ADHD, Hormones, and the Female Brain: A Conversation with Kara Cruz
This week I’m talking with Kara Cruz, a licensed marriage and family therapist and Certified Perinatal Mental Health Professional with over 15 years of experience supporting women through life transitions. Kara’s work focuses on the intersection of ADHD and reproductive mental health—helping women navigate the complex terrain of hormones, identity, and self-trust.
In our conversation, Kara and I dig into how ADHD symptoms can change and intensify across different hormonal stages - puberty, pregnancy, postpartum, and perimenopause - and what that means for real-life functioning. We also get into how ADHD in women often goes undiagnosed or misdiagnosed as anxiety or bipolar disorder, and how learning to track your cycle, protect your energy, and build realistic routines can make a world of difference in your adhd management.
And I want to emphasize that even if you don’t have a cycle there is still a lot to get out of this episode, when I was working on the top tips for this episode I had to cut a few because there was just so much good stuff. I had a great time talking with Kara and learned a ton, I think you’ll love this episode too.
If you'd life to follow along on the show notes page you can find that at HackingYourADHD.com/249
YouTube: https://tinyurl.com/y835cnrk
William Curb: Alright, well, it's so great to have you here. Can you tell me a little bit about yourself and about how you got into doing this?
Kara Cruz: Yeah, my name's Kara Cruz. I'm a licensed marriage and family therapist in California. Outside of that, my work is a therapist. I'm a mom. I'm a wife. And I also was diagnosed with ADHD at a very late age. Later than the childhood age. However, lots of things pointing in the direction. When I look back at common summary report cards and the things that I used to struggle with, it's very apparent and very obvious. It's almost like textbook out of the DSM, the behaviours and things that I would have. But as I went into my 20s, I loved school and I also struggled in school at the same time. But that kind of led me into wanting to become a therapist. I loved working with kids. I loved working with people in the educational and psychology was an interest of mine.
And that's kind of what guided me in the direction of where I'm at today. And as I was going through grad school and learning and working with my clients, I just became really interested in the topic of ADHD. Whenever I could, even if I didn't have clients I was working with on my caseload with ADHD, I just was always interested in knowing about what is it, what causes it, what does it look like, how is it different for girls, for women, and just kind of evolved from there. And when I opened my private practice, I primarily, I moved from working mostly with children to working with adults, mainly with women. And working with women, there's a lot of things that go into their mental health, hormones impact, mental health, just life, what we go through in life.
And when somebody is a woman and has different things like hormones and life stressors in play and has an ADHD diagnosis or is not sure if they have an ADHD diagnosis, it can really kind of complicate things and make things kind of hard challenging. And so it just became an area that I really wanted to learn about, work in. And now I trained, I host training for therapists on the topic. I work with parents and caregivers on how to kind of work with their kids who might be going through something like this. And yeah, that's kind of how I'm here and why I'm here.
William Curb: It's so important that we start getting the information out there that there are differences in how not only how ADHD presents with between men and women, but also how hormones change things and how stages of life change things especially.
Kara Cruz: Yeah, absolutely. One person who maybe is kind of like your neurotypical person, their brain kind of works. It's not like a normal, abnormal, it's just a difference. But a person's brain who's neurotypical with society is kind of set up for them to be more successful versus somebody who's got that neurodivergence difference in their brain. Society doesn't really work as well with those types of people or it's a little bit harder and more challenging. So life stressors and just the way life work, school, how school is set up, our schedules really don't always promote success and settled nervous system for those of us whose brains function differently.
William Curb: Yeah, so maybe we can start here with talking a little bit about how ADHD kind of presents differently in women in light or how they have to deal with their symptoms in a different way.
Kara Cruz: Oftentimes when we think of ADHD, we think of the eight, nine-year-old little boy in school who can't stay in a seat, who might kind of talk out of turn, interrupt, maybe in line kind of intrudes on the friend's space, maybe has trouble with impulse control, maybe they're being really handsy and maybe in a playful way. But sometimes it's harder for them to kind of control those impulses or pick up on the cues from their peers that like, hey, this is kind of being annoying.
This feels annoying, you know. And so it can cause social issues and things like that with girls. It's not as typical. We don't always see the outward expression. And if we do, it can look different. So if we have an impulsive, hyperactive girl, it might look like bossiness, talking out of turn, interrupting their friends. It might not be as physical, but they might experience a lot of internal anxiety and stress and internal hyperactivity where they have a lot of thoughts at once.
