View Full Version : Is Adult ADHD a Childhood-Onset Neurodevelopmental Disorder?


Strutsen
11-22-16, 06:45 AM
Couldn't find a thread about this study so please forgive me if my eyes aint working today.

Im a huge fan of Russel Barkley and I've spent almost my entire life post-diagnose following his work with ADHD. He's been around since the 70s and I've never heard or read anything that claims that you somehow might develop this disorder in adulthood. If so we would've seen it a long time ago. Severity of symptoms can increase/decrease due to thousands of reasons/disorders during life but how can they be sure its due to ADHD and not some other disorder with similar symptoms? My brain is a mess at the moment so please forgive my messy grammar.


https://www.ncbi.nlm.nih.gov/pubmed/25998281


"The findings raise the possibility that adults presenting with the ADHD symptom picture may not have a childhood-onset neurodevelopmental disorder. If this finding is replicated, then the disorder's place in the classification system must be reconsidered, and research must investigate the etiology of adult ADHD"

Fuzzy12
11-22-16, 07:44 AM
Fascinating. Thanks fkf sharing.

Strutsen
11-22-16, 08:21 AM
Fascinating. Thanks fkf sharing.

FKF?

Btw I just read the abstract and the study is pure crap and of no value whatsoever. Mods you may remove this thread


:giggle:

sarahsweets
11-22-16, 09:26 AM
FKF?

Btw I just read the abstract and the study is pure crap and of no value whatsoever. Mods you may remove this thread


:giggle:

Oh good- as far as I know adhd cant develop in adulthood because IMO the impairments would be life long including during childhood.

Strutsen
11-22-16, 09:42 AM
Oh good- as far as I know adhd cant develop in adulthood because IMO the impairments would be life long including during childhood.

Someone might have less impairment in certain domains and barely visible for the public eye and suddenly everything becomes a crisis and ppl think "oh boy he got ADHD in his 30s maybe its not something you're born with its probably the tv or computer". :lol:

There's so much garbage in the field of ADHD :umm1:

Fuzzy12
11-22-16, 09:55 AM
FKF?

Btw I just read the abstract and the study is pure crap and of no value whatsoever. Mods you may remove this thread


:giggle:


For*

I've got butter fingers...:)

Why do you think the study is crap? I've skimmed through the whole paper and it looks interesting to me. The number of adult adhd ers they found is slightly small so I'm not sure how reproducible the study is but I do think that it's something worth not just dismissing. Maybe a lot of us have been misdiagnosed with adhd just be cause currently there is no other category we neatly fit in.

If I understand the paper correctly they are questioning whether adult adhd always has a history of childhood adhd (which in the cases they studied was not true). They also found other differences between adult onset adhders and childhood onset adhders. I think they are questioning whether it's the same disorder and not whether what is traditionally known as adhd and starts in childhood is always developmental.

Since adhd is just the name given to a cluster of symptoms it is possible that the symptoms are caused by something else (which may or may not be genetic in nature) in the csee of adult onset adhd.

Sorry km.not expressing myself very well.

sarahsweets
11-22-16, 10:07 AM
For*

I've got butter fingers...:)

Why do you think the study is crap? I've skimmed through the whole paper and it looks interesting to me. The number of adult adhd ers they found is slightly small so I'm not sure how reproducible the study is but I do think that it's something worth not just dismissing. Maybe a lot of us have been misdiagnosed with adhd just be cause currently there is no other category we neatly fit in.

"As expected, childhood ADHD had a prevalence of 6% (predominantly male) and was associated with childhood comorbid disorders, neurocognitive deficits, polygenic risk, and residual adult life impairment. Also as expected, adult ADHD had a prevalence of 3% (gender balanced) and was associated with adult substance dependence, adult life impairment, and treatment contact. Unexpectedly, the childhood ADHD and adult ADHD groups comprised virtually nonoverlapping sets; 90% of adult ADHD cases lacked a history of childhood ADHD. Also unexpectedly, the adult ADHD group did not show tested neuropsychological deficits in childhood or adulthood, nor did they show polygenic risk for childhood ADHD."
I disagree with this bit. if 90% lacked a history of childhood adhd, then it isnt adhd.

Fuzzy12
11-22-16, 10:29 AM
I disagree with this bit. if 90% lacked a history of childhood adhd, then it isnt adhd.

You disagree with what?

This is what I'm trying to say:

Currently if you are getting assessed for adhd and can't show evidence of childhood symptoms and impairments two things can happen:

1. You are sent away because there js nothing wrong with you apart from being lazy or too ambitious or something like that..

2. You are told that your symptoms are caused by another known disorder like depression and anxiety and you sre given anti depressants or anti anxiety meds in the hope that once the other disorder subsides your adHD like symptoms disappear as well.

