0:04

Welcome to the Attention Deficit

0:06

Disorder Expert Podcast Series by

0:08

Attitude Magazine. Hi,

0:14

everyone. My name is Annie Rogers,

0:16

and on behalf of the Attitude

0:18

team, I'd like to welcome you

0:20

to today's ADHD expert presentation

0:23

titled, The Emotional Lives of

0:25

Girls with ADHD. Starting

0:28

today's presentation is Dr. Lada

0:30

Borg Skogland. Dr. Skogland

0:33

is an author, keynote speaker, and

0:35

entrepreneur from Sweden. Her

0:37

specialty is in psychiatry, addiction,

0:39

and family medicine with a

0:42

specific focus on ADHD. She

0:45

currently holds a position as

0:47

associate professor at Uppsala University

0:50

in the Department of Women's

0:52

and Children's Health. She

0:55

also leads the pioneering research

0:57

group, Goddess ADHD, and

0:59

is author of a wonderful

1:02

new book called ADHD, Girls to

1:04

Women. In

1:06

today's webinar, we're going to

1:08

discuss emotional dysregulation. Big

1:11

emotions can manifest as tantrums,

1:13

meltdowns, even as self-harm in

1:16

young girls with ADHD, or

1:19

it can be hidden. Young

1:21

girls may mask their symptoms and

1:24

their feelings of anxiety and depression.

1:27

They may also struggle socially, saying they

1:29

just don't fit in. Young

1:31

girls need caregivers who understand the

1:34

special challenges they face, and that

1:36

is why we are here. So

1:39

to begin, we'd like to do a little bit

1:41

of a level set by asking you a

1:43

few short poll questions. We'd like

1:46

to know, for those in our live audience, has

1:49

your child been evaluated for ADHD?

1:53

Please let us know the status

1:55

of that. And then to

1:57

follow up, if they have... have

2:00

that they were not diagnosed with

2:02

ADHD. Do you think

2:05

that including emotional dysregulation

2:08

in the diagnostic criteria would

2:10

have changed your child's diagnosis? This is

2:12

your opinion, whether you think it would.

2:15

If your child was diagnosed with

2:17

ADHD, we're curious whether

2:20

they were screened for any

2:22

comorbidities. So specifically, we mean

2:25

co-occurring conditions like

2:28

eating disorders, depression,

2:31

anxiety, anything along those lines. So

2:34

while you do that, I will

2:36

point out that you can find

2:38

answers to common webinar questions about

2:40

slides, transcripts, and certificates

2:43

of attendance by clicking on the

2:45

FAQ tab of your webinar screen.

2:48

And if you support the work we're

2:50

doing here at Attitude to strengthen the

2:52

ADHD community, we encourage you to visit

2:54

attitudemag.com, slash subscribe, and sign

2:57

up for our magazine for yourself

2:59

or to share with someone who

3:02

could benefit from greater ADHD understanding.

3:05

You can click on the magazine tab of your

3:07

screen to learn more. And

3:10

I would be remiss not

3:12

to mention that Attitude has

3:14

an ebook titled Women with

3:16

ADHD that offers some additional

3:18

supplemental guidance on hormonal changes,

3:21

ADHD subtypes, finding a doctor

3:23

who will take your symptoms seriously. You'll

3:26

learn why science has paid very

3:28

little attention to female ADHD and

3:30

how you can benefit from a

3:32

diagnosis at any age. Okay.

3:35

Without any further ado, please

3:37

welcome me in welcoming

3:40

Dr. Lata Borg-Soglin. Thank you

3:42

so much, Dr.

3:45

Soglin, for joining us and leading

3:47

this really important discussion today. Thank

3:51

you so much for the opportunity to talk

3:53

about the emotional lives of girls and

3:55

young women with ADHD. I'm a huge

3:58

Attitude fan. So it's

4:00

a real honor for me to

4:02

be presenting here today. And

4:05

when I started writing this book, I

4:08

looked forward to dive into the

4:10

pool of knowledge about female ADHD.

4:13

But I soon realized that you're not

4:15

supposed to dive in such shallow waters.

4:18

And that was really frustrating for me.

4:21

So at the end of the pool

4:23

dealing with pre-pubertal boys with

4:25

ADHD is so huge and

4:27

deep, right? So this is

4:29

what we're going to talk about today. But

4:32

I would like you to first meet

4:35

Annie. Annie

4:37

is 19 years old, and she

4:39

and her parents have some critical

4:41

questions to us about the

4:44

emotional lives of girls and young women. And

4:46

I think we will have some answers for

4:48

her after this webinar. First

4:51

of all, Annie wonders if her

4:53

ADHD brain is wired differently. And

4:57

her parents wonder

4:59

how emotional dysregulation,

5:01

PMS, PMDD, RSD,

5:03

hormones, and mood disorders

5:05

are associated with ADHD. They

5:08

also want to know what girls and

5:11

women like Annie risk if we keep

5:13

missing their specific challenges. And

5:16

what Annie and her parents can do themselves

5:19

to improve her physical, mental, and

5:21

sexual health and quality of life.

5:24

So really good questions. Hopefully we

5:26

will be able to answer at least some

5:29

of them. Let

5:33

me see. But

5:36

let's start by reviewing what

5:39

problems we may face then if

5:41

we continue to view ADHD from

5:43

the male norm. The

5:46

thing is that when presented with a

5:48

case of a boy with ADHD, I

5:51

can call him Andy, we have

5:54

parents, teachers, health care professionals are

5:56

quite fast to identify

5:58

his problems of cosplay. ADHD and

6:00

suggest evidence-based treatment for him. If

6:04

we change nothing about this

6:06

vignette, but the name Andy

6:08

for Annie, however, we tend to

6:10

think quite differently. So

6:12

then we will focus much

6:14

more on Annie's relationships of

6:16

why she is so desperately

6:19

seeking attention. And have you

6:21

seen the quite provocative content

6:23

on her TikTok account? Maybe

6:25

she's been traumatized somehow, maybe

6:27

she's been sexually abused. Well,

6:29

instead of thinking about ADHD, we start

6:31

looking for psychosocial causes

6:33

to Annie's problem. And

6:35

Annie will probably be offered to talk

6:38

to someone about her problems, maybe a

6:40

consultant in school or a family treatment

6:42

by the social services. And

6:44

if, or rather when, in Annie's case, she

6:46

doesn't yet help by

6:49

that, she will probably be offered

6:51

antidepressants, and perhaps something

6:53

for anxiety, perhaps something for sleep

6:56

disorders, or even mood stabilizer

6:58

for her emotional instability before we even

7:01

consider ADHD in her case. So

7:03

I'm exaggerating to make a point, of

7:05

course, but looking at our research data,

7:07

this is not as far from the

7:10

truth as you would wish. In

7:17

fact, in our most recent

7:19

study, we found that boys

7:21

got a head start of about four

7:23

years, in respect to diagnosis

7:26

and treatments, with,

7:29

instead, females were

7:31

typically missed during the formative years

7:34

of childhood and adolescence. So

7:36

we looked at them five

7:38

years before, and five years

7:41

after they got their ADHD

7:43

diagnosis, and females consistently had

7:45

a higher risk for physical

7:47

and psychiatric comorbidity and self-harm.