They can't focus on one thing at a time because there's a lot kind of going on in their head. Sometimes they can be kind of, you know, physical and out of their seat, but sometimes it can look a little bit different. So they might be that student in class is getting out of their seat and going up to the teacher a lot. So they're out of their seat, but maybe they're not running around the classroom. They're getting out, they're wanting to help the teacher a lot. They're impulsively getting up and going over to a friend who might have a question and kind of intruding in their space.
And as, you know, a girl grows up, what that could look like is impulsive behaviors, not thinking things through, things like overspending, having trouble with executive functioning. So planning out things like planning out the meals for the week, the grocery list, what needs to happen in what order, time management, they might overbook or over schedule themselves and not plan things like, you know, transition time, you know, drive time and be rushed with lots going on. A lot of the hyperactive symptoms, most of the time can look, you might not see that, but the person feels it. So it could look like anxiety.
William Curb: That is an interesting thing too, how like one of the reasons I think a lot of women go misdiagnosed or undiagnosed is they often like, oh, this is anxiety, or this is bipolar, or a host of other things where it's like, oh, this looks like the same thing. But if you don't account for what's actually driving the bus here, it makes it very easy to be like, well, it's just this.
Kara Cruz: Yeah. And a lot of times, you know, with the anxiety, it's, you know, it might not be, they have a lot of worried thoughts, but they have a lot of thoughts at once, but that can be misinterpreted for anxiety, like, you know, racing thoughts, racing mind, or that can even look like you said mentioned bipolar. A lot of times women with ADHD, especially if they're, you know, when I say functioning well and not as a judgment, but like, they're able to keep a job, you know, they have friends, socially, they get along with people that they might sometimes, you know, get into a place where they can't keep up with work or paperwork, or they miss deadlines and due dates or miss appointments.
But for the most part, they're managing well, but they kind of are kind of in that it can sound like pressured speech, like with bipolar disorder, they're talking a lot, interrupting the impulsive spending, impulsive behaviours can look like a hypomanic or manic state. I used to work in a hospital and quite often I would see women who were diagnosed as bipolar because they're coming in with those presenting either looks like anxiety or looks like kind of a manic state, but really that's kind of their default setting. They're like, no, this is how I always function, you know, I always struggle with sleep because as soon as they say sleep trouble, people jump to the bipolar diagnosis as well.
What's really happening is this is kind of like their, I call it like their default setting. They're kind of always like on high energy, anxious all over the place or talking a lot and erupting versus somebody with bipolar disorder where that's going to come in phases, you know, it's going to maybe they're kind of like at a baseline or maybe some depressed mood. And then for four days, three to four days, they're not sleeping well at elevated mood that kind of looks different than their normal behavior where someone might look at them and say, you seem a little like high energy or stressed or like you had a lot of coffee, you know, there's something going on, you know, and with a manic episode, it's going to be a bigger, you know, they're going to see something much bigger.
So when I'm working with somebody and trying to determine the difference, I'm really kind of going through their pattern. Is this kind of like how you are steadily, you know, this kind of on state, fast pace, talking a lot, interrupting, impulsive, or does it kind of come and go, you know, two to three times a year, do you have an episode where this happens? What were you like as a child in school? Those are kind of the questions I start with to get a sense of the pattern in the life history.
William Curb: Yeah, that's absolutely. Because I know there's so many people that are like, oh, yeah, everybody has this like a little bit of ADHD, but for really it's ADHD is this chronic state of like, this is how life normally is. It's not I lose my keys sometimes. It's unless I have a system in place, they will always be gone.
Kara Cruz: Yeah. Yeah. Learning like early on when I became a driver, losing my keys and like, you know, like going to the mall and setting them down, I was looking at t-shirts and like, all of a sudden, I'm getting ready to get in the car and realize where my keys are, you know, losing them at home. I learned real quick, like, you put your keys in the same spot all the time and then that becomes a pattern. So then it doesn't seem like I lose my keys, because I have this pattern that in this like, you know, routine that I've taught myself, you know, keeping a calendar, keeping a schedule, being really kind of like almost seemed OCD like with the calendar and schedule wasn't an OCD trade. It was like a, this is my safety to keep me kind of on track.
