Lotta Borg Skoglund: Biology, hormones & the invisible girls

Jan 15, 2024


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“We miss the girls. Then they grow up and struggle and scream until they finally get a diagnosis, only to get a prescription and get abandoned again.”

Lotta is a senior physician and associate professor of psychiatry at Uppsala University in Sweden. Lotta’s work centers on ADHD and women as well as how hormones impact the mental health of girls and women. She has authored several books, including “ADHD Girls to Women: Getting on the Radar,” which was released in English in 2023. 

Lotta has years of experience in healthcare, working in both primary care and specialized psychiatry, and her list of academic and professional accomplishments is a mile long. She helped to create the GODDESS ADHD research group, which stands for Gender-informed research to Overcome Diagnostic Delay and Emotional dysregulation through Self-awareness and Self-efficacy in female ADHD. She is also one of the founders of Letterlife, a science- and evidence-based app that provides girls and women with ADHD insight and power over how their everyday life is affected by hormones, ADHD symptoms, and other lifestyle factors.

Lotta and I talk all about the profound lack of research around women, hormones, and ADHD, as well as the incredible work she is doing in Scandinavia and beyond to even the playing field. We also talk about the biological differences between the male and female brains and why that contributes to the lack of diagnoses for girls. And we discuss how girls and women are being abandoned by the medical system, even after their diagnosis.

Website: www.borgskoglund.se

Instagram: @lottaborgskoglund

Links & Resources:

ADHD Girls to Women by Lotta Borg Skoglund

Letterlife app




Lotta Borg Skoglund 0:00
The problem is that she may have ended up in a situation where she is more likely to be traumatized than her peers because of her ADHD. And that is not saying that, you know, your skirt was too short, you brought this up on your own is never the case. But the case is that ADHD is a significant risk factor for teenage girls to become victimized and to become traumatized.

Katy Weber 0:32
Hello, and welcome to the women and ADHD podcast. I'm your host, Katy Weber. I was diagnosed with ADHD at the age of 45. And it completely turned my world upside down. I've been looking back at so much of my life, school jobs, my relationships, all of it with this new lens. And it has been nothing short of overwhelming. I quickly discovered I was not the only woman to have this experience. And now I interview other women who like me discovered in adulthood, they have ADHD, and are finally feeling like they understand who they are and how to best lean into their strengths, both professionally and personally. Okay, before we get started, I would love to share with you this review from a listener named Deanna. It's entitled, tears. I just finished listening to your interview with Linda Yee. It made me very emotional, what an amazing story. Thank you, Katie for introducing me to such great women and helping me to accept myself more and more with each interview at almost 63 That says a lot. You have changed my life. Maybe I'll actually get an official diagnosis, keep doing the wonderful work you are doing. Well. Thank you, Deanna. I really appreciate your feedback. And I love knowing that this podcast has helped in such a tremendous way. And if anyone's out there listening to this podcast, and you found it helpful, this is a friendly reminder to head over to Apple podcasts or audible. And you can now leave feedback on individual episodes on Spotify. And if that feels like too much, and I totally get it. You could also just quickly hit those five stars. It makes a real difference. In fact, before you forget, why don't you just pause right now and do it and I promise we'll wait for you. Okay, here we are at episode 170 in which I interviewed lota Borg Skoglund Lodha is a senior physician and associate professor in psychiatry at Uppsala University in Sweden loads his work centers on ADHD and women especially around how hormones impact the mental health of girls and women. She has authored several books on the subject, including ADHD girls to women getting on the radar, which was released in English in 2023. Loaded not only has years of experience in healthcare working in both primary care and specialized psychiatry, but her list of academic accomplishments is a mile long, and she helped to create the goddess ADHD Research Group, which stands for gender informed research to overcome diagnostic delay and emotional dysregulation through self awareness and self efficacy in female ADHD loads is also one of the founders of letter life, a science and evidence based app that provides girls and women with ADHD insight and power over how their everyday life is affected by hormones, ADHD symptoms and other lifestyle factors looked at and I talk all about the profound lack of research around women hormones and ADHD, as well as some of the incredible work she's doing to even the playing field. We also talk about the biological differences between the male and female brains and why that contributes to the lack of diagnoses for girls. And we discuss how girls and women alike are being abandoned by the medical system even after their diagnoses. Now, before I get to this interview, I wanted to add that the English copy of Lotus book which is fantastic, by the way, was published by Jessica Kingsley publishers in the UK, they publish so many tremendous neurodivergent authors go take a look at their selection of books, it's amazing, you're gonna want to get your hands on all of them. So that said, we have an exclusive discount for women and ADHD listeners. If you use the code W A pod 20. You'll get 20% off the book when you purchase it directly from the [email protected]. And of course that link is in the show notes. Okay, without further ado, here is my interview with lota somebody needs to pinch me, you know, there's some days where I feel like, I can't believe this is my job. I can't believe this is my job that I get to interview incredible women like the guests I have today. Welcome loads, this is just incredible. i Okay, so a little bit of background story, and then I'll stop rambling. So one of my former clients and that she's out there, she's listening. Hi, Annette. She's amazing. And she's from Denmark and she wrote me and she said you have to read the Lotus book. You have to interview her she is the shit in Sweden and Denmark when it comes to what I'm in and ADHD. And I was like, Okay, well, how am I gonna get this esteemed, you know, researcher and medical clinician? How am I going to convince her to get on my podcast? And literally the next day I received an email from your publisher, and it was like all the stars aligned? Oh, my goodness, I was so excited. So where do we start? I mean, I guess we could start you're you were diagnosed with ADHD in adolescence. late adolescence, I'd say late adolescence. So in high school and a young adult, yeah. Okay. What were some of the things that you put together, you know, put two and two together to think this could be ADHD, or I should look into this?

