ADHD in the Perinatal Period: When Compensation Cracks and Care Needs to Shift

While attention-deficit hyperactivity disorder (ADHD) diagnosis is on the rise, ADHD is rarely discussed in a perinatal context, despite the profound impact it can have during this critical time.

For clinicians, this gap may show up as clients who arrive feeling exhausted, ashamed, and convinced they’ve “suddenly lost it,” when in fact the perinatal context has stripped away long-standing compensatory routines and exposed attention, planning, and regulation needs at the exact moment the brain is asked to do more (Scoten et al., 2024).

Clinical social worker Gretchen Nelson, LICSW, ADHD-CCSP, PMH-C, has observed this in her work with neurodivergent clients:

“No one was talking about how ADHD, perinatal mental health, and the parent-child bond intersect - let alone how to support it clinically.” - Gretchen Nelson, LICSW, ADHD-CCSP, PMH-C

This shift isn’t a moral failing; it’s context exposing long-used compensations. When feeding schedules, fragmented sleep, hormonal shifts, and identity upheaval collide with a brain that relies on external supports, problems that were once manageable can become crushing (Scoten et al., 2024).

Why ADHD Symptoms Intensify in Pregnancy and Postpartum

Biological and environmental changes across pregnancy and postpartum frequently reveal attention and executive-function differences that were previously masked by structure, predictability, or informal supports (Scoten et al., 2024). When these challenges surface, many individuals experience higher stress and depressive symptoms in pregnancy, and, for those with an ADHD diagnosis, an increased likelihood of pregnancy, delivery, and neonatal complications (Murray et al., 2022; Amikam et al., 2024).

A large Swedish registry study found that 16.76% of women with an ADHD diagnosis were diagnosed with depression in the postpartum period, compared with 3.29% of women without ADHD; 24.92% were diagnosed with anxiety disorders postpartum, compared with 5% of women without ADHD. ADHD remained an independent risk factor even when other known risks were taken into account (Andersson et al., 2023).

At the same time, many birthing people with ADHD remain undiagnosed before pregnancy. When ADHD is unidentified, emerging difficulties in pregnancy or postpartum are easily misattributed to character, effort, or poor coping skills rather than to a long-standing neurodevelopmental profile under new strain.

The story does not end with the parent. A recent cohort study using Adolescent Brain Cognitive Development (ABCD) data found that collectively, pregnancy and delivery complications, substance use, and parental psychiatric history explained about 8% of the variance in childhood ADHD-linked attention problems using information typically known at the time of birth (Dooley et al., 2024). While not a deterministic pathway, it underlines how perinatal context matters for both parent and child.

Taken together, the research suggests that ADHD is not a side note in perinatal mental health. It is a meaningful risk factor for perinatal mood and anxiety disorders (PMADs), a marker of increased obstetric and neonatal vulnerability for some, and part of the developmental story that shapes a child’s later attention profile (Amikam et al., 2024; Andersson et al., 2023; Dooley et al., 2024; Murray et al., 2022). At the clinical level, that means assessment, risk monitoring, and intervention need to account for attention and executive demands, not just mood and anxiety symptoms (Scoten et al., 2024).

Emotional Themes in the Perinatal ADHD Experience

To help clinicians identify the inner conflicts shaping their clients’ stories, Gretchen’s reflective framework outlines five emotional themes commonly described by neurodivergent parents during the perinatal period (Nelson, n.d.):

Connection vs Self-Blame

Parents with ADHD might struggle to connect with their newborns, particularly after difficult births. This can intensify feelings of overwhelm and overstimulation, resulting in guilt and shame regarding their parenting abilities.

Attachment vs Emotional Distance

ADHD can hinder the development of a secure attachment style by complicating emotional attunement due to sensory, executive functioning, and regulation issues, often resulting in shutdowns as a coping mechanism.

Self-Trust vs Fear

ADHD during the perinatal period can undermine confidence in one's intuition, particularly in a medical system that often dismisses neurodivergent perspectives. This leads to increased anxiety when facing uncertainty, lack of support, or pressure to parent in ways that conflict with one's nervous system.

Identity vs Internalized Shame

Adapting to parenting with ADHD can revive past wounds and increase feelings of inadequacy, particularly when societal expectations clash with personal abilities, potentially reinforcing a belief of not being good enough.

Acceptance vs Reactivity

As parents take on new responsibilities, challenges related to ADHD can cause irritability and burnout. Without effective coping tools, they may experience a cycle of emotional reactivity, withdrawal, shame, self-criticism, and anxiety.

For perinatal clinicians, these themes are not abstract. They show up in the room as parents who love their babies and still dread the next nighttime wake-up; who long for closeness and also feel physically and cognitively flooded; who carry long histories of being misunderstood and now fear repeating that story with their child.

Naming these tensions for what they are - neurodivergent needs under strain, in a context that assumes neurotypical regulation and capacity - can reduce shame and open space for more accurate case formulation.

Clinical Implications for Perinatal Mental Health Practice

The research and clinical themes above point to several shifts that can strengthen care for birthing people with ADHD, diagnosed or not:

1. Screen for ADHD when perinatal mood and anxiety are present

Given that ADHD increases the risk of PMADs approximately fivefold, adding ADHD-informed questions during intake can provide a more accurate picture of what the client is experiencing (Andersson et al., 2023).

Briefly exploring longstanding patterns of inattention, disorganization, time blindness, or impulsivity - across school, work, and relationships - can help differentiate “new” symptoms from a chronic neurodevelopmental picture that has become less manageable in the perinatal context (Murray et al., 2022).

