多动症对女性的影响有所不同

我自己就有注意力缺陷多动障碍（ADHD）。我女儿有，我的孙女们有，我妹妹也有。而我们每个人的表现都截然不同。

I have ADHD myself. My daughter does. My granddaughters do. My sister does. And we all look very different.

但我可以告诉你，对我来说，专注于手头的工作是件非常困难的事，因为我有一个充满创造力的大脑，各种想法时刻在脑海中闪现。

But I can tell you that it's a real task for me to stay focused on anything, on something I'm working on because I have a very creative brain in which ideas are pinging all the time.

凯瑟琳·纳多是位心理学家，过去四十多年来一直专注于ADHD的诊断与治疗。她的使命是帮助人们——尤其是女性群体——理解并应对这种障碍。因为我们正是历史上被医生漏诊和治疗不足的人群。为什么？杜克大学女性ADHD研究中心指出，男孩获得就诊转介的概率是女孩的两倍，因为患ADHD的男孩通常表现为多动和冲动，因而更容易引起注意。

Kathleen Nadeau is a psychologist who, for the past forty some odd years, has specialized in the diagnosis and treatment of ADHD. Her mission is to help people, above all girls and women, understand and deal with the disorder. Because we're the ones doctors have historically underdiagnosed and undertreated. Why? The Duke Center for Girls and Women with ADHD says that boys are twice as likely to get a referral as girls, because boys with ADHD tend to be hyperactive and impulsive and therefore disruptive.

以我为例，我有个弟弟确实极度多动。他小时候总爱跑出院子。我母亲为此操碎了心，因为他就是喜欢到处乱跑。

I had a younger brother, this is true in my case, who was so hyperactive. He was always leaving the yard as a toddler. My mother was tearing her hair out because he just had to roam.

这就是他们获得更多关注的原因。患ADHD的女孩往往表现为注意力不集中，同时她们会发展出掩饰症状的应对策略。

That's why they get all the attention. Girls with ADHD tend to be inattentive, and they also tend to develop coping skills that hide their symptoms.

有女孩告诉我：'我总是盯着老师看，因为我知道如果不看着她就会惹麻烦，但其实我并没有在听讲。'所以她们很清楚自己必须假装和适应。

I've had girls tell me, I always look at the teacher because I know I'll get in trouble if I'm not looking at her, but I'm not always listening to the teacher. So they're aware of having to pretend and accommodate.

杜克大学研究中心指出，这种性别差异在成年后似乎会消失，因为女性可以主动要求评估。但诊断过程远非这么简单。无论确诊与否，研究人员估计约2%至5%的成年人患有这种障碍，它会影响人们的记忆力、时间管理、文书处理、清晰沟通和维持人际关系的能力，影响范围极广。纽约大学成人ADHD项目警告说，若缺乏正确诊断和治疗，ADHD可能导致个人生活和职业发展的双重困境。

The gender gap, the Duke Center notes, appears to go away in adulthood when women can simply ask to be assessed. If only the process were that simple. Diagnosed or not, researchers estimate that somewhere between two and five percent of adults have this disorder, which messes with people's ability to remember stuff, manage their time, do paperwork, communicate clearly, maintain relationships. The list is long. Without proper diagnosis and care, NYU's adult ADHD program warns, ADHD can create personal and professional difficulties.

什么样的职业困境？让我分享一下在浏览ADHD女性版块时看到的几个帖子标题：'为什么我就是无法在工作时间内专心工作？''到底该怎么决定职业方向或做任何决定？''今天老板说她不相信我患有ADHD。'

What sort of professional difficulties? Let me share some of the titles I found when I scrolled through the ADHD women's subreddit. Why can't I just work during work hours? How the hell do you decide what career to do or how to make any decisions at all? My boss told me today that she doesn't believe I have ADHD.

我对找工作感到恐惧。虽然已到达职业巅峰，但生活却分崩离析。那个论坛确实是发泄情绪、反思问题和交流建议的绝佳场所。凯瑟琳说过女性特别能从同伴支持中受益，这点我们稍后会详细讨论。但在此之前，先简单介绍她的背景和专业资质。

I am terrified to get a job. I've reached the pinnacle of my career, and my life is falling apart. Boy, that forum actually seems like the perfect place to rant and reflect and swap tips. Kathleen says women really benefit from peer support, and she and I will get into that. But before we do, just a bit more on her background and expertise.

她是切萨皮克中心的临床主任，与团队提供全方位服务，包括神经心理评估、药物管理和团体治疗。凯瑟琳还著有《ADHD职业成功指南》等多部书籍，最新作品《历经多年仍难专注》主要关注中老年群体。由于我们在对话中会提及，她在YouTube上有段相关视频。

She's the clinical director of the Chesapeake Center. She and her staff provide a full range of services, including neuropsychological evaluations, medication management, and group therapy. Kathleen's also written a bunch of books, like the ADHD Guide to Career Success. Her latest is still distracted after all these years, and it centers on older adults. And because I refer to it in our conversation, there's a video of her on YouTube.

视频标题是《ADHD女性如何应对延迟诊断的挑战》，我觉得非常有意思。建议大家稍后观看。感谢你接受采访。

The title is how women with ADHD can transform the challenges of a late diagnosis, which I found extremely interesting. So go watch that afterward. Thank you for doing this.

这是我的荣幸。重要的是要知道，我们有很多方法可以改善状态、提升功能。

Oh, well, it's a pleasure, and it's important to know there are lots of things we can do to feel better and function better.

让我们从ADHD这个缩写开始。它代表注意力缺陷多动障碍，但这个名称其实不太准确，对吧？

So let's start with the acronym ADHD. It's a tension deficit hyperactivity disorder, but that's kind of a misnomer. Right?

何止是不太准确——执着于这个名称正是许多女性未能确诊的原因之一。我认为这本质上是某种大脑类型，其极端表现才构成严重障碍，实际上它存在于一个光谱上。我们可能轻微或严重地具有这种特质，受影响程度也因环境而异。但首先回答你的问题：这绝非注意力缺陷。

I would say it's more than kind of a misnomer. And clinging to that name is one of the reasons why so many women don't get diagnosed. I really think of it as a type of a brain which in its extreme version is a serious disorder, but that it really exists along a spectrum. You can have a little or a lot of this thing we call ADHD and that the degree to which we're impacted varies depending on our circumstances. But to start off with your question, it's not a deficit of attention.

这实际上是一种注意力系统失调，而非注意力缺陷。因此，同一个人可能比常人更能高度集中数小时，但在他们并未真正投入或对活动感兴趣的情境下，也会极易分心。所以这是一种注意力调节失衡。我认为对于教育年轻人的老师、管理年长者的上司来说，关键在于理解这并非主观意愿能控制的。

It's really a dysregulated attentional system, not a deficit of attention. So that the very same person that may wildly hyperfocus for hours more than the average person can also be highly distractible in a situation where they're not really plugged in and interested in the activity. So it's a dysregulated attentional system. And I think what's so important for teachers of younger people, for bosses of older people, to understand is it's not voluntary.

嗯。

Mhmm.

我们无法主动进入超专注状态。这种情况是自然发生的——当我们被某些事物吸引并着迷时，有时甚至发生在应该做其他事的尴尬时刻。

We can't make ourselves hyper focused. It's something that happens to us. We become engaged and fascinated, sometimes at very awkward times when we should be doing something else.

所以你认为这是调节问题。看起来人在一天中某些时段能集中注意力，某些时段则不能。这是有研究依据的。比如有些人下午效率高，有些人下午会犯困。

So you say that it's about regulation. It it just seems that in the course of one's day, you are able to focus at certain times, not that able to focus at other times. That's been documented. You know, some of us are good in the afternoon. Some of us fall asleep in the afternoon.

这种情况到什么程度才算是多动症？

When does that become ADHD?

让我们回到谱系概念来解释。

Well, let me go back to saying it's a spectrum.

嗯。多动症患者普遍面临的困境并非...

Mhmm. There is nothing in general that people with ADHD struggle from,

某种程度上，每个人都会如此。但让我打个比方，焦虑也是如此。每个人都曾感到焦虑，但这并不意味着每个人都患有焦虑症。每个人都曾感到抑郁、情绪低落。

that everyone hasn't to a certain extent. But let me give you an analogy. The exact same thing is true of anxiety. Everyone's been anxious, but that doesn't mean everyone has an anxiety disorder. Everyone's felt depressed, down, low mood.

这些都存在于一个连续谱上。我认为精神病学的整体观点是，与其将这些症状划分为小类别——比如勾选五项或六项标准就能确诊，若只有四项就不算——这种划分很荒谬，因为你可能早上符合四项标准，下午又符合七项，这取决于你当天的情况。所以这是一个连续谱，且与我们日常工作所需高度相关。

All of these exist on a continuum. And I think the whole view in psychiatry is rather than having these little categorical you know, we can check five items, six items, then you have it, and if it's only four, you don't. That's absurd because you might qualify for four items in the morning and seven items in the afternoon depending on what's going on in your day. So it is a continuum. And it really is very related to what we're required to do during the course of our workday.

