Why We Miss Girls with ADHD – and How Hormones Hold the Key

In this episode, Alecia explores the critical intersection of women's mental health, ADHD, and reproductive psychiatry—an area where science is only beginning to catch up with women's lived experiences. Alecia's journey into psychiatry began in Sacramento, California, where she witnessed profound disparities in healthcare access across diverse communities. After seeing loved ones struggle with both physical and mental illness, she pursued medicine with a mission. During medical school, she gravitated toward geriatric psychiatry, drawn to the complexity of caring for older adults. But during residency, her focus began to shift as she became fascinated by something even more fundamental: the intricate dialogue between mind and body. This growing interest led her to consultation-liaison psychiatry, formerly known as psychosomatic medicine, where she served as chief resident. The field gave her a lens to understand how physical illness shapes mental health and vice versa—a perspective that would profoundly inform her later work. She went on to complete a consultation-liaison psychiatry fellowship at the University of Chicago, followed by specialized training in reproductive psychiatry. Alecia’s attention to health disparities guided her toward women's and minority mental health, populations that remain vastly underfunded and underresearched. In her clinical work, she began noticing a troubling pattern: many patients struggling financially, physically, and emotionally actually met criteria for ADHD, yet had never been properly identified or treated. These missed diagnoses often compounded existing challenges, leaving people to navigate life with an invisible burden they didn't understand. In our conversation, Alecia illuminates why girls with ADHD are so often overlooked. While boys typically display hyperactive, disruptive symptoms that demand attention, girls more commonly present with inattentiveness—daydreaming, losing track of conversations, internal restlessness—symptoms easily misattributed to anxiety or depression. This diagnostic blind spot means girls are less likely to receive appropriate medication and more likely to struggle silently through years of self-blame. Alecia then guides us through the remarkable role hormones play in ADHD across the female lifespan. She explains how estrogen acts as a neuroprotective force, supporting the neurotransmitter systems that govern focus and impulse control. During the menstrual cycle, as estrogen and progester