Category: <span>Women’s Health</span>

ADHD Child Wellness Women's Health By Beth Church 0 Comments

Girl ADHD: Why do girls often get diagnosed later or not at all?

Written By: Julie Braciszewski, PhD, LP

When most people think of ADHD, the stereotype of a boy bouncing off the walls often pops into their mind. But this stereotype gets in the way of girls obtaining timely and full diagnoses. In fact, girls are half as likely to get an accurate diagnosis in childhood, and if they are diagnosed, they receive a diagnosis, on average, 7 years later than boys. The amount of growth and change that is missed during that window is mind boggling! So, let’s get to the tricky questions; why is girl ADHD overlooked so often and what can we do about it? 

Why ADHD Symptoms in Girls Are Often Overlooked

The squeaky wheel gets the… diagnosis. Kids and teens who exhibit more of the disruptive behavioral and emotional patterns associated with ADHD – like impulsive behaviors, hyperactivity, intense difficulty following directions and completing tasks, and emotional reactivity – are more likely to be diagnosed with ADHD earlier in childhood. Honestly, this is because they are more likely to be causing frustration and ire among the adults in their lives. Kids and teens who have a more inattentive profile; who might have intense difficulties with regulating attention but look more ‘zoned out’, can’t keep track of tasks, dates and materials, and are turning intense emotional reactions inward are overlooked, often because they are not disruptive.

Common Signs of ADHD in Girls

One of the ways we can all do better in supporting neurodivergent girls is to amplify the girl ADHD profile. Although there are certainly ADHD girls who do present as hyperactive, it is less common. Additionally, hyperactive symptoms in girls look a bit different from boys; boys often exhibit physical hyperactivity while girls are more likely to be hyperverbal, or very talkative, rather than physically dysregulated. The ADHD girl tends to experience more inattentive symptoms, like ‘day dreaming’ or ‘zoning out’. They are having trouble sustaining attention and concentration, and this is often impacting learning, hearing directions and completing tasks, but doesn’t result in the outward hyperactive or disruptive behaviors. Instead ADHD girls are often quietly disorganized, forgetful, easily derailed or distracted from tasks or during conversations, they may hop from activity to activity, have trouble remembering steps in routines, and experience internal restlessness. Girls also tend to use their strengths to hide symptoms or compensate for the difficulties ADHD causes. This results in misdiagnosis and under-diagnosis.

The Long-Term Impact of Undiagnosed ADHD in Girls

Learning to mask and compensate for neurodevelopmental differences is exhausting and stressful! Resultantly, girls with ADHD are more likely to experience anxiety and mood troubles. Unfortunately, these anxiety and mood troubles are often seen as the primary issue, leaving ADHD unrecognized and untreated. 

What is especially tricky is that inattentive symptoms don’t really get better with age without intervention, so ADHD girls tend to struggle for a long time, often being told they just aren’t trying hard enough. The longer term impact of underdiagnosis is substantial; girls and women with ADHD may be at higher risk for additional negative outcomes such as anxiety, depression, eating disorder, suicidal thoughts, suicidal attempts, and even shorter life expectancy, compared to boys and men with ADHD. The long-term consequences of undiagnosed ADHD are well established and highlight why correct diagnosis and treatment are so important. 

How to Get an ADHD Evaluation for Yourself or Daughter

The first stop on the path to a correct diagnosis is often your primary provider or pediatrician. However, pediatricians and primary care providers report varying levels of confidence in diagnosing and managing ADHD. Their hands are often tied by the pressure to move through office visits quickly, and they do not have the means to test for ADHD beyond questionnaires. There is no one biological test for ADHD. Their reluctance to throw a diagnosis on neurodivergent symptoms is completely understandable; primary care physicians and pediatricians’ expertise covers such a wide range of knowledge and they refer out to specialists for many specific health and development related issues. In fact, many pediatricians report feeling that their training offered very limited training in developmental-behavioral pediatrics and psychiatry and readily refer out to psychologists for testing and treatment. So, while your first stop may be to discuss concerns with your primary care doctor or pediatrician, they will likely refer you to a specialist for evaluation and treatment. As you move through an evaluation for ADHD, it’s good to know what a complete diagnostic evaluation should include. For more information on full neurodiagnostic testing click here.

What to Expect From a Comprehensive ADHD Assessment

Because symptoms of ADHD overlap with anxiety, mood troubles, and other neurodivergent learning profiles and disorders, a full assessment is often warranted. It’s important that co-occurring differences or disorders are identified and treated alongside ADHD when present. This typically includes an hour long intake, review of medical and academic records, standardized measures of brain functioning across many areas of functioning as well as several types of standardized questionnaires. Testing should take several hours (4-6 hours, sometimes more) and should result in a lengthy report that explains all of the evaluation data as well as a clear path of recommendations.  

