Treatment of ADHD in Perinatal Women with Dual Diagnosis: A Comprehensive Pharmacological and Psychosocial approach

Attention deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder affecting about 4.4 percent of adults in the United States, with females presenting more commonly with inattention rather than impulsivity and hyperactivity. The perinatal period, followed by transition to motherhood, presents greater challenges for women with ADHD as there is significant worsening of pre-existing deficits in executive functioning due to major hormonal changes, prolonged sleep deprivation, heightened social demands and abrupt discontinuation of stimulants. In this report, we discuss the case of M, a middle-aged woman suffering from inadequately treated ADHD, comorbid with Bipolar disorder, TBI (Traumatic Brain Injury) and history of substance use. We describe the patient’s clinical presentation during pregnancy, difficulties in engagement, and a treatment course with multiple complications. More specifically, we highlight our unique implementation of a long-term treatment approach to address her ADHD-related challenges during the postpartum period and subsequent years as M cares for her children with limited finances and social supports during a global pandemic. Finally, we emphasize outcomes of treatment and future directions for clinical research to design outpatient treatment models individualized to fit the complex needs of this population.