ADHD & Women with Patricia O. Quinn M.D. - Webinar

ADHD and Women Webinar

For the last decade, Dr. Quinn has devoted her attention professionally to the issues confronting girls and women with ADHD. In 1997, she co-founded the Center for Girls and Women with ADHD in Washington, DC and since that time has written several books on this topic.

Her latest book 100 Questions & Answers About Attention Deficit Hyperactivity Disorder (ADHD) in Women and Girls (available on Amazon) is perfect for a woman who has been diagnosed with attention-deficit hyperactivity disorder (ADHD), or the parent of a girl with the condition, this book offers help. This book provides authoritative, practical answers to common questions about this disorder. It presents important information about common symptoms, the diagnosis process, management, and sources of support for women and girls with ADHD. An invaluable resource, this book provides the necessary tools for anyone coping with the emotional turmoil caused by ADHD.

Video Clears Up Around 1 Minute Mark

Transcript

Why is it that so many women don’t get diagnosed until much later in life, if at all and what are the results of that?

First of all we find that women don’t get diagnosed because they really work very hard to compensate for their ADHD symptoms and not let anyone know what’s going on, they really suffer silently

You have to have problems with attention, concentration, focus, so you have the same symptoms that a male has in order to have ADHD, but those symptoms may manifest differently and as I said girls and women tend to compensate, they may develop perfectionist qualities or tendencies, OCD like tendencies, where we say women with ADHD stay in the closet longer, it’s a messy closet but they stay in there and don’t let anybody know about their ADHD.

I find often that women, particularly women with higher IQs or women who are good at getting help, adolescent girls tend to work with their moms or someone else and get their needs met, so that they continue to stay up late doing their homework, recopying, reading things over and over and over again and that’s why they continue to do well academically in school and may not find out they have a problem till they get to college or university when the time management becomes an issue for them.

For a lot of women we find that the symptoms don’t manifest, they’re able to cope with the symptoms by staying out very late and working very hard, but as the stressors outnumber dual careers and families, more children added to the mix, more responsibilities we find that when these stressors outnumber the ability to cope women can start to have more problems and wonder what’s going on here.

We also find that hormones play a role in this, so that hormones as they start decreasing, as a women ages, estrogen particularly affects their ADHD symptoms, and then the third piece that I think is really important and why women don’t get diagnosed until much later is again related somewhat to the compensation, but it’s really the coexisting conditions that they develop.

Women and Anxiety

Some women or some girls very early on get anxious because of their ADHD symptoms. We see them because their symptoms rear their ugly head and cause them to forget projects or be embarrassed and humiliated in front of other people.

These girls and women may develop anxiety and if you lose something or forget something you may start saying well I might have a test tomorrow that I don’t know about or maybe there’s something that I’m missing or forgetting so they start checking and rechecking and going over things and develop some anxieties.

When you talk to them about their anxieties they’re about specific issues, not just a free-floating general anxiety. They can tell you what they’re anxious about, I’m anxious because I’m always forgetting things, or I am anxious because I can’t get things done, or I’m anxious because I can’t do what everybody else can do.   So they can talk about why they’re anxious but they develop anxiety.

Women and Depression

The second piece is depression that we see, girls and women very often become demoralized by their ADHD symptoms, they develop low-grade chronic depression which is called Dysthymia, and other people, professionals, mental health professionals are very good at recognizing depression and the woman gets diagnosed with depression and gets treated in a lot of times, but no one thinks ADHD, they think depression, anxiety but no ADHD.

So again I find that is really a primary reason why women don’t get diagnosed. I’ve seen many women over the years who say to me Dr. Quinn I’ve been in therapy for seven years now, I’ve been on five different antidepressants, don’t go there, something else is wrong with me.

So we can see how this can mask and prevent their getting diagnosed for a long time and it’s unfortunate when we did a survey of high school girls with ADHD we found that 15% of them had been placed on an antidepressant prior to their ADHD diagnosis compared to only 4% of males who have been placed on an antidepressant. So three times as many females compared to males have been put on an antidepressant.

