Episode Transcript
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(00:08):
(Transcribed by TurboScribe.ai. Go Unlimited to remove this message.) Hi, welcome to the Abundant Practice Podcast.
I'm Allison from Abundance Practice Building.
I have a nearly diagnosable obsession with helping
therapists build sustainable, joy-filled private practices, just
like I've done for tens of thousands of
therapists across the world.
I'm excited to help you too.
If you want to fill your practice with
ideal clients, we have loads of free resources
(00:29):
and paid support.
Go to abundancepracticebuilding.com slash links.
All right, on to the show.
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(01:58):
Welcome back to the abundant practice podcast.
I'm your host, Alison Pereira.
I am here with Jen Dahl and we
are going to be talking about ADHD and
women, how it gets missed, what we need
to be looking for, all of it.
Thank you so much for being here.
I appreciate it.
Thank you for having me on.
I'm so excited to meet you and talk
to your people and just talk about this
topic.
Yeah, yeah.
(02:19):
Can we start with maybe origin story of
like, why is this important to you?
Why is this an area of focus?
Why is this an area of focus?
Well, my origin story is as a Gen
Xer.
I did not know until fairly recently.
I feel like I should have known I
was in education for 25 years.
A lot of it in special education, teacher,
(02:41):
coordinator.
I have a doctorate in educational psychology.
I should have connected the dots.
I think there was a point I started
connecting the dots, but you know, as you
know, what people think about is ADHD is
like the eight year old boy who's just
all over the place.
And I would say things to people sometimes
who should know, like, do you think, no,
(03:02):
you, you have a doctorate, you have a
master's degree.
You, you do all this things, you hold
yourself together.
No way.
And I'm like, okay, okay.
But then I would just still keep thinking.
And the more I learned, the more I
learned.
And then I think what really started to
happen was when I started, I had mostly
boys back then.
(03:22):
And over time, I'd got more and more
girls in my classes.
And I started to not relate to them,
but see myself in them in certain ways,
like some of their behaviors.
And I would think, oh, that's me in
middle school, you know?
And so I just, I just kept thinking
that way.
And then, you know, the pandemic hit and
(03:43):
we all went home and we all had
a lot of time at home and more
and more information kept coming out.
And I started bringing it up more and
more.
And finally, I was at a psychiatrist and
we, we went through it and yeah.
And I, by that point, I already knew.
And I think the main reason I was
really pushing it with them was trying to
(04:03):
decide if perhaps medication was something that I
wanted or just being able to look at
it in a more authentic way.
So that is basically it just over time,
learning, learning more, seeing myself meeting other people
who are realizing that they have ADHD and
how much we have in common.
I love teaching because I wanted to really
(04:26):
work with people outside of the school district.
I'd be able to create and do my
own things without, without all the policies and
with, with, you know, all that stuff that's
going on.
Yeah, absolutely.
Yeah.
It's interesting.
So I was having a conversation about ADHD
actually earlier today.
And as a fellow Gen Xer, I said
exactly what you said of like, when I
(04:47):
was coming up, like in grad school, when
we talked about ADHD, it was always like
a rambunctious eight-year-old boy.
Yeah, always.
And I think about like, some context is
I have a tween, one of my daughters
has ADHD, very severe ADHD.
And also seeing the difference, not just between
like typical presentation of boy versus her, but
(05:10):
also developmentally how it shifts and morphs and
changes as she gets older, yet toss some
hormones on top.
And like, we see what happens.
And it's, I think about all the friends
I have who are late diagnosed, clients I've
had who were late diagnosed and how developmentally
it's shifted and changed and how it shows
up now, you know, amongst some of my
(05:32):
peers with kids.
And like, I can't juggle their schedule and
my schedule and like my executive functioning can't
stretch that far.
Like it's stretched far enough for me to
do school or do work and all those
kinds of things.
But like I hit a limit.
Definitely.
Definitely.
I know what you're saying.
