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2 Perimenopause, Menopause and ADHD
- Jeanette Wasserstein, Gerry A Stefanatos, Mary V Solanto
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 881
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- Article
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Objective:
We previously reported the impact of hormonal changes during menopause on ADHD and associated symptoms. Here we provide findings from an expanded sample limited to those 46 and older.
Participants and Methods:Information was obtained from a reader survey sponsored by ADDitude Magazine. Responses were received from 3117 women of whom 2653 were 46 or older. Analyses were limited to this older group, since mean age of perimenopause is around 47 in the general population. The final sample ranged in age from 46 to 94 (mean=53) and 85% had been diagnosed with diagnosed with ADHD. Respondents were asked to indicate their age at diagnosis and the impact of 11 different symptoms or associated problems of ADHD at each of 5-time intervals: 0-9 years, 1019 years, 20-39 years, 40-59 years and 60+years. Co-morbidities were also considered.
Results:Changes in ADHD Symptoms: Sixty-one percent reported that ADHD had the greatest impact on their daily lives between 40 and 59 years of age. The largest group of respondents (43%) were first diagnosed between ages 41 and 50. The reported prevalence of inattention, disorganization, poor time-management, emotional dysregulation, procrastination, impulsivity and poor memory/brain fog increased over the life span. More than half indicated that a sense of overwhelm, brain fog & memory issues, procrastination, poor time-management, inattention/distractibility and disorganization had a 'life altering impact’ during the critical menopausal/perimenopausal window. By contrast, complaints about significant hyperactivity, impulsivity, social struggles and perfectionism remained fairly constant over the lifespan, and were not among the most common complaints (i.e., only endorsed by 25% to 35% of the sample). Interestingly, while 61% reported that ADHD had its greatest impact on daily life between 40-59, only 3% reported the same thing for age 60 and above. Thus, in this expanded sample the first diagnosis of ADHD was most common in adulthood and peaked in the perimenopausal years. ADHD was also again most disruptive during the perimenopausal/menopausal window of time. This shift was most pronounced for symptoms of poor memory/brain fog and 'feeling overwhelmed.' Symptoms either diminished or they adjusted as they moved out of the transition years.
Comorbid Symptoms: Anxiety and depression were most common (73% and 63%, respectively) consistent with the literature. Also elevated, but much less frequent here, were learning, eating and sensory processing disorders (i.e., 10%-13% each). Thus, depression and anxiety may be the most frequent correlates of an ADHD diagnosis, irrespective of age of onset.
Conclusions:Hormonal change during the climacteric often is associated with worsening of cognitive complaints. Such increased complaints can lead to a first diagnosis of ADHD during this period, as well as a worsening of symptoms in those previously diagnosed. Moreover, this hormonal shift may underlie this diagnosis in a subset of the individuals currently characterized as having adult-onset ADHD. Lessoning of complaints in those ages 60 and above raises questions regarding the underlying mechanisms for this change (e.g., physiologic adaptation, compensation or decreased life demands).
Chapter 3 - Developmental neuropsychology of autism
- from Section 1 - What We Know about Autism and How We Know It
- Edited by Mark Reber, Drexel University, Philadelphia
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- Book:
- The Autism Spectrum
- Published online:
- 05 November 2012
- Print publication:
- 11 October 2012, pp 59-82
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Summary
The concept of “autism” originated with the Swiss psychiatrist Eugen Bleuler (1911), who coined the term to refer to the “detachment from the outside world” and the “preponderance of introversion” that he observed in adults with schizophrenia. Bleuler believed that the other pathological accentuation of autistic thinking that occurred in schizophrenia reflected a disintegration of mental function and was associated with other disturbances, including lack of initiative and persistence, aimlessness, impulsivity, bizarre behavior, disordered attention, obsessional and automatic acts, and loss of contact with reality.
Around this time, several reports suggested that the onset of this form of deterioration, previously referred to as dementia praecox, could emerge in children following a period of seemingly normal development (DeSanctis, 1908; Heller, 1908). In due course, the concept of autism was adopted to describe congenital forms of psychopathology in which children failed to develop adequate or appropriate levels of affective contact with others, instead remaining withdrawn and self-absorbed. The Russian neurologist Ewa Ssucharewa, for example, embraced the concept in describing an “autistic attitude” that she had observed in children described as having a schizoid personality disorder (Ssucharewa, 1926). This “attitude” was reflected in social avoidance and a preference for fantasy stories and fairy tales, and was accompanied by characteristic oddities of thinking (perseveration, rumination, and rationalization), emotional dysregulation, and the presence of echolalia, impulsivity, and stereotypic behavior. The Austrian psychiatrist Hans Asperger subsequently utilized the term “autistic psychopathy” to characterize a very similar group of children who seemed self-absorbed in special interests or obsessions and were unaware or unconcerned with social norms and expectations to an extent that they had profound difficulties negotiating social interactions with others (Asperger, 1944).
Chapter 4 - Neuropathology of autism
- from Section 1 - What We Know about Autism and How We Know It
- Edited by Mark Reber, Drexel University, Philadelphia
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- Book:
- The Autism Spectrum
- Published online:
- 05 November 2012
- Print publication:
- 11 October 2012, pp 83-111
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Summary
The last frontier in this world – and perhaps the greatest one – lies within us. The human nervous system makes possible all that we can do, all that we can know, and all that we can experience. Its complexity is immense, and the task of studying it and understanding it dwarfs all previous explorations our species has undertaken.
