Episode 11
Women with Attention Deficit Disorder
Sari Solden, 1995
Why did ADHD in women go unseen for so long?
Juno and Beck are synthetic voices. They are not people, they are not clinicians, and nothing in this episode is about you. The script was drafted with AI assistance and edited and approved by Logan Williamson, a Licensed Professional Counselor in Texas and Louisiana.
Chapters
At the eyepiece
What the episode covers
Sari Solden, a psychotherapist in Ann Arbor, Michigan, first published Women with Attention Deficit Disorder in 1995, among the first books to argue that ADHD in women looks different and gets missed. The episode reads the revised tenth anniversary edition of 2005, with forewords by John Ratey and Edward Hallowell. Her argument: many women have the quiet, inattentive kind; their symptoms collide with an unwritten job description for women (the calendar, the birthdays, the house, the small talk); the result is shame, hiding, and costs that build up behind the hiding. Her way out runs through diagnosis, grief, a treatment model that starts with medication, and three Rs: restructure your life, renegotiate your relationships, redefine how you see yourself. Its best story is her own: a therapist diagnosed in her early forties, who found the book's beginning in a room of adults with ADHD who weren't hiding it.
Beck checks it. Girls missed for being quieter held: a Boston clinic study opened on a gap of about ten boys per girl in clinic samples against three in the community, and its girls were more likely to have the inattentive type. The quiet kind still costing something held: Stephen Hinshaw's Berkeley study followed girls with ADHD into early adulthood, and the inattentive girls rarely differed from the rest. The cover's claim that ADHD affects women about as often as men did not hold as stated, since adult surveys across many countries still find more men, but the gap narrows, partly because women in Stockholm were diagnosed about four years later than men. The book's central mechanism, shame from an impossible job description, stays open, leaning her way.
Juno defends the book for moving shame from character to wiring and for describing, without the word, the hiding that later books call masking. Beck notes that many of its examples come from one kind of life and questions the word embrace; the disagreement is filed next to VAST. Medication is reported as one part of her model, and the show does not advise on it. The AI beat uses a chat window to list a month's recurring tasks against her three Rs, and notes that it can write the job description but can't turn the job down.
The scoreboard
What the book claimed,
and what held
One row for every claim the show checked on air, with the verdict in the show's own words and the method that produced each number. A figure from a registry and a figure from a twin study do not mean the same thing, so neither is printed bare. What each verdict means.
Held
Girls with ADHD get missed because they are quieter.
Biederman and colleagues, 2002, with Gershon, 2002. Clinic-referred samples ran about 10 boys for every girl, against about 3 to 1 in community samples. Among 140 girls and 140 boys with ADHD, the girls were more likely to have the inattentive type and less likely to have disruptive-behavior diagnoses.
MethodA clinic comparison using structured diagnostic interviews, plus a meta-analysis of sex differences. The authors infer a referral bias against girls; a referral gap is an inference from the two kinds of sample, not a direct count of missed girls.
Held
The quiet kind of ADHD still costs girls something into adulthood.
Hinshaw and colleagues, 2012. 140 girls with ADHD and 88 comparison girls followed for ten years, with 95 percent retained. The inattentive and combined types rarely differed.
MethodA prospective follow-up from ages 6 to 12 into ages 17 to 24, with a matched comparison group. The ADHD group had more symptoms and more serious impairment. Higher rates of suicide attempts and self-injury were also found, concentrated in the combined type.
Source02
Did not hold
ADHD affects women about as often as men.
Fayyad and colleagues, 2017, with Skoglund and colleagues, 2024. Across 20 surveys of 26,744 adults, adult ADHD was significantly associated with male sex. In Stockholm, females were first diagnosed or medicated at a mean age of 23.5 against 19.6 for males.
MethodPopulation surveys with a structured diagnostic interview, and a regional health-records cohort of 85,330 people with ADHD. As stated, the claim did not hold: men still outnumber women in adult surveys. Its direction held: the gap narrows in adulthood, partly because women are found later and often after other diagnoses.
Still arguing about it
Women's shame about ADHD comes from symptoms colliding with a job description the culture writes for women.
Young and colleagues, 2020. No figures; an expert consensus.
MethodThe UK consensus names gender bias and compensatory strategies that mask symptoms, which sits close to the book's argument. Nobody has tested the mechanism the way the book frames it. Left open, leaning her way.
Source05
Calibration
Sources
Every research claim on air is listed here with the method behind its numbers. Where a claim on air could not be traced to a source, it is named at the foot of this list rather than quietly left out, and the figure is not repeated on this page.
- Girls with ADHD are under-referred to clinics.
