Trascrizione completa di Dr. Lotta Borg Skoglund - Bridging the Gap for ADHD Girls and Women with LetterLife

She has 25 years clinical experience with ADHD. She is a senior consultant physician as well as associate professor in psychiatry at the Department of Women and Children's Health at Uppsala  University  and the Department of Clinical and Neuroscience at Karolinska Institute. She is the author to six books, amazing, right? Six books, and one has recently been released in English, ADHD Girls to Women Getting on the Radar. It's available in print and audiobook now. And if all of those accomplishments weren't enough, she's also a mother to five children and a late diagnosed ADHD er herself.  📍    Your book, ADHD Girls to Women Getting on the Radar, was just released in English, even though I know you wrote it a couple of years ago.  Do you know if your publisher is going to be doing your other books in English? So I hope  so. Um, obviously. So I have other books. And I actually, I wrote my first book back in, I think 2017 or something. And it's a, it's actually, I think and naturally I'm a little bit biased, but I think it's a great book, but it's a book for parents using motivational interviewing to talk to teenagers and their kids about subjects that often gets like infected and you get like irritated and your kids like retract and don't want to talk to you. So that is like trying to use motivational interviewing that we do in the healthcare setting in a family. So that is the first one. And I think, I still think that's a great book for parents. And then we have, I've written two books together with also with a psychologist, Martina Nelson. It's about ADHD at the workplace and one book that we call Black Belt in Parenting. So it's for parents, but also for like healthcare professionals and social workers and school staff to learn more about neurodiversity and different neurodevelopmental diagnosis and also tricks and tools for how to manage. Life as a parent or as a an adult around these kids. So hopefully there will be more of the books translated as well.  Hopefully. Unfortunately we don't all speak Swedish  and it's very hard. I guess  anglicized of me to just expect it to be in English, but I would, no, that's a dream.  That's a dream for me. And, I'm in the same position, there's great authors in French and in German and in other languages that I can't access. So having them published in, in, in English is, of course, it's a huge advantage if you, we wanna be like part of this discussion and debate and I really do.  Also I, I released my latest book is about getting a diagnosis as an adult and aging with ADHD. So that's also and it's built in the same way as testimonies from my patients and trying  To put their life stories basically in a research context. So I hope so. I will say  I did have a plan, but that's completely gone out the window. , you recently did a attitude magazine webinar where you talked about the emotional life of girls. If you described, I think one of your past patients and you were talking about basically just being an undiagnosed. Teenage girl and the maybe risk behaviors and things that we go through. And I could get emotional thinking about it because I felt like you were describing me as a late teenager. And it just made me realize how common that experience really is. And now there's you know, what I call a wave of women in their thirties, forties and fifties, realizing and being diagnosed that were ADHD, that we've been missed this whole time. But we had, that, that teenagehood, those twenties that you described in that webinar of  perhaps risky behavior and perhaps things that now we know we're seeking. Because of how our brains are wired, but I just appreciate your work so much.   Oh, thank you so much for lifting this up because and I also think it's amazing after writing this book and also we're doing what we do now, building this kind of digital platform. This community letter life is amazing. How universal this language is. It's like the ADHD language among women is a universal language where I just can't say how many times I've heard what you are describing and also could relate to what other women that I absolutely don't know. Don't share any cultural kind of connection to not even age or  anything else, but. Being a woman with a DHD. So that is the common denominator and the language and the experiences and the take homes is universal for us. And I think that's extremely powerful and I think, I hope I am sensing some kind of movement here. It's maybe you're younger than me, but dirty dancing, nobody puts baby in the corner you know what I was thinking about, it's it's time to talk about this now, it's time to stop being shamed, because I've also spent so much of my life and energy trying to cover up  who I am. and why my brain is wired differently. And that has, that is painful to realize. And also what we're, I guess what we're going to talk about in this podcast, eventually, if we ever get there about being a mother and about the heritability of the neurodiversity. And I think for me, the kind of the tipping point came when I saw these traits in my kids and I thought, I can never, I can totally accept what I went through and I totally forgive my parents and everyone around me because we didn't know better, but I would never  forgive myself if I let my children go through the same struggle when I could tell my story and by telling my story, help them not, Putting their energy in, in, in the wrong places. So I think that's a very powerful notion that many of us in, in, in my age and becoming parents will experience. Absolutely. And  You talk about your children. I was really interested to learn that. You come from a family where your parents are in the psych field, but even still, you didn't know that you were ADHD until after you had your own children.  No, I was actually the first one in my family being diagnosed. And I can see so my my, my dad is a psychiatrist, my and almost anyone in my family is, and my mother in law and my father in law,

