Diagnosis & Treatment

Diagnosis & Treatment

Where do I get support?

Diagnosis should be done by a psychiatrist who is specialized in ADHD in women. Recommendations from one’s local ADHD organization or Support Group would be the ideal way to get this information.At the outset, the patient will be required to undergo a physical health check to rule out any other causes for her symptoms. The actual ADHD diagnosis includes completing questionnaires to determine if one’s symptoms indicate possible ADHD. Further questionnaires are also used to analyse mood, sleep patterns and emotional dysregulation. The psychiatrist typically will try to get information about one’s development as a child and adolescent and if school reports are available, s/he would be interested in seeing them. Above all, s/he would ask about the most debilitating symptoms that the woman being tested has had since reaching adulthood.

In Belgium and Germany, the Composite Scale of Morningness (CSM) is used as a way to evaluate circadian rhythm patterns in people being tested for ADHD. Sleep disorders are one of the most commonly self-reported comorbidities of adults with ADHD, affecting 50 to 70% of the population. A team of British researchers set out to see whether this association could be further confirmed with objective sleep measures, using cognitive function tests and electroencephalography (EEG). Asherson, Philip, et.al. “The Key Role of Daytime Sleepiness in Cognitive Functioning of Adults with ADHD” (European Psychiatry (2020),  in: ADHD and Comorbidity.)

Are you a morning person?

The Composite Scale of Morningness (CSM) 

1. Considering only the pace of life that suits you best, what time would you get up with complete freedom to organize your day?

2. Considering only the rhythm of life that suits you best, at what time would you go to bed knowing that you are entirely free to organize your night as you wish?

3. In adequate conditions (favorable environment, without particular constraints, etc.), how easy is it for you to get up in the morning?

4. How awake do you feel during the half hour after waking up in the morning?

5. How tired do you feel during the half hour after waking up in the morning?

6. You have decided to play a sport. A friend suggests that you do an hour-long session twice a week. The best time for him is from 7 to 8 in the morning. Considering only the rhythm that suits you best, in what form do you think you would be?

7. What time in the evening do you feel so tired that you have to go to sleep?

8. You must be at your peak performance for a written examination which lasts 2 hours. You are free to choose the time you think is most effective for you. The best time for you would be:

9. We often hear it said that one person is a “morning” and another an “evening” person. Which are you?

10. What time would you get up in anticipation of an 8-hour workday that you are completely free to organize?

11. If you still had to get up at 6.30 am, how would that seem to you?

12. After a good night's sleep, how long does it take to be fully awake??

13. In which part of the day are you most active?

One or more of the questions remains unanswered. Please make sure you've answered all the questions before pressing submit!

Your Morningness Score is /55

Measured as the theta/beta ratio, EEG slowing is a widely used indicator in ADHD research. While it occurs normally in non-ADHD adults at the conclusion of a day, during the day, it signals excessive sleepiness, whether from obstructive sleep apnea or from neurodegenerative and neurodevelopmental disorders. Coffee reverses EEG slowing, as do ADHD stimulant medication.

The first-line medication that is approved for adults who are diagnosed with ADHD in both Belgium and Germany is methylphenidate based. While this is not a cure-all, it definitely changes the lives of most people who are prescribed this medication after being diagnosed. At the same time, it is highly recommended that most newly diagnosed adults get cognitive behaviour therapy (CBT) to help them reverse any negative survival strategies that they have developed in the interim. They usually need an ADHD coach too to help them with organizational issues. A good ADHD coach helps move the newly diagnosed woman forward in a more regulated, organized and confident way so that new habits and perspectives are formed. This can be a life-changing experience for a newly diagnosed woman.

Other Treatment Options

Medication alone is not the best way to treat ADHD; there have been a lot of studies done about this and it has been shown that the best results are attained when medication is accompanied by Cognitive Behavioural Therapy (CBT) or another therapy suitable for individual patients as well as ADHD coaching (www.chadd.org/coaching). This is especially important when women are only diagnosed in adulthood because they are likely to have used a variety of unhealthy survival strategies by that time and need to systematically wean themselves off these; CBT is the best way to do this and adults respond very well to this form of therapy, especially when coupled with Mindfulness techniques. This is the gold standard for ADHD treatment. 