William Curb: Yeah, absolutely. I know I've developed so many things over the years that I don't even think of as tools to keep me on track, but they're like, absolutely essential. With this, we also have like, with this difference in symptoms, which we can absolutely, having interacted with many people with ADHD, it's like, yeah, this is can both have impulsivity and it can manifest in many different ways. And even like, when I'm like looking at my own impulsivity and realising, oh, yeah, clicking through 12 tabs, that's be being impulsive while I'm doing one thing. But there's also this lens of hormones that I think is really important that we start exploring. Because as I've been hearing more about it, it is a huge issue for this like everyday management of ADHD.
Kara Cruz: Yeah, certain hormones for women are can be protective in terms of their mental health, you know, like progesterone, you know, is something that can be protective and decrease anxiety. So, as a woman gets older or depending on where they're at in their cycle and what's happening with that, pregnancy, postpartum as well, that can impact, you know, a person, you know, where they have heightened anxiety, their distress tolerance drops, and then ADHD traits, characteristic symptoms, whatever we want to call it, you know, then those are elevated because everything else is kind of, you know, the capacity to kind of manage everything is like going down, you know, if your mood is changing, if you're not feeling well physically, estrogen plays a big part.
So different times in a person's cycle or over their lifetime, depending on whether in phases of life, whether it be, you know, puberty, pregnancy, postpartum, perimenopause, menopause, you know, there's different things happening with hormones during those times and that can impact mood, executive functioning, anxiety, sleep, just the capacity to kind of deal with life and just, you know, when you're kind of in a, I'm feeling good state and like I've kind of figured out tools to manage the ADHD, but when you're not feeling as well, you kind of lose the capacity to manage all that, that window, you know, gets smaller, that tolerance window.
William Curb: Maybe we could kind of go through these changes that are happening. So like, do we see distinct differences between like, say, the hormones increased in puberty versus pregnancy?
Kara Cruz: When you're looking at different stages in pregnancy, different hormones are impacted. So if you look at what's happening during which stage and seeing, you know, you know, let's say, for example, we're at a period of time when estrogen is dropping, you might see things like brain fog, forgetfulness, an increase in depression and increasing anxiety, as well as, you know, other hormones, you know, progesterone and things like that. When they're decreasing and dropping, we're going to see, we can see an increase in some of those symptoms. And so when that happens, when we're more anxious, when we're not feeling well, just to kind of keep it in simpler terms, you know, when we're not feeling well, we're anxious, we're in pain, we're tired and sleep deprived, you know, our executive functioning, you know, our logic and reasoning, all those skills are going to kind of go out the window.
We don't have access to, you know, that part of our brain that's intact to protect, you know, logical thinking, rational thinking. We kind of, and sometimes in the therapy world, we say it's kind of like somebody feels like when they say I've like flipped my lid kind of thing, like, yeah, you've lost, you know, that capacity. So all those ADHD symptoms that the person might have already experienced saying are just going to be exacerbated.
William Curb: I mean, I remember my wife talking about pregnancy brain that was before she was diagnosed. And so I can't imagine like doubling up some of these issues that already are quite hard to deal with.
Kara Cruz: Yeah. So you could see, you know, more disregulated mood, like during puberty for girls and adolescents, even before, you know, maybe in that mid to late elementary age, of course, when they get into junior high high school, there's also other things going on in their life that time too, that can impact it. But with pregnancy, during postpartum, you know, that fourth trimester sleep deprivation, so there's sleep deprivation, then there's a huge shift in hormones after pregnancy in the postpartum stage. And so all of that, all at the same time, can really impact the person's mood in particular with depression, anxiety, executive functioning.
William Curb: So I see there is a value of just knowing that this is coming. But other than things that we can do to like, or that women can do to help deal with these, their oncoming cycle and where they, you know, scheduling or other tools they might want to use.
Kara Cruz: I mean, there's a lot of different ways and everybody, depending on, you know, what they want to do and what they're comfortable with, you know, because there's, there's medication, you know, I have clients who have ADHD who take medications and I have some who have ADHD, who choose not to. And most of them, I always just, you know, strongly encourage that they get a consultation and just a consultation, because I'm not pushing it one way or another, but it's more, so they know, they can ask any questions they have, they know what their options are. And they also have it in the back of their mind if they get through a different stage or phase of life and things kind of are harder, that they know what those options would be.
