Beyond Baby Blues

ADHD

• Episode 7

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Attention deficit hyperactivity disorder (ADHD) affects up to 4% of the adult population although it is under-recognised and under-diagnosed in women and girls. 

In this episode we are joined by Dr Shevonne Matheiken, who shares her own lived and learned experience of ADHD and parenthood. We discuss the medical and social models of ADHD, the different ways that it can manifest, the challenges that can arise during major life transitions such as pregnancy and parenthood, and the implications for perinatal mental health. 


Resources and references for this episode:

If you or someone you know is struggling with mental health difficulties, there is lots of help available. You can contact your primary care provider in the first instance, or if you are based in the UK the NHS perinatal mental health website will help you to find support in your local area.

[00:00:00] Lynsey: Hi everyone. And welcome to the podcast. This is beyond baby blues, a podcast about maternal mental health. My name is Dr. Lynsey McAlpine. I'm a trainee psychiatrist based in east London.

[00:00:20] Chrissy: And I'm Dr. Chrissy Jayarajah. I'm a consultant perinatal psychiatrist, also based in London.

[00:00:26] Lynsey: So for today's episode, we are going to be talking about something called attention deficit hyperactivity disorder, or ADHD, in the perinatal period.

And I'm absolutely thrilled to welcome our guest for this episode, Dr. Shevonne Matheiken Shevonne is a trainee psychiatrist like me. Um, and she is a huge inspiration because she's done some incredible work in raising awareness and campaigning for better care for people with ADHD. Shevonne welcome to the podcast.

[00:00:52] Shevonne: Thank you so much, Lynsey and Chrissy. And thanks for inviting me.

[00:00:55] Lynsey: As you know, we've been planning this episode for some time, but the three of us have been so busy with work and life and all our various projects that it's taken a while to find the date that we were all free. So, I'm really glad that we've been able to coordinate our calendars. And we're finally getting to record this episode.

So Shevonne just to get us started. Perhaps you could tell our listeners a little bit about yourself.

[00:01:14] Shevonne: Yes, sure. Um, so I'm an international medical graduate. I came to the UK to train in psychiatry. Going forward a few years, other than the expected challenges of being an international doctor I was mostly a so called high achiever, I guess, until around ST4. um when a deadly combination of, um, second child plus pandemic plus transitioning from junior doctor to registrar all sort of happened at the same time and led to a burnout spiral. 

So fast forward a few months and I got diagnosed with ADHD, which I can only describe as a relief. 

And other people have shared that feeling when they get diagnosed as an adult. 

 Um, so prior to this, my special interests were doctor's well being, EDI and leadership. So now I've sort of pivoted a bit and shaped that a little more with the neurodiversity angle and I'm also trying to self teach myself, uh, advocacy in this area.

I'm very early in the advocacy journey and it was quite intense in the beginning because I realized that it is a very hard thing to do because ADHD is quite a controversial topic. There's all sorts of debates out there. Is it a disorder? Is it a condition? Is it a superpower? Is it a disability? And that's one of the things that triggered my wanting to try and bridge this wide gap between the medical and the social views about ADHD. 

 So I just wanted to start with a disclaimer to say that I'm obviously trying to share my Perspective is based on my experience and a lot of things I've learned from other neurodivergent medics, but I want to acknowledge that that's a very privileged position. So I can't represent everyone's experiences. 

 What I am trying to do is, um, to sort of combine what psychiatry taught me about ADHD and more importantly, what I didn't learn from psychiatry about ADHD. And hopefully that gives some useful things to take away.

[00:03:13] Lynsey: Yeah, absolutely. I think your perspective here will be really valuable. You actually published a fantastic paper about this, um, earlier this year, which was incredibly thought provoking, especially the part where you were discussing the medical and the social models of ADHD. And I think you actually won an award for that paper. Didn't you?

[00:03:29] Shevonne: Um, yes, thanks for that. Yeah, that was a, labor of love and had good feedback so I'm sure we'll talk about it more later on.

[00:03:38] Chrissy: And how little information, I'm probably a bit older than you guys, but how little information there was around neurodiversity, generally, and it was very much in the pediatrics realm and it was very kind of confined and narrow sort of definition 

[00:04:04] Lynsey: yeah. And as I've got more experience in clinical practice and especially working in perinatal psychiatry, I've seen a much broader range of people that fall somewhere on that. neurodiversity spectrum. And we see a lot of people that don't necessarily fit that stereotyped description of ADHD that we learned as undergraduates. 