Antonia Dittner, John Hodsoll, Katharine Rimes, Ailsa Russell, Trudie Chalder (2018): “Cognitive Behavioural Therapy for Adult Attention-Deficit Hyperactivity Disorder: a Proof of Concept Randomised Controlled Trial”

Cognitive Behavioral Therapy and the Treatment of ADHD” in: Interview About CBT With Dr. J. Russell Ramsay by Keath Low, updated on 13 January 2020 (www.verywellmind.com)

Another therapy that has gained ground in the last 20-25 years in Belgium is Neurofeedback. Usually this therapy is in the form of a video game, music, or movie. During a neurofeedback session, what your brain is actually doing is compared to what you would like it to be doing. When your brain is nearing a more comfortable state, you are rewarded with a positive response on a computer screen. Much like physical exercises develop specific muscles, the more your brain is exercised into reaching a more comfortable, more efficient position, the better it gets at it. As with learning any new skill, it simply requires time and repetition. Martijn Arns, Hartmut Heinrich & Ute Strehl (2014): “Evaluation of Neurofeedback in ADHD: The Long and Winding Road” (Biological Psychology, vol. 93; pgs. 108-115) 

The long-term goal is that the Neurofeedback would lead to being able to function without medication. Results are seen at first about six months after completing treatment and these improvements seem to continue to evolve up to two years after completing treatment. At some point after this, it is usually necessary to have supplementary treatment. To find out more about how Neurofeedback treatment is done in Belgium, read: “Neurofeedback and State Regulation in ADHD by Dr. Van Den Bergh, MD, Psychiatrist and Psychologist. It is not a first-line treatment for ADHD in Belgium, rather a complimentary one. Like everything else, it works better for some people more than others. Van Doren, J., Arns, M., Heinrich, H., Vollebregt, M. A., Strehl, U., & K Loo, S. (2018). “Sustained Effects of Neurofeedback in ADHD: A Systematic Review and Meta-analysis” (European Child & Adolescent Psychiatry. doi:10.1007/s00787-018-1121-4)

Ryan, M., Brown, T., Vollebregt, M. A., & Arns, M. (2019). “What’s Sleep Got to Do with it? Circadian Rhythm sleep Disorder, ADHD and Neurofeedback” (Asia Pacific Journal of Neurotherapy, 1(1), 85-98).

Nutrition is also a very important element in managing ADHD symptoms. Eating a balanced diet with plenty of brain-friendly food and avoiding sugar as much as possible are key to this. There are a number of books about nutrition that focus on incorporating certain types of food into your diet forever rather than going on a diet for a specific amount of time and this is the best way to approach the topic of a balanced diet.

Examples of books with this positive message are: Rudolph E. Tanzi, Ph.D. and Deepak Chopra, MD: “Super Brain: Unleashing the Explosive Power of Your Mind to Maximize Health, Happiness, and Spiritual Well-Being”

Dr. Stephen Gundry, MD: “The Plant Paradoxand “The Plant Paradox Cookbook” plus “The Plant Paradox Family Cookbook

Dr. Nicholas Perricone, MD: “The Perricone Promise” and “The Perricone Prescription”

Exercise and sporting activities have a positive effect on one’s overall physical and mental health, from raising levels of serotonin to reducing cholesterol and building a healthy body. The feel-good factor that accompanies exercise of any kind is evidence enough of this. What if you were to incorporate exercise into your daily routine 24/7? Can you imagine what it would do for your mood, your outlook and your self-esteem? It would not have to be very strenuous exercise for lengthy periods each day; there is plenty of research that shows that simply walking for 30 minutes each day can do wonders to one’s mind and body.

Last but not least, Sleep Therapy is an essential element of ADHD management, given that so many people who have ADHD experience sleep problems – getting to sleep, staying asleep, difficulty getting up in the morning, quality of sleep no matter how many hours that they sleep, etc.

In fact, this type of therapy should go to the top of the list because sleep deprivation exacerbates ADHD symptoms significantly and correlates strongly to unhealthy eating habits and obesity. If you suffer from these problems, you should get tested for Obstructive Sleep Apnea and follow the advice given to the letter. For further research about sleep and ADHD, see: Bijlenga, D., Vollebregt, M. A., Kooij, J. J. S., & Arns, M. (2019). “The Role of the Circadian System in the Etiology and Pathophysiology of ADHD: Time to Redefine ADHD” (Attention Deficit and Hyperactivity Disorders, 11(1), 5-19. doi:10.1007/s12402-018-0271-z).

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