A word of caution; general screening measures are an ok place to start, but are often not a good measure of ADHD and co-occurring conditions and disorders. Gender differences among symptoms of ADHD is part of the reason general screenings and short questionnaires often just don’t cut it when it comes to getting an accurate diagnosis. 

No matter where you are in your or your loved one’s journey of diagnosis, we are here to help. We provide comprehensive evaluations that set individuals and families on the path of success with accurate diagnoses, as well as clear, evidence-based recommendations and follow up treatment.

For more information on neuropsychological testing at Monarch Behavioral health click the link here: https://www.mbh-mi.com/testing/general-information/

If you or a loved one are seeking general services, click the link to make an appointment:

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ADHD Perimenopause Women's Health By Beth Church 0 Comments

All I Know is I Think I’m Losing My Mind: Is This Perimenopause, ADHD or Both?

Written By: Julie Braciszewski, PhD, LP

Earlier this year the U.S. Food and Drug Administration lifted warnings that had been on hormone therapy for menopause symptoms for over 2 decades. This has spurred a surge in visibility and discussion of perimenopause on social media, at primary care offices, and in women’s friend groups and families. What used to be a taboo topic is now (thankfully) being ushered into the light and talked about with more candor and less stigma.

“In the last 5 years or so we have increasingly heard women asking, “Is this perimenopause, ADHD or both – because I feel like I’m going crazy!” As women share their experiences and feel less alone in this season of life, they are asking more questions than ever about the cognitive and emotional impacts of perimenopause, why and how these symptoms look and sometimes feel so similar to neurocognitive disorders like ADHD, and what they can do about them. 

Symptoms in Common

Women are right! The drop in estrogen during perimenopause causes real effects in cognition and emotions, and many of the symptoms of ADHD and perimenopause look and feel very similar. Both ADHD and perimenopause can cause difficulties with memory, organization and planning, heightened emotional experience and responding, and restlessness. And although the cognitive fog, mood and anxiety challenges that often accompany perimenopause aren’t a direct symptom of ADHD, many individuals with ADHD experience these challenges as well, secondary to ADHD. Additionally, over half of individuals with ADHD report ongoing sleep troubles, and 40-80% of women in perimenopause also report sleep difficulties. That is a lot of overlapping symptoms and experiences!

There are important differences, however, in the symptom profiles of ADHD versus menopause. For instance, there are subtle but important differences in memory weaknesses. Memory difficulties with ADHD tend to be more around working memory and encoding new information and are most often evenly experienced across verbal and non-verbal tests. Perimenopause can also affect working memory and attention, but has a more specific impact on verbal memory and verbal fluency (e.g., remembering lists, names, recalling words). There are also differences in the onset and course of executive functioning, emotion regulation and sleep challenges seen in ADHD versus perimenopause.  

So, although the cognitive, emotional and executive functioning symptoms of ADHD and perimenopause overlap a great deal, with a good evaluation, you can gain clarity that puts you on a path to deal with either, or both, much more effectively. 

Women: Understudied and Underdiagnosed 

One aspect that makes women wonder, ‘is this perimenopause or has this just been ADHD all along’, is the fact that girls and women are far less likely to be accurately diagnosed with ADHD. In fact, 50 – 75% of girls and women with ADHD go undiagnosed or are misdiagnosed. Girls’ and women’s ADHD symptom profiles have historically been far less studied and are different than their male counterparts. Girls and women tend to exhibit more inattentive symptoms (versus attention-grabbing hyperactive behaviors), and are often mistakenly labeled as anxious, depressed, or ‘difficult/disordered’ personality patterns. Thus, the likelihood a girl with ADHD makes it through adulthood and into perimenopause without being accurately diagnosed is actually pretty high.

A woman who was not accurately diagnosed with ADHD in their childhood has likely been masking or compensating for their ADHD challenges with other strengths (e.g., high intelligence, impressive social skills, over-planning) for decades, is likely finding herself less likely to mask as she crosses the threshold into perimenopause. The added pressure that the hormone and brain changes associated with perimenopause put on women often outweigh their ability to compensate or mask. Many women are finding out in middle age that yes, it has been ADHD all along, and perimenopause and menopause is making it worse!  

Correct Diagnosis

The correct diagnosis is everything when it comes to managing ADHD or perimenopause, or both. The good news is that when we engage in standardized testing of executive functioning and memory, and complete an in depth neurodiagnostic interview, the profiles of ADHD alone, perimenopause alone and ADHD + perimenopause look different! This is incredibly helpful and important because accurate diagnosis puts us on the path to effective supports and treatment. Women with ADHD, menopause or both do not have to continue to mask symptoms and quietly suffer. 

