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The Impact of Neurodivergence on Parenting and Perinatal Mood and Anxiety Disorders


I have never once heard Neurodivergence discussed in any of the Perinatal mental health trainings I’ve attended. ADHD was mentioned once in my Advanced Perinatal Psychotherapy training, just in terms of the amount of stimulant medication passing through breastmilk. I think there is a big need to discuss Neurodivergence, specifically in women and how this influences how we function in the Perinatal period and how it impacts our parenting and our experiences with Perinatal Mood and Anxiety Disorders (PMADs). The reason I say this is because symptoms of ADHD, for example, can fluctuate weekly and even daily depending on where we are in our menstrual cycle and our reproductive stages. As you can imagine, the perinatal period can look quite different for someone who is Neurodivergent.


What is Neurodivergence?


I think it’s important to have some understanding of Neurodivergence before exploring its impact on parents. I like this definition from the blog on Health Assured’s website:


A relatively new term, neurodivergent simply means someone who thinks differently from the way the majority (referred to as neurotypical) expect. Neurotypical means the opposite –someone whose brain behaves in the same way as the majority of society.


This is of course very broad and doesn’t capture how “thinking differently” actually impacts our day-to-day life. Neurodiversity is also a term that is used and was coined in the 90’s by Judy Singer, a Sociologist in Australia. I tend to use both terms interchangeably, but that’s just me. Both terms really mean our brains are wired different from most of the world and we see and experience life differently because of it.

What does Neurodiversity or Neurodivergence include? ADHD, Autism, Dyslexia, Dyspraxia, Dyscalculia, Dysgraphia, and Tourette Syndrome all fall under these terms. I like to refer to these conditions as cousins as there are similarities between them and often people can experience them together, in various combinations. I have ADHD (impulsive/hyperactive type), I also have Dyscalculia, poor handwriting related to Dysgraphia and symptoms of Dyspraxia in that I can be quite clumsy and struggle with organization. I also have Generalized Anxiety Disorder that is often a co-morbid (simply meaning occurring alongside with or at the same time) condition with ADHD. And one size does not fit all in terms of how these conditions show up in people’s lives. I can be quite clumsy however I have really good eye-hand coordination. I have very poor handwriting however I’m an excellent speller. I struggle with impulsivity and hyperactivity, and I am so hyper aware of everything around me that I can appear inattentive; not because I don’t have the ability to pay attention, I just pay attention to everything. I don’t know my timetables (Dyscalculia), yet I can learn something like setting up a website or starting a podcast really fast and get it done!


Some people define these conditions as disabilities, others don’t agree that they’re disabilities. It's important to ask the individual what terms and definitions they use. I do have some impairments because of ADHD but I’m not sure I would view myself as having a disability and at the same time some things are much harder for me than people who don’t have ADHD. AND I’m also a lot better at a lot of things than neurotypical people and I love those strengths. But we ALL have strengths and challenges, Neurodiverse or not. Before realizing that I had ADHD, I always felt like I was missing something, that I just wasn’t as smart as other people or that I just didn’t understand some social cues, just to name a few. I understand now that my brain works differently and in a lot of ways it’s a good thing!


“We define a disability under the Act as “any physical or mental impairment that has a substantial and long-term negative effect on your ability to do normal daily activities”” according to Health Assured’s website. Why is this important? If this is the case for parents with ADHD or Autism then imagine what this would look like in the Perinatal period, and how hard coping with a Perinatal Mood and Anxiety Disorder (PMAD) could be? There is also research showing that people with ADHD or Autism have higher rates of mental illness, which puts us at higher risk of developing a PMAD.


How does my ADHD affect my parenting abilities? How did it affect my perinatal experiences and PMAD symptoms?


As a parent, I can really relate to my 2 kids who have ADHD and I struggle with my kid who is easy going and takes his sweet time walking to the car after school or getting in the car in the morning. He doesn’t seem to live with the same sense of urgency that I do! I find I struggle the most with too much sensory input and being touched out, and I especially remember this in the perinatal period when my boys were little. I desperately need time alone and away from everyone in my family after being with them for long periods of time. I have 3 boys and the noise level in my house is VERY high. I struggle with unexpected, loud noises, and this can be really hard to cope with in the perinatal period (screaming toddlers or kids that think it’s funny to scare you). It’s very helpful for me to recognize when my nervous system is feeling maxed out, and to slow down and take breaks before I completely burn out.


Something I do remember from pregnancy was being hyper-aware of every physical sensation. People with ADHD can experience more somatic complaints and so I was acutely aware of every discomfort which, as you can imagine was pretty annoying. The nice part of that though was I felt my babies move REALLY early, like around 11 weeks. What that also meant, was when my placenta was in the front with my 3rd kid and I could barely feel him move, I experienced a lot of anxiety.


I love cuddling with my children however I get touched out easily and it feels almost urgent when I need them to stop touching me, like I’m going to crawl out of my skin. I’m also extremely sensitive to smell and so my partner was not allowed to cook his favourite curry while I was pregnant! Surprisingly I wasn’t bothered by baby diapers!


Difficulty concentrating/focusing, experiencing high levels of stress, time blindness, developing and maintaining routines and experiencing higher levels of physical illness can accompany Neurodivergence. All of these have negative impacts on the Perinatal period and on coping with a PMAD. It’s very hard to focus on one task when you’re doing laundry, cooking a meal, taking care of a baby, and feeling extremely stressed out. This is magnified when you live with Neurodivergence. Having to suddenly develop routines to support baby’s sleep, feeding and wellbeing can be a really difficult change for parents with ADHD or Autism. And on days where you just don’t keep up with the routine, everything goes to shit (at least it does for me).