And I know a lot of people end
up really finding out when their own kids
(05:53):
become referred or somebody starts talking about it
with them because there's that whole component.
And back when we were young, you know,
it was just personality things.
So you're this, you're that.
And you're so smart.
So why do you do this sometimes?
And so it was never really looked at.
And I think that that's one thing for
especially women, but even men who are finding
(06:16):
out later, having to relook at those stories,
relook at what you've been told, what you
told yourself, all that stuff you've internalized.
And I know a lot of times, and
I can speak for this.
You may have been misdiagnosed with depression or
anxiety or something else because you show up
and you know, your emotional regulation is hard,
difficult, and you're tired because masking and doing
(06:38):
all this stuff is very hard.
Um, oh, well you must be depressed.
So here have some, have some antidepressants, which
all another thing.
Yeah.
It's interesting.
I've been an eating disorder therapist for 20
years.
So I also look back and I'm like,
how much did I miss?
Like how many of my clients who were
(06:59):
perfectionistic and like basically spending all of their,
I think about that internal ADHD, right?
Like they were spending all of that energy
doing things that they needed to do to
be as perfect as possible.
Yeah.
That couldn't succeed all the time.
And like how much of that might've been
wrapped up with ADHD and I missed it
or my clients with binge eating disorder and
(07:21):
the co-occurrence of binge eating disorder and
ADHD is something that like, I had no
idea about for most of my career because
you know, ADHD was for eight year old
boys.
And so it's astounding.
Eating disorders were different.
Like, oh, that, you know, the way everybody,
doctors, parents, everyone really.
Yeah.
Yeah.
(07:42):
That's, that's actually so interesting.
Cause I hadn't, it makes complete sense, but
it was not something the penny just dropped
for me.
I mean, I know it's a binge eating
and that's the thing, but like really looking
at, wow, women with eating disorders and ADHD,
cause just the control and the masking.
And I know that I think I did
(08:04):
well when I taught, especially I taught a
lot of English and so I could be
creative said I taught high school mostly.
So he's like, you had bells.
This is your snack.
Yep.
This is your prep period.
These are the days you work.
This is when grades are due.
And when I left, there were other things
going on.
(08:25):
It was post pandemic.
My husband had died, all these things, but
like, wow, it has taken me time to
figure out how to run a day.
Yeah.
Yeah.
Because we all need structure, whether we have
ADHD or not, but especially if we have
ADHD and when it's formed for you, it's
much easier to follow.
And then if you don't like it, you
(08:45):
don't like it has nothing to do with
you.
Exactly.
There's the bell or yes, we go back
on August 10th or whatever we do.
Grades are due this day.
That's just simply the way it is.
And, and I think people who don't struggle
with it, don't know how hard it is.
Yeah.
Just do it.
So, yeah.
Yeah.
And I fall into that category.
(09:05):
I think I fell into that for a
really long time as somebody who like, if
I have something on my to-do list,
I just do it and it's easy for
me in a way that I thought was
just normal for me, not easy for me,
but having an ADHD daughter and other people
in my family with ADHD, I'm like, oh
no, cause I know them and they're not
like willfully not doing, they're not avoiding just
to be an asshole, you know, like they
(09:27):
just, they can't do it right now.
How many times are you told?
I mean, yeah, yeah.
And so it's the, uh, the stigma that
goes along with the symptoms of ADHD, like
each of the symptoms from the impulse control
to the executive functioning struggles to the emotion
regulation problems.
(09:47):
Like it's, it's easy to fall into this
trap of believing that it's like some moral
failing in some way, because that's what our
culture has told us forever.
Yeah.
And you should be able to do it
all yourself.
Yeah.
You know, now a widow, there's, there's so
many things that just other people did.
Right.
So finally I hired a house cleaner.
(10:09):
I live alone, but you know what?
I had to do that.
Yeah.
It's done.
