The Truth About Female ADHD, The Invisible Struggle (Leading Psychiatrist Explains)

We've let women down in both the diagnostic stage of ADHD, but also in the support that we offer them. We're looking in childhood for very clear symptoms of an impairment with hyperactivity or inattention. Girls are more likely to develop emotional maturity and make efforts to conform to social norms during their childhood. That invites itself for masking to start taking place. Dr. Yathra Mesh is an ADHD specialist psychiatrist with a unique twist. He's treated people with ADHD from ages 18 all the way to 100. So, with regards to ADHD, he's seen it all. With ADHD, people often gravitate to fast-reward, fast feedback mechanisms in order to help cope and regulate your emotions. You could be alcohol, cannabis, shopping, various things that ultimately could lead to an addiction. Do you think if left unchecked and that propensity to seek the low-hanging fruit, the quick dopamine? Can that lead to a dangerous path of crime, perhaps for somebody like that? I think that. Can I have just a second of your time? If this podcast has helped you understand your brain or made you feel less alone, can you do me one favour? Can you hit the follow button? And I'll repay the favour by continuing to book the best and most exclusive conversations on this topic. Please enjoy the episode and always remember, you're not broken, just different and you have always been enough. Welcome to the ADHD Childhood Podcast. Thank you for having me. It's such a pleasure to have you here. The patients that you've treated for ADHD, they range from 18 years old to 100 years old, is there anything that still shocks you about ADHD? So, there are so many things that shock me about ADHD, but I should start off by saying that, I guess, the reason why I treat people within that range is I'm a dual-trained general adult and old age psychiatrist, and as I went through my training, I essentially developed skills with treating neurodivergence in both the adult population, but I also took those skills into the work that I was doing in the older adult population. I think what shocks me about ADHD at the most is the fact that the symptoms can still persist over the different age groups, and in particular, I think what I've learnt from working with people across those different age groups is that although the symptoms themselves can sometimes go away for some people, actually, as life gets more complicated, things can get more complicated for older adults, so yes. So, the symptoms of ADHD can stay consistent throughout someone's life, all the way from 18 to 100, but the way they manifest and show up and cause challenges, does that change as you go through life and get a bit older? Absolutely. So, let me talk you through the different life stages. Okay, so we're going to start with children. Now, I'm going to call this the dependent stage, because at this stage, what we're looking at is the amount of dependence that you have on your parents or your teachers or whoever it is that provides support around you. Now, with children, when it's obvious that you're requiring more dependence on those people compared to others, then we start to notice problems with ADHD, but therein lies the challenge, because if you're very good at masking your symptoms, if your symptoms were there, but you had a sibling who had, let's say, hyperactive symptoms that were more obvious, if there were symptoms that were happening, but there was something else going on, like parental divorce or conflict, and they could be rationalised or justified in another way. For all those different reasons, it's very possible to get through childhood where you have symptoms, but they haven't manifested into something that we might consider ADHD. So, then we go on to your early adulthood. And in this stage, I'd call this the independent stage, because in the independent stage, you're trying to become self-sufficient, but you might find manifestations of ADHD there where you can't. So, I'm talking about the people who do really well academically at school, but then they go into their university years and everything falls apart. They're grades full, they struggle with making friends, or they struggle with being able to prioritise the differences between prioritising school, prioritising work, prioritising friendships, relationships, and the old self that used to jump from one excitement to the other struggles with handling this sort of stage of life. And then we go on to the next stage, which is the integration stage. So, let's say that you manage to get through life and you learn skills of independence, but when you get to actually trying to bring those skills together, so let's say you're a parent, you have your juggling responsibilities with childcare, with aging parents, or you're taking on a leadership role at your work. At this stage, you can struggle with trying to bring all of those different skills together. Why? Because you don't have the opportunity to mask in the same way that you did before. All those times that you used to give yourself that downtime gone. All those times where you used to be able to prepare for conversations, prepare for those situations that you knew were going to be anxiety-provoking for you gone. And at this stage, ADHD can manifest rather than with symptoms, but with difficulty with managing the complexity of life. And there is a whole separate thing I can tell you about with the retirement stage, and perhaps we can talk about that later. I've never, ever had it explained in such a fluent way before, how it can show up at various stages of one's life. So, at different stages of your life, you have different support systems around you, your environment changes, and in response to the sort of ever-changing landscape of what you are in as a human being, how much your ADHD shows up changes depending on that too. Do you think as you grow up and you transition through these different stages, can ADHD get easier to manage as you as an individual become aware of your traits, your challenges, and you're able to self-reflect on them? Yeah. So, there are two arguments for why you might think that ADHD can become easier to manage, and I'd say for some people it absolutely is the case. So, first, pattern recognition. You start to be able to recognise those triggers