7:50

They were more often

7:52

prescribed sedatives, anxiolytics, antipsychotic

7:54

drugs, or even opioids.

7:57

And they showed up absolutely

7:59

everywhere. in the healthcare system and

8:02

in our social services, often due

8:04

to mood disorders or

8:07

consequences of emotional dysregulation.

8:14

Unfortunately, we are just still

8:16

so used to look at ADHD

8:25

from the perspective of the disruptive

8:27

boys. But Annie, just as Andy

8:29

has ADHD, and

8:31

this is how Annie would

8:33

describe her ADHD life because she

8:35

feel that she is different and

8:37

there's always been something different about her.

8:39

Something that is just slightly off, but

8:42

not enough for others to see and

8:44

validate that. Rather, others

8:47

try to normalize. Everyone feels

8:49

like this. Everyone thinks this is

8:52

difficult. Everyone struggles with this sometimes.

8:54

And Annie just feels that there's

8:56

something different, but she can't really

8:58

find the words for it. And

9:01

she also feels that her brain fails

9:04

her, that she's stupid. And

9:06

when she needs to concentrate, her thoughts

9:08

just slips away or stop. And

9:11

when she should relax, her mind start

9:13

working like crazy to solve world peace

9:15

or what happens after you die and

9:18

think about those kinds of stuff. And

9:21

she feels really hopeless because she can't

9:23

control her emotions or her energy levels.

9:25

And she's realized that if she is

9:28

going to pass a school or manage

9:31

life, she will have to be so

9:33

disciplined and so controlled. She'll have

9:35

to control what she eats, when she exercise,

9:37

when to study, how she is with friends.

9:40

And age 19, there's just not

9:42

that much spontaneity left in her

9:44

life. Her perfectionistic

9:46

tendencies are turning into a

9:49

OCD or a direct prison for

9:51

her. And

9:57

from the perspective of me as a clinician,

10:00

and a researcher, I

10:02

know that just by fulfilling the

10:04

criteria for these four letters, ADHD,

10:06

you will live about 10 years

10:08

shorter than a person of the

10:10

same age, sex, and socioeconomic status.

10:14

And many of these years are lost due to

10:16

the comorbidity and undetected

10:18

and untreated ADHD. The

10:21

good thing, though, the light in the

10:23

tunnel is that almost all of these

10:26

years can be saved if we find

10:28

and identify and properly treat women

10:31

with ADHD in time. So

10:43

girls with ADHD, they

10:45

do exist.

10:49

And given how serious and or

10:51

misdiagnosed ADHD can be, the

10:54

fact that girls with ADHD

10:56

fly under our radar is

10:59

a serious problem. And research

11:01

shows that girls with ADHD

11:03

show fewer externalizing symptoms and

11:05

more often get the ADD

11:07

diagnosis. However, these girls exist,

11:09

and they do struggle without

11:12

being recognized. And they experience

11:14

social and academic challenges. And

11:16

they keep it together outside of home.

11:19

Because girls, on a group level, at

11:21

an earlier age, some boys realize what's

11:23

expected of them in social settings. So

11:26

they mask and they compensate, but that drains

11:28

them of energy. And the meltdowns

11:30

and the tantrums that they get in

11:33

the safe environment of home

11:35

or in safe relationships actually

11:37

hurt their relationships and their

11:39

self-esteem very much. So

11:42

ADHD most often doesn't

11:45

grow out of

11:52

your ADHD. These girls that fly

11:54

under our radar will grow up and

11:56

enter puberty, a Period that is

11:59

very, very, very difficult. In ten.

12:02

Am. And biologically

12:04

so silly and existentially emote.

12:06

Both that with the and

12:08

changes going through the body

12:10

and and the socialists as

12:13

situations and now we see

12:15

these women and young women

12:17

everywhere because they struggle with

12:19

their emotions. They show up

12:21

in health. Care for depression,

12:24

anxiety, eating disorders, injuries,

12:26

Or in social services because of trauma

12:28

or victim. I say since and the

12:30

paradox? the car that we miss them

12:33

again. Sell. Because

12:36

of as in the case of

12:38

Andy and any we get the

12:40

cliff somewhat it's just words and

12:42

we blame and his struggles on

12:45

trauma or bullying or p rejection

12:47

or depression instead of considering that

12:49

it may be might be her

12:51

very A D H D that

12:54

puts her at risk for depressed

12:56

and foremost social failure. So this

12:58

is really important when we talked

13:00

about out what's comes first and

13:03

so we need a very differentiated.

13:05

View when we looked at the problems

13:07

of young women with a D H

13:09

D. And

13:12

before and he came at me and

13:14

before I met her she was diagnosed

13:16

and treated for at least ten. Difference.

13:19

At conditions this is us

13:21

really messy picture put for

13:23

any and for me right

13:25

and and them eating Wonder

13:27

is every one before me

13:29

just had missed the core

13:31

of an is problem Her

13:33

A the it's D or

13:35

that we may have seen

13:37

the same struggles or her

13:39

struggles or her problems the

13:41

same way but frames it

13:43

differently and laying the puzzle

13:45

of an his diagnosis A

13:47

D H D Borderline anxiety.

13:49

Bi polar eating disorder, autism

13:51

among other diagnosis that she

13:53

she's hiding her young life

13:56

will find bad in the

13:58

overlap and the intersection. These,

14:00

ah the diagnosis Nice

14:02

emotional this regulation. So.

14:08

Clearly. The. Emotional lives of

14:11

girls with a D H D

14:13

is a big deal and emotional

14:15

this regulation is more the rule

14:17

than the exception in a D

14:19

H D and our emotions are

14:21

important for us as humans. We

14:24

use them to communicate or need

14:26

to others and struggling in by

14:28

with the recognizing and regulating your

14:30

emotions is a huge handicapped and

14:32

life. And it's

14:34

important to tie A Even though

14:36

that the picture the Anna and

14:39

his picture of her com or

14:41

bit of the is really messy,

14:43

it is important to try to

14:45

disentangle emotional this regulation in a

14:47

D H D it's from other

14:50

it's distinct home or with conditions

14:52

such as depression, anxiety, bipolar Disorder,

14:54

a borderline personality disorder since they

14:56

are more common ah in individuals

14:58

with a D H D and

15:01

also they may need specific treatment.

15:03

Outside of the a two treatment.

15:06

At and then we also have

15:09

the downstream consequences of living with

15:11

a D H D such as

15:14

the increase fifth for periods at

15:16

since the same and stigma associated

15:18

with having a behavioral diagnosis that

15:21

increase. The risk of course to develop

15:23

depression. Social. Anxiety and projects

15:25

insensitivity did. For. Hours The

15:27

The obviously there are quite.

15:29

Ah Difference and complex mechanisms

15:32

underlying this overlap between A

15:34

D H D. Mood disorders

15:37

and Emotion. And

15:42

eight. Am.