I've hired somebody to help with certain things
and getting past that, oh, you should be
able to do everything yourself.
Just schedule it to death and do it.
And I'm, I'm in a workspace.
I'm in a little office and a coworking
space.
And I finally started going there and I
have finally come to accept it and love
(10:30):
it because yes, lots of people who are
entrepreneurs, oh, I can work at home.
I can't work at home.
Yeah.
I don't get it done.
And also having the boundaries.
So like for the most part, I leave
my work set here.
This is work.
My brand says work.
And when I leave, but that's taken a
long time to get to.
(10:53):
Absolutely.
Yeah.
And I think about how a lot of
people with ADHD resist routine.
Yes.
And like, there's such a, like, please don't
make me do that routine thing.
And it is the thing that tends to
free them the most.
It just doesn't sound like it will.
So a friend was reading, they'd seen something,
(11:13):
somehow they have been getting ADHD stuff probably
because of me.
And it was, don't tell me what to
do, but please tell me what to do.
Yeah.
Yeah, totally.
I didn't need a deadline, but it has
to be a real deadline.
Cause I know if it's a BS deadline,
I know if it's like, if this is
the deadline it's done and it's there and
it's good.
(11:34):
Yeah.
It's interesting too.
I've been paying attention recently to how many
women in perimenopause and menopause are being diagnosed
with ADHD for the first time.
And like, as our hormones shift, we can't
mask and fake it in the same way
that we might've been able to.
Cause we hit that, like, I don't give
a shit button that is so valuable.
(11:55):
And I love so much.
But like, there's an uptick in diagnoses amongst,
you know, us Gen Xers that I think
goes beyond, like, it just got missed.
It's like, with these hormone shifts, we're just
not able to function the way we were
before.
The more information that's there now.
Yeah.
Oh yeah.
Our moms, was it there?
(12:15):
No, they were probably self-medicating on whatever,
you know?
So it takes so long for research to
come out.
You know that, like you have to do
the studies, do the studies, get it peer
reviewed, get it published, get people to read
it, get it out.
It takes so long.
And so there's this chunk of us who
are just going through this.
And even women who knew, like maybe they
had heard before their twenties or in school,
(12:37):
Oh, you have ADHD, but I don't think
anybody really knew what that meant.
Nobody was really looking at it and looking
at it, what it means for you and
how to, how to work with yours and
your life.
Yeah.
So if we're coming at this from like,
how do we as therapists improve our diagnostic
accuracy?
Like what can we be looking for, screening
(12:58):
for, assessing to make sure we're not missing
women?
So the diagnostic part of that, that is
me, you know, that, you know, the DSM
and a lot of the things that are
out there, I would think, look at it
through a lens, right?
They were created a certain way by a
(13:19):
certain group of people for a certain group
of people.
I think it's probably gotten better, but so
much of it, right.
It was created by men based on studies
on men and boys.
I would really listen to your clients and
see what their story is and see what
they're really saying their whole history, because, you
know, this didn't, they may just be finding
out about it or realizing it, but it's
(13:39):
been their whole life.
So what are those stories they're telling about
things that people said to them, ways that
they felt about things, things that they struggled
with.
You know, there's the whole interest based hyper
-focused where they were really good at something
and they would just deep dive into it.
And like we were talking about, you're not
being defiant, you're not being a jerk, but
like these other things you just can't do.
(14:01):
And people don't understand that.
That's all about, you know, the the emotional
dysregulation, getting really upset about certain things that
other people don't know why you're so upset
about or why it's just such an intense
kick in the heart or the gut.
And so looking at those things, and I,
and I think that the more we can
(14:22):
develop other tools, I've told this story several
times.
I hope the friend doesn't mind, but she
has ADHD, but she was also going through
some testing for autism because there's a huge,
we're finding this huge overlap.
And they had asked me to, as a
friend, as a good friend to fill out
one of those surveys.
It brought me back to the days when
I was teaching.