Shifting between activities is a very big struggle for me and my oldest son. Having to stop what I’m working on to go pick up the kids from school or leave to go to an activity is so frustrating for me. Once I start something, I don’t want to lose my momentum because I know, for me to get back into that activity will either feel impossible or just not happen. Leaving the house to go pick up my oldest from school, when I had a PMAD, felt like I had to prepare myself the entire day. And then when I got out, I didn’t want to go back home. Reflecting back, it seemed that experiencing a PMAD increased my ADHD symptoms.


Neurodivergent people can feel their feelings in big ways. Sometimes it still feels like I’m a teenager and often people with a Neurodiversity are behind their peers in emotional maturity. And yet I am very self-aware, and some days do a really good job of managing my emotions. In the Perinatal period when we are experiencing a lot of hormonal fluctuations (low estrogen negatively impacts ADHD symptoms) our emotions can feel so much more intense and then if a PMAD is present a lot of anger and rage or extreme emotional sensitivity can show up. In this case, gender stereotypes can impact how we cope with these symptoms. Shame and guilt might stop us from disclosing that we’re experiencing these symptoms and make us actually try to repress and hide these symptoms. “Good/nice moms don’t have rage or extreme anger”.


Social interactions can be very difficult for parents with Autism and ADHD. Think about all of the social interactions that we are thrust into as parents. I actually learned very early on that I struggle with “mom and baby groups” and online parent groups. Being involved in school activities and groups is something that I have rarely done. And part of me feels quite guilty about that.


Other symptoms present in ADHD and for me include:

· getting side-tracked

· not following through on instructions

· forgetfulness

· getting bored easily

· trouble organizing activities and tasks.


All these things can negatively impact parenting and coping with a PMAD. It can be very hard to seek support, follow through with therapy or medication compliance with the above symptoms. And the daily (sometimes boring or not fun) activities involved in parenting can feel almost impossible to a neurodivergent parent.


A lot of what I’ve talked about so far involves our executive functioning (working memory, impulse control, ability to organize, prioritize, plan, execute, and controlling our impulses), which is impaired in people with Neurodiversity. And all of those things are key functions of parenting and managing a family, a career, and a home. I could probably write 5 posts just about executive functioning. All of this is further complicated with shame and guilt from unmet gender expectations, which have a very detrimental effect on all parents, and this can feel even more acute for parents with ADHD or Autism.


When we are parenting children with executive function deficits, we are supposed to act as their executive functioning, but my executive functioning is also impaired so you can see how this can feel impossible or not work very well at all.


ADHD symptoms in women vary weekly and even daily depending on how our menstrual cycle affects us and across our lifetime because of hormone fluctuations, which can be really hard to manage. Some women need to change their medication dosage throughout the month and then at different times of their lives such as pregnancy, postpartum and menopause. In pregnancy estrogen is much higher so we can actually feel better. For me personally, I wasn’t diagnosed or even aware that I had ADHD until after my 3rd child so it’s hard for me to really evaluate this, however I do remember feeling quite calm and that I was able to go with the flow through all of my pregnancies and my deliveries, which is not always the case in the rest of my life.


I cannot speak to the personal experiences of parents with Autism however if someone has “moderate to severe” Autism then this will probably have a big impact on their ability to parent. And at the same time parents with Autism can relate to their kids’ experiences if they’re also on the spectrum. Just as explained above, sensitivity to sensory input can be very present for people with Autism and this can impact people’s ability to cope in the Perinatal period. Social communication and reading baby’s cues can also be impaired in parents with Autism, which can impact parenting.


If it’s not a disability or you have a lot of strengths because of it then why does it matter to get diagnosed or why be prescribed medication?


By getting a diagnosis and support with your condition, you can have the language to understand why you are different and then learn ways to cope. For a parent, especially if they are the primary caregiver, receiving a diagnosis can mean the difference between the whole family functioning well or not well. It’s important to understand the extensive impact Neurodiversity has on not only the individual but the entire family, who often have to compensate for some of the person’s behaviours. Much the same way a child with Neurodivergence can really change the dynamic in a family. We can also be prescribed medication, such as a stimulant (for those with ADHD), that can be extremely helpful in coping with our symptoms. Some people don’t want medication, and that’s ok too. Getting a diagnosis, support, and a treatment plan (with or without medication) can be life changing for people, as it was for me but if you’re “high-functioning” there are still many people who don’t understand the deep affects that being neurodivergent can have on your life, parenting abilities and overall functioning. This is why we need to open up the discussion around Neurodivergence and it’s impacts on parents.


This is a very basic, introductory blog post about this topic and there is so much more to talk about. Just highlighting the difficulties above has shown how much a parent with Neurodivergence can struggle in the Perinatal period or when experiencing a PMAD, and yet I haven’t come across specific training on these issues. I also haven’t come across that many sources of support for myself as a parent with ADHD. Most of the discussions, articles, and resources are centred on people who are parenting kids with ADHD or Autism. To help my kids manage their ADHD, I have to know how to manage my own.


Let me know in the comments below your thoughts on this topic!


For more information on ADHD and Autism, my favourite go-to website is ADDitude Magazine https://www.additudemag.com


If you recognize any of the above symptoms in yourself or suspect that you are Neurodiverse, it is highly recommended that you seek a diagnosis for yourself. In Ontario you can ask for a referral from your family doctor to an OHIP-covered psychiatrist who will evaluate you and diagnose you. The wait times vary across the province but can take well over a year for an assessment appointment. You can also pay privately at a fee-for-service clinic if you have the means.


Please note that I do not have extensive training in Neurodiversities. This post is based on my personal experiences and what I've learned on my journey.


References:

https://www.healthassured.org/blog/neurodiversity/

https://www.additudemag.com/adhd-in-women-misunderstood-symptoms-treatment/

https://www.webmd.com/add-adhd/adhd-history



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