15:46

way of looking at the science behind

15:48

this overlap have a d h d

15:50

and emotional distress relations and that resonates

15:53

very well with the testimonies that i

15:55

hear in my clinical practice is developed

15:57

by my friend and research colleagues said

16:01

He and his colleague,

16:03

Xavier Isas-Cattelano, describe emotional

16:05

dysregulation in ADHD and

16:07

borderline personality disorder as

16:10

difficulties in two similar,

16:12

but not entirely overlapping,

16:14

top-down brain regulating mechanisms.

16:17

So in this model, ADHD

16:19

is viewed as difficulties

16:21

in regulating more cool

16:23

or executive attention, while

16:26

borderline and the difficulties

16:29

associated with borderline represent difficulties

16:31

in controlling more hot or emotional

16:33

circuits in the brain. So

16:36

in this way of looking at

16:38

it, ADHD and borderline becomes like

16:40

sister conditions of similar, but not

16:42

identical processes. And Petrovich

16:44

and Catelanos, they argue that we

16:47

may talk about an emotional

16:50

subtype of ADHD located just

16:52

in between ADHD and

16:54

borderline personality disorder. And

16:57

that might help us actually

16:59

also target and tailor interventions

17:01

and treatments directly to a

17:03

specific individual. But

17:10

we have to make the

17:12

picture even messier, unfortunately, for

17:14

us as girls and women,

17:16

because we have to also factor

17:19

in the fluctuating hormones across the

17:21

entire reproductive female lifespan. So

17:23

estrogen and progesterone will be produced in

17:26

the ovaries, among other places in the

17:28

body, and they easily pass

17:31

through the blood, the brain barrier

17:33

and access our brains. And there

17:36

are hormonal receptors in literally

17:38

all brain regions that are

17:40

involved in emotional regulation indicating

17:42

that hormones are very much

17:44

involved in how we feel

17:46

and how we function. So

17:51

this is really

17:53

important and again, not

17:56

sufficiently taken into consideration.

18:00

And the risk, again, that we

18:03

miss when we use research

18:05

in clinical experience based on

18:07

pre-pubertal boys that do not,

18:10

have not entered puberty yet.

18:12

And once they

18:15

enter puberty will not exhibit

18:18

these monthly fluctuations

18:22

of quite dramatic changes of

18:25

estrogen and progesterone levels. So

18:28

firstly, we know that these predictable

18:30

periods of changing hormonal levels

18:32

create vulnerable periods across the

18:34

entire female life or the

18:37

entire female reproductive life anyway.

18:39

So in our research group, we

18:42

have actually targeted these

18:44

vulnerable periods in the women and

18:47

girls' lives and done studies specifically

18:50

in youth centers, in maternal health

18:53

care and in women's clinics. And

18:55

these studies, they

18:57

show that, for example, teenage pregnancies

18:59

and teenage births are six times

19:02

more common in girls and women

19:04

with ADHD. And

19:07

we know that giving birth to a child

19:09

in a very early

19:11

stage in your life will affect both

19:13

you, your, and your

19:15

young child's psychosocial development across

19:17

your entire life. So

19:20

this is something that we wish

19:22

that girls and women, young women

19:24

with ADHD also are allowed to

19:26

plan when they are, when

19:29

they are founding their families. And

19:33

ADHD girls and women are actually five times

19:35

more likely to experience depression

19:37

following the traditional prescribed

19:40

oral contraceptives. And

19:43

we also have shown that 20%

19:45

of pregnant women with ADHD will

19:47

develop postpartum depression and anxiety following

19:49

birth and that women

19:52

with ADHD more often suffer from

19:54

pain and stress related conditions during

19:56

their period menopausal year. So across

19:58

the entire female lifespan. There

20:00

are vulnerable periods associated

20:03

with fluctuations in

20:05

estrogen and progesterone levels. And

20:08

again, I guess I

20:10

will have to stress this

20:12

a lot of times during

20:14

this lecture, but 99% of

20:17

the research is done on

20:19

male or even prepubital boys,

20:22

where this is absolutely not taken

20:25

into consideration. So

20:31

from puberty to many parts, naturally

20:33

cycling females will experience quite dramatic fluctuations of

20:35

circulating sex hormones affecting both how we feel

20:37

and how we function. Let's

20:42

say we have like a cycle of 28 days,

20:46

a normal and regular

20:48

length of a menstrual cycle. Then

20:53

day 1 to 14 or the

20:55

follicular phase will be about the

20:57

body preparing to release or perhaps

20:59

also receive a fertilized egg. This

21:02

is why estrogen levels will rise

21:04

to a maximum peak at day

21:06

14, triggering this ovulation. And

21:09

research actually shows that risk-taking

21:12

behaviors may increase, not

21:15

necessarily due to negative feelings,

21:17

but due to positive emotions. During

21:21

this time of the menstrual cycle. However,

21:23

as often

21:26

is the case in young females with ADHD,

21:29

if the result of even

21:31

though positive impulsive behavior is

21:33

drinking alcohol, taking drugs, having

21:36

risky sex, driving a responsibly

21:39

or shopping impulsively, the consequences

21:41

might be just as serious.

21:45

Also, since estrogen and dopamine may potentiate

21:47

each other, side effects

21:49

of ADHD medication that affect dopamine

21:52

levels may further increase the risk-taking

21:54

behavior. So if you have an

21:56

ADHD profile that is defined mostly

21:58

by impulsivity and hyperg, this

22:01

part of the menstrual cycle may actually

22:03

be the most difficult part of the

22:05

month for you. And

22:08

then, following day 14, estrogen

22:10

levels fall quite steeply, stabilizing

22:12

on a lower level

22:14

during day 15 to 28, the luteal phase.

22:19

Then instead, progesterone levels will

22:21

start rising, creating an entirely

22:24

different hormonal environment where women

22:26

generally report more symptoms of

22:28

depression, anxiety, rejection, sensitivity, dysphoria,

22:31

sleeping problems, cognitive difficulties with

22:33

memories, etc. So

22:35

if your ADHD profile is defined

22:37

mostly by low energy levels and

22:40

anxiety, then the period around a

22:42

higher estrogen level might offer a

22:44

welcome energy and mood boost, but

22:46

you may instead suffer tremendously with

22:49

PMDD, PMS in the later

22:51

part of your luteal phase. And

22:54

this just sheds light on

22:56

how important it is to

22:59

not just use the one-size-fits-all

23:01

regime that we do when we use the

23:03

male as the norm for ADHD. And

23:10

in fact, females

23:15

have shown to have an increased risk

23:17

with everything from stress, depression,

23:20

anxiety, to relapsing into binge

23:22

eating, addiction, suicidal ideation, and

23:24

psychosis in the luteal phase.

23:29

And there is also, even though a

23:31

very limited research at this point

23:34

indicating that women with ADHD are

23:36

at increased risk for just

23:39

experiencing PMDD, postpartum depression, and

23:41

worse climatic symptoms. But

23:43

again, we talk about this and we

23:45

hear this a lot in our clinical

23:47

practice and in our everyday life talking

23:49

to each other. So

23:52

we might think that there is a lot

23:54

of research on these topics out there, but

23:56

it's not. And

24:01

The problem is that the research

24:03

that is there showing

24:05

that there are vulnerable faces

24:07

in a woman's life for

24:09

both ADHD and non-ADHD women,

24:11

still almost no one, me

24:15

included, in the clinic,

24:18

asks us about hormones when we

24:20

seek counseling for mental health issues.