before you let them get to the stage where it becomes a problem for you. You know those people that if you spend time with are going to be triggering for you, you know those situations, those opportunities that if you say yes to, they're going to completely override you, and you know how to avoid those situations. So, yes, for some people, pattern recognition helps. The second thing is emotional maturity. So, when you were younger, your RSD may be driven by lots of perceived threats, hypothetical scenarios about what could happen in the future, but now as you get older, you start to actually realise what does happen, and that can help your RSD to have a more mature understanding about the difference between perceived and actual threat. So, this can be really helpful with being able to have the capacity to manage some of the ADHD symptoms that you have, but I would caveat that by saying that you've got capacity, and you've also got demand, and as you progress through your life stages, the demands on you can also grow up and expand, and when they grow, if your capacity doesn't match the demand, then you personally might not find that ADHD gets easier as you age. So, interesting being able to recognise your patterns, and therefore it gives you the tools to mitigate and avoid perhaps an RSD trigger. Are there circumstances in someone's life as they get older? New experience is that their ability to see coming because of that pattern recognition isn't so useful because they have never experienced that life event before? Yes, so when we look at the experiences that you have as you age, so let's look at some of the most common scenarios here. Parenthood for women, the menopause, for both men and women, the experience of progressing up the leadership ladder within your working environment, for both men and women again, the experience of complex physical health challenges as you age, and again, going through retirement. At all of these life stages, you're experiencing things that you never may have experienced before, and one of the most difficult challenges with this, and I'll give you an example of this, okay? So, one of the things that people in their later stage of life tell me is that they look back at a certain period. It's a right middle adulthood where everyone is caught up in the thick of things and during that time what happens is that you don't have as many interactions with your friends and family around you but those interactions can be detrimental depending on how they play out and so something that I've heard time and time again is I never really had that good relationship with my brother but that one Christmas in 1998 just completely ruined our relationship and they link they link it back to their experience of RSD that might have happened during that moment and what it does is it reinforces to their RSD and to their ADHD brain that this is not a safe space and that you need to be careful with your social interactions so as you go through the life stages things can become more complicated but also your RSD can become more sensitive to those situations from happening. What is RSD? How would you describe it? RSD stands for Rejection Sensitive Disphoria. It is a concept and a term coined by the American psychiatrist William Dodson who I know that you know very well you've interviewed him and essentially what it describes is an intense physical and an emotional symptom or pain that you experience in the context of actual or perceived threats and it's disproportionate to what other people may presume to be a normal reaction to a situation and this is important because in the moment when you're experiencing RSD it's very possible that your emotions and experience are completely logical and justified for that situation based on what's going on in your brain. You might regret it later yes but in the moment you will it will make complete sense to you and one of the most painful things about RSD is that there is a self-perpetuating cycle between RSD and trauma so as we all know you know from ADHD you're more likely to experience trauma in the context of having ADHD. Now unlike other experiences so let's take alcohol the more alcohol you drink the more likely you are to actually dampen your responses to alcohol so that you don't become as sensitized to it over time. It's a complete opposite effect with ADHD and RSD so the more traumas you experience so if we imagine that RSD is this bubble that you have and it's a protective shield it's a heightened flight, vital flight response that you have in order to protect you from trauma. Now if you imagine that every time you experience a trauma that bubble gets bigger and with that bubble it gives you a stronger response so that you protect yourself next time from trauma but as the bubble gets bigger and bigger the problem is that it becomes easier and easier for things to actually hit the bubble so now you get this very heightened response that's also much easier to be able to hit and that can cause you to want to curl up into a ball and avoid all trauma and that's why it can be so painful. William Dodson he theorized and we speak a lot about it and this podcast is is those horrible comments that many of us experience in our early years because of our differences but what other trauma could a child with ADHD be exposed to that perhaps someone who didn't have ADHD might for various reasons avoid? Yeah. So as a child with ADHD you are more likely to go through life being told things that are a different narrative to why you experiencing life the way that you are. So let me just get this out from the start as well because some of these listeners of this podcast will have gone through generations of life where we didn't even have the culture or language to experience expressed neurodiversity so what does that actually mean? So what that means is that in attention wasn't even considered a possibility to be something that was wrong with your brain these children were probably told that you're not listening you're not paying attention there must be something that's you know wrong with you because other children are not like this you're messy you're disorganized you misbehave why can't you just be like you're sibling or someone else so these are ADHD specific traumas that you can have but then there's another problem that happens children with