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?

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.

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?

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
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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

What is MDD?

Major Depressive Disorder (MDD) is a mood disorder that impacts millions of Americans every year. According to the Substance Abuse and Mental Health Services Administration¹:

• 21 million adults in the U.S. had at least one major depressive episode over the past year. (8.4% of all adults). Of those, 66% received treatment.
• 4 million adolescents aged 12 to 17 had at least one major depressive episode over the past year (17% of all teens). Of those, 41.6% received treatment.

Among people diagnosed with ADHD, however, rates of MDD are far higher. It’s estimated that half of people with ADHD will experience a depressive episode in their lives. Because symptoms of ADHD and depression often overlap, one or the other condition commonly goes undiagnosed. For this reason, it’s critical to debunk myths and clear up misconceptions about what depression looks like. To that end, here are six unexpected and/or misunderstood signs of depression.

1. People with depression aren’t always sad.

The word “depressed” is often used casually to refer to a state of being sad, blue, or down in the dumps. In reality, only about 60% of people with depression actually report any sadness. You don’t have to be sad to be depressed.

Most people with depression report a marked inability to experience pleasure from things that used to be pleasurable. Life just feels empty and unfulfilling. Nothing is engaging. This leads to a tremendous amount of futility. When faced with the prospect of doing something that might make them feel better, people with depression feel like: “Why bother? Nothing’s going to feel good.” They think only of negative outcomes, which is a serious obstacle to beginning treatment.

[Read: Depression – When It’s More Than a Symptom of ADHD]

2. Depression moves slowly and sticks around.

All of us have good days and bad days for no particular reason. In some cases, our “mood thermostat,” which typically allows only a fairly narrow range, breaks down and our mood just keeps going up, with increased energy, decreased need for sleep, and wonderful feelings. This is called mania. When the bottom end of the thermostat gives way, we have no energy, we become negative, and we can’t experience pleasure. We call this depression. The change in mood usually happens slowly and imperceptibly over weeks to months and then stays for years-long episodes. If one of these down episodes hits suddenly and lasts less than two weeks, it is probably not depression.

3. The most common emotional symptom of depression is irritability.

Only 60% of people with depression report sadness, but 95% of them report feeling exceedingly, but uncharacteristically, irritable. Little things get under their skin and they have explosive outbursts. This is especially true for children under the age of 12. These children present with a lot of irritability, and tend to experience what’s called “affective storms.” When they explode, it goes on for hours sometimes. Often, you’ll find that everybody in the family walks on eggshells, for fear of setting off the child. Irritability is also a common symptom of ADHD, which helps to explain how and why sadness may be masked by irritability that isolates the individual and pushes away people who might be helpful.

4. If you’re feeling bad because of a bad situation, it’s “reactive depression.”

In MDD, the depressed mood has no trigger and isn’t related to a situation. People will search for some cause, but usually there’s no event, scenario, or relationship that would cause the depth of impairment seen with depression. This is very different from “reactive depression” or “situational depression,” wherein someone feels bad because bad things are happening in their life.

Feeling down because you’ve had a setback or loss is sadness, and it is normal. Reactive depressions don’t respond to medication, but they do respond to steps taken to improve the situation. Counseling can help to make that process go faster.

[Read: Is it ADHD, Depression, or Both?]

5. Depression in teens often looks completely different.

Most people with MDD experience their first depressive episode in late high school or early college, between the age of 16 and 19. That said, depressive episodes in children and adolescents don’t look like depressive episodes in adults. Whereas most people stop eating, teens will eat everything in sight. Where most people sleep more, an adolescent will sleep less. Where most people lose an interest in sex, adolescents will become hypersexual. It’s critical to understand the difference in the way MDD manifests in teens, so as not to miss an important diagnosis.

6. There is no such thing as a “minor” depression.

The term Major Depressive Disorder was coined in the 1970s, with the idea that we might find minor depression, but we never have. What we have found, instead, is that every depression is a major one. The World Health Organization ranks depression as the single largest contributor to global disability.² Half of all depressive cases are rated both by the patient and by the clinician as being severe to extreme. MDD affects every aspect of a person’s life and makes it seem as though life is not worth living. It’s a serious problem that needs to be addressed.

Thankfully, it is highly treatable. About 70% of people get a good response to practically any antidepressant out there, and for the 30% who don’t, the solution is to try another class of medication. Adding in cognitive therapy to the treatment is important, too, as we know that a combination of medication and therapy is the most effective course of action, by far.

