COMPLEX TREATMENT: How should clinicians approach treatment for patients with ADHD and comorbid conditions?

A: As clinicians, we must expect that adults with ADHD will come to us with complex presentations… | Keep reading on ADDitude »

PEDIATRIC COMORBIDITIES: How should clinicians adjust pharmacological treatment for children with ADHD and comorbidities?

A: Though stimulant medication, paired with behavioral therapy, is the first-line treatment for ADHD in children, contraindications and side effects may limit their use. For example, depression and anxiety can worsen… | Keep reading on ADDitude »

ADHD + DEPRESSION: What is the recommended approach for treating ADHD with depression?

A: Options for patients include an array of psychological and psychopharmacological treatments, along with newer, cutting-edge approaches… | Keep reading on ADDitude »

ADHD + EATING DISORDERS: How should clinicians adjust treatment approaches for patients with ADHD and comorbid eating disorders?

A: Treat both ADHD and the eating disorder together and don’t discount the relevance of ADHD symptoms in driving the eating disorder. ADHD has to be treated in order to unlock effective ED treatment… | Keep reading on ADDitude »

ADHD + EFD: How is executive dysfunction related to ADHD, and how should it be treated?

A: The FDA does not allow prescriptions for stimulants to be phoned into a pharmacy or refills to be added to prescriptions — and this adds to the burden of treating patients who take them… | Keep reading on Medscape »

RELATED RESOURCES

Substance Use Disorder and ADHD: Safe, Effective Treatment Options

Expert Webinar with Timothy Wilens, M.D. | Listen now on ADDitude »

Current Guidelines for Treatment and Behavioral Interventions for Tourette Syndrome and Tic Disorders

Expert Webinar with John Piacentini, Ph.D., ABPP | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
> DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

If someone doesn’t value spending time with me as much as I value spending time with them, I feel rejected. Last month, I said to one of my closest friends that I would like to hang out with him more like we used to. He said that he was cool with the way things are. This hurts a lot. What can I do to make this less painful?”

When teens with ADHD struggle with rejection sensitive dysphoria, it affects their relationships — and their self-esteem. Often, they don’t know how to cope with their intense emotions and, feeling overwhelmed, they may lash out at friends and/or family members.

[Read: Why ADD Makes You Feel. So. Much.]

One of my teen clients told me: “When I come home from school, sometimes I just can’t hold it all together. I yell at my mom and then I feel bad afterward, but I know that I can’t get kicked out of my family.” Other kids will withdraw quietly into their rooms and swallow their pain. As parents, there’s a fine line between supporting your adolescent in managing their big feelings and intervening to diminish their distress.

While some ADHD non-stimulant medications or antidepressants, such as SSRIs, can reduce sensitivity and overwhelm, the following behavioral tools can be very effective to quiet the inner critic, shift perspectives, and develop self-confidence.

Sharon Saline, Psy.D., a licensed clinical psychologist, is an expert in how ADHD, learning disabilities, and mental health issues affect children, teens, and families. She is the author of What Your ADHD Child Wishes You Knew.

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.

The Clinicians’ Guide to Differential Diagnosis of ADHD is a clinical compendium from Medscape, MDEdge, and ADDitude designed to guide health care providers through the difficult, important decisions they face when evaluating pediatric and adult patients for ADHD and its comorbid conditions. This guided email course will cover the following topics:

• DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
• DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
• DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
• DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
• DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
• DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
• DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

NOTE: This resource is for personal use only.

CLINICAL REQUIREMENTS: What clinical requirements are required to confirm a diagnosis of attention deficit hyperactivity disorder (ADHD)?

A: All patients must have a full psychiatric evaluation and physical examination. Here is a cautionary note underscoring the need for a full assessment for late-onset ADHD in adolescents and young adults… | Keep reading on Medscape »

PEDIATRIC ADHD: Which diagnostic tests should I administer for the evaluation of pediatric ADHD?

A: Workup in attention deficit hyperactivity disorder (ADHD), previously termed attention deficit disorder (ADD), includes the following… | Keep reading on Medscape »

ADHD DIAGNOSIS: What steps comprise an authoritative ADHD diagnosis?

A: An accurate ADHD evaluation includes several standard diagnostic steps and nuanced considerations; other “tools” are unproven and worth neither your time nor your money… | Keep reading on ADDitude »

COMPLEX ADHD DIAGNOSIS: What tests, assessments, and questionnaires are used to evaluate patients for complex ADHD?

A: Many children and adults begin by taking an online test of common ADHD symptoms and then taking the results to an ADHD specialist for review and evaluation… | Keep reading on ADDitude »

Free Webinar: Expert Guidance for Securing an Accurate ADHD Evaluation

Expert Webinar with Thomas E. Brown, Ph.D. | Listen now on ADDitude »

Free Webinar: How Brain Imaging Helps Us Understand and Treat ADHD

Expert Webinar with Jonathan Posner, M.D. | Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
> DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

ADVERSE CHILDHOOD EXPERIENCES: How do adverse childhood experiences (ACEs) and trauma influence the development of ADHD in children?

A: Trauma and adversity can alter the brain’s architecture, especially in children, which may partly explain their link to the development of ADHD… | Keep reading on ADDitude »

ADHD AND TRAUMA: What are the symptoms shared by ADHD and PTSD?

A: Poor working memory is associated with ADHD, but also may be the hallmark of a mind avoiding thoughts of a traumatic experience. Practitioners must understand ADHD and trauma to treat a patient effectively…. | Keep reading on ADDitude »

ADHD AND PTSD: Is ADHD caused by PTSD? Is PTSD caused by ADHD?