Lotta Borg Skoglund 5:36
Well, it wasn't really that much knowledge back then. Right, and especially not around and girls. So I would say, I would say I couldn't get the picture. To fit with kind of my life, that was pretty awesome. And then I just could not get it to, to work for me. And I, I was so interested in things, and I was so excited about so much. And then when I started to dig into it, and to learn about it, it was like my brain totally just shut down. And I thought that was really scary. And I ended, I couldn't really trust my brain. And I wasn't really, I couldn't really trust my instincts in a way. Because who am I, if I find this, so interesting that I engage in it, and then when I do, it is like, I am just zooming out, and my brain is all over the place and thinking about other stuff. And I kept, you know, putting it on, like, later accounts, or I will read this, I will do this later. And then it kind of kept piling up to a point where I kind of broke down and I quit, and then I started something else. So I think that was kind of a revelation. And I've been, I've been asking around Of course, I'm from a family where like my father's a psychiatrist, there is you're either a veterinarian or a psychiatrist in my family. So there wasn't any really lack of knowledge. And I thought, you know, my parents really, I had a really safe upbringing, everything was kind of good. And I couldn't get my shit together. And I thought I was really, really wasn't knowing and worrying for the rest of my life. So I started feeling very afraid of how am I going to manage life on my own, basically. And then I met a person who said, Well, could this be ADHD? As like? No, of course not. Because I didn't know anything. And I was trying, I was also training to be a psychiatrist at that, you know, same point when when this was, so this was after med school. Yeah, this was after med school, but I was and I was training to be a psychiatrist. So and still, I haven't heard about it. So that is, is kind of something that makes me really humble when I meet other women who are diagnosed later in life. Realizing that me and my colleagues, we were not trained to acknowledge and to find and to search for this and to look for this and to ask for this in girls. And, or in females and in adults, basically, so that was a long, long story of a, a journey that ended with with a diagnosis. And then what I see is in so many, many women that I meet also, a couple of years after that, where i i kept kind of gaslighting myself and saying, Well, I fooled them, it's probably just because, you know, I didn't tell them this, and I can do a lot of stuff, right? So, so I spend a lot of time after my diagnosis, also, wasting that time instead of starting, you know, get shit done. So that is also something that I tried to communicate really clearly is like, okay, yeah, you may have fooled me, I don't think so. I'm a pretty you know, I'm a pretty experienced psychiatrist and ADHD doctor at this point. And I'm also a researcher, so I know a lot of of things and I'm, I specialize in female ADHD. So yeah, you might have fooled me. But the odds are, you know, not in your favor. And that's a start, you know, start working as if you had ADHD if you have ADHD, and then we'll see if you fooled me, and there's something else and it's not ADHD? Well, you know, we haven't wasted that much time, because ADHD, accommodations and ADHD, kind of setting up your ADHD life. That is much like, for people with diabetes, it's like, if you keep this diet for your diabetes, that's good for everyone. Everyone could use these recommendation these diets like so it's I think it's, it can say a lot about the same thing about ADHD. Yeah, well, I

Katy Weber 9:42
think also comparing it to the diet and diabetes is interesting because one of the things I think about ADHD and again, one of the questions we talk about a lot on this podcast is, is this socialized right, which is like fitting women. I feel like we have to have tried everything we have to be at our wits end Before we ask for help, right, so accommodations, we have to show how much we are struggling and how much we have tried to do this on our own, before we even ask for help. And that's like that feels like a very uniquely female perspective. Yeah. So interesting. So now what I've read a lot of books on ADHD at this point, I feel like one of the things I've loved I just absolutely love your book. So thank you so much. I'm, you know, one of my questions, I actually reached out to Annette and I said, are there any questions you want to make sure I asked Lata? And she said, When are your other ADHD books going to be released in English? Like, I want to read them all down? Do you have plans? I

Lotta Borg Skoglund 10:38
am so happy to hear that. And thank you enough if you're listening, because, you know, I have to pinch myself equally hard as you because I have been, you know, I've been emailing my publisher, like, She's so tired of me. It's like, Are you sure I can get on any podcast I want to try. I'm so proud of this book. It's like a dream come true. And it's, it's so close to my heart, of course. So I've been writing I write about my patients, and I put their stories like The all these women that I've met during the years and to be able to tell their story and to, to realize that it's not only relevant for in Swedish context in a Scandinavian and Danish context, but it seems to be also relevant. So this is kind of a universal language that we're talking here. And so and that, I think that's, that's so beautiful, and so empowering. In a sense, right.

Katy Weber 11:28
So that leads to my question about the biological differences, because I don't feel like a lot. You know, one of the I'm always like, what are we talking about? When we're talking about ADHD? I get very confused about, are we talking about behavioral symptoms? Are we talking about a brain? What is genetic? What is socialized? Nobody seems to know what is hormonal. And I really appreciate how much you delve into the biological differences of the brain and the frontal cortex and the cerebellum. So if you're out there, and you're really loved to geek out about this, this is absolutely the book for you. Tell me more about what are some of the biological differences between a girl's brain at a boys brain when it comes to some of the different presentations of ADHD? And in the context of why girls are so commonly overlooked? Yeah,