Biederman J, Mick E, Faraone SV, Braaten E, Doyle A, Spencer T, Wilens TE, Frazier E, Johnson MA. Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic. Am J Psychiatry. 2002;159(1):36-42. DOI
Opens on the gap between clinic-referred samples (about 10 boys to 1 girl) and community samples (about 3 to 1). Compared 140 girls and 140 boys with ADHD at Massachusetts General Hospital with structured diagnostic interviews. Girls were more likely to have the predominantly inattentive type, less likely to have school or spare-time problems, and at lower risk of conduct disorder, oppositional defiant disorder and major depression. The authors suggest a referral bias unfavorable to girls.
- Girls with ADHD remain impaired into early adulthood, whatever the type.
Hinshaw SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, Swanson EN. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol. 2012;80(6):1041-1051. DOI
140 girls with ADHD (93 combined type, 47 inattentive type) and 88 matched comparison girls, recruited at ages 6 to 12 and followed ten years to ages 17 to 24, with 95 percent retained. The ADHD group had more ADHD and co-occurring symptoms, more serious global and specific impairment, and higher rates of suicide attempts and self-injury, with medium to very large effects. The two types rarely differed, except that self-harm was concentrated in the combined type.
- Adult ADHD is more common in men, and most adults with it are not treated for it.
Fayyad J, Sampson NA, Hwang I, et al. The descriptive epidemiology of DSM-IV adult ADHD in the World Health Organization World Mental Health Surveys. Atten Defic Hyperact Disord. 2017;9(1):47-65. DOI
20 nationally or regionally representative surveys, 26,744 adults, assessed with the Composite International Diagnostic Interview. Adult ADHD was significantly associated with being male. Treatment seeking was low in every country and aimed largely at co-occurring conditions rather than ADHD.
- Women and girls are diagnosed with ADHD about four years later than men and boys.
Skoglund C, Sundström Poromaa I, Leksell D, Ekholm Selling K, Cars T, Giacobini M, Young S, Kopp Kallner H. Time after time: failure to identify and support females with ADHD - a Swedish population register study. J Child Psychol Psychiatry. 2024;65(6):832-844. DOI
85,330 people with ADHD living in Stockholm County from 2011 to 2021, with 426,626 matched population controls, from the regional healthcare data warehouse. The first record of an ADHD diagnosis or ADHD medication came at a mean age of 23.5 for females and 19.6 for males. Females with ADHD had more psychiatric comorbidity, medication and health care use, both before and after that point.
- Experts agree that gender bias and compensating can hide ADHD in women.
Young S, Adamo N, Ásgeirsdóttir BB, et al. Females with ADHD: an expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/hyperactivity disorder in girls and women. BMC Psychiatry. 2020;20(1):404. DOI
A UK ADHD Partnership expert meeting. Barriers to recognition include symptom differences, gender biases, comorbidities, and compensatory strategies that may mask or overshadow ADHD. A consensus of experts, not a study.
- Girls with ADHD show fewer outward symptoms and more inward ones than boys.
Gershon J. A meta-analytic review of gender differences in ADHD. J Atten Disord. 2002;5(3):143-154. DOI
A meta-analysis with lenient inclusion criteria. Compared with boys with ADHD, girls with ADHD had lower ratings on hyperactivity, inattention, impulsivity and externalizing problems, and more intellectual impairment and internalizing problems. Page only; not discussed on air.
The book
Women with Attention Deficit Disorder. Sari Solden, 1995.
This link earns Lone Star Telehealth nothing. The same book is at any bookseller or library, and your library is the cheapest way to find out whether you want it.
Book facts stated on air: title, both subtitles (Embracing Disorganization at Home and in the Workplace, 1995; Embrace Your Differences and Transform Your Life, 2005), author, a psychotherapist in Ann Arbor, Michigan; first published 1995; the revised 2005 tenth anniversary edition as the version still in print; the inattentive type as the most common in women and girls, as her claim; the unwritten job description; shame, hiding and its costs; grief after diagnosis; a treatment model starting with medication; the three Rs; the composite girls Jodi and Lucy; the friendship chapter and hormone material added in the revision; forewords by John Ratey and Edward Hallowell; readers' worn, marked-up copies; the publisher's blurb; and the cover's claim that ADHD affects women about as often as men. From her interviews, said as such: testing at work, reading Driven to Distraction and Kelly and Ramundo's book, diagnosis in her early forties, the Ann Arbor conference, six months of writing with ideas sorted into paper bags, and the book's readership in Japan. No passage is quoted.
Every word
Transcript
Every line, with the timestamp beside it. Tap a timestamp and the audio moves there.