A: Research increasingly reveals a strong relationship — and reciprocal risk factors — between ADHD and PTSD. What explains this mutual comorbidity? PTSD is associated with dysfunction in areas of the brain implicated in fear extinction learning… | Keep reading on ADDitude »

ADHD AND PERSONALITY DISORDERS: What is the link between ADHD and personality disorders?

A: Personality disorders are mental health conditions like borderline, histrionic, narcissistic, or antisocial personality disorder that cause unhealthy patterns of thought and behavior that persist over time and across situations, causing significant distress or impairment… | Keep reading on ADDitude »

ADHD AND SUBSTANCE ABUSE DISORDER: What is the link between ADHD and substance use disorder?

A: An estimated 15 and 25 percent of adults with a lifetime history of SUD also have ADHD. So how is SUD linked to ADHD? The short answer is we aren’t sure… | Keep reading on ADDitude »

ADHD AND OCPD: Why are individuals with ADHD at higher risk of developing OCPD?

A: Individuals with OCPD may be rigid and stubborn, insisting that others do things according to their strict standards. They may exhibit these behaviors at the expense of flexibility, openness, and efficiency… | Keep reading on ADDitude »

ADHD AND RISKS FOR EATING DISORDERS AND OBESITY: What is the symptom interplay between ADHD, eating disorders, and obesity?

A: Several factors – biological, cognitive, behavioral, and emotional – may explain why ADHD predisposes individuals to eating disorders and challenges… | Keep reading on ADDitude »

Free Webinar: How Stress and Trauma Affect Children with ADHD

Expert Webinar with Nicole M. Brown, M.D., MPH, MHS | Listen now on ADDitude »

Free Webinar: Borderline Personality Disorder and ADHD

Expert Webinar with Roberto Olivardia, Ph.D. | Listen now on ADDitude »

Free Webinar: How Stress and Trauma Impact Brain Development

Expert Webinar with Cheryl Chase, Ph.D.| Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
> DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

INATTENTIVE ADHD: What other conditions may cause symptoms of inattention typically associated with ADHD?

A: Several disorders can present with cognitive, attentional, and executive functioning deficits that resemble the presentation of ADHD. These include absence seizures and other types of seizures, Lyme disease, HIV infection, and encephalopathy…. | Keep reading on MDedge »

AUTISM AND ADHD DIAGNOSTIC CRITERIA: How are the diagnostic criteria for autism and ADHD in adults differentiated?

A: While research on adult autism and ADHD is scarce, clinicians largely agree on best practices in the evaluation and treatment of patients with both disorders… | Keep reading on ADDitude »

AUTISM VS ADHD:  What criteria must be present to merit an autism diagnosis vs. an ADHD diagnosis?

A: It’s critical for professionals to understand what constitutes a thorough ASD evaluation, and that a patient must demonstrate at least five of the seven criteria outlined in the DSM-5 in order to merit an autism diagnosis… | Keep reading on ADDitude »

TIC DISORDERS: What are the diagnostic criteria for the tic disorders that typically co-occur with ADHD, anxiety, and autism?

A: Tic disorders frequently co-occur with other conditions, like ADHD and anxiety, and can lead to problems in school and in social settings… | Keep reading on ADDitude »

ADHD VS LEARNING DISABILITIES: How is ADHD mistaken for comorbid learning disabilities like dyslexia, dyscalculia, and nonverbal learning disorder?

A: Learn how certain red flags, like an inability to communicate or difficulty remembering facts, might mean your child is struggling with a learning disability… | Keep reading on ADDitude »

HIGH IQ MASKING: How might a high IQ mask symptoms of ADHD and/or autism spectrum disorder?

A: Individuals with an above-average IQ and high-functioning autism, especially those with co-morbid ADHD, are less likely to be diagnosed and more likely to struggle in social spheres… | Keep reading on ADDitude »

Free Webinar: Diagnosing and Treating Comorbid Conditions in Children

Expert Webinar with Mark Bertin, M.D. | Listen now on ADDitude »

Free Webinar: How to Recognize and Address Dyscalculia

Expert Webinar with Daniel Ansari, Ph.D. | Listen now on ADDitude »

Free Webinar: Understanding Body-Focused Repetitive Behaviors with ADHD

Expert Webinar with Roberto Olivardia, Ph.D. | Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
> DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

COMORBIDITIES: What comorbidities are associated with ADHD?

A: The two most common comorbidities associated with ADHD are depression and an anxiety disorder, like OCD or generalized anxiety disorder… | Keep reading on Medscape »

COMORBIDITIES: How can diagnosticians differentiate symptoms of anxiety, depression, and ADHD?

A: Studies find that 80 percent of people with attention deficit disorder (ADHD or ADD) will have at least one other psychiatric disorder in their lifetime… | Keep reading on ADDitude »

ADHD AND DEPRESSION: What are the key distinctions between ADHD and depression?

A: Though ADHD and depression share similar symptoms, they are separate and distinct conditions with different treatment protocols. ADHD is a lifelong neurological disorder that impairs executive functions, attention, and self-control; depression is a mood disorder… | Keep reading on ADDitude »

ADHD, ODD, DMDD: How is ADHD distinct from oppositional defiant disorder and disruptive mood dysregulation disorder?