因此，ADHD必须放在拥有这类大脑的女性生活背景中看待。如果我们生活在平静有序的环境中——少数人如此幸运——那么我们的ADHD表现就会少得多。平静和有序是两个关键因素。嗯。环境可能平静但缺乏结构，这时ADHD就会肆虐。

So ADHD has to be looked at in the context of the woman who is living with this kind of a brain. If we're living in a calm, orderly context, a few of us are that fortunate, then our ADHD is going to be much less in evidence. And calm and orderly are the two important factors. Mhmm. It can be calm with no structure, and then ADHD can become rampant.

嗯，嗯。我看了你那精彩的视频，大约一小时长，但因为你在传递大量对我而言极其宝贵的新信息，时间过得飞快。

Mhmm. Mhmm. So I I watched that great video of you. It's about an hour long. It flies by because you are imparting so much incredibly valuable to me new information.

我想我们可能会在节目笔记中附上视频链接。但你描述女性ADHD时称之为‘自我失调’，请解释一下这个术语的含义。

And I think we'll probably put that video's links in our show notes. But you describe ADHD is for women. You you call it ego dystonic. Explain what that means.

很高兴你问这个，因为这其实是心理学术语。我们可以不用专业词汇来解释：从孩子说起，对比患ADHD的女孩和男孩，男孩的特质更符合社会对男孩的期待——男孩本该活泼、冲动、爱运动、蹦蹦跳跳，当然，男孩不喜欢上学。许多父亲会说‘他就是个典型的男孩子’。

Well, I'm so glad you asked that because, I mean, that's psychobabble. We don't have to use psychological terms. What I mean is if you look, starting with kids, if you look at little girls with ADHD versus little boys, the traits of little boys are so in accordance with the way we expect little boys to be. Little boys are supposed to be active and impulsive and athletic and jumping around, and of course, boys don't like school. And we've had so many fathers say, he's just all boy.

‘他没有ADHD。’所以从心理学角度，我们称之为‘自我和谐’，即特质与期待一致。嗯。而没人会说‘她就是个典型女孩’，因为女孩理应礼貌、守序、自律。当你有ADHD时，要达成这些社会期待会非常困难。

He doesn't have ADHD. So in that sense, in psychobabble, we would call that ego syntonic as in they go together. Mhmm. Whereas nobody says, oh, she's just all girl because girls are supposed to be polite and orderly and self controlled. And it's a real struggle when you have ADHD to do what you are supposed to do.

研究表明，例如，母亲们通常对患有多动症的女儿更为严厉。她们更在意女儿房间的杂乱无章，更担忧女儿情绪失控、容易激动，可能因为感到被挑剔而变得好争辩，或是难以完成任何开始的事情。这并非人们想象中的那种‘甜美可人’的形象。这不是对患有多动症小女孩的描述。这就是我所说的‘自我异质’与‘自我协调’的区别。

So studies have shown, for example, that mothers in general are harder on daughters with ADHD. They're more upset that their daughters have a messy room, that their daughters get dysregulated emotionally, get very upset, might be very argumentative because they're feeling picked on, might have trouble finishing anything that they start. And this isn't the way, you know, sugar and spice and everything nice. It's not a description of ADHD in little girls. So that's what I mean by ego dystonic and syntonic.

更简单的说法是，作为女性，无论是女孩还是成年女性，患有多动症都更为艰难，因为这个世界对女性有着各种期望，我认为即使没有多动症，这些期望也是不合理的。但我们

A simpler way to put it is that it's much harder for us as women as well as as girls to have ADHD because the world expects all kinds of things of women that I think are unreasonable expectations if we don't have ADHD. But we

需要将这些情况投射到职场中。对职业女性有着诸多期望，而这些期望与女性在情绪调节等方面的问题直接冲突。例如，社交技能。

need Let's project that forward into the workplace. There are expectations of professional women that run headlong into some of these problems of dysregulation women are expected to have. The social skills, for example.

是的。

Yes.

她们被认为应具备执行功能。也就是说，能够同时处理无数事务，关注细节，确保一切同步推进。自我控制。你在工作中是如何看到这一点的？

They're supposed to have the executive functioning. So the ability to keep a 100 balls in the air, pay attention to the details, make sure everything is moving forward at once. The self control. How have you seen this play out in your work?

我看到的是彻底的疲惫。是的。可以这样理解：我们的精力是有限的。我曾与一些女性共事，她们告诉我，工作中没人会猜到她们患有多动症。但正因为要维持这一切的有序是如此耗费精力，她们生活的其他部分便陷入混乱。

I've seen it play out with utter exhaustion. Yes. A way to think of it is we only have so much bandwidth. And I have worked with women who have told me no one at work would ever guess I had ADHD. But because it's so exhausting for me to keep all that organized that the rest of my life is in chaos.

我的家一团糟。我没有社交生活，因为我甚至无法组织一次社交活动，无法做计划。我会忘记回电话，忘记写感谢信。

My home is in chaos. I don't have a social life because I can't even organize one. I can't plan one. I forget to return phone calls. I forget to write thank you notes.

我忘记记住今天是我最好朋友的生日，因为我在办公室消耗了太多精力。

I forget to remember it's my best friend's birthday because so much of my bandwidth has been used up at the office.

这对我来说很有趣，因为你说的每句话都让我感同身受。那么对于那些说‘这符合某些特征’的女性，你会怎么回应？我知道我们不该用‘打勾清单’的方式思考问题。

That's so interesting to me because everything you're saying rings painfully true for me. So what do you tell women who say, it's ticking some of the boxes? I know we're not supposed to think in terms of box ticking.

不，这是个好问题。我认为女性首先应该注意到，ADHD具有极高的遗传性。我的家族中有很多人，包括男性成员，都有这种被称为ADHD的症状。所以我首先会建议女性观察你的兄弟姐妹、父母、叔伯姑姨和祖父母。

But Well, no. That's a good question. And the first thing I think women should look at is ADHD is so highly, highly genetic. Many, many people in my family, males as well, have this thing called ADHD. So the first thing that I would ask a woman is look at your siblings, look at your parents, aunts, uncles, grandparents.

我不是在问这些人是否被确诊过ADHD，而是想了解他们是否表现出ADHD特征？比如，家族里是否有特别聪明却大学辍学再未返校的人？是否有以杂乱无章成为家族笑谈的成员？他们总是找不到眼镜、鞋子或车钥匙。所以当女性怀疑自己是否患有ADHD时，如果家族中多代人各方面都运转良好——没有工作问题、财务或时间管理困难——那么她很可能并没有ADHD。

Now I'm not asking you were these people diagnosed with ADHD, but what I am asking you is did they demonstrate ADHD traits? For example, have there been people in your family that were really smart but dropped out of college and never went back? Is there anyone who is notoriously messy and sort of a running joke in the family? They can never find their glasses, their shoes, their car keys. So when a woman is wondering if she has ADHD, it's not likely to be ADHD if everybody else in the family, you know, multiple generations, all sides, just seems to be chugging along and, you know, don't get in trouble at work, don't have trouble managing their finances or managing their time.

这是首要考量：观察家族情况。其次（现在是对职场女性说的）重点不在于你取得了什么成就，而在于你为此付出了多少自我代价。就像水面优雅滑行的鸭子，水下却在拼命划动——这正是ADHD女性维持体面生活却承受巨大压力的绝佳比喻。

Or and so that's the first thing. Look at your family. Second thing is not so much and I'm speaking to businesswomen now, not so much what have you been able to achieve, but at what cost to yourself have you achieved it. Because, you know, the analogy of the, duck that's gliding along the water, but their feet are furiously paddling underneath. That's a great analogy for what it's like to be a woman with ADHD who is managing her life well, but at enormous cost to herself.

让我们深入探讨这个代价问题。你观察到职业女性们具体付出了哪些代价？

So let's I I'd like to just dig in on the cost. What are the costs that you have seen women, professional women paying?

‘不堪重负’这个词，我认为是多数女性用来描述生活的首选词汇。‘我大部分时间都感到不堪重负’——几乎从没有男性来我办公室这样倾诉。我们女性把压力内化为自我攻击，表现为ADHD女性更容易产生焦虑和抑郁情绪。

The word overwhelm is, I think, the word that most women just readily use to describe their life. I feel overwhelmed most of the time. I've almost never had a man walk into my office and say he felt overwhelmed. So women, we women take it out on ourselves. And by that, I mean that women are more likely women with ADHD to feel anxious, to feel depressed.

男性更容易感到沮丧和愤怒。你知道，我的老板是个混蛋，我妻子不讲理，或者我讨厌我的工作。他们倾向于将问题外化。

Men are more likely to feel frustrated and angry. You know, my boss is a jerk. My wife is unreasonable. Or, you know, I hate my job. They're sort of externalizing.

嗯。

Mhmm.

而我们则把矛头指向自己，这种模式从少女时期就开始了。

We take it out on ourselves, and that starts in girlhood.