And so many of the questions, I just
(14:44):
didn't feel were appropriate.
Like the things they were asking, you know,
first of all, it's often in that range,
like never to always ADHD, hate things like
that, because it depends.
But I told her like, you're an adult,
you're Gen X, you've had jobs, you've had
kids, you're married, you mask.
So some of these questions, like, do you
(15:06):
remember to bathe?
Like, I mean, maybe for a young kid,
that's a more appropriate question, looking at those
kinds of things, but she knows how to
mask, she knows how to do it.
Right.
And so I think that they aren't looking
at other details, things that aren't as obvious,
right?
If, if a lot of it's up here,
(15:27):
if a lot of it's hyperactive in your
mind, you're thinking that kind of stuff that
doesn't come out.
We can know how to game the system.
We can know how to show up at
an intake mask and not show it.
You know, you, you go in and you
get these surveys to fill out even for
yourself.
And it's just like, well, it depends what
mood I'm in that day.
(15:48):
Left, it depends if I ate, depends how
comfortable I feel.
Yeah.
And as the parents of a kid with
ADHD, when filling out those forms, it's like,
how aggravating has today been?
Because if it's been a really aggravating day
of trying to like get her on task
and get out the door and all those
kinds of things, and everything's going to be
elevated versus if it just happened to be
a smoother day, like I provided.
(16:11):
Have you had to fight your doctors?
Have you been told you're wrong?
You know, what are the implications of going
there and being there and either hearing yes
or no, you know, that's part of it
too.
Yeah.
Yeah.
I mean, I've seen things where, you know,
just put two people with ADHD in a
room together and you'll figure it out.
(16:31):
Yeah.
Like when I started taking my puppy to
this, this daycare thing, the first step they
do is they put him in a room
with another dog, just see how those two
went.
Like it was like, put, put this person
in a room with somebody else with ADHD.
Yeah.
How the conversation goes and see what happens.
And you know, that kind of thing.
I think listening, listening to their stories, how
(16:54):
they do things, how they think about things,
things that have happened to them.
Yeah.
And then, you know, getting diagnosed officially can
be kind of a privilege too.
It can be very hard to find doctors.
It can be depends on your insurance, how
much you end up to pay, where you
go from that.
Are they going to push beds on you?
Is that what you want?
Is that what you don't want?
(17:15):
Are you not sure?
Because if you're going in and you're confused
and you're just looking for some help, it's
really easy to say, okay, you know, give
me the pills and we'll go from there.
But I mean, that's true for so many
things, you know?
Right.
Right.
Your point about like the assessment, the assessment
is not just the questions, right?
(17:37):
It's the listening.
Right.
They want to know, oh, well, when you
were in elementary school, what did your records
say?
We're jacks.
They don't even, they're in some basement that
probably got flooded, you know, and know that
they probably say, oh, she was too quiet
or she talked to her friends too much,
she didn't stop passing notes or, you know,
she gets silly or.
Right.
And the expectations were different then too.
(17:59):
Right.
Like I remember my report card said a
few times, like talks too much in class
when like, I was not, I was a
rule follower.
I was not trying to like break the
rules and chat with my friends, but like
probably asking for a pencil got me written.
Talks too much in class.
Um, because it was still more of a
scene and not heard by somebody said something
(18:21):
that made you think, and then you just
had to like, right.
Somebody, which comes across as rude to some
people.
Right.
Right.
Yeah.
And I think like I was talking to
somebody else about ADHD, the same person I
was mentioning earlier, and she, um, she was
saying, like, there's a question that's often on
these assessments of, is it hard to get
(18:44):
to appointments on time?
And for a lot of women, it's like,
well, no, I mean, I always get to
appointments pretty much on time, but they had
to set eight alarms to do it or
really early.
Like, yeah.
Yeah.
You can't be late, but really realizing that
figuring out that actual time is hard.
So getting really early.
(19:06):
Right.
Oh, I brought a book.