So with that in mind, I thought it might be helpful to just talk through the basics. So ADHD is described as a neuro developmental disorder, which means that it relates to the way that the brain develops. And more specifically, it affects the part of the brain that's involved in processing rewards. 

And I suppose Shevonne you mentioned the sort of difference between the medical model and the social model of ADHD. And this is where the, um, the medical model would say that there's a deficit in reward processing and reward sensitivity. Whereas the social model might frame it slightly differently by saying that the brain is just wired differently and people with ADHD will have a different experience of reward or motivation compared with neurotypical people.

 We don't fully understand what causes ADHD but we know that there are several different things that probably contribute. So for example, we know that genetics plays a really important role and it often runs in families. 

There has also been some research looking at various environmental things that might increase the risk, especially exposure to different substances during pregnancy, when the fetal nervous system and brain are still developing. But these findings have not been very statistically significant, so they're not likely to have any substantial impact on the development of ADHD. And there's also some evidence that, epigenetics may play a role. And we also know that there's a very complex two way relationship between neurodiversity and early life trauma and adverse childhood experiences.

[00:05:45] Chrissy: So, there are a few different subtypes of ADHD, uh, Shevonne, I wonder if you could talk us through them

[00:05:53] Shevonne: yes. So these are probably quite well known as the hyperactive type, the inattentive type and the combined type

so the hyperactive type, which mainly refers to, what people see as having lots of energy. Often we talk about the physical hyperactivity that's visible to the onlooker, but for a lot of people sometimes what gets missed is the internal or the mental hyperactivity where sometimes we even describe like they always have a internal monologue or racing thoughts. And this is important to identify because it causes distress , but it may not be visible to the clinician or to people on the outside.

 The second type is the inattentive type, which is based on difficulty in focusing. And it's interesting because the sort of newer understanding is that it's not actually a attention deficit, it's more a difficulty with regulating attention. 

 And the third type is the combined type, which means that it's not predominantly the hyperactive symptoms or predominantly the inattentive symptoms, but it's a mix of both.

[00:06:59] Lynsey: And of course, to meet the threshold for diagnosis of one of these subtypes. the symptoms have to be causing really substantial problems with day-to-day functioning. 

[00:07:07] Shevonne: Yes and no one will come to you and say, I think I feel hyperactive, impulsive, et cetera. They may come and say, I can never relax, or I just can not sit still without doing anything or my brain never relax. So they may say I have chronic sleep problems. 

[00:07:21] Lynsey: So just to pick up on one of your points there, you said that the inattentive type of ADHD is actually more of a difficulty regulating attention. And one of the things I've heard people describe is this experience of hyper-focus, which feels like almost the opposite of what you would expect in someone with ADHD. What's going on there?

[00:07:39] Shevonne: I think it's more a case of difficulty in it. focusing attention where we want it to be, because It's a very interest driven brain, isn't it? So even when someone wants to focus their attention at a certain task that's just not what the ADHD brains wired for. So hyper focus is where someone with ADHD can focus for very long periods of time it would be something that they're very interested in. 

[00:08:05] Lynsey: And I suppose that links to one of the other features. Um, something called set shifting, which is a type of executive dysfunction where it's harder for the brain to switch between different tasks.

[00:08:13] Shevonne: That would explain some of this. So you're very intensely interested in this and it's very hard to then shift to the other thing. So it's also relevant because sometimes people even describe that they forget basic things like forgetting to eat, forgetting to go to the toilet when they're in a period of hyperfocus. And this then also drives the problem of with, uh, prioritizing tasks. So the most interesting task might not be the most important one at that point in time. 

[00:08:38] Lynsey: Another thing that people with ADHD describe is that their perception of time can be very warped. So they don't have a very accurate sense of how much time has passed and they can find it hard to predict how long it will take to do any given task.

[00:08:53] Shevonne: There is this concept called time blindness. So how You experience the passage of time, especially when you're very focused on something interesting, it's different to the neurotypical person. And that then can contribute to being late and time management.

[00:09:06] Lynsey: So another thing that you've written about is something called stimming, which is where someone carries out a repetitive action over and over again. Uh, usually as a way of managing sensory overload or a way of processing overwhelming emotions. It's a bit different to fidgeting and it can take several different forms.

