WOMEN WITH ADHD COPING WITH STRESS, FINDING THE BALANCE. Kathleen Nadeau, Ph.D.

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1 WOMEN WITH ADHD COPING WITH STRESS, FINDING THE BALANCE Kathleen Nadeau, Ph.D.

2 Issues faced by Women with ADHD Teaching women daily self-care Transition to adulthood Single women Married women Workplace issues for women Older women

3 DIAGNOSTIC ISSUES FOR WOMEN Missed Diagnoses and Mis-Diagnoses

4 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

5 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

6 Diagnostic issues, cont d #3 Hyperactivity may manifest as: hyper-reactivity, emotional roller coaster hyper-talkativeness tom-boy behavior in girlhood

7 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

8 Common Co-morbid Conditions for Women with ADHD

9 Common co-morbid conditions Depression Bi-polar Disorder Anxiety disorders PTSD and PTS syndrome Sleep disorders Eating disorders Fibromyalgia related to chronic stress

10 Typical mis-diagnoses Most common prior diagnosis is depression Typical experience is that treatment disorganization and overwhelm even though depression was reduced

11 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

12 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

13 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

14 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

15 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.

16 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

17 Eating Disorders and ADHD ADHD complicates treatment due to Impulsivity, difficulty with planning and follow through Compulsive over-eating self-medication Binge eating- bulemia Anorexia Eating disorders specialists need to become more aware of ADHD

18 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.

19 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.

20 Treating ADHD and Coexisting 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

21 Solution-focused Psychotherapy for Women with ADHD

22 ADHD is a Cognitive Disorder- Treatment needs to improve Cognitive Functioning, not just Psychological Functioning

23 Solution-focused Psychotherapy for ADHD Combines aspects of both: Cognitive-behavioral psychotherapy Cognitive rehabilitation

24 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

25 Cognitive-behavioral aspects: Focusing on habit development Changing behaviors Defining reasonable, constructive, meet-able goals Setting short-term and long-term goals Assigning homework

26 Cognitively Focused Treatment 1. Enhancing cognitive functioning 2. Compensatory Techniques 3. Environmental Adaptations

27 Considering Multiple Means to Enhance Cognitive Functioning Medication Exercise Nutrition/supplements Sleep Exposure to nature Stress reduction

28 Compensatory Techniques

29 Compensatory techniques: 1- Developing habits 2- Reducing Stress 3- Increasing structure and support 4- Using assistive technologies

30 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

31 Restructuring the Environment Physical environment Work environment Social environment

32 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

33 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

34 Taking Charge of ADHD The Three S s 1- Structure 2- Strategies 3- Support

35 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

36 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

37 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

38 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.

39 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.

40 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.

41 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.

42 Exercise Important for Self-Care Exercise boosts blood flow to the brain and increases seratonin availability. Recommended exercise is 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.

43 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

44 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.

45 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

46 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

47 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, hairtrigger reactivity, irritability, impatience. Impulsivity spending, eating, over-committing

48 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

49 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

50 Women across the lifespan Early adulthood Leanne and Kerri Mid-life and motherhood Jessica and Jen It s never too late - Lori

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