Okay.
Right.
And so they may say like, no, it's
not hard because I got there, but it
took considerably more effort than it would take
for somebody who's neurotypical and remembering things.
You know, I put something away, you know,
you've got the doom boxes and stuff.
I put something away.
It is gone.
(19:28):
But then if I have everything I need
to remember out, it's a mess.
Yeah.
Well, I think you mentioned earlier about like
being misdiagnosed or maybe the ADHD diagnosis being
missed amongst anxiety, depression, these kinds of things,
which I mean, I've personally think anxiety, having
(19:49):
anxiety and depression makes sense.
If you have been trying so hard to
function in a world that is not set
up for you and you think it's your
fault.
Yeah.
But you just have anxiety and depression of
hell.
Right.
Or like, let's just keep doing therapy, but
you're still going to feel like shit about
yourself because you still can't keep up, so
(20:10):
to speak.
Yeah.
And because your therapist doesn't know, just like
your doctor doesn't really know.
Right.
They know very, very little unless they've gone
out to learn about it or experienced it.
And so it sounds like you self-advocated,
like you self-diagnosed essentially and came into
a mental health professional and said, here's everything
going on.
(20:30):
Yeah.
And I talked about it for a while.
And part of it was, first of all,
I don't think these antidepressants are right for
me and I don't think they're helping.
And I don't think we looked at the
right thing.
And so this whole process of what's really
going on, wanting, you know, just being tired
of all of that.
And then my husband died suddenly and I
(20:51):
have since found a great therapist and she
knows so much about grief and trauma, but
there are so many times where I'm actually
teaching her about ADHD or she'll say something
and be like, okay, so that might work
for some other clients.
But let's just be honest, this isn't going
to work or this isn't how I think.
I know what I'm doing.
I mean, I have, I have a master's
in school counseling.
I know this stuff, but I'm telling you
(21:13):
that from my lens, this is something else
you should know and think about.
And so I think about somebody in the
same position that doesn't have your background and
doesn't have your assertiveness skills and how in
that same, yeah.
And great therapist and, you know, but feeling
like, okay, now I'm feeling it therapy because
I'm not able to do this stupid homework
(21:35):
assignment that I'm supposed to do or whatever,
you know, and how as therapists, we need
to be really mindful of like, are there
certain tasks or homework assignments or ways of
processing or thinking about a thing that we
are asking people to do?
And the same person is having like a
thematic issue with getting some of it done,
(21:55):
in which case that could be a great
red flag for you.
Maybe this is a neurodivergence of some sort
or ADHD or something, you know?
Yeah.
I would think trying to be really open
and honest and listening and asking in a
non-critical way, what is holding you back
from doing this?
Not like, why didn't you do it?
(22:15):
Like what's the problem?
Like, but trying to be like that and
getting to the relationship where they accept that
and they're like, okay, I hear that you
care and you're really asking, and I may
not know, but let's talk about it because,
you know, you've built up all these walls,
like, oh, I'm just stupid or I'm just
lazy.
So taking that time to, okay, so what
really, is it too many steps?
(22:37):
I mean, a lot of the times, something
that neurotypical sync is easy to do.
Like we talk about the laundry, oh, just
do the laundry.
But when you think about it, there's a
lot of steps to do in the laundry
that you've got to plan and do and
remember and keep, got that interest-based thing,
keep interested in from getting it from the
dirty clothes to put away.
(22:58):
And it's a lot.
It's a lot.
So what are the steps, like you could
ask a client, if this is the task,
whether it's a homework assignment for English, or
it's something for your job or something you're
trying to do for your family, yourself, what
are the steps?
And even having, you know, listed that out
at task analysis and seeing what's missing and
where they get lost in there.
(23:20):
Cause maybe they're jumping from A to F
and that's where they get hung up because
then none of this was accounted for.
Or then you just see that this project
has 200 steps and we need to, we
need to move it back.