[00:09:23] Shevonne: so people may understand fidget toys and how Fidgeting can be helpful for people with ADHD, either during exams or at work or sitting through boring meetings and things like that, so I think that helps with the physical hyperactivity bit, but there may be other ways that people stim, which doesn't need to be physically hyperactive. So I mentioned the example of listening to the same song on repeat or, watching the same video on repeat. And maybe these are ways of self regulating or managing emotional dysregulation.

[00:09:53] Lynsey: So moving on, I wanted to talk specifically about ADHD in women, girls and gender diverse people. Now we know that ADHD is underdiagnosed in the UK. It's believed that somewhere between three and 4% of adults have ADHD, but in the UK, less than 1% of adults are actually accessing any sort of treatment or support for it.

It's underdiagnosed in every demographic group, but women and girls are disproportionately affected. I think there's probably a few different reasons for that. I think part of it has to do with stereotypes and expectations. So historically the research into ADHD has focused on young white boys. And so that's what clinicians and parents and teachers and the public all expect to see. And that has a huge impact on who gets referred for assessment.

[00:10:37] Chrissy: So yeah, Lynsey you're absolutely right. there are structural biases as well in research and there's a definite gender data gap. So what I mean by that is we know that it's affecting women. We know that it's affecting ethnic minorities as well, but unfortunately the studies to date really don't take into account the diversity essentially in the population and we need more studies focused on how ADHD presents in women, how ADHD and other conditions present in people of ethnic minorities and I guess not just ADHD, this is perinatal mental health and mental health in general.

[00:11:17] Lynsey: Yeah, of course . And then there's emerging evidence that women with ADHD tend to have a different symptom profile. So they are more likely to have the inattentive subtype. And they're more likely to present with internalizing symptoms. In other words, internal restlessness rather than external fidgeting and physical hyperactivity. And they're also more likely to experience anxiety and mood symptoms as a consequence of their ADHD. So in some cases, I guess it's possible that ADHD is being missed or misdiagnosed in women who don't fit that stereotypical clinical picture. 

[00:11:48] Shevonne: There's also so for example, in screening questionnaires, they'll have something like, do you usually find it hard to stand still in queues? So if it's a person or a clinician who's not aware of masking, they'll just ask that on the surface and If that was asked to me, and I had to answer in one word, I would say no, I don't struggle to stand in queues.

But if someone asked me to say why, what would I do when I had to stand in a queue, I would talk to myself, or I would give myself a topic to think about and while I'm waiting in the queue, I will be thinking intensely about that topic. So that is how I mask because I would feel intensely bored and distressed otherwise. So that's just an example to show how if we go very superficially, women can easily get. Missed.

[00:12:33] Lynsey: Yeah, exactly. And other forms of masking may include deliberately staying very quiet and social situations to avoid misspeaking.

Or another example is women who become extremely detail-oriented. With excessive planning and almost obsessive checking of their belongings and their plans. So that to an external observer, they can appear to be very organized. But it's a coping strategy. That's masking a lot of internal disarray.

 Another reason that the diagnosis might be missed is something that you've written about. Shevonne you called it the fallacy of high functioning. Could you tell us what you mean by that?

[00:13:05] Shevonne: Oh, you hold down a job, you can't possibly have ADHD, or you've done a PhD, you can't have ADHD. So that's sort of dismissive and minimizing of people's struggles because you can be high functioning in some areas, i.

e. job and career in this example, but be significantly struggling with other things, either to do with your health or to do with your social life or personal life.

 So I thought what would help with, Um, explaining this more is to quote two of the, examples that neurodivergent doctors had sent in for our paper.

 So I'll read out two of them. High functioning feels like an excuse to not help. My daughter has inattentive ADHD, but because she's academically able, the additional support needed for her school work wasn't acknowledged by her teachers. As an NHS consultant, I am high functioning. And so no one acknowledged the struggle to keep up with my work. This made it hard for me to seek an ADHD assessment. And I was told things such as, open quote, we all struggle with admin, close quote. ADHD medication has literally changed my life. Not only at work, but also at home, I'm able to be present for my children. For the first time as an undiagnosed high functioning woman, I've had episodes, multiple episodes of depression, because among other things, I cannot keep my house tidy. And the lack of an explanation for my difficulties destroyed my self esteem. 

