Click each image below to read expert insights, personal stories, facts, and important new research on ADHD in women.

April 25, 2023

New York – ADDitude magazine, the world’s most trusted resource on ADHD, is honoring Women’s Health Month with the publication of groundbreaking research on the impact of hormonal fluctuations on female ADHD symptoms during each life stage, from puberty and pregnancy to menopause. The upshot: Wild swings in estrogen levels dramatically worsen ADHD symptoms, and the severity grows more pronounced with age, according to more than 2,000 women surveyed aged 18 to 82.

ADDitude’s new survey also found that men with ADHD were equally affected by the rise and fall of testosterone levels during distinct life stages, and that andropause (often called male menopause) seemed to incite the most dramatic life changes. The survey included more than 2,711 men and women with ADHD between the ages of 18 and 82.

Women and men alike reported the greatest symptom severity from ages 50 to 59 — during menopause and andropause, respectively. Women reported that plummeting estrogen levels during menopause magnified the effects of ADHD, echoing the results of a 2022 ADDitude survey of 3,930 women that found hormonal changes exerted an outsized impact on ADHD functioning during this life stage.

How did the ebb and flow of hormones affect other life stages?

ADHD Link to PMS, PMDD

A staggering two-thirds of women surveyed said they experienced premenstrual syndrome (PMS) and/or premenstrual dysphoria disorder (PMDD) — well over national rates of PMS and PMDD. The overwhelming majority of women surveyed cited irritability, mood swings, cramps or discomfort, anxiety, and lack of concentration as the most impairing symptoms.

“For me, PMDD meant suicidal ideation, increased meltdowns and shutdowns, a decrease in emotional regulation, extreme sensitivity to rejection, and intrusive thoughts,” a woman, 39, who was diagnosed with ADHD, anxiety, and autism, told ADDitude.

Postpartum Depression and ADHD

The hormonal drop associated with postpartum depression, cited by 61 percent of women surveyed, was debilitating and, for many, lasted about one year. Worse, many women said they were not forewarned by their healthcare providers of the potentially debilitating effects of plummeting hormone levels after birth — and almost half said they were offered no treatment options, such as antidepressants or recommendations for therapy.

“The nurses I spoke to did not recognize my postpartum depression and told me it was probably a normal hormonal drop, but things never improved,” a 36-year-old mother in Pennsylvania told ADDitude.

Another woman, now age 50, said she thought she was a “bad mom” for feeling as she did, “so I masked my issues.”

ADHD in Puberty

During the hormonal swings of puberty, men were more likely to report illegal drug use, hypersexuality, and anger-management problems than were women, according to the ADDitude survey. Testosterone levels typically reach their peak around age 20, when challenges shift to procrastination, emotional dysregulation, and relationship problems, the men reported in the survey.

ADDitude will be publishing and promoting insights from its research, as well as other content chronicling the female experience with ADHD and its comorbid conditions, during the month of May at ADHD in Women: In Women We Trust.

For more information on ADDitude’s proprietary surveys of women and men with ADHD and possible interviews with patients, medical review board members, and/or ADHD experts, please contact Carole Fleck at carol@additude.com.

About ADDitude magazine:

Since 1998, tens of millions of readers have trusted ADDitude to deliver expert advice and caring support, making us the leading media network for clinicians, educators, parents, and adults living with attention deficit hyperactivity disorder (ADHD). ADDitude is the world’s most trusted source of strategies and information about ADHD and related conditions, such as learning disabilities, anxiety, depression, and oppositional defiant disorder. In 2021, ADDitude, the voice of and advocate for the ADHD community, joined the WebMD family of health brands.

Half of all women with ADHD receive a misdiagnosis or an incomplete diagnosis before finally identifying and treating their attention deficit disorder. This staggering statistic, revealed in a recent ADDitude survey of 2,760 women, confirms the anecdotal reports we hear often of medical gaslighting, distrust of self, unnecessary suffering, delayed treatment — and the grave consequences of each.

“I was misdiagnosed and received treatment that did not help me,” wrote one survey respondent misdiagnosed with depression and anxiety. “This led to me never getting better and ending up having a mental breakdown before I got my proper ADHD diagnosis 10 years later.”

“I believe if, instead of being diagnosed with bipolar 2 (cyclothymia), anxiety, and depression, I had been appropriately diagnosed with ADHD and given coping skills and treatment for that, my life would be completely different,” wrote another ADDitude reader.

“Antidepressants worked for a while, but my anger and frustration flare-ups were still an issue,” wrote a woman diagnosed with ADHD in her 50s. “Eventually, the antidepressants didn’t work anymore and I hit bottom… By the time I was diagnosed with ADHD, I was on long-term disability and felt I had no control over my life.”

The reasons for incomplete or inaccurate diagnosis range from outdated ADHD and gender stereotypes to low self-esteem and self-trust, seeded by years of criticism for unrecognized and untreated symptoms of ADHD, according to ADDitude‘s Women’s Health Month survey.

“Not being able to verbalize my emotions well continues to be a difficulty, likely due to not being able to trust my own emotions, whether they are valid or an under or over reaction,” wrote an ADDitude reader misdiagnosed with bipolar disorder. “In my opinion, this led to being misdiagnosed.”

This prevalent and debilitating roadblock to an ADHD diagnosis was a topic of discussion with Olympic marathon medalist Molly Seidel during her recent conversation with WebMD about barriers to mental health care for women.

“I wish that I had been more vocal about exactly how I was feeling earlier, because we might have gotten to the solution a lot earlier,” said Seidel, a world-class professional runner who was diagnosed with obsessive compulsive disorder and eating disorders before finally receiving an ADHD diagnosis a few years ago. “Especially as women, a lot of us are willing to almost gaslight ourselves by saying, ‘Oh it’s not really that bad.’ And then you look objectively at it, and you’re like, ‘No, this is objectively pretty bad and there has to be a better way to live than this.’”

For Seidel, an ADHD diagnosis was nothing short of life changing.

“My diagnosis came with such a sense of relief from knowing, Oh my God, there is a reason why I feel the way I feel. Maybe I’m not just thoroughly messed up and thoroughly a terrible person. My brain just works a little bit differently,” said Seidel, who earned the bronze medal in the Olympic marathon in Japan. “That diagnosis was the most freeing thing and the thing that has gotten me to the place that I am now.”