A: Moodiness is common with bipolar disorder, but it’s also common with ADHD, ODD, DMDD, and other neurobehavioral conditions. Differentiating one condition’s symptoms of moodiness from another is critical… | Keep reading on ADDitude »

ADHD AND BIPOLAR: How are the symptoms of ADHD and bipolar disorder often conflated?

A: The rates of misdiagnosis and delayed diagnosis are particularly high among patients with bipolar symptoms; they are astronomical for patients with bipolar disorder plus ADHD… | Keep reading on ADDitude »

ADHD and OCD: What are the shared and distinct characteristics of obsessive compulsive disorder (OCD) and ADHD?

A: To ensure an accurate diagnosis and effective treatment, clinicians must understand the unique interplay between OCD and ADHD, including how ADHD tends to present in patients with OCD… | Keep reading on ADDitude »

ADHD and RSD: How can diagnosing clinicians differentiate between rejection sensitive dysphoria (RSD) – the emotional highs and lows associated with ADHD – and the similar ups and downs of bipolar disorder?

A: Patients with ADHD — and, specifically, rejection sensitive dysphoria (RSD) — get triggered by a distinct event and then experience an intense but fleeting mood. People with bipolar disorder experience the random onset of a mood that lasts for weeks or months… | Keep reading on ADDitude »

RELATED RESOURCES

Treating Anxiety and Depression Alongside ADHD

Expert Webinar with Roberto Olivardia, Ph.D. | Listen now on ADDitude »

ADHD Irritability vs. DMDD vs. Bipolar Disorder

Expert Webinar with William French, M.D., DFAACAP| Listen now on ADDitude »

Why ADHD Is Mistaken for Bipolar Disorder in Women

Expert Webinar with Thomas Brown, Ph.D., and Ryan Kennedy | Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
> DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

“I see a lot of women who probably have undiagnosed ADHD in this sport because we all gravitate toward this… and find that the repetition and structure of running works,” said Olympic marathon medalist Molly Seidel during her recent conversation with WebMD about barriers to mental health care for women. “A lot of people in elite sports, I think, do have something going on… Yeah, we’re all running from something.” (Seidel may be on to something, as some research suggests that ADHD may actually be more common in elite athletes than it is in the general population.)

For Seidel, that something is a late-life diagnosis of ADHD, along with comorbid obsessive compulsive disorder and eating disorders.

“This Is Never Going to Get Easier. And That’s OK.”

It took Seidel years, and a lot of work, to figure out how to manage her conditions, and to find the self-care systems and strategies that are most beneficial for her. She likens this work to her training as a runner, and emphasizes that both are ongoing.

“I think a lot of people assume that I’m a lot more naturally talented than I actually am at this sport. I’m really not,” she said, emphasizing that her success is a product of hard work and dedication. “It’s that consistent, day-to-day work that has translated exactly into my mental health, my realizing that it’s OK that I’m going to have to work at this every day… I also have to wake up every day and brush my teeth, and I’m not expecting that if I brush my teeth enough, I’m never going to have to do it again.”

Seidel’s sharp understanding of herself and what she needs to be at her best every day echoes the advice of Dawn Brown, M.D., a sports psychologist and ADHD specialist who recently hosted the ADDitude webinar, “How to Leverage Sports Psychology to Benefit ADHD Brains:”

“We should adapt to how our brain, our minds are created, meaning we have to find accommodations and strategies that are in line with how our ADHD brains respond to performance and productivity,” Brown said.

Though Seidel has developed effective methods for managing her mental health conditions, she says their impact on her life is far from static. “There are times where these things are very manageable for me,” she shares. “And there are other times when it takes over my entire life.”

Mindfulness and Other Self-Care Strategies

Mindfulness is the lynchpin of Seidel’s daily routine. “I operate on a very high-strung, very over-stimulated level, and I struggle with coming down,” she said. “Being able to decompress, come down from that, [by using] various breathing and calming techniques has been absolutely vital for me. That is something that I have to do every day, multiple times a day.”

Mindfulness, she said, “is about really focusing on lowering the temperature in the system and lowering the breath rate…so that I can come back to almost like a baseline level.”

Mindfulness, like other relaxation techniques, is part of optimal mental performance conditioning — “what great athletes practice,” according to Dr. Brown.

Recovery and Structure Outside the Track

What happens outside her running shoes is just as important for Seidel’s overall mental health and performance, she said.

“I need to have stuff outside that I’m working on,” she said. “Being able to have some sort of structured time and structured assignments is really mentally healthy for me.” Seidel is pursuing an MBA through DeVry University’s Keller School of Management. “It’s nice having something else outside of running to focus on.”

Another important self-care lesson Seidel has learned as a professional athlete: Healing — both physical and mental — is not a luxury, but a necessity. “Recovery is a huge part of my job,” she says. “And I’ve found that it is just enormously helpful for what I do, and for being able to manage not only just life, but a higher level of training.”

Athletes and Self-Care with ADHD: Next Steps

• Read & Watch: “Maybe I’m Not Just Thoroughly Messed Up:” Olympian Molly Seidel On Her Late ADHD Diagnosis
• Read & Watch: “Athletes are Real People with Real Mental Health Issues”
• Webinar: How to Leverage Sports Psychology to Benefit ADHD Brains
• Read: Olympians, Professional Athletes, and Sports Legends with ADHD

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.

ADHD IN ADULTS: How does ADHD present in adults? Does current DSM diagnostic criteria adequately capture adult ADHD?

