This book elaborates on Neurodevelopmental Disorders (NDD) and their treatment in adult women with a special focus on the unique clinical presentation of these problems during the Perinatal period. Problems related to chronic, untreated NDD during adulthood are viewed through the lens of pregnant and postpartum mothers to highlight unique struggles as their family unit expands after having children. The content is based on the author’s clinical experience with mothers under her psychiatric care between 2017-2024 at an outpatient practice, affiliated with Brown University. Comorbid psychiatric problems such as anxiety, mood disorders, trauma and substance use disorders are also reviewed. In addition to sharing clinical anecdotes, the author presents a consolidated review of scientific literature on the subject.

I believe that this book can be an important addition to scientific literature at this time, when Neurodiversity is being explored and accepted more in society and we are more receptive to improving women’s mental health. Afflicted mothers as well as their treatment providers have conveyed to me the profound relief on finally getting accurate diagnosis and treatment for NDDs. Several books have been published documenting the unique presentation and treatment interventions for ADHD and Autism in women, however, this will be the only book addressing symptomology and treatment interventions for NDD specifically during the perinatal period.  I have seen how successful long-term treatment with a specialized team of mental health professionals can significantly improve the quality of life not just for the mother but also, for the entire family unit.

The book will be divided into two parts:

Part 1- Clinical Manifestations and Symptomology in Adult Women with NDD

In the first part of the book, I plan to discuss the approach to diagnosis of Neurodevelopmental Disorders in General Adult Psychiatry and understand reasons for missed diagnosis, especially in females. I will outline my diagnostic and therapeutic approach, conceptualizing NDDsymptomology as variations of higher brain functioning rather than categorization of these symptoms as a “disorder,” and contemplating potential evolutionary advantages to neurodiversity. Based on my clinical practice, I will discuss tools for clinical assessment, including referral for neuropsychological testing and its utility in adults. In addition to the DSM-5 diagnoses, I will also propose conceptualizing difficulties in functioning and subjective distress in terms of symptom domains (executive dysfunction, hyperactivity/impulsivity, sensory overload and emotional regulation) as reflected in day-to-day functioning and social interactions in the adult life of women. Also, differential diagnoses including Obsessive Compulsive Disorder, Bipolar disorder, Post Traumatic Stress Disorder (PTSD), and personality disorders will be discussed, addressing the puzzling symptom overlap as well as genetic predisposition between these psychiatric illnesses and neurodevelopmental disorders. I will describe this association using clinical case examples and, later in the book, propose the inclusion of trauma-based interventions in treatment of Neurodevelopmental Illnesses in adult women. Lastly, comorbid substance use will be addressed. I will highlight struggles related to complex psychopathology and dual diagnosis. Given my training in Addiction Psychiatry, one of my goals is also to reduce stigma and apprehension about prescribing controlled medications in patients with history of substance use disorders. 

Part 2- Perinatal perspective on NDD

Part 2 will have a specific perinatal focus starting with a detailed description of predisposing factors (Behavioral/Social, Psychological and Biological factors) for distress in Mothers with NDD. Behavioral factors include high-risk behaviors that occur in untreated NDD, for example, a high number of unplanned pregnancies in girls and young women with untreated ADHD. I will discuss the effect of societal rules and cultural expectations on maternal mental health, especially during the perinatal transition. I will share my clinical experiences from working with perinatal women over the past 5 years in outpatient as well as inpatient settings. Given that this is the primary area of my work, I can offer meaningful insights based on the subjective experience of women with untreated ADHD, ASD during pregnancy and postpartum period/motherhood. I am not aware of any other source (paper/book) that documents these specific perinatal experiences through the course of pregnancy and postpartum, in a clinical setting like mine- a behavioral health program as part of an Obstetric Hospital.

I believe discussion of these issues can make clinicians more sensitive to screening for and treating these ailments in adult women. This has clinical relevance as I have come across several adult women, who were undiagnosed and untreatedduring childhood but were able to manage symptoms of NDD by developing compensatory behaviors. However, as they grew up and the complexity of their professional and personal lives increased, those compensatory mechanism became ineffective, and they developed clinically significant psychological distress. This is especially true during the postpartum period and early motherhood where intense internal/physiological changes are accompanied by major environmental changes and increased demands on the mother. Such role transition would be difficult for almost anyone, but for the mother with untreated NDD and secondary anxiety/depression, can be much more dysregulating and interfere with daily functioning.

Importantly, I will address issues of attachment within the mother-baby dyad and the family unit as whole after the woman delivers. In child psychiatry, there are several studies on behavioral issues in children with neurodevelopmental disorders and treatments to improve parent-child interactions and social learning. However, studies evaluating the attachment patterns within the mother-baby dyad in women with undiagnosed and untreated NDDs are scarce. I will shed light on these issues and propose potential future directions for research in the perinatal population with NDD.

Lastly, there is a lot of apprehension amongst prescribers about using psychiatric medications during this pregnancy and lactation. Unfortunately, a very common clinical presentation of these mothers to our clinic is after abrupt discontinuation of their meds followed by acute distress. As a perinatal psychiatrist, I will shed light on this subject with the goal of getting more prescribers comfortable with safely prescribing medications during pregnancy to prevent worsening of pre-existing illnesses or new onset of severe distress.

Intended Audience: Psychologists, Psychiatrists/Psychiatric Nurse Practitioners, social workers, ADHD coaches, OB/GYNs, primary care physicians and pediatricians