Updated: Mar 30, 2022
Earlier this year, a new report by Anderson et. al. showed that adult women are filling 350% more ADHD prescriptions than they did 15 years ago. The authors warn that this is a "public health concern," as we need to be more careful about stimulants and pregnancy.
While not untrue, this is a disappointing turn of events. We learn that women are taking back their brains, and the main conclusion is that women may be shirking their baby-making duties.
I have contributed to this 350% increase, as it is not unusual for me to start a 36 year old woman on ADHD treatment for the first time in her life. It has happened consistently enough that I have wondered at this pattern. ADHD is a lifelong diagnosis, so she is not having "sudden onset" of inattentive symptoms (and if she is, there is probably another cause). She is usually driven to seek a consultation by her desire to move ahead in career and life, and acknowledgment of an invisible barrier that seems to have always plagued and stalled this progress, though she could never put her finger on the problem. Then she either finds an online ADHD quiz, or tries a friend's Adderall. The result is a eureka moment, as is often the case with ADHD diagnoses, likened at times to putting on glasses for the first time after having never realized you cannot see the world as clearly as the next guy. In careful assessment in my office, we uncover ADHD symptoms that have been present throughout her entire life.
Why did this not come up until 36? Is she suddenly popping into treatment because now is the time that she wants to stay up all night and rave? Is this a nefarious ploy to outperform her male counterparts at any cost?
In my experience-- no. It is the same problem that is getting a voice across industries.
As women, as girls, we're not loud enough. We don't make enough noise. If we don't fit- in the classroom, in the boardroom- we try harder, we bend farther, we make ourselves fit. These women never came to attention as children probably because they were not hyperactive boys bouncing off walls. They were calm and collected and lady-like-- or else they were "difficult" or "underachievers" or "lazy" or "anxious." Everything, perhaps, was a struggle, and yet with enough parental neck-breathing and a nudge of structure and routine, this was never outwardly apparent. Sometimes in college it becomes apparent as some of that structure and oversight begins to loosen, but often it holds up straight through postgraduate education and it is not until the workplace and family life, when we are required to function at 150% capacity that the reality of the struggle sets in.
These women reach their 30's and get about midway through until they begin to peter out, their brain locomotives huffing and puffing and grinding to a halt. The demands of life, work, family, have finally proven too much for all the compensatory mechanisms they have developed over a life of, for example, not using their anterior cingulate cortex appropriately for certain response inhibition tasks, instead taking a long route and expending unnecessary mental energy, constantly, which takes a toll.
I applaud and admire these women for asking for help, for looking for more, at a time in life when usually their needs are in a way-back seat.
And the response? Pregnancy!!
I don’t deny that people (men and women) misuse prescription medication, and this IS a public health concern. I also agree that women should be well-informed about the relationship between medications and pregnancy. But this is about the well-informed woman, who can make choices about medication and about pregnancy. While a beautiful thing, pregnancy equates the female body to a vehicle, the uterus being the essential operational tool far removed from the irrelevant brain. Be careful, warn the scientists, about these motivated, self-assured women who are trying to get everything they deserve, for what will become of the baby-makers.
The Me Too movement is about women taking back their bodies, their integrity, and their choices. This prescribing trend shows me that it has already started happening over this past decade and I am proud to be a part of it.
Baby-making is a most essential difference between women and men, and one that has historically challenged female ascendancy in the workplace. If every female gain must be considered relative to pregnancy, the gap does not change. If we attach this new progress to guilt and public health concerns we silence more voices that were gearing up to join the rising chorus.