Dr. Jeremy Sharp (00:35)
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Dr. Jeremy Sharp (01:20)
Hey everyone, welcome back to the podcast. I’m glad to be here with you and thrilled to share my guest with you today. My guest today is Dr. Kathleen Nadeau. Kathleen is a world renowned pioneer in the field of ADHD. She has a career spanning over four decades and was inducted into the Chad Hall of Fame in 1999 for her groundbreaking work with girls and women. Most recently received the Chad lifetime achievement award in 2025.
As the founder of the Chesapeake Center and now the creator of the Institute for Lifespan ADHD Training, she’s dedicated her life to moving beyond medical model of ADHD. Instead, she focuses on harnessing the creativity and energy and unique gifts of neurodivergent brains. Kathleen is a prolific author and a leading expert on helping high IQ individuals, women and older adults find the environments they need to truly thrive. So if you have not heard Kathleen on
other podcasts, media, et cetera. She is a true expert in the field of ADHD, like I mentioned. We’re talking today primarily about ADHD in girls, though we end up with a wide raging conversation that covers many aspects of ADHD. So we talk about how our understanding of ADHD has evolved over the last 40 years or so. We talk about
how ADHD looks different in girls. We talk about the hormonal impact on ADHD as girls go through puberty. We talk about accommodations in the school environment that might be more applicable and helpful for girls. We talk about the importance of social skills and relationships for girls and many other things. So this is a true gift. Kathleen is, you know, like you heard, kind of a giant in the ADHD field.
and I feel very lucky to grab some time with her here today. So without further ado, here is my conversation with Dr. Kathleen Nadeau.
Dr. Jeremy Sharp (03:33)
Kathleen, hey, welcome to the podcast.
Kathleen Nadeau (03:36)
Thank you so much for inviting me. I’m looking forward to this conversation.
Dr. Jeremy Sharp (03:40)
Yeah, yeah, me too. Me too. I’m guessing our audience recognizes your name. You’ve been doing this work for a long time and have some, you know, lot of thoughts on ADHD and girls and knowledge to share with us. So yeah, honored to have you here. So I’ll start with a question that I always start with, which is why this, you know, out of all the things you could do with your career as a psychologist, why ADHD and girls?
Kathleen Nadeau (04:05)
Well, first of all, I do a lot more than just ADHD in girls, although specializing in understanding, diagnosing, treating girls is certainly a specialty that I’m known for. So I think the bigger question is why ADHD? And oddly enough, I would say that I’m an accidental ADHD specialist. And the reason I say that is many, many years ago was
Dr. Jeremy Sharp (04:22)
Mmm.
Okay.
Kathleen Nadeau (04:31)
When I was a grad student, ADHD held absolutely no interest for me, but that’s because we didn’t know really much about it. And so at that point in time, ADHD only applied to sort of hyperactive, misbehaving little boys. We mistakenly thought it was almost entirely boys. We mistakenly thought you outgrew it at puberty.
Dr. Jeremy Sharp (04:49)
Mm-hmm.
Kathleen Nadeau (04:56)
And we mistakenly thought it was all about hyperactivity and impulsivity. So we knew so little then and believe me, I was not wanting to spend my entire career helping parents deal with misbehaving, hyperactive, elementary school-aged boys. That did not sound like an interesting career direction to me. And…
I’ve really evolved as a psychologist in the field of ADHD. I was drawn into it when I say accidentally. ⁓ When the public law in the late 70s was passed requiring schools to provide supports and accommodations for students with ADHD, suddenly my phone began ringing off the hook because parents were calling pediatricians, pediatricians
Dr. Jeremy Sharp (05:26)
Hmm.
Kathleen Nadeau (05:46)
in those days were not well trained to diagnose ADHD. we, back then we called it ADD, Adversity Disorder. And so they were calling me saying, we don’t know how to diagnose it, do you? Well, yes, we do. I was in a group practice. And so suddenly we were inundated with so many requests for assessments that we formed.
Dr. Jeremy Sharp (05:54)
Mm-hmm.
Kathleen Nadeau (06:11)
a little division within our small group practice, I and another person that had a background in school psychology. So that’s how it began. And the referrals were all for elementary school aged boys at that point in time. And all we were doing was diagnosing them basically so that they could then be put on Ritalin, which was pretty much the only stimulant available in those days. And that was the very beginning.
What began to intrigue me as I talked with these families is that so many of the parents that I talked to said I was just like that as a kid or my husband was just like that as a kid. And in fact, I or he still have a lot of these issues. It became very evident to me very quickly.
Dr. Jeremy Sharp (06:55)
Mm-hmm. Mm-hmm.
Kathleen Nadeau (07:00)
that this is not something that we outgrow. It’s something that morphs and changes. mean, grownups are not standing on top of desks and throwing spitballs for sure. There are adult manifestations of these very same issues. And at that point in time, we didn’t recognize that. We called it residual. A few poor souls still seem to have it, but most people outgrew it.
And I’ll tell you a funny story. One of the reasons we thought we outgrew it is somebody did a study asking the young adults themselves about their symptoms. And they all reported that, no, no, I’m good. I’m cool. I don’t have those problems anymore. It was, you know, poor self observation and denial going on, but we believed them for a while. Pretty crazy. So,
Dr. Jeremy Sharp (07:42)
You
Mm-hmm.
Kathleen Nadeau (07:52)
I started working from that perspective in the very first book I ever worked on. I’ve now, I’m publishing my 18th book. It’ll come out next month in the middle of June. My very first book was an edited book about ADHD and adults. And it was one of the very first books that came out. And I invited…
Dr. Jeremy Sharp (08:04)
Yeah.
Kathleen Nadeau (08:15)
anybody and everybody that I could find that had done some writing, some research on adult ADHD. And that was the beginning of the explosion. That was in the mid-90s. And suddenly adult ADHD was on the cover of magazines, big articles, and the Wall Street Journal, the New York Times, kaboom, hey, adults have it too. And a book, which a lot of people know about, called Driven to Distraction came out.
which was for the general public. My book was for fellow professionals. So there was that explosion. And I remember having lunch with a colleague in the mid-90s. I was at a conference in New York City. She and I went out to lunch together. And so she said, well, Kathleen, now that you’ve finished your book on adult ADHD, what’s your next project? And literally,
Dr. Jeremy Sharp (08:48)
Mm-hmm.
Kathleen Nadeau (09:09)
in the course of that conversation, she and I had worked with many females as well as males, said, we need to write a book about understanding girls with ADHD. And that literally became the name of our book. And so three women wrote that book. Then we wrote a book called Understanding Women with ADHD, which was the sequel to it.
And that was a real explosion. And Pat Quinn, one of my co-authors and I, won the Chad Hall of Fame Award in 1999 for our work on women and girls. And so I think from that point on, I’d done a book on adult ADHD when nobody was paying any attention to that, and then on girls and women. And I’ve really kind of taken on the role of
Dr. Jeremy Sharp (09:48)
Hmm.
Kathleen Nadeau (10:03)
Who are we ignoring? Who should we turn our attention to? Everybody knows about boys and hyperactivity. And then people will like, yes, okay, they grow up and they’re still struggling. And there are still areas of the broader ADHD population that we’re ignoring. So five years ago, I wrote a book on older adults with ADHD. That group is still being largely ignored.
Dr. Jeremy Sharp (10:06)
I like that.
Mm-hmm. Mm-hmm.
Yeah.