24:23

And this is, again, a

24:25

huge lack and problem that

24:27

we are facing as women,

24:29

where we actually risk not

24:33

getting the correct medical

24:36

advice and support. So,

24:43

in essence, female ADHD,

24:45

emotions and hormones can create

24:48

the perfect storm for girls and

24:51

young women with ADHD. And

24:55

unfortunately, there's almost

24:57

no research validating girls

25:00

and women's experiences here. So,

25:02

at this point, I'm afraid

25:04

to say that it's really up to

25:06

us as girls, women, parents, clinicians to

25:08

try to figure out how this is

25:11

all tied together for every single

25:13

unique girl and woman. And it

25:15

might sound like that is a

25:17

huge job for me

25:19

as a clinician, but it's not, because it's

25:22

really interesting and it's really rewarding. So, I

25:24

really urge all of you, either

25:26

if you are a clinician or if you are a girl

25:30

or woman yourself or a parent

25:32

to a girl, to really lean

25:35

in to this knowledge

25:37

about how hormones affect our

25:39

ADHD symptoms and our mental health. And

25:44

this is also why our research

25:46

group always use patient and public

25:48

involvement and co-create both our

25:50

research questions and the self-care tools that

25:53

we develop, such as Letter Life that

25:55

I'm going to show you soon. And

26:01

to this end, we have developed a model that we

26:03

call ADHD 24-7. And

26:06

this is to capture like the wider

26:09

perspective of the ADHD life for both

26:11

children and adults. Because

26:14

ADHD doesn't go to bed, it doesn't

26:16

take lunch breaks or vacation, it goes

26:18

on 24-7 and it affects every aspect

26:20

of your life. And

26:22

to get the correct support, you

26:25

need to speak the same language and

26:27

to be able to communicate both

26:29

your difficulties, your problems, your

26:31

strengths, and also your

26:33

needs to your doctors or to

26:35

your nurses or to the teachers

26:37

in your child's school. So

26:40

I will just quickly walk you

26:42

through the two, four, and seven

26:45

of our model and try

26:48

to explain why we think

26:50

this is a good way

26:52

to start when we build

26:54

the common language

26:56

and the common knowledge about girls

26:59

and women with ADHD. So

27:02

we start out with a holistic view

27:04

of us humans and we

27:06

argue that we all, regardless

27:08

of if we have ADHD or

27:11

not actually, have some basic needs

27:14

if we are supposed to live a

27:16

good and healthy life. So first of all,

27:19

we need

27:22

a social community where we safely can

27:24

communicate what we think, what we feel,

27:26

and what we need without being judged.

27:29

Many girls with ADHD that I

27:31

talk to does not feel that school

27:34

provides a protective or inclusive

27:36

tribe for them, quite the

27:39

opposite, in fact,

27:41

unfortunately. And

27:44

also, except having

27:46

this social community, we also need

27:49

a calling where we feel that

27:51

what we do contributes to something

27:53

that is meaningful for someone more

27:56

than just me. And

28:00

we okay to feel com the tends to

28:02

handle the challenges that we saved. In

28:05

life and again, so many of

28:07

the girls that I mean difference.

28:09

Ah, and I feel that there

28:11

is very much meanings with anything

28:13

in their lives at the moment.

28:16

school skiing unfortunately again in no

28:18

exception. And it's really

28:20

hard to motivate yourself and to

28:22

motivate yourself when you have a

28:25

D. H D was a motivational

28:27

disorder. Ah am at Lawrence to

28:29

motivate yourself then to go to

28:32

school and to participate in that

28:34

when you don't see the purpose

28:36

of it all and I and

28:39

we think and we have disgusted

28:41

at length of lamb with our

28:43

patient panels and and an hour

28:46

and lead patients users am that

28:48

if we ignore. These two

28:50

and like and basic areas

28:52

of life. our support the

28:54

now interventions risk being ah.

28:57

At vests useful and at worst

28:59

actually harmful for people. For.

29:02

This is a very important basis

29:04

for what we do and then.

29:07

And we have the For in

29:09

our at Twenty Four Seven model

29:11

and and enough important aspects and

29:13

of building the emotional intelligence in

29:15

a D H D is to

29:17

understand how you A D H

29:19

D brain is wired and how

29:21

it deals with information from the

29:23

outside world and from your body.

29:25

So my aunt talking about about

29:27

for all brains are difference ah

29:29

I'm a have strengths and challenges

29:31

and and by using metaphors for

29:33

different complex brain processes such as

29:35

central for he ran. Top

29:37

down regulation me that cognition and

29:40

cognitive flexibility, for example, we allow

29:42

even younger kids to understand why

29:44

some things like for example,

29:47

emotional self regulation may be so

29:49

much more difficult for me

29:51

than for my peers. So

29:54

am the for most

29:56

important. Areas of

29:58

concern here then. and

30:00

that stands out in our research

30:03

are your brain's control tower.

30:07

So this is your ability to overview what

30:10

you need to plan, prioritize,

30:12

organize, execute in your everyday

30:14

life. Imagine

30:17

that your brain is like a huge

30:19

airport with planes coming in from the

30:22

entire world every

30:24

minute, taking off every

30:26

minute and everything needs to be coordinated

30:28

to the very second to avoid like

30:31

crazy or disastrous

30:33

accidents. And then imagine

30:36

that you don't have anyone working in

30:38

the control tower of your airport. You

30:40

have to manage everything manually and

30:43

just an ordinary day in school

30:46

will require enormous amounts of energy.

30:49

So this is the first important area that

30:51

we have to discuss with our girls. The

30:56

next area will

30:59

be to the

31:01

brain's volume button. So

31:05

your ability to regulate and moderate

31:08

not only your activity levels,

31:10

but everything from your energy

31:12

levels, appetite to your emotions.

31:15

So imagine that your volume button

31:17

gets stuck at zero. It's impossible

31:19

to get anything done and everyone

31:22

around you just say, but

31:24

do it. You'll feel so much better afterwards.

31:26

And then imagine how this volume

31:28

button stuck at zero without you

31:30

knowing how or why just ramps

31:33

up to 100. And it's impossible

31:35

to stop eating. It's impossible to quit

31:37

gaming or to wind down and go

31:39

to sleep. So

31:41

that was the other, the second area

31:44

that we need to discuss with our

31:46

ADHD girls. And

31:48

then we need to actually have

31:51

had a common language for. The

31:53

third area here would be our brain's virus

31:55

filter or your ability to filter out irrelevant

31:57

information from the outside world. and

32:00

from your own body. So then

32:03

imagine that every microscopic stimuli

32:05

comes through into your brain

32:07

and requires processed speed in your

32:09

brain, in your brain's

32:12

hard drive. It's everything from how

32:14

the clouds feel on your body,

32:16

your bowel moment, smells

32:18

from outside, everything competes

32:21

for your attention. And

32:24

that is something also that

32:26

girls and women can describe

32:28

quite vividly, how extremely tired they

32:31

get in social situations.

