Written by Cheryle Sherwood, Registered Psychologist
A burgeoning area of interest for me has become Adult ADHD and women. My female patients are reporting a change in their symptoms around the time of both menopause and peri-menopause. Further to this, my daughter (who also has ADHD) reports a change in her symptoms of ADHD around the time of her menses. So interesting….!
When I attended the CADDRA National ADHD Conference in Montreal in October 2013, I registered for a plenary session as well as a lecture entitled ‘ADHD and Women’. I was excited to be able to ask questions about the role hormonal fluctuations play in symptoms of ADHD and how a therapist would best address these. I prepared specific questions, thought about exactly what I wanted to ask, and carried them carefully in my conference folder. Specifically, I wanted to know :
Which hormones were implicated, and why did they affect ADHD symptoms?
What is the typical fluctuation of these hormones and what did research indicate as far as menses cycle, peri menopause and menopause?
Would these hormonal implications end with menopause?
What therapeutic interventions would be best suited to this type of symptom fluctuation?
My hopes soared that I may get a gem of knowledge to be able to impart to my patients. I so wanted to be able to explain to them what was going on, why they were feeling like certain symptoms were getting worse rather than better, and utilize some brilliant therapeutic intervention that would help them take control of the symptoms rather than feeling like their symptoms were controlling them. Being very logical in my own thinking, I figured that if I could explain to them WHY it was happening, and what we were going to do about it together, it would lessen the anxiety and helplessness many of them reported.
I sat excitedly and (somewhat) patiently through the lecture, listening to tales of random controlled trials, sample sizes, and videos of women talking about how ADHD affects their lives. I nodded, impressed, with how much better these same women reported to feel after having received his treatment. I couldn’t WAIT for the question/answer period. Finally it came. I raised my hand and clearly asked my first question. Then I asked the second and third questions. Then the last questions.
I couldn’t have been more disappointed and frustrated in the response of the speaker. He stated that while research absolutely indicates that hormonal fluctuations impact the presentation and severity of ADHD symptoms in women, they still didn’t know why, or how. He couldn’t say what the fluctuation was, and the research wasn’t specific enough to differentiate between menses, peri-menopause or menopause. In fact, in response to my question of what types of therapeutic interventions would be helpful, he replied “That sounds like a great research question! You should do a study on that!”
My heart sank and my teeth gritted together. I couldn’t help but think: Seriously??!!! I don’t have time to do research! I am seeing patients! YOU are the researcher! THIS is what you get all those research grants for!!
After expressing my frustration to my colleagues and processing the disappointment that I won’t be returning to Calgary with a brilliant new understanding and intervention that will help my patients and make my job that much easier, I began to think. So now what?
I realized something that I have realized over and over again throughout my career; I am just going to have to do it myself. I resolved to partner with my female patients and together create a comprehensive picture of how their symptoms affect them at different times in their cycles, how their symptoms have changed, what has gotten worse and what has gotten better. Through mood charts, thought logs, various screening tools and good clinical interviewing, we can figure out at least how they are being affected, if not why.
No, I am not an endocrinologist with reams of knowledge about hormones, their role in the body, and what they do and don’t do. I do have some knowledge of neurotransmitters and how they are implicated in ADHD, so that should help.
I’ll let you know how it goes…..