Lotta Borg Skoglund 12:13
so I think what I'm trying to communicate in this book is that it's biology and social expectations, right? But that biology counts. And that if we keep like using the male brain and the male body as the norm, we will fail to recognize the girls and the women, right? The obvious thing is that girls and boys have males and females. When we look from from a hormonal perspective, we are like two subspecies of the same animal species, right. So for girls, and for females, starting a couple of years before puberty, when our like the sex hormones, the estrogen and progesterone starts increasing. And knowing that our brains are scattered, there are like a hormone receptors all over the place. So from like embryogenesis, then actually having a little bit of a pause during like childhood where the where we are like toddlers, because then then the the biological differences are not that marked, because then we don't produce a lot of sex hormones. But a couple of years before puberty, we will start producing our main sex hormones. So for girls, it will be estrogen and progesterone and for boys will be testosterone. And they tend to affect the brain in a very different way. And looking at the research then, looking at the female lifespan, we can see kind of perfect overlaps of where we as females have vulnerable periods in our lives. So looking at when the comorbidity hits us, for example, so like, during these pre puberty, puberty, those years, there is a lot of females with a DD and ADHD that will tell us that, you know, they get just, you know, they can't regulate their energy anymore. So they get so tired, and they start getting anxious about that, and they start, you know, trying to deal with that energy loss with food or trying to do other stuff that you know, keeps kicking the comorbidity circus and have that going right. So and then you see that in every menstrual cycle after ovulation where estrogen levels can tamper down and falls back and progesterone level starts rising. We also have this periods where women report that we are vulnerable in relation to stress in relation to depression, anxiety, even like serious psychiatric disorders or symptoms like psychotic symptoms or manic symptoms in bipolar. disorders and also relapse into eating disorders and and addiction very like overlapping very viciously with our pre menstrual phase so so between ovulation and the next period, and then we have pregnancy and postpartum on the postpartum period very vulnerable for for females. And then we have equally like prolonged period before menopause. So like up to 10 years around menopause, where the hormonal levels and the estrogen levels starts fluctuating again. So, I think talking about biology is super important when it comes to ADHD. We are far from understanding exactly how these hormonal fluctuations affect our brain. And it's also it seems to be very individual. So it's not like we can build a firm theoretical framework today and say, Okay, so all women with ADHD, react like this. But on a group level, it seems like we have these vulnerable periods. And on top of this, we have to put the social expectations and what we, as a, like a social structure, social creatures, think about how a typical girl or a typical boy should behave. So it seems like when we look at our brains on a group level, it seems like girl brains on a group level, prioritize processes that stimulates enhance our abilities to function socially, to be able to perceive what other people expect of us. Whereas it seems like for boys, their brains on a group level, that's super important. It's always much more difference between two individuals than two groups, of course, but on a group level, it seems like typical boys if you're allowed to say that, but group boys on the group level anyway, they prioritize other parts of the brains abilities, like, for example, coordinating Hand, foot, and visual and motor skills. For example, we assume that since since the biology has been prioritizing differently for girls and for boys, we have also learned to expect that from boys and girls. When girls fall out of that, and a framework, we don't know what to do. And it's also because of girls being more like socially aware earlier on in life, like more socially advanced earlier on in life, ADHD, ADD girls, they know what other people or adults expect from them. So they start finding strategies, they start masking, they start putting more and more and more energy into just being normal, as they say, and yeah, right. The elver Can you call? And that's actually how this book started. Because I started, I started thinking, because you always think that yours, yours, you yourself is usually unique, right? But then I started thinking, it's like, all the women that I meet that eventually get an ADHD diagnosis, they say, something that is always on the theme of like, I've always known that I'm different. But I don't know exactly why. And or I've always know that I'm not normal. But I've tried to explain that to people. And they say, Well, I always I also think that it's difficult to win. I also feel very exhausted and social, you know, I'm not a person who likes cocktail parties, either. It's like, but it's not that it's like, they are trying to normalize something in me that I'm really really, you know, I'm searching for the answer of why I am you know, different. So I think that's, that's some something that starts very early on for girls with with ADHD.

Katy Weber 18:59
Well, and there was something you said about your upbringing, too, that I resonated with, because I was, you know, often from university on was was diagnosed with depression and anxiety and then again, postpartum depression, postpartum anxiety, and there was always that feeling of it not fitting, but also feeling like well, I have a great life. I have a supportive partner. I have children, I had a wonderful upbringing. Why do I insist on being depressed? Right? It was like, I couldn't even get that, right. And so it is, it's that it's that feeling of just off SNESs that is so difficult to articulate.

Lotta Borg Skoglund 19:33
And I think that's also you know, for me, as I said, coming from a family of psychiatrist, then if you feel that something is off, you're sent to a psychologist, then you're sent into therapy rate, what I was experiencing in therapy because I Oh, also, I was searching so I also thought that I needed therapy. But what I kind of I pushed back on very early on On in therapy was when a therapist started to try to build a story around why I was struggling. So it was always like, Well, you probably your parents probably haven't affirmed you. Or I was always told that I was this person who needed affirmation, and that I needed to be this good girl. And I needed to be like, Why do you always have to be that everything has to be perfect. So they assumed that there was some kind of trauma in me, and I never I could never relate to that, because not on the country itself. So I, I actually, I feel like I think that there are a lot of girls and women with ADHD, who can actually be traumatized by having that kind of explanatory model told to them. So this is why this is so difficult for you, this is why you're struggling. And I never felt that that was a an appropriate explanation. And that was also very important for me when I got the diagnosis, and I realized, but Okay, so this is a perfectly, this is a different battle. For me, this is still a battle, like, there's a lot of things that I have to do differently. And I have to take care of myself in a totally different way than my, my friends. But I don't have to, you know, blame my parents, I don't have to quit, or get out of a lot of relationships. So I thought that, you know, a lot of things got explained in the wrong way. So now I know that it's not other people's fault that I can feel socially anxious in, in situation or I get really, really socially exhausted by things. I just know that that is my ADHD brain. And I don't blame others. And I think that has been a huge advantage for me, because otherwise, you tend to get very either defensive or disappointed in life, I think.