“What it took me years to figure out is that, if you are just trying to treat the symptoms and not addressing the underlying causes, it will just tend to jump from diagnosis to diagnosis to diagnosis,” said Seidel, who reported that she’s “in a much better and more stable place than I’ve been in a long time.”

Seidel’s ADHD treatment plan today includes mindful meditation, fine-tuned nutrition, miles upon miles of exercise, and therapy.

“Ultimately, the point of therapy is learning to have a better relationship with your own brain and understanding the mechanisms by which your brain works,”she said. “That has been the biggest thing in becoming more confident and trusting myself.”

ADHD Diagnosis in Women: Next Steps

• Self-Test: ADHD Symptoms in Women and Girls
• Read: Why ADHD in Girls Is Often Overlooked
• Read: Why Women with ADHD Feel Disempowered — And What We Can Do About It

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

As a 62-year-old man with ADHD, I can get emotional quickly and often about relatively insignificant things. I can be immature and irresponsible. For years, I have felt embarrassment and shame about the lack of progress in my career. I also have learned that these characteristics, among others, are more pronounced in many men with ADHD than they are in their female and neurotypical counterparts.

Much has been written, deservedly, about the unique challenges facing women with ADHD. But, arguably, not as much has been written about how men experience ADHD differently. Sure, most of us know that hyperactive boys are more likely to be diagnosed than are inattentive girls. However, the people in our lives really need to understand the differences men with ADHD experience.

Here are examples of how I think ADHD manifests differently in the sexes.

Common ADHD Symptoms in Men

Delayed emotional development. Research has shown that males mature more slowly than do females, and this seems especially true for men with ADHD.

Being quick to anger. While girls tend to internalize emotions, boys are more likely to externalize theirs. It stands to reason, then, that boys with ADHD have higher rates of oppositional defiant disorder (being argumentative, uncooperative, and sometimes hostile). In adulthood, men with ADHD are more prone to emotional outbursts fueled by anger at real or perceived slights.

Resistance to pursuing a diagnosis. In my many years of ADHD coaching, I’ve encountered countless women who struggle with their husband’s or young adult son’s resistance to seek or accept an ADHD diagnosis because they fear the “stigma” of the disorder, and, in their male minds, it’s admitting to “weakness.” Unsurprisingly, most of my female social media followers are the ones who most actively pursue understanding ADHD on behalf of their husbands, their kids, and themselves.

[Take This Test: Could You Have Adult ADHD?]

Lackluster career advancement. This issue for men arises, in part, from the social construct that still expects men to be the head of the household, the main breadwinner. When a man with ADHD is unable to perform optimally in or successfully retain his job (as was the case for me for many years), the shame and guilt can be devastating.

Think about how often new social interactions begin with, “So, what do you do for a living?” In other words, what is your value? And when you’re not proud of what you do, or how well you’re doing it, you feel shame and embarrassment.

How Men Can Manage ADHD Symptoms

Men with ADHD need a safe place to share their struggles, like a support group with people who share similar challenges. Feeling heard, and learning new ideas for how to cope, can be very comforting.

Mindfulness training and exercise can help with mood stabilization and rein in emotions. I also recommend working with your partner, and perhaps a therapist, on communication strategies to control outbursts before they happen.

[Take the ADHD in Men Survey]

I’ve found that understanding common ADHD symptoms in men and working on managing them has helped me become more effective in my life as an adult with ADHD.

ADHD Symptoms in Men: Next Steps

• Read: Men with ADHD Are Asking, “Why Am I So Angry?”
• Blog: “I’m a Better Father, Now a Better Person”
• Download: Emotional Regulation & Anger Management Scripts

Alan P. Brown is an ADHD coach and host of CrusherTV. His free eBook, 5 Things You’re Doing Every Day That Make Your ADHD Worse, is available at www.ADDCrusher.com.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

April 14, 2023

ADHD increases the likelihood of postpartum depression (PPD) and postpartum anxiety in more significant and impactful ways than do other well-established risks like comorbid psychiatric disorders or sociodemographic factors in women, according to a recent study published in the Journal of Affective Disorders. ¹

The research found that 25% of women with ADHD had postpartum anxiety, compared to 4.61% of women without ADHD. In addition, almost 17% of women with ADHD had PPD, compared to 3.3% without ADHD.

“ADHD is an important risk factor for depression and anxiety disorders postpartum,” the researchers wrote. “Therefore, ADHD needs to be considered in maternal care, regardless of sociodemographic factors and other psychiatric disorders.”

Using population-based registers from Sweden, the researchers identified 773,047 women who gave birth to their first or second child between 2005-2013. Of that number, 3,515 had received an ADHD diagnosis before their pregnancy. They also analyzed data on women’s depression and anxiety diagnoses before pregnancy, maternal age at delivery, highest achieved maternal education at childbirth, cohabitation status with their child’s father, and family history of depression and anxiety disorders.

The study found that the risk of PPD and postpartum anxiety was lower for women diagnosed with a psychiatric disorder before pregnancy and those with a history or family history of depression or anxiety. The researchers suggested that women diagnosed before pregnancy with ADHD and depression or ADHD and anxiety may have received greater support and treatment during and after their pregnancies compared to women diagnosed with ADHD alone.

Women with ADHD Become Pregnant Younger

Women diagnosed with ADHD were more likely to have a lower education level and less likely to live with the father of their child compared to women without ADHD, according to the researchers.

The study also reported that women with ADHD gave birth to their first child at a younger age (15–24 years) than did women without ADHD (25–34 years), supporting previous research. A study published in the Journal of Attention Disorders of more than 7,500 adolescents with ADHD and 30,000 adolescents without ADHD in Taiwan found that participants with ADHD became pregnant younger, more frequently, and had a higher risk of early pregnancy than did their neurotypical peers.² A large Danish study published in the Journal of the American Academy of Child & Adolescent Psychiatry reported that girls with ADHD were more than three and a half times as likely as their peers to become pregnant between the ages of 12 and 15.³

“It’s common to find a history of early initiation of sexual activity, early intercourse, more sexual partners, more casual sex, less protected sex, more sexually transmitted infections, and more unplanned pregnancies in women with ADHD,” said Ellen Littman, Ph.D., in discussing how hormonal fluctuations impact women in the ADDitude webinar titled Why ADHD is Different for Women: Gender Specific Symptoms & Treatments.

