The Edinburgh Postnatal Depression Scale is not enough for ADHD/Autistic Parents
With every detail that comes to light in the Lindsay Clancy case, I become more enraged at how grievously neurodivergent conditions are missed. But when it happens during the postpartum period, it feels especially heinous. Clinicians and physicians are missing an entire population of people in need of mental health services and help, during the most vulnerable transition of their lives. I know because I was one. Twice.
After my third child was born, I remember crying. A lot. I’m not a crier usually. I remember feeling constantly overstimulated, and spending my days dreading sundown, when my witching-hour baby with colic couldn’t be put down from like 4-7pm. I snapped at my older two kids, who were only 6 and 4 years old at the time. I once passed on going to a local pizza place with two families we were close to because I was exhausted and just thought I could hang with the newborn at home, so I told my husband to just take the other kids and enjoy himself. My new baby promptly screamed at the top of her lungs for about a half hour before I started crying and screaming too. Without texting anyone, I drove down and walked into the local pizza shop sobbing, carrying my newborn in my arms, and handed her to whichever mom from the family friends got to me first. I put in a request for a psychiatric referral for postpartum depression the next day, and started Prozac that same week.
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Standard postpartum depression screening tools—the ones we rely on, the ones insurance companies recognize, the ones we learned in grad school—they’re designed for one presentation: depression. They look for depressed mood, loss of interest, sleep disturbance (with a newborn? WHO IS SLEEPING?!), guilt, and concentration problems among other symptoms. But your ADHD or Autistic postpartum client’s depression may not look like the symptoms listed above. It may look like dysregulation, or having full executive-function collapse, or wanting to pull off their skin when they hear the baby cry because of sensory issues. And our current screening tools? They don’t account for any of those symptoms.
Clinically, we know that mothers with undagnosed ADHD and autism have a higher risk of postpartum anxiety (PPA), postpartum depression (PPD) and postpartum OCD. If the EPDS is the only screener we’re using at appointments for this population of clients, we have the potential of missing the underlying causes and therefore potential interventions for these clients.
I’m writting this for clinicians who are watching the Clancy case (which, I acknowledge is centered around postpartum psychosis and quesstions around bipolar, NOT autism or ADHD), and want to learn more about how to help close the gap. I’m not a postpartum or perinatal mental health clinician, but I do specialize in working with late diagnosed ADHD/Autistic adults, and many of them sought assessments because of their negative postpartum experiences.
Why look at ADHD and Autism specifically?
Because ADHD and Autism show distinct patterns in postpartum mental health.
ADHD in Postpartum:
Women with ADHD experience higher rates of postpartum depression and postpartum anxiety (one study showed that birthing mothers with ADHD are 24% more likely to be diagnosed with PPD than mothers without ADHD). Why? Because postpartum creates a significant strain on the birthing parent in terms of executive functioning, hormones are drastically fluctuating, and sleep deprivation exacerbates or masks ADHD symptoms. To top it all off, care tasks are cyclical in nature, creating a never-ending open-loop spiral that the ADHD brain can collapse under.
Autism in Postpartum:
Autistic mothers show similarly elevated rates of postpartum depression and anxiety, often with distinctive presentations: sensory dysregulation, social masking burnout, demand avoidance around parenting tasks, shutdown responses to overstimulation, and difficulty with the constant transitions of infant care. A study released in 2024 with a sample size of 55,440 birthing people found that the probability of PPD or PPA was significantly higher among autistic people than people with or without intellectual disabilities only.
The Gap:
Standard postpartum screening tools were developed and validated on populations that don’t include ADHD or Autistic birthing parents. The EPDS, the Patient Health Questionaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) are all built to catch depression and anxiety. These screeners don’t evaluate executive functioning or sensory sensitivities or symptoms of masking burnout. They don’t catch shutdown responses or even depression showing up as rage.
So while your client scores “normal” on the EPDS (I did, all 3 times I took it, and ended up with PPD 2/3 times, once totally untreated), she’s also completely unable to initiate any task. She can’t leave the house because sensory input is too much. She’s performing normalcy around her partner but falling apart when alone. She’s forgotten she has a pediatrician appointment three times. Her executive function has collapsed, but the screening tool says she’s fine.