Kathleen Nadeau (10:30)
I think there are many more segments of the population. think we’re really ignoring very highly intelligent adults with ADHD. In fact, most of them for years were told you can’t possibly have it. If you have a master’s degree, a doctoral degree, an MD, a law degree, you can’t possibly have ADHD, which we now know couldn’t be further from the truth, that you could be very bright and accomplished.
Dr. Jeremy Sharp (10:40)
Mm-hmm.
Kathleen Nadeau (10:58)
and have ADHD. So I continue in that vein to this day. It has continued to fascinate me and looking out in many directions and continuing to think more deeply about what is this. It’s much more complex than most people realize. I can’t sit down on an airplane without…
Dr. Jeremy Sharp (11:00)
Of course.
Kathleen Nadeau (11:23)
you know, starting to chat with somebody sitting beside me and, my son has it, my nephew has it, I have it, you know, yeah.
Dr. Jeremy Sharp (11:30)
Right. I’m
surprised you even talk to people on airplanes, to be honest, knowing that it’s just going to open up all those conversations. I mean, I think that’s a good that really leads to one of my my first questions, which is, know, you’ve seen, I think, such an evolution of our understanding over the years. And I’m curious, you know, from your standpoint, what you what you would say are some of the biggest
Kathleen Nadeau (11:33)
Ha ha ha!
Absolutely.
Dr. Jeremy Sharp (11:57)
maybe guideposts or the sort of like game changers that we found over the last 40 years, know, and thinking about ADHD that’s actually kind of changed the trajectory.
Kathleen Nadeau (12:09)
Well, there are lot of pivot points and there will be more because we’re learning much, much more about the brain. So one of the biggies was discovering predominantly inattentive ADHD. In fact, there was a huge debate over, this a completely different disorder? How can it possibly be the same disorder? You know, these are impulsive and hyperactive and these are daydreamers and you can…
Dr. Jeremy Sharp (12:14)
Mm-hmm.
Mm-hmm.
Sure.
Kathleen Nadeau (12:37)
Some of them don’t say a word, and yet it is the same disorder with different manifestations. And what we know now is that people can start out with hyperactive impulsive symptoms and yet as adults are predominantly inattentive, that it morphs and changes. So that was a giant game changer. Then when we got to adult ADHD,
Dr. Jeremy Sharp (12:55)
Mm-hmm.
Kathleen Nadeau (13:02)
There’s this giant debate about adult onset ADHD and is this, you know, is it just emerging in adulthood? And we had lots of debates about that for a number of years and we have basically concluded, and I will really credit Tom Brown who is recently deceased. I think he is just one of the, you know, mountains in
Dr. Jeremy Sharp (13:07)
Yeah.
Kathleen Nadeau (13:28)
ADHD world, had great respect for him. And one of the things he talked about is that ADHD is manifested when the demands of our circumstances are greater than can be met. And so the better you learn how to compensate, the more highly intelligent you are, the better you’re matched with your environment.
Dr. Jeremy Sharp (13:31)
Mm-hmm.
Kathleen Nadeau (13:54)
the less your ADHD will be manifested. And so we’ve worked with many women who were functioning very well and they’d been good students and they got out and they got a good job and then they had their first baby. And that just tipped them over the, can’t cope, I can’t cope. And one of the hallmark words that I find women using to describe themselves is I’m overwhelmed.
Dr. Jeremy Sharp (13:58)
Mm-hmm.
Yes.
Kathleen Nadeau (14:20)
And so the question is, at what point do you become overwhelmed?
Dr. Jeremy Sharp (14:20)
Yeah.
So great question. I think that really, I mean, it gets to the point that you were making earlier about, you know, highly intelligent individuals with ADHD. feel like, I don’t know, this is a real conundrum that we get into as practitioners around essentially the functional impact component, right? Like if we can’t see the impact, what do we do with that? You know, if you’re getting straight A’s through school or, you know, you’re doing well in your job.
if there’s no outward manifestation of that functional impact, how do we, how do we work with that? And
Kathleen Nadeau (14:57)
And I’ve got an answer for you. Because we’re looking at it way too simplistically. I remember talking to a fellow, I lived not far from the University of Maryland. And I over and talked to the head of student disability services there. And he was a gentleman in a wheelchair. And he said, I’ve got a real disability. You know, all this.
Dr. Jeremy Sharp (14:59)
I bet you do. Yes. Let’s, what you got?
Mm-hmm.
Kathleen Nadeau (15:21)
ADHD stuff. I mean, he had stuff and nonsense. I’ve got the real disability. But in talking to him, I thought of an analogy. And that is if somebody’s mobility is tremendously challenged and they’re on crutches or maybe even in a wheelchair, they could probably crawl up a set of stairs. It would take them a heck of a long time, but if they had to do it, they could probably get up there.
Dr. Jeremy Sharp (15:51)
Mm-hmm.
Kathleen Nadeau (15:51)
And if
all the teachers were looking at us, look, he’s on the first landing. What are you talking about? Where’s the disability? They hadn’t watched what he had to do to get there. Then maybe nothing was apparent. And I say that to teachers that what you’re not looking at is this student pulled two all-nighters to get this brilliant paper done because they couldn’t get themselves going to write it earlier. ⁓
Dr. Jeremy Sharp (16:03)
Mm-hmm.
You
Mm-hmm.
Kathleen Nadeau (16:19)
These students are working 10 times harder than their non-ADHD peers to accomplish the same thing. And I’ll tell you a story. I worked years ago with a physician. He was the head of his department at a big hospital in DC, very well known, widely published. And he’s exactly the kind of person, how could he possibly have ADHD?
And he told me that one day he was driving into the hospital on Saturday morning. He said, as I do every Saturday morning, because I can’t get all my work done during the week. so he’s driving down this beautiful parkway into the city and a guy comes back in the opposite direction with a kayak on the roof of his car. And he said, I thought to myself, I will never get to be that guy.
Dr. Jeremy Sharp (16:57)
Hmm.
Kathleen Nadeau (17:14)
The only way I can do what I do is to have no personal life. He said, my buddies, they’re on the golf course, they’re sailing their boat, they’re at their kids’ soccer game. I’m at the hospital because that’s the only way I can get my work done. And I think that’s, that we really need to look at what does it take to get where you’re going. And the other point that we need to make is what is your comparison group?
If you are very high IQ, you should be compared to other people that are in the 99th percentile, not to the average viewer. Of course you can do more than somebody with an average IQ if you’re in the 99th percentile. One of my favorite people in the world just finished her dissertation at age 64. And I was on her dissertation committee and listened to her defense and
Dr. Jeremy Sharp (18:05)
Ha ha ha.
Kathleen Nadeau (18:09)
brilliant. She herself has ADHD, she’s an ADHD coach. And I remember a number of years back saying, you’re way too smart to you. You should go on in school. She she’d never gone beyond college and she decided to do it. And her dissertation, I thought this was brilliant was on people with ADHD having difficulty completing their dissertation.
Dr. Jeremy Sharp (18:36)
wow. Talk about meta. That’s good.
Kathleen Nadeau (18:39)
And so she interviewed all these faculty members who had managed to complete their dissertation despite their ADHD. And then she was interviewing people that were struggling. And I’ve always said that if you got all the ABDs, know, all but dissertation people together in a giant stadium, you would have a giant collection of highly intelligent people with undiagnosed ADHD.
They got through all of that and they just didn’t have the executive functioning skills to complete the dissertation. So that’s what I tell when you say, is the disability? have to compare them to other people of likeability and you really need to look at what did it take them to accomplish that? How long did it take them to crawl up those stairs?