Katy Weber 21:57
Yeah, I also love the, you know, the whole conversation around this orchid or dandelion, right? This, this genetic element of their brain that is reacts more adversely to types of trauma, like neglect or abuse. I mean, I have, I don't think I've met a woman who hasn't experienced some form of sexual trauma and sexual you know, sexualization from a young age. So a lot of that is a traumatic experience. And I think there's probably some connection there with the overlap of ADHD and autism and gender nonconforming gender dysphoria. Like I think that's such a fascinating topic, too, right? So it's like, how do you begin to parse how do you begin to even unravel the brain's reaction to those small t traumas, like you said, a life undiagnosed or a life of experiencing these senses of like fundamental rejection that many women experience in terms of their worth and their value in the room? So that's where I get really confused about what are we talking about?

Lotta Borg Skoglund 23:02
I think, you know, what I think I think it's really good to admit that you're confused, because I think it's when we force this, you know, if we try to simplify these associations, I think we go wrong, and we your risk at going wrong there. So I think it's really brave of you. And I think also, the older I get, and the more kind of diplomas and titles I get, the more kind of brave also, I get to admit how little we know, we know. And, and I think I was much, you know, more scared years back to admit that. It took me when I wrote my PhD, it took me four years after my dissertation to understand what my thesis was about. I never admitted that to anyone, of course. And ideally, I did I passed, but when you when you try to be bigger than you are, and try to find explanations that are not really like, right, they're not enough, they need some more information to be sustainable. So I think that's really, really healthy. And I think we should do that much more. And I think we have to, to also maybe that's it isn't that's a good ADHD traits that you don't tolerate uncertainty or that the puzzle is not laid yet, or, but we have to, I think we have to, to live with that and to learn to do that. Actually, that's that's funny that you said and the funny that you told me about the net, because I went to Copenhagen.

Katy Weber 24:28
She was there, she heard you.

Lotta Borg Skoglund 24:30
She knows then she knows that I was there. And I talked for two days. I had no idea when before how this would go. I had done I've never done it before. And I was supposed to talk about female ADHD hormones. And the take home message is that hormones matter, but we don't really know exactly how. And then I have to give a two day talk on on a topic where I basically have to say no, the jury is out still. And we had so much fun We learned so much from each other. And it was like such a giving and rewarding experience. So if we can admit that and we can start pulling out the different, you know, stories and testimonies and and see, where do we all like fit this together, I think we can do really, really good things together. But there are still a lot of pieces in the puzzle that is missing. And that's a shame, because we haven't focused on girls and women, historically, and the research, but I think we're going we're getting there. And we are filling in the blanks, one by one.

Katy Weber 25:37
You know, I've gone back to school to become a mental health counselor. And so I'm finding that even in the curriculum, like every case, study client presents with depression, anxiety, and I'm like, it's everywhere. Everywhere I'm diagnosing clients with ADHD. And that makes sense, because so many of us end up with these comorbid diagnoses. But it's, you know, if I was in my 20s, I probably would have been like, Huh, that's interesting. I don't know if I've got this right. But I feel like now that I'm more experienced, I come at these with like, oh, I have a lot to offer this field because nobody is talking about this. Right. And it's amazing to me that it's it's not at all, you know, that neuro divergence just isn't part of the curriculum. So you had also mentioned in the book, the difference between the DSM and the ICD, the International Classification of Diseases and how it feels like the DSM is more amenable to the diagnosis for women versus the ICD. What's the difference there? Can you talk more about that?

Lotta Borg Skoglund 26:35
So first of all, I think from a Scandinavian perspective, it's been that we have we entered the DSM five in 2013 14. And we still haven't really implemented ICD 11. So we are living with an old version of so in the DSM five from the DSM four, it was intentionally relaxed on the diagnostic criteria to better fit adults. And, and also, like other displays of, of ADHD than typical, like, Boy norm. So I think that is one of the things that has affected and that the DSM five has very intentionally, intentionally, actually relaxed, the diagnostic criteria to open up for for and other symptom displays. But there's still a lot of things and I know because I read in the in the email that you were thinking about also the emotional dysregulation. Why is that not even, like, taken up as examples of impulsivity and hyperactivity in a way were for females specifically, in my opinion, that is the thing that is the most impairing for females, and it gets worse, with age. So a lot of things when living with ADHD, knowing about your ADHD, a lot of things gets better, and a lot of things gets better with time. But the emotional dysregulation tends to be this scar, that you have experienced a lot of things due to your difficulties in regulating emotions that will affect how you approach the world instantly, and so many women with ADHD and up lonely and feeling lonely and feeling failure in their relationships. And, again, we have different expectations of girls and women boys, we will not raise our eyebrows that much of a boy who is just you know, super focused on his things and don't really tend to the other social activities there. So we say Oh, this is like a little nerd and he'll he'll get around. But for girls like whoa, this is really very, this is something you know, off with her. And also for us as adult women. How much of the social kind of interplay that is expected of us and are like dudes, they just tag along like, oh, there's dinner at that place. There's dinner at that place. Did you get you know the Christmas gifts for No, no. And if you fail, that as a woman, it's much more like you put on yourself and also what other people can attend to think it is easier seems to for for society to kind of like shake off if a dad forgets the kids gym bag. It's like the hats will be the heads right? But if I as a mom forgets to like bake for the school sailor or don't have like the snacks at home And that is like, I'm a very I'm a really shitty mom. And it's like there's something wrong with this family. Right? So there's such a totally different social expectations or expectation on girls from from start and then on us as women, and that is, of course mirrored in why the diagnostic criteria feels so off sometimes for us and why I think it can become problematic for a unexperienced clinician to recognize ADHD, if you just look at the diagnostic criteria of the and then but from from the DSM five we have had a little bit of a relaxation that is making it a little bit easier anyway for for the clinicians to involve like, like females specific symptoms, but it's it's it's far from from like, adapted or or sufficient that would say, right,