Full transcript, 190 lines
Juno: Picture a busy household. Who knows when the dentist appointment is?
Beck: And whose name goes on the permission slip, and whose birthday is Saturday, and what's for dinner.
Juno: That person. In today's book, it's usually a woman. And when her brain can't hold the list, she doesn't blame the list.
Beck: She blames herself.
Juno: Women with Attention Deficit Disorder. Sari Solden, a psychotherapist in Ann Arbor, Michigan.
Beck: First published in 1995. Among the first books to argue that ADHD in women looks different, and gets missed.
Juno: And it opens a new stretch of the run.
Beck: Movement two. Late diagnosis, women, masking, and what it costs to pass for fine.
Juno: Today: Women with Attention Deficit Disorder, Sari Solden, 1995.
Juno: The Observatory. Presented by Lone Star Telehealth. Here's what the book says, and here's what held up.
Juno: Two episodes back, Vermeulen had autistic brains bracing for a world that won't keep its word.
Beck: Today the world keeps its word all too well. It hands women a list of duties, and the trouble starts with whoever can't keep up.
Juno: Start with the argument. Keep it simple.
Beck: In the early nineties, adult ADHD was barely on the map. And the picture everyone carried was a hyperactive boy.
Beck: Solden says plenty of women have it too. They just don't look like that boy.
Juno: What do they look like?
Beck: Quiet, often. Dreamy in class. Disorganized at home. Overwhelmed more than disruptive.
Juno: So nobody calls the school about them.
Beck: Nobody calls. And she says the inattentive kind is the most common one in women and girls.
Juno: Mm-hm.
Beck: Then comes the part that makes the book hers. The symptoms run straight into what the culture expects of a woman.
Juno: Which is what, in her telling?
Beck: She writes it up as a job description. Keep the family calendar. Remember everyone's birthday. Run the house, keep it fit for guests, and handle the small talk at work.
Juno: Unpaid, I assume.
Beck: And nobody applies. It's simply handed out.
Juno: And when a woman with ADHD can't do the job?
Beck: She doesn't see a brain difference. She sees a personal failing. Solden's word for what follows is shame.
Juno: So shame is the symptom that never makes the checklist.
Beck: In her account, yes. Shame, then hiding. Then the costs that build up behind the hiding.
Juno: Such as?
Beck: Work that stalls below her ability. Low mood. Friendships left to lapse, because calling back feels too exposing.
Juno: And the way out?
Beck: A diagnosis first. Then grief, which she treats as a normal stage of getting one, not a setback.
Juno: Grief for the years before.
Beck: That's how she frames it. After that, a treatment plan in several parts, and then what she calls the three Rs.
Juno: Go on.
Beck: Restructure your life around how your brain works. Renegotiate your relationships. Redefine how you see yourself.
Juno: And what's it like on the page?
Beck: Like a therapist talking with you across a desk. Warm, practical, lots of exercises.
Beck: She follows a pair of invented girls, Jodi and Lucy, built from many clients, from childhood into grown life.
Juno: Composites, then. Not case files.
Beck: Composites. She says so up front.
Juno: What's Jodi like?
Beck: The quiet one. Well behaved, liked by her teachers, and struggling where nobody can see it.
Juno: And which version are we reading?
Beck: The revised anniversary edition from 2005. That's the version still in print. It adds a chapter on friendship and more on hormones.
Beck: The first foreword is John Ratey's. The revision adds a new one from Edward Hallowell.
Juno: Our very first authors, holding the door for her.
Beck: And the title changed too. The first subtitle was about embracing disorganization, at home and at work.
Juno: And now?
Beck: Embrace your differences and transform your life. A wider promise.
Juno: Somebody held on to the verb.
Juno: Where's the heart of the book? I'd guess it's her own story.
Beck: It is. The book begins with it, and she's filled in the details in interviews since.
Beck: She was working at a clinic for adults with learning disabilities. A helper, by trade.
Juno: On the steady side of the desk.
Beck: From the outside. Inside, things had been slipping since college. At work she couldn't take notes and talk at once.
Juno: That's hard to hide in a counseling job.
Beck: Her boss sent her for testing. Around then she read two books on adult attention problems, and one of them was Driven to Distraction.
Juno: Our first episode. So Hallowell turns up in this story twice.
Beck: Twice. The other was by Kate Kelly and Peggy Ramundo, who later wrote the introduction to hers.
Juno: And the diagnosis?
Beck: It came in her early forties.
Juno: A therapist finding it in herself, halfway through a career.
Beck: And then keeping it quiet. She's frank about that part.
Juno: What changed?
Beck: One of the first conferences for adults with ADHD came to Ann Arbor, her own town. She walked into a room full of adults who weren't hiding it.