A: Understanding the weak points in standard diagnostic criteria — and how to factor for them in evaluation and treatment — requires a nuanced understanding of how ADHD manifests in adults… | Keep reading on ADDitude »

ADHD IN GIRLS: How does ADHD present in girls and women?

A: Research and clinical practices are built around male presentations of ADHD, and science has historically paid little attention to female manifestations and impairments… | Keep reading on ADDitude »

LATE DIAGNOSIS: How does ADHD present in older adults? How should clinicians change diagnostic and treatment approaches? (ADHD)?

A: Though the diagnostic manual was rewritten in 2013 to include descriptors for adult ADHD, it still does not adequately consider how the disorder manifests and evolves in patients past mid-life… | Keep reading on ADDitude »

CLINICIAN GUIDELINES: How can I, as a clinician, ensure more equitable and effective care for African American children with ADHD?

A: Great care requires clinicians to probe and consider each individual patient’s unique experiences, and the role that ADHD stigma plays in BIPOC communities… | Keep reading on ADDitude »

ADHD AND WOMEN: How should clinicians consider the impact of hormones, trauma, and mental health when evaluating girls for ADHD?

A: New research suggests that to effectively diagnose ADHD symptoms in women and girls, doctors should consider hormonal fluctuations, trauma, family dynamics, self-esteem, and eating habits… | Keep reading on ADDitude »

ADHD AND WOMEN: How does the presentation of ADHD change in perimenopause and menopause?

A: What we do know – about menopause in general, the role of estrogen, and the effects of hormonal fluctuations on ‘ADHD-like’ symptoms – may help us understand the menopausal transition for women with ADHD… | Keep reading on ADDitude »

CLINICIAN GUIDELINES: How can clinicians protect the mental health of LGBTQA+ youth with ADHD?

A: Health care providers must also do their part to provide inclusive care and reduce barriers to mental health care services for this group, as 60% of LGBTQ youth who wanted mental health care in the past year were not able to access it…. | Keep reading on ADDitude »

RELATED RESOURCES

Free Webinar: The Science Behind Diagnosing and Treating ADHD in Older Adults

Expert Webinar with David Goodman, M.D., FAPA | Listen now on ADDitude »

Free Webinar: Equity in ADHD Care

Expert Webinar with  Tumaini Rucker Coker, M.D., MBA | Listen now on ADDitude »

Free Webinar: Key Concerns in Diagnosing and Treating Adolescents with ADHD

Expert Webinar with Timothy Wilens, M.D. | Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x MDEdge x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
>DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

PATHOPHYSIOLOGY: How does ADHD impair the areas of the brain responsible for executive function? (ADHD)?

A: Findings from neuropsychological studies suggest that the frontal cortex and the circuits linking them to the basal ganglia are critical for executive function and, therefore, to attention and exercising inhibition… | Keep reading on Medscape »

DEFICIENT EMOTIONAL SELF-REGULATION: Is emotional dysregulation an ADHD trait? How does it affect diagnosis and treatment?

A: DESR, or deficient emotional self-regulation, is a core facet of ADHD that carries significant consequences. However, it is not included the disorder’s diagnostic criteria. As new research confirms…| Keep reading on ADDitude »

SLEEP: Why does ADHD impact a patient’s sleep?

A: Sleep disturbances caused by ADHD have been overlooked for a number of reasons, including the late age of onset. But recent studies confirm that ADD symptoms do not go away at night… | Keep reading on ADDitude »

COMPLEX ADHD: What is complex ADHD?

A: Most children and adults with ADHD have one or more co-occurring conditions, which almost always impact treatment and outcomes. “Complex ADHD” is a relatively new term that reflects this phenomenon… | Keep reading on ADDitude »

RSD AND ADHD: Is rejection sensitive dysphoria a symptom of ADHD?

A: Rejection sensitive dysphoria is not a formal ADHD symptom, but it is commonly experienced by patients with ADHD who experience extreme emotional sensitivity and emotional pain. It may imitate mood disorders with suicidal ideation and manifest as instantaneous rage at the person responsible… | Keep reading on ADDitude »

RESEARCH ON EMOTIONAL DYSREGULATION: What do I need to know about the latest research on ADHD and emotional dysregulation?

A:  Recent findings suggest that problems with emotional regulation, including anger and negative emotions, are genetically linked to ADHD… | Keep reading on ADDitude »

STIGMA: How can clinicians address the stigma around ADHD in Black communities to ensure better healthcare?

A: Battling stigma is nothing new in the ADHD community. The lack of understanding is surprising, even among professionals. But in Black and other marginalized communities, it abounds. | Keep reading on ADDitude »

RELATED RESOURCES

Deficient Emotional Self-Regulation: The Overlooked ADHD Symptom That Impacts Everything

Expert Webinar with Russell Barkley, Ph.D.| Listen now on ADDitude »

Complex ADHD: The New Approach to Understanding, Diagnosing, and Treating Comorbidities in Concert

Expert Webinar with Theresa Cerulli, M.D. | Listen now on ADDitude »

How ADHD Shapes Your Perceptions, Emotions & Motivation

Expert Webinar with William Dodson, M.D. | Listen now on ADDitude »

ADHD Then and Now: How Our Understanding Has Evolved

Expert Webinar with David Anderson, Ph.D. | Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x MDEdge x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
> DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

SYMPTOMS: What is attention deficit hyperactivity disorder (ADHD)?

A: ADHD is a developmental condition of inattention and distractibility, with or without accompanying hyperactivity. There are 3 basic forms… | Keep reading on Medscape »

FREQUENCY: What is the prevalence of ADHD?

