ADHD across the lifespan. (Ages & Stages).

Because ADHD is usually a lifelong disorder, how it manifests itself and how it's handled throughout various life stages can differ.

In women, ADHD is complicated by hormonal fluctuations, says Patricia Quinn, MD, who directs the National Center for Gender Issues and ADHD.

Basically, the higher the level of estrogen--during pregnancy and breastfeeding, for instance--the fewer the ADHD symptoms. The lower the levels of estrogen--just before your period, and just before, during and after menopause--the worse the symptoms. That's because estrogen seems to increase the amount of serotonin and dopamine available in the brain, she says. Estrogen may even affect the effectiveness of ADHD stimulant medications, with one study finding that the medication appeared most effective when estrogen levels were high during monthly cycles. (33)

Early childhood. Even the experts admit that a list of ADHD symptoms reads like a list of typical childhood behaviors. The difference is in the intensity, and if those behaviors interfere with day-to-day life. You have to look for clues, says Dr. Quinn, particularly in girls who may not demonstrate the disruptive hyperactivity that garners most boys their diagnosis. "A clue is if the teacher says she's only giving a half hour of homework, but it takes your daughter three hours to do it," she says. There's more daydreaming, perhaps labeling as a "ditzy airhead inattentive" type of girl, says Dr. Resnick, PhD, professor of psychology at Randolph-Macon College in Ashland, VA. And while girls in general tend to talk more than boys, girls with ADHD become like Chatty Cathy dolls. Early diagnosis and treatment is important to prevent lifelong academic and social problems that can escalate into mental health problems like depression and eating disorders, experts note.

Puberty. As the hormones kick in, the ADHD severity can kick up a notch, with repercussions that go far beyond academic difficulties. Problems controlling impulsivity puts adolescents with ADHD at higher risk for dangerous behavior, says Dr. Resnick. For instance, it's not uncommon for girls with ADHD to go through stages where they have multiple sexual partners. They're likely to have their first sexual experience a year earlier than girls without ADHD, and are five times more likely to become pregnant, he says. Even driving--that pinnacle of adolescence--poses problems for ADHD adolescents. One study found boys and girls with ADHD were up to four times more likely to have an accident, three times more likely to be injured in an accident, and four times more likely to be at fault in the accident than adolescents without the disorder. (34)

Pregnancy. According to Dr. Quinn, many women find their ADHD symptoms abating or even disappearing altogether during pregnancy and breast-feeding, which is a good thing, since they shouldn't take ADHD medications during this time.

After the birth, however, women with ADHD who don't breastfeed are at significant risk of postpartum depression as their estrogen levels drop, notes Dr. Quinn. Lack of sleep and the overall stress that occurs with pregnancy also play a role. So make sure your doctor is aware of your diagnosis, and can work with you after delivery to make any adjustments in your medication or therapy necessary.

Premenstrual syndrome (PMS). Though many women experience the irritability, physical discomfort and other assorted premenstrual symptoms that can turn your life and personality on their head, more than half of women with ADHD complain of the symptoms--and severe ones at that. Additionally, their ADHD symptoms seem to worsen just before their periods, says Dr. Quinn. One suggestion: talk to your doctor about increasing your medication during the week before your period.

Perimenopause and menopause. Women with ADHD get hit with a double-whammy as estrogen levels drop in the years prior to menopause. In addition to the symptoms related to low estrogen levels--hot flashes, mood swings, insomnia, vaginal dryness, forgetfulness--they find their ADHD symptoms, many of which may mimic menopausal symptoms, increasing, says Dr. Quinn. Even increasing medication dosages may not help. In fact, most women diagnosed for the first time with ADHD seek help in their mid- to late 30s--just when those levels of estrogen begin declining.

References

(33.) Nadeau KG, Quinn PD. Understanding Women with 40110, Advantage Books, 2002

(34.) Barkley RA, et al. Motor vehicle driving competencies and risks in teens and young adults with 40110. Pediatrics. 1996 DEC; 98 (6 Pt 1):1089-95.