty
Cristen: Guilty?
Caroline: Yeah, I mean like when letters started rolling in that mentioned rejection sensitive dysphoria, I kinda side-eyed it. You know I was like, is this the same thing as people who call themselves empaths? You know, aren’t we ALL sensitive?
Cristen: Don’t we all fear rejection? I know I do.
Caroline: Well so I looked it up, and it's not a medical diagnosis, per se. It's more like an umbrella term for the emotional dysregulation associated with ADHD. So like, on the one hand you know folks with ADHD their brain wiring predisposes them to heightened moodiness. But on the other hand, you know you’ve grown up afraid of being criticized as lazy or undisciplined.
Cristen: Yeah, here's where it is probably unsurprising to learn that many women and girls with ADHD are also diagnosed with mood disorders — and sometimes those mood disorders can almost kinda hide the ADHD symptoms. So here’s another listener, named Victoria.
[CLIP: Victoria voice memo]
I was only diagnosed with ADHD a year ago after my son had been diagnosed a year prior. And It was extremely difficult to get my ADHD diagnosis because I'd been going to psychiatrists and psychologists for years and my ADHD was often just diagnosed as part of my anxiety or bipolar disorder. And it really took six doctors and multiple visits in order to really have someone listen to me and be able to understand my symptoms and that my other medication that I was on wasn't helping.
Cristen: Another interesting thing about Victoria’s voice memo is how she got that diagnosis. Because ADHD is highly heritable — aka it’s in ya genes — moms like Victoria often get diagnosed when their kids do. Like essentially, they recognize their own experiences in those diagnostic criteria, basically.
Caroline: That kid connection is one of the most common ways women get diagnosed with ADHD. And there’s another common route. Basically the wheels fall off. All of the masking and coping strategies — the perfectionism, the striving — it all just crumbles, and these exhausted women reach a breaking point and finally look for help
Cristen: Yeah, it’s like Ally crying on her kitchen floor, you know? So why though does it take SO much just to get some help? We learn about the moral baggage getting in the way … after a quick break..
Caroline: Stick around.
[Sting]
Caroline: We're back. At this point in our ADHD story, the unladies we heard from had reached their breaking point. They finally sought help and were diagnosed with ADHD, and it’s this huge breakthrough moment. So problem solved, right??
Cristen: Yes and no. Yes and no. We heard from a listener named Kayla who got diagnosed with ADHD at 30. It was definitely a breakthrough moment for her, but she says, “even with this newfound awareness, I have problems holding down jobs, paying bills, checking emails and maintaining relationships.” And Caroline another listener who got diagnosed with ADHD in grad school made a very good point that "the unrealistic expectations of capitalism do not help."
Caroline: OH yeah. The expectation that we should all fit perfectly into the capitalist hustle machine you know or otherwise something must be wrong with us … that is actually embedded in the history of ADHD. Physicians have been studying what we call ADHD for 200 years now, and in addition to framing it as a childhood disorder that mostly affects boys … it was also seen as a moral failing in those children.
Cristen: Yeah, yeah. So OK let’s travel back to 1902, we’re going to a lecture from Sir George Frederick Still, who’s known as the father of British pediatrics, and he described ADHD as “an abnormal defect of moral control in children.” Now I don’t \know if he spoke like that exactly, Caroline, but I’m just going to assume. He couldn’t figure out another explanation for like, why do these otherwise healthy kids, like why can’t they just sit still? And his conclusion was that these kids only care about self-gratification, and y’all they just really need to get in line.
Caroline: And Cristen, I can hear the side effects of all this moralizing hand-wringing in the listener letters and voice memos we got. Like, yes 1902 was a long-ass time ago, but I still think the stigma of ADHD’s original conception as an immoral, immature boy thing gets in the way of girls getting a diagnosis.
Cristen: Oh absolutely. And while more women are getting diagnosed these days there’s another kind of hand-wringing and moralizing going on. So, Caroline do you remember that staggering statistic that blew your socks off at the top of the show?
Caroline: Oh boy do I.
Cristen: Never forget, right? So in case y’all forgot, we said that between 2003 and 2015, there was a 700 percent increase in ADHD drug prescriptions for women in their late 20s. To underscore that, that's an increase in drug prescriptions, which is not necessarily the same thing as ADHD diagnoses. And the kinds of prescriptions we’re talking about are for stimulants, things like Adderall, Vyvanse, Ritalin. Buuut Caroline, as anyone who has been on a college campus lately can probably tell you, stimulants also have a dicey reputation and history of abuse.
Caroline: Yeah, for just one example, the drug now branded as Adderall was actually first sold as diet pills. I mean, my mom was taking a stimulant diet pill that got yanked off the market because it was giving people heart attacks. So like stimulants, whether they are related to ADHD or not, just people give them a lot of side eye.
