In this episode, Ash and Dusty discuss the important topic of when worsening ADHD symptoms may actually be caused or worsened by other physiological or medical conditions. They explore how hormonal changes related to PMS, PMDD, perimenopause, and menopause can significantly impact cognition, mood, and executive function. Dusty shares her personal experience with PMDD and how medication has been life-changing in managing symptoms that overlap with ADHD but require different treatment approaches. They also highlight other health issues such as anemia, mast cell activation syndrome (MCAS), hypermobility disorders like Ehlers-Danlos, TMJ, migraines, and sleep disruptions that can mimic or exacerbate ADHD symptoms.
The hosts emphasize the importance of recognizing these co-occurring or separate conditions and how ADHD coaching can support managing them by focusing on follow-through, executive functioning, and problem-solving rather than “coaching out” chronic illness itself. Ash and Dusty encourage listeners to advocate for themselves with healthcare providers, get regular checkups, and explore potential underlying causes when symptoms suddenly worsen. They also caution against dismissing new or worsening symptoms as just ADHD and stress the value of integrated care between medical treatment and coaching to improve overall functioning and quality of life.
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Episode Transcript:
[00:02:13] Dusty: Hi, I’m Ash.
[00:03:16] Asher: And I’m Dusty. Wait, that’s not how that goes. Let’s try that again. Hi, I’m Ash.
[00:09:27] Dusty: And I’m Dusty.
[00:10:27] Asher: And this is Translating ADHD.
[00:13:12] Dusty: Hey, everyone. Just a reminder that a boot camp is coming up in June. So the ADHD Boot Camp is our mega home organizing doom boxing body doubling extravaganza. You get to hang out with me for 40 hours on a zoom call. Not all at once. Don’t worry, we’re going to take breaks and everything. Me and a bunch of my clients, we do this every year.
We go through and we decompress every room of our house that has gotten cluttered. We go through the drawers, we go through the cupboards, we reset things. We look at various pieces of content and media and philosophies around organizing. I’m not an organizing expert, Ash is, but I’m a repository of organizing hacks. So I help people come up with ideas for problem areas of their homes and what they can do about them.
We also tend to get a little bit of digital decluttering in. And so this is going to be starting June 7th. We are going to try to tackle most, if not all, the major rooms of your house. There’s going to be intersession support. It’s going to be lots of fun. We’re going to take lots of breaks.
It sounds scary, but it’s not. So if you would like to sign up for that, please go to https://www.adhdstudio.ca/. I will help you crush all those doom boxes, or at least take them from 40 doom boxes to I don’t know.
[01:25:07] Asher: Listeners, our next Patreon subscriber event is with me on Tuesday, May 14th at 8 p.m. EST. This is a live coaching demo, so I will coach one participant around a topic of their choice and afterwards we will talk about what happened in the coaching. If you’ve never been exposed to coaching before, this is a great way to see what coaching looks like in action.
I also find from my group coaching courses that witnessing other people being coached can help you understand something new about your own ADHD, so this is a really worthwhile event to attend if you have the time to do so. If you’re not currently a Patreon subscriber, you can visit the website at https://www.translatingadhd.com/, click on the Patreon tab, and for $5/month you gain access to these monthly events with either Dusty or myself, and you gain access to the podcast Discord.
I am also still taking new clients. I’m really trying to pack my schedule, guys. I recognize that the economy isn’t great, so I’m doing more sliding scale, which means I need more clients. So if you are thinking about ADHD coaching and interested in working with me, visit my website, https://coachasher.com/, and fill out the form and we’ll have a conversation from there.
So Dusty, today we are talking about something that has been relevant in a lot of my coaching sessions recently and actually has been relevant for me as well. And that is the fact that it’s not always ADHD. And I’m going to give the “moral” of this particular episode up front and that is if ADHD symptoms are suddenly worsening in a pretty significant way, there’s a pretty good chance that there is something else physiologically going on with you.
[03:13:14] Dusty: How so? What do you mean?
[03:15:14] Asher: This could be any number of things. So I’m going to start with one that we’ve already covered and we dedicated an entire episode to. But it is absolutely worth repeating for those of you who menstruate.
