WOMEN WITH ADHD – COPING WITH STRESS, FINDING THE BALANCE

Kathleen Nadeau, Ph.D.

Issues faced by Women with ADHD

Teaching women daily self-care Transition to adulthood Single women Married women Workplace issues for women Older women

DIAGNOSTIC ISSUES FOR WOMENMissed Diagnoses and Mis-Diagnoses

Diagnostic Issues in Women

Often no report of early childhood issues Inattentive type often overlooked by professionals,

parents and teachers Girls more teacher compliant Often report good academic records in early years Hyperactivity/impulsivity less common

Diagnostic Issues, cont’d

Symptoms often present at puberty High IQ girls may function well, but at a great cost Often a history of treatment for anxiety and/or

depression Often mis-diagnosed as bi-polar if hyperactive

component is present

Diagnostic issues, cont’d #3

Hyperactivity may manifest as: hyper-reactivity, emotional roller coaster hyper-talkativeness tom-boy behavior in girlhood

Typical Presenting complaints

Feel overwhelmed by daily activities Chronically disorganized Chronically late, poor time management Sense of shame, inadequacy - can’t live up to

typical societal expectations Challenged by household management,

meal-planning and preparation

Common Co-morbid Conditions forWomen with ADHD

Common co-morbid conditions

Depression Bi-polar Disorder Anxiety disorders PTSD and PTS syndrome Sleep disorders Eating disorders Fibromyalgia – related to chronic stress

Typical mis-diagnoses

Most common prior diagnosis is depression Typical experience is that treatment disorganization

and overwhelm even though depression was reduced

ADHD and Bi-Polar Disorder

Shared features: mood instability, bursts of restlessness talkativeness, racing thoughts impulsivity, impatience impaired judgment, irritability chronic course, lifelong impairment strong genetic clustering

Distinguishing features

ADHD more likely evident in childhood ADHD always present, Bi-polar episodic ADHD moods triggered by external events ADHD mood shifts almost instant, bi-polar shifts take

hours or days ADHD mood shifts of short duration 20-25% Bi-polar also have ADHD

Anxiety Disorders & ADHD

Feelings of anxiety can develop early Peer issues Criticism from adults Academic struggles

ADHD daily life management trigger anxiety Medication for anxiety to tolerate stimulants. Stimulants may reduce anxiety triggers

“OCD” and OCD

Pressure upon women to be organized may result in “OCD” - extreme efforts to rigidly maintain organization

OCD tendencies common in high-functioning adults with ADHD

OCD may be primary and must be treated first before ADHD treatment can be effective

Posttraumatic Stress

Adelizzi, J. - Studied women with ADHD and/or LD symptoms returning to school and found:

1-Most had symptoms of PTSD - Possible link between trauma proneness and ADHD?

2-Many reported that most severe trauma had been “classroom trauma” related to shame and humiliation in classroom. Are girls more susceptible to classroom trauma?

3-Trauma experiences must be recognized and treated if return to educational setting is to be successful.

Sleep Disorders and ADHD

Disturbed sleep patterns common “Night owl” syndrome, difficulty waking Racing thoughts can prevent falling asleep Chronic sleep deprivation increases ADHD symptoms

Eating Disorders and ADHD

ADHD complicates treatment due toImpulsivity, difficulty with planning and follow throughCompulsive over-eating – self-medicationBinge eating- bulemiaAnorexiaEating disorders specialists need to become more aware

of ADHD

Fibromyalgia (FMS)and ADHD in Women

No research yet, but clinical experience suggests that FMS, related to chronic stress, is common among women with ADHD

Different stress response in women - “tend and befriend” vs. “fight or flight” - tends to keep women in chronic stress situations more than men.

Stimulant medication tends to alleviate FMS symptoms.

Learning Disabilities & ADHD

Recent research finds 70% overlap when writing difficulties are also considered.

LD, like ADHD, affects all aspects of adult life, not just educational issues.

LD evaluation should be part of ADHD assessment for adults.

Awareness and compensatory strategies can reduce stress.

Treating ADHD andCoexisting Conditions

Therapist must address all conditions, interweaving therapy to focus on both practical, psychological, and interpersonal

Needs close working relationship with physician who can prescribe medications appropriate for ADHD and other conditions

Solution-focused Psychotherapyfor Women with ADHD

ADHD is a Cognitive Disorder-

Treatment needs to improve Cognitive Functioning, not just Psychological Functioning

Solution-focused Psychotherapy for ADHD

Combines aspects of both:Cognitive-behavioral psychotherapyCognitive rehabilitation

Cognitive-behavioral aspects:

Reframing ADHD Moving from self-blame to self-understanding Defining ADHD as a set of traits with both positive

and negative traits

Cognitive-behavioral aspects:

Focusing on habit development Changing behaviors Defining reasonable, constructive, meet-able goals Setting short-term and long-term goals Assigning “homework”

Cognitively Focused Treatment

1. Enhancing cognitive functioning2. Compensatory Techniques3. Environmental Adaptations

Considering Multiple Means to Enhance Cognitive Functioning

Medication Exercise Nutrition/supplements Sleep Exposure to nature Stress reduction

Compensatory Techniques

Compensatory techniques:

1- Developing habits2- Reducing Stress3- Increasing structure and support4- Using assistive technologies

Increased supports

ADHD Coaching to support Constructive problem solving Habit development Staying on track to meet goals

Therapist can also provide coaching function in collaboration with ADHD coach

Restructuring the Environment

Physical environment Work environment Social environment

ADHD-friendly Environments

Low-maintenance Reduce tasks in areas of weakness Reduce distractions & temptations Lower stress Find constructive sources of stimulation Emphasizes skills & interest Emotionally supportive people Structure & support from others

Professional Organizers can help build ADHD-friendly Environments by:

Reducing clutter Developing organizing systems Simplifying – less is more Creating user-friendly storage systems Building in visual reminders

Taking Charge of ADHD – The Three S’s

1- Structure2- Strategies3- Support

Special Treatment Issues for Women

Self-blame, shame Low self-esteem that limits choices Self-assertion Gender role expectations More difficult social demands Motherhood more challenging Fluctuating hormones Relationship issues; domestic violence

Daily Self-Care for ADHD Women

Women with ADHD often neglect their own care taking on too much, being on duty at both ends of the day putting themselves last

Cognitive functioning is adversely affected by lack of sleep lack of exercise stress, poor nutrition hormonal changes

Teaching women with ADHD to Put Themselves First

Taking care of themselves allows them to have the energy and stamina to take care of others and their daily tasks or job.

Women taking care of themselves set a good example for their daughters—teaching self-respect and good habits.

Need to simplify their lives, say “no” more often, delegate more, and make a guilt-free commitment to themselves

Sleep Issues and Strategies

Lack of sleep adversely affects executive functioning, energy level, and mood.

Sleep architecture disturbed in ADHD—delayed sleep phase syndrome.

Avoid overstimulation 1-2 hours before bed—television shows, news, Internet, videogames, engaging books, active play.

More Sleep Strategies

Try a warm, quiet bath; low-key reading; soothing massage; soft, slow music; nature sounds; relaxation/meditation.

Go to sleep early enough to get about 8 hours of sleep—make a commitment to yourself to honor this! Put yourself first.

Stress Management

Simplify your life as much as possible—reduce extra activities, clubs, committees, and commitments.

Take care of yourself—get enough sleep, exercise, down time, and healthful food.

Learn and practice relaxation, meditation, yoga, deep breathing.

Get yourself out in nature—very ADD-friendly! Maintain one or two close relationships for support. Develop ADD-friendly job and home environments. Hire an ADD coach and/or organizer to help. Make sure to incorporate laughter and play in your life.

Helpful Strategies

Develop consistent morning and evening routines. Prepare as much as possible the night before—

shower, lay out clothes, pack lunch, use staging area to gather items.

Establish a designated location for important items—wallet, keys, glasses, etc.

Develop a good sense of humor and be able to laugh at “ADD moments.”

Use a support group and stay socially connected.

Exercise Important for Self-Care

Exercise boosts blood flow to the brain and increases seratonin availability.

Recommended exercise is 30-45 minutes at least 5 times per week.

Suggestions to enhance compliance—exercise buddy/personal trainer, regularly scheduled class (pre-paid),, add movement during day (use stairs, park far away, dance around house to favorite music), take brisk walks.

Nutritional Self-Care

Higher-protein, lower-carbohydrate diet Eat protein at all meals—especially at breakfast on

an empty stomach. Protein contains the amino acid building blocks for

neurotransmitters on the brain—essential to a “concentration” diet.

Many ADHD individuals crave sugars and refined carbohydrates – self-reward, energy boost, can lead to binge eating of simple carbs

Strategies Women

Build a social support system. Seek out other women with ADHD through support

groups—online or in person. Join groups, clubs, or organizations with scheduled

activities, events, and meetings Find work that is well-matched to strengths and

interests—work is often primary source of meaning and validation.

Common career issues for women with ADHD

Being the support system rather than having a support system

More pressure because more often the primary parent

Low self-esteem can lead to fear of change –remaining stuck in ill-suited job

ADHD Behaviors that Impact Relationships

Low self-esteem—low expectations, settling, lack of assertiveness.

Executive dysfunction—disorganization, forgetfulness, poor time management, clutter

Self-stimulation through creating conflict or arguments out of nothing

ADHD Behaviors that Impact Relationships Cont’d

Communication issues—interrupting others, only hearing parts of what was said, failing to communicate (“I thought I told you”)

Emotional sensitivity and over-reactivity—prone to outbursts, moodiness, easily hurt or offended, “hair-trigger” reactivity, irritability, impatience.

Impulsivity – spending, eating, over-committing

ADHD women in retirement years

ADHD challenges sometimes increase due to reduced structure

Health at risk as nutrition and sleep suffer Social isolation increases vulnerability Needed to be re-connected with family and

community

At Every Age, Women with ADHD find balance through:

Reducing stress Building structure and support Seeking out supportive people Develop brain-friendly habits Simplifying all aspects of life Being accepting of themselves and recognizing

strengths

Women across the lifespan

Early adulthood – Leanne and Kerri

Mid-life and motherhood – Jessica and Jen

It’s never too late - Lori