So you can see that there’s a lot of factors that prevents the diagnosis, again may not look the same, may not manifest the same, women may be compensating for it, not seek help but then as their symptoms kind of overwhelm their ability to cope.

The True Desperate Housewives

I was once asked about women with ADHD and I said you know they’re the true Desperate Housewives. So when we talk about what are some of the complaints of women with ADHD one of them is that they really can’t accomplish what other people seem to be able to accomplish.

That they can’t get ordinary household tasks done, they may have to wait till everyone goes to bed and the house is quiet in the evening, again staying up very late because they need to do all those things and organize through the evening hours into the early morning sometimes. So we see that is a particular problem.

Dr. Nadeau always says she wants to write a paper on the women who are all but dissertations, ABD’s who when you a structured program you can follow in graduate school, you can take the class, the next class, the next class, and you can study and stay up late and get things done, but when you have to then do original research, have a lot of organizing your own time organizing your own research, getting it in, getting it done, getting that dissertation written, there just impossible tasks for them to accomplish.

So either whether it’s in education or whether it’s in their career or whether it’s at home as far as being a housewife we see that as the kind of ante is upped, it’s more difficult for girls and women to be able to accomplish.

Coexisting Conditions and ADHD

When we talk about the aspects of coexisting conditions and ADHD I want to just talk about bipolar disorder quickly and then we can talk about aging, menopause, hormones.

Let’s just quickly talk about bipolar disorder because often again women are misdiagnosed as having bipolar disorder, instead of their ADHD getting diagnosed particularly if they’re hyperactive or people may think they’re Hypomanic or manic.

Quickly, you can have ADHD and bipolar, it’s important to treat the bipolar first then treat the ADHD because if you don’t treat the ADHD you’re going to continue to have symptoms and problems. One of the things though that I like to do is help differentiate and I say you know be a good consumer, if someone diagnoses you with bipolar disorder go to that DSM for the Diagnostic and Statistical Manual, rip out the page, bring it to the person who’s diagnosed you and say okay here’s the criteria for bipolar disorder, why do I have that?

The differences are ADHD is always there, it’s pervasive it affects all aspects of your life, it’s been there for many years, whereas the manic phase of bipolar disorder comes and goes, is very short-lived. Again, another difference that we see in bipolar and ADHD is genetic history of bipolar disorder, also sleep differences, people with bipolar disorder may not sleep when they’re in a manic or Hypomanic phase. They don’t need to sleep.

For women with ADHD as we’ve been talking about they don’t get enough sleep, they may have a sleep disorder, they may stay up very late to get things done but they need sleep, they wish they could sleep, so it’s again the need for sleep is also another differentiating factor that we can see.

Let’s move along now and talk a little bit about the life of a woman with aging and something that everyone wants to talk to me about and that’s menopause and hormones.

Menopause and Hormones

I talked a little bit about why the symptoms of ADHD worsen in women as their Estrogen levels decrease. I just want to give you a little bit of biochemistry first.

We never knew that the brain was a target organ for Estrogen. For many years we thought it was just the ovaries, uterus, etc. now we know skin, other organs are affected, bone, calcium, being put down in our bones. We also know that the brain is a target organ for Estrogen now, and there are cognitive deficits associated with menopause, I’m not going to talk about those, but the point that I want to make now is that when we see dopamine and serotonin, which are mono amines in the brain which are neurotransmitters, we now know that about twenty or thirty percent of the amount of the transmitters we have are the direct result of enhancement by estrogen, enhancement of their release by Estrogen.

For men, they have the same amount of Estrogen every day of their lives through till they are maybe in their 70s and 80s because their androgens, their male hormones are being converted by their liver to Estrogen.

For females there are monthly cyclical fluctuations as well as a decrease as you enter Perimenopause and menopause. Your hormones, your Estrogen, start decreasing about ten years before you go into menopause.   So that’s why in the 40s we see women start having more problems.

As your Estrogen decreases your brain dopamine decreases. You already have a problem with brain dopamine if you have ADHD. So we see ADHD symptoms worsening as a woman enters menopause.   We also see that monthly with hormonal fluctuations, so that the week before your period your ADD symptoms may be worse, or your meds don’t work as well as they did before.