In addition, the Swedish study found that 59% of the women diagnosed with ADHD had an additional psychiatric disorder compared to only 5% of the women without ADHD.

“The combination of being diagnosed with ADHD and being pregnant at a young age could increase the vulnerability and therefore the risk of being diagnosed with a psychiatric disorder postpartum, such as depression and anxiety,” researchers wrote. “However, results from the present study also show that women diagnosed with ADHD have an increased risk of depression and anxiety disorders regardless of age. This highlights the importance of health care providers to evaluate women diagnosed with ADHD across the lifespan.”

Postpartum Depression and ADHD

In a recent ADDitude survey of 2,027 women with ADHD, one-third of mothers reported that they experienced PPD, including the following symptoms:

• crying spells: 76%
• feelings of worthlessness, shame, guilt, or inadequacy: 76%
• mood swings: 66%
• irritability: 62%
• lack of concentration: 58%
• sleep problems: 57%
• withdrawing from friends and family 55%
• restlessness 46%
• appetite changes (increase or decrease) 37%
• thoughts of harm to self or others 31%
• other 24%
• extreme mood disorder or psychosis 13%
• self-harm 6%

“My ADHD got significantly worse postpartum,” said a survey respondent. “I felt overwhelmed and was not supported by my husband. He’d say things like, ‘Sarah next door has four children, and she copes. I don’t understand why you can’t even manage to keep things organized when you only have one!’”

“Something in me definitely changed after giving birth,” said an ADDitude reader from Ontario, Canada. “My doctors told me it was ‘anxiety’ and hormones. Although tired and sleep-deprived from the baby, I could not shut down my racing mind. I was constantly irritable, impatient, and a complete space cadet. I did suffer from postpartum depression after the birth of my second child. That is when I looked deeper into the root of my troubles. I have always wondered if I had PPD after my first child, or was my ADHD so out of control that I didn’t even notice?”

ADDitude survey respondents reported that their PPD symptoms lasted:

• 1-3 months 13.14%
• 4-6 months 18.63%
• 7-13 months 21.63%
• 14-24 months 13.63%
• Longer than two years 14.14%

Women Lack Treatment for Postpartum Depression

Almost half of ADDitude survey respondents said their healthcare providers did not offer treatment for their postpartum depression or anxiety.

“The medical community didn’t take baby blues seriously when my children were born,” said one ADDitude reader. “I just ‘needed to exercise, lose the rest of the baby weight, and focus on my family.’ Then I would be all better.”

“No one talked about it, and my doctor never asked how I was doing. So, I assumed I was weak,” said another survey respondent.

One ADDitude reader found the help she needed on her own. “No doctor cared,” she said. “So I self-treated by researching natural treatments and took several supplements that helped.”

According to the ADDitude survey, 41% of respondents received prescriptions for antidepressants, and 20% received therapy for PPD.

“PPD made it hard to get through anything without going into a guilt-depression spiral,” an ADDitude reader said. “It was awful. Antidepressants changed everything so I could function without spiraling or wanting to disappear.”

Postpartum Depression with Undiagnosed ADHD

Many ADDitude readers who experienced postpartum depression or postpartum anxiety were unaware of their ADHD diagnoses at that time.

“I had depression, anxiety, and just went into full paralysis,” an ADDitude reader said. “I didn’t know I had ADHD. I thought I sucked at everything, so I might as well add motherhood to the list.”

“I lost all sense of myself and pretended to cope,” said an ADDitude reader from Edmonton, Canada. “It wasn’t until I was diagnosed and looked back on my pregnancy that I realized how much ADHD and hormones played a role in my lack of coping. I wish I could go back and talk to that frightened, overwhelmed, and so very sad me and let her know there was a reason for it all.”

ADHD and Maternal Care: Next Steps

The Swedish researchers recommended that primary healthcare providers assess women with ADHD for the risk of PPD and postpartum anxiety beginning with the first prenatal visit. In addition, they said, women with ADHD should receive parental education before conception, psychological surveillance during pregnancy, and social support after childbirth.

According to Littman, women should find a doctor who understands the impact of hormones on ADHD and the interplay with medication. “Finding this professional is perhaps the most important and most difficult thing to do,” she said. “Be sure to ask about their experience treating ADHD in women.”

Sources

¹Andersson, A., Garcia-Argibay, M., Viktorin, A., Ghirardi, A., Butwicka, A., Skoglund, C., Bang Madsen, K., D’onofrio, B.M., Lichtenstein, P., Tuvblad, C., and Larsson, H. (2023). Depression and Anxiety Disorders During the Postpartum Period in Women Diagnosed with Attention Deficit Hyperactivity Disorder. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2023.01.069

²Hua, M.H., Huang, K.L., Hsu, J.W., Bai, Y.M., Su, T.P., Tsai, S.J., and Chen, M.H. (2020). Early Pregnancy Risk Among Adolescents With ADHD: A Nationwide Longitudinal Study. Journal of Attention Disorders. https://doi.org/10.1177/1087054719900232

³Østergaard, S.D., Dalsgaard, S., Faraone, S., Munk-Olsen, T., and Laursen, T, (2017). Teenage Parenthood and Birth Rates for Individuals with and Without Attention-Deficit/Hyperactivity Disorder: A Nationwide Cohort Study.  Journal of the American Academy of Child and Adolescent Psychiatry. https://doi.org/10.1016/j.jaac.2017.05.003

Masking, specifically ADHD masking, is a burden for people with ADHD. For women, it’s even more intense because many may have already adjusted themselves to fit an outdated definition of feminine success.

Creating a more inclusive professional environment for neurodivergent women — one where companies can leverage the very unique and needed strengths neurodivergent talent brings to the table — depends on having an accurate view of the obstacles tripping up women with ADHD.

Missing this perspective often leads to well-meaning but harmful advice such as, “Just be yourself, and success will follow.”

What is ADHD Masking?

In general, ADHD masking is a concept and strategy that women with ADHD may intuitively understand before they hear the definition. Put simply; masking is intentionally shifting your behavior to hide your differences. For example, a woman with ADHD might smile and nod during a conversation even though she tuned out long ago, or she may secretly work late into the night to overcompensate for not staying on task for a deadline.