– Neil R. Carlson, Physiology of Behavior (2009).Introduction
In Kanner’s (1943) original description of infantile autism, he conjectured that the disorder was based in an “innate inability to form the usual, biologically provided affective contact with people” (1943, p. 250). He regarded the disorder as inborn, rooted in the constitution of the mind, rather than learned or acquired through experience. Kanner later abandoned this biological perspective in favor of one that emphasized the role of environmental factors, and in particular he implicated emotionally cold and unavailable parents as an important causal influence (Kanner, 1949). This “psychogenic” viewpoint was embraced by psychiatry and went largely unchallenged for many years. However, factions in psychiatry (e.g. Van Krevelen, 1958) and psychology (e.g. Rimland, 1964) began to voice strong opposition to this theory, arguing instead that the disorder resulted from profound central nervous system dysfunction of unknown origin.
The biological perspective subsequently gained support from observations that children with what is now termed autistic disorder (AD) had a raised prevalence of certain minor physical anomalies (Walker, 1977; see Ozgen et al. (2010) for a recent review) and were more likely to demonstrate positive findings on neurologic examinations. Schain and Yannet (1960), for example, reported a high frequency of seizure disorder in their cohort of 50 children with autistic disorder attending a residential school for children with mental retardation. As pediatric neurologists, they highlighted the role of limbic dysfunction in epileptogenesis and speculated that AD may be based in limbic system damage or maldevelopment. In support of this assertion, they disclosed the results from a single autopsy case whose “only neuropathologic findings consisted of dropping out of cells in the hippocampal formation” (p. 565).
Waves of the Brain, As Luck Would Have It
- Gerry A. Stefanatos
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- Journal:
- Journal of the International Neuropsychological Society / Volume 13 / Issue 3 / May 2007
- Published online by Cambridge University Press:
- 20 March 2007, pp. 556-557
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An Introduction to the Event-Related Potential Technique (Cognitive Neuroscience), by Steven J. Luck. 2006. Cambridge, MA: Bradford/MIT Press, 376 pp., $40.00 (PB)
The dramatic increased interest in event-related potential (ERP) techniques in recent years has been very gratifying in light of concerns a few years ago that this approach to studying brain function would be eclipsed by developments in other areas of functional neuroimaging (e.g., PET, fMRI) that have better spatial resolution. Instead, there has been increasing recognition that the study of event-related electrical potentials and neuromagnetic responses remains a critical complements to “hemodynamic” approaches, in part because they provide a millisecond-by-millisecond record of neural information processing that occurs between presentation of a discrete stimulus and the production of the motor response. This exquisite temporal resolution cannot be matched by techniques such as PET or fMRI. Moreover, ERPs provide a more direct index of neural activity related to stimulus events than procedures dependent on the coupling of brain activity with cerebral blood flow. The instrumentation is comparatively low cost for setup and maintenance and potentially portable so studies can be obtained in a variety of settings. In this context, this engagingly written Introduction to the Event-Related Potential Technique by Steven J. Luck represents an important and long overdue entry-level book to provide practical and concise information about ERP theory and methods.
Signs of Mental Activity: An Essential Guidebook
- Gerry A. Stefanatos
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- Journal:
- Journal of the International Neuropsychological Society / Volume 11 / Issue 6 / October 2005
- Published online by Cambridge University Press:
- 21 October 2005, pp. 791-792
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Event Related Potentials: A Methods Handbook. Todd C. Handy (Ed.). 2005. Cambridge, MA: Bradford/MIT Press, 404 pp., $60.00.
The dramatic increase in interest in functional magnetic resonance imaging in recent years has been accompanied by a wealth of literature on the scientific foundations of the procedure and the highly complex methodological issues that must be considered during experimental design and data analysis. To some extent, progress in this exciting area has eclipsed significant developments in other areas of neuroimaging, particularly the “neuromagnetic” approaches that study time-locked brain electrical potentials or magnetic field changes produced in the course of processing perceptual, cognitive, and motor events. However, there has been increasing recognition that the study of event-related electrical potentials and neuromagnetic responses remains a critical complement to “hemodynamic” approaches because of their exquisite temporal resolution and because they provide a more direct index of neural activity related to stimulus events than procedures dependent on the coupling of brain activity with cerebral blood flow. In this context, Event Related Potentials: A Methods Handbook, edited by Todd C. Handy, represents an important and long overdue handbook. It provides practical and concise information on ERP methods that is comparable to literature available for fMRI techniques.
On pure word deafness, temporal processing, and the left hemisphere
- GERRY A. STEFANATOS, ARTHUR GERSHKOFF, SEAN MADIGAN
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- Journal:
- Journal of the International Neuropsychological Society / Volume 11 / Issue 4 / July 2005
- Published online by Cambridge University Press:
- 01 July 2005, pp. 456-470
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Pure word deafness (PWD) is a rare neurological syndrome characterized by severe difficulties in understanding and reproducing spoken language, with sparing of written language comprehension and speech production. The pathognomonic disturbance of auditory comprehension appears to be associated with a breakdown in processes involved in mapping auditory input to lexical representations of words, but the functional locus of this disturbance and the localization of the responsible lesion have long been disputed. We report here on a woman with PWD resulting from a circumscribed unilateral infarct involving the left superior temporal lobe who demonstrated significant problems processing transitional spectrotemporal cues in both speech and nonspeech sounds. On speech discrimination tasks, she exhibited poor differentiation of stop consonant-vowel syllables distinguished by voicing onset and brief formant frequency transitions. Isolated formant transitions could be reliably discriminated only at very long durations (>200 ms). By contrast, click fusion threshold, which depends on millisecond-level resolution of brief auditory events, was normal. These results suggest that the problems with speech analysis in this case were not secondary to general constraints on auditory temporal resolution. Rather, they point to a disturbance of left hemisphere auditory mechanisms that preferentially analyze rapid spectrotemporal variations in frequency. The findings have important implications for our conceptualization of PWD and its subtypes. (JINS, 2005, 11, 456–470.)