So I always encourage that. But, you know, medication, of course, is one way that it can be addressed. And that's to a psychiatrist or doctor for women. I strongly recommend that they see a reproductive psychiatrist, someone who's a specialist in reproductive mental health. There's not as many of them out there, but they are out there, because they're going to be able to know what to recommend, how to recommend based on pregnancy, postpartum, any other underlying issues if there's ADHD, and then, you know, perimenopause, things like that.
They'll be able to kind of speak to all the aspects. If they're not choosing to do medication or if they are and that's helping, you know, lifestyle, you know, sometimes it's, and this is a hard one, it's slowing down, doing less, protecting boundaries. That's a lot of what I do in session with clients is sometimes I have people I work with who like to say yes, they struggle with saying no.
Sometimes they like to say yeah, they want to do the extra things and they want to be involved in a lot of things, but it burns them out. And so we really have to look at protecting their energy. And even if we can just get creative around certain times of the day, the week, you know, being kind of strategic, their cycle, you know, I always have my clients track their cycles, even if they're not having any kind of reproductive health issues or anything like that, we just track it and just see if we notice any themes and patterns, and particularly those with ADHD, we tend to see, we tend to see shifts and mood and, you know, how much, you know, capacity they have to like, you know, one week they're really productive.
Taking on a lot, they're using kind of that hyper focus part of their brain that can feel good, you know, but then another week they're like, I have zero energy to do anything. And instead of looking at it like, well, you're depressed or there's something wrong, could it just be that this week, we need to protect your energy more and we need to think about really protecting your sleep, making sure basic needs are met, getting support when you need to, letting go of certain things, you know, whatever the extra tasks and things aren't going to get, you're not going to get to them this week.
So some of its strategy, and it's going to be different from person to person, depending on what they experience. But what I always recommend any of my clients is sleep is really important, particularly with hormones and with ADHD, somebody with bipolar disorder, those are, that sleep is always kind of like the first line of defence is making sure that you're sleeping, it's nighttime, you know, consistent sleep to keep your circadian rhythm restored.
We're really watching things like what types of like alcohol substances, things because that can impact sleep quality. And we're looking at body movement, moving, not burning out, you know, protecting time and boundaries. So a lot of its strategy, but it's doable, you know. And so working with the therapist who knows kind of how the ADHD brain works, you can really come up with kind of a customised plan for your life and what looks right for you.
William Curb: And knowing that you can do something is also what I find incredibly helpful when I'm feeling like burnt out and I'm just like, I don't know what to do. And I'm like, okay, you can do something though, that always.
Kara Cruz: Yeah, I really like to kind of help my clients get in touch with a nervous system in their body. And sometimes that people think that sounds really like weird and woo, but really with ADHD, it's like their bodies tell them a lot because a lot of people with ADHD have really, you know, a lot of sensory issues or they pick up when they're starting to feel tired or burnt out, it's like they feel it when their batteries drain, they feel it. And so going into kind of the body and what's happening, especially those who kind of overwork work a lot, they get really hyper focused, and then they burn out or really paying attention to what are the cues that your body starts to tell you early on so that you can kind of pause and then disengage from that activity, even though it's hard, but we need to protect your energy, your rest, make sure that you're not that hyper focused or that energy isn't used against you and burning you out too.
William Curb: Yeah, because I do find too, the energy levels often are just shifting just because if I'm doing too much one week, you know, the next week, I'm essentially borrowing extra energy from my future self, especially with hyper focus.
Kara Cruz: Yeah, well, it can feel really good when you're doing something you enjoy and you're in it, you're in that zone. And then there's just like this threshold that you cross where it's like, then all of a sudden your brain starts to feel like mush and you're like, when did I eat last? Have I drank water? Have you used the bathroom? You know, you're not taking care of yourself. Have I got it, you know, moved around, walked around a little bit or have I been plugged into the computer or whatever it is you're doing, you know?
William Curb: Yeah, it's funny, I was hearing someone describe hyper focus the other day, like your body, it feels like hunger and needing to rest and something is happening to all to some other body. And I was thinking in my head, but it's not, it's still happening to you, you're just not noticing it anymore.
Kara Cruz: Yeah, yeah. And so that being mindful and aware of the body and doing lots of, you know, check-ins, I'll have some of my clients who really they struggle when I say, give me a, you know, just take a breath and just check in with your body and tell me what sensation you notice in your body. They go to their head, like, well, I think that like, no, no, no, like let's check back in. Oh, well, I noticed that like, I'm clenching my jaw, I'm noticing like my chest feels tight, I'm noticing that there's kind of like a, an achy feeling in my head right now.
