The average age of diagnosis for women with ADHD, if they weren't identified in childhood, is 36 to 38. That's a long time to wait for relief. Because females typically present with the inattentive type of Attention-Deficit/Hyperactivity Disorder, frequently, they are diagnosed with depression and/or anxiety.
Edward Hallowell, M.D. and John Ratey, M.D., both psychiatrists, wrote a book titled Driven to Distraction. This book was the first to propose that the ADHD symptoms seen in adults were not, indeed, "adult residual ADHD" or those ADHD symptoms that were "leftover" from childhood, but was ADHD in adults. The book contains a checklist that may help you to determine if you're experiencing ADHD.
Previous to the publication of this book, many adults were treated for depression and anxiety and not ADHD. Needless to say, treatment was not as effective as treating the ADHD itself. If depression/anxiety were diagnosable, then all conditions were treated.
A point of clarification is that those with ADHD have a brain "architecture" that makes them vulnerable to anxiety and depression because there is less available dopamine and serotonin. Dopamine is a powerful part of the motivation and reward system and serotonin is the "naturally occurring antidepressant". Some of the medications for ADHD increase the effectiveness and availability of dopamine.
With the intense social "jungle", 6 classes each with a different teacher who has a different teaching style who's teaching a different subject requiring mountains of homework and after school activities, yeah, sounds like a battlefield of sorts. OMG! So different from elementary school.
Kids in 6th, 7th and 8th grade are intensely engaged in developing and using higher order thinking skills such as analysis, generalization, coming to conclusions and synthesizing data. Whew!
And, there are twice as many kids as there were in the 5th grade. The campus is huge and everything moves so so so fast! The pace of instruction is much more intense. The "production" requirements of tests, assignments and projects, not to mention the increase in the kinds of thinking that's required for middle school creates unique pressure.
On top of all that, if their executive functioning skills related to decision-making, judgment, planning, organizing, time management, getting started, finishing, sequencing, on and on and on are compromised, things go downhill very fast.
So much going on on so many different levels. The stress takes a little getting used to.
If you have ADHD and you're female and just starting to have periods, it's a tough call as to whether or not your challenges are related to the new school setting and academic requirements, the new social landscape, your state of development or the ADHD. Well, of course, it's the "combo plate" of all four of these factors!
The combination of these physiological changes occurring at the same time as the environmental stressors of school and the social setting make for a perfect storm.
About a week before her period, a girl's progesterone levels increase and stimulant medications just don't work as well. Her thinking is fuzzy, she's disorganized and she lacks concentration and motivation. However, when she is mid-cycle, because estrogen is increased, she has adequate dopamine and serotonin and life clicks along without a hiccup.
What can be done? Studies show that an increase in medication does not benefit girls as much as boys, but reworking the medications and possibly supplementing them with high- quality fish oil is a good start.
Make sure that appropriate supports are in place such as a Section 504 Plan to accommodate her educational and executive functioning deficits. Consider hiring a private educational therapist (www.aetonline). An educational therapist can help teach your kid the "hacks" of getting tasks done in order to reduce the misery index.
It would be very helpful if parents, usually mother, kept a journal for about 3 months, to share with the medicating physician about the "when" and "what" she sees in terms of her daughter's productivity, concentration, executive functioning skills and emotional stability.
Note your daughter's strengths and weaknesses and give her some slack when she's argumentative, resistant, uncooperative or just plain irritable.
Unlike teenage boys, girls internalize their problems. Boys with ADHD act out (and boys, in general), and girls keep their stress to themselves unless "something blows" in her behavioral, academic, or emotional presentation. By that time, it's a muddy mess with multiple layers of issues that need to be addressed. It takes a long time to recover from a "multi-level crisis".
Girls with ADHD in their "tween" years (early teens) are more aggressive, show earlier signs of substance-abuse and related problems, have more academic issues and greater rates of depression than girls without ADHD. You can appreciate how dangerous this situation can get.
Give her every chance to move through this challenging time. Teach her what she needs to know because she'll be on her own sooner than you realize and she'll need those problem-solving skills you're teaching her.
I'll be following up on this with posts focusing on ADHD and pregnancy and on ADHD during the menopausal years.
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