So what we very often see for women with ADHD is a premenstrual magnification of their ADD symptoms, so their symptoms get worse, and I tell all women you need to look at this for two consecutive months and pick out five symptoms, rate them, rate them everyday for those two months, one being a good attention span four being a terrible attention span, one being in a good mood, four being depressed, and if you see you’re getting all four and irritable and disorganized.

So if you see everything getting worse before your period you may want to increase the dose of your medicine for that week, your stimulant medicine, but you also may want to think about evening that out with hormones. Now if your pre menopausal and well into puberty, we don’t do this early in puberty but if you’re well into puberty and menstruation what we do is we sometimes use oral contraceptives that have a very high Estrogen content.

Sometimes we even use Estradiol patches for a period of time and then have one 10-day period of Progesterone that we add to that to protect the uterus from cancer risks, and that you only get four periods a year and you’ll need to deal with this four times now instead of 12 or 13 times a year.

So we do that for women who are in menopause we or close to menopause we think about hormone replacement therapy, which does definitely help but again you need to discuss this with your physician, there are lots of pros and cons about hormone replacement therapy, but again Estradiol which is the pure Estrogen does help.

Soy has not been shown to help, it can help hot flashes and other symptoms of menopause but does not help with any of the cognitive symptoms. So some of the other flavonoids and some of the other remedies don’t seem to help with these neuro biochemical changes with the dopamine and it’s really Estrogen or Estradiol whether it’s compounded for your particular situation or whether it’s the estradiol patches that are available.

We also see depression, premenstrualy and in menopause as a result of the lowering Estrogen and subsequent lowering serotonin. Again, treatment with Estrogen helps also treatment with omega-3s are very important, that’s another aspect that I do recommend all women take omega-3s as well to help with some of that.

So I think we need to make sure that we understand the Estrogen connection as far as our symptoms worsening, to get treatment for it if necessary, increasing meds if necessary, but knowing that this is what’s going on, knowing that this is what you’re dealing with, and then it’s a much more complicated picture when we’re dealing with ADHD in a female than with a male, and make sure that whoever you’re seeing for your treatment of your ADHD understands ADHD in women and understands this hormonal connection.

I think again when you’re talking about this, there is a monograph on our website, there’s hormonal fluctuations and its effect on women with ADHD, you can get that, print it out, bring it to your therapist and help him or her understand.

I Was Diagnosed Later In Life – I Feel Like I Wasted My Life

How do you cope with the feeling that you wasted your life when you could have been so much more productive if someone had known? First of all I love working with ADHD because it’s such a hopeful diagnosis, once we make the diagnosis there’s lots we can do about it and people’s lives really do change. A lot of women become very sad when they get depressed or some become angry just for the reason that this question that this woman sent in, about the fact that often.

One woman I remember became very angry and I said ‘well why are you angry?’ and she said ‘well my brother was diagnosed when he was seven and he’s CEO of a multi-million dollar company now what could I have been if I had been diagnosed when I was seven?’ I think at that point we really do need to go through the stages of grieving with anger and depression and dealing with it, but you know no matter when we’re diagnosed we can go forward from there. We may need to make some amends for what happened in our past or we may need to look at what’s going on, but we can go forward with the understanding and the hope that things can change for us and we don’t want to dwell in the past. We do want to continue to set goals and to get help for our ADHD and our ADHD symptoms which is again very, very, important.

Why Doesn’t My ADHD Medication Work as Well as it Used To?

I think again another part of that question is why is it that it seems like my ADHD medication does not work as well as it did in the beginning. Again there’s lots of reasons why we see fluctuations in the response to medication. Sometimes it’s just that you see it’s so different, the change from when you’re not working on medicine to when you are is so great that as you go along you kind of get used to the new you and you don’t feel like there’s as much of a change.

Also if you started taking meds before you went into Perimenopause your meds may not be as effective as your estrogen levels start to go down and you may need to increase the dose or do other things. So again there’s lots of reasons why your meds may not be as effective as you age or as you get further from the area of diagnosis but I think that thinking about targeting symptoms is extremely important, so you can assess what’s going on.