嗯。我很好奇，疫情期间，那些总是承担更多家务和家庭责任的女性，在同时需要居家办公的情况下，你们接到的求助电话有增加吗？更多人寻求帮助了吗？

Mhmm. So just curious. During the pandemic, when women who always take on more of the household work, the family responsibility, had to do this all at the same time as they were working from their their dining tables, did you see an uptick in calls? Did more people come seeking your help?

哦，我最近看到一个有趣的数据：2020至2022年间，被诊断并开具ADHD兴奋剂处方的女性人数翻了一番。翻倍啊。原因就是我们被困在家里。虽然我这个年纪不用在家带孩子，但我女儿——她担任我大型诊所的CEO，有两个特殊需求的孩子在家，他们都有ADHD——那几年是她人生中最艰难的时期。

Oh, I there's an interesting statistic that I only recently read that the number of women diagnosed and prescribed stimulant medication for ADHD doubled between twenty twenty and twenty twenty two. Doubled. Wow. And it's because we were at home. I mean, I wasn't at home with kids because of my age, but I've talked many times to my daughter who has a very demanding job.

许多原本勉强维持（尽管压力巨大）的女性在疫情期间彻底崩溃，寻求诊断并被确诊为ADHD。

She is the CEO of my large clinic, and she had two children at home. And they were special needs children. They both had ADHD. And I think those were the hardest years of her entire life. And I think that that many women who could kind of hold it together with, mind you, a great deal of stress completely lost it during the pandemic and sought a diagnosis and were diagnosed with ADHD.

所以我想对收听节目的女性强调：我们所说的ADHD是动态变化的，并非静止不变。它会起伏波动，时好时坏。

And so I think the thing that's so important for women that are listening to this need to understand is that this thing we call ADHD is very dynamic. It's not static. It comes and goes. It gets worse. It gets better.

当我们疲惫时，情况会变得更糟。生病时会更糟。焦虑抑郁时会更糟。当家庭出现重大问题时会更糟。任何导致更大压力或痛苦的因素都会加剧我们的ADHD症状。

It gets worse when we're tired. It gets worse when we're sick. It gets worse when we are anxious and depressed. It gets worse when we have huge problems at home with our families. All anything that's going to cause greater stress or distress makes our ADHD worse.

关键是要认识到，这也为我们提供了改变生活以减轻ADHD影响的所有线索。我强烈建议女性朋友们学会'少做一点'。

The important thing to realize is that also gives us all the clues about what we need to change in our life to reduce the impact of ADHD. I really encourage women to underdo it.

'少做一点'是什么意思？具体指什么？

Underdo it. What do you mean? What does that look like?

我的意思是，我们常常被自己不切实际的期望所困，需要允许自己不必事事完美。嗯。我经常帮助女性进行压力分析：让我们看看你生活中的主要压力源是什么。对职场女性来说，主管或老板可能是个难相处、不讲理、要求苛刻的压力源。

What I mean is that often, we are the victims of our own unreasonable expectations that we need to give ourselves permission to not try to do it all. Mhmm. I really help women go through a stress analysis. Let's look at what are the major stressors in your life. And for women on the job, a major stressor may be that their supervisor or boss may be difficult, unreasonable, demanding.

也许她们不需要转行，而是需要换一个对ADHD更包容的上司。她们是否面临经济压力？是否把生活安排得过于紧凑？通勤时间是否太长？

Maybe they don't need a different career. Maybe they need a different job with a boss who is more ADD friendly. Are they under financial stress? Have they created a life where they just can't do it all? Their commute is too long.

孩子的需求是否过于繁重。我会逐一梳理主要压力源：可能有患病的亲戚，年迈的父母等等这些问题。

Their children's needs are too great. And I I really go down a list of what are the major stressors. Maybe you have a relative who's ill. Maybe you have an aging parent. All of these things.

然后进行务实的解决问题：如何降低你生活中的压力水平？因此治疗ADHD的重要方法就是简化、简化、再简化。目前还没有相关研究——事实上，关于什么对ADHD女性最有效的研穷少得令人痛心。

And just do some pragmatic problem solving. How can we lower the stress level in your life? And so a big piece of getting treated for ADHD is simplify, simplify, simplify. And no one has done any research on this. In fact, there's remarkably, painfully little research on what is most helpful to women with ADHD.

我认为最有帮助的事情之一，就是与其他患有ADHD的女性一起参加辅导支持小组，这样你才能真正获得肯定和理解。我自己也经历过这种情况，某种程度上是互相允许不必试图做到面面俱到。

And one of the things I believe is most helpful is to be in coachingsupport groups with other women with ADHD so that you can really receive affirmation and understanding. And that happens to me too, and sort of giving each other permission to not try to do it all.

你提到了各种外部因素对ADHD相关行为症状的影响。那么荷尔蒙在其中扮演什么角色？

You mentioned all kinds of external factors in just the occurrence of ADHD related type behavior symptoms. What is the role of hormones?

哦，很高兴你问到这个问题。在我们国家，我们并没有重视这一点。令人欣慰的是，加拿大和欧洲的人们正在关注这个问题，我认为这最终会影响我们国家开展更多相关研究。我的老友兼写作搭档帕特里夏·奎恩是医学博士，我们已共事三十年。她曾是少数坚持强调荷尔蒙波动对ADHD女性巨大影响的倡导者。

Oh, I'm so glad you asked that. And we are not paying attention to that in this country. Wonderfully, people in Canada and Europe are paying attention to it, and I think that that will eventually influence more research in this country. But my longtime friend and writing partner, Patricia Quinn, is an MD, and we have worked together for thirty years. And she was sort of the lone voice beating that drum of the huge impact of hormonal fluctuations on women with ADHD.

为什么这么说？因为雌激素对大脑中与焦虑、抑郁和ADHD相关的受体有着巨大影响。当雌激素水平较高时，我们更少焦虑，更能集中注意力，情绪也更稳定。这对所有女性都适用。这就是经前综合症（PMS）的成因——在月经前一周雌激素水平下降时，有些女性会感到极度焦虑、情绪化，几乎像变了个人，其他人则反应相对温和。

Why is that? Because estrogen has a huge impact on the receptors in the brain for anxiety, depression, and ADHD. When estrogen levels are high, we're less anxious, we're more focused, we're less moody. And that's true of all females. That's what PMS is all about, that as estrogen levels drop in that week before a period, some women severely feel anxious, moody, almost feel like a different person, others more moderately so.

但有个非常有趣的现象：历史上女性通常在两个阶段被确诊。一是青春期到来时。二十多年前人们还注意到，成年女性最常见的确诊年龄是39岁。猜猜39岁平均会发生什么？那几乎是我们所有人进入围绝经期的开始。

But there's a very interesting phenomenon that there are two points historically at which females were typically diagnosed. One was when they hit puberty. And the second thing that was noted twenty years ago or more is that the most common age for diagnosis as an adult female was 39. Guess what happens on average at age 39? That is the beginning of perimenopause for almost all of us.

所以精神病学家、妇科医生都没有接受过荷尔蒙如何影响认知和情绪功能的培训。确实没有。他们认为只要检测你的荷尔蒙水平在所谓的正常范围内，你就没问题，不可能是荷尔蒙的原因。但现已发现，引发ADHD症状的不是雌激素的绝对含量，而是其波动水平。因此这两个时间点充分证明了荷尔蒙的重要性。

And so it's psychiatrists, gynecologists are not trained in how hormones impact cognitive and emotional functioning. They're really not. And they think that if we just measure your hormone levels and they're in the quote normal range, then you're fine, couldn't be hormones. What has been discovered is it's not the absolute amount of estrogen but the fluctuation of estrogen that causes the ADHD symptoms. So we've got these two points that just are screaming for hormones are so important.

明白了。关于这点我有很多疑问。首先，处于围绝经期的女性——我们说的是长达十年甚至更久的阶段...

Okay. I have so many questions about this. First of all, women in perimenopause, and we're talking about years It's a decade. Many.

整整十年了。

It's a full decade.

她们该怎么办？如何获得帮助？帮助的形式是怎样的？她们该如何应对这种情况？

What do they do? How do they get help? What does the help look like? How do they handle this?

嗯，如果她们幸运的话——虽然我们大多数人并不那么幸运——她们生活在大都市地区，那里通常（虽然不总是）有了解激素波动对情绪和注意力巨大影响的妇科医生或激素替代治疗专家。我们对ADHD女性接受激素替代疗法（HRT）的危险性存在完全扭曲的认知。确实，对于有强烈乳腺癌家族史的女性，她们必须非常谨慎，可能不适合接受激素替代治疗。但我们其他大多数人都是适合的候选者。

Well, if they're lucky, and not many of us are, so lucky, they live in a metropolitan area where there are usually women, not always, gynecologists or hormone replacement specialists that understand the huge impact of mood and attention caused by hormonal fluctuations. We have a completely distorted, distorted view of the danger of hormone replacement therapy, HRT, for women with ADHD. It is true that for women who have a strong family history of breast cancer that they have to be very careful and probably aren't candidates for hormone replacement therapy. But the rest of us are, and the rest of us is most of us.