32:34

Not because they don't appreciate social

32:36

situations, because they cannot handle the

32:38

influx of competing

32:41

stimuli. And then the

32:43

fourth area would be your

32:45

brain's gearbox, or your

32:47

ability to shift out of negative

32:49

ruminating thoughts, or to

32:51

try something new when the things that you

32:54

do actually don't work anymore. So

32:56

then imagine that you keep getting stuck

32:58

in loops of negative

33:00

toxic thoughts. And even

33:03

though you know that it

33:05

would be really good to try to view

33:08

things in a lighter perspective, and

33:10

that these clouds really, or

33:13

thoughts really cloud your mind

33:15

and poison your relationships, you

33:17

just can't think past them

33:19

or stop their toxic influence

33:21

on your mental state. And

33:24

that is also something that is common

33:28

for female with ADHD

33:30

to describe, and that we have

33:33

to have a common language for. And

33:35

then moving to the next last

33:38

part of the ADHD 24-7 model then, is

33:44

our seven lifestyle factors that cost

33:47

so much of the risk for

33:49

both mental and psychiatric

33:51

comorbidity in ADHD, but

33:53

also that carries great possibility

33:55

of improving our emotional intelligence

33:57

and build emotional resilience. we

34:00

can find healthy routines and

34:03

we can do them with moderation. But

34:05

it's no secret. And research clearly

34:07

shows that the ADHD brain finds

34:09

it so much harder than neurotypical

34:11

brains to set up and keep

34:13

healthy routines for diet, exercise, sleep

34:16

and work load in school or

34:18

at work. Also,

34:20

it's so much more difficult to

34:22

regulate your emotions and get much

34:25

more easily, much more easy to

34:28

get addicted to nicotine, alcohol, drugs

34:30

and gambling or have

34:32

problems with gaming, shopping or social

34:34

media. And as we grow up and

34:37

as our children get more and

34:39

more independent, we also are expected

34:41

to manage and structure our lives

34:43

independently to pay our bills, to

34:45

remember to take our medication or

34:48

to meet appointments and deadlines

34:50

without our parents or partners having to

34:52

remind us of the time. And these

34:55

areas, these seven life areas are

35:00

standout in our research and

35:02

also in other research as

35:05

carrier of so much of the

35:08

comorbidity load and the decreased quality

35:10

of life load for

35:12

both males and females. And

35:18

the problem here, unfortunately, having ADHD,

35:20

you will live in

35:23

a world designed for the 95% of

35:25

the neurotypical people and you risk getting

35:28

a lot of well meaning but

35:31

quite useless or even

35:33

actually harmful advice for

35:36

how you should manage life and why

35:39

life keeps being so difficult for you.

35:41

So my favorite advice then would be,

35:44

since I have a background in addiction

35:46

medicine, would probably be, oh, you seem

35:49

so tense and stressed out, you know,

35:51

live a little, have a drink and

35:53

relax. Or why not on

35:55

the topic of the emotional lives of

35:57

girls with ADHD. If you... you

36:01

need to stand up for yourself

36:03

and say that. That's really, really

36:05

bad advice when so much of

36:07

the emotional life of girls revolves

36:10

around social struggles and rejection

36:13

sensitivity. So this we

36:15

need to focus on

36:17

better advice to

36:19

try to build our emotional

36:22

intelligence. As

36:25

a outcome, we help then girls and young

36:27

women with ADHD to develop their emotional intelligence.