Juno: After all that time hiding hers.
Beck: She's said that room is where the book started.
Juno: And the writing itself?
Beck: About six months. She's described writing ideas on scraps and sorting them into paper bags, with her husband helping put them in order.
Juno: A book on disorganization, assembled out of paper bags.
Beck: And it's stayed in one piece longer than most filing systems.
Juno: Fair.
Juno: And the readers?
Beck: They wrote back. The revision opens on them. Women with worn, marked-up copies, saying the book told a story they'd never told anyone.
Beck: And it traveled. It found a big readership in Japan, where, she's pointed out, women's roles were set even more rigidly.
Juno: So the job description translates.
Juno: The publisher's blurb even promises to get you past thinking of yourself as a slob or a space cadet.
Beck: On a show with a telescope, space cadet sounds like a promotion.
Juno: We do own the telescope.
Beck: We do. And being seen by a book still isn't the same as being right. That's the next segment.
Juno: How does she hold up against the research? Start with the girls nobody noticed.
Beck: Her opening claim. Girls with ADHD get missed because they're quieter. That held.
Juno: On what?
Beck: A 2002 study from a Boston hospital opens on a gap. Clinic samples ran about ten boys for every girl, while community samples ran about three.
Juno: So the clinics were seeing far fewer girls than the community had.
Beck: Right. The authors' reading is that the missing girls were never sent in.
Juno: Why wouldn't they be?
Beck: The same team compared a few hundred children with ADHD, half of them girls.
Beck: The girls were more likely to have the inattentive kind. Fewer problems at school. Less likely to carry the disruptive-behavior diagnoses.
Juno: That's her quiet girl, nearly word for word.
Beck: Close to it. The authors call it a referral bias that works against girls.
Juno: Okay.
Juno: Her other claim. The quiet kind still costs something.
Beck: Held, and it's the one I'd underline. Stephen Hinshaw's team at Berkeley followed girls with ADHD from grade school into their late teens and early twenties.
Juno: Against whom?
Beck: A matched comparison group. And they kept nearly everyone, which is rare over that long.
Juno: What did they find?
Beck: As young women, the ADHD group still had more symptoms, and more serious trouble in daily life.
Juno: And the inattentive girls? The ones nobody calls home about?
Beck: They rarely differed from the girls with the combined kind. Quieter didn't mean milder.
Juno: Yeah. Quieter didn't mean milder. That's the first half of her book, right there.
Beck: It is. And Hinshaw comes back near the end of the run with a book of his own.
Juno: Logan opened this movement with her for a reason. Now the claim I expect you to trim.
Beck: The book's cover says ADHD affects women about as often as men.
Juno: And?
Beck: As stated, it didn't hold. The direction did.
Juno: Meaning what?
Beck: The World Health Organization ran household surveys across many countries. Tens of thousands of adults, all given the same structured interview.
Juno: Mm-hm.
Beck: Adult ADHD still came out more common in men. A gap, not an even split.
Juno: So more men, still. The gap is real, just not the whole story.
Beck: That's the picture.
Juno: So she overshot.
Beck: On the number. She was right that a lot of the gap came from who got looked at.
Juno: Then why do women close the gap as adults?
Beck: Partly because they're found later. A Stockholm study went through about a decade of the region's health records, tens of thousands of people with ADHD.
Juno: And?
Beck: Women and girls got their diagnosis, or their first ADHD medication, about four years later than men and boys.
Juno: Four years, on average, of the shame she describes.
Beck: On average, across the group, yes. And before that diagnosis, the women already carried more psychiatric diagnoses than the men did.
Juno: Hallowell says as much in his foreword. Women called depressed, or anxious, before anyone said ADHD.
Beck: The world surveys point the same way. The few adults with ADHD who got any care were mostly treated for something else.
Juno: Fair.
Juno: What goes in the open column?
Beck: Her central mechanism. That the shame comes from colliding with a job description written for women.
Juno: That's the heart of the book.
Beck: It is, and it's an argument, not a measurement. A British expert panel in 2020 landed close to her: gender bias, and coping that covers the symptoms over.
Juno: So the experts agree with her.
Beck: They do. But a consensus is experts agreeing. Nobody's tested it the way she frames it. Open, leaning her way.
Juno: She covers medication too.
Beck: She does. It's the first letter of her treatment model, alongside education, strategies, support and therapy.
Juno: So one part of the answer, in her book.
Beck: One part. And here's where we add ours.
Beck: We don't tell anyone what to take, and we don't line medicines up against each other. That's not our field or our job.
Beck: Your prescriber is the expert. That's the relationship to lean on.