如果你不适合接受激素替代治疗怎么办？那你该怎么办？

What if you're not a good candidate for hormone replacement therapy? What do you do then?

嗯，我们需要做很多很多事情来改善大脑功能。压力管理，无论是瑜伽、冥想、深呼吸，你能想到的任何降低压力的方法。低升糖饮食——因为对于不了解的人来说，升糖指数基本上衡量了我们代谢食物的速度。纯糖在升糖指数上最高，而纯蛋白质则处于最低端。食用我们过去称为淀粉类的食物，如米饭、土豆、面食、糖、面包，会导致大脑炎症。

Well, there are many, many things that we need to do to improve brain functioning. Stress management, whether it's yoga, meditation, deep breathing, you name it, anything to do to lower our stress. A low glycemic diet because for people that don't know, the glycemic scale basically measures how rapidly we metabolize food. And so pure sugar is the highest on the glycemic scale, sort of pure protein is at the bottom. And eating foods, what we used to call starches, rice, potatoes, pasta, sugar, bread, leads to brain inflammation.

我们知道有氧运动能改善认知功能。你不需要去跑马拉松，只需每天快走15到20分钟让心率保持上升即可。所以运动、饮食、压力管理、社交联系都很重要。关于患有ADHD的老年人，最让我担忧的问题之一就是社交隔离的危险——由于种种原因，ADHD患者更容易陷入这种状态。

We know that aerobic exercise improves cognitive functioning. Doesn't you don't have to go run marathons. You can just keep your heart rate up for fifteen or twenty minutes a day by walking briskly. So exercise, diet, stress management, social connection. And one of the things that worries me about older adults with ADHD is the danger of social isolation that is more likely when you have ADHD for a whole bunch of reasons.

我的住处一团糟。我永远不想让任何人走进我的前门。我似乎就是无法自我组织，无法承诺做某事，无法主动联系别人，无法制定计划走出去。我与朋友失去联系，因为我就是不够专注和有条理来维持这些关系。拥有良好的支持性社交生活需要一定的执行功能技能。

My place is a mess. I would never want anybody to walk in the front door. I just don't seem to be able to organize myself, to commit to something, to reach out to people, to make a date, to get out there. I lose touch with friends because I'm just not focused and organized enough to stay in touch with them. It takes some executive functioning skills to have a good supportive social life.

嗯。ADHD在我们生活中展现的许多方式都让我感到尴尬。比如我家一团糟，或者我不想和你讨论我的更年期问题，诸如此类。羞耻感在这其中扮演了什么角色？

Mhmm. So so many of the just the ways that ADHD shows up in our lives strike me as embarrassing. My house is a mess or I don't really wanna talk to you about my menopause problems, or whatever it is. What is the role of shame in all of this?

我认为羞耻感对女性影响巨大，这可以追溯到各种社会期待。如果你患有ADHD，某种程度上你就不符合'好女人'的标准。这就是为什么我觉得互助小组很棒，它们能把女性从'我的人生一团糟，我的家乱得像狗窝'这种压倒性的羞耻感中解救出来。我始终致力于帮助女性思考如何简化生活——比如看看我的衣柜，首先它并不时髦，但非常实用。

I think the role of shame is enormous for women, and it goes back to all these expectations. If you have ADHD, you're sort of bad at being a woman. And that's why I think groups are so wonderful in pulling women out of that overwhelming sense of shame that I'm a mess, my house is a mess. I mean, I just really try to help women think of how can you simplify. If you look at my wardrobe, you would find that it first of all, it's not a very exciting wardrobe, but it works fine.

每件衣服都能搭配黑色，因为我发现如果买了海军蓝和棕色...

And every single thing goes with black because I just realized if I get navy blue and brown

感觉你就像我异父异母的姐妹。让我们再回到羞耻感这个话题。当你的行为模式、内心感受、以及你对自己身心状况的认知让你产生羞耻感，并影响到工作时，你会如何帮助客户应对这种情况？

I feel like you're my sister from another mother. Yes. So just back to shame for a second. When the behaviors, the kind of the way you feel, what you know about, what's going on inside your head and inside your body, cause you shame and it's affecting your work. Talk about how you help clients handle that.

这是个很好的问题。我的建议是：不要公开宣布自己患有ADHD。原因在于，这种声明会让人对你产生各种糟糕的预设。绝大多数人自以为了解ADHD，其实他们认知中的ADHD只适用于多动冲动的男孩。

That's a very good question. And the answer is I do not recommend that they go in and announce I have ADHD. Mhmm. And the reason I don't is because people make all sorts of awful assumptions about you if you make that announcement. Because most people think they know about ADHD, but what they know about ADHD really only pertains to hyperactive impulsive little boys.

没错。他们会武断地认为'既然你有ADHD，肯定无法胜任这份工作'。我听过太多案例：有人因公开ADHD诊断而失去晋升机会、被解雇、或被撤走项目。所以我告诉人们不要透露诊断名称——这个标签对不同的人意味着不同的东西。

Right. They make an assumption. Well, if you've got ADHD, you can't possibly do this job. And so I've had so many people tell me they, a, didn't get the promotion or lost their job or projects were taken away from them if they announced they had ADHD. So what I tell people is don't name the diagnosis, which can mean different things to different people.

嗯。我的方法是引导他们深入思考职场环境和个人岗位特性：我天生擅长什么？需要多少结构化支持？更适合团队协作还是独立工作？

Mhmm. What I try to do is get them to think deeply about the circumstances of their workplace and their particular job. What am I naturally good at? How much structure do I need? Do I wanna work on a team rather than solo?

你是否最擅长处理短期项目？能否在一周内完成一项任务，因为那种紧张刺激感让你效率倍增，但如果是长达六个月的项目就会迷失方向？你真的需要好好了解自己。

Do you work best on really short term projects? Can you turn something around in a week because it's intense and exciting but get lost if you're on a six month project. You really need to get to know yourself.

嗯。

Mhmm.

我想告诉你的是，ADHD存在于特定情境中，我们能做的最重要的事就是找到或创造一个能支持我们发挥最佳状态的环境。因为这种大脑类型也有许多积极特质。我很享受自己的ADHD——比如我会同时阅读《大西洋月刊》《泰晤士报》和《科学美国人》的文章，然后惊呼：哇！我能把这些内容串联起来，这就会成为我的下一篇文章主题。

I think what I'm trying to tell you is that ADHD exists within a context and that one of the most important things that we can do is find or create a context that will support us at doing our best. Because there are also very positive things about having this kind of brain. I enjoy my ADHD. I mean, I'll read an article in The Atlantic and an article in The Times and an article in Scientific American and go, wow. I'm connecting all these things, and that's gonna be the next article I write.

只有ADHD类型的大脑才会持续进行这种思维跳跃。

And it takes kind of an ADHD brain to be constantly doing that.

是啊，我刚才笑的就是这点。它奇妙之处在于你能在众多话题间快速切换。但关于自我认知这个话题，你描述了很多不同症状和表现方式。人们如何判断自己是否患有ADHD呢？

Yeah. That's what I was chuckling at. There is something kinda wonderful about it is that you skitter across so many topics. But on the topic of getting to know yourself, you've described a lot of different symptoms, way this condition shows up. How do you know if you have this?

筛查流程是怎样的？

What's the screening process?

最理想的筛查方式是深度临床访谈。虽然有很多问卷可以'诊断'ADHD——比如若29个症状中你符合22条，就极可能患有ADHD。许多对ADHD经验不足的专业人士会依赖这些问卷，这并非坏事。但正如我最开始提到的，要通过深度访谈确诊时，追溯家族病史至关重要。

Well, the ideal screening process is an in-depth clinical interview. There are lots and lots of questionnaires that can, quote, diagnose ADHD. You know, if you can say yes to 22 of these 29 symptoms, then it's extremely likely that you have it. And I think a lot of professionals that are less expert in ADHD rely on these questionnaires, and that's not a bad thing. But that in-depth interview to find out if you have it, going back to what I talked about at the very beginning, it's so important to look at your family.

这是遗传的。女性在成年后被诊断出多动症最常见的情况，是因为她的孩子被确诊了。当孩子被诊断后，她们开始回想，我小时候也经常这样。于是她们就会去寻求诊断。

It's genetic. The most common way that a woman gets diagnosed with ADHD as an adult is because one of her children is diagnosed. And the child is diagnosed, and they start thinking that, I did a lot of this stuff when I was a kid. And then they seek a diagnosis.

但对于我们这些没有孩子的人来说，没有这种线索。

But for those of us without children to sort of Without children. Clue.