36:30

Well, in our research, based

36:32

on this patient and public involvement

36:35

and our co-creative development of

36:37

the digital support tool for

36:40

women, Leterlife, we have identified

36:42

some key areas for female

36:44

ADHD. So, first

36:47

of all, many ADHD girls and their parents

36:49

feel abandoned by health care and

36:52

they feel left with a, at best,

36:54

an incomplete toolbox. Many

36:56

women also specifically

36:58

say that their ADHD problems

37:01

stem from difficulties in regulating

37:03

emotions and energy levels. And

37:06

many feel that they somehow

37:08

have to choose between strategies

37:10

based on medication and health

37:12

care or self-care, self-help or

37:14

skills training. Or that medication,

37:16

for some reason, doesn't work properly or that

37:19

both side effects and effects are

37:22

inconsistent and hard to understand, perhaps

37:24

due to hormonal situations. And

37:27

to build the emotional intelligence

37:29

and resilience, we focus on some

37:31

key ingredients that are adapted from

37:34

CBT, GBT, motivational interviewing

37:37

and mindfulness. Because

37:40

if you have masked or mimicked in

37:42

order to feel normal your entire life,

37:45

your self-awareness is probably

37:47

quite underdeveloped. And you

37:49

may feel very overwhelmed

37:51

by questions like,

37:54

what do you feel or what do you want me

37:56

to do or what do you need? So,

37:58

when monitoring, instead

38:01

of focusing on how you feel, focusing

38:03

on how you are doing. You

38:05

might start by monitoring how you do on

38:08

the different lifestyle factors that we talked about

38:10

in our 24 seven model, for example. That

38:12

might be a good start for understanding your

38:14

emotions and what triggers them. It

38:17

can be everything from hormones to rebound

38:19

effects of medication or a bad night

38:22

sleep. And

38:24

then when you keep track of what

38:26

works and what you have

38:28

to struggle with, you can also send messages to

38:30

your future self before upcoming

38:32

PMS days, instead of having

38:35

others like parents pointing out

38:37

to you when you

38:39

are misbehaving or when you're probably

38:41

having a bad day. This

38:45

might be especially than empowering for

38:47

teenagers. And collecting

38:49

also your own real life information

38:51

about yourself will also armor you

38:54

with objective and personal data, allowing

38:56

your healthcare professionals a better basis

38:58

for their medical decision-making. And

39:01

as we said, there are almost all no

39:03

research on this topic. So we have to

39:05

provide the information for the healthcare professionals. We

39:08

have to provide the

39:10

information on how hormones, for example,

39:12

influence how we feel and how

39:14

we are doing. And

39:17

our emotional intelligence is built in

39:19

interaction with others that

39:23

we feel safe with and

39:25

respected by. So that is

39:27

why techniques from motivational interviewing,

39:29

for example, like active and

39:31

non-judging listening and

39:34

reflecting is really crucial. So instead

39:36

of coming up with suggestions and

39:38

delusions, try to just reflect

39:40

back what your child is telling you. So

39:44

to be heard and to be listened

39:47

to is really empowering

39:49

and it builds emotional

39:51

self-efficacy. So

39:53

finally, we

39:55

have identified some key concepts where

39:58

the common language of the... the

40:01

ADHD 24-7 model may help us

40:03

to come through to other important

40:05

adults in our children's life. So

40:08

you wanna make sure that your daughter's

40:11

school, for example, has sufficient understanding of

40:13

her unique challenges. And by

40:15

explaining her difficulties using the metaphors that we

40:17

use in the 24-7 model, may

40:20

help the teachers and school staff to

40:22

see beyond this compliant and silent little

40:24

girl that keeps it together in the

40:26

class just to explode when she comes

40:28

home. She does

40:31

really well in school, but it's so drained

40:33

of energy that she just has to go

40:35

straight home after school and

40:38

miss out on all the important

40:40

social life that the other

40:42

girls share. So

40:44

use our metaphors here or invent

40:46

your own, but the important thing

40:48

is to start to quite

40:51

early in life, talk to your child

40:53

about how emotions and lifestyle factors are

40:55

tied together. So

40:57

don't forget to talk about how in

40:59

period of hormonal changes, for example, or

41:02

other stressors, we have to be extra

41:04

careful with our body balance and make

41:06

sure to eat healthy, to have a

41:09

good sleep routine, and

41:11

to exercise regularly to build our

41:13

emotional resilience. And also that

41:15

it's not cheating, but really, really

41:17

smart to start building a

41:19

really diverse toolbox to handle your emotion

41:22

in different parts of your life. And

41:29

reaction sensitivity dysphoria or RSD

41:32

is characterized by extremely painful emotional

41:34

responses to real or imagined criticism

41:36

or rejection from others. And it's

41:38

really common in ADHD

41:41

and it can become a self-fulfilling

41:43

prophecy. So I

41:45

would just like to tell you

41:47

a little story, our little results

41:50

from a research study actually, who

41:52

shows the power

41:54

of teaching girls with

41:57

emotional dysregulation to give... time

42:00

to not react on instinct,

42:02

but to try to reappraise what they

42:04

are seeing and what they are experiencing

42:07

in different situations. Because if someone shows

42:09

you a picture of a woman crying

42:11

and asks you to

42:14

guess what she's feeling, you'll probably say that

42:16

she looks sad, right? But if

42:18

you don't hear that she just met her son

42:20

who's been traveling in Asia for a year, you

42:22

might perceive her reaction quite differently, right? So

42:25

this reinterpretation influences our

42:29

emotional brain processes, something

42:31

that we actually make use of when

42:34

we develop our emotional intelligence. And

42:37

a key to

42:39

that emotional intelligence is to recognize

42:42

when your brain is more easily

42:44

triggered, perhaps using or during PMS,

42:47

and to work actively to reappraise

42:49

your perception and emotion and refrain

42:52

from acting until you feel emotionally

42:54

anchored. And

42:57

finally, how do we build emotional resilience

42:59

in our children? Well, first of all,

43:01

we want to make sure to optimize

43:04

the things that we can actually

43:06

influence. Some research

43:08

suggests that stimulus

43:10

medication may improve emotional

43:13

discrimination, but others show

43:15

less promising effect. Some

43:18

things that we don't know, and we have

43:20

anecdotal evidence pointing to differences in

43:22

medication effects across the menstrual cycle. And

43:24

since dopamine and estrogen may moderate each

43:27

other's effect, this is a valid

43:29

hypothesis. And that could

43:31

lead to both over and understimulating a

43:34

stimulation of the medication, depending on the

43:36

hormonal status that we talked about earlier.

43:40

And also, if your child suffers from

43:42

distinct comorbidity, she may need treatment for

43:44

that also, because it's not certain that

43:46

ADHD treatment will take care of symptoms

43:48

of anxiety, depression, or bipolar disorder. Second

43:52

of all, we have mindfulness.

43:54

So part of building emotional resilience

43:57

is finding ways to stop the

43:59

emotional impositivity. and buy yourself time

44:01

to reflect and choose a way to react

44:04

that you can live with, even

44:07

though the emotion will pass. So

44:09

even though there is not much

44:11

evidence for the effectiveness of mindfulness-based

44:13

practices in ADHD in younger children,

44:15

it's often used in DBT, treatment

44:17

for older adolescents with emotional dysregulation.

44:20

And again, it's almost never either or. You

44:23

don't have to choose medication or to

44:25

meditate your way out of ADHD, but

44:27

rather try to introduce this aspect of

44:29

reflecting on your body balance and

44:31

recognizing your emotions and talk to

44:34

your child about that. And

44:36

then finally, moderation. So if

44:40

you and your daughter are anything like the

44:42

many girls with ADHD in women that I

44:44

know, moderation is probably not your middle name.

44:48

But then my experience,

44:50

however, is that even very young children can

44:52

visualize the volume button in the ADHD 24-7

44:54

model. And

44:57

working towards moderation in

44:59

all aspects will build,

45:01

actually, emotional resilience. So try to

45:03

be creative. Maybe you can

45:05

do a check-in race of how long

45:08

you can go without

45:10

entering the volume button's danger zone,

45:12

how long you can stand doing

45:15

things in the

45:17

activity level between 40 and 60, or

45:21

how you can take yourself out of the

45:23

danger zones. And

45:30

really, really important also when

45:32

we talk about the emotional life of girls

45:35

and women is to understand

45:37

that they have probably, if

45:40

they are un- or misdiagnosed,

45:42

build up a life

45:44

with perfectionism, stigma,

45:47

and shame around themselves and their

45:50

behavior. So

45:52

to identify the downstream psychological consequences

45:54

of living with undiagnosed or untreated

45:57

ADHD is really important. girls

46:00

and women, young women, they have developed a harsh

46:02

and negative choir of voices

46:04

playing on auto repeats day and night.

46:07

Voices of self-doubt, not doing things good

46:09

enough, letting yourself or others down, or

46:11

being a failure and impostor. So

46:14

this is why we have to

46:17

work empowering and compassionate

46:20

and try to exchange the vicious

46:22

choir by a

46:25

compassionate choir and self-awareness. And

46:28

knowledge that emotions are made

46:30

from perceptions, interceptions and previous experiences is

46:33

key here. And

46:35

knowing that as long as you

46:37

don't act on your emotions they

46:39

can't hurt you. Again

46:41

self-discipline might sound counterintuitive

46:46

when it comes to fighting perfectionism,

46:48

but the truth is that setting

46:50

empathic boundaries for yourself and

46:54

for others, for example

46:56

asking for a timeout in a

46:58

heated discussion before it turns into

47:00

a conflict, you buy yourself time

47:02

and you show yourself and

47:05

others that you can stay in

47:07

control. And you take responsibility for

47:09

the situation and you stay accountable

47:11

by circling back then afterwards when

47:13

the temperature is cooled off. And

47:15

then self-compassion is a necessary component

47:17

to heal and to move away

47:19

from degrading self-image and to build

47:22

healthier relationships to yourself

47:25

and to others. Maybe enjoy

47:29

a gratitude practice every evening or

47:31

when you drive your kid

47:33

to work. So

47:36

before we round up, do

47:38

we have the information now

47:41

to answer Annie and her parents questions? Do

47:43

you remember the questions? First

47:47

of all, Annie asked

47:49

us if her brain was wired differently.

47:51

And I think we could say yes,

47:53

but also that all brains are different.

47:55

So we will ask her to be

47:57

curious about her own ADHD profile. Then

48:01

they asked us, her parents, how it

48:03

all would tie together. And we could

48:05

say that, yes, emotional dysregulation is the

48:07

core feature of ADHD, especially in females.