ADHD who are exposed to the same traumas that someone without ADHD doesn't have so let's say parent or divorce for example they not only experienced the worries that they might have caused it because of all the things that they were told about themselves but for their RSD suddenly you go from having a perceived threat to confirmation that there is an actual threat here this event actually happened in your life and maybe you might have had some contribution to it and I find this one of the most painful experiences to hear about when people carry that so yeah childhood trauma has a very very strong role to play in how ADHD develops in children gosh it's heartbreaking if a child experiences those traumas you were just mentioning and they're in there really early stages they're developing years and they are on the receiving end of all of those horrible comments or they witness this this event like a divorce and they internalize it and think that it's their fault like what does a child do how do they react how do they respond to those messages do they change who they are a child tries to make sense of this by building a narrative about themselves so that narrative might be that there's just something that's fundamentally wrong or flawed or different about me and that narrative then can cause a reaction so for some it might make them withdraw it might make them want to spend more time with themselves and not with other people because they worry that about what other people are going to say or how other things might play out in future relationships that withdrawal for some people could look like an anxiety so you may see a child you know diagnosed with social anxiety as a result some children withdraw so much that they stop doing things and they stop gaining pleasure in things and that again could could cause issues with their mood and again that could play out as a depression other children especially when going through adolescence and learning about how to regulate emotions can have difficulties with identifying with what's safe and what's not safe and that can very strongly contribute to emotional dysregulation all of that I guess could lead to a child presenting with different mental health issues but also as you get older you start to learn different coping strategies now with ADHD one of the things that we know that people often gravitate to are fast reward fast feedback mechanisms in order to help cope and regulate your emotions what that could involve is it could be alcohol it could be cannabis and it could progress to other substances like cocaine or it might not be drugs at all it could be shopping gaming various things that ultimately could lead to an addiction so these are just different ways that trauma can have an impact on when children I asked Dr Ned Hallowell what ADHD if it's not recognised and managed can turn into and he summarized what you just said it can turn into addiction and compulsive spending and it explains a huge percentage of the prison population do you think if left unchecked and that propensity to seek the low hanging fruit the the quick dopamine can that lead to a dangerous path of crime perhaps for somebody like that so I actually simultaneously worked in the NHS in specialist ADHD service within within our local area and I also worked in a drug and alcohol addiction service at the same time and essentially what I was doing was seeing ADHD presenting into different populations within the addiction service we actually had a specific sub-team called the criminal justice team because of the propensity of crimes that were committed by people within within that service but what you could actually see was that the exposure to traumatic life experiences the combination of not having the resources to be able to support those people through the education system, through the social care system, and inevitably what happened for some of those people is that they experienced an addiction, but without the financial resources to be able to manage the addiction, you end up trying to fund it. So how do you do that when you don't have the skills or resources to have a job that's going to help you? You need to find other ways so you end up in the criminal justice system. Then what happens there doesn't fix the problem. And so when you're out of the criminal justice system, you start looking for a way to cope again. And then there's a cycle that happens between being in trouble with the criminal justice system, the addictions, and it's very difficult to break that cycle. And that's fundamentally what we try to do within our service. So yes, criminality and ADHD definitely have a commonality. And it's sometimes just your life experiences early on that can shape which direction you go. It's such a big motivator for me. Like as some of myself, who's an addict and an alcoholic, like I've been in the hospital wards with tubes hanging out of me, I've been in the back of police cars, I've been down an alleyway with someone calling an ambulance, because I just can't stop drinking. And then I got my diagnosis of ADHD, I got sober. And suddenly I realized that so much of what was holding me back was my not being aware of my addiction and how much ADHD played into that. And with awareness, I was able to manage that challenge, which was my addiction, get that under control. And then afterwards you can really lean into the many strengths that come with being different. And that led onto the podcast and sat here today interviewing incredible people like you. And it's such a passion project of mine. And to hear similar stories of people having that moment where they get a diagnosis and so much makes sense. And they're able to turn their challenges and confusions into strengths out of the patients that you've seen. Yes, do you have any stories of somebody getting a diagnosis and it being totally transformative to their life? I have many stories. So what I'm actually going to tell you about is and I guess this comes from my experience of working with people across the lifespan is I had the pleasure of actually treating three different generations of one family and seeing how ADHD changed things for them. So I'm going to start off with my original patient. So she was a 19 year old young woman who was struggling with transition to university. Again, she did well academically but really