没有孩子作为触发点的情况下，根据我的经验，女性比男性更常主动寻求诊断。通常是因为她们看了一部纪录片、听了一期播客或读了一篇文章，现在网上有很多由患有多动症的女性撰写的、面向多动症女性的内容。互联网上涌现了大量帮助和支持资源。我鼓励女性们去广泛搜索，因为如果你患有多动症，你会逐渐从这些信息中认出自己身上的各种特征。关键在于我们通过日益增长的信息来自我识别，然后去寻求诊断和治疗。

Without children for that trigger, I it is, in my experience, much more common for a woman than for a man to seek a diagnosis. It's very often that they saw a documentary, that they saw a podcast, that they read an article, and there's a lot out there by women with ADHD, for women with ADHD. There's just been a blossoming of help and support on the Internet. And I would encourage women to go out and really search around because you're gonna begin, if you have ADHD, to recognize all kinds of things in yourself that you're hearing about. And it's really a matter of us identifying ourselves through the growing information and then going to seek the diagnosis and treatment.

能详细说说这个吗？

So say more about that.

遗憾的是，标准治疗只是触及表面。虽然标准治疗确实有帮助——比如开具兴奋剂类药物处方——这点毋庸置疑。嗯。但并非所有女性都能耐受兴奋剂药物。如果你本身容易焦虑，它可能会让你更焦虑。

Well, the standard treatments sadly are only scratching the surface. The standard treatments, which are helpful, no doubt about it, are to be prescribed stimulant medication. Mhmm. Not all women can tolerate stimulant medication. If you're on the anxious side, it can make you feel more anxious.

因此有不少女性会同时服用某种抗焦虑药物来配合多动症治疗。最简单、最标准的治疗方案就是使用兴奋剂。如果幸运的话，你找到了合适的剂量和药物，效果会很好。我想对女性们说的是：保持耐心，不要对药物治疗持怀疑态度。

So there are quite a few women that take some kind of antianxiety medication in combination with their ADHD. So the most the easiest and the most standard treatment is here's a stimulant. If you're lucky, you get the right dose, you get the right medication, it's very helpful. What I would say to women is be patient. Don't be skeptical of medication.

我们已经取得了很大进展。现在兴奋剂药物有多种给药方式，也有很多不同类型。如果某种药让你感觉糟糕，不要认为所有药物都会如此。现在有很多选择机会。

We've come so far. There are so many different delivery methods of stimulant medication now. There are so many different types. If one makes you feel terrible, don't assume they all will. There there are lots of opportunities out there.

凯瑟琳，这次谈话信息量很大，非常感谢。我从你这里学到了很多。

Kathleen, this has been so informative, and thank you. I've just learned so much from you.

也非常感谢你的邀请。

And thank you so much for inviting me.

克里斯汀·卡特和她的播客《我有ADHD》，正是凯瑟琳刚才提到的互联网上涌现的帮助与支持力量的一部分。

Kristen Carter with her podcast, I Have ADHD, is part of that blossoming of help and support on the Internet that Kathleen just mentioned.

当我们寻找关于成人ADHD的研究资料时，面对那些临床症状描述，往往很难想象它们在实际生活中会是什么样子、如何体现。

When we go looking for research on ADHD as an adult and we're met with the clinical symptoms, we have a hard time often imagining what that might look like and how they might manifest in our real lives.

以冲动性为例，这是克里斯汀记得自己曾搜索过的症状。

Take impulsivity, a symptom that Kristen remembers Googling.

但并不真正理解：好吧，那我算冲动吗？这意味着什么？在我的现实生活中会怎样表现？我怎么判断自己是否冲动？

And not really understanding, okay. Well, am I impulsive? What does that mean? What does that look like in my real life? How would I know if I'm impulsive?

因为关于ADHD患者的一个鲜为人知的事实是：我们缺乏的执行功能之一就是自我反思能力。

Because a little known fact about people with ADHD is one of our deficient executive functions is self reflection.

这是她在接下来十年里，通过阅读众多作者的大量书籍所了解到的众多事实之一，其中一些作者后来还在她的节目中接受了采访，她在节目中谈论了羞耻感、情绪爆发以及设定和实现目标。听众们不断寻求实用、个性化的建议，因此在2019年，她成为了一名全职生活教练。克里斯汀将她吸收的所有信息和听到的故事转化为一系列症状清单，每一项都配有多个生动、易懂、令人不安且容易引起共鸣的例子，并将这份清单发布在她的网站上。在“工作记忆差”这一项下，她写道：你会忘记做你说过要做的事。在“即时满足成瘾者”这一项下，她写道：枯燥乏味的任务让你感觉生不如死。

A fact among many that she learned over the next decade in reading a shelf full of books by a host of authors, some of whom later on she'd interview on her show, where she was talking about shame and emotional explosions and setting and achieving goals. Listeners kept asking for practical, personalized advice, and so in 2019, she became a full time life coach. Kristen translated all the information she'd ingested and the stories she'd heard into a list of symptoms, each with several vivid, easy to understand, scary, relatable examples, and she put that list on her website. Under poor working memory, she has, you forget to do the things you say you're going to do. Under gratification junkie, she writes, tedious menial tasks make you feel like you wanna die.

在“时间盲症”这一项下，你无法准确估计一项任务需要多长时间。克里斯汀·卡特在这里，为我们带来更多关于成年生活的直白讨论，尤其是关于患有ADHD的职业女性。她还想轻轻推你一把，让你去寻求你真正需要的帮助。克里斯汀，凯瑟琳提到的一点是，ADHD患者倾向于过度承诺，即带宽问题。而她建议的是，你应该简化你的生活。

Under time blindness, you cannot accurately estimate how long a task will take you. Kristen Carter is here with more straight talk about being an adult, particularly a working woman with ADHD. She's also here to nudge you to ask for the kind of help you actually need. Kristen, one thing that Kathleen touched on is the tendency among people with ADHD to overcommit the bandwidth issue. And and what she advises is that you simplify your life.

这也是你对客户说的话吗？

Is that the same thing you say to your clients?

是的。我真的鼓励我的客户做出B减水平的工作。这是多年前我从一位生活教练那里听到的，它改变了我的生活，因为我一直在追求A加水平的工作。对于一个聪明、过度努力的女性来说，这意味着我承担了太多。我分散得太开，总是感到羞耻，永远跟不上节奏。

Yeah. I really encourage my clients to produce B minus work. That's something that I heard a life coach say years ago, and it changed my life because I've always been striving for A plus work. What that looks like for an intelligent, over functioning woman is that I take on way too much. I'm spread way too thin and I'm always feeling shame and I'm never able to keep up.

所以，如果我能够转变思路，问自己：今天的B减水平会是什么样子？那可能就是照顾好我的基本需求，处理好工作中那些真正需要完成的事情。在我看来，这实际上是在一个典型的水平上运作。我认为有太多高成就的ADHD女性在过度透支自己，部分原因是我们患有ADHD，我们想要弥补症状带来的不足。

So if I can flip the script and say, what would B minus look like today? That would look like taking care of my basic needs, taking care of the things at work that just like really need to be done. It would look like actually functioning on a typical level, in my opinion. I think there are so many high achieving women with ADHD who are overextending themselves partially because we have ADHD and we wanna make up for the symptoms.

所以我必须问这个问题，因为这么多高绩效、有动力、嗯、雄心勃勃的女性都是完美主义者。而你却对一群完美主义者说，弄清楚什么是足够好，并努力做到足够好。嗯。她们对此作何反应？

So I just have to I have to ask about this because so many of these high performers, these driven Mhmm. Ambitious women are perfectionists. And you're saying to a bunch of perfectionists, figure out what good enough is and strive to be good enough. Mhmm. And how does that go over?

她们接受吗？需要时间吗？你如何让这个信息深入人心？

Do they accept it? Does it take time? How do you get that message to land?

我是说，我认为当人们初次听到我的方法时，他们要么非常反感，要么完全被吸引。对于完美主义者来说，听到‘你需要少做、少做’可能非常难以接受。但我们在研究中了解到，Russell Ramsey博士——他在宾夕法尼亚大学或曾在宾夕法尼亚大学——对成人ADHD进行了研究。他发现完美主义是成人ADHD中最常见、最被认同的思维扭曲。

I mean, I think when people first hear my approach, they're either really put off by it or they're completely drawn to it. It can be very difficult for perfectionists to hear, listen, you need to do less, do less. But what we know in the research, Doctor. Russell Ramsey, he's at UPenn and, or he was at UPenn, and he did research on adults with ADHD. And he found that perfectionism is the number one, the most frequently endorsed thought distortion of adults with ADHD.

因此，完美主义在患有ADHD的男性和女性中非常普遍。能够识别出自己身上的这一点，并理解这只是一种应对机制，实际上并无帮助，反而是适应不良的表现。它让我的生活变得更难，让我的症状更加严重。

So perfectionism runs rampant in men and women with ADHD. To be able to identify that in yourself and understand that that's a coping mechanism. It's not actually helping, it's maladaptive. It's making my life harder. It's making my symptoms worse.

这是一个完整的过程。我的意思是，ADHD的治疗和恢复是一个漫长的过程，但完美主义是我一次又一次需要解决的问题。

And that's a whole process. I mean, ADHD treatment, ADHD recovery, this is a long process, but perfectionism is something that I tackle over and over and over.