In both cases you don't get treatment for adhd ie stimulants.

Now what if there is a third possibility. What if you have a disorder that shares the same symptoms as adhd but that started in adulthood and thst does not respond to anti depressants etc but to stimulants? So it looks like adhd and is treated like adhd but it's not developmental as it didn't start in childhood. It might be a different disorder (but not depression, etc)

Maybe there are other things, another currently unknown disorder, that cause problems with executive functions or that impact the dopamine pathway in some form. This might vwry well be different to the classical adhd (and there is no need to vl calll it adhd) but there is no reason why it's not possible.

The paper says I think that the adult onset adhders were significantly impaired (ie in need of treatment or being treated..I forgot what they said about meds) and they did not have depression or any other disorder.

dvdnvwls
11-22-16, 12:10 PM
I think there are some shortsighted professionals who believe that if there wasn't a diagnosis in childhood then there wasn't a condition in childhood either. I think it comes down to that.

Fuzzy12
11-22-16, 12:36 PM
Well, not in this study.

If I understand correctly they didn't just look at diagnosis / no diagnosis in childhood. They considered the views of both the test subjects and someone close to them to assess whether they had adhd as children.

namazu
11-22-16, 03:40 PM
We know that the frontal lobes (which are key for "executive function") continue to mature throughout adolescence; this consideration has been the basis for numerous ethical and policy questions that I won't get into so as not to run afoul of ADDF guidelines.

But the trajectory/rate of development may not be consistent throughout that period. Most kids with ADHD become adults with ADHD. But in adolescence/early adulthood, when a minority [?]* of kids outgrow their ADHD, it is also possible that some number of people grow into ADHD. If they had been on an "average" frontal lobe maturation trajectory, and that maturation dramatically slowed (or failed to keep pace) upon reaching puberty or later, those people could fall behind. (Think of a marathon runner who keeps a good pace for the first 15 miles, but then runs out of gas and can't finish the race, or finishes with a very poor time.)

If ADHD is conceived as a developmental delay in executive function, then it may be reasonable to extend the definition (or at least allow treatment) of people who are impaired by symptoms that began later in life. Even ADHD as it is currently laid out in DSM-5 is likely highly heterogeneous; although we typically share symptoms and impairments (though these vary from person to person), the underlying causes may differ from person to person.

Dvdnvwls has a good point in saying that some people probably had ADHD symptoms earlier but simply can't remember/document it -- this can be an unfortunate barrier to diagnosis and treatment for some adults with ADHD who have inflexible doctors and lack the ability to corroborate early-childhood symptoms. Some may also have had mild (but present) symptoms in childhood that became much more impairing when demands on executive function became much greater, like when entering college.

But there may also be people whose symptom onset was indeed later than early childhood, and who are significantly impaired in adulthood due to symptoms of developmental delay that aren't explained by another disorder.

Whether this later-onset delay should be called "ADHD" or "late-onset ADHD" or something else entirely is -- in my opinion -- less important than substantiating the existence of this late-onset disorder, determining how common the problem is, and evaluating whether or not the treatments used for ADHD are as effective in that population. I think as we get a better handle on the specific etiologies of ADHD, the nomenclature will change, anyway.

The authors write:
Our data suggest the possibility that adult ADHD may not be the same disorder as childhood ADHD. Does this imply that adults presenting with the ADHD symptom picture do not need treatment? Unequivocally no.


*Unusually, in this study they found that at least 85% of adults who were diagnosed with ADHD as children had "outgrown" their ADHD (per reduced DSM criteria) by age 38, which is considerably higher than in most studies. To some extent, the relatively high incidence of "adult-onset" ADHD without childhood history reported in this study may reflect underdiagnosis of ADHD (especially among kids who were less hyperactive and among girls) when the study was initiated in the mid-1970s, and thus it may also overestimate the "outgrowing" rate.

C15H25N3O
11-22-16, 03:51 PM
If AMP and MPH were available for everyone over the counter there was no discussion if ADHD exists.

The whole discussion is a schizophrenic result of war on drugs and on excluding people from social life.

namazu
11-22-16, 04:23 PM
Too late to edit post above...

I found a commentary on the study, written by F. Xavier Castellanos (https://en.wikipedia.org/wiki/Francisco_Xavier_Castellanos), who is a long-time ADHD researcher.

The full text is available here: Castellanos FX. (2015) Is Adult Onset ADHD a Distinct Entity? Am J Psychiatry 172(10):929-931. (http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2015.15070988)

It gives a summary of the findings and how they might be interpreted, in the context of other research. It's not very critical of the study, but it makes the point that our understanding of ADHD is constantly evolving, and that there's a lot we still don't know (and that's hard to study).

ginniebean
11-22-16, 04:28 PM
Well, as I understand it head trauma, brain injury can become or develop into, a diagnosis of adhd. The treatment would be the same. Otherwise, it has to present in childhood. Adult onset is not adhd.

aeon
11-22-16, 06:38 PM
My mom took me to doctors and specialists as a young child because she thought something was wrong with me,
and as she describes it, it sounds like she thought I had ADHD, although she did not know of it (the disorder, or its
names) at the time.