struggled with how to navigate everything in her first year. And what became apparent when we actually started to unpick her symptoms and she had a lot of inattentive symptoms that she was masking. Was that at certain age around 15 or 16 she stopped pursuing the things that she was actually good at and pursued the things that she felt she needed to be good at. So there was a lot of masking that was happening around that time. She picked subjects not based on her strengths but again based on a narrative that she was playing. Perhaps there's a bit of people pleasing in there and it progressed into university. So for her, when we made an ADHD diagnosis, what she actually benefited from was understanding herself, understanding where she was masking and through coaching she realised that perhaps actually the choice that she made in terms of the degree wasn't the right one for her and she actually changed her course and thrived in what she did. What was interesting was that during the diagnostic assessment process, so her mum completed an informant questionnaire. And we see this a lot where parent completes the questionnaire and the parent identifies with a lot of the symptoms. Yes. And the child herself said, "My mum has undiagnosed ADHD when I asked about the family history." So mum herself was going through a difficult time so mum was in her 50s and she was experiencing a recurrence of problems that she used to have in her 20s, again in attention based. But more recently she was also having sort of short-term memory problems as well. And when we unpicked things from mum, it wasn't just a case of diagnosing ADHD. It was also recognising that she was going through the menopause and the impact that ADHD and the menopause can have on each other in terms of symptoms. So with mum, what she actually benefited from, I mean she had a choice of what to do but she lived life up until that point without ADHD medication. So she decided to try hormone replacement therapy and it worked wonders for her. But the insight into her diagnosis also helped her too. Usually that's where the story ends but in this case during mum's assessment process, so my original patient's grandma helped mum with the diagnostic assessment and grandma identified with a lot of the symptoms not just of inattention but also of hyperactivity as well. A lot of people in a later stage of life don't necessarily pursue an ADHD assessment even if they know that information. But interestingly grandma was actually already under mental health services. She had a diagnosis of generalised anxiety disorder and she was seeking treatment. She was trying medication after medication nothing was working for her and she also had a small stroke a couple of years ago and was riddled with health anxiety since then. So we went through the assessment process with grandma, we had to get lots of background information in order to confirm the diagnosis. But once I made a diagnosis of ADHD in her case, actually we did talk about starting medication and we started her on ADHD medication but we also thought about the fact that her health anxiety was very understandable in the context of what she was going through. We actually found out that she almost died when she was a small child and that really had an impact on her when she was going into her later life and it brought back those memories and thoughts about death again. So with a combination of ADHD medication and also anxiety at focused therapy she did really well and so I mean this is just an example how even within one family you can approach ADHD in completely different ways and that's actually how to deliver individually tailored support for someone. What a story, what a what a what a fantastic argument as well for some other naysayers who might say that it's not genetic. Do you mind me asking how old the grandmother was? Yeah so grandmother was in her late 70s. Do you think there is I want to get to the age in a bit but just rewinding a tad. Do you think there was a general grieving process that someone goes through when they get an ADHD diagnosis? Oh yes so I have met people who have accessed so much content that's out there for ADHD. I've had conversations with people at the assessment who can tell me so much of the information that you put out through this podcast because they identify with so much of it they identify with having ADHD but when they hear the words from my mouth confirming that they have the diagnosis usually the first reaction is still shock because despite all of the times that they thought that they must have ADHD there was also always that little voice the RST that was saying it you might not yeah it might not be you it might be everyone else but just not you so there is a big shock when people can can get the diagnosis but then what happens is when you let that ride out there's another emotion that comes in and it's relief because once you start realizing that actually all along that narrative that you held that you were flawed that there was something fundamentally wrong with you wasn't actually as true as you thought it to be because there is an explanation you are reacting in a predictable way based on the way that your brain was hardwired you can start to understand yourself in the past but it also gives you a clarity to be able to understand yourself in the present and to look to the future so there is a grieving process but fundamentally at the end of it when it works you come out with more clarity than you had before so interesting and just circling back to the age you said she was in her late 70s that's right do you think the older someone is when they get that ADHD diagnosis is the grieving is that a bigger process the older you are So the older you are, the more likely you are to have lived life by writing your own narrative and your own autobiography. So I guess let's start off with, we are all all the time writing our own autobiography in our heads. And when you're much older, you've already written many of the chapters. So when you get this diagnosis, often one of the first questions you ask yourself is, how am I going to fit this into my book? How am I going to make sense of everything that I've written before, all the conversations that I've had with people in the past about myself? How's it all going to fit together? And with that comes another question, which is, would this book have looked different if I was diagnosed earlier? And that contributes certainly to the grieving process as well. What I would say is that I always ask people this, and it doesn't matter what age you are, but I always ask people to think of three priorities that they have, that they would like to improve as a result of having the diagnosis, because it helps people to narrow it down. I don't think it's helpful to have the ADHD diagnosis and then feel like you've got nowhere to go and reflect back and think, I wish my life was better. You need to have a clear direction of what you want out of this, and that's where we can help. So that often usually helps people to get through. I suppose it's the ultimate twist in the tale, isn't it, if you get a diagnosis in your late 70s, that perhaps nobody saw coming in their story? If you're in your late 70s, is there a chance that that particular woman, that particular grandmother was masking her entire life without knowing about it? Absolutely possible for that to happen. And if we think about what that actually looks like, so, festival, ADHD symptoms, if you don't have another explanation for them, become embedded into what you think is your personality. So when you think about the fact that I'm not able to spend time with other people without having energy for myself, if you don't have ADHD as an explanation, what might you label that as being an introvert? I need that downtime for myself before spending time with other people is what you think you need. What is actually happening is you're rehearsing conversations before you meet them. You're trying to remember all those things that they told you last time so that you don't come across as being inconsiderate when you see them. So many people with old age are masking and they have no idea because they think it's their personality. But then there's a second bit and I think this is almost sort of the ultimate mask is aging. So you go through many stages in life and you try and find different ways to rationalize your symptoms. But then all of a sudden, as you get to a certain age, you can actually justify what your executive dysfunction problems by talking about the fact that you're getting older and society accepts that as well. So I meet a lot of old people who what they tell me is that they're going through aging and they tell me that this is all something that's new. But when you actually hear the story, the problems have been there all along, it's just got a new name for it now. My sincerest apologies for interrupting your hyper focus, but a quick word from our sponsor. Like many in the new year, we want to turn over a new leaf, looking to be more productive, more organised and never late. Well, Timo app is here to help. Timo wasn't named app of the year in 2025 for no reason. It's the ultimate planning partner gently guiding you towards busting your day-to-day chores list. The important difference is Timo is designed by neurodivergent brains for neurodivergent brains and you can tell it's built to adapt to your neurodivergent way of thinking and be flexible to your way of planning. And now it's even more simple with the AI planning assistant. Timo offers an incredible new voice transcribing service, making it even easier to use. It's almost so simple that it feels like a cheat code to play life on easy mode. Give it a go and use the link in my bio for 30% off. Just a note though, this code is only applicable on the web browser, not the smartphone, back to the episode. At that age, yes. In your perhaps late 70s, is there a, perhaps a degree of not wanting to unmask? And a sort of mindset, well, I've got to late 70s, I've coped up until now, what's the point of making changes now? Or do you see people at that age wanting to make changes to accept their true self after all of those years? If you're seeing a psychiatrist at that age, it's probably because you've got to a stage where you're experiencing some level of distress about something. And I'm going to give you an example here just to help with painting this picture. So I had a gentleman in his early 80s who was due to see me for an assessment. And he actually wrote into the clinic to ask if the appointment could be moved forward. And the reason for that is that he said that I'm not sure if I have time, you know, I'm going to be alive and around for the assessment. And he'd just been given a diagnosis of a life-limiting cancer. And he'd always considered the possibility of neurodivergence. But once he had the cancer diagnosis, he was worried that he might not ever find out whether this could explain things for him. And actually, what's interesting as this goes on is that he'd actually been doing really successfully, but there was one bit of his life that he didn't understand. And this is what happens in later life. You start to reflect and you start to want to understand that every bit of your life. So we I saw him earlier and we did his assessment and he came with his daughter who gave us lots of useful information. But what transpired was that this was a man who struggled through much of his childhood with inattentive symptoms and also hyperactivity symptoms called a naughty boy. Punishments looked a bit different back then to what they are now. So he was punished a lot at school. He then went into a corporate role and really struggled with managing the administrative parts of that role. There was a lot of masking going on in his job that he didn't realise. And he then got to a stage where he couldn't cope with the demands of family life and his role. So he was married, he had a daughter and he came back every day with no energy for the rest of the day. Eventually he started to use alcohol as a way to cope. And at one point when his daughter was aged eight, his wife cited his lack of interest in the relationship, his lack of interest in parenting and his alcohol use as a reason why she was separating from him. That was the first chapter in his life. The second chapter of his life, he started to turn things around. He became sober, he moved out of the corporate world and he became a decorator. He ran his own business, he did something he loved and he had a team and he continued with that career for decades and decades and he only retired in his late 70s. Why did this man come and see me? Because the narrative he told himself was that I went through a difficult time, I made a mistake and I turned things around by starting my own business and getting more freedom and developing life in a different way. That's what he told himself but it didn't explain everything for him. What he struggled with was the fact that he was now isolated, couldn't understand why things got so bad and he'd lost, he'd become estranged from a lot of his friends and family. When we unpicked it and he realized how much of his first part of his life he had masked and how he had built his second half of his life around his ADHD symptoms inadvertently, it all started to make sense for him. But then what came was I guess what do you do next in that scenario and for him what was really important is first of all he needed to forgive himself so he felt really guilty about the fact that his daughter had parents who'd separated when she was younger because he'd been through the same thing and he'd repeated the cycle for his daughter. He needed to forgive himself about that. The next thing is that he needed to make contact with the people, the friends and family that were still living that he'd lost contact with in order to explain to them and apologise to them for how he had been and what he His daughter said to us, after all of this is before his passing, this was one of the most impactful things that he did in his life before he died. So yes, there are some people who actually are happy to go through life where they can mask and continue into old age, but there can be that niggling feeling that I'm not content with life, and that can cause people to come and pursue an assessment at such a late stage like this. Such a powerful story. Yes, thank you so much for sharing that. So he struggled in his early years, he made changes, he took a path that was better suited to him. If you suspect like he did, that you have some kind of neurodivergence in your life, at that stage to get that confirmation, had he already done some processing and accepted it and therefore at that stage, is it more a case of it being some kind of closure? It's difficult to come to that understanding yourself, I think, when you have multiple competing factors that are there as well. So during the time when he was using alcohol, he was also experiencing depression. And I think this is a particularly big challenge with ADHD and the comorbidity, is you start to question, was it that I was depressed and is that why everything was happening at the time or was it the ADHD? And actually, on its own, on your own narrative, sometimes it is difficult for you to be able to make that distinction. So one of the things that actually helped is yes, he did identify with neurodivergence from things that he'd read, but he couldn't want his own, join up all the dots because of all the different things that were going on in his life. The assessment process itself allowed us to bring together different people that knew him at different stages of his life and collate and combine all that information in order to build this narrative about him. Once we've done that, yes, absolutely, it started to make sense to him even before I'd confirm the diagnosis, but sometimes you do need to go through that process of getting all that information, a bit of detective work to help people with this. Yeah, whenever I meet someone who's dedicated so much of their career towards a particular topic, in this case, neurodiversity, I always wonder where their passion comes from. So what is your mission? Right. So I'm going to go a bit deep with this, Alex, if that's okay. I grew up with a parent who had a severe mental illness and has had so for all of my life. And that person, my mother, is also who made me who I am today. So from seeing her, what I learnt was that it's possible to both suffer and thrive at the same time. But to be able to lean into your thrive state, you need to be able to be seen for you, to hold you beyond any diagnoses, beyond any labels, beyond all of that. And this links into, I guess, how I entered the ADHD space really, because when I was working within mental health and seeing people with the full range of mental health conditions, it was only after I started to work in specialist ADHD services that I realised that there was a complete dimension and foundation that we were missing with some of the people that were struggling to respond to treatments. I realised that we were trying to create all these different software updates when we didn't even know what operating system we were dealing with. And this links in to my mission now. So first of all, I want to reduce the anxiety that people can have around seeking an ADHD assessment. There are going to be people listening to this podcast today who are terrified about having an assessment. And the reason that they're terrified is because they're worried that what happens if I get a diagnosis, but it doesn't actually help explain me, it doesn't join the dots up for me. Or I get a diagnosis and I get pigeonholed into starting medication that may not work for me. What do I do then? And for all those people, I want you to know that there are clinicians who will see you for you, who will see you beyond all of that, see both your strengths and your challenges and can help you through that. And tied in with this is my second mission, which is to challenge the notion that there is a one-size-fits-all approach to treating ADHD. There are going to be people who have questions like, am I too old to have medication for ADHD? If I treat my ADHD with the anxiety, go away. And I want those people to be one better informed at having conversations about what's going to work for them, but also to appreciate how individual those decisions are. In the era of information, it's really easy to be both heard and feel so lonely and isolated at the same time. It's really easy to hear a story and think, that's me and question whether any of the advice linked to it should be applied in your own life. And I want those people to know that there is support and there are ways to help you. Yeah, just circling back to the grandmother you mentioned earlier, because I know 85% of the people who listen and watch this podcast are women. Do you think generally women get diagnosed later in life? And if so, why? There is really good data on this. So, historically, it