by Anne Eglash MD, IBCLC, FABM
Should mothers be treated for attention-deficit hyperactivity disorder (ADHD) during breastfeeding? ADHD is common, occurring in approximately 2.5% of adults. Typical symptoms, starting in childhood, include difficulties with attention, disorganization, and hyperactivity along with impulsivity. Females tend to exhibit fewer hyperactivity symptoms as compared to men, so women with ADHD often are under-diagnosed compared to men. People with ADHD have a higher risk of depression and anxiety along with other psychiatric disorders. According to a recent review in the Journal of Midwifery and Women’s Health, untreated ADHD symptoms may affect women at times of more stress such as pregnancy and childbirth.
Based on the authors’ literature review in this week’s article, what do you think are accurate statements regarding ADHD, parenting, and breastfeeding?
- Stimulant therapy does not help to improve adult ADHD symptoms.
- Stimulant therapy during lactation is contraindicated due to documented negative effects on infants.
- Mothers with ADHD symptoms have less effective disciplinary behavior.
- Mothers with ADHD symptoms have lower parental self-esteem.
- Effective psychosocial treatment options include cognitive-behavioral therapy, coaching on executive functioning and organization, and teaching patients to focus on self-care.
- Weight control is a common reason for misuse of stimulants among women.
See the Answer
Answers: C, D, E, F (not A or B)
Attention-Deficit Hyperactivity Disorder: Clinical Considerations for Women
Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by hyperactivity, impulsivity, and/or inattention. Women with ADHD represent a particularly vulnerable group, given their increased risk for psychosocial and parenting difficulties. Women’s health care clinicians should expect to encounter women with diagnosed and undiagnosed ADHD that may or may not be treated. Pharmacologic intervention, namely, prescription stimulants, is an important consideration for pregnant and breastfeeding women with ADHD, especially because the US Food and Drug Administration has determined that there is not enough information to confirm either harm or lack of harm to the developing fetus following exposure to these drugs. Due to the increase in use of prescription stimulants without a prescription, clinicians are also likely to encounter women misusing stimulants for a variety of reasons. This article provides an overview of ADHD diagnosis, outlines effective treatment options, and offers insight into the importance for clinicians to consider prescription stimulant misuse. Guidance concerning treatment of ADHD during pregnancy and lactation is reviewed.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
The importance of this article appears two-fold. First, we need to recognize adults who have symptoms of attention deficit disorder and help them establish a diagnosis and treatment. Secondly, we should not wait to restart a new mother’s medication for ADHD just because she is not back to work or school yet. From my point of view, caring for children has to be one of the biggest challenges for anyone who struggles with concentration, organization and impulsivity. This article points out that people who have untreated ADHD symptoms have poorer parenting skills. The struggles with parenting not only may increase their risk of depression, anxiety, and substance use, but there may be increased risk of psychopathology for their children.
Thus far, studies show that stimulant medications appear safe during lactation, although higher doses of stimulant therapy may reduce the milk supply, according to Lactmed. Levels of stimulant medication in breastmilk appear low.
This article also points out that psychosocial interventions may also aid in treatment of ADHD symptoms. Counseling may help individuals with strategies for control of impulsivity, executive functioning, organizational skills, and self-care to improve sleep, nutrition, and exercise habits.