my mother is a teacher. So there's a lot of knowledge about. Typical development and atypical development in my family and still, we, I was the first diagnosed as a young adult, but still think we we did not know and I think that the knowledge has increased so dramatically the last 10, 15 years over the time where I've, had my diagnosis. So, and now when I look back and see the older generations of my family, I totally see where it came from and how my parents have struggled with their own difficulties and what we called it back then.  So on. So I think  that, Gives you a great humility towards kind of knowledge and science and why research is so important in this domain,  actually. Absolutely. And you don't have to say if you don't want, but are any of your children, ADHD?   Oh yeah, so I have five kids and two of them are diagnosed with ADHD, more of the ADD type. And then one of my sons has a quite severe dyslexia as well. But he doesn't have ADHD. So we have and then, of course, being a psychiatrist myself, being like an ADHD, quote, unquote, expert you are afraid that you are biased in, in, overly sensitive towards your kids, of course and, of course, my, my kids also know what I'm working with so sometimes  they can abuse this language at home of,  he is so much ADHD, and he is so autistic in a totally neutral way, because, they know that I've got that diagnosis. They know that I love my patients and I love my work. So for them, there's absolutely no negative connotation in saying that someone is like, so ADHD or so autistic, but still of course you were afraid that you would influence kind of these. So I have been. Very now  I've kept a very backseat position when it comes to them and also just  asked colleagues that I trust to, to to talk to them and but then again I realized that I have fallen short of my own kind of paradigm here where I Whereas my son was diagnosed without any hesitation when he was nine. And then my daughter was also assessed when she was nine due to all these symptoms that I lecture about. And she was not diagnosed because she has symptoms. had so high, as my son also, but high intellectual or IQ and all these other factors that they thought that she did not reach the diagnostic criteria. And then she, of course, crashed when she, in her late teens, and then she was diagnosed. So  typical story right in front of my  feet in, in that sense. And that was, I think, because I actually, it was so important  for me not to influence them and not to drive my own agenda toward in, in the sense, but they should have the same assessment as other children, their age  and not be by having a mother,   a researcher  has that experience then. impacted your work now.  You've recently released  a post talking about research where you found that girls are across the board diagnosed four years later than men. And I was a bit taken back by that only because I feel like Most women I know it's not four years. It's decades later   Yeah, it

is. And so I also thought that wasn't less than I thought but I think also it's This is huge materials like population based studies. So in the individual case, that is also my experience that it might be and also if you look at the data in that study, that the majority of the boys are diagnosed in these, crucial years in school when they are like 9, 10, 12, exactly when my son was diagnosed.  And then the majority of the women are diagnosed in their early adulthood. Around 23, 24 so it's a spread. But when you look at where. We find the the majority of the boys, it's still when they are younger and when they are in a situation, when other people notice them and when they are disturbing and so on in classrooms. And then unfortunately, the girls and the young women, they are not diagnosed until they crash or develop other more serious comorbidities. Unfortunately,  I  always say, so my story that I went through my whole life, not realizing I was ADHD until I had my daughter and I no longer could have my coping mechanisms that I didn't even realize were coping mechanisms. And I always say there's  what I have just anecdotally seen as pivotal points of either puberty, if we're lucky,  Early motherhood. When your children are going through the process themselves and you go, oh, I took all these boxes or perimenopause  exactly because it's  Those are just the common ones that I see but I'm curious Your app and website and everything, LetterLife. I had mentioned this before, I've used it now for a couple of months and I think it's fantastic. I think it's such a valuable tool that really everybody should be using.  Great, yes. And we are building as we go. So we need this feedback and we don't just need the praise. We need also, Oh, you should do it like this. You should. So this is extremely interesting for me as well to get this feedback, of course, but great to hear that you like it. And you're doing  the changes really quickly. Cause even just in the few months that I've been using it, I have noticed changes and you've recently updated a little layout, but  I know. When so for people that don't have the app you check in every day and there's these seven pillars of wellness Or as you've sometimes referred to them the seven deadly sins of adhd if we neglect them  And so you check in with that and then also there's a community board There's insights that you can track over time and I know it feeds into your research. So how I don't think anyone should be Privacy concerned. It's very upfront. But how is that feeding into your research? And  what more can we do to get women in the research?  