has always been the case that boys are more likely to get diagnosed than girls during childhood. And it's only at a later stage in life where the gender gap narrows. So, if we look back 10 years ago, so 10 years ago, five times as many boys were diagnosed with ADHD compared to girls, and that gap would narrow over time. Now, what's happened is, and the most recent data, so this is publicly available data for the 2024 to 2025 year, is that at every age group, we're getting better at being able to diagnose ADHD in girls and women, which is great, but the gender gap still exists with age. So, for the zero to 18 age group, for every two boys, there is one girl that gets diagnosed with ADHD. That gap sort of narrows, you know, as you get older, up until around 34 to 44, where it's around one and a half boys to one girl, 45 plus, it's almost even, and really interestingly, at 65 plus, if you look at the total number of ADHD diagnoses, more women are being diagnosed than men at that age group in that last year. So, why is this the case? So, overall, I'd say it's probably because we have actually, I mean, I've got to be direct about this. So, let's look at the diagnostic stage here. So, at the diagnostic stage, we're looking in childhood for very clear symptoms of an impairment in school and the home environment or other environments, with hyperactivity or inattention. Who's most likely to get picked up at that stage? It's more likely to be hyperactive boys, and why is that the case? Well, first of all, let's look at inattention in girls. So, girls are more likely to develop emotional maturity and make efforts to conform to social norms during their childhood. So, that invites itself for masking to start taking place. So, here, I'm talking about the girls who may struggle with being able to complete their work with making mistakes all the time, but then going through it, three or four times before they ever submit it, so no one ever finds them out. The girls who sit through lessons and have no idea about what the teacher has actually gone through in terms of material, but then over-prepare for subsequent lessons by studying at home. In these situations, it's really difficult for these girls to get a diagnosis of ADHD because they've masked so well. But then, if we progress things, there's an opportunity, not only for us to miss the diagnosis, but there's an opportunity to miss diagnosed ADHD. Now, there is a significant overlap between ADHD symptoms, particularly emotional dysregulation and a'r RSD, a'r other conditions, a'r bi pole diwythau, a'r bi pole diwythau, a'r sy'n ysbytru'n gwybod ymwyr, a'r ysbytru'n gwybod ymwyr, a'r ysbytru'n gwybod ymwyr, a'r sy'n gwybod ymwyr, a'r bi'r ysbytru'n gwybod ymwyr, a'r bi'r ysbytru'n gwybod ymwyr, a'r bi'r ysbytru'n gwybod ymwyr, a'r sy'n gwybod ymwyr, a'r bi'r ysbytru'n gwybod ymwyr, a'r bi'r ysbytru'n gwybod ymwyr, a'r bi'r ysbytru'n wneud beth Ras絵'u componer, avait na much teap erhoed else mawedd rhesan hun ddys ymlargydil hab… a'i diwr, ' SMOOTH BACHER' gera fel yma'u bod na'r mewn ' SMOOTH BACHER' a sleeperatuw' robeil barydd yn bithio bwysydd incentive er pharwhon gerran a pan i'r Women Rha Interviewer a'r ymg i'r ysgol oedd yn ddys ymg ymg i'r gwybod yn ddys ymg oeddwn yn ffyrdd yn'r gwybod ymg a'r gwybod yn ddys ymg a'r aewodol ymg ac ymg i'r gwybod yn ddys ymg a'r gwybod yn ddys ymg a'r gwybod yn ddys ymg a'r gwybod yn ddys ymg a'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg aewodol ymg aewodol ymg aewodol ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg aewodol ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg i'r gwybod yn ddys ymg H魔begeg enλλen nhw. Mast y cyhu'r hau hyrgu gweld yn per knocking. Hernau â Tao'n�nu allwydd唨иadau du anわかro expectio. Ten septau a'r pwya fy humnu an Industry, ac yta angen unig unig bethethol a hynny ef e intellectuti. I am vitaliadau hwnnw, i'r prwyste i'r pan y ffordd o'r atiadol o'r atiadol oeddyddu gynny. I am vitaliadau hwnnw i'r atiadol i'r atiadol oeddyddu. I am vitaliadau hwnnw i'r atiadol oeddyddu. A'r atiadol oeddyddu, a'r atiadol bod yn dynnau awr. Gydol yna, ac ni'n ffydwch. A'r atiadol oeddyddu. A'r atiadol oeddyddu, ac ni'n ffydwch. I want the lizards and lizards of this podcast to be able to walk away from this knowing that there are clinicians who can help you with being seen for the whole you so that you can get an individualised plan that best fits your life and helps you to move forward. Ieith am yw'n gweld. Thank you so much, Yath, and speaking of the listeners, we do have three very interesting questions from the listeners for you, which I'm going to ask you, and they're inside the washing machine of woes. And it's called the washing machine of woes, because they're woes from the audience, and in the washing machine, because for me it represents memory loss, because I always forget my clothes in the machine. So I do ask all my guests. Do you relate to that memory loss? Do you leave your clothes in the machine after the cycle's finished? Oh, Alex, so first of all, I have to have a timer on my phone, and if I forget to put the timer, then those clothes could stay there for days. Yes, so yeah. I don't really relate to that. That's good. I've not the only one now, which is very, very good. I do rely on the Timo app, which does help me actually, but the smell of mold, the smell of damp is getting less frequent, but we're still there a little bit. The first question, yeah, somebody has asked, does ADHD cause a lot of distress in the people that you treat? And why is this? So with ADHD, you have the double whammy of the fact that life can be more difficult for you from a young age because of the fact that you were dealing with ADHD symptoms. But at the same time, you have all the criticisms that you have throughout your life because of the fact that you have ADHD symptoms. And I'd say there's a third segment to this now as well, which is that you're constantly trying to address this and trying to learn strategies while society might be challenging the diagnosis and challenging you. And so for all those reasons, it can be very distressing. Do you see an increase in distress amongst your female patients over your male patients? So with female patients, what I see is the combination and the complication of how all of the things that I just mentioned can affect