Katy Weber 31:01
yeah. Now I've noticed you've been saying ADHD add, is that something you intentionally do to be more inclusive? Because I know like, I certainly never thought I had ADHD because of the name. Many women I'm sure the hyperactivity element they don't relate to. And I've often wondered why, when the three presentations were rolled under the ADHD umbrella, what was behind that choice? Because it feels like it's a disservice to women and girls to have those presentations are listed under ADHD. Do you know what the history is there?

Lotta Borg Skoglund 31:36
Yes, I know. Yeah. So why why I say it's, it's why I say also add is because I usually I get reminded after having like, a course in two days, and then someone says, like, I just have a question, are you going to talk at all about add, like, Oh, my God, I thought that in the beginning that I do not make any difference between those. Because we, I think as an as a neuroscientist, and as a clinician, I don't think it really has any true bearing it has for the person and to be able to, to explain your difficulties, I think, and that I have that I have seen a, you know, on a lot of my patients, and they it's really important for them, so that no, no, I have ADD, aha, okay. So it has a value, it has a meaning. But for me as a clinician, it's the same assessment. I what I see is like you can have ADD symptoms and a part of your life and then you have more of an ADHD symptomatology. And for females, I would say they have kind of a hockey stick situation where you typically you see the boys having a lot of hyperactivity that is, you know, obvious for the they can maybe they're disruptive and be you know, all over the place. And then sometimes during puberty or like in the early teens, the hyperactivity tends to kind of go away, but the inattention symptomatology is kind of stable for the boys. So it seems like then, this boy or this teenage boy has grown out of his ADHD, right? Because the hyperactivity, impulsivity is not as visible for the people around, it's not. And we know that the this the inattention symptoms that is associated to the adverse outcomes. So we have wrongfully assumed that the boy will grow out of his ADHD because of the hyperactivity and being less prominent, right. But the girls, they tend to do like a different trajectory, where they fly under our radar, when they are small girls, they are masking, they're conforming, they are adapting, they're trying to fit in, they're struggling, they're struggling, they're struggling, they're super stressed. And they say they're like, overwhelmed, and they but they look like white knuckle and they are making it and people tend to say yeah, you're really good. And but you just have to try a little bit harder, you know, you should just, if you just listen a little bit a lot, and they, they, you know, they absorb that and they try and they try, but then and the movies, we miss them, they fly under our radar outside of it, and then they enter puberty and the hormones kick in approximately the same time as the boys starts, you know, behaving a little bit better. The girls start to, you know, be more extroverted. And then they they start, you know, having more of the hyperactivity, impulsivity symptoms, you were talking about trauma and, and one of our like, biggest concerns here are the small girls that we have missed, that have developed a very low self esteem, entering puberty, realizing that sexual capital is a currency where I can get some kind of affirmation and I can get some kind of acceptance and I can be like, I'm trying to fit in I'm trying to be loved by someone right. And then on they are on our radar. They or in our face, because they start behaving in a way that when they take risks, right? And it's also coexisting with the first time when we were trying alcohol or perhaps even stronger drugs, maybe for the first time in your life, right? So you may end up in so, so, so dangerous and harmful situation. So due to your ADHD, you end up in situation where you you risk being victimized, traumatized. And then we fail them again, because then we find their symptoms. And we say, this poor girl, she's acting out or she is depressed, or she's having like these nightmares, because she's been traumatized. And we miss her ADHD again, because we have looked at the trauma. And the problem here and the problematic and the difficult thing to communicate to both the girls, their parents, and to healthcare professionals is that, yes, she has been traumatized. Yes, she may have a lot of symptoms due to trauma. But the problem is that she may have ended up in a situation where she is more likely to be traumatized than her peers because of her ADHD. And that is not saying that, you know, your skirt was too short, you brought this up on your own is never the case. But the case is that ADHD is a significant risk factor for teenage girls, to become victimized and to become traumatized. And that is such an important topic and in something that I know I'm, I feel so passionate about finding these girls before they become teenage women with ADHD, and ending up in situation that may might scar them for life actually.

Katy Weber 36:55
I remember very early on feeling so frustrated by a lot of the therapeutic treatment, where there was just that lack of curiosity, it was so solution focused, it was so like you have depression and anxiety as though you caught it in the air. Without tracing like where Keep going Keep going. Why are we like keep uncovering and you know, being so quick to figure out okay, well, you know, change your behaviors or Medicaid or something, but no, not getting to the route of like, the essence of these behaviors. Yeah. Oh, my goodness. And