Dr. Jeremy Sharp (19:13)
Mm-hmm.
Mm-hmm.
Kathleen Nadeau (19:33)
compared to their same IQ peers.
Dr. Jeremy Sharp (19:37)
Yeah. Yeah. I love that example or that comparison, you know, the crawling up the stairs onto the landing. That’s that, that hits pretty powerfully. Yeah. I think it’s, you know, part of the, the difficulty maybe is that that also kind of forces us as practitioners to just to get below the symptoms. You know, we’re not just asking about symptoms. It’s, you know, kind of the qualitative experience and that gets a little murky sometimes for us, you know, cause we’re like out in the wild a little bit. And once we get away from those symptom guidelines,
Kathleen Nadeau (20:07)
But you know, it is murky and I’m glad you brought it up. I think the symptom guidelines, we’re trying to make something definable and exact that isn’t. It’s sort of like deciding what does beautiful mean?
Dr. Jeremy Sharp (20:19)
Yeah, it’s a great point.
Mm-hmm.
Kathleen Nadeau (20:26)
Let’s have a checklist of what beautiful means. I remember listening a fellow named Hans Lucas Toyberg, who is the father of neuropsychology. He was a professor at MIT. And when I was a grad student, I went to the University of Florida and he came to speak at the medical school. And I just…
Dr. Jeremy Sharp (20:29)
Sure. That’s a good way to put it.
Hmm.
Hmm.
Kathleen Nadeau (20:48)
sat there agog, here’s this Titan, you know, coming to lecture to us. And he started his lecture with a very simple statement, which was our brains are as different as our faces. And we’re trying to put people into these tiny little boxes. And I think that has more to do with the law than with understanding the brain.
Dr. Jeremy Sharp (20:53)
Yes.
Yeah.
Kathleen Nadeau (21:12)
And the more I do this, the more I believe that we ought to think of brains the way we think of faces and fingerprints.
Dr. Jeremy Sharp (21:22)
Completely unique, Yeah.
Kathleen Nadeau (21:23)
Yeah. And,
you know, we can’t smart, medium dumb. That doesn’t make sense. I mean, some people are brilliant in one set of skills and absolutely incompetent in other sets of skills. I mean, my husband is an astrophysicist, ask him to write a sonnet and he’s lost.
Dr. Jeremy Sharp (21:30)
Hmm.
That
sounds like an interesting house. Nice.
Kathleen Nadeau (21:46)
Yeah, absolutely.
So we need to think in a much more complex and nuanced way and we need to get away from the medical model. I mean, the medical model is based on health and illness.
Dr. Jeremy Sharp (21:58)
Mm-hmm.
Mm-hmm. Mm-hmm.
Kathleen Nadeau (22:06)
And Hans-Lucas Tordberg was not talking about functioning brains and poorly functioning brains or neurotypical versus neurodivergent. The neurotypical baffles me because I’ve never heard a single parent say, I want my child to be average, dead average. That’s what we’re, I mean, that’s not what they’re going for.
Dr. Jeremy Sharp (22:31)
Yeah, yeah, that’s true.
Kathleen Nadeau (22:33)
But that’s what neurotypical means, average.
Dr. Jeremy Sharp (22:36)
Sure. Yeah, fits in the box. Yeah. Oh my gosh. There’s so many directions. Maybe I’ll hone in on this diagnostic criteria theme and we can keep going with that. first of all, just reflecting, it’s kind of amazing. Like you wrote a book, you said in 99 about girls, or know, girls in ADHD. And it feels like, I mean, we’re almost 30 years down the road and it still feels like uncharted territory or something. Like we,
like we still don’t understand a whole lot about it. And so maybe there’s a discussion about diagnostic criteria in there and you know what’s what’s going wrong with that or you how are we missing these girls like why and women you know why why is this a thing that we continue to talk about and misunderstand.
Kathleen Nadeau (23:22)
Well,
I think we’re still wondering because I think the medical profession as a whole is very conservative, very loath to change. And a lot of research is dependent upon not changing the diagnostic criteria. If I did all this research based on these criteria, by God, I don’t want them to change. Does that invalidate all my research? And I remember
Dr. Jeremy Sharp (23:31)
Mm-hmm.
Mm-hmm.
Mm-hmm.
Kathleen Nadeau (23:51)
Years ago, I had a panel at APSARD and for your listeners, APSARD is the American Professional Society for Attention and Related Disorders. And if you’ve ever wondered what a name created by a committee would be, it’s APSARD.
It took me years to remember what the heck does that stand for? Sometimes I call it absurd, but at any rate, I organized a panel about women with ADHD, and this was 25 years ago, at least. And so I invited the very few researchers on women that were there and Dr.
Dr. Jeremy Sharp (24:11)
Yeah. Yeah, that fits too.
Kathleen Nadeau (24:28)
Joseph Biederman, who is no longer with us, and he is of course a luminary in the field of ADHD, said, Kathleen, I’ve done research on girls. I should be on that panel. I said, okay, Joe, come on, be on the panel. So it was all women and Joe. And then we had Q &A at the end and several women stood up and said, is there any evidence that hormonal fluctuations, this was a long time ago, impact
Dr. Jeremy Sharp (24:55)
Mm-hmm.
Kathleen Nadeau (24:56)
symptoms because they sure seem to impact my symptoms. And I said, absolutely. It’s very well known that, and we know why, because estrogen levels impact the sensitivity to dopamine and serotonin. That’s why. That’s why the moodiness of the menstrual cycle, and of course it relates to ADHD. So.
then Joe says, excuse me, there is absolutely no evidence that hormonal fluctuations impact ADHD symptoms. And I thought to myself, I didn’t say it, but I thought to myself, absence of evidence is not evidence of absence. All you’re saying is nobody has bothered to do the research on that. But us clinicians out here working with people,
Dr. Jeremy Sharp (25:28)
You
Mm-hmm.
Kathleen Nadeau (25:49)
and know, and Joe was primarily working with little girls who hadn’t even reached puberty at that point, didn’t have the clinical experience. And he was absolutely right. The research hadn’t be done, hadn’t been done. But I was absolutely right that yes, I work with women and you better believe it impacts ADHD symptoms along with symptoms of anxiety and depression, which is well known, which is well known.
Dr. Jeremy Sharp (26:13)
Yeah.
Yeah, yeah, certainly. That’s funny you mentioned that. think I read a headline just this morning. It was another article about how estrogen influences ADHD presentation in dopamine. Yeah.
Kathleen Nadeau (26:23)
yeah, it’s all over the place. But interestingly,
I would say the majority of the research is being done outside of the United States. And almost all of it’s being done by women.
Dr. Jeremy Sharp (26:30)
Mm-mm. Mm-hmm.
Mm-hmm. Not surprising. Not surprising. My gosh. Yeah. I love that story. Of course, it’s the man that stands up and says there’s no evidence of hormone. Yeah.
Kathleen Nadeau (26:36)
Not surprising.
However, and he was right,
literally, the research has not been done. That’s true.
Dr. Jeremy Sharp (26:49)
Well,
sure. So let’s talk a little bit more. You know, let’s get into some detail with, you know, this ADHD in girls. And I guess, you know, we’ll focus, I guess, on younger girls or adolescent girls, but very maybe basic question to start off. But I would love to hear, you know, your perspective on how ADHD looks different in girls and what we know, you know, on the whole or how it manifests different.