What Does Targeting Symptoms Mean?

When you’re diagnosed Dr. Nadeau and I put together something called the sasi. It took me a long time to think of that name SASI, a sassy woman’s rating scale and it means the Self-Assessment Symptom Inventories  (pdf auto download). SA self-assessment symptom inventory the sassy, and we put together that tool because it helps women look at all areas of their lives and rate what they were like in the past, what symptoms they have now, childhood symptoms versus adult symptoms, and then target areas where you’re having problems.

You can then go on by using this instrument to set up this is what I want to work on now, my organizational skills, my time management skills, my distractability, my attention and focus, my impulsivity, my distractability, whatever comes up that you see is a problem area for you, you and your therapist can work with this form, this rating scale, it’s not diagnostic it’s really meant to be used as part of an interview process and finding areas and target symptoms that you need to work on.

Then with medication, with coaching, with working in other areas you can see by taking this again, gee that area is getting better and you can rate the various symptoms and it’s very important to have some accountability, some form you don’t have to use that scale, but to have some form either the one that you’re diagnostician used when he diagnosed you, but some form that you can look at symptoms and measure how they change over time depending on what you’re doing.

So again, rating whether your medication’s effective or not by looking at these target symptoms and then going on and see ‘okay we’ve got indestructibility taken care of, what about time management? I’m always late, I’m always procrastinating, let’s work on that now’. That they not be with medication, that may be with working with a coach, with setting up goals for poor estimation etc.

Is it Normal to Not be Able to Remember Things Without Writing it all Down?

Absolutely, and not only because you have ADHD but again as you age there are cognitive deficits and working memory deficits associated with menopause, and with word retrieval, you can’t remember your name, anyone else’s names and we also have difficulty with working memory and recall of information, short-term recall particularly.

So one of the things that is important with ADHD is to understand that you need to write things down to help organize yourself.   To-do lists are very important, but these are, again, coping strategies that we can continue to use. You know, you may be so distractible you forget what you were doing.

You know a lot of us with ADHD, I know I have four children three of whom have ADHD, but I have one that I call Mr. Distractible, and I called him that when he was three years old, you know. You go upstairs and you say, you know what am I doing here? I can’t remember why I’ve just come upstairs. So you maybe, or you feel like that my son I’d send him upstairs to get dressed and I go upstairs to be playing and I’d say why aren’t you dressed? and he’d say oh that was what I was doing, he got distracted by something else.

I always said doing laundry should be a diagnostic criteria for women with ADHD, lots of steps, you have to go, come back, go away, come back, again and … you know. I think we could use how many times did you have to wash the same load of laundry as probably a diagnostic tool for ADHD for a lot of women. So these tasks that we have to remember and we get distracted from are very difficult for us, so writing things down is a tool that really helps.

What Are The Cognitive Deficits of Menopause?

I want to go back though and talk about menopause and the cognitive deficits of menopause. I always say there’s no such thing as adult onset ADHD, you have to have had symptoms, not before the age of seven for girls particularly, but by the time you’re in high school.

So by the time you’re a teenager, well into your middle school, high school year, so 13 14 15 we absolutely see symptoms that have already established themselves by then; trouble paying attention, trouble with distractability, trouble with interpersonal relationships, not being able to make and keep friends, arguing, being bossy, being stubborn, impulsivity, acting without thinking, making poor decisions, having poor problem-solving skills.

We’ll see these very early on and be able to say, okay I’ve always had trouble with paying attention. I remember I diagnosed a 68-year-old woman once and when I was taking her history we were asking for symptoms early on and she said “Oh Dr. Quinn I remember when I was four I used to peel off the wallpaper, color underneath and stick it back so my mother wouldn’t know” and I went ah ha symptoms before the age of seven.

We have problems with cognitive functioning resulting from menopause and those are working memory difficulties, word retrieval problems. So you can’t remember the names of things and you have difficulties again with remembering what you’re doing so that you have some of the symptoms of paying attention that look like ADD, but there’s no such thing as adult onset ADHD, it probably is the cognitive deficits associated with menopause which early on may respond, women who take a hormone replacement therapy early very close to when they start menopause.