Lotta Borg Skoglund 37:30
I think it's so important for me, I think it's so important for me, and I can also almost see when you work with people, how like, their shoulders just cannot go. Oh, okay. So this is how it's all tied together. And I think it's so I think the knowledge I always like, I this is my mantra, like, knowledge is power. So knowledge about how your brain works, knowledge about your ADHD, your unique neuro diverse brain. And that's why I'm going all about this ADHD 24/7 model, because I think we need kind of a framework to put our unique ADHD profile into, to be able to start working with this. Otherwise, if we simplify it, then we're just telling people to go blind folded into like, the war of life is like, you need to know why you have to struggle a little bit harder with this than others. Otherwise, I think it's almost reached re traumatizing to say to people just do this. It's like asking a kid to eat things or to do to wear things that is like you have this perceptual sensitivity, like you wouldn't do that to a child. And you shouldn't do that to an adult person or adult woman either to ask of them to try to treat their depressive symptoms and try to fight their social anxiety without giving them a theoretical rationale of why this is so much harder for me than for others. Otherwise, it's like setting you up for failure, I think and what you need when you have failed so much in your life previously. I think you need to feel it every step of the way. You are so but you want to you know, tap yourself on the backseat. You go girl. That's great. You, you ace that cocktail party. Like Yeah, it's awesome. You know, to go to cocktail parties. Yeah, let's invite it. No, not for me. It's like, okay, I'm gonna go there. I know. It's worth it. I love the people who's there and I love the the guy or the girl hosting it. I'm going to other I'm going to be exhausted for two days afterwards. It's like, oh, this you know, people talking and what am I missing? And did I say something stupid now it's like, I need to bring that with me to the cocktail party. Otherwise, I'm twice you know, it's a double whammy. It's I'm twice the loser there because I'm there. And people expect me to enjoy it. I don't really, but I don't want to miss it. So I think I think it's so important that we get as you We're saying, like, we need the explanation, we need to know why certain things in life is an uphill struggle. And why do we still have to struggle uphill, because we have to do it because a lot of other things are important for us or for our loved ones. And a lot of things I need to do to live a healthy, long life. And it doesn't come natural to me, but it's much easier to do it. If I know that, okay, I put twice as much energy into this simple thing, then the other guy or the other girl there. And I should feel very proud of myself for doing right. Yeah, absolutely.

Katy Weber 40:41
And I think it's also you know, not only the the psychoeducation, but also to figuring out the tools for your coping strategies, the toolbox, that never worked for you before, right. Other people will give you this advice, and it never worked for you. And so the the, the assumption was, well, that they, it's my problem, I'm the problem, right? And it's like, there's, you know, thinking about getting through the cocktail party, it reminded me of, of when I had an MRI for the first time, and I came out of it. And I was like, Why does nobody talk about how crazy that experience is. And I realized, because nobody told me how long this was going to take. I was in this as perfectly still, it's a nightmare for somebody with ADHD perfectly still, I had no idea how long this was going to happen. I had no idea how long I was going to be in there for and so I just had to get to this link disassociation, where I was like, I live here now, I guess.

Lotta Borg Skoglund 41:36
Awesome. That's an awesome example of mica, cognitive, you know, breaks out.

Katy Weber 41:42
But you think about how many times that is the that no explanation is given. Just like, you know, menopause, the way of dealing with menopause is grit your teeth and get through it. It's over eventually. Right. And so many things happen to women new motherhood, oh, it's fine. You'll just get it, you know, eventually you'll get through it just you know, grit your teeth?

Lotta Borg Skoglund 42:00
No, it's not true. It's not No, no, it's so much fun, I need to tell you, when when when my male colleagues, they start, you know, doing all this evolutionary natural thing, you know, and they start explaining all these things with a natural. So they, we I used to say, okay, so if we're going to talk about natural, then the normal or natural thing for a female on the savanna, because they always like to talk about on the stone age, you know, when we were like hunters or gods, okay, let's talk about when we were hunters and gatherers, the natural thing for a woman would be to get pregnant when when, when they are like 12 1314, perhaps the natural thing would be like to have 1015 pregnancies, perhaps, maybe six, eight of those kids are survived. And then the natural thing would be like to die giving birth, because that's kind of the most dangerous thing that you do. So being born or, or, or giving birth is the most dangerous thing a woman can do. And then so I want to talk about what's natural. And I think that's so typical. And I can say that, you know, I'm a neuroscientist, I'm a doctor. I'm a researcher, I'm a woman, I have three teenage daughters, I have a mother, I have a mother in law as a psychiatrist, I was totally unprepared. For, for menopause, for for a parent, it was totally, I had no idea what to do. Like no one told me about the postpartum situation. No, it's like this, as you say, it's like, well, that's natural. That's something that women just do. And then you in the name you think, Well, it's, it is a perhaps it is something that, you know, neurotypical females can struggle through. It's difficult. It's tough for a lot of, you know, women, regardless of your neurocognitive status, but, but for females with ADHD, I see it all the time that during these periods of vulnerability or her mama vulnerability, people really, really struggle. And there's a lot at stake, right? Talking about, you know, postpartum depression, you already have three kids, and then you kind of just go down in the basement, mood wise and hormonally. And everyone says like, well, everyone struggles. It's normal to feel stressed out. If you have two small kids, and you're, you know, lactate isn't it's normal. And then that is kind of what you get. What we've seen, what I've seen in my research is that we, we tend to, to miss the girls and then they end up as females getting an ADHD diagnosis eventually, if they get it and then they get abandoned again, because you only get like, okay, so I got my diagnosis. And I didn't get anything else like an explanatory model or anything and I get I got a prescription. And I'm supposed to now so now what right so and are slow And our mantra is, is no girl left behind. No woman abandoned me, is what we're trying to achieve with the grand grand grand mission. I know. But but it feels like that is what's happening all the time we miss the girls. And then when they struggle enough and they scream high enough to get an assessment and a diagnosis, then they get the prescription and then they get abandoned again. That is that right?

Katy Weber 45:29
Or told to lower your expectations, right? Just be grateful. We don't we're still not on the savanna.