Kathleen Nadeau (27:11)
Absolutely, it looks different in girls because girls look different than boys. I mean that in a very general way. mean we know that nothing to do with ADHD, boys are more active than girls. We know boys are more aggressive than girls. We know girls are more social.
than boys. mean, if you just look at the general population, and so it’s an overlay that here we have these differences between the genders, and then you add ADHD to the equation. And so I would say that the main struggles that girls experience, and of course there’s overlap, I’m talking in generalities, and of course there’s overlap. There are shy, inattentive boys whose experience is more like the girls, and there are
hyperactive, more aggressive girls. We don’t need to get involved in that. I’m just talking in generalities. But Steve Hinshaw at the University of California, he was the head of the psychology department there for years, had a summer camp on campus for girls. And it was a living laboratory for him and his grad students to study.
Dr. Jeremy Sharp (28:03)
Of course.
Kathleen Nadeau (28:25)
girls with ADHD. However, they didn’t know that they were being studied for ADHD. And the summer camps included, you know, faculty kids, you name it, it was a day camp. And half the girls had ADHD and the other half didn’t. And Steve Hinchaw and his grad students were there carefully observing the interaction among these girls. They were
Dr. Jeremy Sharp (28:27)
Mm-hmm.
Kathleen Nadeau (28:50)
getting girls to draw social networks, like who do you feel closest to? Who are the three people you’re closest to? Who do you feel least close to? So they were sort of creating social webs of connection among all the girls. And some fascinating, but troubling results came of that. And that is that in general, girls with ADHD, whether they’re inattentive or hyperactive,
have a lot of trouble connecting with non ADHD girls. And they have trouble connecting for very different reasons depending on how their ADHD is manifested. So that the more hyperactive girls might be seen as loud, intrusive, bossy, demanding, we’re gonna play this game or we’re gonna play it my way or just bursting in and interrupting a conversation to.
Dr. Jeremy Sharp (29:21)
Mmm.
Kathleen Nadeau (29:46)
say whatever. So they were having a lot of trouble with regulation, physical and emotional regulation. And Hinshaw described them as being socially rejected. You know, we don’t like Molly. She’s mean, she’s bossy, she hits people, whatever. And then they’re the quiet and attentive type. And he described them as being socially neglected. I thought that was a very good term.
that nobody disliked them, they were just not included. They didn’t know how to join into group interactions. They were shy. They sort of couldn’t keep up. Girls’ verbal interactions, as a psychologist, I don’t have to tell you, are complicated and fast-paced and clicky and political.
Suzy and I don’t like Molly and so we’re going to leave her out and are you going, you know. And so the social interactions amongst girls in elementary school are much more complex than the social interactions amongst boys. mean, boys are much more involved in parallel play. Hey, let’s go kick a ball, throw a ball, do something active. They’re not
Dr. Jeremy Sharp (30:48)
Mm-hmm.
Kathleen Nadeau (31:00)
forming cliques and saying, Jim, let’s not speak to Tommy. I mean, that would be almost unthinkable. wouldn’t.
That’s not on the radar.
Dr. Jeremy Sharp (31:09)
Right? Yeah.
Sure. Sure. Yeah. I mean, this, feel like I’ve had a front row seat to this. You know, I have a 13 year old daughter, 14 year old son, and our daughter, you know, was diagnosed with ADHD when she was nine, maybe. And she did fall on, you know, that more hyperactive impulsive side. And so we saw a lot of that, you know, like she’s too wild, she’s too loud, she’s too bossy. And it’s thankfully gotten better as she’s gotten older, but you know,
possibly because she’s connected with other girls who maybe share some of those characteristics. And I think her brain’s coming online a little bit. she’s regulating a little more.
Kathleen Nadeau (31:43)
Absolutely.
And a lot of what I have done over the years with parents is what I call social engineering of let’s look for places where your kiddo is going to fit in there. And I’ve had lots of luck with more hyperactive girls fitting in very well with
Dr. Jeremy Sharp (31:57)
Hmm.
Kathleen Nadeau (32:05)
horseback riding and a lot of parents automatically say, that’s for the elite. I can’t possibly afford that. But there are plenty of girls that go over and muck out stalls and get permission to ride a horse that nobody’s riding at that moment and just love the physicality of being around horses and that everybody there is what you might call a tomboy.
Dr. Jeremy Sharp (32:17)
Hmm
Kathleen Nadeau (32:32)
They don’t have to be
Dr. Jeremy Sharp (32:32)
That’s great.
Kathleen Nadeau (32:33)
neat and tidy and prissy. They can be themselves. I think there are a lot more opportunities now for girls to be physical and more aggressive because girls are more involved in sports. that’s a great place to learn to control your physicality. You can be very physical, you can be aggressive, but there are limits or you’re gonna be called a foul. So.
Dr. Jeremy Sharp (32:46)
Absolutely.
Mm-hmm.
Mm-hmm.
Right.
I love that. I love that.
Kathleen Nadeau (33:01)
So in
ways it’s easier for more hyperactive girls. But working with women, it’s an almost universal statement that women will say, I knew I was different from other girls. I just didn’t know why. just didn’t fit in. I just didn’t fit in.
Dr. Jeremy Sharp (33:19)
Mm-hmm.
That’s interesting. Yeah. I, you know, I think of that, dynamic of, you know, ADHD girls getting along with other ADHD girls better. you know, I hear that in the context of autism a lot, you know, we talk about sort of the double empathy problem and you know, how autistic individuals don’t really have that when they all get together, you know, and, but I’d never heard it in the context of ADHD. It does kind of make intuitive sense, but it’s nice to hear you articulate that clearly that there’s some research.
Kathleen Nadeau (33:49)
Absolutely.
And I think…
I think the therapy that we’ve done, the treatment that we’ve researched, in some ways is missing the boat that we’re trying to train people to not have ADHD.
Dr. Jeremy Sharp (34:02)
Mm, also.
Yeah.
Kathleen Nadeau (34:09)
And so
I’m always talking to people about a balance. Yes, you need to learn to remember better. You need to find ways to be more aware of the passage of time. You need to find ways to remind yourself to follow through on multi-step tasks or projects. No question, if you’re gonna be successful. But you also…
just as importantly need to look for environments where you’re gonna naturally fit in better, where you don’t have to not be yourself all the time. And I think one of the most exhausting things growing up as a girl with ADHD is that the masking of ADHD begins in kindergarten.
Dr. Jeremy Sharp (34:45)
Mm-hmm.
Hmm.
Kathleen Nadeau (34:57)
mean,
girls don’t want to get in trouble. They don’t want their teacher to be mad at them. They don’t want the other girls to be mad at them. And it’s exhausting to constantly be trying to check yourself so that you don’t get criticized or rejected. And I think girls as a gender, and I know a lot of people are gonna say, you can’t make these generalizations about gender well.
Dr. Jeremy Sharp (35:07)
Mm-hmm.
Kathleen Nadeau (35:22)
I’m sorry, but you know, I live on planet Earth and there are gender differences in every animal I’ve ever looked at. I don’t think we’re any different. You know, that I really don’t think elementary school boys are that worried about. I don’t know what page we’re on or this is done. This is boring. I’m not going to study for that stupid test. They they’re not as worried about it.
Dr. Jeremy Sharp (35:32)
Mm-hmm.
Sure.
Kathleen Nadeau (35:49)
where’s the girls
Dr. Jeremy Sharp (35:49)
Yeah.