PMS is that time right before or at the beginning of your period. For every single one of my clients who menstruate, we’ve noticed a pattern where ADHD symptoms worsen, where brain fog is higher, and where negative thought patterns, especially when we get to a point in the coaching where we’re having a new experience with those negative stories, where clients are more readily able to sort of notice and dismiss those stories as not being true, rather than reacting to them during the PMS moment, that can be much harder to do.
When I was still experiencing PMS, I used to call that the PMS Gremlins and naming it that way sort of helped me recognize that yes, things feel bleaker or darker right now, but giving it a name reminds me that this isn’t a permanent state of being, and that yes, things are going to be a little tougher for me in this moment.
Alongside that, perimenopause and menopause are another stage of life. For those of you who menstruate, I’ve had so many clients who are in that perimenopause moment and maybe don’t quite realize that when we’re in coaching and we come to this awareness that they’re their concern about worsening ADHD symptoms, to the point that some of my clients have been concerned that maybe there’s something else going on in their brain.
Suddenly, their memory doesn’t work the way that it used to. Am I losing memory? Am I losing cognitive function? And we find that the answer is actually they’re in perimenopause and that’s having a significant impact on their cognition.
[05:11:00] Dusty: Yeah, certainly. And just to kind of add on to what you’re saying about PMS, there’s a threshold where we start calling it PMDD – Premenstrual Dysphoric Disorder. And this is really, really new research. And I was actually recently diagnosed with PMDD. I’ve had to start taking Fluoxetine or Prozac in the week before my period in my luteal phase.
And it’s crazy because, you know, for most of my reproductively active years, which I’m still in, I had different kinds of hormonal birth control. And for about 20 of those years, I had an IUD. So I had the kind where you just didn’t get a cycle at all. And so I think I kind of never realized this, but thinking back to my early teens, it actually made sense.
And so for me, with PMDD, the rejection sensitivity goes up so high that it actually crosses the threshold into paranoia, it’s like social paranoia, phobia and ruminating thoughts. It’s so disruptive. I’ll be crying, weeping in the kitchen at 7am trying to get my kids lunches ready. Then they walk in and now I’m running late because I’ve been obsessively checking my phone and thinking about somebody that I think is talking about me behind my back, it’s crazy. It’s out of control.
I take a low dose, I take 20mg of fluoxetine for 5-7 days and honestly, Asher, it’s been life changing. There’s so many days where when I’m in that phase and I’m on those meds, I just think to myself – I’m having a good day, sometimes I’m having a bad day, but I’m having such a normal day. My brain feels totally normal.
I can feel the difference between how I feel and when I’m in “crazy land”. And I’m just so grateful that I’m not because I have so much stuff to get done. It’s so separate, but it is connected because it has impacts on your executive function. It has impacts on your emotional regulation.
But it can even lead to thoughts of suicidality and all kinds of stuff. So, it can completely incapacitate you. I’m so glad that we have so much more research about how the life cycle of our menstrual cycles impacts our cognition and our executive function.
So that is a huge one for sure, and one that personally, I’ve had to manage these past couple of years.
[07:31:24] Asher: Wow. Thanks for sharing that Dusty.
I’ve now had a hysterectomy, so I don’t have those particular challenges anymore. And because I’m on testosterone, I don’t have the cognition effects of menopause, thankfully, which I am appreciative for. But I do think that that might have applied to me as well and would have been worth pursuing for me had I known.
So, listeners, if this sounds like a challenge for you, it might be something to check out, but now let’s talk about some other ones that have come up recently.
I have a client who has been in a serious season of struggle, just went through a couple of major life transitions, and this client is AuDHD. We’re going to do that episode on AuDHD at some point, but the relevant piece of information that distinguishes AuDHD people for the context of this story is that AuDHD people tend to find comfort in routine in a way that those of us who are purely ADHD don’t necessarily experience. So this person’s life transition meant that previous supportive structures and routines just are not there anymore and are not an option for her in the way that they were before.
And so we’ve been in this place of struggle in our coaching for a while, trying to find some footing. Meanwhile, she discovered that her anemia had come back in a big way, so she had incredibly, incredibly low iron.