And a second example is people who know me. Only on a superficial level would probably say I'm high functioning because I managed to get through medical school and I work. If they saw my house or how tired I am or how I often just crash with exhaustion when I'm not at work, their opinion would change. My work impacts other people, so it gets prioritized over everything else, leaving very little energy for me.

[00:15:07] Lynsey: There was a really powerful point in that first quote that you read. About having an explanation for the difficulties. 

I know that a lot of people with ADHD can have very low self-esteem and they often put their difficulties down to laziness or a lack of capability. And getting the diagnosis I think that having that explanation is so important because it gives people a neuro biological explanation about why their brain works differently. Which can really help people to understand why they're finding things difficult.

Having an explanation can help to challenge those self-critical thoughts about being lazy or incapable or not good enough.

[00:15:41] Shevonne: We've written in the paper with quotes of people who've said that finding answers lifted their mental health so much because just knowing an explanation had a very positive impact.

[00:15:52] Lynsey: Yeah. And then once it's been diagnosed, there are lots of treatments available. So for example, there were quite a number of different medications that we can use to treat ADHD. And I know that a lot of people who take medication for the ADHD, have described it as absolutely life changing. Because these drugs have a very large effect size, which means that when they work, they are incredibly effective.

[00:16:14] Shevonne: So yes, medication is a significant bit. Other things Transcribed Also include things like ADHD specific coaching so people can access things like this, even while they're on the waiting list, there are other ways to access psychological support. therapy but with a small caveat that a lot of psychological therapies are not tailored for neurodivergent people. So someone could have CBT and find that extremely difficult to do because filling forms and doing homework for CBT may be very difficult for someone with ADHD to do when they're already in a crisis.

And then I think people do need support to find their own ways of dealing with burnout so for me, it's things like journaling and a big thing I mentioned is about self compassion.

[00:16:59] Lynsey: So we've mentioned that people with ADHD can develop strategies for managing their difficulties. And this can often be very effective, but we know that times of transition and change can be particularly challenging. So for example, going through puberty or moving from one stage of school to the next. Or leaving home to live independently for the first time. Or changing jobs or going through the peri-menopause. 

Anything like that can be de-stabilizing. And that's partly because of the biological changes. So I know we don't have time to go into too much detail here, but just to mention it briefly, it's believed that fluctuating levels of the female hormones, estrogen and progesterone can affect ADHD symptoms. 

And of course periods of change are also potentially de-stabilizing because there's a loss of routine and because previous coping strategies might not be effective anymore. Um, and because of the cognitive demands of adapting to something new. And one of the biggest life changes imaginable is pregnancy and the transition to parenthood.

[00:17:54] Chrissy: Yeah. And we know that people with ADHD may face some specific challenges as well during their pregnancy or after having the baby. So Needing to plan, coordinate lots of appointments, taking lots of new information. Um, and also the other aspect of it, which is the, the sort of how the maternity system, or I guess the perinatal maternity system, it's quite rigid. There's a lot of rules. There are a lot of appointments. There's not much room for maneuver and a bit like what Shevonne was saying earlier it does require you to, to kind of be present at certain times and that might be really difficult. And that's just in the pregnancy. I also think we need to think about the postnatal period. So when you've got a baby and then you've got double the amount of appointments and you've got midwife review health visitor review, uh, GP appointment , getting the baby's immunizations, etc. You've got another person to think about. Um, so that can be doubly challenging.

[00:18:57] Lynsey: Yeah, and it can have a huge impact on the health of the pregnant person and the health of the pregnancy. We know , that young people with ADHD are at higher risk of teenage pregnancies. And there's evidence that people with ADHD are more likely to have. Unplanned pregnancies and more likely to have a late booking appointment with their midwife. 

And as you mentioned, Chrissy, pregnant people are often bombarded with lots of instructions and rules that they need to follow. But someone with ADHD, might struggle to attend all the appointments, to take on board all of the dietary advice, to stop smoking, and other things that are important for the health of the pregnancy. 

And then on top of that, there is evidence that people with ADHD have higher rates of a number of different pregnancy related complications. Including things like preeclampsia, gestational diabetes, sepsis, and preterm birth. So all pretty serious stuff, which means that the overall experience of the pregnancy can be very stressful.