Kathleen Nadeau (35:50)
are.
Dr. Jeremy Sharp (35:52)
It makes sense to me how masking or camouflaging comes into play with hyperactive or impulsive girls. Like that feels like a very, like kind of heavy cognitive process to like tamp that down. I’m curious, how do you see masking or camouflaging coming up with the inattentive girls? Cause that almost feels, you know, they’re already kind of like flying under the radar. They’re not like, you know, they’re not really rocking the boat. Like what does, what does it look like for them?
Dr. Jeremy Sharp (37:36)
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Kathleen Nadeau (38:41)
it’s a constant struggle. They don’t want to be embarrassed. They cringe if the teacher’s calling on them. I’m going to sound so stupid and I wasn’t listening. What are we doing? What page are we on? I did my homework, but I forgot to bring it. I mean, they’re just, you know, all that forgetfulness and inattention. You see a lot more school avoidance in girls. I don’t feel good. Can I stay home? Because
Dr. Jeremy Sharp (38:45)
Hmm.
Mmm.
Kathleen Nadeau (39:08)
school is stressful. School is stressful. And I was a hyperactive girl growing up in the South. And I had the good fortune of being a sister between two brothers and we you know, the three of us just hung out and you know, got dirty and threw balls at things. So that was fine at home. But I remember, you know, in the South, the pressure to be
Dr. Jeremy Sharp (39:10)
Yeah, that makes sense.
Kathleen Nadeau (39:33)
a young lady to be polite and tidy and quiet and is so great. And I remember coming in from the playground in fifth grade and one of my knees was bleeding because I played hard on the playground and I skinned my knee. And I came in and told the teacher, I need to go to the nurse and get a bandaid or something. And she said to me, do you know, if you keep skinning your knees like that, you’re going to have
permanent scars and no one will ever marry you. I mean, that was a very direct quote from my fifth grade teacher who spent an awful lot of time looking at herself in the mirror of her cosmetics case. So no one was going to marry me if I had scarred knees. So there’s a lot of pressure.
Dr. Jeremy Sharp (40:06)
talk about a message.
Kathleen Nadeau (40:24)
whether you’re shy and inattentive or hyperactive. But there’s another set of issues and that is a very poignant poem that was given to us and we included it in our book, Understanding Girls, was titled, I Wish My Mother Had Known and it was written by a woman who was diagnosed as an adult with ADHD and her mother had been a teacher and just.
Nobody knew about Girls with ADHD as she was growing up. And she talked in that poem about, wish you understood why it was so hard for me to keep my room tidy. I wish you had helped me because I was going to school with my shirt button drawn, or my clothes didn’t go together very well, or I forgot something.
Dr. Jeremy Sharp (40:53)
Mm-hmm, yeah.
Hmm.
Kathleen Nadeau (41:17)
critical, you my jacket’s still at school and it’s cold, that I just couldn’t keep my act together and all I got was criticism for it rather than understanding. Yeah.
Dr. Jeremy Sharp (41:28)
⁓
yeah, yeah. What do you think, you know, we get a lot of, let’s see, unremarkable, let’s say teacher reports from the girls that we are working with. I mean, what do think teachers are missing in school, you know, with girls these days who have ADHD? Like, should we be looking
Kathleen Nadeau (41:48)
Well,
I have written a questionnaire for elementary school teachers to better identify girls. I have given that questionnaire to the Center for Girls and Women with ADHD at Duke, and they are planning to develop norms and validate it.
Dr. Jeremy Sharp (41:51)
Yes.
Kathleen Nadeau (42:07)
and I’m sure it’s gonna take a number of years to go through the whole process, but that’s exactly why I wrote it. And I want this to be a questionnaire that’s just in the public domain. So there’s no question about, we can’t afford to use that. mean, you can’t afford not to use that. Here it is. Please use it. And it’s telling teachers, a girl come in frequently late? Does she seem…
Dr. Jeremy Sharp (42:24)
That’s great. Yeah.
Mm-hmm.
Kathleen Nadeau (42:37)
disheveled, does she always seem to need to borrow a pencil from her neighbor? Does she often not quite know what she’s supposed to be doing at the moment? Does she have trouble finishing seat assignments in time? She’s still working on it and everybody else is turning it in. Just a long list of things like that, ⁓ which are noticed by teachers but may not at all be attributed to ADHD.
Dr. Jeremy Sharp (42:57)
Mm-hmm.
Yeah, yeah. Well, and some of those questions go beyond the kind of standard questions, think, on our the measures that we’re currently using.
Kathleen Nadeau (43:13)
Absolutely. Does she seem shy? Does she have trouble integrating into the social groups in the class?
Dr. Jeremy Sharp (43:21)
Yeah, yeah, that’s great. Well.
Kathleen Nadeau (43:23)
So there are
lots of things for teachers to be aware of. And I think there’s real interest among teachers. I introduced my questionnaire to a private school in Baltimore that asked me to come on one of their teacher training days. There was a lot of interest because if families can scrape together the money to do it, there are a lot of girls with undiagnosed ADHD in private schools, Catholic schools.
non-religious schools because the parents are looking for smaller classrooms and more structure and support, knowing their daughter needs something and that they’re not going to survive very well in the public school system.
Dr. Jeremy Sharp (44:05)
Yeah, yeah, that makes sense. Well, I know folks are probably excited to hear about this questionnaire and hopefully there will be an announcement when it comes out and we’ll be able to find it. Yes. Let me, I want to ask you about the hormonal topic. We alluded to that earlier, talked about it a little bit, but with adolescent girls, what’s the impact from going through puberty? Like how does ADHD shift or change?
during puberty for
Kathleen Nadeau (44:31)
Well, puberty is a very common time for girls to be diagnosed because all of the masking and all of the lack of good teacher training that keeps them from being diagnosed ⁓ in elementary school. There is a big crunch that occurs when girls enter middle school because yes, they’re going into puberty, but they’re also going into middle school.
Dr. Jeremy Sharp (44:36)
Hmm.
Mm-hmm.
Mm-hmm.
Kathleen Nadeau (44:57)
And so all of a sudden they have five teachers instead of one or two. They have all kinds of homework assignments and the teachers are not coordinating those assignments. It’s up to you. Write it down. Keep track of it. So the demand for executive functioning just suddenly rises up. That’s number one. Number two, I don’t have to tell you the social interactions between kids in middle school are
Dr. Jeremy Sharp (45:09)
Right.
Kathleen Nadeau (45:24)
utterly different. mean, suddenly, you won’t just play with somebody because they happen to be sitting next to you. Kids are really sort of figuring out who am I in this cohort of age mates? And, you know, am I a jock? Am I a prissy princess? Am I a studious? I mean, you know, where do I fit in? Where do I belong? And it’s a complicated process. And here we are.
Dr. Jeremy Sharp (45:50)
Mm-hmm.
Kathleen Nadeau (45:54)
talking about girls who have always been wondering where they belonged. And now, now they’re wondering directly with their peers. And I think it’s infinitely harder with social media.
Dr. Jeremy Sharp (46:10)
100%.
Kathleen Nadeau (46:11)
I remember many years ago, I my kids are middle-aged, but when one of my daughters was in early high school, I remember she had a big fight with another girl. I don’t even remember what it was. And so that girl responded by having a sleepover party and inviting everybody in the group except her. And so then she responded, well, her birthday was coming up. I’m going to invite everybody but Tina.
to my party, you know, it was very local level. Well, now that stuff happens every day, every day online, where, I mean, it’s, it kind of amuses me that everyone has become their own PR agency, you know, so you can’t do anything without recording it and posting it, you know. And so you’re advertising, look how pretty I look, how many friends I have, how many parties I’ve gone to, look at me on vacation, look at
Dr. Jeremy Sharp (46:41)
Mm-hmm. Mm-hmm.
It’s true.
Kathleen Nadeau (47:09)
You know, we really have become our own PR agencies. And so you see that every day of look at all those people I’m in class with that got together and didn’t include me. And so I think social media is absolutely crushing vulnerable girls. I mean, there are many kinds of vulnerability, not just ADHD, but it’s much, much harder.
Dr. Jeremy Sharp (47:13)
Mm-hmm.
Kathleen Nadeau (47:36)
And so I’m always really trying to help girls figure out where do I belong? If I’m kind of nerdy and academic, then maybe it’d be good for me to work on the school newspaper. Or I worked with one girl who had ADHD and autism and she was terrified going into ninth grade. And…
Dr. Jeremy Sharp (47:45)
Mm-hmm.
Kathleen Nadeau (48:00)
I told her, do you know there’s a thing called It’s Academic? And she was a real good student nerd, worked hard. And she didn’t know because she hadn’t been to high school yet. And I said, I think you’re going to really enjoy that. And she joined them and they all had lunch together. So there wasn’t that awful, who am I going to sit with in the cafeteria? She had her tribe. And I think that really saved her.
Dr. Jeremy Sharp (48:15)
Yeah.
Kathleen Nadeau (48:27)
socially and emotionally during high school. That she didn’t fit in with the athletes and the cheerleaders and whatever, but boy did she fit in with the academic crowd. And I think it’s important to figure out who we are and where we belong and what we have to contribute. But gosh, I wish it weren’t done in such a brutally painful competitive.
Dr. Jeremy Sharp (48:46)
Mm-hmm.
Mm-hmm. Yeah, absolutely. Well, it’s not lost on me either that there is a lot of opportunity for let’s say impulsive behavior in social situations in middle school, know, like responding, know, firing off responses, you know, without thinking through them and you can, you know, kids can get themselves into a lot of trouble pretty easily.
Kathleen Nadeau (49:17)
It keeps going. I have just in the past two months worked with three families whose daughters with ADHD are in college and they were going through sorority rush freshman year, the same caddy competitive, you’re in, you’re out, you’re up, you’re down. And in all three cases, these girls had a few close friends.
Dr. Jeremy Sharp (49:26)
Mm.
No, guys.
Yep.
Kathleen Nadeau (49:44)
that didn’t have ADHD, you it might be a maid and a couple of girls down the hall. And then they start pledging sororities. And one case, one girl had two friends and the three of them pledged the same sorority and she didn’t get in because she was, which is very common among kids with ADHD, she was basically neurologically immature.
Dr. Jeremy Sharp (49:46)
Mm-hmm.
Hmm.
Kathleen Nadeau (50:10)
I mean, she hadn’t started dating. She didn’t drink. She didn’t party. She was perfectly nice girl, but she would have fit in better with 10th graders than college freshmen. And so her friends were selected by the sorority and she was not. And they immediately dropped her. Immediately dropped her and she was friendless and called her mother and she…
Dr. Jeremy Sharp (50:21)
Mm-hmm. Mm-hmm. Mm-hmm.
Kathleen Nadeau (50:37)
you know, just painfully limped through the rest of the year and transferred schools to somewhere else. ⁓ I just talked to my mother this week, same thing. And in her case, it wasn’t that she was shy or immature, it that she was very smart and confident and outspoken.
Dr. Jeremy Sharp (50:44)
Yeah, it’s brutal.
Kathleen Nadeau (50:57)
And she was not selected because you’re full of yourself. You think you’re so smart. you know, her, so again, she is leaving at the end of her freshman year, she is leaving that school and transferring and it’s becoming more the social competitiveness and conformity and intentional, you know,
Dr. Jeremy Sharp (51:03)
.
Kathleen Nadeau (51:24)
creation of envy, ⁓ in many ways by falsely presenting yourself as having this fabulous life.
Dr. Jeremy Sharp (51:26)
Yeah.
It’s so bad. It’s so bad. Yeah. I mean, I’m grateful right now. You know, our kids, we’ve kept them off social media up to this point and hope to do so for a couple more years. But yeah, it’s just, hard to be a human these days, you know, and it’s hard to be young. And I think especially be female. Like that’s what the research says, right? Like social media is worse for girls. Yeah. It’s not good. So do we know what? go ahead. Do we know?
Kathleen Nadeau (51:48)
It is.
Yes.
Absolutely. ⁓
Dr. Jeremy Sharp (52:00)
a lot about the actual like kind of you know, fluctuations so to speak of ADHD symptoms through the hormonal cycle. mean are there, ⁓ is there something to that that we could pay attention to?
Kathleen Nadeau (52:08)
yes, absolutely. ⁓ there’s absolutely
something to it. And we’ve always known that girls became moodier, more tearful, more irritable, and that absolutely is related to lower estrogen levels. And some brains seem to respond much more intensely to that.
Dr. Jeremy Sharp (52:25)
Mmm.
Kathleen Nadeau (52:34)
up and down regulation throughout the month than others. And so we’ve always known that it impacted anxiety and depression, but what we hadn’t paid any attention to is for the very same reason, it impacts ADHD symptoms. And that’s because estrogen hugely impacts the sensitivity of receptors of serotonin and dopamine, mood and attention.
Dr. Jeremy Sharp (52:36)
Mm-hmm.
Mm-hmm. Mm-hmm.
Kathleen Nadeau (53:02)
there’s a
very good reason for that. And so I think some really informed physicians are now increasing doses of stimulants during that month, the lowest estrogen week. Some, if they’re on an SSRI for anxiety or mood issues, they may increase the dose. It’s now becoming more more recognized, this is very real. And
as if they weren’t already having trouble, now they’ve got another.
Dr. Jeremy Sharp (53:33)
Another thing, yeah, to keep track of. Yeah, I hear you. Maybe we turn our conversation toward the assessment process, or the clinical process, I suppose. My audience is largely psychologists and neuropsychologists doing assessment. so we’re always wondering, how can we update our assessment process to catch more of these kids that we might be missing? So maybe we start with the intake. I mean, do you have thoughts on?
Kathleen Nadeau (53:34)
fluctuation to deal with. Yeah.
Yeah.
Dr. Jeremy Sharp (54:00)
you know, questions we could be asking differently or different questions to ask that might help cast a wider net.
Kathleen Nadeau (54:07)
Absolutely. I and my co-authors developed a girl’s self-report form many, many years ago. And there have actually been a couple of dissertations studying that self-report form, but it has never made it into the mainstream. And our whole focus was, if you think about the questionnaires that we psychologists use,
Dr. Jeremy Sharp (54:21)
Thanks.
Kathleen Nadeau (54:31)
They’re usually parent report and teacher report. We’re asking them about observable things when ADHD in girls is primarily an internalizing disorder. And so why aren’t we asking the girls what’s going on? So that’s what led us, and the questionnaire is available in the back of understanding girls with ADHD.
Dr. Jeremy Sharp (54:36)
Mm-hmm.
Mm-hmm.
Kathleen Nadeau (54:58)
which, so I think that our intake should focus much more on the girls and asking them very specific questions because of course they don’t know what’s ADHD and what’s something else. I mean, they’re just living their lives and that’s why we, we wrote the questionnaire. and so there are a lot of questions in there about their feelings in relationship to other girls, their questions.
of I get nervous when I think the teacher is going to call on me. I have trouble staying organized. I always seem to be forgetting something to take to school or forgetting to bring home the permission slip to ask my mom to find it. You know, there’s always a rotting banana on top of the permission slip in the bottom of my backpack, you know, because I didn’t unpack my backpack. You know, that just
Dr. Jeremy Sharp (55:46)
my gosh. Yeah.
Kathleen Nadeau (55:53)
keeping track of just the daily stuff of life is so much harder for girls. And I think it’s especially hard for them when their mother does not have ADHD.
And there’s a real pattern, clear pattern of men with ADHD tend to marry very organized women with excellent executive functioning skills. They marry their executive functioning system, which is kind of hard. Yeah, exactly. So think about it. So this couple gets married and then they have kids with ADHD. Well, that mom
Dr. Jeremy Sharp (56:21)
I’ve seen that so many times. Yeah.
Kathleen Nadeau (56:32)
not only doesn’t have ADHD, she’s hyper organized and she really values being organized and focused and knowing what time it is and remember to take your cleats and you’ve got a dental appointment this afternoon, da da da da da da da da da. And studies have shown that moms are a lot harder on their daughters than their sons.
The boys in elementary school get a lot of leeway. they’re gonna put their feet on the couch. You know, they’re gonna kick the soccer ball in the house even though we’ve told them not to. They’re gonna be noisy. That’s just boys. That’s just boys. And that tolerance is not extended to girls because our job is to raise well-behaved, organized.
Dr. Jeremy Sharp (57:04)
Mm-hmm.
Kathleen Nadeau (57:17)
orderly non ADHD daughters. And so there’s a lot more criticism of girls when their mother does not have ADHD. I don’t think that’s been studied nearly enough, but it’s very, very much a phenomenon. The other phenomenon that’s important for psychologists to know in terms of what to ask about in intake is
Dr. Jeremy Sharp (57:27)
Mmm.
Mm-hmm.
Kathleen Nadeau (57:44)
Does your daughter come home from elementary school?
irritable, just ready to explode over nothing. You know, my sister took my shoes or where’s my brush or who ate the last donut? It doesn’t matter what it is. They’re just ready to lose it. And so the poor mom often gets blamed for that because the teachers say, no, she’s a perfect angel in class all day. Well, think what it’s costing her to be that.
perfect angel in class all day. so, safer to lose it at home. And so, this screaming Mimi gets off the bus.
Dr. Jeremy Sharp (58:20)
Mm-hmm.
Yeah, that sounds familiar too.
Kathleen Nadeau (58:29)
and moms don’t know what the heck’s going on. So we teach elementary school girls about having a calm down corner. And some moms have created wonderful calm down corners. In fact, I’ve even had moms pull everything out of their closet and put it in a wardrobe and drawers so they can, the closet can be their.
Dr. Jeremy Sharp (58:33)
Yeah.
Mm-hmm.
Kathleen Nadeau (58:54)
safe space, their secret space, and make it really cool and really comfortable with their favorite animals and pillows and music and lights and fix it up. And that’s where can go and just, you the world has been with me way too much all day instead of having that.
Dr. Jeremy Sharp (58:54)
Yeah.
Yeah.
Sure.
Kathleen Nadeau (59:14)
And so that’s
one problem. If the mom doesn’t have ADHD, she’s likely to not understand and be pretty darn intolerant of messiness. You know, I can’t believe the way your room looks, you’re not coming out of your room until you clean. And not knowing that cleaning up the room requires organizational skills she just doesn’t have and feels overwhelmed by.
Dr. Jeremy Sharp (59:35)
Yeah.
Kathleen Nadeau (59:38)
And the other pairing is, okay, mom’s got ADHD too. And so mom’s been fried by the day. And they both come home going, wow, one tired and hungry too. What do you think?
Dr. Jeremy Sharp (59:43)
Mmm.
Mm-hmm. Mm-hmm.
Yeah, yeah, this is this is the situation in our house. So if we could solve that real quick, that’d be great Kathleen, you know, help me figure that out. But it is
Kathleen Nadeau (1:00:00)
Well, I’m a
big fan and I think you need to have a calm down ritual. You need to eat, you need to have a cup of tea, you need to go cuddle your stuffed animals in your closet. You need to learn how to calm down.
Dr. Jeremy Sharp (1:00:18)
Yeah, yeah.
Kathleen Nadeau (1:00:19)
I’m talking to
a wonderful woman here in the DC area that has an arts program for neurodivergent kids after school. And she’s talking about they’re just totally fried by the time the school day is over. And how can we develop and teach them rituals of, of course, feed them. I mean, they’re starving, they’re thirsty, they’ve had it. They need to move.
Dr. Jeremy Sharp (1:00:35)
Mm-hmm.
Kathleen Nadeau (1:00:46)
And we’re going to be talking about possibly having Tai Chi, which is a great way for kids that are neurodivergent. I need to move. can’t just sit here and meditate, but to decompress. And we need to learn that as families to really understand how to decompress and teach people. In fact, I taught my youngest daughter that so much for me that
Dr. Jeremy Sharp (1:01:05)
Yeah.
Kathleen Nadeau (1:01:12)
that mommy needs some quiet time, because I was working and I would come home and just take a 15 minute break. And so mommy needs quiet time. And we were at a family party at my aunt’s and my aunt was going into the kitchen and shut the door just because it was messy in there at the party. And so my little preschool daughter says, do you need some quiet time? Is that why you’re going in there and shutting the door?
Dr. Jeremy Sharp (1:01:34)
That’s great.
Right. Right. Hey, that’s all right. She’s learned. She’s learned. Yeah. Love that. Yeah.
Kathleen Nadeau (1:01:38)
She’s learning, right?
So I think psychologists don’t know what to look for. And they’re going down these checklists that are based on the DSM. And they’re really missing the boat. It’s not that those symptoms aren’t there and aren’t accurate. I would say they’re necessary, but not sufficient. There’s so much more that we need to know.
Dr. Jeremy Sharp (1:01:47)
Hmm.
Mm-hmm.
Yeah.
Well, the thing that I’m pulling from this conversation is this, like trying to understand the qualitative experience of the relationship, at least between, you know, mothers and daughters. Yeah. Could ask more questions around that beyond, you know, what we typically do really dig in.
Kathleen Nadeau (1:02:23)
Absolutely. And one
of the things I try to do, I mean, I’m talking about creating an ADHD friendly family, and that it can be really helpful to work on developing better habits together, because kids love nothing better than reminding their parent that you left the towel on the sink and didn’t bring it back up. Hey, I get to tell mom, know.
Dr. Jeremy Sharp (1:02:31)
Mmm.
Of course.
Kathleen Nadeau (1:02:49)
But at the same time, she’s remembering that you’re supposed to hang up the towel. And so I think I’m a huge fan of collaborative problem solving. And one of the stories I love to tell, I worked with a lot of gifted kids and this was a highly gifted seven-year-old boy with runaway inattentive ADHD. I mean, he’s gonna be some amazing person when he grows up, but.
He lives between his ears, you know. He was an only child and his mom would go to work at oh dark 30. So she’d be home by the time school was out and dad was on the morning shift and then he’d work later. So that there was always somebody there. So dad came and saying, I’m losing my mind because I go downstairs. He’s second grader, make his lunch, get his breakfast ready. Where are you? You’re supposed to be getting dressed. Where are you? We’re gonna be on. And he said every morning.