Signs of Depression: Next Steps

• Read: What Is a Mood Disorder? Recognizing and Treating Depression
• Self-Test: Depression in Adults
• Read: The ADHD – Depression Link: Symptom Parallels and Distinctions
• Read: Treatment for Depression and ADHD – Treating Comorbid Mood Disorders Safely]

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Sources

¹Delphin-Rittmon, M.E. (July, 2020). The National Survey on Drug Use and Health (NSDUH), Substance Abuse and Mental Health Services Administration,
https://www.samhsa.gov/data/sites/default/files/reports/slides-2020-nsduh/2020NSDUHNationalSlides072522.pdf

²Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; 2017, https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf

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Adults with ADHD are up to six times more likely than are their neurotypical peers to have Major Depressive Disorder (MDD), which is characterized by extreme sadness, loss of interest, and mania. Not only is MDD more prevalent in adults with ADHD, but the disorder can have an outsized effect on women and girls who have both conditions. MDD is associated with an earlier age of onset, a longer duration, more severe impairment, a higher rate of suicidality, and a greater likelihood of requiring psychiatric hospitalization in girls with ADHD.

When treating depression in patients with ADHD, it is critical for clinicians to recognize a patient’s feelings of worthlessness, which, as one study points out, were directly related to suicidal thoughts and planning in adolescents.

In this webinar, you will learn:

• About MDD and other mood disorders that are highly comorbid with ADHD, including bipolar disorder, disruptive mood dysregulation disorder, and emotional dysregulation
• About symptoms of mood disorders and how they co-exist with ADHD
• About new and alternative treatments for MDD, including medication, neurofeedback, and neuromodulation therapy, trans-cranial magnetic stimulation (TMS), and esketamine treatments
• Which therapies are in clinical trials that may hold promise
• About strategies to help people with depression and mood disorders

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:

Nelson Handal, M.D., DFAPA, is the Founder, Chairman, and Medical Director for Dothan Behavioral Medicine Clinic (DBMC) & Harmonex Neuroscience Research (HRX). As a practicing Board Certified Child, Adolescent and Adult Psychiatrist, Dr. Handal has dedicated much of his career to developing and implementing technologies that elevate the quality of patient care.

Dr. Handal participates in extensive clinical research and has been primary investigator in over 85 clinical trials. In the late 1980s, Dr. Handal was president of one of the first telemedicine referral services in the world. This system was featured in Business Week. CliniCom® is an online psychiatric assessment tool Dr. Handal has been developing for the past 10 years and which has been used by over 54,000 patients. In May 2009 Dr. Handal was invited to testify before the United States House Committee on Veterans’ Affairs regarding innovative technologies and treatments for veterans; he spoke about CliniCom®.

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When I was young, I felt little connection or fulfillment when children came over for play dates. Playmates would often not return to my home after the first visit. It was likely due to my silent nature and difficulties with reciprocity. I struggled to read nonverbal cues and to practice give-and-take communication. In adolescence, I had a small group of friends but was often excluded from activities outside of school. I was introverted by nature, but despite my social anxiety, I still wanted bonds. I branched out and started over in college.

One day, sophomore year, I was strolling through the student union when a male student at a booth approached me and said, “Would you like to take a free depression screening?” Caught off guard, I shrugged and said, “sure.”

The student indicated afterward that I showed high anxiety markers. He asked if I wanted to work with a student clinician at the university’s psychology clinic for a low-cost fee. I felt like there was little to lose. After all the years of wondering what was “wrong” with me, perhaps I could get answers. I had dreamt of therapy since I was a teenager; I just thought it was a luxury or for people who struggled more severely.

I felt so wonderful just letting it all out during my intake session. I told my clinician about my insecurities about being labeled mousy and shy and being teased due to my passive nature in middle and early high school. I talked about my difficulties with being assertive. I explained how awkward and silent first-time meetings were for me and how I had been labeled “rude” and “standoffish.” I discussed how I never knew what to say when making small talk and how I felt my heartbeat, got sweaty palms, and froze in social situations.

Diagnosis: Social Anxiety

After multiple sessions, my therapist drew some key conclusions: Many things make me anxious, but most of my triggers are social situations. On a scale that measures social anxiety disorder, I scored a 30, which was considered “severe.”