[00:19:47] Shevonne: I guess the other related thing for obstetrics would be about pain thresholds. So you both will know better than me about how pain's dismissed in women and this with the neurodiversity angle just adds another layer during that whole period of obstetric care because people experience pain differently and the thresholds would be very different. 

[00:20:10] Lynsey: There has also been some research looking at what happens to the severity of ADHD symptoms over the course of pregnancy and the postnatal period. So this is not necessarily true for everyone with ADHD, but the general trend seems to be that symptoms will improve in early pregnancy and then gradually return to baseline over the course of the pregnancy and then rapidly deteriorate in the days and the weeks after birth.

Now I have to admit that pattern doesn't correlate with my own experiences in clinic, but I suppose there's some selection bias there because I'm more likely to get referrals for the people whose symptoms are getting worse and whose mental health is affected. 

Um, there are a few different theories about why most people experience this particular pattern with a sudden deterioration postnatally. And I think specifically the precipitous drop in estrogen levels after delivery and the neuroplastic changes in the brain in the early postnatal period and the, um, the demands of adapting to the new role of being a parent, which involves new responsibilities and a huge number of tasks that need to be planned and carried out. And of course the changes to sleep patterns in the postnatal period may also be relevant.

[00:21:15] Shevonne: Yeah um, you spoke a lot about sleep in the sleep episode and I think sleep's a worthwhile thing to discuss. So we know that goes, completely chaotic with a newborn. And I think that makes it much harder for a neurodivergent parent. A lot of people with ADHD struggle with delayed sleep phase syndrome and chronic sleep problems, which may not have affected functioning so much. But this might be the tipping point that all hell breaks loose. 

[00:21:41] Lynsey: Yeah, I suspect it's often the cumulative effect of all of these things and the sleep deprivation is often the final straw. And then in addition to the ADHD symptoms getting worse postnatally, we also know that neurodivergent people are at particularly high risk of developing comorbid perinatal mental illnesses, especially postnatal anxiety and depression. And because this develops on top of the ADHD, it can present slightly differently compared with neuro-typical people, which means that it might be missed.

[00:22:07] Shevonne: I can only speak about anxiety as a comorbidity and how I describe is that um, anxiety with ADHD is like anxiety on rocket fuel. So a lot of ADHD folk are very creative. So something that triggers anxiety would lead to Oscar worthy catastrophizing anxiety spiral of mental images. Sometimes people with ADHD can give elaborate descriptions of things.

So when they're concerned for their child, for example, but they may get dismissed as, Oh, you're just being an anxious parent so yeah, just, uh, take away about not dismissing concerns.

[00:22:43] Lynsey: Yeah. And another thing to think about is that neurodivergent people can process sensory experiences differently. And I wonder how that could manifest in the perinatal period.

[00:22:53] Shevonne: I didn't know I was neurodivergent when I was pregnant so this is sort of in retrospect. Um, but I think it would have helped a lot to anticipate the sensory overwhelm. 

 So for example, the sleepless nights, particularly the newborn stage with all the crying. I understood sensory issues more in the context of autism until my own experience. And it's very relevant to ADHD as well.

 So I would have been a bit kinder to myself. when I knew why I struggled with like high pitch meltdowns and needed time to myself to recover from that, which I've only learned now when the children are six and 10. 

So a lot of mom medics wanted me to pass on the message that professionals shouldn't blame them when they're not able to cope with the crying or the meltdowns. It's, it's not necessarily, choosing not to bond or something like that, but it's because they're finding it overwhelming. And if particularly if it's someone who's not diagnosed, they wouldn't know how to describe why they're finding it overwhelming.

[00:23:53] Chrissy: Yeah, I think, I think that's something we see a lot in, in perinatal services. And again, I know I've mentioned it before, but one of the really good things about being referred or having advice from a perinatal specialist team is that we have not only obviously psychiatrists and nurses, but parent infant, psychotherapists and psychologists, and all of us, um, have had training in um, parent, infant Bonding and attachment and trying to understand the differences between what is an issue around the relationship and the bonding and what may be, as you've just described Shevonne, um, hypersensitivity to sounds sensory stimuli. It's very subtle and like you said, it's, it's difficult to explain, but yeah, you're absolutely right. important point.

One of the questions we get a lot, is what do we know about ADHD medication and pregnancy? Lynsey, I wonder if you could tell us a little bit more.