[Free Webinar: “‘Invisible Disabilities’ at Work – How to Foster Neurodivergent Advocacy and Acceptance”]

Masking is often preceded by asking, “What would a ‘normal’ person do?” And then working hard to mimic that. It’s a survival strategy that neurodivergent individuals use to navigate and thrive in a workforce not designed for them.

And it is completely and utterly exhausting, contributing to fatigue, burnout, and feelings of self-deprecation. The emotional, cognitive, and even physical labor that comes with trying to fit a mold not built for women with ADHD can feel like holding down multiple jobs at once.

Women are More Likely to be Undiagnosed, Misdiagnosed for ADHD

Women are less likely to be accurately diagnosed with ADHD in childhood. ¹ (According to the Centers for Disease Control and Prevention (CDC), boys are twice as likely as girls to get diagnosed with ADHD.) ²

Now we are seeing a fast-growing cohort of women in their 30s, 40s, and 50s getting diagnosed with ADHD for the first time. Their diagnoses aren’t benign. They occur after decades of being misdiagnosed with depression or anxiety or repeatedly being told to “get their act together.” Such sentiments often leave women wondering, “What is wrong with me?” and becoming extremely good at masking.

[Free Resource: What to Ask Yourself to Find the Perfect Job]

When a neurodivergent woman lacks a diagnosis that could help her understand and accept her unique wiring, the impulse to hide oneself can arise. Masking may become unconscious and automatic, so much so it becomes ingrained in her brain and, nonetheless, exhausting.

Women in the Workplace Walk a Tightrope

In January 2023, Fortune reported that women, for the first time, lead more than 10% of Fortune 500 companies as CEOs. ³ Those numbers may mean progress, considering that in 2015, The New York Times famously reported, “Fewer women run big companies than men named John.”  ⁴

But surely, it’s not enough. Gender disparities aren’t limited to the C-suite. For the eighth consecutive year, McKinsey and Company’s annual Women in the Workplace report found that women struggle to advance in the ranks, beginning with entry-level positions, thanks to “broken rungs” on the corporate ladder.⁵

And the disparity is much more significant for women of color and non-binary individuals.

Women must walk across a fragile tightrope at work, and neurodivergence makes this more challenging: One issue is that feminine traits are not the standard for leadership. But at the same time, women who don’t exhibit femininity are judged as less likable. Often, women in leadership positions are amazingly aware of their emotions — and the reactions of others when those emotions become visible. Knowing this compounds the fear neurodivergent women may carry that neurotypical people may notice the things they try and conceal.

Women in the Workplace: Expectation Bias

Unconscious bias causes people to unknowingly alter how they see the world to fit their expectations. Expectation bias occurs when people dismiss others who don’t fit their expectations.

Now, consider stereotypical expectations for women in the workplace — like note-taking, event planning, and saying “yes” to menial projects outside their role — against the backdrop of common ADHD symptoms and executive function weaknesses with planning, organization, and multitasking.

The cost of not conforming to expectations, even unreasonable ones, may involve a backlash that impacts a neurodivergent woman’s standing or security at work.

Let’s Stop Failing Women: How to Navigate the Journey Together

Neurodivergent women can work to cease and desist unhelpful masking behaviors. But until workplaces move the needle on bias in general, this leaves a disproportionate burden on women’s shoulders.

While unmasking has tremendous benefits, it also carries a risk. The American Disability Act (ADA) protects individuals with disabilities; however, unconscious bias is real. There is no shortage of stories about individuals who experienced career consequences after revealing their neurodivergence to employers and colleagues.

For women, gender bias at work makes unmasking more complicated. However, there are plenty of good reasons to show up more fully.  One safe place to start could be discussing work preferences and needs with one or two close colleagues. For example, a woman could say, “The back-to-back Zoom meetings really wear me out and prevent me from being fully productive. Do you mind if we make our weekly check-in a phone meeting?”

As neurodivergent women navigate their journeys in the workplace, one thing we know for sure is that ADHD masking is not simply an individual issue.

Sarah Greenberg, MFT, MA, M.Ed., BCC, is a psychotherapist, board-certified coach, and Executive Director of Behavior Change & Expertise at Understood.org. 

Neurodivergent Women in the Workplace: Next Steps

• Free Download: Use This ADHD Blueprint to Find Your Passion
• Read: The Real-Life Risks and Rewards of Disclosing ADHD at Work
• Learn: How to Help Your Boss Help You
• Blog: “I’m Not Hiding My ADHD Anymore”

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Glasofer, A., Dingley, C., Kim, J., Colosimo, R., & Gordon, H. R. D. (2023). Medication Decision Making in Low-Income Families of Black Children With ADHD: A Mixed Methods Study. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547231158382

¹Young, S., Adamo, N., Ásgeirsdóttir, B.B., Branney, P., Beckett, M., Colley, W., Cubbin, S., Deeley, Q., et al. (2020) Females with ADHD: An Expert Consensus Statement Taking a Lifespan Approach Providing Guidance for the Identification and Treatment of Attention-Deficit/Hyperactivity Disorder in Girls and Women. BMC Psychiatry. 20(1):404. https://doi.org/10.1186/s12888-020-02707-9

²Centers for Disease Control and Prevention. Data and Statistics About ADHD. https://www.cdc.gov/ncbddd/adhd/data.html

³Hinchliffe, Emma. (January 12, 2023) Women CEOs Run More Than 10% of Fortune 500 Companies for the First Time in History. Fortune. https://fortune.com/2023/01/12/fortune-500-companies-ceos-women-10-percent/

⁴Wolfers, Justin. (March 2, 2015). Fewer Women Run Big Companies Than Men Named John. The New York Times. https://www.nytimes.com/2015/03/03/upshot/fewer-women-run-big-companies-than-men-named-john.html

⁵McKinsey & Company. Women in the Workplace 2022. (October 18, 2022). https://www.mckinsey.com/featured-insights/diversity-and-inclusion/women-in-the-workplace

The use of ADHD medication during pregnancy causes no impairment of a child’s neurodevelopment or physical growth, according to research published in Molecular Psychiatry.¹ A large population-based register study found in-utero exposure to medication for ADHD, including stimulants, did not impair a child’s neurodevelopment or growth compared to children whose mothers stopped taking ADHD medication prior to conception.

