Puberty – A time for Hormonal, Neurobiological and Social Changes
The invisible girls with ADHD grow up and become adolescent young women with ADHD. And then they are far from invisible to us. The unfortunate paradox, however, is that we missed them as young girls because they tried to hide their challenges. And that we miss them again as adolescents when they show them in bright daylight.
When research is done on prepubertal boys, girls and women with ADHD will miss out on critical interventions and personalized treatment to help manage their ADHD symptoms.
During the time girls and women remain undiagnosed, displaying their ADHD symptoms come masked as comorbidity and sexual risk-taking.
Young women with ADHD will present in school and clinical settings with symptoms looking like depression, mood-, anxiety- or eating disorders, substance use, addiction and trauma.
Indeed, females with untreated ADHD have been put at higher risk for depression and anxiety, intimate partner victimization. Including teen and unplanned pregnancies.
Our research suggests that it is precisely during these formative adolescent and young adult years that we miss females with ADHD.
This is not just a matter of gender equity. It’s a matter of life or death!
Puberty – A Triple Whammy!
Hormonal changes – Puberty and adolescence come with massive hormonal changes. Where the increasing levels of hormones released from the brain (gonadotropins) stimulate the ovaries to start producing estrogen. That kick-starts the development of female sex characteristics.
Neurological changes – In parallel with these dramatic hormonal changes, major neurological changes are underway. During adolescence, the brain undergoes extensive pruning of excessive brain capacity. These processes involve the trimming of a substantial part of the brain’s processes and synapses that were developed during our fetal and childhood life.
The transition helps ensure we get a brain profile that is best suited for the environment we end up in. This, and the gradual maturation of the prefrontal cortex, prepare us for our adult selves.
Social changes – Last but not least, we also undergo quite fundamental social processes in the years around puberty.
These include extremely transformative years for our emotional and educational development.
The Female Body
For girls and young women adolescence is characterized by increasing levels of estrogens – but also increasing levels of testosterone.
Estrogen will affect and maturate the vaginal mucosa and initiate breast growth.
Increasing levels of estrogen will also affect the distribution of body fat. The young girl’s body will start changing towards a more “female form”.
From now on, healthy adolescent girls and women can’t look like boys or young men anymore. Rather they will need a layer of fat tissue to keep their hormone production on a stable level.
A challenging period especially for girls with AuDHD
Many girls and women with ADHD, will testify that this period of transition of both brain and body can be a critical and challenging period for them. This goes especially for those with high autism traits (AuDHD).
A Girl or a Woman?
Most girls get their period sometime between the ages of 12 and 14. It’s still normal to get your period between 9 and 16 years old.
The age at which a girl gets her period is often hereditary. So one of the best guesses for when your own daughter will get her period is to try to remember at what age you got yours.
The first ovulation is triggered when the rising estrogen levels reach a certain critical level.
Although ovulation and menstruation are biological signs of becoming “an adult”. It’s unlikely that many people today would consider a 12-year-old girl getting her first period as anything other than a child. This also applies from a legal and psychological context.
However, it’s important to remember that from a biological perspective, there’s no need to let girls and young women suffer from heavy menstrual bleeding or menstrual pain. Something that can easily be treated and alleviated by the same methods as any other woman.
Therefore, children and adolescents with severe problems related to their periods can be treated with hormonal contraception without necessarily being sexually mature or active.
Puberty + neurodiversity = trouble?
In adolescence, hormonal levels fluctuate sharply several times per month.
This doesn’t just do things to our bodily functions but also, obviously for most adolescents and their parents, also affects the brain. A brain that is far from mature.
More intensely experienced by neurodiverse girls
Many neurodiverse girls and young women with ADHD, ADD and autism experience these hormonal fluctuations more intensely. And are more severely affected by them than their peers without a diagnosis.
This is a period when the body is also changing. A process that can be more stressful for neurodiverse girls that struggle with change and strive for “sameness”.
Parents Prepare Yourself!
If you live in a neurodiverse family and suspect that you have a neurodiverse daughter – come prepared!
As a parent make sure to:
Pick up on the early signs of hormonal fluctuations that may start years before she gets her first period.
Read up on what you can from secure and good sources (but be aware, there is a lot of BS out there as well), talk to your daughter and try to discover the patterns together.
If she doesn’t want to talk right now, never push your agenda but rather make sure she knows your door is always open.
Keep track of her hormonal cycles and if her AuDHD symptoms change along with them, bring it up at the next checkup.
Let us know what knowledge or facts you’re missing, and we will provide them in our knowledge bank Mindhub!
Lotta Borg Skoglund
MD PhD & Letterlife Co-founder
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