Attention-Deficit/Hyperactivity Disorder (ADHD) in Women
Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent condition affecting many women, including those in their reproductive years. Managing ADHD during pregnancy and postpartum presents unique challenges that require careful attention and planning.
**Diagnosis Challenges in Women**
Women with ADHD often go undiagnosed or are misdiagnosed with depression and anxiety. This is partly because women and girls present ADHD symptoms differently from boys and men, making diagnosis more challenging. Research on ADHD in girls and women only began in the 1990s, leaving significant gaps in understanding.
**Masking Symptoms and Consequences**
Some experts have explored why women are often undiagnosed and found that women often mask their symptoms, leading to excessive anxiety. As undiagnosed girls age, they can become overwhelmed by daily activities, disorganized, consistently late, and struggle with household responsibilities, leading to chronic shame. This is only exacerbated in the perinatal period. One mom shares her experience of how her undiagnosed ADHD exacerbated her perinatal mood and anxiety disorder, highlighting the extreme stress and worry she faced as a new mother. With a sensitive toddler and a new baby, her lifelong issues and unchecked problems led her to finally seek help.
**Consequences of Untreated ADHD in Women**
A study by Stephen Hinshaw explored the consequences of untreated ADHD in women. His 2006 study found that ADHD affects 5.3 million women in the U.S., but less than 20% are diagnosed. Dr. Stephen Hinshaw’s research indicates that undiagnosed or untreated ADHD in women can lead to:
- Increased depression and anxiety
- Self-harming behavior
- Chronic stress disorders and fibromyalgia
- Sleep disorders
- Impulsive behaviors
- Marital difficulties
**ADHD Symptoms During Pregnancy and Postpartum**
Many women with ADHD find their symptoms increasingly challenging to manage during pregnancy and the postpartum period. This is partly due to the heightened demands of these stages and the potential increase in depressive symptoms when psychostimulant medications are discontinued during pregnancy, despite the continued use of antidepressants. Pregnancy can negatively affect neurocognitive functions in general, and this impact may be more significant for women with ADHD. Impaired memory, disorientation, confusion, and reading difficulties are commonly reported. Some studies suggest that women with preexisting ADHD may experience more pronounced cognitive impairments during pregnancy and postpartum.
**Challenges for Parents with ADHD**
Parents with ADHD often face overwhelming challenges, especially if they lack organizational skills to manage their symptoms. This can lead to increased parental distress in the first year postpartum compared to parents without ADHD.
**Effective Management Strategies**
Effective management of ADHD during pregnancy can be achieved through preconception counseling and comprehensive perinatal planning. This includes:
- **Developing a Management Plan**: Involving the pregnant person, their family or support network, psychiatry, obstetrics, and primary care. The plan should incorporate ongoing monitoring and, if necessary, adjustment of medications throughout the perinatal period.
- **Addressing Worsening Factors**: Managing stress, ensuring adequate nutrition (with a focus on regular eating throughout the day), and combating sleep deprivation are critical to maintaining functioning during the perinatal period.
**Risks of ADHD Stimulant Treatment During Pregnancy**
Research indicates that ADHD stimulant treatment at any time can lead to small increases in the risk of adverse pregnancy outcomes. When treatment occurs before or during pregnancy, the risks are more pronounced, even after several years of being treatment-free. Notably, stimulant treatment for ADHD during pregnancy is linked to a higher risk of spontaneous abortion and preterm birth due to amphetamine abuse. Please note that this is information gathered from resources and not the opinions or advice of the writer.
**Additional Health Considerations**
Women with ADHD tend to have higher rates of pre-existing diabetes and smoking during pregnancy. Treatment with stimulants at any stage (before, during, or after pregnancy) is associated with lower rates of spontaneous labor and higher rates of cesarean delivery, active newborn resuscitation, and neonatal admissions lasting more than four hours.
**Addressing Shame and Mental Health**
Managing diagnosed or undiagnosed ADHD during the perinatal period comes with its challenges. Unfortunately, many women have internalized this struggle, leading to deep shame, postpartum mental health issues, and distress. As a therapist, I have found that both psychoeducation and planning have been extremely helpful for moms. A sense of relief, letting go of this deep shame, and moving into holistic support where her needs are being met in a safe way. Psychoeducation has proven effective in reducing disorganization and inattention and increasing self-confidence.
**Planning Ahead for Support**
If moms are able to plan ahead, their planning may include support for managing sleep disruptions, mood changes, and quality of life issues that arise due to nighttime infant care. It is also essential to consider both parents when evaluating parenting stress in families affected by ADHD, as co-parenting stress can significantly impact family dynamics.
