ADD / ADHD

What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a condition that features hyperactivity, inattention, impulsivity, or a mixture of these behaviors, at levels inappropriate for a persons developmental level. Typically, ADHD is recognized during childhood, often because of issues at school, and it frequently continues through adulthood. If you have an adult form of ADHD prior to becoming pregnant, you will probably continue having it during pregnancy and motherhood. In such cases, you are likely to experience emotional and cognitive effects, which could lead to, or exacerbate, any social problems or problems in your work or school. Particularly during pregnancy, recognizing ADHD for the first time can be difficult, since hormonal changes of pregnancy can have a major impact on how you feel and think.

There are three types of ADHD. In one type, inattention predominates over other symptoms. People with this type of ADHD tend to have difficulty listening to others and focusing on, concentrating on, and remembering to perform tasks, especially tasks that are routine. For adults, such tasks can include reports at work, lists, and shopping activities for the home, or for ones coming baby, paying bills, or going to doctor appointments. For those in school with the predominantly inattentive type of ADHD, problematic activities may include taking notes in class, practicing repetitive math problems, keeping a lab notebook in order, and following a lab procedure. Those students may also procrastinate or forget nitty-gritty requirements, such as registering for classes on time. They may also miss important information and comments from a professor or their fellow students. This type of ADHD is more common in females than males, although by adulthood it comprises most ADHD cases for both genders. Consequently, if you are pregnant with ADHD, in all likelihood you suffer from the inattentive type.

The second type of ADHD is the predominantly hyperactive/impulsive one. This is more common in males, particularly young males, and what it means is that the person has trouble staying still. She or he may be standing in a setting in which everyone else is sitting, for instance. If forced to sit, he may be fidgeting, playing with his fingers, moving legs, or tapping his feet. She may also get up suddenly and jump around or leave the room.

Finally, there is a mixed type of ADHD, also more common in males, characterized by the presence of inattention as well as hyperactivity and impulsiveness.

How common is ADHD during pregnancy?

ADHD is a fairly common condition, with an estimated prevalence in the range of 2 to 4.5 percent of adults. However, mental health experts suspect that most adults with ADHD are undiagnosed. Consequently, while there are no available statistics on ADHD specifically in pregnancy, the number of expectant mothers with the condition is probably quite high.

How is ADHD during pregnancy diagnosed?

ADHD is a clinical diagnosis, meaning that no laboratory tests or imaging scans are required. Patients are assessed by a mental health professional based on patient history, performance in school or work, and interaction with peers and family. In the context of historical information and performance, patients with suspected ADHD are interviewed and assessed to determine whether they meet a minimum number of criteria associated with ADHD. In the setting of an adult woman entering pregnancy, in most cases, the type of ADHD being considered is the inattentive type, the criteria of which are defined as follows:

• Lack of attention to detail — Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (eg, overlooks or misses details, work is inaccurate)
• Difficulty sustaining attention — Often has difficulty sustaining attention in tasks or play activities (has difficulty focusing during lectures, conversations, or lengthy reading)
• Difficulty with listening skills — Often does not seem to listen when spoken to directly (mind is elsewhere, even in absence of any obvious distraction)
• Difficulty with task completion — Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
• Difficulty with organizational skills — Often has difficulty organizing tasks and activities
• Difficulty with tasks requiring sustained attention — Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
• Frequently loses belongings — Often loses things necessary for tasks or activities
• Easily distracted — Often easily distracted by extraneous stimuli
• Forgetful — Often forgetful in daily activities

In deciding whether the patient meets the ADHD criteria, the mental health professional must make certain that the symptoms are not the result of a different condition, either medical or behavioral. Often, this can be difficult, as ADHD is frequently accompanied by other medical or behavioral conditions.

Does ADHD cause problems during pregnancy?

ADHD may be harmful to the mother and/or the baby by way of complications. In particular, certain forms of ADHD with impulsivity could be dangerous, as the complications include high-risk behaviors such as substance abuse (eg, tobacco), traffic accidents, and violence. The inattentive form of ADHD can be harmful as well, as it can lead to a mother-to-be to neglect her health. Risky behavior can also include indiscriminate, unprotected sexual encounters with increased risk of sexually transmitted disease (STD), which can infect the baby. Disease-causing organisms that may spread through unprotected sexual activity include human immunodeficiency virus (HIV), hepatitis B virus, hepatitis C virus, herpes simplex virus (HSV), human papilloma virus (HPV), Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum. Unprotected sexual activity has also been associated with unwanted pregnancy, the incidence of which is elevated among parents of ADHD children.

Does ADHD during pregnancy cause problems for the baby?

