Research – Pilot Study – Treating Women with PMDD and ADHD: A Pilot Study

Maxime de Jong, MD, , Dora Wynchank, MD, PhD, Emma van Andel, MSc,, Marieke Michielsen PhD, prof. J.J. Sandra Kooij, MD, PhD, PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands; Amsterdam UMC, VUMC, Dept. of Psychiatry, Amsterdam, The Netherlands;  Antes Elderly, Rotterdam, The Netherlands

Introduction – While psychostimulants are the mainstay of Attention-Deficit
Hyperactivity Disorder (ADHD) treatment, multi-modal treatment improves treatment effect. This includes psychoeducation, psychotherapy and skills training. We propose that the periods of reproductive hormone fluctuation
(menstruation, pregnancy, menopause) are neglected in (treating) women with ADHD. We have previously shown that hormonal changes impact and exacerbate ADHD symptoms and associated mood disorder.

Implementing practical steps to accommodate these changes in daily life can improve the lived experience of many women with ADHD and hormonal related cognitive and mood changes.

Objectives – We created a treatment group specifically for women with
ADHD, premenstrual dysphoric disorder (PMDD) symptoms and self-reported, premenstrual worsening of ADHD symptoms. Here, we describe the group programme and assess the experiences of the first participants in order to further develop this group and help improve female ADHD care in general.
Six women participated (age 25-47, mean 36 yr).

Initially they described:
• difficulty relaxing;
• poor recognition of tiredness
• poor self-care
• (premenstrual) disordered eating in majority intensified ADHD/emotional dysregulation symptoms

After group therapy, they reported:
• Insight into hormonal effects / their own menstrual cycle helped them regulate their ADHD and mood symptoms
• Altering self-expectations per menstrual phase improved self-image and interpersonal communication.
In this qualitative descriptive study, we assess the experiences of participants of the first closed treatment group for women with ADHD and PMDD symptoms at PsyQ, The Hague.

Results 
Six women participated (age 25-47, mean 36 yr).

Initially they described:
• difficulty relaxing;
• poor recognition of tiredness
• poor self-care
• (premenstrual) disordered eating in majority intensified ADHD/emotional dysregulation symptoms

After group therapy, they reported:
• Insight into hormonal effects / their own menstrual cycle helped them regulate their ADHD and mood symptoms
• Altering self-expectations per menstrual phase improved self-image and interpersonal communication.

Conclusion – From this pilot study, we note an improvement in both ADHD
and PMDD symptoms in women.
• Future content should include a pharmacotherapeutic approach and focus more on disordered eating during the menstrual cycle (prevalent within our group).
• We suggest developing similar groups for perimenopausal and postnatal women with ADHD.
• Greater understanding and developing coping tools appear to improve social-emotional wellbeing, and increase selfawareness and self-acceptance.

Explanation and discussion provided feelings of relief, reduced shame & allowed for increased self-acceptance.

References:
1. Faraone SV et al. The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the
disorder. Neurosci Biobehav Rev. 2021 Sep;128:789-818. doi: 10.1016/j.neubiorev.2021.01.022. Epub 2021 Feb 4. PMID: 33549739.
2. Arnold LE et al. Effect of treatment modality on long-term outcomes in attention-deficit/hyperactivity disorder: A systematic review.
PLoS One. 2015;10:1–19.
3. Dorani F et al. Prevalence of hormone-related mood disorder symptoms in women with ADHD. J Psychiatr Res. 2021 Jan;133:10-15.