ADHD and fatigue

[DontEatTheMushies]

I'm posting this in General, as whilst its my kid, she is basically an adult (5ft 7, adult weight etc), and I am hoping maybe someone has some advice?

Eldest is 17. Just before she turned 16 she got her diagnosis and meds.

Those have since changed and she is now on Vyvanse.

What hasn't changed is how tired she is.
I let them get as much sleep as possible, and we live close to the school so they can literally be up at 7:30 to be at school an hour later.

She struggles to stay awake after school, and even if she then naps for 1-2 hours she will be asleep again easily by 10pm.

Weekends she can sleep for between 8-14 hours a day.

We are up at 5am 3 x a week for her hobby, and she also has it 2 evenings a week, and 2 extra associated classes for it. Plus 1 hr of dance. so about 8 hrs of that hobby. Not a huge amount, and many do a lot more.

She has changed up her eating - not restricting but more protein, and she has introduced more green veg as well (she struggled as it wasnt a safe food but we got there), in case of Iron issues. Its a fairly balanced diet.

Caffine has 0 effect on her - she will sleep after caffine.
Energy drinks make her normal - she useds them in place of her ADHD meds for exams as they give her focus without feeling like her body was going to explode. She only has these for exams as I am not a fan.

The problem we have now is that she is on a work placement. It is a 9-5 day, not the 8:30 - 3/4pm of school. And it seems to be wiping her out more.

She says she isnt any more or less active than at school - physically or socially - but she is feeling so fatigued.

She fell asleep in the car on the way home within 5 mins last night.

I myself have an autoimmune disorder and get fatigue, but not at all to this level. Doctors don't seem concerned. I just feel this is extreme for a child of her age.

Thyroid check to be sure.

But my ADHD comes with Hedgehog Mode as well as Energiser Bunny Mode.

Sometime the world and the insides of my head are all too much and despite what I’d like to do, my mind and body roll up into a ball and refuse to do anything under the title of “knackered”.

Still check the thyroid though. I though I was just hedgehogging, but it turned out my thyroid had decided to join the party of dysfunction and disintegrate.

Can’t help with the ADHD meds, since I’m too old and take meds that don’t mix with them. But friends have reported they crash into exhaustion after the effect wears off.

Thank you. I will suggest that to her. It took 3 months of persuasion to get a blood test out of her previously - then she passed out so she's not a fan of them.

She does have her days. If they are off we get to like day 4 and she is full of energy - until about 2 weeks off then she is mentally and physically bored of that. I am just worrying that before shes really gotten going life is going to be annoyingly hard for her :(.

She is also getting PMDD symptoms, really sore periods that make her want to pass out (tbh she gets dizzy/visual snow when she stands up anyway), has really dark arm hair compared to OH and I (like more than her brother) and now we have seen noticable lower leg swelling on the daily, which she is actually worried about. I had thought maybe PMOS. So will ask them to look at everything.

They already think I'm a hypercondriac as I do have similar issues, but its cos I is fat apparently (-40kg, still there, go figure).

How long has this tiredness being going on for? Has the GP done any blood tests? If so, what was the result?

I have ADHD, ME/CFS and autism. Unofficially, ME/CFS is comorbid with ADHD. One of the main symptoms of ME/CFS is fatigue.

https://monitormyhealth.org.uk/advanced-thyroid-test/

Hard to get full thyroid panel via GP - make sure results are optimal not just in range

ask for full blood count in writing, explain what you have said here about decline. Keep a diary. Check HRV in case of autonomic issues

That description reminds me of me when I was around 20 and very hypothyroid. I was barely functioning and could easily sleep 16 hours. I lost weight as I forgot to eat/ had no appetite so was misdiagnosed for a while.

If I had to get up at 5.30am 3x a week, I'd be having daytime naps too.

Nor do I think it out of the ordinary for a teenager to be sleeping "between 8 and 14 hours at the weekend".

Not sure there is anything about this that is strange, or necessarily ADHD related, even while acknowledging that ADHD meds can affect your sleep.

Given your own history, my instinct would be to start with the general health screen via your GP to rule out any underlying conditions and contributing factors and treat accordingly.

Though two, would be check how much sleep she is actually getting - does she drop off soon after going to bed and sleep through the night or wake regularly? Is she getting enough sleep for her teenage needs?

An outside option to consider discussing with your prescribing team, if her sleep is adequate, is whether she would benefit from a small dose of short-acting dexamfetamine in the mornings to be taken at the same time as her lisdexamfetamine. Some people need the short acting release to kick in before their lisdex gets going for the day.