A: In 2016, an estimated 6.1 million US children aged 2–17 years (9.4%) were diagnosed with ADHD. Of these children, 5.4 million… | Keep reading on Medscape »

PATHOPHYSIOLOGY: Which regions of the brain are involved in ADHD?

A: The underlying brain regions predominantly thought to be involved are frontal and prefrontal; the parietal lobe and cerebellum may also… | Keep reading on Medscape »

CAUSES: What causes ADHD?

A: Parents and siblings of children with ADHD are 2-8 times more likely to develop ADHD than the general population, suggesting that ADHD is highly familial… | Keep reading on Medscape »

INATTENTIVE: What characterizes the inattentive ADHD subtype?

A: Formerly called ADD, inattentive ADHD is characterized by symptoms of disorganization, poor time management, faulty working memory, and a lack of focus… | Keep reading on ADDitude »

RISK FACTORS: What do we know about prenatal and environmental risk factors linked to ADHD?

A: Biological, genetic, and environmental factors — including prenatal and early life exposures — may play a role (and to varying degrees) in the condition’s development… | Keep reading on ADDitude »

EARLY SIGNS: Can ADHD be diagnosed before age 6?

A: The AAP says children may be diagnosed with ADHD no younger than age 4, but that doesn’t mean that toddlers cannot have ADHD. There are real differences in the ADHD brain that are present at birth, and… | Keep reading on ADDitude »

RELATED RESOURCES

ADHD Then and Now: How Our Understanding Has Evolved

Expert Webinar with David Anderson, Ph.D. | Listen now on ADDitude »

What Is ADHD? Everything You Need to Know Before and After an ADHD Diagnosis

Expert Webinar with William Dodson, M.D., LF-APA | Listen now on ADDitude »

Focus on Inattentive ADHD: The Under-Diagnosed and Under-Treated Subtype

Expert Webinar with Mary V. Solanto, Ph.D. | Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x MDEdge x ADDitude:

> DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

May 1, 2023

Hormonal fluctuations worsen symptoms of attention deficit hyperactivity disorder (ADHD) for men and women alike, and the severity grows more pronounced with age, according to a recent ADDitude survey of 1,829 adults with ADHD. Across genders, ADDitude readers almost equally cited progressively more debilitating challenges during the marked hormonal shifts of puberty, pregnancy, postpartum (the time after childbirth), perimenopause, menopause, and andropause (often called male menopause).

These findings suggest that the traditional view of ADHD — as a childhood disorder that resolves after puberty — was entirely backward.

In reality, both women and men with ADHD report the greatest symptom severity from ages 50 to 59 — during menopause and andropause, respectively. On a scale of 1 (minor impact) to 5 (life-altering), ADHD symptoms from age 50 to 59 earned a 4.24 rating from women and a 4.14 rating from men. In contrast, symptoms during childhood earned ratings of 2.79 and 2.9, respectively. Fading memories, late diagnoses, and recency, or availability bias, may factor into these ratings, but the stories shared by ADDitude readers support the idea that ADHD grows more pronounced — not less — with age.

“The reason so many women are not diagnosed until menopause and beyond is because estrogen falls, leaving our brains when we need it more than ever,” wrote one Californian diagnosed with ADHD at age 62. “Estrogen and dopamine go hand in hand — or, rather, synapse to receptor! Whatever dopamine you have in the center of your brain needs estrogen to get it moving to the frontal lobe, where executive function takes place. It’s a travesty that menopausal women are typically left to feel like we have finally lost our minds.”

Another interesting survey finding that contrasts with traditional thinking: The rate of inattentive-type ADHD was nearly identical across genders, impacting 36.6% of women and 37.9% of men.

[Get This Free Download: Hormones & ADHD in Women]

Both genders share more in common than we might have imagined, however distinct and important differences do exist. For one, women with ADHD are far more likely to experience debilitating comorbidities. According to the ADDitude survey:

• Anxiety affected 77.6% of women surveyed (with an average age of 46.4) and 68.9% of men surveyed (with an average age of 47).
• Depression impacted 67.9% of women and 61.3% of men.
• Migraines were cited by 25.8% of women and 13.4% of men.
• Eating disorders affected 16.5% of women and 7.9 percent of men.

Other important gender differences influenced by hormonal spikes and dips were revealed in the ADDitude survey.

Hormonal Changes: ADHD in Puberty

Men said their ADHD showed up in puberty, when testosterone production increases nearly 30-fold¹, by way of the following:

• Academic performance issues: 61%
• Anger or hostile behavior: 49%
• Risk-taking behavior 42%

[Read: Boys 2 Men — When ADHD and Puberty Collide]

For women with ADHD, adolescence was marked by the following:

• Feelings of sadness or depression: 70%
• Rejection sensitive dysphoria: 63%
• Greater worry or anxiety: 58%

A staggering two-thirds of women surveyed said they have experienced premenstrual syndrome (PMS) and/or premenstrual dysphoria disorder (PMDD) — well over the  prevalence of PMS and PMDD in the general population.² Survey takers said they experiences the following PMS and PMDD symptoms:

• Irritability: 80%
• Mood swings: 79%
• Cramps or discomfort 79%
• Tension/anxiety: 68%
• Lack of focus/concentration: 66%

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

Women also were more likely to report social anxiety, self-harm, and eating disorders in adolescence. “I didn’t show any signs of ADHD or major depressive disorder until I started menstruating. Then all hell broke loose,” said a 41-year-female diagnosed just two years ago.