She was dismissed, over and over, for what she feels were two reasons; 1. the doctors and specialists were men,
and didnít want to listen to, or consider, what a woman with no degree or letters was telling them, no matter how
articulate was her presentation, and 2. as a child I was an inveterate adult-pleaser, and I was bright and polite, so
I would pay attention to the medical professional with laser focus, and I would answer their questions and do their
puzzles to the best of my ability, and one by one, they were charmed, and each said the same thing...I had nothing
wrong with me, and indeed, I was a remarkable little boy.

Later in life, at age 41, my doctor diagnosed me with ADHD, primarily inattentive, and severe in presentation.

Now, did I have that as a child such that I could have been diagnosed?

Maybe...but to be honest, it would be difficult to determine if my presentation was one of a neurodevelop-
mental disorder, or the sequelae of head trauma from having been concussed so many times during the
beatings that made that remarkable little boy into the remarkable man I am today.


Namaste,
Ian

namazu
11-22-16, 07:21 PM
Otherwise, it has to present in childhood. Adult onset is not adhd.
That accurately describes current DSM-5 criteria for ADHD, which require symptom onset by age 12.

But perhaps the current criteria (or the set of named disorders) are missing a group of adults who have an ADHD-like syndrome that
- is substantially impairing,
- isn't explained by other disorders or life circumstances, and
- could improve with treatment.
That seems to be what the authors of the linked study are pondering.

Given that the conceptualization of ADHD and the diagnostic criteria have never been set in stone, it's hardly sacrilege to suggest that they're imperfect. If there is good-quality evidence that can't be accommodated by current models, then the models need rethinking. In this case, maybe a different name for this presentation of symptoms in the absence of childhood history of ADHD would be appropriate.

I'm not convinced of it yet myself -- the study has real limitations/caveats, and more work in other populations is needed to replicate these findings -- but the idea isn't implausible on its face. Development is a long process, and it may not get off-track for everyone at the same point or in the same ways.

mctavish23
11-22-16, 09:57 PM
You can "acquire" ADHD at any time; the most prevalent way is a Traumatic Brain Injury.

Hope that helps.

tc

mctavish23

(Robert)

sarahsweets
11-22-16, 10:42 PM
You can "acquire" ADHD at any time; the most prevalent way is a Traumatic Brain Injury.

Hope that helps.

tc

mctavish23

(Robert)

Yes but does that mean some starts to have symptoms of adhd- can have it now when they showed zero issues growing up?

Stevuke79
11-22-16, 11:10 PM
https://www.cdc.gov/ncbddd/adhd/facts.html

"Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. Recent studies of twins link genes with ADHD.

In addition to genetics, scientists are studying other possible causes and risk factors including:

*Brain injury
*Exposure to environmental (e.g., lead) during pregnancy or at a young age
*Alcohol and tobacco use during pregnancy
*Premature delivery
*Low birth weight"


Causes like brain injury can of course occur long after childhood.

mildadhd
11-22-16, 11:18 PM
There are different forms of deficits of self-regulation.

Example #1) There are deficits of self-regulation that are due to delay in certain areas of neurodevelopment. (No damage)

Example #2)There are deficits of self-regulation that are due to damage in certain areas of neurodevelopment.


In first example neurodevelopment of self-regulation becomes delayed, to a snails pace, when the rapid biological rate of BrainMind neurodevelopment declines about the age of 4-7.

The second example can occur at any age, neurodevelopment of self-regulation may have even have matured already, but if a person experiences traumatic brain injury resulting in damage to the right prefrontal cortex for example, can appear to be very similar to the first example of deficits of self-regulation.

Both forms of self-regulation deficits are acquired very differently.



G

namazu
11-22-16, 11:23 PM
Yes but does that mean some starts to have symptoms of adhd- can have it now when they showed zero issues growing up?
If problems arising in adulthood are due to a clear traumatic brain injury, they would usually be diagnosed as traumatic brain injury rather than as ADHD.

The symptoms and impairments caused by TBI can be similar to ADHD, though, and some of the treatment approaches and accommodations may also be similar.

The study linked in the OP is not about people who've sustained obvious brain injury. It's about a group of adults who meet the symptom and impairment criteria for ADHD, but without a history of ADHD in childhood, and without their symptoms being clearly explained by some other disorder or circumstance.