Yeah great question. Because I think it's there, there's two,  two ways of looking at this. So we build the app and the support tool based on the research that we do. So based on this study that we just mentioned, and the other studies that where we see how women are  vulnerable in certain periods of life, as you said, and that those periods tend to be associated with hormonal change. So in our research, we have shown that for example, um, women with or young women with ADHD they don't tolerate their hormonal contraceptives in the same they tend to become depressed more often by them, so they go off them. Okay, so next study clip okay, teenage pregnancies in ADHD, we show that ADHD, young ADHD girls and women are six times more likely to become mothers when they are  basically still just, children themselves. And then we did  a study where we looked at a pregnancy and discontinuing, discontinuing ADHD medication during pregnancy. What do we know about that? So that just was recently published last week. And then we have done another study looking at the increased risk of developing postpartum depression. When you have ADHD. So there are, we're trying to build this research framework around these issues. Issues. So that is like one  part of the story.  And then we do then we do this interviews is also research qualitative interviews with women. And there's such an interesting and like a picture emerging here. Because looking at the data and talking to healthcare professionals, they say, okay, oh, we absolutely know who these women are. They are everywhere in the healthcare system. So they are suffering from pain condition, from chronic fatigue, from burnout. From IBS from endometriosis from all these somatic conditions that we really can't treat because they're symptomatic. And talking to a health. care professional, they would say, okay, I feel really in, inadequate in relation to these women because I can't help them. And they consume so much healthcare and they are unhappy with me. And then they move on to a colleague of mine in another field. And so they are like a flipper ball in the healthcare system, consuming 10 times more healthcare resources than a woman without a diagnosis. Okay. So that is the.  That is in the view of the healthcare system. These are, it's a growing group of women consuming a lot of healthcare and they aren't happy with us.  Talking to the women,  they also say this, but the interesting thing is when healthcare people say, they are there everywhere, they consume so much resources, they even consume so much resources that they threaten to Over flawed and what do you say, force out other groups of patients. So there is a, there is something communicated from the healthcare system is these are it's, I don't like what they're communicating, but it's almost okay, so they are getting something at the cost of others. But then when you talk to the women,  you know what the first thing that comes up is, the first thing in these, looking at this group from the healthcare sector, it's almost like a parasite growing on the healthcare body, right? Do you know what the first thing that these women say is their problem is?   Oh, probably they're not getting help from anywhere. No one can help  them.  Exactly. They,  I don't get any help. I am abandoned. So from the letter life, from the app

perspective, this is what we are trying to do is to try to bridge this gap, because I don't think I can, persuade my colleagues in the healthcare system that they are wrong. I think I have to accept that this is a group that is in, that is consuming very much research and that we in the healthcare system, we're failing them because we can't address it. what they really need. And I can't, I don't think I can persuade the women that they are feeling wrong, feeling something, that they should feel in another way or so. So I think what we can do here is try to build something that addresses what the women actually need. So first of all, our first thing on their list then is I feel abandoned. So that's why we created the community in LetterLife.  Okay, so here we can talk about things in a safe community that is distinct from other social media and we ask the users of the app to address different topics that they feel is relevant. And then other users jump in and provide their perspective. And that's a beautiful thing too. I am in that community. I am, everyone is of course is anonymous. So you're just, using your avatar or your profile but still it's such a supportive. Community and where you provide your perspective or your best tricks or hacks and also just, a little something to just make you feel that you're not alone in this. So that is one thing in the app. And then the other thing is that no one knows what I am feeling. No one knows anything about the ADHD association with hormones association with somatic health. Then it's Everyone thinks that I'm imagining this, but I'm not, this is what I feel, this is what my stomach, this is what my, body is telling me and then I go to the healthcare system and they say that I'm imagining these things. So then we have designed this mind hub, where me and my colleagues are trying to provide like evidence based good content in short, in a very, Brief ways where you can also. Just access hopefully like answers to your most burning questions. And then there's the tracking the, that you follow yourself and trying to connect the dots with how your ADHD brain is affected by, as you say, the different seven deadly sins or seven, like health care factors or lifestyle factors. But also your hormonal changes. And your medication and basically try to get everything together to collect the data about you  to armor you basically with good real life data. When you go see your healthcare professional, if that is what you do, or just to learn by living your life and looking at the pattern and seeing where you. can find yourself in very vulnerable periods in relationship to hormonal changes or medication changes or other changes in life that you can't really affect or do anything about. But and then there's this self awareness self efficacy approach where we hope I guess for myself that it's been really important to, to be less dependent on a health care that doesn't want me there. So that is, is trying to to build. True empowerment for women.  