Integrated Treatment

An integrated treatment approach in which a woman’s medical provider and mental health provider are working in concert is ideal. Many of the symptoms associated with perimenopause can be alleviated with an integration of medical care and evidence-based treatment like Cognitive Behavioral Therapy (CBT) and/ or Acceptance and Commitment Therapy (ACT). Additionally, CBT is the most effective treatment for ADHD by far – so for those experiencing both ADHD and perimenopause – CBT can be life changing. 

Empowering Girls and Women at all stages of life

At Monarch Behavioral Health we leverage our knowledge of well-conducted research to empower girls and women to get the care they need and deserve  throughout their lives. With accurate diagnoses and evidence-based care, girls and women can move through all stages and phases of life with a sense of pride and well-being. 

Make an appointment today: https://www.mbh-mi.com/make-an-appointment/

Depression Mental Wellness Therapy Women's Health • • • • • • • By Beth Church 0 Comments

Understanding PMDD: Shedding Light on a Hidden Struggle

Written by: Sarah Engels, MS, TLLP

For many, the days leading up to their period can be a little tougher– mood swings, irritability, or fatigue are common symptoms. But for those living with Premenstrual Dysphoric Disorder (PMDD), these symptoms are far more intense and can disrupt daily life, relationships, and work. PMDD is more than just a “bad period,” or PMS. PMDD is a serious, hormone-related condition that affects mental, emotional, and physical health. 

How is PMDD different from a normal period?

PMDD is a much more severe version of PMS (premenstrual syndrome). PMDD is a health condition that affects people of child bearing age and requires attention and treatment. Key differences between PMDD and PMS are summarized in the following chart:

Feature PMS PMDD
Severity Mild-Moderate, manageable Severe, often debilitating
Mood Irritability, mild mood swings Extreme irritability, anger, and intense anxiety/depression
Physical symptoms Bloating, breast tenderness, headaches, etc. Higher intensity of normal PMS physical symptoms
Functioning Mild to moderate impact on daily functioning Significant impairment to life, work, and relationships
Prevalence Very common (around 90% of women report symptoms) Less common (around 3% -8% of women report PMDD)
Treatment Self-care, over the counter remedies May require medical intervention (e.g., CBT, SSRIs)

How can I tell if I have PMDD and how is it diagnosed? 

Typically, symptoms of PMDD start around 1 week before your period starts, and end a few days in. They disrupt daily activities and can impact home, work, and relationships at this time. The difference in mood and functioning is notably different than other times during the month. 

The following are common symptoms of PMDD: 

  • Depressed mood, hopelessness, or feelings of worthlessness
  • Increased anxiety, tension, or feeling on edge
  • Mood swings
  • Sensitivity to rejection
  • Frequent/sudden tearfulness
  • Increased irritability
  • Increased relationship conflicts
  • Difficulties concentrating
  • Changes in sleep (excessive sleep or difficulty sleeping)
  • Changes in appetite (lack of appetite or overeating)
  • Physical symptoms like breast tenderness, headaches, joint/muscle aches, weight gain, or bloating

If you are experiencing any of these symptoms, reach out to a medical professional. It is likely that your provider will ask you to keep a diary or journal of symptoms, coinciding with your menstrual cycle to differentiate between PMDD and other disorders with similar symptoms such as depression or anxiety. 

Living life with PMDD: treatment approaches and more

PMDD is a serious and chronic condition. However living with PMDD can be manageable with appropriate care and treatment. Lifestyle changes, therapy and medication can decrease symptoms of PMDD. A combination of the following approaches can be pivotal in symptom reduction: 

  • Changes in diet, such as; decreasing sugar, salt, caffeine, and alcohol, and increasing protein and carbohydrates
  • Getting regular exercise
  • Practicing stress management, like mindfulness and relaxation techniques
  • Therapies such as CBT (cognitive behavioral therapy)
  • Vitamin supplements, like magnesium or calcium
  • SSRIs (selective serotonin reuptake inhibitors)
  • Birth control pills

Conclusion

May is Women’s Mental Health Month, and in turn, we draw attention to the unique challenges that women face and their impacts on mental health. PMDD is often a hidden struggle for many women, dealing with the stigmas surrounding women’s health, both physical and mental. But you and your loved ones are not alone. If you believe that you or a loved one is experiencing symptoms of PMDD, do not hesitate to make an appointment with a clinician at Monarch Behavioral Health to discuss your concerns and make a plan for treatment and support. 

Make an appointment at Monarch Behavioral Health: https://www.mbh-mi.com/make-an-appointment/ 

Further resources: