ADHD Weekly 2017-08-10

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• The teen brain changes rapidly as it evolves from the brain of a child.
• In teens, there are higher levels of two important chemicals used in brain communications—dopamine and norepinephrine.
• But the levels of those chemicals are typically low in brains affected by ADHD.
• Estrogen, the key female hormone, affects the brain and the levels of dopamine and norepinephrine in the brain.

Hormones and ADHD in teen girls

While boys typically have a decrease in ADHD symptoms when they reach puberty, the opposite is true for girls as estrogen increases during puberty. 

Estrogen and progesterone levels fluctuate during monthly menstrual cycles. ADHD symptoms change along with rising and falling hormone levels. As girls approach and go through puberty, they experience significant physical changes and changes in their brains. These changes directly affect their ADHD symptoms. Because ADHD is a brain-based disorder, it is strongly impacted by hormonal fluctuations. 

• Estrogen levels begin to increase on the first day menstruation starts. This is the beginning of the menstrual cycle, and sometimes results in an increased sense of wellbeing. 
• When ovulation occurs (10-17 days after the first day of menstruation), estrogen levels take a dive and progesterone levels increase. Moods can take a turn, with increased irritability and lower energy levels. 
• In the last days of the monthly cycle, both estrogen and progesterone drop, causing a significant shift in mood and energy for most women. 
• Sadness and mood swings
• Difficulty sleeping
• Irritability
• Anxiety
• Confusion
• Fatigue

–From ADHD: What Happens When PMS Strikes

• ADHD symptoms usually worsen a few days before the start of the menstrual cycle, according to Patricia Quinn, MD, a developmental pediatrician.

Tools and strategies

“The majority of clinicians don’t understand the impact of hormones on ADHD symptoms,” says Terry Matlan, MSW, ACSW, a psychotherapist and ADHD coach who specializes in ADHD in adults, with a special focus on women. “If a girl or woman is undiagnosed, she sees herself as lacking or less-than, rather than understanding it is part of a disorder. That leads to shame, which impacts all aspects of her life.”

Matlan urges women and girls to learn to embrace the difficulties of ADHD. “If you pretend it doesn’t exist, you won’t be a whole person,” she says.

How can you use information about hormones’ affect on your daughter’s ADHD as she approaches and goes through puberty? 

Educate yourself and your daughter. It is important for you, and your daughter, to learn as much as you can about ADHD and how hormonal fluctuations affect ADHD symptoms. Here are two books recommended for young girls:

• Get Ready for Jetty! My Journal About ADHD and Me, Jeanne Kraus. A simple book written in diary form, this tells the story of a young girl who faces challenges after entering fourth grade. The book can help young girls recognize they are not alone when facing ADHD, and provides ideas and strategies to help them become more organized and aware of their strengths and challenges. 
• Attention, Girls! A Guide to Learn All About Your AD/HD, by Patricia Quinn, MD, is a good book for young girls to learn more about ADHD and its presentations. While it includes different characters and illustrations to make it more understandable for young girls, it is helpful to read the book with your daughter and use it as a discussion tool.

Have your daughter track her cycle. It is helpful to understand how fluctuations in ADHD symptoms align with the normal hormonal fluctuations that occur during her monthly cycle. She will learn what is “normal” for her in terms of symptoms, what happens most often when she’s stressed or her routine changes. By mapping her symptoms to the timeline of her cycle, she can work with her healthcare provider to better manage her treatment.

Dr. Quinn says she increases stimulant medication levels on certain days for her female patients based on their cycle and symptoms. “Some women may need an increase in dosage a few days prior to getting their period, while others may only need it while menstruating. What I do with these women is very individualized based on their symptoms.” 

• Clue Period Tracker, rated number one by the journal Obstetrics & Gynecology. It is available for iPhone and Android. 
• Period Tracker for Android and Period Tracker Lite for iPhone 
• My Calendar – Period Tracker, for iPhone and Android

• One or two days before you expect a shift in symptoms, focus on self care: eat well, get enough sleep, exercise and reduce stress. 
• Mindfulness training can help improve awareness of the present moment, and allow you to shift from the multiple thoughts that typically bombard someone affected by ADHD. It can help you let go of self-judgement—that inner voice that pops in with criticism.
• Ask for help. Girls are taught from an early age to be self-reliant and not ask for help. Early diagnosis and treatment are important to prevent the self-esteem issues and self-harm that is much higher with girls affected by ADHD. Instead, teach your daughter to ask for help when she is frustration, sad, or feeling overwhelmed.

Resources for Parents:

• 100 Questions & Answers About Attention Deficit Hyperactivity Disorder (ADHD) In Women And Girls, Patricia Quinn, MD
• Understanding Girls with ADHD, Updated and Revised: How They Feel and Why They Do What They Do, Kathleen Nadeau, PhD, Ellen Littman, PhD, and Patricia Quinn, MD
• Raising Girls with ADHD: Secrets for Parenting Healthy, Happy Daughters, James W. Forgan, PhD, Mary Anne Richey, MSEd

Do you have a question for our health information specialists? Call us at (800) 233-4050, Monday through Friday, 1-5 p.m. or post your question to one of our new Online Communities for Parents of Children with ADHD or for Adults with ADHD.

We explored the role hormones play for women and girls with ADHD In Part One of this three-part series, and why they may experience challenges with managing their ADHD symptoms. In Part Two, we focus on how these challenges are more complicated for girls with ADHD during puberty.