Beck: What a therapist adds comes before the appointment: help putting your days into words a prescriber can use.
Beck: That's harder than it sounds. It's a big reason people leave those visits with less than they could.
Juno: I hear Logan in that.
Beck: It is, and not for legal cover. It's how he handles that conversation with the people he sees, and he'd like every therapist to handle it that way.
Juno: And anyone who'd prefer to skip it?
Beck: Gets the same respect. Medication is a frontline treatment, and we won't pretend otherwise. Whether to take it is still your choice.
Juno: And the question that matters here. Does a book built around a household from the nineties still speak to an adult reading it now?
Beck: Your case first.
Juno: It does, because of the shame. She took a feeling women were hiding and moved it from character to wiring.
Juno: And the job description never went away. People call it invisible labor now. The list is still there, and still unpaid.
Beck: Say more.
Juno: She names a cost of doing business before anyone had the phrase. Hiding takes effort every single day, in a world set up for somebody else's brain.
Juno: And hiding is the word this whole movement turns on. Later books call it masking. She was describing it without that word.
Beck: I'll give you the shame chapters. They're the best thing in the book.
Beck: Here's the cost. A lot of her examples come from one kind of life. A wife and mother running a house.
Juno: That was who walked into her office.
Beck: Sure. But a reader outside that life has to translate. And the book came out before most of the research on girls.
Juno: Research that mostly backed her.
Beck: It did. She was writing from her own caseload and her own life, and that's where the warmth comes from. It's also where the blind spots come from.
Juno: Every book in this movement will have that trade.
Beck: Probably. My other worry is the word embrace.
Juno: You think it's too cozy.
Beck: Yeah. Too cozy, for some readers. A woman about to lose her job doesn't need to embrace anything. She needs the restructuring, and soon.
Juno: And restructuring comes first of her three. Embrace is the title, not the order.
Beck: Fair. We still hear that word differently.
Juno: We do. Put it next to VAST.
Juno: Here's what I keep thinking about. Her job description is mostly remembering. Dates, forms, rides, who needs what.
Beck: Tracking. And tracking is where a chat window can help, as a scaffold you hold for your own life.
Juno: How, in practice?
Beck: Ask it to list every recurring task in a month of your life. Then go down that list with her three Rs.
Juno: What stays, what changes, and what gets handed back.
Beck: Right. It can even draft the note that hands one back.
Juno: Isn't that just moving the list from a woman to a machine?
Beck: Only the remembering. The deciding stays with her.
Juno: And the usual limits?
Beck: It's a tool, not treatment. Nobody's tested it for this.
Beck: And keep private things out. A chat isn't a medical record, and nobody's obliged to protect it like one.
Juno: So it can write out the job description.
Beck: It can't turn the job down. That's the second R, and it takes a person on the other side of the table.
Juno: Women with Attention Deficit Disorder, Sari Solden, 1995, revised in 2005. Read it for the job description and the pages on shame. Read its claim about how common this is next to the surveys.
Beck: The tally, then. Girls missed for being quiet, held. The quiet kind still costing something in adulthood, held. As often as men, didn't hold as stated, though the gap narrows in adults.
Beck: And shame from an impossible job description stays open, leaning her way.
Juno: That's a lot of held for a book from 1995.
Beck: Nine books in, it's one of the cleaner sheets. Her caseload saw it before the studies did.
Juno: And it opens the movement the right way. Every book after it asks who got missed, and what passing for fine cost them.
Juno: It stays. I'd hand it to a friend who just got the word, with the Stockholm study tucked inside.
Beck: Next time: A Radical Guide for Women with ADHD. Solden again, writing with Michelle Frank, twenty-four years later.
Juno: Same author. I want to see which parts she'd still sign.
Juno: That's the book.
Beck: That's the book. See you in two days.
Juno: This show is made by Lone Star Telehealth. Logan Williamson is a Licensed Professional Counselor in Texas and Louisiana. You heard education about a book, not counseling, not a judgment about you, and no stand-in for care. A diagnosis takes a real conversation with someone who knows you, so there isn't one here.
Beck: Sources and the full transcript are on the episode page. The next one lands in two days.
Juno: One last note, plainly. Juno and Beck, the voices you've been hearing, are synthetic. Not people, not licensed, and nothing here was about you. Each script starts as an AI-assisted draft and is edited and approved by Logan Williamson, at Lone Star Telehealth. Logan Williamson is a Licensed Professional Counselor in Texas and Louisiana.
Corrections
No corrections have been made to this episode. If we got something wrong, write to [email protected] and say where in the episode it was. We check the claim against the source, then we fix it or we explain why it stands. Either way you get an answer.
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