Unknown Speaker 45:37
Exactly, exactly. Okay, so

Katy Weber 45:39
let's talk about the app, the letter Life app, is there. Is there like a communal biofeedback element to this app? Or is it really just a community of skills and strategies? Or it feels like it's an interactive experience? Right? Yeah. It's supposed

Lotta Borg Skoglund 45:56
to be an interactive experience. And basically what we're trying to do, we're trying to co create and we build as we go. So we are a couple of researchers trying to use our like, neuroscience background and knowing about from from epidemiology. Okay, so what do we know from from research that females struggle with? How can we based on that knowledge, together with females with ADHD? How can we build a tool that solves this abandonment situation, basically. So what we're trying to do, what we have done is that you you, you track yourself on your kind of on your different biological phenotypes, so your hormones and how you're doing in life in everyday life. And then there's also this community where you can share your experiences with others. So and the aim is to be less dependent on health care. And the aim is to fix the situation that we showed in our latest study, we were that was published last week, actually, is called time after time. And what we saw in that epidemiological study is that females get diagnosed four years later than boys for extremely formative years of their lives, where we actually have the opportunity to become equals, with our male peers. So we have the opportunity to, to get an indication we have an opportunity to if we don't, and I've ended up with all the adverse outcomes that is associated with female ADHD. So if we don't fall short of comorbidity, if we don't fall short of sexual risk taking and end up becoming teenage mothers, that we also in our research group group showed last year that teenage girls and adolescent women with ADHD have a six times increased risk of becoming teenage mothers. So, these are formative years, where we can base like the fundament and the family planning for a life that is equal and that is social, psychologically healthy, in a lot of in a lot of senses. So, so, what we are trying to do with letter life is that we are trying to, to look instead of looking from a research perspective, we are looking from the female perspective. Okay, so what are females with ADHD struggling with while we're struggling with a situation where we call the seven deadly sins, this seven factors that is actually associated with eight to 13 years decreased life expectancy in in adult ADHD. So we are looking at what all people know that they have to do, but that is so much more difficult when you have ADHD. So getting routines for diet for asleep for exercise for work life balance and stress for emotional regulation, addictive behaviors, and for life structure like meeting your doctor or appointments or paying your bills and stuff like that. So we have tried to build an app where you track yourself on these seven deadly sins, and see how your abilities and how you're doing fluctuates with your hormonal cycle or with if you have hormonal contraceptives or if you take other if you if you have other treatments, I can see how the it's all tied together. And the aim of course is again, knowledge is power. Knowing how your life plays out and where your ADHD messes up things in your life makes you much more skilled patient if you want. If you want you can. You can give your healthcare professional a better data driven decision, you know, forms to make decisions for your, for your treatments, or for psychosocial treatment or for medical treatment as well. So, but it's a very exciting venture. And it's a very also, I would say, last driven project, where we are we set out not to build a tool for women with ADHD, but with women with ADHD. So it's a it's a panel of our lead patients, users, patient organizations that is governing all the things that we do, and everything that we put into the app is by recommendation on on the the experts to the females with ADHD,

Katy Weber 50:43
and this is an international audience, ideally,

Lotta Borg Skoglund 50:47
so yes. So again, this warm appreciation of the book that it feels like this ADHD, women, it is an international language. So we decided to do it in English straightaway and also for our Danish friends. Because even though we're neighbors, we, we hardly a Swedes hardly understand what they are better, they understand us much better, but we thought why not do it in in English, and see if it is an international issue. And, and also, it's, we hope that this is also a we have like a care view. So you can you can share your your data, you can share that with a coach, for example. So the coach, if you're a coach, you can go in, and you can you will talk about the same things you will talk about, you know, the same issues, and then you can see, and you can follow up on what you do, if that actually has any, you know, effect on the most important things in your life. And you set your own goals into the app as well.

Katy Weber 51:50
Hmm. It reminds me of the I have a timeline, a graphic timeline of all of the various medical ailments that I always bring it every time I go see a specialist for something new, I bring this printout of this timeline that I've created. And they always look at me like I'm crazy, but it's it's amazing. To me, I feel like the detective with the all of the red string on the wall trying to make all these connections. And that actually reminds me quickly like the you know, one of the things that is you talked about in the book, which I had never heard about before was the fact that a stimulant medication was originally it was stumbled upon as a treatment for headaches, which I feel like we you know, we talk a lot about some of the nervous system, comorbidities in terms of autoimmune disorders and migraines. And I mean, and PCOS, like there's such a long list of of comorbidities with ADHD. Is there a biological component to the headaches?

Lotta Borg Skoglund 52:50
Yes, yes. And isn't that isn't it nice that we are finally, almost or soon I hope giving all these women and men at right? What they have explained, tried to explain to us that, you know, the brain and the body is actually connected somehow. But as I can feel, as a doctor, I have spent too much time trying to explain to my patients why they are imagining things, right. And now, the research are, you know, they are giving them right, and I was wrong, because we don't know everything yet. But we know that there's something in this from these small children that don't want to use socks because they feel that something is you know, off to adult women knowing that their migraines are associated with their ADHD and their fibromyalgia is and their pain conditions. But there is something here going on. And I feel that the what they're actually telling us is that signals from their own body is equally disturbing and distracting as stimuli from the external world. Right? So it's like, well, this is how you don't typically you don't tell people now know the light is not too. We used to do that so that no denial is not too bright. No, that sound is not no it doesn't smell. We know now that people with autism, for example, but also with the ad ADD and ADHD, they have a different sense of matory, like perception. And I think that is the same thing that we have to acknowledge from the stimuli sent from our own body up to the brain. It's like, there's no filter there either. So we are experiencing all this stuff in differently than neurotypical people. And I think we're just beginning to scratch on that surface. And I think, you know, the next 1020 years in research will be so exciting because I think we will explore so much of these overlaps and connection that our patients have tried to tell us about and we just discharged. It's like, no, it's just in your head, you know? Yeah. It is probably also in our head, and it's probably relevant, there's probably for real. So I think we will have to admit that we have been quite arrogant, coming from the medical profession in many areas. And I look forward to it. I look forward to admitting that