This is the gap, and the hole it leaves has far-reaching implications.
What ND Postpartum Actually Looks Like
We have to first know what we’re looking for before we can see it, so let’s talk about ADHD and Autism in postpartum. These symptoms can be present whether or not the client is formally diagnosed, but as the mental health clinician seeing them, you need to familiarize yourself with how this population is impacted by the postpartum and perinatal period.
ADHD Postpartum Presentation (which you can read more about here):
Trouble initiating tasks/freezing up (“I know what I should be doing but I can’t force myself to get up and do it.”)
Working memory is overloaded (“I have 100 post it notes everywhere and if I don’t write it down, I forget it.”)
Emotional flooding (“I just feel so overwhelmed all the time”)
Rejection sensitivity
Baby’s cry feels physically painful (I used to describe my baby’s cries as sounds that went “straight to my brain”)
Touch becomes overwhelming
Lights, sounds, textures all feel aggressive
Sensory overload triggers shutdown or rage
Constant “what-if” spiraling about baby’s safety
Intrusive thoughts
Difficulty tolerating uncertainty
Anticipatory anxiety (the anxiety I’d feel when it started to get dark was this)
Autism Postpartum Presentation (which you can read more about here):
Performing normalcy or trying to perfect being a “good parent” exhausts all available energy (client may or may not be aware they’re doing this)
Shutdown when alone (literally can’t move, can’t think, everything feels impossible)
Social demands of postpartum (visitors, family involvement, partner presence) feel unbearable
Infant sensory profile (constant touch, crying, smells, textures) is difficult or intolerable
Sensory seeking behaviors
Rigid routines (which feel safe) conflict with unpredictable and varied infant needs
Hypervigilance about “doing it right”
Difficulty asking for help
Similar to ADHD: time blindness, task initiation, working memory overload
Often worse because sensory dysregulation takes all available cognitive energy
How Standard Screening Misses This
The EPDS is the gold standard for screening for depression at postpartum check ups, and asks about depressed mood, loss of pleasure in activities, self-blame, and anxiety, among others.
A neurodivergent postpartum client might score low-to-normal on this and still be at risk for PPD or PPA. The questionaire asks if she’s depresssed, which the EPDS describes as crying for no reason, or having thorughts of hurting herself. And this particular client might not have those symptoms, but she may be totally dysregulated and feels guilty that having the baby in a baby carrier makes her feel like peeling off her skin sometimes. She may not have answered “Yes, most of the time” to the question “I have been so unhappy that I have had trouble sleeping,” but she may find herself sitting up at night watching the baby monitor to make sure the baby is still breathing.
So her screening result ends up being “normal postpartum adjustment.” And her PPD/PPA goes uncharted.
Resources for Your Practice
Screening Tools to Consider Adding:
Conners Adult ADHD Rating Scale (CAARS) — for ADHD domains
Autism Spectrum Quotient (AQ-10) — brief autism screening
Executive Skills Questionaire-Revised (ESQ-R) — for executive dysfunction
Your own tailored questions (above) — designed for postpartum context
Training/Education:
For Your Clients:
Clinician Karen Kleiman currently owns this space in terms of resources for your client. You can find a list of her books here.
Search for postpartum and perinatal support groups on Psychology Today or Inclusive Therapists. Encourage parents to connect with a group even if it’s virtual, to reinforce that they aren’t alone.
Your Next Step
This gap exists because postpartum mental health in neurodivergent populations hasn’t been prioritized in clinical training.
We can start with one addition: Add in executive function screening to your postpartum assessment, asking about time, task initiation, and working memory. See what you start noticing, and listen for themes. Follow up by asking sensory questions, and listen for sensory dysregulation narratives. Then ask about masking and social fatigue. Build it slowly, but build it. Because the clients who are currently being missed—they’re in your practice right now, scoring “normal” on depression screening while their lives collapse and they blame themselves.
They need clinicians who know what they’re looking for.