Yeah, and you said self awareness, and honestly, even just taking the,  whatever, minute or two minutes to do the check in, sometimes is that like Circuit breaker for me of going, Oh yeah, I have not been very balanced today. And I have, and thinking about, and I am such a huge proponent for cycle tracking for anyone who still has a cycle, because I think it gives us  such valuable information. And so I know those three days before my period, like  I'm, it's not a good time for anybody. You mentioned abandoned and It's something that you actually talk about a lot. I'm sure you're probably aware of that, but inspired by your attitude magazine webinar, I took to TikTok as people do. And I put a call out because when I got my ADHD diagnosis, there was very little support. And so I basically just asked the community on there  when you got your diagnosis, what type of support did you get? And. Over 300 people responded and the resounding,  unfortunate answer was nothing or  just a prescription. There were a few people that felt the need to correct me and tell me that psychiatrists can only give you a prescription so I shouldn't have expected any support, which I was not.  Really peeved at, but mine also gave me some book recommendations, so I guess I should be happy for that, but   This is this is exactly the gap that we're talking about here. Yeah,  I'm talking to my colleagues who are still working in psychiatry I am as well but not at the moment not now I'm working here in the gap in between right. But looking at, their situation, I do realize that this is very difficult. They have limited resources and that is, but I think there's so much about communication here. The, I think the big problem is so maybe that is psychiatry's  kind of core issue.  What do you say? Responsibility is to prescribe, say that is the case then. Okay, so that is what they are there for. Very boring job, I have to say, and I hope I never,  as a psychiatrist, when I'm, supposed to just do that and write prescriptions, because pills don't build skills. That is something that we know.  Say that is the the thing that my, you know, superiors or that the politicians decides. Okay. So that is what you do. There's still room for communication around this. And there's so much that you can do that empowers a person to actually go out and search For a for other resources in this system. And I think what we are trying to build. And I guess that is how I am wired as a person. I tend to when I enter resistance, , I tend to my brain tends to immediately go to how can I go around this. Okay, you say this, but I say we can do it another way.  Would it be possible for me as a psychiatrist to train people that actually could do that job instead of the psychiatrist? So there may be too few psychiatrists. Okay. If that's the fact, then we have to work around that. And then I think that we could join forces with other professions. And that is also something that we are

looking at in the app to build a mentor program or a buddy program where you can actually train the coaches and other healthcare professionals to take that psychoeducative kind of approach towards or work together always together with the psychiatrist. So you get the prescription, but you also get that other kind of aspect. And that is so important for you to be able to manage your ADHD and your medication also over time.  Your  head goes, how can we go around this? How can we find, and my head also does that. And my head also says, let's make it as easy as possible. And I'm just thinking just have a ready set email template that you say, Hey, here's some resources you might want to look into, it just seems like it could be so simple.  I really want to ask because I feel like it ties in with everything. We know how important hormones are. We know hormones affect our symptoms. Recently on letter life, you had a blog post and I don't know if you wrote it or one of the colleagues wrote it, but talking about cyclical dosing of ADHD medication.  Is that me? That was you. Okay.  That's something that I have been interested in and talking to, others who still have a cycle.  But it seems like a lot of psychiatrists or GPs, depending who your prescriber is, are a little bit resistant. So how can we convince them that this is the best option for us because our hormones do affect us differently than our male counterparts?   Yeah, that's a really good question. And that's also what we are aiming to, explore in our upcoming research to actually because we know that women are doing this already. They are they are actually taking their medications in a way that is suitable and effective for them, but we don't have, we almost have no research around this. So it's anecdotal and it's.  It's a on a case to case basis at best. And the thing here is that and I guess also why there are so little research is that we as researchers tend to think that females, oh, they are so difficult to study because they have this cycle, right? And on top of that, they can get pregnant. So my God, no but it's, it is a problematic big But it's even more problematic knowing this and trying to interpret research and reading a paper where the authors are so proud of having 50 percent males and 50 percent females like, yay,  we're so modern here. But the problem is that they don't state if these women are on or off. Any contraceptives if they have a cycle if they are pre or post puberty or pre or post menopause, we don't know where in their cycle they are and.  