The question is what the researchers are looking at (and how to address it):
- Is there some late-onset disorder that presents like adult ADHD, which hasn't previously been recognized, but should be?
- Are these people with childhood-onset ADHD that was just missed early on? (Maybe, but their data suggest otherwise, since these people were followed from birth and some apparently lacked ADHD symptoms in childhood.)
- Is this some age-related mental decline phenomenon (and if so, due to what)?
- Some other explanation?

Strutsen
11-23-16, 12:07 AM
I find it a bit problematic because childhood ADHD in general seems to be centered around obvious symptoms and adulthood severity of impairments.




Its quite easy to spot the disruptive hyperactive type compared to inattentive especially girls who might look like they pay attention but their mind is someplace else.
instead of questioning the possibility(not very convincing)of a potential Adult ADHD they should expand the DSM-5 criteria. I've got tons of suggestions but my inattentiveness and lack of English vocabulary prevents me from doing so It took me nearly 2 hours to write this. I'm sorry I cannot contribute more.

mildadhd
11-23-16, 12:19 AM
One reason why they changed the required age of symptoms present for diagnosis, from before age 7 to age 12, is for people who do not remember before the age of 7, and lack other ways/people for verification of possible symptoms before the age of 7.

Everyone who has delayed deficits of self-regulation has had symptoms of ADHD from at least the age of 4-7, (edit, simply because delayed deficits of self-regulation never fully matured to begin with, before decline in the rate of development.)


G

namazu
11-23-16, 12:32 AM
instead of questioning the possibility(not very convincing)of a potential Adult ADHD they should expand the DSM-5 criteria.
The DSM-5 criteria (released in 2013) were based on a combination of the old criteria, the research that accumulated since the DSM-IV to support changes (or keeping things the same), and a committee's discussions (and the politics that go along with that).

If it can be reliably, convincingly demonstrated that there's a group of people who are impaired due to an ADHD-like syndrome that truly begins in the teen years or later, it's possible that when DSM-6 (or DSM-5.1) comes out, the age-of-onset criterion for ADHD could be changed or scrapped. It's also possible that this newly-recognized condition could be classified as a separate condition from ADHD and given a different name. Or inertia could prevent it from being included at all.

With DSM-5, the age of onset (when symptoms first had to appear) was raised from age 7 to age 12. This move generated a lot of controversy -- as did the decision to reduce the number of symptoms required for diagnosis in adults. Some people felt it was justified by the scientific evidence and a need to help people who were being denied treatment by the old criteria. Other people suggested that it was a ploy to create a larger market for pharmaceutical companies by making more people eligible for a diagnosis. Dropping the age-of-onset criterion altogether would be a big deal, and it's not likely to happen without really compelling evidence.


Everyone who has delayed deficits of self-regulation has had symptoms of ADHD from at least the age of 4-7, (edit, simply because delayed deficits of self-regulation never fully matured, before decline in the rate of development, in the first place.)
What the authors of the paper in the OP are suggesting is that some people may experience self-regulation deficits that do not begin in early childhood.

This suggestion goes against the current models of ADHD, and it may turn out to be a separate condition, or an illusion. But the fact that researchers are observing things that are different from what we expect (and different even from what they expected!) suggests that there's still a lot we don't know.

mildadhd
11-23-16, 01:04 AM
What the authors of the paper in the OP are suggesting is that some people may experience self-regulation deficits that do not begin in early childhood.

This suggestion goes against the current models of ADHD, and it may turn out to be a separate condition, or an illusion. But the fact that researchers are observing things that are different from what we expect (and different even from what they expected!) suggests that there's still a lot we don't know.

Delayed neurodevelopmental deficits of self-regulation must occur in early childhood.

If a person develops mature self-regulation, any regression in that maturity would not be delayed neurodevelopmental deficits of self-regulation. (aka, ADHD).


G

namazu
11-23-16, 01:19 AM
Delayed neurodevelopmental deficits of self-regulation must occur in early childhood.

If a person develops mature self-regulation, to begin with, any regression in maturity would not be delayed neurodevelopmental deficits of self-regulation. (aka, ADHD).
If you define a delay as something that can only happen from birth/early childhood, then that would be true.

If you consider the possibility that people who were developing in a more typical (or even accelerated) way could lose developmental momentum and even fall behind the curve to the point that they are clinically symptomatic/impaired relative to other people, then maybe it's not universally true.

Think about it this way (and bear with this imperfect analogy):

A football team who can't score in the first quarter of a game (against a team who scores) will be behind from the beginning, and assuming the other team keeps scoring and they don't, they'll be playing catch up the whole time, and eventually lose the game.

That's the current model of ADHD. The delay starts early in the game, and persists.

A football team who scores early and is keeping pave with the other team in the first half, but then melts down in the second half (due to loss of key players, fatigue, morale, whatever), loses their lead, and then loses the game.