Like we need a smaller task, a smaller
goal, a smaller project first.
(23:40):
And just a little win.
Cause that's something that I really like is
just settle shifts, little wins just to make
this a little bit better.
And then just went a little bit better
because we can, we can dive in like,
yes, I have a doctorate and, but that's
very directed, you know, it's like, it is
step-by-step.
Whereas I'm trying to write a book, much
(24:05):
more out there, you know?
And so that kind of thing kind of
went off on a tangent, I think.
No, that's good.
That's all good.
It's all relevant.
Right.
Yeah.
I was in an interview with somebody, I'm
going to start doing some webinars, teaching through
some entrepreneurs and HR and stuff like that.
And the person, she's don't, don't take this
(24:26):
the wrong way, I can tell you have
ADHD.
Yes.
And I promise I can also show up
and I can pull it together and be
very, very pulled together.
Yeah.
Cause you've done it your whole life.
You've had to, right?
And I think that's the interesting piece is
like there's masking and there's figuring out what
works for you to get shit done.
(24:47):
Yeah.
And whether that's accommodations or alterations or however
you need to make it happen.
There's clearly a lot of work you did
in your schooling at all different points to
make things happen.
So while it's directed, it doesn't mean you
always wanted to do what they said to
do.
It wasn't great.
I know I was barely interested in a
(25:09):
lot.
There was very little that I was interested
in, in some of my grad school classes.
Yeah.
It took a lot for me to make
myself do it and I don't have ADHD.
So there's some way that you accommodated that
on your own through probably a lot of
hard wine and error and just white knuckling
it through.
Yeah.
And I think that's some of the beauty
of getting diagnosed and getting accommodations in certain
(25:31):
circumstances, probably some of what you're working with
HR on in different places to help them
make it a more accessible workplace for folks.
Cause I've seen workplaces that don't work and
I've seen nothing against them, but they just,
they don't know.
I think I've heard things like, they get
like one little hour, one day in all
of med school on it.
(25:54):
That's nothing.
Yeah.
It's not enough.
And the research probably kind of old.
Yeah.
So I appreciate you talking to us.
You've got an audience of therapists listening to
you right now.
Is there anything specific you want to leave
them with?
I would just like to say we all
have so much to learn.
(26:14):
I would suggest to whatever level you want
to learn more, whether it's talking to people,
listening to, there's some really great podcasts out
there like this, reading books, just doing some
thinking or workshops on your own.
And then listening to your clients, like to
the extent that you can actually listen to
them and maybe get some information out of
them and just keep thinking that we want
(26:36):
to just keep moving forward.
And like many things, it'll show up in
different ways to different people.
So, I mean, that's something else that we
can sometimes hear is, Oh, well, my sister
does this.
This is the calendar my sister uses.
This is what you should use.
And great.
It might work.
It might not because it shows up both
in how it shows up and in our
lives getting to this point have been different.
(26:57):
Yeah, absolutely.
So some of the stuff that I pulled
together is I have some stuff on my
website, like quick and easy hacks.
I have a, an SOS ADHD card deck
that I pulled together that gives little scenarios
and some suggestions.
And then like a main idea about what's
going on behind that, just trying to work
through things like that.
(27:18):
Let's not tackle all of this.
Let's tackle something, whether it's a low hanging
fruit or your boss or your partner or
something is really, really impacting your life.
And that's where you want to start.
And so we're not going to tackle all
of that.
We're going to take a little bit and
work through it and see what works and
see what we can add on to and
then go from there.
(27:39):
Yeah.
Love it.
Cause it's going to take time because it's
been there forever.
Awesome.
Well, thank you, Dr. Jindal.
Y'all can find her at ADHDholistically.com.
I'll put that in the show notes to
make it easy to click and thanks for
your time today.
Thank you so much.
Take care.
If you're ready for a much easier practice,
(28:01):
Therapy Notes is the way to go.
Go to therapynotes.com and use the promo
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