[00:24:51] Lynsey: Yeah, I'd love to. So the only caveat here is that this is not medical advice, and I would always encourage our listeners to speak to their own doctor before making any decisions. Um, decisions about taking medication in pregnancy are incredibly personal and I think every individual person has to weigh up the pros and cons of their own personal circumstances.

So broadly speaking, there are two types of medication that we use to treat ADHD. There are stimulants like dexamphetamine and methylphenidate. And then there are, non-stimulants like Clonidine and bupropion and atomoxetine. The stimulant medications are used much more frequently. Uh, so we have more safety data on them.

 So just to be absolutely clear, there is no medication that is a hundred percent safe in pregnancy. And I'm not just talking about psychiatric medication here. That's true virtually all prescribed medication.

But sometimes we decide that the benefits of the medication outweigh the risk. And we knew that for some people, untreated ADHD can be risky and can have a substantial effect on their ability to function. I mentioned earlier that people with ADHD have higher rates of pregnancy complications and poorer obstetric and neonatal outcomes. And that specific study showed that the people with ADHD who continued to take their medication during pregnancy actually had better outcomes compared with the people who stopped, which suggests that taking medication actually has some protective effects. 

And then looking at the longer term effects on the infant, the most substantial and significant piece of research in this area is a large population based cohort study that was published in 2023 which followed up children who'd been exposed to ADHD medication in utero um, and looked at their longer term neurodevelopmental outcomes. And the results of this study were actually pretty reassuring. 

Their analysis suggested that the risks associated with ADHD medications, especially stimulants, are much lower than we used to think. 

put links to the studies in the show notes for anyone who's interested in reading more.

So Shevonne, we really appreciate you coming onto the podcast and sharing all of your lived and learned experience. It's certainly given us a lot to think about. 

Before we wrap things up for today, I wanted to reflect on what all of this means for our clinical practice in perinatal mental health. Chrissy, what have you taken from today's episode?

[00:27:07] Chrissy: It's been a really interesting episode. It's certainly opened my eyes into a lot of things around ADHD that maybe I took for granted. I've certainly learned a few new things today just learning from you and from mothers that you've spoken to. I think my major learning point is that it's a lot more common than we think it is and actually it can present in a different way during the perinatal period. So just to kind of keep it in the back of your mind that actually this could be the first time someone's presenting. So I think that's what I'll take away, um, in terms of my clinical practice. 

[00:27:45] Lynsey: For me, the most important learning point is about understanding how hard it can be for neurodivergent people to navigate maternity services and mental health services and parenthood. It's left me reflecting on what we can do as healthcare professionals to make our services more accessible for neurodiverse people. 

Part of it is about getting the basics right? So things like having really clear information that's communicated simply and effectively. Um, making it easier to book and reschedule appointments and making sure that we're working with people in a flexible and compassionate way. 

And I was also thinking that I guess, The reason that we've chosen to work in healthcare and in perinatal mental health specifically is because we want to support people in their parenting journey and we want every family to thrive. And in the past, when I've worked with patients with ADHD, I've always been amazed at how effective the treatment can be. And how much scope there is to improve people's lives. I think it can just have such a huge impact on, on the individual, and the wider family as well.

Shevonne. Is there anything else you want to add? What do you think healthcare professionals should take away from this episode?

[00:28:48] Shevonne: I would say learn the red flags to watch out for undiagnosed ADHD. You mentioned some of them already, Lynsey if medication's not working and it doesn't seem like. your depression's responding, or if there's something else going on so that's another thing to keep in mind. 

 I guess the key message would be if the possibility of undiagnosed ADHD comes up, , in the perinatal period, don't dismiss it. Because I've heard people say, uh, that's a different team that diagnose it. Let's figure it out after the babies here. 

 So we know about NHS waiting times. The last estimate was five to 10 years for an adult for a new ADHD assessment. The child would be five years old by then. So I would say start the process towards assessment. We've already discussed how the perinatal period can be one of the most chaotic, vulnerable, unpredictable, risky times for a neurodivergent mother. So getting answers to why they struggle with certain things, even if they can't have medication straight away, I think will go a long way in making it less painful for everybody involved.