Knowing as just living as a woman and what you talked about before have these, PMS PMDD days where like it's all hell break loose and you like you live in a completely different world, and then you did five days earlier or five days  after.  So not taking that into account is a huge. Problem, a huge bias in, in, in almost all studies looking at medication  and then back like doses then. So we don't have any research to rely on. Okay. We know that we think that women are already titrating their doses to their own hormonal cycle. So then you have the theoretical.  Framework for this and then the theoretical framework would be that estrogen and dopamine love each other, potentiate  each other's effects.  Easy enough. So then, according to the theoretical framework, then you may need slightly lower doses the first two weeks of your menstrual cycles when estrogen levels are steadily increasing.  And then you have the  Ovulation where you have the maximum peak of estrogen levels following the  lal phase where estrogen levels are lower. And also counterbalanced by increasing progesterone levels, right? And then you might need slightly higher dose.  So that is the theoretical framework like lower doses or your original dose perhaps in the follicular phase, the first two weeks of your cycle, slightly higher doses, perhaps increased doses in the luteal phase. The problem is that we also have to add the difference or the heterogeneity of ADHD into this mix.  So say, for example, that you have maybe as I have a more hyperactive form of ADHD. So your problem is more that you are all over the place, that you are have this scattered brain and that you tend to become impulsive.  You're not very much struggling with depression or low energy or difficulties getting things done, but rather that it's a little bit too much that gets done and things that shouldn't be done gets done as well. Let's  hypothetically talk about that person.  Hypothetically, that person might struggle not as much in the luteal phase.  Oh, that person might also have PMS, but  hypothetically, that person might be even worse off. During ovulation when the estrogen levels are high, because then hypothetically that person become even more impulsive. And then that person with that dose of central stimulant also triggers that kind of even more energetic even more impulsive. Um, behavior.  So we see a lot of women with ADHD  where we see them not due to kind of anxiety or psychiatric ill health  and behaving in a way that puts them at risk just because they are basically high on life during that period. Where they have this estrogen boost and then they should lower their medication during that those days because that is a period of risk.  And then it would  be not just estrogen during that period, right? Because I know while testosterone is an important for dopamine synthesis.  Testosterone does add to our bravado and potentially to our impulsivity and to our  potentially undertaking what could be risky behaviors.   Exactly. So there's so much of that dynamic going on across a hormonal cycle that kind of has to be put in context of that person's ADHD profile. So that is again what we're trying to do in Letter Life where we talk about the ADHD 24 7 model where the seven, in this model we talked about the seven deadly sins or the seven lifestyle factors, there's the two and the four. of that 24 7 model. The four is the

ADHD profile. The four is the four major or overarching like neuropsychological types or processes that you typically struggle with when you have ADHD, but just, you typically also struggle not as much with all four. So based on how you are doing on these four different kind of areas or processes,  You get your own ADHD profile. So if you have a, and we talk about these four areas is the control tower of the airport, the overview or executive function, meet the cognition, that kind of the psychologist would call it that. And then you have the volume button, the self regulation. And then you have the virus filter, the perception, the proprioception, the interception, and how you basically receive and process the external and internal stimuli from the surroundings and from your entire, from your internal body. And then you have the, and the shift the gearbox of the brain and your how cognitive flexibility or inflexibility. So these four areas, provide you with your personal ADHD profile, if you will. And then you have to put that. Profile into the context of how the hormones and the medication affects each other. So it's, it is more complicated than you would wish, but it is not possible to understand how it is for you. Although it is a little bit difficult to try to communicate this because people love it when it's easy. So it's, you would like to say that, okay, estrogen is good. Dopamine is good. you feel better during the follicular phase and you feel shitty during the PMS. But that's not true for everyone, right? And that is also some, something that we try to do in letter life that you can track yourself and you can identify yourself and you learn more about yourself and you collect your data.  And does the current research, and I know we have so little on women and so little on medication, is there any research to indicate whether There are certain medication that helps better, stimulant versus non stimulant in women specifically.  No,  unfortunately, yet, and this is actually also what we want to do in this research program. We want to do this for contraceptives. We want to see what is the best contraceptives for females, because also Helena Kopp Kellnar calendar and me, my gynecology partner in this.  We also see that women tend to report that. They get better in their emotional regulation from some contraceptives and from some strategies. And so that's really interesting to see also that it might not be all about the ADHD treatment because sometimes, me and my patient, we just get to an end point where it's like, There's just nothing more we can try here because, and nothing seems to work. And then I send them to Helena and she starts tailoring out a hormonal treatment from, with contraceptives or with hormonal or menopausal replacement therapy. And that is what, shifts the paradigm and makes things work. So that's also very. Interesting that it seems like we have to collaborate and to also talk to each other between different specialties