That's the idea suggested by the paper linked in the OP -- that there may not be a lag at first, but it shows up later, and when it happens, it's important.

mildadhd
11-23-16, 01:30 AM
If you define a delay as something that can only happen from birth/early childhood, then that would be true.

If you consider the possibility that people who were developing in a more typical (or even accelerated) way could lose developmental momentum and even fall behind the curve to the point that they are clinically symptomatic/impaired relative to other people, then maybe it's not universally true.

Think about it this way (and bear with this imperfect analogy):

A football team who can't score in the first quarter of a game (against a team who scores) will be behind from the beginning, and assuming the other team keeps scoring and they don't, they'll be playing catch up the whole time, and eventually lose the game.

That's the current model of ADHD. The delay starts early in the game, and persists.

A football team who scores early and is keeping pave with the other team in the first half, but then melts down in the second half (due to loss of key players, fatigue, morale, whatever), loses their lead, and then loses the game.

That's the idea suggested by the paper linked in the OP -- that there may not be a lag at first, but it shows up later, and when it happens, it's important.

The normal dramatic decline in the rapid rate of development of self-regulation occurs before the age of 4-7 in everyone. (ADHD or not)

That is why the guideline that symptoms must be present before the age of 7, is extremely important in diagnostic criteria.

There are at least 50 medical issues that mimic ADHD, all of these medical issues mimic delayed deficits of self-regulation in some way, including the example (#2) of TBI to the right prefrontal cortex, but they are not ADHD (aka, delayed neurodevelopmental deficits of self-regulation).



G

namazu
11-23-16, 02:02 AM
The normal dramatic decline in the rapid rate of development of self-regulation occurs before the age of 4-7 in everyone. (ADHD or not)

That is why the guideline that symptoms must present before the age of 7, is extremely important in diagnostic criteria.
I agree that there's a decline in the rate of development in early childhood.

However, the DSM-5 has set the age of onset threshold at 12, in part because there are children whose symptoms aren't apparent by age 7 (not just people who can't remember/prove symptoms prior to age 7).

Given that brain development occurs throughout life (even at different rates), I see no reason to arbitrarily restrict the term "neurodevelopmental disorders" to conditions with onset prior to age 7. There are some people or organizations who use a narrow definition for various reasons, but others consider a longer period of development to be relevant.


There are at least 50 medical issues that mimic ADHD, all of these medical issues mimic delayed deficits of self-regulation in some way, including the example (#2) of TBI to the right prefrontal cortex, but they are not ADHD (aka, delayed neurodevelopmental deficits of self-regulation).
Yes, there are many conditions that mimic ADHD, but this one doesn't yet have a name, and it has a lot in common with ADHD in terms of symptoms and impairments.

Let's call it "Late-Onset Self-Regulation Disorder" if you prefer to reserve ADHD for the heterogeneous, poorly-etiologically-defined grab-bag of childhood-onset conditions to which it currently refers.

Whether or not you want to call it ADHD, if there are people who are clinically impaired by this problem, it's important to figure out why it occurs and how to help.

mildadhd
11-23-16, 02:19 AM
Everyone who has delayed deficits at age 12, had delayed deficits at age 7.

That being said, I do not disagree with the age of 12 as a guideline for people who do not remember or do not have other ways to verify if they had symptoms before the age of 7.

It is extremely important to consider how self-regulation develops in early life, and not to get away from that understanding.


G

namazu
11-23-16, 02:23 AM
Everyone who has delayed deficits at age 12, had delayed deficits at age 7.
Maybe so, maybe not.

It is extremely important to consider how self-regulation develops in early life, and not to get away from that understanding.
Yes, I agree that the development of self-regulation in early life is very important in understanding ADHD.

But to me, it is not the only thing that is important, especially when considering adults who cannot go back in time to change their developmental context.

If it turns out that there are people whose self-regulation deficits actually arise later in life, then it is important to consider how those problems occur and can be treated, too. That's what the study linked in the OP suggests.

mildadhd
11-23-16, 02:31 AM
Maybe so, maybe not.


Yes, I agree that the development of self-regulation in early life is very important.

But it is not the only thing that is important, especially when considering adults who cannot go back in time to change their developmental context.

If it turns out that there are people whose self-regulation deficits actually arise later in life, then it is important to consider how those problems occur and can be treated, too. That's what the study linked in the OP suggests.

I think we need to understand how self-regulation develops in early life, first.

I do not buy this go back in time argument, what about prevention, etc? it is not only about us but the hypersensitive people who are not born yet.

I think understanding how self-regulation develops before the age of 4-7, is one the most ignored, and most valuable questions involving these topics, I have been trying to discuss that question for years.