Dr. Jeremy Sharp (1:03:18)
Mm-hmm.
Kathleen Nadeau (1:03:46)
drives me nuts. And so I said, why don’t you bring your little fella in? And very verbal, very bright. And we talked about it. And he says, it’s right. I do get distracted. There’s so many things in my room. They’re so interesting. And I’m not doing it on purpose. He was really thoughtful about it. And I said, well, can you think of a different place to get dressed that isn’t so fascinating?
I mean, he would just sit on the floor and start reading a book. ⁓ And so he said, he lived in this little townhouse and there was a powder room, you know, right by the front door. And he said, I can come down with my clothes and get dressed there. And there wouldn’t be anything to play with except I might play with the water a little bit. He was really thinking it through in a very intelligent way. How can I?
Dr. Jeremy Sharp (1:04:17)
So, yeah.
That’s great. Yeah.
Kathleen Nadeau (1:04:43)
stay focused, and that worked beautifully. And they figured it out together instead of, you you’re gonna get punished if you’re late one more time, which isn’t gonna do anything but make everybody miserable.
Dr. Jeremy Sharp (1:04:49)
Nice.
Yeah, yeah, certainly, certainly. So gosh, lots that we could talk about. Maybe we pivot to recommendations here. I know we’re starting to come down time-wise, but I’m particularly curious about accommodations at school for girls. I mean, we have our standards, I think. I’m interested to hear what you found to be some of the more powerful accommodations at school.
Kathleen Nadeau (1:05:20)
Well, what I always tell parents is a teacher has an impossible job, an absolutely impossible job. And how in God’s name can she look, well, there are these five IEPs and accommodations for ADHD and, know, humanly impossible. And so what I always talk to teachers about is just make your classroom ADD friendly. If it’s good for kids with ADHD, it’s going to be good for everybody. So you don’t need to…
Dr. Jeremy Sharp (1:05:27)
Mm. So true.
Yes.
Mm-hmm.
Kathleen Nadeau (1:05:50)
you know, specifically accommodate this, that or the other. And by that, I mean, make the routines very clear, make the instructions very clear, allow kids to turn in their homework electronically so they don’t have to worry about forgetting that they did it, but they forgot to bring it in. Be understanding about slower processing speed.
that they just may not be able to get the assignment done in their seat in that 20 minute period. Just make it more ADD friendly. And I, you know, had the best accommodation system you can think of. I didn’t think of it that way, but my best friend in elementary school did not have one lick of ADHD. Her name was Julie and we were besties and I sat next to her and all the time.
What page are we on? What did she say? Are we supposed to? I mean, she was right there and she had all the answers. Yeah. And.
Dr. Jeremy Sharp (1:06:41)
Hahaha
Yeah, that’s great. So is there a way that we
can build that into a class, you know, like a little like a buddy system or,
Kathleen Nadeau (1:06:54)
a
buddy system. And the other thing, I mean, my teachers had no idea about ADHD in girls. And so even though I was a straight A student, I was always in trouble for talking in class. You can tell I’m talkative. ⁓ And I joke about the only reason that I know my multiplication tables so well is the punishment for talking in class.
Dr. Jeremy Sharp (1:07:09)
No. A little bit.
Kathleen Nadeau (1:07:20)
was to write your multiplication tables X number of times at home that night. So my hand would be falling off, but boy did I learn them.
Dr. Jeremy Sharp (1:07:30)
one way to do it. It seems like it worked. Yep. I got you. I got you. Is there anything that we know about medication and girls? Like any medication differences we need to be aware of? Not like we’re prescribing, right? Of course we’re psychologists, but…
Kathleen Nadeau (1:07:43)
Right. No, they’re
not, they’re not medication differences with the exception that girls with ADHD are much more likely than boys to be diagnosed with anxiety. And the anxiety is there, but in many cases it’s secondary to the ADHD that they’re anxious because they’re always afraid that they’re going to screw up in some way or another and be in trouble. And so.
Dr. Jeremy Sharp (1:07:56)
Mmm.
Mm-hmm.
Kathleen Nadeau (1:08:12)
So many pediatricians and even child psychiatrists start by treating the anxiety, not recognizing. Let’s start with the stimulant because in many cases, when a girl feels calmer and more focused, the anxiety is greatly reduced. So girls are more likely than boys in elementary school to be on an SSRI plus.
Dr. Jeremy Sharp (1:08:28)
Mm-hmm.
Kathleen Nadeau (1:08:37)
stimulant. But I would say in most cases that begins more puberty when the anxiety really starts spiking, that there’ll be on both. But there’s just, we’re not educated enough about how ADHD manifests in girls. And so teachers, pediatricians, even child psychiatrists go for the anxiety and think that’s the primary issue. I remember talking to a newly minted child psychiatrist
Dr. Jeremy Sharp (1:09:02)
Mm-hmm.
Kathleen Nadeau (1:09:06)
had just come out of Children’s Hospital in Washington DC, an excellent child fellowship. And I was telling her about the book, Understanding Girls, and that’s something my clinic was known for and blah, blah, blah. And she said, they didn’t teach us any of that in my residency. Just wasn’t there. So.
Dr. Jeremy Sharp (1:09:20)
or yeah, I believe it.
Before we wrap up, mean, since you brought this up here at the end, I would love to hear, I mean, how do you separate anxiety and ADHD in girls particularly? That comes up a lot.
Kathleen Nadeau (1:09:36)
Well, people say that it could be the anxiety that’s making it difficult to focus. And I say that’s such a simplistic way of looking at ADHD. mean, ADHD is not a difficulty in focusing. Difficulty in focusing is one of umpteen symptoms. So yes, anxiety, if you’re very frantic, it’s hard for you to concentrate. But that doesn’t mean that
Dr. Jeremy Sharp (1:09:42)
Mm-hmm.
Kathleen Nadeau (1:10:03)
a girl who only has anxiety is going to have all the other symptoms of disorganization and messiness and poor time awareness, forgetfulness. Anxiety doesn’t do that. They’re looking at it way too narrowly when they say, how can you tell? They’re just looking at, yeah.
Dr. Jeremy Sharp (1:10:14)
Mm-hmm. Mm-hmm.
Yeah, yeah. I mean, I think we get thrown off because one of those symptoms of GAD in kids is difficulty concentrating or something. And we extrapolate that very broadly. ⁓ And assuming.
Kathleen Nadeau (1:10:35)
Right. Well, that’s one thing.
Yeah. But what about all the other things about ADHD?
Dr. Jeremy Sharp (1:10:40)
Right, right. I mean, that’s giving a lot of power to anxiety to say like, well now it’s causing, you know, lateness and, you know, trouble getting assignments done and trouble getting started on things.
Kathleen Nadeau (1:10:46)
Yeah, right, and you can’t make your
bed and you forgot to brush your teeth because you’re so anxious. I don’t buy it.
Dr. Jeremy Sharp (1:10:53)
Yeah, yeah, yeah,
I’m with you. Okay. Well, we’ve talked about a lot of different things. I know there’s so much more we could talk about. I will definitely put your website in the show notes. It’s a great website and people can access all of your books and resources and lots of things there if they would like to. Yeah. likewise. Yeah. Thank you so much for being here, Kathleen.
Kathleen Nadeau (1:11:09)
Wonderful. Well, I’ve really enjoyed chatting with you.
Good.
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