WHAT YOU’LL LEARN

• Why Women With ADHD Are Often Undiagnosed 
• How Hormones Impact Moms with ADHD
• Why Moms with ADHD Struggle
• Diagnosis and Treatment for Moms with ADHD
• Tips For Moms Coping With ADHD

Answers for Moms with ADHD: The Relationship Between ADHD and Hormones

Like so many women, I went undiagnosed for ADHD for years. In fact, it wasn’t until I started the evaluation for my son that I had a lightbulb moment. 

Suddenly, so many of the challenges I faced in motherhood made even more sense. The struggles with executive functioning, the overstimulation, the difficulty juggling the mental load. 

All of these pieces can be challenging for any overwhelmed mom—but when you’re a neurodivergent moms, they’re often even more difficult to navigate. 

Looking back, I can see my signs and symptoms from a young age. But motherhood brought them to the surface in a whole new way. The coping mechanisms I’d built up to function as a solo person no longer worked when I was executive functioning not just for myself but for three little ones as well. 

This is a common experience for moms with ADHD. They’re often undiagnosed and don’t even realize they might have ADHD until they enter motherhood. This is partially because women are underdiagnosed in general. But research also shows that hormones impact the severity of ADHD—meaning that moms with ADHD might not have shown obvious signs before the perinatal period. 

But for moms who feel like they might be struggling, there are often more questions than answers. Is this a sign of ADHD or am I just coping with motherhood burnout? If it’s ADHD, why are my symptoms so much more extreme? How do I know what’s ADHD and what’s something else, like anxiety or hormone changes? 

This week on The Momwell Podcast, I’m joined by clinical neuropsychologist and ADHD specialist Dr. Jeanette Wasserstein, author of Adult Attention Deficit Disorder, to discuss the relationship between hormones and ADHD, and what moms who suspect they have ADHD can do to seek support. 

Why Women With ADHD Are Often Undiagnosed 

Research shows that while ADHD is diagnosed three times as often in boys as in girls, the gap narrows in adulthood. Adult men and women are about as likely to have ADHD. This has highlighted the fact that girls are going undiagnosed until adulthood. 

But why does this happen? Part of it is the presentation. ADHD can either be hyperactive, inattentive, or combined. Each of those types has a range of presentations. For example, hyperactive ADHD can present as lots of disruptive or physical behavior, but it can also present as fidgeting, picking at nails or skin, or even making excuses to get up (like going to the bathroom, sharpening pencils, etc.)

Dr. Jeanette pointed out that girls are more statistically likely to have inattentive ADHD, which makes it harder to catch. This form of ADHD often shows up in subtle ways, like frequent daydreaming or zoning out. Without more obvious signs, such as hyperactivity, it can go unnoticed, leaving many girls and women undiagnosed.

Girls might mask their ADHD to adhere to gender norms. 

Dr. Jeanette also said that socialization is a factor. Girls are often expected to follow rules or conform—and they might mask their ADHD to adhere to these gender norms. Boys are often expected to be “unruly,” while girls are more pressured to control their impulses. So girls might turn to less “disruptive” presentations, even if they have hyperactive ADHD. 

Medical bias also contributes to the underdiagnosis problem. Doctors might not expect girls to have ADHD and therefore overlook their symptoms, or evaluate them against criteria that was established for boys—which might miss diagnoses, especially for inattentive ADHD.

How Hormones Impact Moms with ADHD

Underdiagnosis due to gender norms isn’t the only reason ADHD can come to the surface after having a baby. More and more research highlights the fact that hormonal shifts impact ADHD—which means that moms in the perinatal period or women in perimenopause or menopause are more likely to start showing symptoms and struggling. 

Estrogen in particular affects cognition and ADHD symptoms. It regulates dopamine and serotonin (dopamine is related to focus and executive function, while serotonin affects mood and anxiety). So when estrogen levels undergo drastic changes, it makes sense that ADHD symptoms might show up more. 

Dr. Jeanette said that there’s still a lot of research to be done on the relationship between ADHD and estrogen, but it appears that there is a direct correlation between estrogen, cognitive function, and even responsiveness to medication. 

The more estrogen, the easier it is to function, and the better we respond to medications.

Generally, the more estrogen, the easier it is to function, and the better we respond to medications. This also explains why ADHD symptoms can fluctuate with the menstrual cycle (even for those who are prescribed ADHD medication). 

Dr. Jeanette said that for this reason, pregnancy is actually often a good time for moms with ADHD—their estrogen levels are high, and their symptoms might be less severe. But in the postpartum period, as well as in perimenopause and menopause, estrogen drops off radically, making executive function and emotional regulation symptoms worse. 

Dr. Jeanette pointed out that these hormone shifts are also likely a contributing factor to why moms with ADHD are more likely to develop postpartum depression and anxiety. 