I would love for someone to prove me wrong and start a thread discussion on the topic of how self-regulation develops, in early life.




G

sarahsweets
11-23-16, 07:01 AM
That accurately describes current DSM-5 criteria for ADHD, which require symptom onset by age 12.

But perhaps the current criteria (or the set of named disorders) are missing a group of adults who have an ADHD-like syndrome that
- is substantially impairing,
- isn't explained by other disorders or life circumstances, and
- could improve with treatment.
That seems to be what the authors of the linked study are pondering.
I think if the current criteria doesnt address these issues, its because maybe there needs to be a "new" or defined disorder that isnt adhd, but can be treated like adhd?
Not to be simple, it reminds me of treating cancer. You can treat most forms of cancer with chemo and/or radiation. But one person might have breast cancer and another might have lung cancer. The symptoms and markers for both are extremely similar and they both fall under the cancer category, but the important thing is they could both benefit from the same kinds of treatment. Dol I make sense. So IMO with adhd- there could be a different disorder out there that shares symptoms of adhd, and has similar treatment guidelines,but is still its own disorder.

Strutsen
11-23-16, 03:12 PM
What the authors of the paper in the OP are suggesting is that some people may experience self-regulation deficits that do not begin in early childhood.



How many adults with ADHD remembers their childhood in terms of deficits except those who got mental straitjackets or sent home on a regular basis? Humans(especially kids) worst fear is to stand out differently(weird, abnormal, disturbed) in a negative way and is the single best predictor of who's gonna get bullied and separated from the group.

In adulthood its impossible to ignore the severity of impairments you struggle with and that's part of why I think this study is completely unnecessary.

Just like talent doesn't necessarily needs to be assessed in childhood/youth -> late bloomer :giggle:

Fuzzy12
11-23-16, 03:52 PM
How many adults with ADHD remembers their childhood in terms of deficits except those who got mental straitjackets or sent home on a regular basis? Humans(especially kids) worst fear is to stand out differently(weird, abnormal, disturbed) in a negative way and is the single best predictor of who's gonna get bullied and separated from the group.

In adulthood its impossible to ignore the severity of impairments you struggle with and that's part of why I think this study is completely unnecessary.

Just like talent doesn't necessarily needs to be assessed in childhood/youth -> late bloomer :giggle:

You are deciding that one possible reason for the result reported in the paper is the only reason required but what if that's not true?

What if there is a disorder that truly only starts in adulthood and shares symptoms of adhd and responds to the same treatment? Wouldn't that be important to know? Wouldn't that be worth investigating?

namazu
11-23-16, 04:43 PM
How many adults with ADHD remembers their childhood in terms of deficits except those who got mental straitjackets or sent home on a regular basis?
I suspect many people do remember if they were frequently excluded, mocked, punished, or failed because of impulsive things they did or said -- precisely because standing out in a negative way is such a social liability.

I don't know what %, and I don't know how many can "prove" with documentation or a family member to corroborate weaknesses, either. This is a barrier to many adults with clear symptoms and impairments whose doctors are sticklers for the "age of onset" criterion as it currently stands. It also helps ensure that adults who've conveniently developed a list of symptoms they can recite in search of drugs with street value are less likely to acquire them. I'm not sure it's the best way to screen out the latter, and I know it can be a problem for the former.

In the study you linked, the individuals were followed from birth, and
Assessments were carried out at birth and ages 3, 5, 7, 9, 11, 13, 15, 18, 21, 26, 32, and, most recently, 38 years, when 95% of the 1,007 study members still alive took part. At each assessment, each study member is brought to the research unit for a full day of interviews and examinations. So, in theory, adult memory of childhood deficits should not be a problem, because these people were assessed throughout childhood.

Criteria for ADHD diagnosis were different at that time, with slightly different symptom lists (and biases about girls and non-hyperactive individuals that are less prevalent today), which may have decreased detection of (today's) ADHD when these people were young.. But if there had been concern from parents or teachers or the kids themselves, it seems more likely than usual (compared to a person who's not being frequently assessed by a team of study professionals) that these concerns might have been recorded.

For what it's worth, I agree with you that inability to document ADHD symptoms in childhood shouldn't prevent adults who really need help from getting it.

Strutsen
11-23-16, 06:27 PM
What if there is a disorder that truly only starts in adulthood and shares symptoms of adhd and responds to the same treatment? Wouldn't that be important to know? Wouldn't that be worth investigating?

What's the point with a separate "Adult ADHD" if the symptoms and impairments are identical but varies from child to adulthood. Intensive research on ADHD should've picked up something already that would somewhat confirm or put it in the right direction for such claims. Re-inventing the wheel aint necessary from my point of view.



I suspect many people do remember if they were frequently excluded, mocked, punished, or failed because of impulsive things they did or said -- precisely because standing out in a negative way is such a social liability.


For what it's worth, I agree with you that inability to document ADHD symptoms in childhood shouldn't prevent adults who really need help from getting it.


Personally I hardly know any adhd-adults who can identify themselves in childhood as being impaired to the degree of ADHD but one or two symptoms and that's not enough. I've never believed in self-reports as the only tool for diagnostics and that's what this study is based upon more or less. Don't forget subjects arent 100% identical and personality is a huge factor which means everyone will look differently both symptomatic and impairing with this disorder.

Don't forget mocking someone for his appearance is as common and like Russel Barkley said:" just because you've got a sparkling personality doesn't mean you got ADHD." And someone with his skills would've adressed this issue long time ago. Personally I think ppl focus to much on symptoms instead of impairments and in adulthood they're crystal clear, in childhood they're not exception to the rule is hyperactivity since inattentive can be very subtle and overlooked.

I recommend this lecture from Dr Barkley its 3 hrs so have patience.

https://youtu.be/SCAGc-rkIfo?t=1

mctavish23
11-23-16, 08:03 PM
mild,

Age 7 was never empirically derived, which is why the DSM-V changed the criteria to onset by age 12.

Hope that helps some.

tc

mctavish23

(Robert)

aeon
11-23-16, 10:08 PM
In retrospect, it is clear (to me now) that I had ADHD as a child, before the age of 7.

That said, the nature of hindsight, memory, and self-assessment are all such that it might be best to dismiss my thoughts and feelings in this regard.

No matter, because something remains that is not just compelling, but evidentiary and nearly a proof in and of itself: the narrative of comments from teachers as found on years' worth of school report cards.

Read one by one, those comments suggest they had a DSM as a guide to refer to when writing, which of course they did not.

I was a classic case, but some of my other characteristics all but insured my ADHD would never be diagnosed when I was a child.


Cheers,
Ian

mildadhd
11-23-16, 10:23 PM
mild,

Age 7 was never empirically derived, which is why the DSM-V changed the criteria to onset by age 12.

Hope that helps some.

tc

mctavish23

(Robert)

mc

That is simply not true.

The rapid rate of self-regulation development declines to snails pace, before the age of 4, age 7 at the latest.

I have already explained why the age was changed to age 12. (look it up if you do not believe me).

Anyone who has delayed deficits of self-regulation at age 12, had delayed deficits of self-regulation at age 7. (Look it up if you do not believe me)



G

mildadhd
11-23-16, 11:05 PM
..The peak years of parental influence are below 7.

From 7 up to 12, it drops dramatically..

-Dr. Barkley, "Essential Ideas Parents", (video)

Emotional environmental neurodevelopmental influences are most influential on neurodevelopment of self-regulation before birth and the age of 7.

Watch Dr. Barkley's video, if you do not believe me.

G

Strutsen
11-24-16, 08:17 AM
In retrospect, it is clear (to me now) that I had ADHD as a child, before the age of 7.

I was a classic case, but some of my other characteristics all but insured my ADHD would never be diagnosed when I was a child.

Cheers,
Ian

Would it make you feel better if there was a separate disorder called ADULT ADHD?

aeon
11-24-16, 08:24 AM
Would it make you feel better if there was a separate disorder called ADULT ADHD?

No, and I don't feel poorly at all that there isn't such a thing.


Cheers,
Ian

sarahsweets
11-24-16, 11:58 AM
Personally I hardly know any adhd-adults who can identify themselves in childhood as being impaired to the degree of ADHD but one or two symptoms and that's not enough. I've never believed in self-reports as the only tool for diagnostics and that's what this study is based upon more or less. Don't forget subjects arent 100% identical and personality is a huge factor which means everyone will look differently both symptomatic and impairing with this disorder.
I also believe there needs to be more than just self reports to diagnose adhd. But sometimes because a child has parents who dont believe in it, or because they did well in school, all an adult with adhd has to work with is their own experiences.

Don't forget mocking someone for his appearance is as common and like Russel Barkley said:" just because you've got a sparkling personality doesn't mean you got ADHD." And someone with his skills would've adressed this issue long time ago. Personally I think ppl focus to much on symptoms instead of impairments and in adulthood they're crystal clear, in childhood they're not exception to the rule is hyperactivity since inattentive can be very subtle and overlooked.