Research was conducted using data from Danish nationwide registers, including more than one million children born between 1998 and 2015. Of those, 898 children were delivered by mothers who started or continued taking ADHD medication during pregnancy; this became the study’s “exposed” group. The “unexposed” group included 1,270 children whose mothers discontinued — but had previously taken — ADHD medication before conception.

Prenatal & Postnatal Exposure to ADHD Medication

After adjusting for maternal demographic characteristics and psychiatric data, researchers found no difference in long-term neurodevelopmental or growth outcomes between the two groups. In other words, women could stop taking medication before conception or continue during pregnancy without putting their child at greater risk of neurodevelopmental psychiatric disorders (ADHD, ASD); neurodevelopmental impairments (vision, hearing, seizures, epilepsy); or growth impairments.

Though the percentage is small, the number of pregnant women taking ADHD medication has steadily increased over time.^{2, 3} In fact, ADHD medication is one of the most common medications prescribed during pregnancy.^{3, 4}

In a recent survey of ADDitude readers, 2.39% of 1,170 women who had been pregnant reported taking medication for their ADHD following conception. Many of those who did not take medication said they remained undiagnosed and untreated at the time of their pregnancies, and therefore had no prescribed medications. Just 2.58% took ADHD medication while breastfeeding.

If a woman decides to discontinue use while both pregnant and breastfeeding, she may go a year or longer without pharmacological treatment — a first-line treatment for ADHD.

“I stopped [taking] Adderall leading up until delivery, and had been told I couldn’t take it at all during breastfeeding,” wrote one 33-year-old woman in Texas. “I went back to work three months postpartum. I really struggled with symptoms and felt unable to do my job.

“I did some additional research… that suggested a low breastmilk transfer rate for Adderall, and an even lower rate with Ritalin. Five months postpartum, I brought that data to my GP, who agreed to prescribe 5mg of Ritalin twice daily. I continued exclusively breastfeeding for two more months, then did a combination of breastfeeding and formula until weaning completely when my daughter was nine months. At that time, my GP switched me back to Adderall. During this time, my daughter showed no adverse effects, remaining on her growth trajectory in the 90th percentile and sleeping like a champ!”

Impact on Children

The decision to cease or continue treatment for ADHD while pregnant is difficult, in large part because the effects of ADHD medication in utero are not well-documented. Due to the nature of the problem, research is limited to register studies like this most recent one — the second and largest long-term register study to examine the effects of ADHD medication during pregnancy.

In addition, the research is conflicting. A 2015 U.S. population-based study found that ADHD medication use in early pregnancy was associated with three specific, selected birth defects.⁵ Another U.S.-based study, published in 2017, suggested an increased risk of cardiovascular defects from prenatal exposure to methylphenidate — but not amphetamines.⁶

While exposed children faced no increased risks for common neurodevelopmental outcomes in the present study, researchers found that exposed children born to mothers who used other psychotropic medication during pregnancy were more likely to develop ADHD. This was also found when the mother had filled two or more prescriptions for ADHD medication during pregnancy.

Because the increased risk was limited to ADHD only, researchers speculate these results may be “driven by severity of maternal ADHD” through “higher disease liability for ADHD and through referral bias, that is, offspring of mothers with severe ADHD are assessed more carefully for ADHD.”

Impact on Women with ADHD

On average, women in the U.S. have their first child by age 27.⁷ According to the ADDitude survey, it’s around this time that women report a major impact caused by their ADHD symptoms. The majority — 64% to 70% of 2,010 respondents — said the overall impact of ADHD was major or life-altering in their 20s and 30s.

Half of survey respondents who had been pregnant said their ADHD symptoms remained stable during pregnancy. But following delivery, 56.7% of them said they experienced symptoms of postpartum depression. Around more than one-third told ADDitude these symptoms lasted for more than 6 months; for nearly 10%, postpartum depression lasted more than two years.

Similar findings were discovered in a 2020 survey conducted by the MGH Center for Women’s Mental Health. No significant changes in ADHD symptoms were reported by women during pregnancy, but those who chose to discontinue psychostimulant medication experienced a significant increase in postpartum depressive symptoms. Women who elected to adjust their ADHD medication use, or maintained the same prescription schedule, did not experience a significant change in depressive symptoms.

Limitations and Future Research

“Pregnant women who depend on stimulants for daily functioning must weigh the potential of exposing their fetus to unknown developmental risks against potential medical, financial, and other consequences to both mother and child that are associated with exacerbation of ADHD symptoms when stopping the medication, such as inability to maintain employment and unsafe driving,” the researchers stated.

ADHD medication in the present study included stimulants (methylphenidate, amphetamine, dexamphetamine, lisdexamphetamine) and other treatments (modafinil, atomoxetine, clonidine).

“The present study provides reassurance that several essential categories of child outcomes that could reasonably be suspected to be affected by stimulants, including body growth, neurodevelopment, and seizure risk, do not differ based on antenatal stimulant exposure.”

Compared to women without ADHD, the study’s sample population of women with ADHD tended to be younger at the time of childbirth, more likely to smoke during pregnancy, and more likely to have children born preterm or with low birth weight. This finding was consistent regardless of whether the mother took ADHD medication during pregnancy.

Finally, more research is needed to differentiate between the effects of ADHD medication types, dosage, and trimester. This study was limited to diagnoses formally entered into the Danish register. Future research should be expanded to include a larger sample population.

Sources

¹Madsen, K. B., Robakis, T. K., Liu, X., Momen, N., Larsson, H., Dreier, J. W., … Bergink, V. (2023). In utero exposure to ADHD medication and long-term offspring outcomes. Molecular Psychiatry, 1–8. doi: 10.1038/s41380-023-01992-6

²Lemelin, M., Boukhris, T., Zhao, J. P., Sheehy, O., & Bérard, A. (2021). Prevalence and determinants of attention deficit/hyperactivity disorder (ADHD) medication use during pregnancy: Results from the Quebec pregnancy/children cohort. Pharmacology research & perspectives, 9(3), e00781. https://doi.org/10.1002/prp2.781

³Haervig, K. B., Mortensen, L. H., Hansen, A. V., & Strandberg-Larsen, K. (2014). Use of ADHD medication during pregnancy from 1999 to 2010: A Danish register-based study. Pharmacoepidemiology and drug safety, 23(5), 526–533. https://doi.org/10.1002/pds.3600

⁴Louik, C., Kerr, S., Kelley, K. E., & Mitchell, A. A. (2015). Increasing use of ADHD medications in pregnancy. Pharmacoepidemiol Drug Saf, 24, 218– 220, doi: 10.1002/pds.3742.

⁵Anderson, K. N., Dutton, A. C., Broussard, C. S., Farr, S. L., Lind, J. N., Visser, S. N., Ailes, E. C., Shapira, S. K., Reefhuis, J., & Tinker, S. C. (2020). ADHD medication use during pregnancy and risk for selected birth defects: National birth defects prevention study, 1998-2011. Journal of Attention Disorders, 24(3), 479–489. https://doi.org/10.1177/1087054718759753

⁶Huybrechts, K. F., Bröms, G., Christensen, L. B., Einarsdóttir, K., Engeland, A., Furu, K., Gissler, M., Hernandez-Diaz, S., Karlsson, P., Karlstad, Ø., Kieler, H., Lahesmaa-Korpinen, A. M., Mogun, H., Nørgaard, M., Reutfors, J., Sørensen, H. T., Zoega, H., & Bateman, B. T. (2018). Association between methylphenidate and amphetamine use in pregnancy and risk of congenital malformations: A cohort study from the international pregnancy safety study consortium. JAMA psychiatry, 75(2), 167–175. https://doi.org/10.1001/jamapsychiatry.2017.3644

⁷Osterman, M.J.K., Hamilton, B.E., Martin, J.A., Driscoll, A.K., & Valenzuela, C.P. (2023). Births: Final data for 2021. National Vital Statistics Reports; 72(1). DOI: https://dx.doi. org/10.15620/cdc:122047.

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Pregnancy is magical and excruciating. Exciting and overwhelming. Demanding and the calm before the storm.

This is true for most people who experience pregnancy, but it’s doubly true for those with ADHD, roughly 96% of whom cease taking stimulant medication while pregnant and nursing. On top of that, the new and unrelenting demands of caring for an infant, while experiencing changing hormone levels and disrupted sleep, can amplify ADHD symptoms and bring a new level of difficulty to daily functioning.

For women who discontinued ADHD medication use during pregnancy, in particular, coping with raw emotions, a new routine, and a new baby may feel next to impossible and lead to comorbid anxiety and depression. It is important for clinicians treating perinatal women with ADHD to consider the benefits and risk of stimulant use in this critical time of transition.

In this webinar, women, partners, and professionals will learn:

• About the intersection of ADHD symptoms and neurobiology in perinatal women during and after pregnancy
• About the risk analysis of stimulant use versus discontinuation in pregnancy and postpartum
• How to anticipate the demands of early motherhood and risk for depression and anxiety in women with ADHD
• About the impact of hormones on ADHD throughout the lifespan, and the interplay with medication

Have a question for our expert? There will be an opportunity to post questions for the presenter during the live webinar.

Meet the Expert Speaker:

Allison Baker, M.D., is a clinician, researcher, and educator with the Perinatal and Reproductive Psychiatry Clinical Research Program at Massachusetts General Hospital, with an appointment at Harvard Medical School. She has expertise in pediatric obsessive-compulsive disorder, ADHD, adolescent mood disorders, and perinatal psychiatry. Dr. Baker frequently lectures and leads workshops on a variety of topics in child and perinatal psychiatry.

Dr. Baker received her medical degree from the University of Virginia, where she was elected to the Alpha Omega Alpha Honor Society for her excellence in scholarship and professionalism. She completed her residency in general psychiatry at Columbia University, serving as Chief Resident. Dr. Baker trained in child and adolescent psychiatry at the combined program of Columbia and Cornell Universities. Dr. Baker then served on the faculty at Columbia University Medical Center and was a Senior Pediatric Psychopharmacologist at The Child Mind Institute before moving to Boston.

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“Reading the book, I diagnose you with ADD,” Maté said, referring to the Duke of Sussex’s autobiography, Spare. “I see it as a normal response to normal stress, not a disease.”

Maté, author of Scattered Minds: The Origin and Healing of Attention Deficit Disorder and The Myth of Normal, also diagnosed the prince with anxiety, panic disorder, depression, post-traumatic stress disorder (PTSD), and substance abuse issues during the 90-minute, live-streamed event, which has been described as both unorthodox and reckless.

Maté made his diagnosis before meeting the prince and, admittedly, based his evaluation solely on stories of grief, trauma, and substance abuse from Spare. In his past work, Maté has called ADHD a “normal response to normal stress,” which he says may be healed without medication. In last week’s conversation, he suggested Prince Harry’s ADHD stemmed from his childhood, especially the death of his mother, Princess Diana, when he was just 12.

There is a lot to unpack here and so much ADHD misinformation to correct. Here, leading ADHD experts address Maté’s claims regarding ADHD and trauma, respond to his spontaneous diagnosis, and fact-check his treatment advice.

[Download This Free Guide to Debunking ADHD Myths]

Can Clinicians Diagnose ADHD Based on a Patient’s Life Story?

In short, no.

“An accurate and well-rounded ADHD diagnosis is a complex, multi-step process including a clinical interview, a medical history review, and the completion of normed rating scales by loved ones, educators, and/or colleagues,” says Thomas E. Brown, Ph.D., a clinical psychologist who served on the clinical faculty of the Yale School of Medicine for 21 years and has published six books on ADHD.

Only a medical professional, such as a pediatrician, a psychologist, a psychiatrist, or an advanced practice registered nurse (APRN), should diagnose ADHD. An in-depth, well-rounded ADHD evaluation comprises several components, explains Brown, the director of the Brown Clinic for Attention and Related Disorders in California.

First, Brown says, a clinician will determine whether the patient has the ADHD symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V). (A patient must have shown at least six of the nine symptoms of inattention and/or hyperactivity and impulsivity before age 12.) Next, the clinician will conduct an interview with the individual (and, if possible, with one or two people who know that person well) or refer the patient to a medical or mental health clinician who is familiar with ADHD and with the other medical or psychological disorders that produce similar symptoms, Brown explains.

“A good clinical interview may take two to three hours, including time explaining to the patient what we now understand about ADHD and what it means for them,” he said in the ADDitude article, “The Building Blocks of a Good ADHD Diagnosis.”

[Self-Test: Common ADHD Symptoms in Adults ]

The clinician should use normed ADHD rating scales, such as the Barkley, BASC, Brown, Conners, or BRIEF scales, to gather self-reported information from the patient and observer information from parents, teachers, partners, or others who have seen how this individual has functioned over recent months and previously in various aspects of daily life.

“A clinician should also conduct a complete physical exam to rule out medical problems, such as thyroid conditions or pinworms,” Brown says. A physical exam can also assess whether an individual can safely take ADHD medication.

A complete assessment may take several visits and/or visits with an ADHD specialist.

Does Trauma Cause ADHD?

Not exactly. Studies show that experiencing trauma increases a patient’s chances of being diagnosed with ADHD. However, research does not support the idea that trauma causes ADHD.¹

“Research does tell us that ADHD is a condition that’s largely genetic and inherited and that it causes specific areas of the brain to be underdeveloped or otherwise impacted,” says Nicole M. Brown, M.D., MPH, MHS, a general pediatrician and health services researcher and Chief Health Officer of Strong Children Wellness Medical Group in New York.

“Because trauma affects those same areas of the brain, it exacerbates ADHD symptoms,” she said in the ADDitude webinar titled How Stress and Trauma Affect ADHD in Children of All Colors — and How to Heal the Wounds. Her research on the topic was published in Academic Pediatrics, the official journal of the Academic Pediatric Association.

“ADHD is a brain-based disorder often diagnosed after a child struggles in school, or even later in life,” adds Kerry J Heckman, LICSW, a Seattle-based licensed therapist specializing in somatic therapy for the treatment of trauma. “Trauma is the result of exposure to stressful events or experiences that can occur anytime during a person’s life. Childhood trauma that occurs when the brain develops may lead to cognitive and emotional changes resembling ADHD.”

Epigenetics, which the Centers for Disease Control and Prevention (CDC) defines as “the study of how your behaviors and environment can cause changes that affect the way your genes work,” sheds some light on how environmental factors and experiences, such as trauma, may impact brain development. However, ADHD is not solely a result of trauma.

“It starts with genes,” says Joel Nigg, Ph.D., a clinical psychologist, and professor in the departments of psychiatry and behavioral sciences at Oregon Health & Science University. “But everyone is exposed to different environmental toxins and advantages beginning at conception — and after we’re born, psychological inputs like stress, adversity, and even trauma begin to factor in. Epigenetics uses this input to change how genes are expressed — meaning a gene’s output isn’t fully known until environmental and personal histories are factored in.” Nigg further explained how epigenetics affects ADHD in the ADDitude webinar titled Genes and the Environment: How Biology and Exposures Contribute to ADHD in Children.

Can ADHD Be “Healed?”

No silver-bullet solution or magic elixir exists for ADHD; it is a lifelong condition that persists well into adulthood for most people who have it.

The best treatment for managing the core symptoms of ADHD in children is a combination of behavioral parent training and medication. Stimulants (methylphenidate and/or amphetamine) are considered a first-line pharmacological treatment for adult ADHD.² Several types of non-stimulants (considered second-line treatments) can address ADHD symptoms as well.

Even medication can’t “cure” ADHD. “There is no ‘cure’ that we know of,” said Larry Silver, M.D., a psychiatrist, and former Clinical Professor of Psychiatry at Georgetown University Medical Center in Washington, D.C. “Think about a person with diabetes on insulin. Insulin corrects a chemical deficiency and allows a person to metabolize sugar. Once it wears off, however, the person can no longer do this. At this time, we can’t correct the problem, only compensate for it, and medication is an effective approach.” Silver was the former Acting Director and Deputy Director of the National Institute of Mental Health (NIMH).

Laurie Dupar, PMHNP, RN, PCC, a senior certified ADHD coach, trained psychiatric nurse, and founder of the International ADHD Coach Training Center, agrees with Silver. “We know from years of research that ADHD medications work — in fact, studies show they work up to 80% of the time,” she says.

Adults should expect to work closely with their physicians to adjust medication and dosage and to find the right ADHD treatment combination to alleviate symptoms.

For those individuals with ADHD who cannot or prefer not to take medication, cognitive behavioral therapy, nutrition, meditation, exercise, lifestyle changes, and/or brain training, among other natural treatments, may help alleviate or lesson some ADHD symptoms like poor focus and memory.

Can Individuals with ADHD Effectively Self-Medicate with Marijuana and Psychedelic Drugs?

The Duke of Sussex and Maté talked candidly about the benefits of drinking ayahuasca, a plant-based psychedelic from South America.

“I would say it [taking ayahuasca] is one of the fundamental parts of my life that changed me and helped me deal with the traumas and pains of the past,” Prince Harry said. He also described his experiences using cocaine, smoking marijuana, and trying magic mushrooms (Psilocybin).

While some individuals with ADHD seek alternatives to first-line treatments, research does not support the idea that illegal substances assuage ADHD symptoms. According to Roberto Olivardia, Ph.D., a Clinical Psychologist and Clinical Instructor of Psychology at Harvard Medical School, the risk of developing cannabis use disorder (CUD), a problematic pattern of cannabis use linked to clinically significant impairment, is twice as high in people with ADHD.³

“Contrary to popular belief, individuals can be mentally and chemically dependent on and addicted to cannabis. Contemporary marijuana has concentrations of THC higher than historically reported, exacerbating this. What’s more, the adverse effects of cannabis are especially amplified in people with ADHD,” he says.

Cannabis use may also exacerbate paranoia, panic, and mood disorders, explains Olivardia. Further, the increased risk of suicide associated with cannabis use further complicates marijuana among individuals with ADHD, who already face an elevated risk for suicide compared to neurotypical individuals.⁴

“The substance’s negative effects are most harmful to developing brains,” Olivardia says. “Many studies show that usage earlier in life, particularly before age 25, predicts worse outcomes. One study found that heavy marijuana use in adolescence was associated with a loss of 8 IQ points, on average, in adulthood.⁵ Another study found that people under 18 are four to seven times more at risk for CUD than adults.⁶  Olivardia discussed marijuana and the ADHD brain in the ADDitude webinars titled Marijuana and the ADHD Brain: How to Identify and Treat Cannabis Use Disorder in Teens and Young Adults and Marijuana and the ADHD Brain, Part 2.