Katy Weber 55:20
I look forward to it. I mean, I think that's why it's been by hyperfocus Gnosis for so many years, because it's so fascinating. And it feels like it's changing so dramatically, in such a short period of time, and just in terms of like my own understanding, but just didn't the general conversation about where it's going. And I feel like I've often said on this podcast that I think ADHD is like a gateway diagnosis to so many other to neuro divergences as a whole, right, and kind of how we start to understand the brain and the, and the neural pathways and receptors and all the biological things. I don't know what I'm talking about. But it Yeah, it's so fascinating to me.

Lotta Borg Skoglund 56:00
And also, hopefully, that we will look beyond the diagnosis and look at the neuro like neuro psychological processes instead, that's also something that we're building into the app is like, we don't really care if you call it add ADHD, autism, or we call it, we look at it from a neuro diversity perspective. And then we try to map out how the different brain processes actually can explain what you are experiencing. So then you can get your own brain map. And I think that's super work. For me, that's super important to us. And to know why certain things are so difficult for me, okay, so I can put that in the, in the area of my flawed filter function, or I can put it in in the area of having not like my server or in my volume button. In my reward system. It's like kind of it's not off, but it certainly works differently than my husband's, for example. So so and it explains a lot of what I typically end up struggling with. But then that's also the future for ADHD add, looking at. Okay, so how can we understand the brain? And what do we know from brain science? Now, that can explain a lot of the difficulties that people with ADHD struggle with, and adding on the hormones on top of that, again? What do we know about the brain and the hormones that can explain how females explain why they PMS PMDD hits the roof, during certain days of the month, and so on. So I think there are a lot of data out there that feels really soothing, and also empowering to to know about because you have to build self efficacy. This is not a disorder, this is not something that we can treat, and get rid of. We will lean into this and we will live with it. And I think that's so important. And then you have to but then you have to have like the the manual to your brain. I think otherwise, it's very arrogant to expect for someone to lean in. Really? Huh.

Katy Weber 58:04
Oh, my goodness, I feel like I could talk to you for hours.

Lotta Borg Skoglund 58:11
As you hear I can talk for hours. I

Katy Weber 58:17
well, I anyone if you're listening, and you go out and get ADHD girls to women getting on the radar, buy it in English now. And you can also listen to it. I listened to the audiobook. It's fantastic. I hope we will wait with bated breath for the you have one on neuro divergence in the workplace also. And then you have another book on on Aging, right.

Lotta Borg Skoglund 58:38
Aging and ADHD and black belt in parenting and parenting. Exactly. So I tried to write about, like the entire lifespan. So but but this is this is the this is closest to our It's like a candy.

Katy Weber 58:57
It is and like you said the kid the patient. What is it anecdotes are is I think the best part, right? I mean, it's it's really just there was so many times where I was moved to tears thinking about these stories of, of so many experiences that so many of us had, and the just feeling so defeated. And it just it felt really good to, like you said put those put some of the connections together. And I think it takes ADHD researchers to be able to do that right, to be able to start connecting those dots. Yeah,

Lotta Borg Skoglund 59:27
I think we do together. And I think we have a lot of, you know, when we join forces, so you're doing so much, you know, good by moving the needle with what you're doing with the podcast and having people talk about it. And so I think from a neuro scientist perspective, I can just, you know, jump on the bag bandwagon with all the great advocates for free mela ADHD out there. And the US of course is you're always first

Katy Weber 1:00:00
Awesome. Okay, well, I will definitely have a link to litter life. I guess at the moment, it's really getting on the waitlist. That's what I'm on right now.

Lotta Borg Skoglund 1:00:08
Yeah, so we do we don't want to admit too many people, since we are building as we go. But but we we are trying to admit more and more so. And we have, I think we have 1000 people actually active in lead or life master suite. So it will be awesome to get I think you probably will get ahead of the line if you if you register from the US Oh,

Katy Weber 1:00:30
awesome. Well, okay, well, I'll I'll wait for that. Because one thing I've don't have is patience. So. But thank you so much for spending this time with me. And your research is so incredible. And I'm just thrilled to have discovered you and, and so thank you. Likewise,

Lotta Borg Skoglund 1:00:48
likewise, it's a it's an honor, it's a privilege and I could have talked the entire night with you.

Katy Weber 1:01:01
There you have it. Thank you for listening. And I really hope you enjoyed this episode of the women and ADHD podcast. If you'd like to find out more about me and my coaching programs, head over to women and adhd.com If you're a woman who was diagnosed with ADHD and you'd like to apply to be a guest on this podcast, visit women and adhd.com/podcast guest and you can find that link in the episode show notes. Also, you know, we ADHD ears crave feedback. And I would really appreciate hearing from you the listener, please take a moment to leave me a review on Apple podcasts or audible. And if that feels like too much, and I totally get it. Please just take a few seconds right now to give me a five star rating or share this episode on your own social media to help reach more women who maybe have yet to discover and lean into this gift of nerd urgency and they may be struggling and they don't even know why. I'll see you next week when I interview another amazing woman who discovered she's not lazy or crazy or broken. But she has ADHD and she's now on the path to understanding her neurodivergent mind and finally using this gift to her advantage. Take care till that