[Get This Free Download: Social Anxiety Facts and Falsehoods]

I met with this clinician for about a year and a half. During our sessions, we practiced exposure therapy, which included role-playing social situations with other clinicians, recording them, and receiving critiques. She also asked me to look for real-world opportunities to initiate contact with people. Every few months, she evaluated my social anxiety score. Eventually, my score fell to a 10; I still met some criteria, but it was much lower.

She didn’t diagnose me as neurodivergent; that came years later. But every day, I am grateful for my wellness journey that began at age 20. I was never seen as a person who struggled immensely in the world. I could get by day to day. But the start of my journey taught me not to settle; I am worth more than just getting by. I deserve fulfillment. I deserve to thrive. I am in a better place than before.

Exposure Therapy Techniques That Worked

Below are examples of exposure therapy exercises I repeated with my therapist. She would tell me that I don’t have to do these things regularly, but knowing I am capable is important.

Journal Prompts

First, write down the following:

• How anxious are you?
• What are your physiological symptoms?
• What thoughts and emotions do you have (e.g., “This person won’t like me”)?
• How can they be challenged?

[Free Webinar: How to Reduce Social Anxiety and Foster Connections”]

Social Activities

1. Go to a restaurant or cafe alone. Don’t bring work; face the fear of others seeing you alone. Goal: Learn to enjoy your own company and to pursue your own interests.
2. Repeat the above, but this time people watch. Observe those around you — their body language, conversation topics, and other patterns.
3. Talk to a service worker, unfamiliar colleague/classmate, or patron (e.g., at a bar, party, restaurant, store, waiting room, etc.). You can start with a compliment, a friendly statement like “you look familiar,” or a question or comment about a product or service. Build off that and continue to talk about other topics. Roleplay with a counselor or friend to ease into this activity, if necessary.
4. Repeat the above, but approach someone you find attractive (I found this to be the hardest!)

Finally, return to your journaling prompts. Rate your anxiety. Then repeat the activities until your anxiety number goes down.

Disclaimer: I am not a healthcare provider; work with one as needed before attempting these activities.

Social Anxiety: Next Steps

• Free Download: Become a Small-Talk Superstar
• Read: The ADHD Guide to Natural Flowing, ‘Normal’ Conversations
• Q: “My Paralyzing Anxiety Tells Me I’m Not Good Enough”
  
• eBook: The ADHD Guide to Making Social Connections

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About 60% of children with attention deficit hyperactivity disorder (ADHD) will have a comorbid condition.¹ Comorbid means that one disorder often co-exists with a separate disorder. The most common comorbid conditions with ADHD include anxiety disorders, OCD, oppositional defiant disorder (ODD) and autism spectrum disorder. ADHD symptoms and symptoms of comorbid conditions may overlap, but they each require their own treatment.

Stimulant medications effectively treat the symptoms of ADHD, but they may worsen comorbid behaviors. For example, temper tantrums — common in ADHD and in other conditions — may worsen after taking medication, even if the same medication improves other ADHD symptoms.

[The ADDitude Symptom Checker: Use It to Scan for 17 Comorbid Conditions]

On the other hand, some of the medications commonly used to treat comorbid conditions like depression and anxiety — medications like Zoloft, Prozac, and Celexa, for example — are known to worsen ADHD symptoms.

As a result, the following scenario is common: Clinicians will start a child on a stimulant medication to control core ADHD symptoms. While the child’s ADHD symptoms improve, the same medication may cause them to experience more irritability and temper tantrums. So, the clinician adds a non-stimulant medication to address these worsening behaviors. But that second medication, in turn, worsens ADHD symptoms. In response, the clinician increases the dose of the stimulant — which helps improve the ADHD symptoms but worsens the tantrums and irritability.

At this point (and to stop the cycle), most clinicians will consider changing course and treating ADHD with a non-stimulant medication alone. Though not as effective as a stimulant, a non-stimulant will reduce the ADHD symptoms and at the same time, many symptoms of comorbid conditions as well.

Finally, it is important to note that many comorbid symptoms can be effectively treated with counseling as well. If the comorbid symptoms are mild to moderate, counseling may be the first treatment option before trying non-stimulant medication. But if the comorbid behaviors interfere with learning and social interaction, then a non-stimulant would be indicated.

[Read: What Is Complex ADHD?]

In all, the presence of comorbid conditions certainly complexifies ADHD. It can be difficult alone to determine whether a symptom like difficulty focusing stems from ADHD or anxiety – or both. Making the distinction between ADHD and other co-occurring conditions takes time, and comes from getting to know an individual patient.

