Why I’ll still be taking pills even if I get pregnant: a follow-up

A few months ago, I shared a post in which I revealed I’m planning to continue taking my ADHD medications even if and when I someday get pregnant. I explained that I literally wouldn’t be able to afford to stop taking my daily dose of CNS stimulants; sans pills, I can barely function, which means I would be unable to work (or even drive to work, for that matter). In short, I would have to risk exposing my unborn child to all manner of adverse health outcomes in utero.

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As it turns out, however, such exposure may be far less likely than originally thought. As reported in a Nov. 29 ADDitude article, “The risks associated with taking an ADHD stimulant medication during pregnancy are real, but quite small,” according to an extensive population-based study published last month in the journal Obstetrics & Gynecology

In the study, the authors examined a cohort of pregnant women “and their liveborn neonates” enrolled in Medicaid from 2000 to 2010. They compared women who took Adderall or Ritalin alone in the first half of pregnancy to unexposed women, and women who continued to take the medication past 20 weeks’ gestation to women who discontinued.

The takeaway? 

Psychostimulant use during pregnancy was associated with a small increased relative risk of preeclampsia and preterm birth. The absolute increases in risks are small and, thus, women with significant ADHD should not be counseled to suspend their ADHD treatment based on these findings.

This is an indisputably significant development in the field of ADHD research. Until now, studies of methylphenidate (Ritalin) use during pregnancy were based on cases “not representative of the general adult ADHD population having methylphenidate as monotherapy during pregnancy,” according to a 2014 systematic review published in the British Journal of Clinical Pharmacology. That is because “all the articles reported combinations of methylphenidate with either known teratogenic drugs or drugs of abuse.”

But this new revelation is equally noteworthy for what it represents. In the past, discussions of whether women should discontinue their ADHD medication during pregnancy were cloaked in foreboding language, declaring it should only be done “if the potential benefits to the mother outweigh the potential risks to the fetus.” To me, it seems inevitable any woman faced with such tacit guilt-tripping would opt to go off her daily pill regimen — to, in short, prioritize the safety of her unborn child over her own well-being.

Also, this new knowledge has given me a newfound sense of legitimacy. While I’m an ardent feminist, I can’t deny that in Western society, motherhood is held up as the quintessential state of womanhood. So when years ago I found out having ADHD may mean I could not become a mother — at least, not if I wanted to continue to receive treatment for it — I felt like an essential part of myself was forcibly eroded. It was as though I was no longer a real, full-fledged woman because I probably wouldn’t be able to have a baby. And it wouldn’t be for a legitimate reason, like income or infertility; it would, like so many other things, be dictated by my need to take medication, to engage in preemptive damage control of my disability. In essence, it would have meant a disability I had from birth would prevent me from giving birth, myself. And when that dawned on me, one thought repeatedly ran through my mind: “It’s not fair.” 

I don’t know if I’ll ever end up having a baby. As I said in my earlier post, because of the strong likelihood my offspring would have ADHD as well, I would only want to bring a child of mine into this world if I knew it were a world more tolerant of ADHD than the one in which I grew up. Plus, I couldn’t handle single parenthood, and I don’t know what the future holds for me vis-à-vis finding a life partner. 

But with the publication of this study, for the first time in my life, I know if circumstances do align for me, I’ll be able to do what I’ve always wanted — become a mother — without stigma and without the overwhelming fear of putting my baby at risk in the process. 

That’s an invaluable gift. 

Pregnant-woman-with-hands-forming-heart-shape-on-belly

Is Twitter the next big thing in ADHD diagnosis?

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Yesterday, I received my daily Google Alert email update for the search terms “attention deficit.” I’ve had this set up for several years, but I must admit, I don’t often check it; I can offer no better excuse than that it is rather hard to keep abreast of daily news about attention deficit if you suffer chronically from it. In any case, this time, something compelled me to read through the headlines compiled in the email, and one caught my attention (no pun intended): “Searching for ADHD in a Million Tweets.” It states: 

After analyzing 1.3 million tweets written by nearly 1,400 Twitter users, researchers at the University of Pennsylvania have created a machine learning model that can predict which of the site’s users are affected by attention deficit/hyperactivity disorder (ADHD). […] Researchers monitored Twitter users with self-reported ADHD, comparing them to a set written by age- and gender-matched controls. The team then used various machine learning models to search for patterns in the two sets of tweets.

It might come as a surprise to you, my readers, but I must say, I find the whole thing terribly problematic. Why? Because it fails to take into account the fact that there are as many manifestations of ADHD as people living with it. The effects of ADHD in the life of one person may be entirely different from that of another.

For example, Lyle Ungar, one of the study co-authors, was quoted as saying, “I didn’t realize how common it was for patients to use marijuana to treat their symptoms, so you see people talking more about dope and weed.” But in contrast to these ADHDers, I avoid pot like the plague, not wanting to be any more dumbed down than I already am.

Meanwhile, according to the abstract of the article accompanying the research, published Nov. 8 in the Journal of Attention Disorders, “Users with ADHD are found to be less agreeable, more open, to post more often, and to use more negations, hedging, and swear words. Posts are suggestive of themes of emotional dysregulation, self-criticism, substance abuse, and exhaustion.” It seems to me the way these results have been reported is liable to reify negative stereotypes associated with ADHD. 

ADHD: not ‘one-size-fits-all’

I commend anyone wishing to shed light on ADHD, which after all is still arcane to most people who neither live with it or know someone who does. Also, for the record, I’m well aware of the inherent value of the internet, and social media, in particular, having minored in communication studies as an undergrad at the University of Oregon.

Even so, this research is misguided. It assumes there is one, and only one, kind of life ADHDers live, regardless of gender identity, socioeconomic status, race, etc. 

True, some health outcomes are more likely for people with ADHD. Depression, eating disorders, and self-injury are among a slew of comorbidities, or co-occurring conditions, in ADHD women, for instance. But therein lies the salient point: These aspects are common in ADHD women, specifically. As Devon Frye notes in a blog post on ADDitude, “men with ADHD are more likely to have substance-abuse problems while women with ADHD are more likely to have personality or mood disorders.”

Thinking outside the ADHD box

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Far from demarginalizing ADHDers, the reasoning driving this research homogenizes the ADHD experience. I love the idea of a group of researchers at an Ivy-League institution setting out to make things easier for people who may have ADHD. This is especially so because Ungar has said while ADHD is less well studied than conditions like depression, “Understanding the components that people have or don’t have, the range of coping mechanisms that people use all leads to a better understanding of the condition.”

What we really need

What people with ADHD — those who have been diagnosed with it, those who suspect they have it, and especially, perhaps, those who live with it unknowingly — really need is for the medical community to realize there is no one, singular ADHD experience.

Yes, this does make it harder to single out people who are likely to have undiagnosed, and thus, untreated ADHD. Yes, this does mean there would need to be a concerted effort to map all tweets from studied ADHDers, and not just those that appear so frequently as to be acceptable to make generalizations about said ADHDers.

But the effect — newfound insight into ADHD in all its countless iterations — would be well worth it.