And so getting into that and noticing when it's like at a level 10 and you're like about to shut down and just throw yourself in bed, or it's just kind of like whispering to you at a two and a three. And so I work with my clients and really learning when it's getting to that middle range that we can like step back a little bit and take care of ourselves. And then you'll have the energy to come back to what you need to versus burning out. And then you just, you know, you want to doom scroll or just shut down the rest of the night.
William Curb: Yeah, when you're like, and then you get that to that stage where it's doing the things that would make you feel better are just incredibly hard to do where you're
Kara Cruz: like, oh, I have no energy, right?
William Curb: I have like my, my back is super tight and I need to stretch it out. And I have to do that. I don't, I can't.
Kara Cruz: Mm-hmm. Because your body, your brain, everything's just tired, you know?
William Curb: One of the other places I want to hit here too is Perimenopause, which I don't know a ton about. So can you speak on that for a little bit real quick?
Kara Cruz: Yeah. So, Perimenopause is basically the leading up to the stage before menopause. If you think about it in three stages, there's a leading up to menopause, which is Perimenopause. Menopause is basically one day. So it's when a woman has gone 12 consecutive months without a menstrual cycle, and this is where they're at in life, and that day is considered menopause. So, so that it's the end of their reproductive stage of life. And then anything after that is post menopause. But Perimenopause is kind of being talked about. This is like a, it's not new, but more people are talking about it now.
It can start as early as 35, although there's information that's being shared out there that if you're 35, 40, you're too young, which is absolutely not true according to the menopause experts. And that's who I'm getting trained and learning from. These are doctors, medical professionals, psychiatrists, therapists who are specifically trained in menopause. So Perimenopause can start as early as, you know, 35. So some people are starting their families and still having children in 35. So postpartum, pregnancy, Perimenopause can overlap essentially.
Can you imagine that with ADHD? That sounds like a lot of fun. But 35 up into the 40s, the average age for menopause so that, you know, one day when there's been 12 consecutive months, no menstrual cycle, that is 51 to 52. So menopause averages is 51 to 52, but a person can be in Perimenopause for several years leading up to that.
William Curb: And so in Perimenopause, you're having a shift in your hormones and stuff?
Kara Cruz: Yeah. So what's happening is estrogens dropping, progesterones dropping. There's other hormones in play. But basically, you know, every month when a woman ovulates, she releases eggs. You're boring with as many eggs as you're going to have your entire life. After ovulating for so many years, that egg supply is diminishing and decreasing and eventually will be zero. And that marks the end of the reproductive stage of life or menopause. And so what's happening is there's rapid shifts and changes in hormones. Hormones are dropping. The egg supply is dropping. We're nearing the end of the reproductive stage of life. So a lot of things are happening hormonally. And that can cause physical symptoms like hot flashes, night sweats, joint pain. There's estrogen, estradiol receptors in the joints. Estrogen is actually an estradiol.
They're very protective in terms of pain relief, anti-inflammatory. And so when that hormone starts to drop, women can experience joint pain, frozen shoulder, their cholesterol and blood pressure can be impacted. They can have dental issues, hair thinning, hair falling out, dry skin. Just all kinds of physical symptoms. But there's also emotional symptoms, psychological symptoms. So brain fog, irritability, rage, even anxiety, panic attacks. Someone who's never had a panic attack before can... There might not be any stressors happening. And all of a sudden they're experiencing panic attacks, insomnia. There's a whole list of it. I actually have a symptom checklist. If anybody listens to this, if a woman listens to this and wants to hear more and get my symptom checklist, it's a free checklist I give to women in therapists that can go down the list.
It has lots of resources on who to contact, what to do, and where to get support if you're going through this. But that's essentially what's happening during perimenopause. And so it's those years leading up. A lot of times it starts for women with a change in their menstrual cycle where they'll skip it, have it more frequently, have it more heavier, just be really different and off from what they're used to. So they start to think that there's something maybe medically going on. They start to... And we think that we're seeing things, right? We think of things like ovarian cysts or cancer or something else happening. And it really could be the body kind of saying, hey, we're getting towards the menopause stage of life.