emotional dysregulation, how they can interact with the menstrual cycles and menopause, as we talked about as well. But also the fact that it's difficult for some of our female patients to get the right type of individualized support that they need to be able to handle all of that complexity and all of that absolutely causes more distress for them. Very useful. Thank you very much. Yeah. And secondly, on to the next question, what exactly do you try to figure out during an ADHD assessment and what is the threshold to be diagnosed? Okay. So ultimately, what we're trying to do with an ADHD assessment is to identify a pattern of symptoms that have existed from your childhood, persisted into your adult life, which are to do with how you regulate yourself. It could be to do with inattention, to do with your activity levels, or I guess in the case of autism as well, to do with structure and routine and how that influences regulation. What we're looking at is to see how that affects you across multiple settings, and we're looking for impairment. And this is where there is a subjective element here, because on a superficial level, impairment can be quite obvious for some people. But not for others. If you're very good at masking, you can go through a lot of domains without actually showing an impairment, and a typical one would be, oh, I was academically really good at school. Yes, it's possible to do really well at school academically, but be masking at the same time. So we look for that as well. And I think that this is where this subjectivity element probably gets questioned a little bit. And I get asked more frequently than I expect by people about, isn't it just that we all have a bit of ADHD in us, and aren't we all a bit on the spectrum? Well, first of all, if you go through the process of an ADHD assessment, you find out that actually not all of us are all on the spectrum. Some of these challenges completely don't make sense to someone who's neurotypical. Yes, you might identify with an individual symptom, but not with the whole constellation of issues. But the second thing is about predictability. So if we try to conceptualize ADHD for most of the population, it doesn't help us to predict or understand them. It doesn't at all. And that's why it's really important to go through the assessment process and to identify these things. You mentioned something earlier, you said that sometimes ADHD can look similar or perhaps sometimes get misdiagnosed as BPD, borderline personality disorder. So I suppose when someone comes into your clinic, how can you tell the difference between ADHD and BPD? The overlap is very significant. And I've got to say that this is probably the conversation of the debate between these two diagnoses as well. There are many psychiatrists who would argue that we should be screening for ADHD and anyone diagnosed with borderline personality disorder. Often what we can look at is with ADHD, the microtromas that we experienced in our childhood can contribute to emotional dysregulation and to RSD. And they can sort of feed into that. With borderline personality disorder, you might find that there are specific individual traumas that can be a very significant driving force behind a lot of the symptoms within borderline personality disorder. So some of them may experience symptoms like flashbacks, nightmares, re-experiencing of a select few childhood traumas. And what that means is that ultimately some people with BPD will require a trauma-focused approach in order to help them with dealing with those individual traumas. But this is where it gets particularly complicated because there can be people who have ADHD but are also exposed to all of these individual traumas that are so painful that they have a trauma response to them as well. And that complexity might mean that you're handling both ADHD and borderline personality disorder and you need two approaches for both. So yeah, that's it in a nutshell. So interesting. This section of the show is slowly becoming the most unpredictable part of the show. I never know when I'm going to put out of the washing machine. But this is such nice bite-sized bits of information. So thanks so much, Ethan. Finally, the last question from the washing machine which ties in nicely to what we've been speaking about. Someone asked, "I'm 73. Do you think it's too late for me to get a diagnosis of ADHD?" It's absolutely not too late for you to have a diagnosis. And let me talk to you about some practical things to help you with that pathway. So first of all, if you are having an ADHD diagnosis, it's helpful for us to get as much information as possible about your background. So I know that might not be easy, but if there are people that knew you across different life stages, it's useful that you do involve them in the process because they can help with building up a picture about you. But don't worry if you don't have that information. The next thing is, if you are going through a particularly difficult time at the moment, let's say fatigue is really getting to you, you're exhausted, then it can be helpful to make sure that some of those basic things with your health are checked out, make sure that you've seen your GP recently, you had blood tests because it's useful to rule out some reversible things that are very quick to change before you go through the ADHD diagnostic process. But I hope from listening to me, you know that you definitely can and will be seen for this age. Dr. Yath, thank you so much on behalf of all of the people that have written in questions for this week's episode. I just wanted before we finish delivered to you a letter that was written by the previous guest where they wrote a letter to their younger self. There we go. Cool. All right, better handwriting than mine. So, to my younger self, you don't have to be quiet and well behaved all the time. You are allowed to share different ideas and be silly. If you start different clubs and interests, you get excited and you give up. You are not irresponsible and immature. Your brain is just working in that way. Feel good about yourself and keep going. Incredible. You did. What a lovely tone to finish on to. Dr. Yath on behalf of everyone listening, trying to grapple and understand their brains and the many complexities that come with it. Thank you so much. [BLANK_AUDIO]