那么你之前——我希望是‘之前’——那些完美主义者，那些你鼓励她们做B-工作的雄心勃勃的职业女性，这对她们的职业生涯有什么影响？她们在前进吗？她们达到了她们想去的地方吗？

So your former, I hope, perfectionists, these ambitious professional women whom you've encouraged to do b minus work, how has that affected their careers? Are they moving forward? Are they getting where they wanna go?

是的。因为事实是，完美主义者眼中的B-工作，在普通人看来已经是A+的工作了。所以当我完成一个项目，对我来说它并不完美，我能发现缺陷，我只想不断调整、调整、调整，直到无法提交，无法按时完成，让团队中的每个人都感到沮丧和愤怒，这行不通。但如果我能说，好吧，我看到了缺陷，但它已经足够好了，我会提交它。如果有反馈，我会完全接受并处理。

Yes. Because the truth is that a perfectionist version of b minus work is a typical person's version of A plus work. And so when I complete a project and to me, it is not perfect and I can identify flaws and I just want to keep tweaking it, keep tweaking it, keep tweaking it to the point of not turning it in, not meeting the deadline, not getting it in on time, making everyone on my team at work upset and angry, that doesn't work. So if I can say, okay, I see the flaws, but it's good enough, I'm going to turn it in. And if there's feedback, I will totally work with it.

这实际上推动了我的工作进展，因为现在我能够按时完成任务。现在我能够与团队协作，接受反馈并说，好的，我会调整后再提交。

That actually propels me forward at work because now I'm meeting deadlines. Now I'm working collaboratively with my team. Now I'm accepting of feedback and saying, okay, great. I'll go tweak that and then give it back.

Kathleen还提到，对于患有ADHD的女性来说，职业成功很大程度上依赖于工作场所中的强大结构和大量支持。但如果你是自雇人士呢？你自己就是自雇的。你是如何为自己设定成功路径的？

So Kathleen also talked about how career success for women with ADHD depends heavily on having a strong structure and a lot of support in the workplace. But what if you are self employed? You, yourself are self employed. How have you gone about setting yourself up for success?

凯瑟琳完全正确。这就是结构和支持。我自己也在实践这一点。所以虽然没有老板指挥我，但我雇佣团队成员并要求他们监督我。我有运营总监和行政助理，他们清楚知道我需要专注的工作内容。

Kathleen is absolutely right. It's structure and support. And I do that, I implement that on my own. So I don't have a boss telling me what to do, but I do hire team members and I ask them to hold me accountable. So I have a director of operations, I have an executive assistant, and they know exactly what I need to work on.

我们有明确的截止日期和问责机制。每周四次例会——因为你的女孩需要这么多监督。我是认真的。像客户辅导、互动支持这类我擅长的工作根本不需要监督。

And we have clear deadlines and we have a lot of accountability. We meet together four times a week because your girl needs that much accountability. I mean, I really do. The tasks at work that I am amazing at, the coaching, the interacting with clients, the supporting people, that comes so easy. I don't need accountability with that.

真正需要监督的是确保账单支付、邮件撰写、后台事务顺畅运行这些细节。只有这些琐碎事务运转良好，才能避免时刻处于压力崩溃状态。所以我的团队知道：如果克里斯汀要写邮件，必须有人通过Zoom会议盯着我完成，因为我自己根本不会主动写。这听起来可能很幼稚。

What I need accountability with is making sure the bills are paid, making sure the emails are written, making sure that everything is running smoothly in the background. All of those little details need to be running smoothly in order to not be stressed and overwhelmed 100% of the time. And so my team knows that, hey, if Kristen's gonna write an email, somebody needs to be sitting in a Zoom meeting with me to make sure that happens because I'm not gonna write an email on my own. And I know that sounds simple. It sounds childlike.

但你知道吗？我不在乎。我有注意力缺陷多动症（ADHD）。我有惊人优势，也有明显短板需要支持。对我而言，支持就是大量'陪伴工作'——我强烈推荐企业员工或自由职业者都试试：与他人共同工作，利用这种陪伴来保持专注。当有人在你身边工作时，大脑会更容易进入该有的工作状态。

Guess what? I don't care. I have ADHD. I have some amazing strengths and I have some very stark weaknesses that I need to have support for and support for me looks like a lot of body doubling, which I really recommend for anyone in corporate or working on their own is use other people working, co work with other people so that you are held accountable in that way. It is so much easier for your brain to comply and do what it's supposed to do when you have the accountability of somebody else working next to you.

但具体怎么操作呢？

Okay, but how do you make that happen?

在职场上，你可以找信任的同事说'我们一起做这个项目吧'，各自坐在工位通过Zoom远程协作。但并非所有人都有这样可靠的职场伙伴能坦然说'姐妹我需要监督'。

Okay. So if you're in a corporate setting, you can either have a friend, a safe person at work where you can say like, hey, can we work on this project together? Like you sit at your desk, I'll sit at my desk, we'll be on Zoom together. Like, we'll just like co work on Zoom. But not everyone has safe people in the office, in the workplace where you feel comfortable saying like, hey, girl, I need a little accountability.

比如'能陪我一起工作吗？'我的辅导项目提供全天候在线陪伴资源，全球不同时区的ADHD患者可以随时加入虚拟陪伴室共同工作。想象你坐在办公室，却与全世界ADHD伙伴隔空相伴工作的场景。

Like, will you sit with me, please? There are a lot of online resources in my coaching program. We have body doubles around the clock. So people in all different time zones can join a body double twenty four seven and just show up and work together. So you're sitting in your office and you're on a body double with other ADHDers around the world.

还有一些在线共同工作会话，比如Focusmate或Cave Day，人们可以付费加入，但这类问责机制非常重要。而阻碍我们利用这些的正是这种想法：我们，尤其是患有ADHD的大多数人，特别是女性患者会认为'我不该需要这个。我不该需要有人坐在我旁边监督。我算什么，小孩吗？'

There are also online just co working sessions that people can pay for and join like Focusmate or Cave Day, but those kinds of accountabilities are so important. And here's what stops us from taking advantage of that. We, most humans with ADHD, especially women with ADHD think I shouldn't need that. I shouldn't have to have someone sitting next to me. What am I, a child?

我要说的是，如果你患有ADHD，你就应该需要它。如果你不需要，可能你并没有ADHD。明白吗？如果你确实患有ADHD，你就确实需要问责机制。如果你想成为高效完成工作、准时提交成果的优秀人士，你就必须要有问责机制。

And I will say that if you have ADHD, you should need it. If you don't need it, you might not have ADHD. Okay? If you do have ADHD, you do need accountability. If you do have ADHD and you want to be a high performer who gets stuff done and who gets it turned in on time, you're going to need accountability.

那么具体会是什么形式呢？当你完全接纳自己的ADHD及其伴随的缺陷时，你就能更好地支持自己。但如果你总想着'我不该需要这个，太可笑了，我不够成熟，我应该靠自己就能完成'——很遗憾，这种想法很可能来自你童年时监护人或老师的灌输，比如'这对你不应该这么困难，我知道你很聪明'。

So what might that look like? When you fully accept your ADHD and the deficiencies that come with it, then you can support yourself. But if you think I shouldn't need this, this is so ridiculous, I'm being immature, I should just be able to do this. I'm sorry, but that's probably something that you heard from a caregiver or a teacher. Like this shouldn't be so hard for you because I know you're smart.

有时这些声音会成为我们成年后内化的思想。我强烈建议大家对自己说：不，不，不。我就应该需要它。我患有ADHD，我就应该需要问责机制。

Sometimes those become our internalized thoughts as adults. And I would just really encourage people to say, no, no, no. I should need it. I have ADHD. I should need accountability.

我就应该需要支持。

I should need support.

但特别是女性，克里斯汀，我们都知道这点。对我们而言，仅仅显得能干...

But women particularly, Kristen, we we both know this. For us, just appearing competent

嗯。

Mhmm.

这非常重要。嗯。我在想，你如何平衡那种需要显得有能力、并从能力中获得自信的需求。你如何将这与你的建议相协调，也就是去倾听。我需要帮助，并且我正在获得所需的帮助。

Is so important. Mhmm. And I wonder how you square that need to appear competent and to gain confidence from that competence. How do you square that with what you're suggesting, which is to say, listen. I need help, and I'm getting the help I need.

是的。我认为这里有几个线索需要跟进。首先，一个人需要对患有ADHD意味着什么有非常深刻的理解。如果我不真正理解患有ADHD意味着什么，我就不会有信心去寻求帮助。如果我只是想，哦，我只是难以集中注意力，那么我就不会明白它实际上影响了我生活中每一分钟的每一个方面。

Yep. I think that there's a couple there's a couple threads that we need to follow here. Someone first needs to have a very robust understanding of what it means to have ADHD. I am not going to have the confidence to ask for help if I don't truly understand what it means to have ADHD. If I just think, oh, I just struggle to focus, then I'm not going to understand that it actually affects every single aspect of every single minute of my life.