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

“I have always had procrastination and time-management issues, but porn and masturbation became my dopamine release in adolescence, and after the pleasure, it became exhausting,” wrote one 31-year-old male with combined-type ADHD. “It’s been almost 20 years, but my porn addiction hasn’t gone despite trying in multiple ways.”

Hormonal Changes: ADHD in Pregnancy

During pregnancy, a woman will produce more estrogen and progesterone than she will throughout the rest of her life. For 20% of women surveyed, heightened hormones during pregnancy brought greater focus, drive, organization, and sleep.

“My sleep problems completely resolved in pregnancy (I was able to fall asleep easily at a ‘normal’ time and wake up when needed in the morning),” said one 34-year-old woman in the UK. “I was able to focus and felt the most productive I’ve ever felt in my life.”

But 44% of women said they noticed no difference in ADHD symptoms during pregnancy, perhaps because spiking hormone levels were offset by discontinued stimulant medication use (98% of women said they stopped treatment in pregnancy). Another 36% of ADDitude readers said their ADHD symptoms worsened in pregnancy with exhaustion, poor memory, emotional dysregulation, and sensitivity topping the list.

[Free ADDitude Webinar: ADHD, Pregnancy, and Motherhood]

Hormonal Changes: Postpartum and ADHD

Estrogen and progesterone fall off a cliff following childbirth, contributing to postpartum depression in roughly 15% of women.³ Among our survey takers, the rate of self-reported postpartum depression skyrockets to 61%. ADDitude readers reported that symptoms of postpartum depression lasted roughly one year, and included the following:

• Crying spells: 76%
• Feelings of worthlessness, shame, guilt, or inadequacy: 72%
• Mood swings: 66%
• Irritability: 62%
• Lack of concentration: 58%
• Sleep problems: 57%

“It still makes me sad, nearly 20 years later,” said one 49-year-old woman with inattentive ADHD who suffered postpartum depression. “I didn’t want to hold my child and actively sought to hand him off to others in the early weeks. I felt strongly that I wanted a redo, that this wasn’t what I had expected…. I still feel robbed of that miraculous time, but my son and I are closer now than ever — he’s awesome and gives great hugs. Maybe that makes up for it a little.”

Almost half of ADDitude survey respondents said they were not offered any treatment for their postpartum depression, while 41% were prescribed antidepressants and 20% received therapy. “I thought I was a bad mom for feeling how I did, so I masked my issues,” said one 50-year-old mother with ADHD in Colorado.

“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,” said a 36-year-old mother in Pennsylvania.

Hormonal Changes: ADHD in Menopause and Andropause

In 2022, ADDitude fielded a survey of nearly 4,000 women regarding ADHD symptoms in menopause, when production of both estrogen and progesterone drop. It found, among other things, that 70% of women said ADHD had a “life-altering” impact in their 40s and 50s — a finding echoed in the latest ADDitude survey, which found that half of women called ADHD “extremely severe” in menopause.

The most debilitating symptoms during menopause, they said, were the following:

• Procrastination and time management: 79%
• Working memory problems: 74%
• Feelings of overwhelm: 72%
• Greater disorganization: 70%

“Menopause coincided with my ADHD diagnosis, starting medication for ADHD, 1-on-1 and group therapy, and I have better coping strategies now than I have ever had,” said a 55-year-old woman diagnosed with ADHD four years ago. “The sadness is still there, for what I have lost and my struggles, but I feel I have developed wisdom, self-acceptance, and awareness.”

In men, testosterone levels gradually drop with age, triggering andropause in their 40s and 50s. Nearly three-quarters of ADDitude survey respondents aged 40 and older said they have experienced andropause, which heightened these symptoms:

• Procrastination and time management: 79%
• Feelings of sadness and/or depression: 70%
• Work performance issues: 68%
• Working memory problems: 67%

For many, it was difficult to assign blame to dwindling testosterone, or one of many other life factors during this life stage — namely, divorce, the death of parents, the loss of a job, other health problems, or decades of low self-esteem and a feeling of failure.

“My anger at the world increased and I always felt unsettled,” said one 61-year-old man about how andropause impacted his mental health. “I experienced drug use and fear of sexual failure. I was either bored of things or obsessing on things, feeling frustrated, and intensely trying to please people.”

“In my 40s and 50s, I started to feel an accumulation of self-doubt as I questioned why I was not successful and why I was so self-isolating. I was just not feeling good about myself,” said a 58-year-old male who noticed signs of stress, anxiety, and physical deterioration that led him to seek a diagnosis late in life. “This carried a heavy burden of not feeling pride or confidence in myself, of not liking who I had become, and of never being able to let go of my failures to move on.”

Hormonal Changes and ADHD: Next Steps

• Free Download: Menopause & ADHD — Treatments & Interventions
• Read: Perimenopause Problems — How Changing Hormones Exacerbate ADHD Symptoms
• Read: Inside the Aging ADHD Brain
• Resource Hub: The Ages & Stages of ADHD

Anni Layne Rodgers is general manager at ADDitude.