48:09

And hormones affect brain processes. That

48:13

is crucial to regulate behaviors. They

48:16

also asked us what we risk. When

48:19

clinicians don't understand, that goes differently. And

48:21

we can say that this is

48:24

a great question because early detection

48:26

and adequate support is crucial to

48:28

prevent multimability, polypharmacy, and extensive health

48:30

care utilization associated with female ADHD.

48:33

And finally, they wanted to have tips

48:35

and tools to navigate. And we say

48:37

that, yes, there are a lot of

48:40

tools out there, but it's really important that you

48:42

are aware of

48:44

your own ADHD profile and that communicate

48:47

your own needs to others.

48:50

And that you arm yourself with your

48:52

own objective real life data for

48:55

safe, shared decision making with your health

48:57

care professionals, for example. And

49:00

then I would just like to say, again,

49:03

thank you so much for

49:05

the opportunity to talk to

49:08

you today. And

49:10

looking back at the time that has

49:12

passed since I first became interested in

49:14

the emotional lives of girls and women,

49:16

I feel very fortunate that

49:19

the literature and the interest is growing

49:21

and that me and my research group

49:23

is standing on the shoulders

49:25

of some true heroes in our eyes.

49:28

So we hope to be part of the movement

49:32

forward and to be able to be

49:34

part also of the increased knowledge and

49:37

support for females with ADHD.

49:46

And if you

49:50

want to read more about girls and women, there is

49:53

a discount offer from my

49:55

publisher, Jessica Hingsley Publishing. about

50:00

Letter Life, our co-created digital tools

50:02

for females. You're very welcome to

50:04

visit, and we will allow you

50:06

direct access to the app

50:09

for free. And

50:11

please follow me and others advocating and

50:13

raising awareness for female ADHD on social

50:15

media. I'm on Instagram, Facebook, and

50:18

LinkedIn, and almost on TikTok now. Not

50:20

according to my kids, but I

50:23

feel very confident that I will be

50:26

on TikTok in just a

50:28

while. And I

50:30

want to give this quote to round up from the

50:32

French philosopher and author Albert Camus. I

50:34

think it sums up so very much of what girls

50:36

and women with ADHD tell us about their lives. So

50:38

thank you so much for listening, and

50:41

hopefully I will be able

50:43

to take some questions now. Yes.

50:45

Oh, Dr. Skoglin, that was an

50:47

incredible masterclass in ADHD in women.

50:51

And I want to congratulate everyone who's

50:53

listening, because I think at this point,

50:56

our audience probably knows more

50:58

about ADHD in women than

51:00

many of the medical professionals

51:03

who they see. I

51:06

can say that a little bit flippily,

51:08

but it's actually true. Oh,

51:11

unfortunately, that is true. I

51:14

wish that it was not the case. But

51:18

again, we have to educate

51:20

ourselves, and we have to lead the way, I think.

51:23

Yes. So thank you for

51:25

helping us do that. I'm going to do

51:28

a quick recap on the poll question that

51:30

we asked at the outset of

51:32

the presentation today. We asked about the

51:35

percentage that had been evaluated, and that

51:37

was 74% had been evaluated and

51:42

diagnosed their children, and 21% had

51:44

not. Now

51:48

among those children who

51:50

had been diagnosed with ADHD, I'll point

51:52

out that only 42% were screened

51:57

for co-morbid disorders

51:59

like... anxiety and

52:01

depression. I probably

52:04

don't even need to ask this question, but

52:06

Dr. Skogland, should that number not be 100%?

52:08

Oh, definitely. It needs

52:11

to be 100%. Otherwise, you

52:13

haven't really done your work properly.

52:16

I guess I

52:18

will get a lot of angry

52:20

colleagues when I say this, but

52:23

the comorbidity is the rule rather

52:25

than the exception. Sometimes you get

52:27

the misperception that ADHD in females

52:29

is a light version of ADHD

52:32

in males and nothing could be

52:34

further from the truth, actually. Our

52:37

data and other research

52:39

groups focusing actually on females show that.

52:42

We have to be prepared that when

52:44

you have a girl or

52:46

a woman with ADHD, you should be

52:49

prepared for anxiety, depression,

52:51

eating disorders, self-harm,

52:55

even more

52:57

serious than actually for the boys.

53:00

Great. Someone wrote in just now

53:03

to say, is it standard for children to

53:05

get tested for all of

53:07

those in an ADHD diagnosis? I

53:10

think it's really imperative

53:13

for caregivers to insist.

53:17

Yeah, I think it is. It looks

53:20

very differently in different countries and

53:23

even in a small country like Sweden, it

53:25

looks very differently in different settings.

53:27

So we have to advocate for

53:30

this as parents and as

53:32

patients to make sure that we get

53:34

the full picture because we

53:36

need the full picture. That's why the ADHD 24-7 model, we need

53:38

this full picture to move

53:42

forward. Otherwise, we risk actually driving

53:46

off course and doing things,

53:48

wasting time and

53:50

resources. That

53:53

is very serious both for us and for

53:55

the healthcare system, actually. Absolutely.

53:57

You mentioned this. several

54:01

times in your presentation, but I

54:03

think it's worth repeating that girls

54:06

in particular are prone

54:08

to masking their symptoms.

54:10

And sometimes that may look like

54:12

perfectionism, it may look

54:15

like procrastination, even a

54:17

lack of motivation, but it really

54:19

is critical for the clinician to understand

54:25

that the signs and symptoms will

54:27

look different. In

54:30

girls and of ADHD, but

54:32

also, you know, those comorbid like anxiety

54:34

in particular, I'm thinking. And

54:37

we have to be curious and clever

54:39

when we ask about this because

54:44

having masks and having

54:46

mimics and having done

54:48

this your entire life

54:51

or your entire life from being a girl to

54:54

a young woman, it's not certain that

54:56

you have the words or that you

54:58

have the expression to actually explain what

55:00

you are going through and what you

55:02

are suffering from. So we have to

55:05

be very

55:07

receptive and actually also

55:09

look on the full

55:11

picture of how

55:13

this girl is doing. And

55:17

overwhelmed would be one

55:19

of the core words, like

55:23

the slogan, I would say,

55:26

for overwhelmed and over flooded.

55:29

That will be so many of the girls that

55:31

I see talk about

55:34

that in different words

55:37

and on different themes. And

55:40

I have to say this dovetails with

55:43

something I heard. I

55:45

mentioned that the Attitude Team attended a

55:48

conference for ADHD this last weekend. And

55:50

one of the leaders in the field,

55:53

Dr. Anthony Rothstein Said, you know, he

55:55

questioned, why is it that ADHD is

55:57

diagnosed on the basis of the ADHD?

56:00

Impairments, but other conditions are diagnosed

56:02

on the basis of suffering or

56:04

just stretch nice and sunny. This

56:06

is like such a lightbulb moment.

56:09

that wouldn't we all say that?

56:11

that are? you know? This.

