When ADHD, Hormones, and Motherhood Collide: Are We Paying Enough Attention?
As a clinician, and as a member of a family with multiple females diagnosed with ADHD, it has long been apparent to me that hormonal changes can have a significant impact on the mood, cognition, and ADHD symptoms of some women. Research, unfortunately, has lagged far behind clinical and lived experience.
I remember organizing a panel on women with ADHD at APSARD in 2017. Hormones and ADHD were a hot topic among questions from the audience. Dr. Joseph Biederman, who had volunteered to join the panel, stated emphatically that there was no evidence that female hormones influenced ADHD symptoms.
At the time, he was correct: there was virtually no research documenting the connection. But women with ADHD and the clinicians treating them were already telling us that something important was happening.
Nearly a decade later, the research is finally beginning to catch up.
The evidence is complicated
A 2025 systematic review examining ADHD and female sex hormones found only 11 eligible studies. Overall, the evidence suggested a relationship between hormonal changes and ADHD symptoms, particularly during puberty and across the menstrual cycle, but the authors emphasized how limited the research remains.
More recent survey research reinforces an equally important point: women don’t all respond to hormonal changes in the same way. In a study of 600 females reporting ADHD, 70.4% of those reporting on the postpartum period perceived their ADHD symptoms as worsening postpartum. Yet cross-sectional ADHD symptom scores did not differ significantly across hormonal life stages, illustrating just how much remains to be understood.
This variability is crucial. Some women appear highly sensitive to hormonal fluctuations; others much less so. As in so many aspects of ADHD, we need to understand the individual woman rather than assume a universal female ADHD pattern.
Pregnancy and postpartum deserve particular attention
The postpartum findings are especially concerning.
A Swedish national registry study followed 773,047 women, including 3,515 who had been diagnosed with ADHD before pregnancy. During the first year after childbirth, 16.8% of women with ADHD were diagnosed with depression and 24.9% with an anxiety disorder. Compared with women without ADHD, the prevalence of both disorders was approximately five times greater.
A large U.S. study subsequently compared 13,588 women with ADHD with 474,789 women without ADHD. Women with ADHD experienced higher rates of several forms of psychiatric distress at six weeks and 12 months postpartum, even after adjustment for preexisting mental and physical health conditions and demographic factors.
And a 2026 Danish study of 363,904 mothers and 524,936 births found that first-time ADHD diagnoses declined dramatically during pregnancy but eventually rose above prepregnancy levels two to five years after childbirth. The investigators identified the postpartum years as a potentially important period for ADHD symptom worsening and recognition.
These findings should change the questions we ask.
What happens to executive functioning after a baby arrives?
Motherhood creates an extraordinary new executive-function load.
Suddenly there is chronic sleep disruption, relentless scheduling, constant interruption, competing demands, appointments, feeding schedules, household management, emotional regulation, and the responsibility for anticipating another human being’s needs—all with very little uninterrupted recovery time.
For a woman with ADHD, the problem may not be that her underlying ADHD has suddenly become more severe. The demands on her executive functioning may simply have exceeded her capacity to compensate.
Add sleep deprivation, hormonal change, possible discontinuation or reduction of ADHD medication, anxiety, and the enormous emotional adjustment to motherhood, and it becomes easy to understand why a previously successful woman can suddenly find herself overwhelmed.
Remarkably, we have very little prospective research measuring executive functioning in women with ADHD before pregnancy and following childbirth. We know even less about what happens after a second child, when the organizational demands become exponentially more complex.
These are questions begging to be studied.
Medication decisions need to consider the mother, too
For years, many women with ADHD were advised, or assumed, that stimulant medication should automatically be discontinued during pregnancy and breastfeeding.
The evidence today is more reassuring, although it does not establish that stimulants are completely risk-free.
A very large international study involving U.S. and Nordic populations found no increased risk of overall congenital malformations associated with amphetamine exposure. Methylphenidate was also not associated with increased malformations overall, although researchers identified a possible small increase in cardiac malformations.
Other research following children exposed to ADHD medication during pregnancy has found no increased overall risk of later neurodevelopmental or growth disorders after adjustment for maternal characteristics.
The question, therefore, should not simply be:
“Is there any risk in taking this medication?”
It should also be:
“What are the risks to this woman and her baby if we leave her ADHD inadequately treated?”
That is a very different clinical conversation.
Breastfeeding does not automatically require stopping ADHD medication
The lactation evidence is particularly reassuring for methylphenidate.
According to the NIH’s LactMed database, methylphenidate appears in breast milk at very low levels and has been undetectable in the serum of infants studied. LactMed states that when methylphenidate is needed by the mother, its use is not in itself a reason to discontinue breastfeeding.
Amphetamine preparations transfer into breast milk to a greater degree. However, available evidence has not demonstrated serious adverse effects at therapeutic doses, although the long-term neurodevelopmental evidence remains limited. LactMed notes that some experts consider therapeutic amphetamine compatible with breastfeeding when infants are monitored for irritability, sleep disturbance, and feeding difficulties.
These decisions should be individualized and made collaboratively by the woman and her healthcare providers.
What we should move away from is the assumption that stopping medication is automatically the safest choice. Untreated illness and impairment carry risks too.
Who is seeing the whole woman?
This brings me to an important recent essay in ADDitude by Liz Fiorino, “The Lindsay Clancy Case Should Alarm ADHD Moms.” Fiorino uses the tragedy of the Lindsay Clancy case to ask a much larger question about our healthcare system: Are we adequately recognizing and responding to psychiatric vulnerability in neurodivergent women during pregnancy and postpartum?
Read Liz Fiorino’s article in ADDitude
One question from her essay particularly struck me:
“Who was seeing the whole picture?”