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

¹ Nottelmann, E. D., Susman, E. J., Inoff-Germain, G., Cutler, G. B., Jr, Loriaux, D. L., & Chrousos, G. P. (1987). Developmental processes in early adolescence: relationships between adolescent adjustment problems and chronologic age, pubertal stage, and puberty-related serum hormone levels. The journal of pediatrics, 110(3), 473–480. https://doi.org/10.1016/s0022-3476(87)80521-8

² Clark, K., Fowler Braga, S., Dalton, E. (2021). PMS and pmdd: Overview and current treatment approaches. US Pharm, 46(9), 21-25. Retrieved from https://www.uspharmacist.com/article/pms-and-pmdd-overview-and-current-treatment-approaches

³ [1] Bauman, B. L., Ko, J. Y., Cox, S., D’Angelo Mph, D. V., Warner, L., Folger, S., Tevendale, H. D., Coy, K. C., Harrison, L., & Barfield, W. D. (2020). Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression – United States, 2018. MMWR. Morbidity and mortality weekly report, 69(19), 575–581. https://doi.org/10.15585/mmwr.mm6919a2

A little boy bouncing off the walls of his classroom, blurting out and squirming incessantly. This is the image of ADHD burned in our popular culture — and in the minds of too many medical professionals. But for the majority of people with ADHD, particularly women, this representation does not match their experience. More troublesome than distractibility and external hyperactivity, you tell us, are ADHD overwhelm, volatile emotions, shame, racing thoughts and mental fatigue, rejection sensitivity, and social struggles. These symptoms, while common, are often overlooked and misunderstood.

So, we asked the women who read ADDitude to share their misunderstood symptoms, and to answer the question: What do you wish the world knew about ADHD? Read their answers below — and share your own thoughts in the comments section above.

“I just don’t feel believed, especially about how much my hormones and menstrual cycle deeply impact all of my symptoms. When I try to explain that my ADHD symptoms are more severe during the second half of the month, I’ve been told by more than one doctor that they’ve ‘never heard of anything like that.’” —Maria, Colorado

“Neurotypicals need to know that hyperactivity in women doesn’t present as the stereotypical ADHD little boy who fidgets and runs in circles. Our hyperactivity is invisible: it’s in our heads. My ADHD mind is like a L.A. highway with high-speed cars zooming here, there, and everywhere.” —Michelle, Mississippi

“I think the most misunderstood symptom of ADHD is emotional dysregulation. And particularly for women I think this piece gets either downplayed or used to justify mood disorder diagnoses that aren’t accurate.” —Em, New York

[Read: DESR – Why Deficient Emotional Self-Regulation is Central to ADHD]

“I wish health care professionals knew we struggle with many more medical issues than the general population.” —Elizabeth, New Hampshire

“I wish that women with ADHD were better represented in scientific studies and the media. The common assumption of what ADHD looks like is very outdated and stereotypical. And it’s still embedded within our education and health systems, leading to under and misdiagnosis of women with ADHD.” —An ADDitude reader

“I wish the world knew how severely inattentiveness can affect someone’s life. For me, it meant the difference between having and not having a successful career. For a lot of women, it means they are forced to be financially dependent on a spouse and prone to suffering from the ADHD tax.” —An ADDitude reader

[Read: What Is Inattentive ADHD? ADD Symptoms, Causes, Treatment] 

“You can be academically gifted and have ADHD. My psychiatrist told me that I was ‘too smart to have ADHD.’”  —Anna

“Undiagnosed ADHD in girls and women will lead to dangerous behaviors including substance abuse and suicidality. There is so much shame that comes from not being typical. I personally struggled with substance use disorder due to undiagnosed ADHD and even after my diagnosis at 40, I felt I could never live up to being a ‘good’ wife and ‘good’ mother.” —Beth, Colorado

“Some of us don’t look like we struggle, because we are working overtime not to disappoint, but this extra effort takes its toll on our physical and mental health and is often unsustainable. If we are asking for help, it’s because we can see the wall we are heading for at high speed and know the impact will be catastrophic.” —Sarah

“The most misunderstood ‘symptom’ to me is invisible to others and it is the deep shame I feel.” —Aimee, Maryland

“The difficulty, anxiety and misunderstanding that come from rejection sensitivity dysphoria. I find it really challenging across all areas of my life. It causes me great difficulty in my workplace, as I find it really difficult to take on constructive feedback even though rationally, I know it’s not a biggie.” —Madeline

“I wish the world understood that I don’t always read the underlying social cues around me and it makes navigating social situations difficult.” —Sara, New Hampshire

“We need medication on weekends too, not just 9-5, Monday through Friday, for work. Juggling tasks and responsibilities doesn’t stop when we clock out, especially for those of us with children.” —Lynette

“In conversation, if a thought comes into my head that is relevant, I have to say it then and there, otherwise the constant bombardment of thoughts means if I wait, it’s gone or forgotten. I don’t mean to be rude, I just want to join in and be accepted.” —An ADDitude reader

Misunderstood Symptoms of ADHD in Women: Next Steps

• Read: ADHD is Different in Women
• Download: Free Guide to Hormones and ADHD in Women
• Read: Why ADHD in Women is Routinely Dismissed, Misdiagnosed, and Treated Inadequately
  

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.

ADHD symptoms can impair work and home life so severely that women are increasingly electing to continue taking their medications during pregnancy. In perinatal psychiatry, clinicians meet with women and their families as they plan for pregnancy and review the risks associated with continuing and discontinuing their ADHD treatment throughout pregnancy.

ADHD Treatment Considerations

The new demands of caring for their babies during a time of changing hormone levels, infant feedings, and sleep disruption are exceedingly difficult for some women. Being an effective mother requires the ability to get and stay focused, modulate attention, control impulsivity, and utilize executive function skills. Women with ADHD struggle in these domains, yet this population and the course of their condition during pregnancy and the postpartum period have received little attention and systematic study.[Read: Women, Hormones, and ADHD]

Women of reproductive age with ADHD would benefit from working with a psychiatrist and/or medical team to understand the impact of hormones on ADHD throughout the lifespan, and the interplay with medication. For example, stimulants may be less effective during the second half of the menstrual cycle, and hormone replacement therapy can improve ADHD symptoms in postmenopausal women.