Those women tend to do very well cognitively. If you wait too long and have a too long a period while you’re in menopause starting hormones later will not help those cognitive deficits.

I Have two Grown Adult Children, one works on Wall Street and the other in Japan they have no signs of ADHD. Does it Skip Generations?

Well I presume you have ADHD if you’re asking that question, well it’s not directly inherited in the sense of its dominant and that when one person has it every person has it in the family, although there are families who every child has ADHD as well.

We say there’s about a 60% chance for every child you have, not sixty percent of your children, but every time you’re pregnant there’s a 60% chance that that child may have ADHD. So if you have two children who don’t seem to have ADHD you lucked out in both of those drawings as far as that’s concerned. So they may not have ADHD.

The other thing that I want to talk about is again if they’re very bright and very intelligent and if they choose careers that are ADHD friendly you may not see signs of ADHD.

What’s an ADHD friendly career? Working on Wall Street you need to take risks, people with ADHD love to take risks, it’s very stimulating, very exciting all day long. People with ADHD love excitement, love to be stimulated, you can forget what happened yesterday, you’re very good at forgetting what you should be doing and what just happened. So you lose you know a million dollars of your portfolio, you can go on and keep going and the next day go right ahead and buy and sell again.

So Wall Street we have found there are a lot of people with ADHD just like there are a lot of entrepreneurs, a lot of EMTs, a lot of firefighters, a lot of people in very daring professions have ADHD because it’s stimulating for them, they can use their positive traits and the negative traits don’t matter, being distractible, risk to being a risk-taker is great if you’re on Wall Street.

So again your son or daughter whoever it is on Wall Street hopefully we have girls on Wall Street too, women.   Your son or daughter who’s on Wall Street may have just chosen an ADHD friendly career and that’s what we hope for everyone, play to your strengths, find what you do well and when someone with ADHD chooses something they’re passionate about you can’t stop them you can’t hold them back. So again I wouldn’t say you may not have any signs, he just may be using them to his or her advantage.

I get Tons of Exercise and Eat Sensibly But I Can’t Lose the 20 pounds I put on when my Thyroid Went South. You once spoke of the Connection with ADHD, what should I know?

I think the first part of your statement is extremely important, then we’ll get to weight loss in a minute. In addition to an ADHD friendly life career we would like you to have an ADHD friendly lifestyle. That’s a healthy lifestyle for everyone. What is it? Eating well, eating healthy, eating good foods, taking those omega-3s, calcium, sometimes zinc. Children with ADHD have been found to be low in zinc when they studied it, and then getting lots of exercise very important.

We know that as John Ratey has said in his book Spark and lots of other people knew that exercise both improves mood and decreases hyperactivity. Also out-of-doors, green time increases your mood, decreases your hyperactivity, not specifically ADHD related, hyperactivity in general. So lots of exercise, eat sensibly.

Now thyroid is associated with ADHD, we can see subclinical hypothyroidism associated with some ADHD symptomatology and we do recommend again thyroid replacement therapy for those women in associate with some cognitive deficits worsening of your ADHD. So again if your thyroid is a little bit out of balance, may not be clinically yet hypothyroidism but it’s almost there that’s an issue.

Hyper or increased thyroid is associated with hyperactivity but again we’re talking here about low thyroid increasing ADD symptoms, increasing cognitive symptoms, responding very well to thyroid replacement therapy and you may have put on some weight.

I also want to talk just about eating disorders and weight with women with ADHD. We know John Fleming up there in Toronto in his obesity clinics found that there were about forty percent of individuals who had high BMI who were very, very overweight who had difficulty losing weight it’s probably because about 40% of them had ADHD undiagnosed and what we find is that impulsivity is associated with binge eating and eating disorders in women with ADHD.

Women also eat for stimulation, women with ADHD also eat because they’re bored, or not feeling well, they eat a lot of carbs. So again and when you ask them to follow a diet plan, plan there’s the word they can’t stick to it.