Once she started taking care of that, all of the sudden her context isn’t different. But our ability to do something with it is because she was experiencing such severe brain fog and low mood, that cleared up almost immediately. So now there’s opportunity to find clarity and do something with that clarity that just wasn’t present when this unknown physiological thing was happening in the background.
[09:51:28] Dusty: Yeah. It’s interesting that you say this, Ash, because sometimes I think you could have a health issue that’s completely unrelated to ADHD, but giving you similar symptoms like brain fog or overwhelm or mood issues.
But then what’s also so interesting to me is we’re finding out more and more that some of these conditions are co-occurring. So a couple of big ones I’ve been learning about lately are MCAS or Mast Cell Activation Syndrome and hypermobility, usually related to EDS or Ehlers-Danlos Syndrome.
So I’ve had clients where they sometimes come to coaching not knowing that there’s any connection. And of course I’m not telling them there is, but I’m like, hey, maybe you should read up on this because I’ve heard that there might be. They have neck issues and they have joint issues and they have a lot of body and back issues that are actually often related to hypermobility or they’ve got MCAS, which has to do with things like histamine.
This is the big, trendy thing right now. I want to caution anyone listening about over-reading into it. I feel like we go through phases in the grassroots, neurodivergent space where we hook onto one idea, right now the big trendy thing is histamine.
And so, two things can be true. Certainly it’s true that histamine can be related to brain fog, executive function, feelings of tiredness, etc. And there can be some co-occurring conditions, like MCAS that are more prevalent in those with ADHD and vice versa. But histamine doesn’t explain everything right now. Everyone’s like, it’s all histamine, everything’s histamine.
But there are some really interesting overlaps there where I have clients who have completely separate physiological conditions that completely play into, like you said, our ability to get anything done. It’s not ADHD. They are physically too fatigued or they’re physically in too much pain. And so it’s always interesting to me when those conditions do show up more with ADHD. But they’re, for all intents and purposes, kind of separate things that have to be managed separately.
And yeah, when you’re in pain all day, it drains your executive function because you have to regulate so much more. And of course, your irritability is going to be increased and your ability to manage communications is going to be decreased. It makes sense.
[12:04:08] Asher: It absolutely makes sense. And in some cases it’s also disrupting sleep. I have a couple of clients struggling with TMJ, which by the way, I learned from one of those clients, has strong links to ADHD.
[12:22:12] Dusty: Yeah and migraines too.
[12:24:02] Asher: And migraines too. Those clients are experiencing sleep disruption that needs to be managed by trying to manage or have a different experience with the TMJ itself. This isn’t an ADHD, sleep, procrastination, revenge, bedtime type problem. This is waking up and unable to go back to sleep and now you’re awake and in pain problem. No amount of coaching or managing the ADHD is going to create a different experience there.
[12:59:13] Dusty: I am so glad you said that, Ash, because when you go through coach training, you learn how to coach from the ICF standards, and there’s sort of a right and a wrong way. I think that standard coaching just doesn’t have the framework for the fact that this subset population of people needs more specificity in general.
Sometimes we do need someone to just body double us. Sometimes we do need someone to just help us come up with a solution. But then moving one step further, like what you’re talking about, you can’t coach someone out of their chronic illness. And so what does coaching look like when you’re working with someone like that? For me personally, and I’d love to hear your experience.
Again, for me personally, sometimes coaching does just have to be more executive functioning support, problem solving and scaffolding because we have to focus on managing those underlying things first. There’s just no point trying to go one level up to when you’re in pain or when you just can’t get through the day. It can be disempowering.
[14:02:14] Asher: I agree with you, Dusty, but I will also add that there is a school of thought in coaching that really acknowledges the brain body connection, and I have had multiple instances of success there where coaching alongside medical intervention can make a significant difference.
For example, I have a client who, when we first started working together, experienced pretty significant migraines, but also had some awareness about what that pattern looked like for her. It was really related to what we call on this show, the ARC cycle (Adrenaline Response Cycle).
She was a student and so at the end of semester where it’s cram time, rush time, get everything done time, that level of stress in her body would ultimately lead to a migraine. So I’m coaching a couple of different things there.