因此我需要帮助。但此外，我认为我们需要了解生活中哪些人是安全的，哪些是不安全的。所以明白也许我不会去找这个同事或那个同事寻求帮助，但我知道这边的这个同事是安全的，或者我知道这位特定的经理会尊重我。另外，ADHD受到《美国残疾人法案》的保护。所以你确实有权获得合理的便利。

And therefore I need help. But additionally, I think we need to understand who the safe people are and the unsafe people are in our lives. So understanding that maybe I'm not going to go to this coworker or this coworker and ask for help, but I know that this coworker over here is safe, or I know that this particular manager is going to treat me with respect. Additionally, ADHD is covered under the Americans with Disabilities Act. So you do have a right to accommodations.

然而，我知道凯瑟琳说过，嘿，我不鼓励你公开宣布。我也持相同观点，你需要了解你的听众。但我认为一个理论上简单且有效的方法是真正理解你的工作职责范围，并严格在这个范围内工作。我认为ADHD女性常做的一件事是，我们为了证明自己有能力，会过度承诺超出工作职责范围的事情。相反，我们需要将工作职责视为护栏和边界，并只在这个范围内工作。

However, I know that Kathleen said like, hey, I don't encourage you to announce it. And I am of the same vein that you need to know your audience. But I think a big and pretty easy, in theory, approach to this is truly understanding the scope of your job description and working exclusively within your job description. I think that one thing that women with ADHD often do is we over commit beyond the scope of our job description in an effort to prove that we're competent. And instead, what we need to do is see the job description as the guardrails and the boundaries, and just work within that.

在你的工作范围内做到非常出色，不要过度承诺，不要对你的同事说，当然，我可以做那个。是的，我能行。为什么我们要对每件事都说“是”？我们需要更经常地说“不”。

Be really good within the scope of your work and don't over, don't say to your co, Sure, I'll take that. Yeah, I can do that. Yeah. Why are we saying yes to everything? We need to say no more often.

嗯。回到简化，简化。百分之百同意。在你的播客中，你做了一些关于各种执行功能的节目，那些节目非常棒。

Mhmm. Back to simplify, simplify. 100%. So in your podcast, you did some episodes on the various executive functions, which were absolutely terrific.

谢谢。

Thank you.

我想知道你是否能为我们逐一讲解这些内容。

And I wonder if you would walk us through each one of them.

好的。我要看这边，因为我把它们写下来了，因为我们难以应对的执行功能之一是非语言工作记忆，就像回忆这些事情。那么开始吧。总共有六个，一、二、三、四、五、六。好的。

Yes. I'm gonna look over here because I have them written out because one of the executive functions that we struggle with is nonverbal working memory, which is like recalling these things. So here we go. There are one, two, three, four, five, six. Okay.

每个成年人都有并利用六种执行功能来帮助自己专注于任务、表现和完成事情。对于患有ADHD的成年人来说，大脑的额叶发育不足，而那里正是我们的执行功能所在之处。不过，正如凯瑟琳提到的，这是一种谱系障碍。因此，你可能会发现某些执行功能运作良好，而其他一些则可能非常不足且具有破坏性。这取决于个人。

There are six executive functions that every adult has and uses to help them stay on task, perform, and get things done. For an adult with ADHD, the frontal lobe of the brain is underdeveloped, and that's where our executive functions are housed. However, as Kathleen mentioned, it is a spectrum disorder. And so some executive functions you might find are working great and others maybe are really, really deficient and debilitating. And it's going to depend on the person.

首先，我们有自我意识，这是评估、反思和长期观察自己行为的能力。患有ADHD的人会一遍又一遍地犯同样的错误，因为我们不会计算这种行为加那种行为等于这个结果。因此，自我评估能力非常不发达。当然，它可以通过治疗、辅导等方式得到提升。但如果我们没有药物治疗或支持，情况会非常糟糕。

So first we have self awareness, which is the ability to evaluate, reflect, and look at your behavior over time. Someone with ADHD is going to make the same mistakes over and over and over because we don't do the math of this behavior plus this behavior equals this outcome. And so the self evaluation skill is way underdeveloped. It can of course be enhanced and we can go to therapy and we can get coaching and we can improve it. But if we are unmedicated, unsupported, it's going to be real bad.

接下来是抑制能力，即在采取行动前停下来思考的能力。这是药物真正有帮助的地方，因为药物影响大脑中负责刹车的区域。我们的非语言工作记忆非常不足，这是指将某件事记在脑中足够长时间以完成任务的能力。你的语言工作记忆也不足，即你内部叙述和自我对话的能力。克里斯汀，我们现在需要坐下来写这三封邮件，一切都会好起来的。

Next we have inhibition, which is, your ability to stop and think before you take action. This is where medication really helps because medication affects the area of the brain where the brakes are. Our nonverbal working memory is very deficient, which is the ability to just keep something in your mind long enough to complete the task. Your verbal working memory is also deficient, which is your ability to narrate and say, talk to yourself internally. Kristen, what we need to do now is we need to sit down and we need to write these three emails and it's going to be fine.

这只需要你十五分钟。只管去做。完成后会很棒。我们没有那种能力，所以必须外化它。我得给自己写个便条，姑娘，你得完成这个。

It's going to take you fifteen minutes. Just do the work. It's going to be great when it's over. We don't have that, so we have to externalize it. I gotta write myself a note, girlfriend, you get this done.

十五分钟后就能完成。所以我需要能看到它，因为我无法进行内部对话。情绪调节能力非常不足。我们识别和处理情绪的能力几乎不存在。在儿童身上，这表现为发脾气和崩溃。

It'll be done in fifteen minutes. And so I need to be able to look at it because I'm not doing the internal dialogue. Emotional regulation is very deficient. So our ability to identify, process our emotions, it is not there. And in a child, it looks like temper tantrums and meltdowns.

在成年人身上，它可能表现为大量逃避行为、频繁的情绪爆发。比如对老板或同事大吼大叫，与妻子争吵，或是被孩子轻易激怒。我们在情绪调节上困难重重，自我激励也举步维艰，这与多巴胺系统有关。

In adults, it can look like a lot of avoidance, a lot of explosions. Yelling at your boss or yelling at your coworker or fights with your wife or getting really triggered by your kids. We struggle so much to regulate. We have a lot of trouble self motivating. That has to do with our dopamine.

这关系到我们的任务启动机制——尤其是那些我们不愿做的事情。就像我知道锻炼有益健康，明白每天运动30分钟就能改变人生。但我想做吗？不想。

It has to do with our task initiation, but getting started on something, especially something that we don't want to do. So like, I know exercise is good for me. I know if I just worked out thirty minutes a day, my life would change. Do I wanna do it? No.

我能强迫自己去做吗？不知为何就是做不到。虽然没人喜欢锻炼，但我看到很多人坚持着。为什么唯独我连开始都如此困难？对吧。

Can I make myself do it? For some reason, no. Like no one likes to work out, but I see a lot of people doing it. Why am I the one that struggles to get this started? Right.

这些都属于自我激励范畴。最后还有一组相关症状：计划制定、问题解决和优先级排序。说到职场女性——注意了！注意了！注意了！

And so that, that would fall under the category of self motivation. And then last, there's like a cluster here that is planning and problem solving and prioritizing. I mean, and like, if we want to talk about women at work, hello. Hello. Hello.

听着！计划、排序、解决问题。必须说明，ADHD患者往往擅长解决问题，我们宏观思维和愿景规划能力很强。但落实到具体执行细节，比如确定步骤优先级和重点事项时，就完全束手无策了。

Hello. Planning, prioritizing, problem solving. And I want to say that ADHDers are often really good at problem solving. We're really good at the big picture, the big vision. But when it comes to the nitty gritty details of following through and knowing which step do I take first and what's the most important, it's it's over.

我想很多听众听到ADHD的表现时，都会暗自思忖：这听起来和我正在挣扎的许多问题很像。

I still imagine that a lot of our listeners are hearing about how ADHD shows up, and they're saying to themselves, this sounds a lot like some of the stuff I'm struggling with.

嗯。

Mhmm.

你会在什么情况下对他们说，去做个筛查吧。去看看是不是这个问题。

At what point do you say to them, go get screened. Go go see if this is the problem.

是的。我认为这是个很好的问题。我想补充凯瑟琳说的是，当你的行为或症状严重到影响生活时——比如你意识到自己无法入睡、吃不下饭、生活一团糟，与同事的生活状态截然不同。没错，我们都完成了项目，但我熬了三个通宵才搞定，而他们不用。这不仅仅是‘大家都会分心’那么简单。

Yeah. I think that's a a great question. And one thing that I just want to add to what Kathleen said is that when your behaviors or symptoms are at a level where they're debilitating, where you're realizing I'm not sleeping, I'm not eating, my life is so chaotic and it looks really different from my coworkers' lives. Like, yes, we're all getting the project turned in, but I had to pull three all nighters to get it finished and they didn't. It's not just like, yeah, everyone struggles with distractibility.