Why Moms with ADHD Struggle

Beyond the hormonal relationship, motherhood itself can bring out symptoms of ADHD. One of the key signs of ADHD is a difficulty with executive functioning, or the ability to manage and complete everyday tasks. 

The invisible load of motherhood is overwhelming and exhausting. We’re juggling schedules, making appointments, coordinating drop-offs, monitoring diapers and wipes and a seemingly never ending pile of laundry—it requires essentially non-stop executive functioning. 

This is likely why diagnosis of moms skyrocketed during the pandemic. Moms were at home, handling the bulk of the mental and household labor, creating extra stress and pressure and highlighting executive functioning struggles that might have been hidden before. 

Dr. Jeanette said executive functioning is mediated by frontal lobes—the action part of our brain. Our executive functioning capacity impacts our ability to self-regulate, make decisions, plan things, and prioritize tasks. 

It’s hard enough to maintain executive functioning for all of the components of the invisible load. But when your brain makes executive functioning difficult, it can feel impossible. 

It makes sense that moms with ADHD would struggle to keep all the moving parts going. 

This can lead to a lot of guilt and shame for moms with ADHD. We might feel like we’re dropping the ball or being “bad moms” when we forget to do simple tasks, or find things like laundry or dishes too overwhelming. We might feel ashamed when we have difficulty getting everyone out the door and to wherever we’re supposed to be on time. 

But it makes sense that moms with ADHD would struggle to keep all the moving parts going. It can be excruciating to carry the weight of so many tasks and needs and to-dos.

If you find yourself struggling with these pieces and feeling overwhelming, you might wonder whether ADHD is present or whether you’re just overwhelmed and burnout by unreasonable pressure and expectations. But if you’re questioning it, it doesn’t hurt to seek support and be evaluated—there are treatment options that can bring so much relief for moms with ADHD. 

Diagnosis and Treatment for Moms with ADHD

In a world where misleading online information goes viral daily, it can be hard to know what’s accurate and how to get a diagnosis. Where do you even begin? What type of doctor do you see? Do you need a referral? Will insurance cover evaluations and testing? 

For moms with ADHD or those who suspect it and are struggling with executive functioning, navigating those questions and even locating a doctor can feel overwhelming—especially when different countries have different medical systems and policies. 

In Canada, seeing a primary care physician is the first step—accessing specialists is unlikely without a referral. But in the United States, the steps are less clear. You can start by raising concerns with your general practitioner, but ultimately a psychiatrist is the best source for a diagnosis. There are psychiatrists who specialize in diagnosis and treatment of ADHD. 

You might navigate challenges like insurance coverage or waiting periods for testing—but if you suspect ADHD, keep advocating for yourself until you are able to be evaluated. 

If you suspect ADHD, keep advocating for yourself until you are evaluated. 

If you receive a diagnosis, there are two primary medication options—stimulants (dexamphetamine, like Vyvanse or Adderall) and non-stimulants (like Strattera). 

Additionally, if hormonal changes are at play, you might need to consider other medications as well. Dr. Jeanette recommends connecting your OBGYN and the psychiatrist handling your ADHD prescriptions if at all possible. Finding the right medication treatment combination can be challenging and might take trial-and-error. 

Tips For Moms Coping With ADHD

Whether you have an official ADHD diagnosis or you suspect ADHD, there are ways you can cope with the challenges more easily and tools to assist with executive functioning. 

Dr. Jeanette joked that the first six months after an ADHD diagnosis is essentially “planner therapy.” A single planner can help you keep track of what needs to be done and stay organized. (But she cautions against trying to use multiple planners or fall down the rabbit hole of all the options and tools—it’s just more to keep up with.)

She recommends staying very focused on prioritizing. Asking yourself repeatedly what are the most important tasks and setting those priorities in your planning can help you avoid getting sidetracked or freezing up from overwhelm. 

Dr. Jeanette also recommended multiple clocks and visual tools. Time blindness, difficulty perceiving and managing time, is very common with ADHD. You might find yourself fixated on something with no awareness of how much time has passed (or what you’re about to be late to). Having clocks on display and visual reminders can help you stay on track. 

Most importantly, be self-compassionate and forgiving. Moms with ADHD can find themselves feeling ashamed when they fall short of the “perfect mother myth.” But being a good mom doesn’t mean keeping a tidy home or baking goods for the baked sale from scratch or enrolling your kid in all the activities that add more to-dos to your plate. 

It’s okay to struggle or forget things. It’s okay to need to reevaluate and build new tools in place to help you remember things. It’s okay to opt out of some household labor that’s less important than others. And it’s okay to choose the path of ease. 

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Remember, your kids don’t need a perfect mom—they need you! 

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Maybe that means takeout for dinner or storing clothes in bins instead of folding them or keeping toys more minimal—whatever helps you function. Remember, your kids don’t need a perfect mom—they need you (and they need you to be happy and care for yourself). 

‍If you are struggling and you need mental health support, our therapists are here for you. Book a free 15 minute consult today!