Potentially, any social disruption brought on by ADHD can have negative consequences for mother and baby. However, the propensity for physical harm from accidents is of particular concern, as is the risk of infection from a sexually transmitted disease. Furthermore, children whose conception was unplanned, and fathered by a partner whom the mother chose for sex on impulse are more likely to experience familial and social problems, and also to have ADHD themselves.

What to consider about taking medications when you are pregnant or breastfeeding:

• The risks to yourself and your fetus, if you do not keep your ADHD under control
• The consequences in your family life, if you stop your ADHD medication
• The risks and benefits of each medication you use when you are pregnant
• The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat ADHD during pregnancy?

Although there is a growing awareness that ADHD is common in adults, and although an increasing number of women are being diagnosed and treated for the condition during their childbearing years, very little is known about the effects of ADHD medication on the fetus and newborn. The first-line medications for this condition (medications that are tried first as they are usually effective and generally safe) are the stimulants dextroamphetamine and methylphenidate. A non-stimulant medication called atomoxetine also is offered to some patients ADHD.

There is no data from human studies from which we can draw any conclusions regarding the safety of atomoxetine during pregnancy or lactation. As for the stimulants, there are some data showing decreased birth weight in babies born to mothers taking dextroamphetamine, but in a drug abuse setting, rather than as an approved treatment for a diagnosed condition such as ADHD. One big issue with ADHD is that some individuals have obtained prescription stimulants by visiting healthcare providers and faking ADHD symptoms and lying about their histories. Sometimes, this happens in a drug abuse setting, but it also occurs among people who are seeking to use stimulants as nootropics smart drugs, medicines that are believed to enhance mental or physical performance.

As for methylphenidate, the few data that are available suggest that it does not cause birth defects. However, there may be a slight increase in the risk of spontaneous abortion, loss of a fetus or embryo early in pregnancy. It is very important to weigh this possibility of what could be a much greater risk of losing the pregnancy or delivering a fetus very early, due to inappropriate behavior resulting from stopping an ADHD treatment that has been effective.

As for the lactating mother, the small amount of evidence available suggests that only a tiny amount of the medications make their way into breastmilk if any.

Who should NOT stop taking medication for ADHD during pregnancy?

Given that the risks of taking ADHD medications at the proper dosage appear to be very low, particularly when it comes to methylphenidate, any mother-to-be who is performing well on her medication and would have a relapse of severe ADHD symptoms if the medication were terminated, should consider continuing her treatment.

What should I know about choosing a medication for my ADHD during pregnancy?

For the time being, since data are very limited, the most important thing to do is to select a pediatrician and make that pediatrician aware of your condition and medication. Maintain good contact with your pediatrician throughout your pregnancy, so that if any new information about ADHD medications becomes available, you, your mental health provider, and the pediatrician can decide on whether its best to continue or modify your current treatment plan.

Perhaps the most important thing to know about ADHD medications is that, while severe side effects and complications are rare, the most serious side effects of stimulant are cardiac effects. Particularly if not dosed appropriately for you, there is a slight chance that stimulants can affect your heart rate and blood pressure. If this happens, most likely, the effect will be small and not dangerous, but it is important to have your vital signs monitored after you begin drug treatment. Such drugs also can interfere with your sleep, thereby exacerbating any sleep difficulty that you already have on account of pregnancy.

You may find Pregistrys expert reports about the individual medications to treat ADHD here. Additional information can also be found in the sources listed below.

What should I know about taking a medication for my ADHD when I am breastfeeding?

Based on the limited studies available, exposure of a nursing infant to ADHD medications in breastmilk is minimal. If you are concerned, however, do not breastfeed. Although new mothers are encouraged to nurse, the benefits of breastfeeding over infant formula that are cited frequently are hypothetical. On the other hand, if you require medication to keep your ADHD in check, stopping the medication and trying to breastfeed at the same time will cause you unnecessary stress. This may lead to the return of symptoms, such as inattentiveness, that could lead you to stop breastfeeding anyway!

What alternative therapies besides medications can I use to treat my ADHD during pregnancy?

Various behavioral therapies and educational and occupational interventions are available to treat and manage ADHD. With mild cases, these therapies may be adequate, but generally they are most effective when used in combination with drug therapy, rather than a single mode therapy.

What can I do for myself and my baby when I have ADHD during pregnancy?

Stay in contact with your pediatrician and work with your mental health provider to optimize your treatment.

Resources for ADHD during pregnancy:

For more information about ADHDduring and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:

• CDC
• National Resource on ADHD
• Anxiety and Depression Association of America