The use of very low (micro) doses of psychedelics, such as LSD and psilocybin, appears promising for treating symptoms of obsessive-compulsive disorder, cluster headaches, and ADHD; however, additional research is required and these treatments are not without risks, cautions psychologist Ari Tuckman, Psy.D., and Stephanie Moulton Sarkis, Ph.D., NCC, LMHC, an AMHCA Diplomate and Clinical Specialist in Child and Adolescent Counseling. They stressed that psychedelics can potentially worsen symptoms of bipolar disorder or lead to psychosis and said that “these drugs are illegal unless they are administered in medical or research settings.”

Why Is a Public ADHD “Diagnosis” Like Prince Harry’s So Dangerous?

Doctor-patient confidentiality prohibits doctors from sharing patients’ medical information with others. It appears Maté disregarded this by diagnosing Prince Harry with ADHD in a public — and profit-generating — setting. Access to the interview required purchasing a $25 ticket (ticket holders received a hardcover copy of Spare.).

According to the American Academy of Family Physicians website, “a confidential relationship between physician and patient is essential for the free flow of information necessary for sound medical care. Only in a setting of trust can a patient share the private feelings and personal history that enable the physician to comprehend fully, to diagnose logically, and to treat properly.”

ADHD is not globally understood. Myths and misinformation abound, leading to systematic barriers to helping and supporting adults and children with ADHD. Some people falsely believe ADHD is a fake disorder, an excuse for bad behavior, or a pharmacological fairy tale. None of these things is true, but that doesn’t change the fact that enduring stigma impacts how and whether adults with ADHD choose to share their diagnosis.

The UK did not recognize ADHD until the publication of the NICE (National Institute of Clinical Excellence) Clinical guideline CG72 in 2008.⁷ According to a 2022 study published in BMC Psychiatry, before that time, there was an enormous amount of skepticism about ADHD and virtually no recognition of it in the UK.⁸

“While the last two decades have seen a stepped change and increase in the provision of adult ADHD clinical services in the UK and elsewhere, demand currently outstrips provision by a long way in many regions and countries,” the study’s authors wrote.

ADHD is treated as more of a “niche problem,” they wrote, “with diagnosis, treatment initiation and monitoring frequently constrained to scarce specialist services with limited capacity.”

By offhandedly diagnosing a public figure, Maté diminishes the experience of many people with ADHD in Europe who already struggle to access care.

The ADHD Foundation, UK’s leading neurodiversity charity, tweeted: “Gabor Maté — it is neither ethical nor appropriate to tell someone for the first time, — in a public interview, that they have ADHD. It is for the individual to decide whether to disclose their neurodiversity.”

Debunking Prince Harry’s ADHD “Diagnosis:” Next Steps

• Download: 31 ADHD Myths in 31 Days —Debunked
• Learn: The Brain Circuits that Link ADHD and PTSD
• Read: 21 Ignorant Comments (and Lies) About ADHD 
• Q: Who Can Diagnose ADHD? 
• eBook: Secrets of the ADHD Brain 

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Sources

¹Brown, N.M., Brown, S.N., Briggs, R.D., Germán, M., Belamarich, P.F., Oyeku, S.O. (2017) Associations Between Adverse Childhood Experiences and ADHD Diagnosis and Severity. Acad Pediatr.https://doi.org/10.1016/j.acap.2016.08.013

²Kolar, D., Keller, A., Golfinopoulos, M., Cumyn, L., Syer, C., & Hechtman, L. (2008). Treatment of Adults with Attention-Deficit/Hyperactivity Disorder. Neuropsychiatric Disease and Treatment. 4(2), 389–403.https://doi.org/10.2147/ndt.s6985

³Lee, S. et. al. (2011). Prospective Association of Childhood Attention-Deficit/Hyperactivity Disorder (ADHD) and Substance Use and Abuse/Dependence: A Meta-Analytic Review. Clinical Psychology Review. 31(3), 328–341. https://doi.org/10.1016/j.cpr.2011.01.006

⁴Balazs, J., & Kereszteny, A. (2017). Attention-Deficit/Hyperactivity Disorder and Suicide: A Systematic Review. World Journal of Psychiatry. 7(1), 44–59. https://doi.org/10.5498/wjp.v7.i1.44

⁵Meier, M, et. al. (2012). Persistent Cannabis Users Show Neuropsychological Decline from Childhood to Midlife. Proceedings of the National Academy of Sciences. 109 (40) E2657-E2664; https://doi.org/10.1073/pnas.1206820109

⁶Winters, K. C., & Lee, C. Y. (2008). Likelihood of Developing an Alcohol and Cannabis Use Disorder During Youth: Association with Recent Use and Age. Drug and Alcohol Dependence. 92(1-3), 239–247. https://doi.org/10.1016/j.drugalcdep.2007.08.005

⁷NICE. Attention Deficit Hyperactivity Disorder: The NICE Guideline on Diagnosis and Management of ADHD in Children, Young People and Adults: The British Psychological Society and The Royal College of Psychiatrists; 2008.

⁸Asherson, P., Leaver, L., Adamou, M., et al. (2022) Mainstreaming Adult ADHD into Primary Care in the UK: Guidance, Practice, and Best Practice Recommendations. BMC Psychiatry. 22, 640 https://doi.org/10.1186/s12888-022-04290-7</a?

“Depression” is used casually and colloquially to refer to a fleeting experience, as in “Oh, I’m so depressed by the rain and gloom today.” Or “I’m super depressed that I couldn’t get Taylor Swift tickets.”

It’s important to understand, however, that depression is a serious mental illness — and one that is far more common in people with ADHD than it is in the rest of the population. About 30% of people with ADHD will experience a depressive episode in their lifetime.

Major Depressive Disorder (MDD) is one of the most common mental health conditions in the United States, affecting 6.7% of adults. Despite its casual usage in the popular vernacular, depression is something beyond simply feeling sad. In fact, many people with depression will tell you that their experience has less to do with sadness and more to do with feeling the absence of all emotions — the absence of everything, really, that makes them feel human. Depression is isolating and terrifying, but with medication, psychotherapy, and other treatments, most people who experience depression notice an improvement in symptoms.

The first step toward getting help is diagnosing the problem — which can be a challenge when symptoms of depression overlap with symptoms of ADHD.