View Full Version : News: Is ADHD Properly Diagnosed & Treated In Adults?


SolarLife
01-09-07, 11:36 AM
*** Adult ADD & its treatment with appropriate stimulant medication are still controversial and misunderstood even amongst the medical community. Hopefully this editorial, written by a prominent British psychiatrist, will better help educate the public and medical colleagues alike to the problems of undiagnosed ADHD in adults. ***

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Is ADHD Properly Diagnosed And Treated In Adults? (http://www.medicalnewstoday.com/medicalnews.php?newsid=59968)

03 Jan 2007

An editorial written by Professor Philip Asherson, a leading psychiatrist in adult ADHD (Attention Deficit Hyperactivity Disorder), at the Institute of Psychiatry, King's College London strongly recommends that general adult psychiatrists should diagnose ADHD in adults appropriately with stimulant drugs [emphasis mine - SL]. It is published in the January issue of the British Journal of Psychiatry.

Although ADHD can be effectively treated with stimulant medication, and such treatment is widespread in the young, general adult psychiatry has not yet followed suit in identifying and treating substantial numbers of affected people.

ADHD is a common disorder affecting children and adults, and is a predictor of adult mental health problems. Symptoms include high levels of inattentiveness, impulsiveness and restless over activity, and are regarded as a source of disability in children and adolescents, as well as a risk to adult psychological adjustment.

Young people are entering adult life whilst still receiving medication for ADHD, and adult psychiatrists are needed to take over treatment when symptoms persist. Moreover, some adult patients with ADHD may be misdiagnosed and ineffectively treated for other disorders, such as depression and personality disorder.

Research suggests that between 15% and 65% of children diagnosed with ADHD still have symptoms of the disorder in adulthood. However, many children with ADHD go unrecognised, and may be diagnosed in adulthood for the first time.

A survey of schoolchildren with ADHD in the London Borough of Newham found that although levels of restless activity diminished between the ages of 7 and 17, the 17-year-olds showed a level of hyperactivity similar to that found in a group of normal 7-year-olds.

When the same people were followed up at the age of 26, they were found to have disabilities associated with high levels of psychiatric disorder, which were all the more significant because of increasing demands in adult life for self-organisation and the ability to plan ahead.

Adult behaviours linked to ADHD are associated with the childhood symptoms of motor hyperactivity, attention deficit, unfocused thinking, mood changes, disorganisation and impulsiveness.

They include - at the severe end of the spectrum - feelings of restlessness, difficulty in relaxing, feeling depressed when inactive, lack of concentration on detail, depression or excitability, poor time management, difficulties sustaining relationships and a tendency to make rapid and facile decisions without full analysis of the situation.

Psychiatrists diagnosing ADHD in adults need to be aware of the fact that people with this disorder often show decreased symptoms in a novel situation like a psychiatric evaluation. It is therefore important to base mental state evaluations on a typical week and a variety of normal situations.

Mood instability is very common in adult ADHD, and can lead to diagnoses of depression or personality disorder. Many adults with ADHD also have other problems, such as antisocial personality, alcohol and drug misuse, anxiety disorders and learning difficulties. ADHD in childhood may also lead to the development of antisocial behaviour.

Some symptoms of adult ADHD are similar to those of bipolar disorder, but ADHD tends to show a persisting trait of irritability and volatility, very different from the grandiose and euphoric symptoms of mania and the depression found in bipolar disorder.

Professor Philip Asherson comments: "Adults with untreated ADHD use more healthcare resources because of smoking-related disorders, increased rates of serious accidents, and alcohol and drug misuse. Further research is needed to quantify the contribution of ADHD to psychiatric disorders in adulthood."

Professor Asherson's editorial is published in the British Journal of Psychiatry, January 2007.

Institute of Psychiatry - The Institute of Psychiatry is part of King's College London and closely affiliated to the South London and Maudsley NHS Trust. The Institute is a world-renowned centre for treatment, research and training in psychiatry and mental health. The organisation is involved in pioneering new and improved ways of understanding and treating mental illness and brain disease. Its wide-ranging field of work includes depression, trauma, eating disorders, brain imaging, genetics and psychosis.

http://www.iop.kcl.ac.uk (http://www.iop.kcl.ac.uk/)

wallywest
01-09-07, 11:53 AM
Interesting. About the only part of that that doesn't fit me (33 years old) is the substance abuse. Never had a single cigarette and I've never been drunk in my life. Partially because it just holds no appeal for me, and partially because I'm afraid I would be easily addicted to things like that. Sounds like that was a good call.

SolarLife
01-09-07, 12:14 PM
Interesting. About the only part of that that doesn't fit me (33 years old) is the substance abuse. Never had a single cigarette and I've never been drunk in my life. Partially because it just holds no appeal for me, and partially because I'm afraid I would be easily addicted to things like that. Sounds like that was a good call.I smoked and drank pots of coffee to self-medicate. Drank, too. I would have drunk more if I had a stronger stomach and didn't hate the hangovers so much. Quit cigs several months ago but still love the coffee :D. Lost all interest in alcohol after started Adderall.