How to Treat ADHD in Children: Next Questions

1. What ADHD medications are used to treat children?
2. Is ADHD medication right for my child?
3. What are common side effects associated with ADHD medication?
   • How can I address appetite suppression caused by ADHD medication use?
   • How can I solve sleep problems associated with ADHD medication use?
   • What can I do if ADHD medication use causes tics?
   • How can I prevent the afternoon ‘medication crash?’
   • What if my child becomes a ‘zombie’ while taking meds?
   • Should my child take an ADHD medication vacation?
4. What natural treatments help kids with ADHD?
5. What if the medication stops working?
6. How can I find an ADHD specialist near me?

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “ADHD Medication Options and Benefits for Children” [Video Replay & Podcast #438] with Walt Karniski, M.D., which was broadcast on January 19, 2023. Dr. Karniski is the author of ADHD Medication: Does It Work and Is It Safe?

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

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 Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2018). Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 47(2), 199–212. https://doi.org/10.1080/15374416.2017.1417860

Trichotillomania (i.e. hair pulling) and dermatillomania (i.e. skin picking) disorders—also known as body-focused repetitive behaviors, or BFRBs—are seldom discussed openly. Though BFRBs are relatively common, people struggling with them feel ashamed and misunderstood. Behavioral treatment for BFRBs is available and effective. Learn how they are treated and how parents can support their children.

In this webinar, caregivers will learn:

• What defines a BFRB: How they are diagnosed and what to know about these misunderstood childhood disorders
• About the current functional model for understanding why people pull their hair and/or pick their skin
• About ways parents can effectively and lovingly support their child with a BFRB
• The current best practice treatment approaches for BFRBs

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

More on BFRBs in Children with ADHD

• Download: Is It More Than Just ADHD?
• Read: Understanding Body-Focused Repetitive Behaviors in Children
• Read: Trichotillomania, ADHD, and My Daughter — How It Got Better

Obtain a Certificate of Attendance

If you attended the live webinar on May 4, 2023, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker:

Suzanne Mouton-Odum, Ph.D., is a licensed psychologist and a leader in the field of Body Focused Repetitive Behaviors, Anxiety Disorders, and Obsessive Compulsive and Related Disorders. She has served on the Scientific Advisory Board for the TLC Foundation for BFRBs for over 20 years and has published several books and numerous journal articles in the BFRB space. In addition to doing research and writing about BFRBs and the treatment thereof, Dr. Mouton-Odum has treated hundreds of individuals with BFRBs and their families.

Recently, Dr. Mouton-Odum and other co-authors published a clinician guide for the treatment of people with BFRBs with Cambridge University Press. She is the President of PsycTech, LLC, the Founder and Director of Psychology Houston, PC: The Center for Cognitive Behavioral Treatment, Vice-Chair of the TLC Foundation for BFRBs Scientific Advisory Board, and Clinical Assistant Professor at Baylor College of Medicine. In total, Dr. Mouton-Odum has published five books: Out of the Rabbit Hole: A Road Map to Freedom from OCD; A Parent Guide to Hair Pulling Disorder: Effective Parenting Strategies for Children with Trichotillomania; Psychological Interventions for Children with Sensory Dysregulation; Helping Your Child with Sensory Regulation; and Comprehensive Behavioral Treatment of Body Focused Repetitive Behaviors (in press).(#CommissionsEarned)

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

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Early childhood sleep problems, including irregular sleep routines, short nighttime sleep duration, and frequent night awakenings, correlate with subsequent ADHD diagnoses, according to research published in the Journal of Child Psychology and Psychiatry. ¹

Researchers conducted an observational review of the Avon Longitudinal Study of Parents and Children (a U.K. birth cohort study), which included 7,769 10-year-old children (49.6% girls; 50.4% boys). Participants’ parents assessed their children’s sleep habits at age 3.5, answering questions such as ‘Does your child have regular sleep routines?’ ‘How long does your child sleep during the day?’ and ‘How often during the night does your child usually wake?’ Researchers calculated nighttime sleep durations from questions asking what time (to the nearest minute) the child ‘normally’ went to sleep in the evening and woke up in the morning. Findings showed that short nighttime sleep durations, frequently waking up in the middle of the night, and irregular sleep routines increased the toddler’s risk of receiving an ADHD diagnosis at age 10. (Researchers used the Development and Wellbeing Assessment to identify children with ADHD.)

Prior studies have identified sleep disturbances as a common comorbid condition with ADHD ² and found that 70% to 85% of children with ADHD experience sleep problems.³ However, researchers said this is the first longitudinal study that “specifically investigated the prospective association between inflammation, sleep, and ADHD.”

“These results highlight the potential of future preventative interventions in ADHD, with the novel target of sleep and inflammation,” they said.

Sleep Problems Comorbid with ADHD

The study’s findings mirror those of a recent ADDitude poll, which found that 66% of participants noticed sleep problems in their children with ADHD at age 3 or younger.

“As an infant, my daughter was a horrible sleeper,” said a reader from Colorado. “She almost never napped for more than 20 to 30 minutes. She woke up several times throughout the night until she was 18 months old. She’s 7 now and still has trouble falling asleep without melatonin. Even with melatonin, she’ll wake up after a couple of hours.”

Said another respondent, “Our son has fought sleep since infancy. He has always tried to stay awake as long as possible. He often has disrupted sleep and does not want to return to sleep, even at midnight.”

“She would wake up every two hours and then be ready to party for two hours,” said a panelist from Maryland. “It was absolutely exhausting. At age 1, she finally started to sleep more consistently but continued to wake up very early (before 5 a.m.).”

Sleep Problems in Early Childhood

Reader panelists indicated the following early childhood sleep problems in their children who were later diagnosed with ADHD:

• Shorter nighttime sleep due to difficulty falling asleep: 71.63%
• Frequent waking during the night: 60.58%
• Shorter nighttime sleep due to waking up very early: 44.71%
• Inconsistent bedtime routine: 25.96%

Sleep problems persisted for some panelists’ children as they aged. “Both of my kids took forever to fall asleep,” said a panelist from Wisconsin. “By the time my son started daycare at four months old, I could not get him to nap. One of us still lies with our kids at night; we usually fall asleep and spend the night in their beds. They are now ages 8 and 5 (both have ASD along with ADHD), and there is no end in sight.”

“My child seemed to need less sleep from the beginning,” said another parent. “As an infant, she often woke up in the middle of the night and was wide awake for quite some time. She took very short naps and gave up napping very early on. As she got older, we had to put an alarm on her door because she would go out in the garage during the winter or climb on kitchen counters looking for candy in the middle of the night.”

ADHD Sleep Solutions

Creative thinking, natural supplements, and medication helped some ADDitude readers’ children get to sleep. “There were a lot of ‘midnight snack’ escapades and much wandering around the house,” said a panelist from Georgia. “We made an approved snack drawer for her and gave her a flashlight, books, coloring books, etc., so she could do what she needed and stay in her room.”

A Michigan panelist said, “We were militant about sleep hygiene, diet, screens, etc., and it did not make a difference. Even lots of exercise wasn’t the answer. We finally had to use clonidine. It was like a miracle. My now 13-year-old is off clonidine with a ‘normal’ sleep routine.”

“My child began having difficulty falling asleep at six months,” a panelist from Virginia said. “Melatonin is a staple in our household. Just like you know, if you forgot your child’s ADHD medication on a Saturday morning, you also know when they haven’t had their melatonin!”

A North Carolina parent turned her son’s insomnia into a positive. “My oldest had a terrible time going to sleep,” she said. “Early on, I found ‘go to sleep’ meant nothing, so switched to ‘Lie down and be still and quiet;’ that was something he could do (even if it didn’t lead to immediate sleep). I read to him at length at night — and through middle school. It became a close sharing time and a chance to read some really good books.”

Sources

¹Morales-Muñoz, I., Upthegrove, R., Lawrence, K., et al. (2023). The Role of Inflammation in the Prospective Associations Between Early Childhood Sleep Problems and ADHD at 10 years: Findings from a UK Birth Cohort Study. J Child Psychol Psychiatry. https://doi.org/10.1111/jcpp.13755

²Bondopadhyay, U., Diaz-Orueta, U., and Coogan, A.N. (2022). A Systematic Review of Sleep and Circadian Rhythms in Children with Attention Deficit Hyperactivity Disorder. Journal of Attention Disorders. https://doi.org/10.1177/1087054720978556

³Yürümez, E., and Kılıç, B.G. (2013). Relationship Between Sleep Problems and Quality of Life in Children with ADHD. Journal of Attention Disorders. https://doi.org/10.1177/1087054713479666

“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?