每个人都有情绪困扰，这是人之常情。但当它严重到阻碍你发挥潜力，让你明明知道自己聪明却无法坚持，明明可以做得更好却力不从心时，当你感受到现实表现与自身潜力之间存在鸿沟时，就是真正需要探究是否存在问题的时候。

Everyone struggles with their emotions. Like, that's just being a human. But when it's at the level that it is impairing you, where you are not reaching your potential, where you're able to say, I know I'm smart and I am just not able to follow through. I know I could be working at a better level, but for some reason I cannot. When you feel like there's a gap between your potential and your performance, that's when you really want to investigate and see if there's something going on.

那你下一步会怎么做？

And what is your next step?

这个问题很有趣，因为答案取决于人们所处的环境。我总建议先做研究——遗憾的是大多数临床医生根本没接受过成人多动症培训。现有的多动症诊断标准是为儿童制定的（我知道这很荒谬）。DSM-5曾试图制定成人标准，最终因分歧而放弃。

Yeah, this is where it can get interesting because it really does depend on where people are in the world. I always love to say, first, do some research because unfortunately most clinicians are not trained in adult ADHD at all. And the diagnostic criteria for ADHD was developed for children, which is, I know it's, I know it's ridiculous. So the DSM-five, they tried to come up with a diagnostic criteria for adults and they couldn't agree. So there's like, oh, I guess we're just not going to do it.

所以现在医生只能用儿童标准来诊断成人。我的建议是：先了解症状特征，记录它们在生活中的具体表现。比如我网站上有症状清单，你可以对照着看‘这个我有，那个我也有’，从而理解这些症状如何体现在你身上。

So now all we have is diagnostic criteria for children that clinicians are using for adults. And so what I want to say is educate yourself on the symptoms and maybe make notes as to like how you see it playing out in your life. So just like, you know, run through, I have a symptoms list on my website. You can run through that symptoms list and say, oh yeah, I do this, blah, blah, I do this, blah, blah. And you can just kind of understand how it looks in your life.

我非常赞同凯瑟琳的建议：调查家族成员是否有类似症状。如果长辈有这些表现，他们很可能未被诊断——婴儿潮一代大多没机会获得诊断，这很遗憾。同时询问家人：‘你们记得我小时候有这些表现吗？具体是怎样的？’你自己可能不记得，但母亲或姐妹或许记得。

And I loved Kathleen's suggestion of kind of doing an intake of your family to say like, who else is exhibiting these types of symptoms? If they're older than you, it's likely that they're not diagnosed because most people, you know, in the boomer generation don't have the privilege of being diagnosed, which is so sad. Then also think through and ask your family members like, did you notice this in my childhood? Well, how did this play out? You might not remember, but maybe your mom will, maybe your sister will.

就谈谈这个吧。所以我总是鼓励人们用一些数据武装自己，因为你的临床医生可能会不屑一顾，尤其是如果你是女性，尤其是有色人种女性，如果你还事业有成，那概率更是天文数字般高。如果你是一位成功的女性，你的临床医生很可能会看着你说，你不可能有注意力缺陷多动障碍（ADHD），你可是哈佛毕业的。我刚采访了一位佐治亚理工学院的博士候选人，她的医生就是这么对她说的。你不可能有ADHD，你可是哈佛毕业的。

Just talk about that. So I always encourage people to kind of arm themselves with some data because your clinician might be dismissive, especially if you're a woman, especially if you're a woman of color and like astronomically more if you are accomplished. If you are an accomplished woman, there is a huge probability that your clinician will look at you and say, you can't have ADHD, you went to Harvard. I just did a podcast interview with a PhD candidate from Georgia Tech who, and that's what her clinician told her. You can't have ADHD, you went to Harvard.

因此，尤其是女性听到这样的话，只会放大我们内心的羞耻感。哦，我想我只是懒惰。我想我只是不够努力。我想我只是需要找到合适的日历或系统。

And so, because women especially hear things like that, it just magnifies the shame that we feel. Oh, I guess I am just lazy. I guess I am just not trying hard enough. I guess I do just need the right calendar or the right system.

我缺乏自律，是啊。

I'm undisciplined, yeah.

没错。所以如果有人对你说这种话，去找个真正会认真对待你的人。我听过我的客户说，你知道吗，我的第一位临床医生说，你不可能有ADHD，你是律师。你根本不可能读完法学院。这不是真的。

Exactly. And so if someone says that to you, find somebody else that will actually take you seriously. I've heard clients of mine say, you know, my first clinician said, you can't have ADHD, you're a lawyer. You never would have gotten through law school. That's not true.

凯瑟琳说过一句原话，代价是什么？我特别喜欢这句话。因为当你把自己和同事比较，或者和同学、研究生院的同龄人比较时，你是一样的吗？因为我知道我不是。对吧？

And Kathleen said these exact words, at what cost? And I loved that. I loved it because when you compare yourself to your colleagues or you compare yourself to your, fellow students, to your peers in graduate school, were you the same? Because I know I wasn't. Right?

我会环顾四周，心想，这些人是怎么应付的？我完全不明白。他们用计划本记东西，还能一项项划掉清单。我完全搞不懂这是怎么做到的。而我整夜熬夜，一团混乱。

I would look around and be like, how are these people handling this? I do not understand. Like they're writing things down in planners and checking things off a list. Like I do not understand how this is happening. I'm pulling all nighters and full of chaos.

我聪明吗？是的。我在学校表现好吗？确实不错，但过程一点也不轻松。看起来可没那么光鲜。

Am I smart? Yeah. Did I do well in school? I did, but it was not cute. It did not look good.

这一点都不可爱。所以回答你的问题，我建议人们先从全科医生开始，要么要求他们为你做筛查，要么要求他们为你转诊。别让他们说‘不，你不能做这个’。他们可能会将你转介给心理医生进行诊断，也可能推荐他们认识的ADHD专家。

It was not cute. So to answer your question, I recommend that people start with their general practitioner and either demand that they screen you or demand that they refer you. Don't let them say, nah, you can't have it. And they might refer you to a psychologist for diagnosis. They might refer you to someone that they know, an ADHD expert.

重要的是，也许不是ADHD，可能是其他问题，这完全没关系。我们不是在强求诊断，而是在要求被倾听、要求接受筛查，因为确实存在某些状况。所以如果不是ADHD，那到底是什么？

Now it is important, like maybe it's not ADHD, maybe it's something else and that's totally fine. It's not that we're demanding a diagnosis. What we're doing is we're demanding to be heard and we're demanding to be screened because something's going on. So if it's not ADHD, what is it?

这个结束语太棒了——如果你觉得哪里不对劲，那很可能真的有问题，值得深入探究。

Well, that is such a good note to end on. That if something seems off to you, it's probably off, and it's worth investigating.

100%同意。

100%.

代价太高了。

Cost is too high.

是的。抱歉刚才打断了你。

Yes. I'm sorry I interrupted you there.

没关系。看，你又来了。

No worries. Well, there you go again.

我知道。看看我这冲动的样子。100分。没错。如果感觉不对劲，请寻求某种筛查，因为它能为你带来大量帮助和支持。

I know. Look at me being impulsive. 100. Yes. If something feels off, please seek a screening of some sort because it can lead you to so much help and support.

克里斯汀，你表现得真是太棒了。非常感谢你与我们分享这些深刻的见解和智慧。

Well, Kristen, you have been fantastic. Thank you so much for sharing all this insight and wisdom with us.

非常感谢邀请我参加。

Thanks so much for having me.

下周，如果你结婚的话，职业生涯会如何影响你决定保留或更改姓氏？如果我看待自己的方式不同了，如果家人对我的态度稍有不同，那么同事又怎会不区别对待我呢？《哈佛商业评论》还有更多播客节目，助你管理自我、团队和组织。访问hbr.org/podcasts查找，或在苹果播客、Spotify等收听平台搜索HBR。《职场女性》的编辑制作团队包括阿曼达·克西、莫琳·霍克、蒂娜·托比·麦克、罗伯·埃克哈特、埃里卡·特鲁克斯勒、伊恩·福克斯和汉娜·贝茨。

Next week, if and when you get married, how does your career factor into the decision to keep or change your last name? So if I look at myself differently, if my family treat me a little differently, then why wouldn't my coworkers treat me differently? HBR has more podcasts to help you manage yourself, your team, and your organization. Find them at hbr.org/podcasts, or search HBR in Apple Podcasts, Spotify, or wherever you listen. Women at Work's editorial and production team is Amanda Kersey, Maureen Hoch, Tina Toby Mac, Rob Eckhart, Erica Trucksler, Ian Fox, and Hannah Bates.

罗宾·摩尔创作了本期主题音乐。我是艾米·伯恩斯坦，你也可以通过women@workathbr.org联系我和艾米·G。

Robyn Moore composed this theme music. I'm Amy Bernstein, and you can get in touch with me as well as Amy G by emailing women@workathbr.org.