ADHD in adults?

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A reader has asked me about adult ADHD. He writes that he has encountered some checklists while browsing on the Internet, and considers that he meets the criteria according to those.

Firstly, I must say that one should be very cautious about using some of the checklists on offer, as they are usually unscientifically constructed, and tend to be worded in such a way that most people would find themselves meeting the criteria for ADHD.

A further problem is that symptoms like inattention and distractibility can also be caused, especially in adults, by other disorders as well as by other aspects of one's life situation, so making the diagnosis is not so easy.

The standard textbooks do not describe ANY adult variety of Attention-Deficit Disorder (ADD), insisting that it "attenuates with age", that is, it fades out as one grows up. For many years the accepted consensus was that the condition resolved spontaneously. It is very rarely diagnosed in adults, and I have been able to find no convincing description or argument that it ever arises or starts in adult life.

What is happening, though, is that as larger numbers of children who have been diagnosed as having ADHD, and under treatment for it, grow up, we are coming to see more adults who could be claimed to have ADHD. The impression one gets is that there are some young adults who still have some of the symptoms of ADHD, though not necessarily all those which would lead to the diagnosis being confirmed.

There have been only a few long-term follow-up studies to see what actually happens to children who have been diagnosed with ADHD. One which followed 6-12 year-olds until they were 16-23, finding that around a quarter still met criteria for diagnosing ADHD, a third meeting criteria for diagnosing a personality disorder, and a sixth matching criteria for a substance abuse disorder.

It has been reported that 9% of the group with ADHD were found to be in jail, compared with 1% of a comparative group of otherwise normal folks. Another study looking a further seven years ahead, found the proportion diagnosable as still having ADHD had fallen to 8%.

Evidence as to whether drug treatment continues to be effective is lacking; there is some indication that methylphenidate such as Ritalin may continue to be helpful.

As to the original question from our reader, then - an over-the-Web checklist cannot diagnose anything. But if it leads you to concern that you might have a particular disorder, see your friendly neighbourhood psychiatrist and discuss your concerns - they should have the skills to assess you comprehensively and to advise you as to whether there is any problem needing treatment. If you didn't have ADHD as a child, starting early in childhood, it is unlikely that you are suffering from it now.

(Prof M.A. Simpson, 2001)

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