Cristen: Absolutely. And I will say that caution is warranted when it comes to taking stimulants. They are not a cure-all. Full stop. And neither though is getting a diagnosis. Caroline,I say this because of an article I ran across on a little website that loves to peddle some pseudoscience called Goop.
Caroline: Oh God.
Cristen: Oh God. Oh Goop. This is an article by a child psychiatrist and sort of an ADHD spokesman named Ned Hallowell. Tell me what you think about Dr. Hollowell’s take on ADHD. Here’s Ol’ Ned. “If you are an adult reading this and you feel you are underachieving, learn more about ADHD. Diagnosis and treatment could replace frustration and underachievement with success. The diagnosis of ADHD and the treatment that follows, if done properly, truly can change your life at any age from one of frustration and underachievement, if not worse. To one of triumph, fulfillment and joy.”
Caroline: And achievement.
Cristen: And achievement. Particularly if you were underachieving before. Like y'all. An ADHD diagnosis and certainly a prescription to a stimulant drug are not a panacea.
Caroline: No.
Cristen: And it being sold as one, is very concerning.
Caroline: Right, because. you're not replacing your brain or like, yeah, you don't become a new person with a pill.
Cristen: Well, and I think I think we are in living in and health and I put air quotes around wellness era that is so emphatic about success, joy, fulfillment. Oh, it's like, oh my God. Well, like you said, Caroline, there's nowhere to go but up, apparently, like, achieve, achieve, achieve. So I think the the question that I that I have for unladylike listeners is how do we separate ADHD symptoms and its treatment from our culture of productivity obsession.
Caroline: Right.
Cristen: And the capitalist grind. Is there a pill for that, am I right?
Caroline: I think that's such a good question because it's hard to argue with the listener responses that we have already gotten before we even put out an episode. Like you cannot argue with the heartbreak that those women are describing. And the sadness and at times bitterness that they feel over having had such a hard fucking slog of it through childhood and high school and college and on that they are just now getting help and identifying what's going on in their brains. And you can't tell me that those people are all just trying to be capitalist cogs in a wheel, you know what I mean?
Cristen: Yeah.
Caroline: But. The question you ask is not wrong because like we are all boiled in this stew.
Cristen: Mm hmm.
Caroline: This cissexist, heteropatriarchal, capitalist society.
Cristen: Woo!
Caroline: And one big important thing to note is that it's not just that there can be a silver lining to getting an ADHD diagnosis — not only do you finally get access to resources, potentially meds and therapy, if you need them. But there's also the true fact, Cristen, that getting that ADHD diagnosis can allow people to appreciate their own unique brain wiring. Like embrace neurodiversity. This world doesn't make a lot of room for it. But I think that a lot of listeners that we have heard from really were able to appreciate their creativity.
Cristen: Yeah, their creativity. And even Caroline, I don't remember exactly which listener told us this, but she was talking about that rejection sensitivity dysphoria and how really intense and negative it can be. And she says the flipside, though, is that she also experiences a lot of joy, like there are high highs. And it seems like the biggest takeaway for me is that the key to that kind of breakthrough moment that we heard from so many folks was not, you know, kind the a big pharma looming oh, just give people pills, pills, pills. But rather, it was finally having some understanding and a sense of of how to work with themselves rather than against themselves. So like figuring out how to lean into those jags of hyperfocus where they can be totally sucked into a creative project and really lose themselves in a positive way, but at the same time, developing the resources to, you know, just build some structure in their day to day lives.
Caroline: Thank you again to all the listeners who shared their stories!
Cristen: You can find us on instagram, facebook and Twitter @unladylikemedia. You can also support Cristen and me by joining our Patreon; you’ll get weekly bonus episodes, listener advice and our undying love at patreon.com/unladylikemedia.
Caroline: Nora Ritchie is the senior producer of Unladylike. Gianna Palmer is our story editor. Shruti Marathe transcribes our tape. Our music is by Flamingo Shadow, Amit May Cohen and Sarah Tudzin. Mixing is by Andi Kristins. Sound design and additional music is by Casey Holford and Andi Kristins. Executive producers are Peter Clowney, Daisy Rosario and Unladylike Media.
Cristen: This podcast was created by your hosts, Cristen Conger
Caroline: And Caroline Ervin of Unladylike Media.
Cristen: Next week …
Raquel Willis: We've got to get out of the space where we think that trans people are just having this magically, radically different experience. Like, yes, we're fabulous, we're brilliant, we're beautiful, we're amazing. You know, we're we're breaking down the binary. But like, you can do some of that work, too, in your own way. You can also break down the binary.
Caroline: We are talking to one of our heroes and friends: Raquel Willis. Raquel is a transgender activist and organizer. We talked with her about the weaponization of womanhood and the power of the Black trans movement she’s helped to build.
Cristen: You don’t want to miss this episode! Make sure you’re subscribed to Unladylike. Find us in stitcher, spotify, apple podcasts or wherever you listen to podcasts.
Caroline: And remember, got a problem?
Cristen: Get Unladylike.