within health care. So that is yet another thing that we,  Advocate for to break down these kind of silos within healthcare is no, we work with psychiatry here. No. So we work with gynecology and hormones here. Okay. No. So we focus on the gastrointestinal. And knowing anything about ADHD, that these women, they are, as we said, they're everywhere. They're in all these silos being treated by specialists not looking at the full picture, not having the holistic kind of view of of this  kind of  condition.  And I was interested to hear recently you had said, and again, it just  confirmed something that I had always felt, but everyone told me I was wrong and crazy for that. oral contraceptive pills made me more depressed.  I took them a few times, like for a few periods when I was in my early twenties. And then I stopped because I said, these are making me depressed. And everyone's no, that doesn't happen. But you had said that that is indeed true, especially for people with ADHD. So while I recognize that in my house, the best form of contraceptive has been a vasectomy. And it's just, it's, it doesn't affect my hormones. It doesn't make me depressed  and there's nothing to worry about.   Yeah, exactly. So I think we have to be open to that. And you're exactly correct. We show that women with ADHD are five times more likely to become depressed following like the traditional hormonal oral contraceptive prescription that we are doing typically in, in youth clinics and, or in primary care. Again, we see that the patients, what they were telling us was right. We didn't believe it because typically hormonal contraceptive doesn't induce depression. We know that from large scale studies, but that is for the general population.  Things like women with ADHD are more vulnerable. To this and that is a problem when we have this increased risk for sexual risk taking and teenage pregnancy. So that is a contradictive thing that we have to solve. So really important to explore what you said, if there are medications that is is functioning better for women. If cyclic dosing is something that, that could help women and what contraceptives. Work for women with ADHD. These are three extremely important I think questions to, to address in, in, in future research. But today we don't know.  I am excited for which we didn't get to talk about, but the goddess ADHD collective, because I know one of your counterparts is a gynecologist. You're what you've called her your work wife. And so at least  I see there's two worlds talking to each other and there's. Oh.   There is hope and that is so rewarding. It is so much fun to realize that what you are doing is actually relevant in someone else's world. I can't, express enough how rewarding that is. So I hope that more physicians and more researchers actually allow themselves to go outside of their comfort zone and invite other perspectives because I think it's so important. so rewarding to and also to hopeful to see that  maybe when I enter a dead end, there's someone else that actually can call me out on that and say try this. And maybe you don't have to solve all these issues yourself. Maybe there are other explanations. To be, looked upon and viewed on. So I think it's rewarding and fun. And I absolutely think it's the future.   Fingers crossed. I have loads more that I could talk to you about perimenopause and hormones. Oh my God. We have so much.  Why don't we leave it up to the listeners to see if they want to hear more of this question and if they want to hear more of me I tend to talk a lot. So maybe they are just  fine with this.  Thank you very much. See you never. But if there are questions that, that are interesting to address, I'm happy to jump on another podcast with you.  Perfect. And I won't mess the time up. I promise. I swear I wish I could have promised you the same, but I can't because I know that I will. I am infamous for mixing time zones up. But let's give it a try  anyway.   I do appreciate you so much taking the time. I'm so looking forward to seeing what research you guys continue to come out with because what you've put out so far is.  so valuable. And if people don't know, I'll put it, of course, in the show notes, all of your details, but the letter life, the site alone, your blog posts, like it is so informative, but it's digestible. You  don't  have to be a doctor.   That's the point. And also we are extremely open for feedback. And we want to build the best tool for women. And that is also, that is actually something that is non negotiable. So I have all these research collaborations that we think in the future may if our users allow for it, use the data anonymously, of course, but use the data to try to get to know more about women. What is non negotiable is that they cannot add questions or screening forms or anything that makes it  Too tight is too to fill in so the app should always be aiming for the, what the users want to have in the app that is non negotiable. So that's why we are extremely, um, Just extremely adherent to whatever feedback that we get. We can't do, of course we can't, build everything that every, everyone wants but we will definitely listen to it, to what everyone has to say. And take that into consideration.  I can definitely say as a ADHD woman, it is user friendly. It is easy to navigate and it's  really valuable. So I do suggest people get onto it. I, again, I thank you so much for your time.  Thank you.   So nice to talk to you