William Curb: Yeah. Well, and I can see too how that would be such a big impact on ADHD with just the symptoms themselves being brain fog and insomnia. That would absolutely be horrendous to deal with at the same time as having your normal symptoms. And then I also know that ADHD medication is often highly influenced by hormones. So if your hormones are shifting, then your medication is probably being less effective.
Kara Cruz: Yes. Which is why it's really important. If somebody's... They might have gone through part of their life prescribed a medication from their PCP or anyone, but once they get to the stage perinatal or perimenopause and things are shifting and changing, it could be helpful to seek out a reproductive specialist, a psychiatrist who specialises in reproductive mental health because they're going to know more about the hormones and how the medications can be influenced and what medications might work better, especially if there's somebody with ADHD or bipolar disorder or something like that.
William Curb: And then so we have this transition and then you have this post menopause transition. I imagine that also has another effect on your ADHD as well. So it's this transition after transition where you have to keep recalibrating things.
Kara Cruz: Yeah. And I just want to also point out there is a study done that showed that people with ADHD are two to three times more likely to experience mental health symptoms during puberty, pregnancy, postpartum, perimenopause, those stages of life. So if you have ADHD, you have a higher likelihood that you're going to experience these mental health symptoms during any of those hormonal stages of life, which sounds obvious. When you say it, you think, of course, but I just like to share that as well because that's pretty significant.
William Curb: It was funny with all the things that are like, oh, this seems obvious with ADHD, but then we just forget that ADHD does affect everything in our life.
Kara Cruz: I know for many men too, but many women aren't diagnosed until later in life. And often it's either when their child is diagnosed and they're taking the family history of the child and then sometimes you'll get a doctor and they're just like, well, what about you? And that's what I've had friends that I know that colleagues and friends that are closer to me that had shared that, that that's how they got diagnosed because their child was in the middle of it.
And the doctor just kind of like did some extra, asked some extra questions to the parent. And also during perimenopause, like 40s, 50s, that that's more common as well if they didn't get diagnosed when they're like, if their kids did or during that time, if it wasn't caught, then oftentimes it can be in their 30s and 40s.
William Curb: Because then I see, yeah, if ADHD is suddenly becoming this roadblock in life that was before manageable at least, probably not fun, but at least manageable to get through things. But then you have this shift and everything that is like, oh yeah, we need to look into something.
Kara Cruz: And I think if there's other things going on too, if the person has a traumatic history or if they've kind of learned to self medicate through substances or alcohol, things to kind of shut down their brain, sometimes we kind of lose that that's what it's kind of like, what's the underlying thing happening? We start to focus on what are the behaviors, that's the problem, whether it be substance use or the trauma responses or anxiety. We're focused over here when really like that underlying that kind of started everything was that ADHD diagnosis. And not to say it's something wrong with the person, but again, our society is really tailored to a different type of brain.
William Curb: And I know like for a long time, I treated some of my ADHD symptoms purely through anxiety. So I was never late to anything, but it was highly stressful to me to like make sure that it was on time. And it's something I'm still working on because it's not exactly the best way to go about trying to be on time because then it leads to other things going on where I'm like, oh, I'm not just stressed. I'm like angry at people for like being late and like, okay, this is not the way to do this.
Kara Cruz: Yeah, the window of tolerance, the capacity, they're frustrated yelling at partners or kids because it's just like, it's hard to manage that all.
William Curb: I remember specifically like trying to drive my daughter to preschool and I was like speeding and then it just like hit me in the like, I am speeding to get her to preschool on time. This is not the way I want to live.
Kara Cruz: Right. Or just that rush like rushing kids in the morning and then feeling like you're kind of like on, you know, anxiety is on, you're like kind of fight or flight yelling and it's like, what's more? Yeah, is it more important how like our nervous system is going into our day or that tardy? And, you know, sometimes it's like, that's already can happen because like, you know, we're going to remember like that interaction with our parents, you know, forever, but it's, it's hard when you're in it. It's hard to kind of talk yourself down from that and subtle when you're feeling on, especially if you had a history of most people at ADHD have some kind of history with getting in trouble for being late or getting in trouble at work or, you know, it is a pattern and they see it as a pattern.
It's like a default. There's something wrong with you, but it's really just like, people are just trying the best they can to kind of hold it all together and to do all the things in the morning. And, you know, so much goes into, you know, just getting ready throughout the day and getting the kids ready and getting things packed, like all that executive functioning when you're tired, it's, it's really hard.