I'd like to think that someone can tell the difference between mocking because of appearance or economic status or something like that and mocking as it applies to adhd. Like if someone is spacey, distractible, has issues with personal space or seems dumb because they cant focus on their work- they could be made fun of because of their adhd.

sarahsweets
11-24-16, 12:05 PM
How many adults with ADHD remembers their childhood in terms of deficits except those who got mental straitjackets or sent home on a regular basis? Humans(especially kids) worst fear is to stand out differently(weird, abnormal, disturbed) in a negative way and is the single best predictor of who's gonna get bullied and separated from the group.
I dont understand the straight jacket comment....
I was diagnosed at age 6. Not treated until my 20's. I was always getting in trouble for talking and being in people's business, emotional, not quite hyperactive but certainly not still and my teachers always said things like " not working up to potential" or "Sarah is quite the social butterfly (which is teacher speak for talks to much) I wasnt sent home frequently in a straight jacket and I definitely stood out- sometimes I realized it and other times I didnt care.

So I think its more common to remember your own struggles pretty clearly. As for the study? Ha, not my cup of tea.

Fuzzy12
11-24-16, 12:17 PM
What's the point with a separate "Adult ADHD" if the symptoms and impairments are identical but varies from child to adulthood. Intensive research on ADHD should've picked up something already that would somewhat confirm or put it in the right direction for such claims. Re-inventing the wheel aint necessary from my point of view.






Personally I hardly know any adhd-adults who can identify themselves in childhood as being impaired to the degree of ADHD but one or two symptoms and that's not enough. I've never believed in self-reports as the only tool for diagnostics and that's what this study is based upon more or less. Don't forget subjects arent 100% identical and personality is a huge factor which means everyone will look differently both symptomatic and impairing with this disorder.

Don't forget mocking someone for his appearance is as common and like Russel Barkley said:" just because you've got a sparkling personality doesn't mean you got ADHD." And someone with his skills would've adressed this issue long time ago. Personally I think ppl focus to much on symptoms instead of impairments and in adulthood they're crystal clear, in childhood they're not exception to the rule is hyperactivity since inattentive can be very subtle and overlooked.

I recommend this lecture from Dr Barkley its 3 hrs so have patience.

https://youtu.be/SCAGc-rkIfo?t=1


The point is knowledge and understanding.

Also it might aid diagnosis. Right now there might be a risk of fitting retrospective symptoms in childhood to adults or there is the risk thst silts don't get yhe treatment they need because they can't show evidence of childhood symptoms.

Also if we never researched anything in the belief that it should have been picked up by now by some else I'm sure we'd have missed out on a lot of findings. It's like saying no need to rrsearch quantum mechanics anymore because max plank would have picked up everything that there is to know by now.

Strutsen
11-24-16, 04:21 PM
I dont understand the straight jacket comment....
I was diagnosed at age 6. Not treated until my 20's. I was always getting in trouble for talking and being in people's business, emotional, not quite hyperactive but certainly not still and my teachers always said things like " not working up to potential" or "Sarah is quite the social butterfly (which is teacher speak for talks to much) I wasnt sent home frequently in a straight jacket and I definitely stood out- sometimes I realized it and other times I didnt care.

So I think its more common to remember your own struggles pretty clearly. As for the study? Ha, not my cup of tea.

Im from Sweden and the public view of ADHD wasn't particularly pleasant at all until the beginning of year 2000. My brother got his first diagnose early 80s and when parents found out he had a disorder they more or less put a jacket on him and banned him from socializing with their children and mum had a hard time finding a kindergarten who could accept his disorder. I know its hard to believe but compare to NA we recently moved out of stone age and treatments involving medication hasnt been around that long. The overwhelming majority of clinicians still view this disorder as something wonderful and exciting I don't know if they're ignorant or just wants to make us happy by lying their asses off. Same goes for parents and lots of "patients" who claims medication to be drugs that will put you on the street and eventually kill yourself. I know its sad but its Sweden in a nutshell...everything is dangerous...especially if its from the states because its all about the money anyway.

My mouth got me into trouble all the time all those social ques :lol:

ginniebean
11-26-16, 05:16 PM
That accurately describes current DSM-5 criteria for ADHD, which require symptom onset by age 12.

But perhaps the current criteria (or the set of named disorders) are missing a group of adults who have an ADHD-like syndrome that
- is substantially impairing,
- isn't explained by other disorders or life circumstances, and
- could improve with treatment.
That seems to be what the authors of the linked study are pondering.

Given that the conceptualization of ADHD and the diagnostic criteria have never been set in stone, it's hardly sacrilege to suggest that they're imperfect. If there is good-quality evidence that can't be accommodated by current models, then the models need rethinking. In this case, maybe a different name for this presentation of symptoms in the absence of childhood history of ADHD would be appropriate.

I'm not convinced of it yet myself -- the study has real limitations/caveats, and more work in other populations is needed to replicate these findings -- but the idea isn't implausible on its face. Development is a long process, and it may not get off-track for everyone at the same point or in the same ways.

You're absolutely right. There is a darker side to this tjo and that is thhe risk of legitimizing drug seekers. they are already a problem. I imagine this will take a lot of time for researchers to come to any concluaions.