2. Assume under-diagnosis, especially in birthing people

Many birthing people will enter pregnancy without a formal diagnosis, but will describe lifelong experiences of disorganization, heightened sensitivity, or low self-esteem. For these clients, it can be clinically meaningful to gently wonder with them about neurodivergence - not to overpathologize, but to widen the frame beyond character and willpower. Psychoeducation that locates these challenges in a body–brain system adapting to increased demands can itself be regulating (Scoten et al., 2024).

3. Integrate executive-function supports into perinatal care plans

Studies and clinical guidelines highlight the functional consequences of ADHD during pregnancy and postpartum, including higher rates of impaired executive functioning, relationship strain, and health-risk behaviors when symptoms go unmanaged (Amikam et al., 2024; Scoten et al., 2024).

For perinatal clinicians, this means:

• Treating follow-through not as a matter of motivation but as an executive-function task that may need external scaffolds, such as visual schedules or cueing systems.

• Naming sleep deprivation as an ADHD multiplier and problem-solving around realistic rest, even in 15–20 minute increments.

• Supporting clients in structuring high-stakes caregiving tasks, such as feeding plans, medication schedules, and appointments, with checklists and reminders rather than relying on memory alone.

These are not productivity hacks; they are safety and attachment supports for families whose functioning depends on external structure.

4. Hold the parent–infant dyad in mind

Perinatal ADHD sits at the intersection of parental mental health, caregiving capacity, and the developing bond between parent and child. Data linking perinatal complications and parental psychiatric history with later ADHD-linked attention challenges in children, alongside higher rates of PMADs in parents with ADHD, suggests that early, dyad-focused support is a meaningful upstream intervention (Dooley et al., 2024; Andersson et al., 2023).

Gretchen’s framework invites clinicians to attune simultaneously to:

• The parent’s nervous system (overwhelm, sensory load, executive fatigue),

• The internal narrative (shame, guilt, fear of failing their child),

• And the relationship with the baby (moments of closeness, avoidance, rupture, and repair).

  
  

When we work at all three levels, nervous system, story, and relationship, we are better positioned to reduce risk, support bonding, and strengthen the family’s capacity to grow alongside a neurodivergent identity, their own or their child’s.

Closing the Clinical Gap

Drawing on her background in ADHD, early childhood development, and perinatal mental health, Gretchen designed her course, Overlooked & Overwhelmed: Supporting ADHD in the Perinatal Years, in direct response to this clinical gap to help clinicians take a more ADHD-informed approach to their perinatal care.

Overlooked & Overwhelmed: Supporting ADHD in the Perinatal Years

🗓 January 13, 2026

Gain the knowledge and tools needed to better recognize and support navigating both neurodivergence and the profound transitions of the perinatal period.

LEARN MORE AND REGISTER

Led by Gretchen Nelson, LICSW, ADHD-CCSP, PMH-C, this training will teach you how the perinatal period and parenting can intensify ADHD and how to adapt your current therapeutic strategies to work for clients with ADHD using a neurodiversity-affirming, developmentally sensitive lens.

Moving Toward ADHD-Informed Perinatal Care

When compensation cracks during the perinatal period, many neurodivergent parents experience it as proof that they were never capable to begin with. As clinicians, we are often the first ones invited into that story.

The emerging research makes it clear that ADHD is not peripheral in perinatal work. It shapes risk for depression and anxiety, intersects with obstetric and neonatal outcomes, and influences how parents experience bonding, identity, and safety in early caregiving.

When we begin to ask different questions - about executive functioning, sensory load, long-standing patterns of self-blame, and the specific ways parenting tasks strain a neurodivergent nervous system - we move from trying to motivate parents to try harder to helping them live inside systems that were never designed with them in mind.

As Gretchen teaches, truly responsive care asks us to “hold their history, support their nervous system, and acknowledge their bond.” In doing so, we make room for parents with ADHD to experience themselves not as broken, but as worthy of the kinds of support that make caregiving feel possible - for themselves and for their children.

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References

Amikam, U., Badeghiesh, A., Baghlaf, H., Brown, R., & Dahan, M. H. (2024). The association between attention deficit hyperactivity disorder and pregnancy, delivery and neonatal outcomes - An evaluation of a population database. BMC Pregnancy and Childbirth, 24, 364. https://doi.org/10.1186/s12884-024-06561-5

Andersson, A., Garcia-Argibay, M., Viktorin, A., Ghirardi, L., Butwicka, A., Skoglund, C., Bang Madsen, K., D’onofrio, B. M., Lichtenstein, P., Tuvblad, C., & Larsson, H. (2023). Depression and anxiety disorders during the postpartum period in women diagnosed with attention deficit hyperactivity disorder. Journal of Affective Disorders, 325, 817–823. https://doi.org/10.1016/j.jad.2023.01.069

Dooley, N., Healy, C., Cotter, D., Clarke, M., & Cannon, M. (2024). Predicting childhood ADHD-linked symptoms from prenatal and perinatal data in the ABCD cohort. Development and Psychopathology, 36(2), 979–992. https://doi.org/10.1017/S0954579423000238

Murray, A. L., Hall, H. A., Speyer, L. G., Valdebenito, S., Hughes, C., & Barker, E. D. (2022). Associations between ADHD symptoms and maternal and birth outcomes: Evidence from a population cohort study. Journal of Attention Disorders, 26(13), 1713–1723. https://doi.org/10.1177/10870547221105064

Nelson, G. (n.d.). ADHD in the perinatal years: Emotional themes workbook [Clinical training material].

Scoten, O., Tabi, K., Paquette, V., Carrion, P., Ryan, D., Radonjic, N. V., Whitham, E. A., & Hippman, C. (2024). Attention-deficit/hyperactivity disorder in pregnancy and the postpartum period: Best-practice guideline for clinicians. American Journal of Obstetrics & Gynecology, 231(1), 19–35. https://doi.org/10.1016/j.ajog.2024.02.297