William Curb: Yeah. And it's, it takes a lot more than just like, it was very helpful to have my realization like, oh, this is not how I want to live. But then I'm like, okay, then I need to put in things to practice to make sure that I'm not going to go back to that pattern when it's a less what I'm late again.
Kara Cruz: Yeah. And sometimes it's kind of a, the choice that people will make is I'm not going to over commit myself. I'm going to say no, I'm going to maybe make some people upset by having different boundaries, by not staying at like the get-togethers as long by prioritizing my sleep. Because that means that something else, we have to take other things off our plate. It might, might mean you have a different type of job, you know, because the traditional, you know, corporate world, it's like, go, go, go. And there's so many demands that doesn't work for everybody, you know. And so you see a lot of business owners, entrepreneurs, people in different types of jobs because it's more manageable.
William Curb: So I'm just thinking about the ideas of like these life transitions and how we might want to try to start trying to build that thought process into our head. Like how do we, are there ways that we can start thinking about, okay, we are going to, a lot of times with, I know with my ADHD is I try to visualize that I'm going to be doing something forever, which I know is not the way I want to be. This is not the way to actually do things, but in my head, I'm like, oh, I'm going to start this process.
I'm going to do this forever. But I think it'd be helpful to also be starting to get into my head that like, oh, there are going to be times in my life that I'm going to have to start managing my ADHD in a different way. And that is whatever I'm doing now isn't forever. I need to figure, to kind of plan for that and be cognizant of that life changes. And I need to be able to try and keep up with that, maybe plan ahead a little bit.
Kara Cruz: Are you kind of thinking of when things change in terms of like work or family or as you age? What are you kind of thinking of?
William Curb: Yeah, I think kind of as I age, because I know, like even though I'm not going to go through menopause or any of that, I am going to still have hormonal shifts and it is going to be something that I deal with. And then I'm also with aging, I have my family, I have a daughter that will be in the next few years going through puberty and a wife that will also be dealing with these things and then my responsibilities and the way I react are going to be important as well.
Kara Cruz: And I think it's really knowing what you anticipate being most challenging as you get older. Would it be that slowing down? Would it be taking care of the physical health? Would it be saying no to things, taking things off your plate, getting help, support with maybe extra tasks in your business? So it's really having, I think it can be kind of individualized, depending on the person going forward. I think like particularly with women, it is just knowing that this stage of life can come up.
And so when it happens, not being caught off guard and having, I see them going like this other direction, thinking there's something completely different going on, not even considering that could be hormones. But when you have some awareness that, yeah, my forgetfulness might increase as I get older, I might need more sleep, I might not be able to take on as much as I get older. And when you start to kind of get towards that point and knowing that your tolerance and capacity is like feeling like it's kind of shrinking, that might be a good time to kind of see if adjustments need to be made. You'll start to feel that, I'm not able to kind of keep up with this like I once was. Could this just be kind of just a natural part of aging?
Or could I be in a different stage of life that's requiring more? Maybe there's like the sandwich generation where you have adults taking care of children and then they're also taking care of their aging parents. And finances can get more stressful in the 40s and 50s because, not saying, I don't know how old you are, but like the 40s and 50s, that's when kids start to get older and require more different kind of attention.
There's more finances and there's different things. So really just anticipating what's coming up and what might be supportive. But when I'm working with my clients, it's really just listening to like when something starts to feel off, could we be approaching something new? And how do we plan for it? Not thinking too far ahead though, because I think if we think too far ahead, then that puts us kind of in an anxious state of anticipation and you don't know what's gonna come, right? You could actually get to that next stage in life and things might feel better.
William Curb: Yeah, because yeah, it's interesting with like, as my kids get older, I'm like, oh yeah, they do need different attention, but it's, you know, there's goods and negatives, you know, there's the more hormonal outbursts. But then there's like, oh yeah, we can play serious board games now. This is great. And different responsibilities and changing and it, and I do like this thought too, because of when I talk to people about like, you know, if they have ADHD or not, is to try and think like, if you are struggling, there's a reason that you're struggling and it's not because you're a bad person. There's something underneath going on. And so maybe it is ADHD, maybe it isn't, but it's worth trying to get the help to look and the reflection to see what's going on.