56:13

Emotional distress that were

56:15

describing here. Is

56:18

it? Even

56:20

if is indeed impairing right arm is

56:22

that if the chives a good points

56:25

and I think we should be both.

56:27

I think we need to look

56:29

at both the impairments because it's

56:31

a lifelong from for many ah

56:34

individuals' and then and the suffering

56:36

of course. Sir.

56:38

And and then I am again when

56:40

you when you get the adequate for

56:43

it's as need to be ah and

56:45

impairments. Everly or for I'll

56:47

be blunt else or it so

56:49

that that that It's a really

56:51

interesting. Ah

56:53

diagnosis that we are fortunately

56:56

insisted. I think. Yes,

56:59

And to that point, and humans, And

57:01

you know a lot of the. Risks

57:04

associated with eighty see this as

57:06

a clean girls and and several

57:09

people asking whether and there's research

57:11

suggesting that on medication use for

57:13

a D C does help to

57:16

reduce those risks. So things like

57:18

on the sexual promiscuity or and

57:20

the Dance on a know you

57:22

name it on yeah there is.

57:25

There is a lot of research

57:27

actually showing that medication can be

57:29

helpful as to reduce a lot

57:32

of the adverse outcomes associated with.

57:34

A D H D Again, what

57:36

we have to remember is that

57:38

may be as we have that

57:40

at samples that include and us

57:42

women and but the I'm what

57:44

what's this ah when I'm almost

57:47

one hundred percent said not is

57:49

that we do not know if

57:51

these women are at oh what's

57:53

their part of their menstrual cycle

57:55

they are or if they're also

57:57

am taking oral contraceptives. So we.

58:00

know about their hormone status, for example,

58:03

when we look at the outcomes. So again, the

58:05

research is flawed in that sense, even

58:08

though it's getting better because we also

58:10

have female samples now. So we have

58:12

a sample that has actually perhaps even

58:14

50-50 females. But then

58:17

we forget that, sometimes

58:19

we forget why we actually

58:21

add females into the research

58:23

studies. And that is because we are

58:25

like two different subtypes

58:28

of the same species. And we have

58:30

to consider the hormonal aspects,

58:32

I think, specifically when

58:34

we consider ADHD, because hormones

58:36

have a lot of

58:38

cognitive effects. Absolutely.

58:41

Such an important

58:43

reminder. We received a lot

58:45

of questions today about whether,

58:47

again, there's research on the

58:49

impact of contraception, birth

58:52

control in adolescent girls

58:55

with ADHD. And

58:58

we know that the comorbidity with PMDD

59:01

is so high. Is there

59:03

any research one

59:05

way or the other? Yeah. So we

59:07

did one study where we showed that women

59:11

with ADHD are five times more

59:13

likely to develop depression following hormone

59:16

oral contraceptives. However, what we saw

59:18

that there was no difference between

59:21

progesterone pills only or combined pills.

59:23

So we don't think that it

59:25

is the absolute level of hormone

59:28

that is important, but rather that

59:30

females with ADHD, due to their

59:32

ADHD, might forget to take their

59:34

pills or take them more irregularly.

59:37

So there will be fluctuations again. And

59:39

that is something that we see and

59:41

that we are going to follow up

59:44

in future studies. That we think that

59:46

it's not the hormones per se or

59:48

the actual hormonal levels, but when hormones

59:50

change, that is

59:53

especially bad for

59:56

neurodiverse women and

59:58

girls. So in And that's also what we

1:00:00

see during the lifespan,

1:00:03

right? That in periods where

1:00:05

hormones are fluctuating or changing,

1:00:07

in puberty, after birth,

1:00:11

postpartum, and in

1:00:13

pyraminopods, across almost 10

1:00:15

years across pyraminopods, when hormones

1:00:17

again. I usually

1:00:20

say, once you finally start understanding

1:00:22

your hormones, then they start changing

1:00:24

again. No, so it's a

1:00:26

huge part of life where

1:00:29

our hormones are actually unpredictable

1:00:31

to us. And

1:00:34

I know we're out of time, but I

1:00:36

have to throw in one last question because

1:00:39

it's just so pertinent here. And that is,

1:00:42

we've been hearing a lot

1:00:44

at Attitude about very new

1:00:46

thinking regarding the ADHD

1:00:48

medication use and how it

1:00:50

may be adjusted to accommodate sort

1:00:56

of the hormonal monthly cycle. Is

1:00:59

there any research that you know that's

1:01:01

going on? And do you see this

1:01:03

as something that we will probably see

1:01:06

more of in the coming years, the

1:01:08

recognition that your dosage may need to

1:01:10

change? Definitely.

1:01:13

So there's a very limited research. There's

1:01:15

only, to my knowledge,

1:01:18

one observational study just

1:01:20

published by Sandra Coy and her

1:01:22

research group. However, this is

1:01:24

something that we see in our clinic all the time,

1:01:26

and that is, that I, usually

1:01:29

I work a lot with cyclic

1:01:31

dosing. So that is definitely

1:01:33

something that we will see more, but

1:01:36

also that's something that we need to

1:01:38

research more thoroughly. So we are

1:01:40

doing, our research group are doing a lot of studies

1:01:42

on this. Hopefully, you will

1:01:44

see them published in a year or

1:01:47

so because research takes time. But while

1:01:50

waiting for research, you should ask

1:01:52

your clinician, what do you know

1:01:54

about this? Can we

1:01:56

educate ourselves together? Can we see how

1:01:59

this is? laying out for

1:02:01

me in my hormonal life.

1:02:03

So don't wait for us

1:02:05

researchers, but hope for us

1:02:07

because we will come

1:02:10

with the evidence in a while,

1:02:12

but it takes some time. So

1:02:14

just start educating yourself and make

1:02:16

sure that you know how hormones

1:02:18

affect you. Dr.

1:02:21

Skoglin, I cannot tell you

1:02:23

how much we appreciate this session.

1:02:25

It really was just mind

1:02:29

blowing. I

1:02:31

really, really

1:02:34

appreciate your contributions, not only to

1:02:36

the attitude community, but to this

1:02:38

whole field of understanding

1:02:40

and being able to help better

1:02:43

women with ADHD. So thank

1:02:45

you from the attitude team. Again,

1:02:49

thank you for having me. It's

1:02:51

a huge honor, thank you. And

1:02:54

thank you to everyone who attended here today.

1:02:57

Please know that you will receive

1:02:59

a replay link for

1:03:02

this video as well as a copy

1:03:04

of the slides. And we encourage you

1:03:06

to share both of them with

1:03:09

your treatment team. And

1:03:12

we hope that you will join us as

1:03:14

well for another Attitude Webinar in

1:03:16

the future. Our next one is on

1:03:18

living with ADHD in year 20. So

1:03:22

please join us again. Sign up

1:03:24

at attitudemag.com/newsletter so you don't

1:03:26

miss a thing. And we

1:03:28

will see you again soon. For

1:03:33

more Attitude podcasts and information on

1:03:35

living well with attention deficit, visit

1:03:38

attitudemag.com. That's

1:03:41

a-d-d-i-t-u-d-e-m-a-g.com. Thank

1:03:51

you.