 In terms of accommodations, you mentioned a few things and sensory would be top of the list. Sensory accommodations, reminders with appointments, both for the mothers and the child's healthcare and a low threshold for early help. So I say that with a caveat that a lot of people who are neurodivergent can be very self critical so the person would default to thinking I'm not good enough, I'm not capable of looking after my child and they'll go down a spiral. So I think it needs to be conveyed gently to help them reframe why that's being suggested.

[00:30:19] Lynsey: Yeah, absolutely. We've actually got another episode coming up quite soon on compassion in perinatal mental health, which feels like it would be incredibly relevant here.

And then the other thing I wanted to ask you about is whether you had any advice for parents or prospective parents who have ADHD. 

[00:30:36] Shevonne: Well, you've spoken about the, planning aspect of it and all these things that you need to think about for making informed decisions for the million decisions you have to make in pregnancy and parenthood. That aside, I will sum it up as, um, Learn how to tackle the self stigma because I think it takes years to come to terms with an adult ADHD diagnosis and at some point in that you would find it very difficult to reach out for help or ask for help.

 It helps to learn terms, so things like ADHD tax, so that's not a medical term at all, but it takes some shame away from The ways in which ADHD affects your finances, for example. So when you learn that kind of terminology, it makes it much easier for you to explain to other people in your life, understand why you struggle with certain things, and then eventually figure out what your triggers are and find your own strategies that work with that and things will get better. I want to give an analogy about plastic balls and glass balls. I don't know if you both have heard of that

 So it's It's something I heard in a wider, parenting context, but it's something that's been really helpful for me. So I will demonstrate with an example.

So, if you have a nursery aged child and they have pajama day or crazy sock that would Classify as a plastic ball. Um, whereas if you have like a clinical emergency that would be the glass ball for that particular day and allow yourself to hold onto the glass ball and don't beat yourself up about forgetting crazy sock day, which is the plastic ball. Vice versa. If your child's first ever nativity is happening on a day and you need to ask for some flexibility from work, the nativity would be your parenting glass ball for that day. And you don't want to miss that because it's important. And on that day work, maybe the plastic ball. So it's about self compassion essentially and to not beat yourself up about the plastic balls you have to drop as long as you're not dropping the glass balls, which would be much more disastrous. 

 Um, so that was a helpful analogy, I thought because juggling so many things, um, every day and one scale up for neurodivergent parents 

and yeah, I wanted to end on a positive note, uh, because we've talked a lot about deficits and difficulties. And I think that is generally the angle we take in psychiatry because we are trying to fix people's problems, isn't it? So I wanted to end for parents on a positive note saying, I think you can be a really amazing, fun, highly empathetic parent, even with ADHD, as long as you have the right tools to understand and manage your condition. And um, in the future, you, you're probably likely to be in a better position than the average parent to advocate for your children and others, both in education and accessing healthcare when they do need that. 

And I hope that, people can get timely support in a way that for every day that you're crying in the shower, feeling overstimulated and overwhelmed, there'll also be a day when you've gone on a impulsive, hyper focused adventure trip for your child. And you've had an amazing day out. And I hope those days balance out, and that you find a way to deal with this positively.

[00:33:49] Lynsey: That's a really lovely note to end the episode. 

[00:33:52] Chrissy: Yeah, just wanted to say a huge thank you to Shevonne for your openness and sharing your story, both your personal and professional experiences. 

It's been really lovely to have you on our podcast. And also, of course, thanks to the Royal College of Psychiatry Perinatal Faculty for all their support with the podcast. 

And, if you would like to learn more about ADHD, uh, Shevonne has published a fantastic paper about rethinking our approach to adult ADHD. And I should add, it also won the British Journal Psychiatry Advances Editor's Choice Paper of 2024,

is fantastic we'll put a link in the show notes along with any key references and resources that we've talked about in this episode.

[00:34:40] Shevonne: Thank you both. Shout out to my co authors as well.

[00:34:43] Chrissy: Yeah, and you have enjoyed our podcast, you can follow us on social media, we've got an Instagram, we've also got an ex forward slash Twitter at beyondbabyblues. Please do share, rate the episodes, leave reviews, it really helps us to get out to a wide audience. And of course you can subscribe and listen to more episodes on Apple podcasts, Spotify, or wherever you listen to your podcasts. 

People on this episode

Contributor

Dr Chrissy Jayarajah

Host
Contributor

Dr Lynsey McAlpine

Host