Working with an integrated, informed, and supportive health care team can lead to better outcomes for women.

ADHD Treatment in Pregnancy: Next Steps

• Read: Motherhood with ADHD
• Download: Free Guide to Hormones & ADHD in Women
• Download: Free Parenting Guide for Moms & Dads with ADHD
• Read: Why ADHD in Women is Routinely Dismissed, Misdiagnosed, and Treated Inadequately

Allison S. Baker, M.D., is a child and perinatal psychiatrist at Massachusetts General Hospital.

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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.

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Like most moms, I can clearly recall the moment my baby was first placed into my arms. It was real… She was here! Ten fingers, ten toes, bright eyes, and a cute little mouth with pink, bowed lips. She was perfect. My urge to protect her and offer her the happiest life possible was immediate.

Looking back, almost 15 years later, I can see I was brimming with the idealism innate to most all new parents. Our babies often represent a fresh start, a clean and bright beginning. The hopes we project onto them are inevitable. But life almost always has other plans.

Releasing the Myth of the Perfect Childhood

When my daughter was 2, I realized that I needed to leave my marriage. I left with no savings, assets, or job. When she was 4, my mother had a massive brain hemorrhage. After my mother died, my stepfather was in an accident and required care before eventually also dying. I battled through graduate school during this time.

I noticed that my daughter was unique as she reached school age. She was brilliant, verbose, and creative, but also different in her behaviors. She began to have massive meltdowns after school every day — tears, tantrums on the floor, and generally losing her shit, especially if homework was on the table.

Though she was extremely bright and an early reader, tearing through Harry Potter books in second grade, she also struggled in the classroom. It was hard for her stay on task, and she got out of her seat during lessons. I struggled to reconcile how my child, who was reading at an adult level and had unusually mature social insights, could also be so messy, irritable, disruptive, and so often unable to focus. As I searched myself and the world for an answer, I took the road we so often do as mothers. I blamed myself. Even my experience as a therapist and years of studying child psychology couldn’t help with the huge blind spot I had when it came to my own kid.

[Read: Why ADHD in Girls Is Often Overlooked]

Maybe it was because of the divorce — or because of my grief. Maybe I had spent too much time studying. I read to her every night, but maybe if I had focused more on math, she would be doing better with it. Essentially, I blamed myself for everything.

Consulting the Experts

As I tried to gather more info from “the experts,” I felt even worse. Seasoned parents told me that my daughter was disrespectful and needed a firm hand. School meetings, where I faced a row of teachers telling me about behavioral issues, left me feeling as though I was on trial. Even meeting with child therapists for consults confused me, since they’d only tell me that my daughter was precocious and creative and seemed to have a high IQ, but they did not otherwise offer any concrete help.

I pushed my daughter into martial arts, amped up her nutrition, discussed her ongoing issues with my mental health colleagues, and tried different therapists. Deep down, I saw her struggles as my own shortcomings. I was exhausted — and it didn’t help that she slept erratically.

Without answers, my daughter’s struggles worsened. Things had spiraled into a hatred for school, difficulty with activity transitions, trouble with organizational tasks, panic attacks, and even thoughts of self-harm.

[Read: 5 Things Every Doctor (and Parent) Should Know about Girls and ADHD]

It was our pediatric primary care provider who finally brought up ADHD. Could it really be that my daughter’s brain just needed some extra dopamine? ADHD ran in my family and in her father’s family as well. I began to wonder what a pediatric ADHD prescription would do.

As it turned out, it did a lot. Once we found the right medication and dose, the world opened up for my daughter. Her anxiety quieted. Her focus improved. Thoughts of self-harm and panic attacks receded. What’s more, she he was having fun. Life wasn’t a constantly overwhelming battle. We could both breathe.

Advocating for Girls with ADHD

I wondered why my daughter’s diagnosis had been so hard to arrive at and why it had taken so long, even for me, a mom and a trauma-informed therapist with a clinical degree. As I reviewed research on ADHD, things became clearer.

We often think of wild and unruly boys when we picture ADHD. The reality is that many girls are also silently suffering with ADHD without any understanding or support. That’s why ADHD is more commonly diagnosed in boys and is often underdiagnosed in girls. Educator and medical provider bias may also contribute to this.

Girls are more often misdiagnosed (or only diagnosed) with depression or anxiety. Socialization patterns may also be a factor. Some researchers theorize that girls are more likely to “mask” ADHD symptoms. This is particularly concerning, because research indicates that ADHD in girls is correlated with more severe pathologies such as self-harm and major depression. These unique risks mean that our girls are in danger if an ADHD diagnosis is missed or delayed.

Today, my daughter is thriving. In my clinical work, I now advocate for girls to be automatically screened for ADHD if they are struggling with what seems like anxiety or mood dysregulation. I wish I had the information I have now when my daughter was in her early grade school years. I’m grateful, however, that I now have the awareness to fight for her and for other girls.

Girls’ Mental Health and ADHD: Next Steps

• Self-Test: ADHD Symptoms in Women and Girls
• Read: Stop the Cycle of Shame for Girls with ADHD
• Read: I Searched So Hard for ADHD That I Missed All the Signs

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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.

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