Number one, reducing the crunch time thing. Getting things done more consistently so that crunch time isn’t so crunchy when it does happen. And number two, for her very kinesthetic person in general, picking up a consistent running practice, which is a way for her to relieve stress in her body. These were two things that significantly changed her relationship with migraines.
And by the way, for those of you that have experience with migraines, I’m not at all saying that behavior changes will necessarily create change for you. I’ve had clients for whom that’s not true, that no amount of behavior change is going to help. But for this client, changing habits and behaviors and doing some work on the ADHD side of things so that things don’t all end up falling into a very small period of high stress, made a significant difference for her.
I think the other opportunity as a coach, and this is also an opportunity for me to bring in another ADHD connected disorder, which is IBS. IBS is well known to be connected to ADHD.
I have a client that is currently working through understanding his IBS, and our coaching in part has been consistent implementation of the strategies or practices that have been recommended by his medical practitioners and observing what impact that does or does not have, which can be really hard for those of us with ADHD.
This is also a common theme for my clients. I have some clients with some physical disorders that have regular physical therapy that they need to be doing, so coaching can look like coaching to the ADHD that’s getting in the way of doing that. And again, also observing, noticing, turning our attention towards is this having a positive impact? And if so, what is that?
And if it’s not having a positive impact? Now that client has some information to take back to their medical practitioner to look for next steps or adjustments along the way.
[17:17:29] Dusty: Yeah, I’m so glad you said that. And I actually think we are talking about the same thing, because what you’re talking about is leveraging coaching to follow through on the actions that would help a person manage that condition. And that’s what I’m saying as well. I’m saying to me, that’s where it kind of becomes more about that really logistical.
We talked, I don’t know how many sessions ago or I don’t know how many episodes ago, about these different types of coaching, but that’s what I’m saying, right? Like sometimes the coaching is much more cerebral. And I think that’s not as useful when it’s like, what can you do to manage your migraines.
And that’s what it has to be about because then we can get to the other side of that. So this is actually something I talk a lot about in the context of pregnancy coaching, you’re hitting the nail on the head here, Asher, ADHD impacts our ability to manage these conditions.
I had this issue myself. I got this weird rash on my tattoo. I had a tattoo on my arm and I went to Mexico, and then all of a sudden, part of the tattoo, like one of the colors in the tattoo, started bumping up and getting itchy.
It was all covered in bumps, and that happens to me from time to time. But this was consistent. I talked to the tattoo artist about it. They told me that sometimes when you go through a barometric pressure change, it happens. But it just never went away. It was there for like a year and it was really weird. It would sort of come and go.
So finally I went to the dermatologist and they gave me this steroid cream. And I was using the cream, but I was not using it as per their directions and just not using it as frequently as I was supposed to. And the rash or the bumps in the tattoo never went away.
It wasn’t until I finally talked to my partner at the time about it, and he’s like, you really need to be using this way more than you are. You’re not using it enough. And I had to use my ADHD strategies and have alarms, notes, reminders, etc. for a period of a couple of weeks, to ensure I was applying it topically enough times.
And…it went away. I’ve never had that problem again, but I had it so much longer than I needed to. I’ve had that with other steroid cream related conditions and I’m just not good at applying it as many times as I’m supposed to. And what you’re saying about physical therapy, I’ve also had so many clients who struggle with physical issues for way longer than they need to, because doing the thing as many times as they need to do it is really hard.
So how this relates back to pregnancy is my colleague Alex Bacon, who is a midwife, taught me a term that clinical practitioners use, which is I think it’s treatment noncompliant. But it’s something about noncompliance. And that’s tough because medical practitioners may not understand the way that it impacts our ability to follow through on treatments that are recommended and needed.
And so that is where coaching, whether it’s from your therapist and it’s a therapeutic tool or it’s from your physical therapist and it’s a stretching tool or a physical door, sometimes we need to sit down with that coach and be like, okay, how am I actually going to make sure that I do this enough times? Because otherwise it just doesn’t happen.
So the ADHD plays into the chronic illness, which plays into the ADHD. It’s just a spiral, I do think you’re right about that. Sometimes the coaching needs to be focused on how do we get you to follow through on the thing that you know you need to do? And what does that actually look like?
