Last week I had the pleasure of spending an hour in conversation with Dr. Ellen Littman — the clinical psychologist the American Psychological Association describes as a pioneer in identifying gender differences in ADHD. She has co-chaired the Women & Girls with ADHD Special Interest Group for APSARD (the American Professional Society of ADHD and Related Disorders) and has been studying, treating, and advocating for girls and women with ADHD for over 35 years — since long before most of the field believed they existed.
In fact, that’s how her most famous book came to be. At an ADHD conference in the early 90s, a keynote speaker declared that girls with ADHD were “ADD wannabes.” Ellen went to the microphone and argued with him — and kept arguing, even when he asked her to sit down. She walked out to the lobby certain she’d just committed professional suicide. Instead, two women (Dr. Kathleen Nadeau and Dr. Patricia Quinn) approached her and asked: would you like to write a book about that?
That book became Understanding Girls with ADHD. 📖
Why the Field Missed Them 🔍
Three decades later, the research has caught up with what Ellen was seeing in her office.
Hinshaw and colleagues (2022), reviewing decades of studies on ADHD in females, found that girls are diagnosed at just under half the rate of boys in childhood — a gap that nearly closes by adulthood. Girls show more inattention and internalizing struggles; boys show more hyperactivity and outward disruption. And clinicians miss girls not because the impairment isn’t there, but because it doesn’t announce itself — and because girls and women get very good at compensating in ways that hide how hard they’re working.
Littman and Wagenberg (2023) put a finer point on it: the diagnostic criteria themselves were built largely from samples of disruptive young boys. So the quiet, internalizing, capable-looking girl never crosses the threshold. And the delay isn’t harmless. They trace how years of being unrecognized compound into serious outcomes, and they argue for a fundamental shift — away from counting visible behaviors, toward asking about lived experience.
The Tug of War No One Talks About 💭
In my recent conversation with Dr. Ellen Littman, we landed on something I think about constantly in my work: the erosion of trust in oneself.
Here’s what I mean. So many women with ADHD describe a feeling of being divided against themselves. You know what you want to do. You intend to do it. You care about it, deeply. And then, somehow, your brain has a different idea.
Dr. Littman put it in words I haven’t stopped thinking about:
“Their own psyches betray them. And that is the terrifying part that no one talks about — where you feel like you know what you want to do, and somehow your brain had a different idea, and you didn’t win that tug of war.”
Do that a few hundred times and something quietly breaks. You stop believing yourself. Not just your abilities — yourself. Now imagine doing it for twenty or thirty years without a name for what’s happening. That’s the cost of the diagnostic delay the research describes — not a missed label, but decades of evidence stacking up against your own character.
And here’s the part that matters: that inner separation doesn’t stay inside. We project it outward. If I can’t trust myself, surely no one else can trust me either. The isolation from ourselves becomes isolation from others.
The Slot Machine 🎰
When trust in yourself is diminished, the natural next move is to look outward. You start referencing the outside world for validation: Is it okay? Am I doing it right?
And here’s the neuroscience twist: the feedback you get is intermittent. Sometimes it comes back positive, sometimes negative. And intermittent reinforcement is the most powerful reinforcement there is — it’s what keeps people pulling the lever on a slot machine. The seeking itself is dopaminergic. You’re looking for reassurance because you’re uncertain about yourself, but the unpredictability of the answers is exactly what turns looking outward into a reflex.
So the habit strengthens. And slowly, identity starts to feel… loose. Who really am I? Because you’re not centered in yourself anymore — you’re centered in the question “Am I okay with you?”
Dr. Littman sees it in her office all the time:
“You can always tell when people come in with a parent or a partner, and you ask them a question, and they look at the other person. They’re already like, I don’t even know how to place myself in this context, because I don’t know who I’m supposed to be in this room.”
Oof. 💛 If you just felt that one in your chest, you are very much not alone.
Coming Back Home to Yourself 🏡
So what helps? A safe, accepting, and consistent place, which you can build inside yourself. Consistency matters because ADHD itself is inconsistent — some days you’re doing well, some days you’re not — and you need a place that doesn’t change its opinion of you based on which day it is.
That’s the beginning of rebuilding self-trust: being met the same way on your worst day as on your best one — until, eventually, you can meet yourself that way too.
Because the goal was never to win everyone else’s approval. It’s to come back home — to that felt sense of connection with yourself that got interrupted so long ago. It was never gone. Just waiting. ✨
More soon — this conversation is part of a bigger project I’m working on, and I can’t wait to share it with you. ✨
Warmly, Liz Adams, PhD, LP, ABPP
P.S. If this stirred something up, that’s worth paying attention to — gently. Noticing the pattern isn’t a verdict on you. It’s the first step out of it. 💛
References