They don’t have Plan B, you have to have the food in the house, you have to go to the store, have to cook you have to

Prepare, you have to do all these things, it’s very hard to follow a diet if you have ADHD and they were distracted when they were eating. So they weren’t paying attention when they were eating and that some individuals who are obese morbidly obese with ADHD symptoms actually may eat 1,500 calories a day they don’t know about.

So again two studies retrospectively the Biederman did and Hinshaw’s follow-up of girls with ADHD and a survey doctor Nadeau and I did in 1998 found that women and girls with ADHD are at risk for eating disorders, particularly binge eating and compulsively eating or impulsively starting to eat and continuing to eat and not being able to stop, and then also having difficulty losing weight, so that maybe some of what’s going on.

What Tests for Low Thyroid Issues?

Thyroid tests, you can look at thyroid stimulating hormone TSH and t3 and t4, and you’re looking for your levels of t3 and t4 even if they’re in the normal range, if one’s high and ones low that’s what we kind of consider subclinical hypothyroidism and you still may need treatment for that. So the three tests you want your physician to do are TSH thyroid stimulating hormone, t3 and t4.

Do you have any opinions on the possibility of relationship of ADHD and Fibromyalgia?

I sure do and it would again women like you taught me about it initially but I’ve done some really, in our books we have chapters on ADHD and Fibromyalgia. I’ve worked some with Patti Stevens and what we see is if you have ADHD and you are not getting your symptoms treated, you’re chronically living under stress and because you’re stressed you’re stressing the hypothalamic pituitary access in your brain, again we’re getting back to the brain and because someone who’s existing under a state of chronic stress we can see that they get several disorders and these are usually chronic fatigue and we also see Fibromyalgia symptoms in these individuals.

So we see an association of ADHD and chronic fatigue and Fibromyalgia, and one of the things that’s significant to the treatment is you need to get your ADHD treated, and when you use a stimulant for the treatment of your ADHD many women report that their fibromyalgia pain significantly decreases or goes away.

I’ve had women tell me they know when their meds wear off because their Fibromyalgia pain comes back. So again I do have an opinion, I do believe there is an association between long undiagnosed ADHD and the development of Fibromyalgia and I do believe that when you treat the ADHD the ADHD stimulant also helps regulate the receptors and also the reception of the Fibromyalgia pain so you see some changes there with what’s going on. So there is an association between these symptoms.

I also want to go back to eating disorders, in treating eating disorders if you have ADHD. One of the things with eating disorders again that we found Dr. Dukarm, Carolyn

Dukarm who’s in Buffalo New York in an eating disorders clinic there, she has done some work with this and has shown when you treat the ADHD in an individual who has ADHD and eating disorders, when you treat the ADHD you’ll see that there is not only a decrease in the ADHD symptoms, so you’re not impulsively eating, you’re not distracted when you’re eating, so you can better pay attention to when you’re full, when you’re hungry, how much have I eaten, am I finished now. So you can pay more attention to the calories you’re taking in, but that the stimulants also decrease the urge to binge.   Not associated with the anorexia or appetite suppression and actually stimulants aren’t good appetite suppressants.

I have never found anyone who’s lost more than ten pounds on stimulants. Actually Adderall which is one of the treatments for ADHD formerly was Obetrol, it was a failed obesity drug it was Obetrol and it was a failed appetite suppressant.   It was put on the shelf and then someone said hey that’s a stimulant maybe we can use it for ADHD, and they dragged it out and repackaged it as Adderall and it became a treatment for ADHD.

So stimulants however can decrease the urge to binge not related to the appetite to decrease that sometimes seen and by the way the appetite decrease that we see doesn’t occur in everyone, only about 10% of the people and when it does occur it gradually decreases over the first three months of treatment.   So even if you see some appetite suppression initially that gradually wears off as well and you don’t see continued appetite suppression.

How does one access the SASI questionnaire?

That is available on our websites (automatic pdf download) You can purchase it take it to your therapist or mental health professional or healthcare professional and work with it.

When my Medication Wears off I Seem to Want to Eat Everything in the House

That’s what we’re talking about and I have worked with many women who have this issue. I remember working with one woman who was on a long-acting methylphenidate product, OROS Methylphenidate, she took that in the morning and then she took Strattera non-stimulant at bedtime and she said when her meds were off at four o’clock in the afternoon she just started eating and ate until she went to bed.

So I did talk to her therapist about giving her another medication at four o’clock in the afternoon to treat her ADHD and her urge to binge. No one with ADHD has a 12-hour day ADHD affects us 24 hours a day and for many of us we may need to treat our symptoms much longer into the night.

Women for example reported that when you treat their ADHD into the evening with continuous dosing, taking meds twice a day, taking meds three times a day, when you treat their symptoms into the evening they’re more efficient in the evening, they get their work done, they don’t need to stay up so late and many individuals with ADHD have trouble with sleep initiation, trouble falling asleep, and they have trouble falling asleep because of their ADHD symptoms and their meds have worn off and their ADHD is back in full bloom and you lie there with racing thoughts and you can’t fall asleep.

If you take your stimulant meds and if they’re working when you try to go to sleep you can fall asleep better. So women report they’re more efficient, they get to bed earlier, they can fall asleep, they get more sleep, they wake up refreshed in the morning.

Sleep deprivation, one night of sleep deprivation decreases your ability to pay attention the next day. So women with ADHD who are also sleep-deprived because they’re working, because they can’t sleep, because they have sleep disorders, also or worsening their ADHD symptoms. So we want to make sure that your symptoms, whatever they are even including your urge to binge are under control well into the evening hours.

Is There an Adjustment like for Depression Medication when one starts taking ADHD Medication?

I don’t know what you mean by adjustment. When one starts taking ADHD medications we usually start at a low dose and we gradually increase the dose. So we do see over time that we do need to regulate the dose and that takes anywhere from eight to ten weeks in a lot of people although you see symptoms decreasing they may not be at your most effective level or optimum treatment level initially with the first dose.

You may not see anything with the first dose and actually that’s good because you’re not seeing side-effects either. What we try to do is titrate and get the most effective level of the medication with the fewer side-effects that we can get.

So we try to titrate a balance between efficacy and side effects. As far as I want to talk about depression. Very often for women who have PMS or who have the worsening of depression prior to their period, who are already depressed, who have premenstrual magnification of their ADD symptoms you may adjust your dose of antidepressant medication the week before your period and we also may a the dose of your stimulant or whatever medication you’re taking for treatment of your ADHD the week before your period.

So we may need to do some adjustment of both your antidepressants, if you’re on them you also have to have some adjustment of your ADHD medication in relation to your menstrual cycle as well. So there may be some adjustment there.

I mentioned PMS a few minutes ago, one of the things I found again in studying women was that women with ADHD also tend to have more PMS symptomatology, which may need to be treated in addition to their ADHD.

So we may need to treat anxiety, we may need to treat depression. We may need to treat PMS with an antidepressant like Prozac, prior to a woman’s period to help her with these other issues that are making things worse for her.

I remember treating one high school senior and I’ve been treating her for years for ADHD, and she came in to me as a senior and she said Dr. Quinn I know you’re treating my ADHD and that’s fine she said but you know I really don’t care about my ADHD, you got to treat my PMS, I can’t stand myself and no one else can stand me. So again there are other issues that come in and that is something we need to make sure it’s being treated as well.

Why does Caffeine not Affect my Hyper-ness?

Caffeine is a stimulant, it’s not as good as the methylphenidate or amphetamines that we use for the treatment stimulants we use for treatment of ADHD. Also depending on how you’re delivering the caffeine to yourself, whether it’s in pill form whether it’s in coffee, whether it’s in sports drinks, you’re getting some other things with it. You’re getting a volume of liquid in your coffee and tea.   You’re getting tannins, you’re getting other your own diuretics that are there as far as you probably would have to drink the equivalent of ten cups of coffee at one time to get the amount of caffeine that you need, that’s accompanied by a lot of jitteriness as well.

So we don’t see caffeine affecting the symptoms of ADHD as well as the other stimulants. Caffeine is a stimulant it’s just not a very good one and it really doesn’t help. Now a lot of people try to self-medicate with caffeine, you know it does help alert you, it does help you stay awake, if you take enough and all of that but it really doesn’t help with the symptoms of ADHD, with the distractibility, the attention span, the hyperactivity.

Also when you’re on a stimulant I always say pay attention to how much caffeine you’re getting because if you’re getting jittery it may not be your stimulant, it may be the amount of caffeine you’re getting in addition to your stimulant. So you may want to decaffeinate yourself when you’re on medication for ADHD, if you’re on a stimulant.

What Natural Supplements Other than Omega-3s do you Recommend Especially for Menopausal Women.

Calcium is extremely important and vitamin D is important, not related to ADHD related more to menopause itself, but I definitely recommend Omega threes for women. I find that that’s the most important one for brain health as well, the others are more related to your bones.

What are the Implications if any for an ADD Afflicted person Who Drinks Alcohol?

Okay I’m glad you brought this up, it’s a very, very important point. We all use various substances no matter what they are to really help us. A lot of people who are very anxious will use alcohol to deal with their anxiety, you may use alcohol for various other reasons, but again you’re using these various substances to either deal with the effects of having ADHD. Again using beer or getting intoxicated is more for the stimulation, not for trying to calm yourself down.

Individuals with ADHD have a lot of addictive behaviours associated with their ADHD. So whether it’s food addiction, whether it’s alcohol addiction, whether it’s substance, whether it’s shopping, you don’t have good control, you’re impulsive, you lack impulse control and you have a lot of stressors and you have a lot of fallout, anxiety, depression is poor self-esteem.   Women with ADHD very early on get poor self-esteem.

So you have a lot of reasons why you may want to be using these substances for stimulation, for your self-esteem, to escape whatever we see a lot of addictive behaviors.   As a matter of fact in adolescence girls are at greater risk for substance abuse than boys with ADHD. So we see a lot more risk-taking behaviors in girls with ADHD.   So you may in shopping, we see a lot of women who are shopaholics, workaholics, we can develop a lot of addictive behaviours associated with our ADHD and it’s important to look at those in relationship to you’re seeking therapy.

Also if you’re on stimulants you don’t want to mix alcohol with your stimulants. So that’s again another reason to get help if you feel that you do have a problem with any substance or any addiction, whether its food or shopping.

Is there a standard dosage for omega-3s?

No, the ratio does matter, but I find that most of the products you can get over-the-counter are engineered to give you an effective dose for your omega-3 depending on… I know I take a gram in a capsule in the Lovaza capsules as far as that’s concerned, and I take four of those a day. So I take a lot of omega-3 but I think that you can talk to your health care professional about that, if you’re taking any supplement you should talk to your health care professional before you do that.

There may be reasons if you’re on anticoagulants that you should not be taking a lot of omega-3, there may be reasons based on cardiovascular disease why you maybe should be taking more omega-3s. If you are on antidepressants you should talk to your mental health professional about the fact that you’re going to be adding omega-3.

So any supplement natural or otherwise, vitamins anything before you take it and add it particularly if you’re already on prescription medications it’s very, very important to speak to your care professional about that.

In Summary

I think the most important thing that I can say is it’s never too late. That was one of our questions in the beginning, but if you have ADHD it’s very important to get a formal diagnosis and to work on a total treatment program, that may include Medications, but definitely an ADHD friendly lifestyle, an ADHD friendly career, making ADHD friendly decisions for yourselves and try to always operate in your green zone, things that you do well, to assess your strengths to assess your weaknesses.

ADHD isn’t all who you are, don’t define yourself by your ADHD, find out what you are all about, what you want to do, dream your dreams, go for it.

ADHD has lots of traits that will help you get there and as I said it’s a very hopeful diagnosis and once it is diagnosed there are lots of things you can do in addition to medications and lifestyle changes, working with coaches, working with professional organizers, getting things back on track for yourself and enjoying part of your ADHD that is you but enjoying also the rest of yourself and who you are, and the rest of your life and live well with your ADHD.