[20:39:16] Asher: Dusty I also just went through a period where I was significantly affected by something I wasn’t taking care of, and I didn’t realize it. So one more thing I want to name that is worth checking out if it’s something that might apply to you. My challenge was high hematocrit, which is when your body produces too many red blood cells.
This is a potential side effect of testosterone hormone replacement therapy for anyone who falls into that category. But it can also happen if you live at a high altitude, if you have sleep apnea, or if you smoke. So there are a number of potential cautions for high hematocrit. It is more common in bodies that run on testosterone, but it’s not exclusive to bodies that run on testosterone.
High hematocrit causes brain fog because it increases the thickness of your blood, which impairs blood flow to the brain. And this is something that I know is a side effect of my HRT (hormone replacement therapy). I am supposed to donate blood once every six weeks or so, and I had not donated blood in several months. But alongside that, I was diagnosed with a chronic health condition and I had a hysterectomy.
And so I was in this place where I was experiencing extreme fatigue, which is another side effect of high hematocrit and extreme brain fog, and Dusty, I honestly just thought that I was chronically depressed. Like between the state of my life and the state of the world, I was like, this is just my new normal. And because I have ADHD, I had just plumb forgotten to take care of my high hematocrit.
It was so far out of my brain, and every time I would remember I’d be in the car or something, like not in a place where I could make a note or make an appointment or do something about it. So this went on for months, and I finally took care of it about a month ago. And it was absolutely incredible how much better I felt.
So a couple of things about that. Number one, to double down on your story that ADHD can make it hard to do the thing you know you ought to do. But to add to that, ADHD can sometimes make it hard for us to get past the symptoms, in my case, fatigue and brain fog, and get curious about what’s the cause.
[23:10:04] Dusty: Right? Because you just think it’s ADHD.
[23:12:11] Asher: Right. You think it’s ADHD and or you tolerate discomfort. There’s this mounting discomfort that we just tolerate, and we don’t realize to what degree we are tolerating it. So listeners, a couple of opportunities here.
Number one is if we’ve expressly named something here that applies to you – pull on that thread and see how you can have a different or better experience. It’s going to help you have a different or better experience with ADHD symptoms that are made worse by these things, but I think more so than that with ADHD, we just often don’t pay attention to our bodies in a useful way. So if all you know right now is your ADHD symptoms seem worse, the opportunity here is to tune in to your body and see if pulling on that thread from a physiological standpoint isn’t what makes the most sense.
I know that I am terrible about getting regular checkups, so if I didn’t have to get my labs for my HRT prescribed, I would not have my labs around regularly. I would not know what was going on with my Hema. If you haven’t had just a general checkup, had your labs run just to see where you’re at, where you might have some deficiencies, do that because there are a number of deficiencies that we did not name today that can absolutely make ADHD symptoms worse.
[24:48:25] Dusty: I also want to just flag it here too, that unfortunately, not everybody’s care provider is like that. And sometimes people do bring up their concerns and they get dismissed. So if you have a care provider who you feel like isn’t being as attentive or taking your concerns seriously, one tip I heard is to ask them to note that down in your chart.
Like if you say, I think I might have POTS and I’d like a tilt table test or I’d like to explore that and they go, yeah, I know you don’t really meet any of the bars for that, I don’t think that’s a problem for you. You can go okay, so we’re not going to do the test but would you mind please, noting that down in my file that you’ve declined to, pursue this further. Because sometimes we don’t have the best care providers, unfortunately.
[25:26:02] Asher: Dusty, I’m really glad you said that, because the final point I was going to make is the unfortunate truth that a lot of my clients, particularly those that are experiencing things that sound like ADHD, that are experiencing things like brain fog if they have an ADHD diagnosis already, they are dismissed by the care provider as “yeah, that’s just your ADHD”.
So don’t be afraid to advocate for yourself. Don’t be afraid to say no, this is not just my ADHD, this is something more. I know what my ADHD looks like and this is significantly different than that. I really feel that there is something else going on with me. On that note, Dusty, I think that this is a good place for us to wrap for this week. So listeners, until next week, I’m Ash.
[26:13:22] Dusty: And I’m Dusty.
[26:14:02] Asher: And this is the Translating ADHD podcast. Thanks for listening.