Scattered
01-09-07, 02:03 PM
Adult behaviours linked to ADHD are associated with the childhood symptoms of motor hyperactivity, attention deficit, unfocused thinking, mood changes, disorganisation and impulsiveness.

They include - at the severe end of the spectrum - feelings of restlessness, difficulty in relaxing, feeling depressed when inactive, lack of concentration on detail, depression or excitability, poor time management, difficulties sustaining relationships and a tendency to make rapid and facile decisions without full analysis of the situation.Good article -- thanks for sharing it. I especially like the description of how the childhood symptoms look in adulthood -- it certainly fits for me.

Thomas Brown in his book Attention Deficit Disorder: The Unfocused Mind in Children and Adults does a good job too of describing how this impacts the emotional well being of adult ADDers and their development of comoribid problems. We so often miss the adult connection, because the words used to describe childhood ADD just don't fit well for adults. Also even mild ADHD problems can be very problematic when faced with adult responsibilities withpout all the structure and support that may have been available from others as a child.

Scattered

peridot
01-09-07, 03:40 PM
On the brighter (but strictly anecdotal) side, I've encountered a greater awareness of adult ADD in the medical and psychological community. Just look at the number of adults here (including myself) who have only recently been diagnosed.

Of course, a cynic would attribute that to adult ADD being a trendy diagnosis right now, but I don't think that's the case.

FuturePast
01-09-07, 09:31 PM
To give some context here: in the UK, adult ADHD is barely recognised, including in the psychiatric departments of the National Health Service.
Even when properly diagnosed, GPs are hesitant to prescribe stimulant medication (to adults). In fact, I believe that no stimulant med is actually licenced for use by adults, and are currently prescribed "off-label".

So for this editorial to be published in the British Journal of Psychiatry is a huge step forward in the recognition and future treatment of the condition.

Professor Asherson, author of the editorial, runs one of only two adult ADHD clinics (within the NHS) in the country.

QueensU_girl
01-09-07, 09:45 PM
i think the ADHD is recognized but the effects of the often accompanying Executive Dysfunction are not...

http://i4.photobucket.com/albums/y143/emma_chase/ADDChart-ef_syndrome.gif?t=1168393498



This article explains how Adult ADHD does not look the same as Childhood ADHD, and how that creates doubt about diagnosis and treatments.

http://www.neuropsychiatryreviews.com/feb01/npr_feb01_adhd.html

Scattered
01-10-07, 05:44 PM
http://www.neuropsychiatryreviews.c...feb01_adhd.html


Great article, QueensU Girl -- thanks for the link!:)

Scattered

QueensU_girl
01-13-07, 12:13 PM
I guess what I find so offensive about the popular media is that they give society's the SIMPLISTIC take-home message that : "If we Eliminate the Hyperactivity (or Inattention or Impulsivity), and all is fixed".

Given the amount of reading I've done on ADHD (incl. scientific journals; courses in Neuroscience covering the Dopamine regions of the brain/frontal lobe), I can't say that *I* even know if MEDS help Executive Dysfunction. (AND, If they do, then why aren't I able to get thru my Second degree and do Grad Skewl, etc?)

Scattered
01-13-07, 01:43 PM
I guess what I find so offensive about the popular media is that they give society's the SIMPLISTIC take-home message that : "If we Eliminate the Hyperactivity (or Inattention or Impulsivity), and all is fixed".

Given the amount of reading I've done on ADHD (incl. scientific journals; courses in Neuroscience covering the Dopamine regions of the brain/frontal lobe), I can't say that *I* even know if MEDS help Executive Dysfunction. (AND, If they do, then why aren't I able to get thru my Second degree and do Grad Skewl, etc?)QueensU Girl, try reading some of Mel Levine's (a developmental behavioral pediatrician) stuff. I found it very helpful in answering the very question you posed. Meds helped a lot in some domains for me, but others were still very impaired. In his two books, The Myth of Laziness and A Mind at a Time, he further breaks down the dysfunctions and recommend specific approaches for dealing with them. Instead of lumping all the ADD things together, he finds it more valuable to break them down into specific problem areas. He does prescribe meds, but doesn't find them helpful for all areas. I recommend you check his books out -- it really helped me wrap my mind around it all and adapt some specific skills. Another book that has really helped me is Mastering Your Adult ADHD by Safred, Sprich -- it is a researched tested cognitive behavioral program. It's helped me a lot.

Take care,
Scattered

dormammau2008
01-13-07, 05:36 PM
hey queengirl would like to know all the junals you have read plasess...as to meda its allways the next big thing they just to smiplics in the way there look at things

dorm