Kara Cruz: More of what I work with my clients on is not the ADHD symptoms surprisingly. It's the impact that growing up with it had on them. And usually that has to do with beliefs about self, self-esteem, confidence, anxiety, depression. We are, it's like those second, we're dealing with all that. And the realization sometimes of ADHD is like a well no wonder. It's almost like a relief. You know, for some, there is a little bit of like an adjustment or there might be grief, they might have beliefs about it and there's education that I provide. But for the most part, there's almost a sense of like, well, there's an explanation for why it wasn't just that I wasn't trying hard enough, I was lazy.
So we're working on all that stuff. You know, that's all the stuff we have to like undo these beliefs about self and unlearn. The person feels like they're, you know, unworthy or bad or a failure or whatever it is. It's like, no, it's not even about that ADHD is a, you know, like a disorder.
It's like, it's a difference. And so how can we plan your life around your difference, ignore and kind of throw out all of like what society says we should and have to do. And, you know, there's some things obviously we do, you know, most of us need to work and do certain things. But how can we kind of like sort out what really needs to be happening and what we think others are expecting of us external pressures versus like what we, you know, what's in alignment with our values and how we want to live our life.
And so we're doing a lot of that work. We're not sitting there doing like executive functioning planning and like, let's manage the ADHD symptoms, we're undoing all this other stuff.
William Curb: Yeah, there's the built up shame and the response to our symptoms, maladaptive coping strategies like anxiety and addictions. And yet often that is the far more damaging side I see.
Kara Cruz: Especially when I would work with kids, the one thing that they would always talk about is how they felt like they were bad or they were annoying or nobody likes them. And it wasn't like, oh, I get distracted or I want to like, you know, run around the room, but like, that's not what they want to work on. They would come in and talk about, you know, I'm a bad friend or I'm a bad kid or it's all my fault. That's the theme of what we would be addressing in session.
William Curb: Yeah, and I could definitely see how addressing like being inattentive, you could be like, oh, yeah, we're going to help you be a better friend. But it is because oftentimes it's the story we're telling in our head. It's not always reflective of what's actually going on.
Kara Cruz: And we are, yeah, we're definitely teaching skills and working on impulse control and, you know, doing little cues to ourselves and little, you know, we're working on those things, but really kind of the deeper work that I try to prioritize is the impact it had on them emotionally. And because that's going to kind of determine how they kind of navigate life moving forward. You know, just if anybody, you know, has any other questions or wants to learn more, there's so many different organizations out there.
There's a lot of resources that offer, you know, free trainings and books. And just if you're feeling like this is something you're going through, you're not sure, I think that's usually where I get most of the questions is, well, if I think this might be happening for me, what do I do next? And it really is, you know, finding somebody who can talk with you about the symptoms, do some screening.
So whether that be a therapist who specializes in ADHD or a doctor or psychiatrist, getting the diagnosis has been life changing for a lot of the clients that I work with and knowing what's going on so that they can learn how to kind of navigate their life moving forward. Awesome.
William Curb: Yeah, I'll keep a link in the show notes for people for the paramedipause symptoms.
Kara Cruz: Yeah, checklist. Yeah. Yeah.
William Curb: Checklist you mentioned. So I'll make sure I keep that in there because I'm sure there's a lot of people that would be interested in that. And thank you so much for coming on. I really appreciate it.
Kara Cruz: Thanks for having me.
This Episode's Top Tips
ADHD symptoms don’t exist in a vacuum and hormones can crank them up or turn them down. And this can be greatly impacted depending on your stage of life or if you have a cycle, and then where you are in that cycle.
Burnout is often a side effect of saying “yes” too many times when your brain and body are already maxed out. Protecting your energy starts with noticing when your capacity dips and giving yourself permission to scale back. It’s important to create these boundaries so that you are protecting the version of you that you that you still want to be at the end of the week.
A big takeaway from Kara’s work is that your body will tell you what’s up, tight shoulders, clenched jaw, fatigue, restlessness are all early warnings that your system’s running on fumes. Building quick body check-ins into your day can help you catch burnout at a “three” instead of waiting for it to hit “ten.”
Managing ADHD isn’t only about planners and meds; it’s also about repairing your relationship with yourself and the shame that has built up from ADHD struggles. That means recognizing how years of undiagnosed or misunderstood ADHD may have shaped your self-esteem through shame and self-blame and learning to separate your symptoms from your worth.
And with that last tip, I just want to remind everyone, yes, you are enough.