Get them to check B12, folate, vitamin D and iron levels along with her thyroid. All of mine were through the floor when I was experiencing the sane as your daughter. I was sleeping 19 hours a day at weekends, and close to 16 hours in the week - if I wasn’t working I was sleeping. I was falling asleep at work too. 2 years of every other day B12 injections, daily 10,000iu of D3, iron supplements, thyroid meds and 5mg folic acid all finally got me well and, in my view, saved my life.

look into thyroid. An outlier, but POTS is co-morbid with ASD. Extreme fatigue is main symptom but lots of other symptoms too so have a google

Sounds exhausting getting up at 5am 3 times a week and then also doing that hobby for two whole evenings a week.

Is it a physical hobby? I mean there’s your answer..

Yes people with ADHD are more tired in general for various reasons such as masking, sleep issues etc. But it’s the 5 am starts and then no downtime in the evening twice a week on top of everything else.

For me the caffeine actually makes me more tired. Pre adhd diagnosis I used to wonder why I could have a redbull and fall straight to sleep. If I took a pre workout for the gym I would be so tired I couldn’t do my workout. Try and cut out the caffeine and see if that helps (I know you said it’s only occasionally)

Have a look at PoTS criteria, the visual snow on standing could point to it. Is she hypermobile? Any outbreaks of hives? PoTS/EDS/MCAS can all be comorbid with neurodivergence

I would also do as others have already suggested and get her thyroid, iron, B12, Folate, and Vitamin D all checked, but then get copies of the results and check them yourselves rather than accepting the GP saying 'all normal'. Lots of deficiencies can also run hand-in-hand with neurodivergence

Re getting blood tests done, there's a numbing spray that works far better than the numbing cream, it's the only reason my ND dd is ok with getting them done. But it may need prescribed by a consultant rather than GP, or you can buy it yourself online from pharmacies in mainland Europe

This sounds a lot like me from 16 years to 21 years and it was glandular fever/ ME. Blood test for this is simple.

We also had the numbing cream for my DS who is neurodivergent and it works really well and he HATES injections.

exhaustion from the hobby?

And to be fair, at this age they’re still doing a lot of growing, especially brain wise. Brain growth carries on till 25 (or even 30 they think now) And tend to crave those lie ins. And they’re necessary from a physiological point of view.

The school that ran 10 am starts based on this philosophy isn’t that far from me. (Sadly closed now)

Yes exactly. I’ve done loads of research in to this - teenage brains are not naturally happy getting up early - even at say 7 so 5am will have a huge impact. And that’s without any ADHD. They just need loads of sleep. I was so supportive of later school times. It’s shame it hasn’t happened.

OP my ADHD son is exhausted with school hours - he is up at around 6.50. He would not be able to do a physical hobby at 5am 3 mornings a week and two evenings. He does do sport but that is in the school day and one day at the weekend.

Go back to the doctor and tell them everything.

Could be an ADHD misdiagnosis.

The napping after school is very familiar from a hypothyroid pov.

I do know that adhd can lead to extreme random tiredness - this is the main feature of adhd in a female relative in her early 20s who can’t do anything without medication. There’s a lot about being night owls in adhd and not going to bed early but I think the opposite is an under reported / recognised feature of adhd, as well as needing to nap a lot. A lot of the children I teach with adhd get very tired or just fall asleep randomly. Some don’t sleep at night but others do. (OTOH many cultures do have siestas and you could argue that we run ourselves into the ground.)

I need a lot of sleep and was a serial napper. (A skill I’ve lost 😭) When training to be a teacher in my 20s I’d have to have a nap when I got back from placements. The one thing I’ve found really does make a noticeable difference to me QUICKLY is more protein, especially in the first half of the day. I was completely wiped yesterday so rested a lot (I’m part time) and also ate a lot more protein. I feel a lot better today. Deep bone aches I had are also gone.

The other issue I’ve always had is I forget to eat. Your daughter may benefit from a bigger breakfast, around 30-40 g protein and also 30-40g carbs. Add in a nice tasting protein shake (there’s lovely ‘clean’ ones now like puriton with 20 g protein and some carbs and extra fibre.) Low energy reserve is common in young women; she simply may need to fuel more. Women’s circadian rhythms and energy levels respond well to more fuel in the morning. The body prioritises energy for fertility at the expense of brain and energy. (This is how I’ve managed fatigue of menopause without hrt - and clearly still get it wrong!) She’s still young and growing and may just need more sleep than other people.

But I would check and optimise all the other things too.

Oh I missed it was a physical hobby!

If everything else is good it may be she’s basically not fuelling well enough for what she’s doing. And it’s important she does as under fuelling can affect bone density. (Look up REDs and LEA.)

Have a look at the fitr woman app. Is free and Has recipes and fuelling recommendations for different parts of the menstrual cycle. Lots of information about the importance of fuelling appropriately. (That eggs and avocado recipe is really lovely!)

It's normal for ADHD, IMO. DD3 is 17 and she wakes up at 7.30-8 am each day and goes to bed at 8.30 pm.

Your DD is having less sleep 3 times per week and spending 8 hours doing something physical, plus travel time.