That question extends far beyond this tragic case.
A woman may have an obstetrician managing her pregnancy, a psychiatrist prescribing medication, a therapist treating depression or anxiety, and a primary-care physician monitoring her physical health.
But who is putting the pieces together?
Hormones, ADHD, sleep, depression, anxiety, medication, relationships, physical health, and the overwhelming executive demands of caring for a newborn do not exist in separate silos simply because our healthcare system does.
And who is particularly poorly equipped to serve as her own healthcare case manager?
A woman with ADHD who is already overwhelmed.
We need a different standard of care
I believe ADHD should become part of the conversation about maternal mental health.
Known ADHD may identify women who warrant closer monitoring during pregnancy and postpartum. And when a previously undiagnosed woman becomes profoundly overwhelmed after childbirth, ADHD may be one of the possibilities clinicians should consider, not instead of postpartum depression or anxiety, but alongside them.
We should be asking:
How is she sleeping? How overwhelmed does she feel? Can she organize basic daily demands? Has her emotional regulation changed? Was her ADHD medication discontinued? Is she experiencing severe anxiety or depression? Does she have adequate practical support? Who is monitoring her psychiatric medications?
And perhaps most importantly:
Who is responsible for noticing when she begins to deteriorate?
The next evolution in women’s ADHD care
Forty years ago, ADHD was largely understood as a disorder of hyperactive school-aged boys. We now understand it as a lifespan condition affecting girls and women, adults and older adults. The next evolution must be to understand ADHD in the context of a woman’s life—including menstruation, pregnancy, postpartum, perimenopause, menopause, sleep, relationships, parenting, co-occurring conditions, and the changing executive demands placed upon her.
We also need to stop forcing women to navigate the chasm between specialties. Obstetricians should not be expected to become ADHD specialists, nor psychiatrists reproductive endocrinologists. But they do need ways to communicate and collaborate.
Liz Fiorino’s essay is personal and provocative rather than a scientific review. Some of its conclusions go beyond what research can currently establish. But the questions she raises are increasingly supported by evidence, and they deserve our attention.
For decades, women have been telling us that their ADHD changes with their hormones and with major life transitions.
Sandra Kooij and her colleagues in the Netherlands are pioneering precisely the kind of collaborative care that women with ADHD need. Kooij, a psychiatrist specializing in adult ADHD, joined with cardiologist Janneke Wittekoek and gynecologist Dorenda van Dijken after realizing that they were often seeing the same kinds of women from three different medical perspectives. Their Head–Heart–Hormones (H3) Network brings psychiatry, gynecology, cardiology and primary care together rather than requiring women to navigate each specialty separately. Their goal is not simply better referral among specialists, but genuinely integrated care—recognizing that ADHD, hormonal changes, mood, sleep and cardiovascular health can interact across a woman’s lifespan. The model is now being expanded through regional H3 networks across the Netherlands.
The H3 model begins with a deceptively simple idea: the psychiatrist, gynecologist and cardiologist are not treating three different problems—they are treating the same woman. Kooij and colleagues (2025) propose an interdisciplinary approach to women’s ADHD care that integrates psychiatry with gynecology, endocrinology, cardiology, and neuroscience. Their model recognizes that ADHD symptoms, hormonal transitions, mood, medication response, sleep, and cardiovascular health interact across a woman’s lifespan and therefore should not be treated in separate medical silos.
It’s time for research—and clinical practice in the US and elsewhere —to catch up.
That is ADHD Evolution.
Stay up to date with my new endeavor, the Institute for Lifespan ADHD Training (ILAT) and join us for its first big event, the ILAT Global Lifespan ADHD Clinical Training Summit October 29 – 30 online (recordings available for all registrants) where topics such as ADHD in girls, women, and the impact of hormones will be discussed in greater detail.
Join the ILAT community: www.ilat.org/join-now/
Learn more about the ILAT Global ADHD Summit:www.ilatglobal.org
Key references
Osianlis E, Thomas EHX, Jenkins LM, Gurvich C. ADHD and Sex Hormones in Females: A Systematic Review. Journal of Attention Disorders. 2025;29(9):706–723. doi:10.1177/10870547251332319.
Andersson A, et al. Depression and anxiety disorders during the postpartum period in women diagnosed with attention deficit hyperactivity disorder. Journal of Affective Disorders. 2023. PMID: 36681302.
Babinski DE, Riggle K, Tuan WJ. Postpartum Distress Among Women With and Without Attention-Deficit/Hyperactivity Disorder. Journal of Clinical Psychiatry. 2025;86(3):24m15724. doi:10.4088/JCP.24m15724.
Madsen KB, et al. Maternal ADHD Diagnoses Before and After Childbirth: A Danish Population-Based Cohort Study. Journal of Attention Disorders. 2026. PMID: 41067916.
Huybrechts KF, et al. Association Between Methylphenidate and Amphetamine Use in Pregnancy and Risk of Congenital Malformations. JAMA Psychiatry. 2018;75(2):167–175. doi:10.1001/jamapsychiatry.2017.3644.
Kooij, J. J. S., de Jong, M., Agnew-Blais, J., Amoretti, S., Madsen, K. B., Barclay, I., Bölte, S., Skoglund, C. B., Broughton, T., Carucci, S., van Dijken, D. K. E., Ernst, J., French, B., Frick, M. A., Galera, C., Groenman, A. P., Kallner, H. K., Koerner, J. K. A., Kittel-Schneider, S., et al. (2025). Research advances and future directions in female ADHD: The lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women’s Health, 6, Article 1613628. https://doi.org/10.3389/fgwh.2025.1613628