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National Public Radio (NPR) interviews Dr. David W. Goodman on ADHD in older adults

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ADHD in adults has now been recognized by clinicians for many years now. However, ADHD in older adults has received almost no attention because research has limited its work to those people under the age of 50. There is a body of research developing in older adults and I recently published with my colleagues a review of world-wide english published literature.

National Public Radio had the foresight to understand that this population of older adults with ADHD needs acknowledgement with a call to attention for their need for evaluation and treatment. To that end, they developed a broadcast with my assistance.

I invite you to listen/read both the audio and web text version are now available to the public. We can no longer discount the consequential negative impact of untreated ADHD on your parents and grandparents.

David W. Goodman, M.D.

ADHD in older adults: First published review of world-wide literature

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On December 16, 2015, our article reviewing the world’s English scientific literature on ADHD in adults over age 50 years was published online in Drugs and Aging, an international journal. While there is a paucity of research, there are enough publications to merit pulling this literature together into one paper. Most of research comes out of the Amsterdam ADHD research group under the direction of Dr. Sandra Kooji. Some preliminary findings:

  1. Prevalence estimated at 3%. To put this into perspective, ADHD prevalence rate for children in the U.S. is approximately 8%, and 4.5% for adults. We know that for most children ADHD symptoms persist into adulthood. While we have prospective, longitudinal studies of ADHD children for 30 years, we do not have this information as the children age past 50 years old.
  2. Only 1 of 5 memory clinics actively screen for ADHD. This will leave many with ADHD misdiagnosed and likely mistreated
  3. Older adults on stimulant medication report better attention and greater ability to manage daily tasks compared to ADHD older adult not on medication.

Our paper reviews a broader range of findings and will be helpful to researchers and clinicians seeking to broaden their knowledge and polish their clinical skills as these patients present for evaluation of cognitive complaints. We look forward to participating in the expansion of this knowledge.

David W. Goodman, M.D.

Clinical Presentation, Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder (ADHD) in Older Adults: A Review of the Evidence and its Implications for Clinical Care

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Goodman DW, Mitchell S, Rhodewalt L, Surman CBH. Drugs and Aging. Dec 2015. p1-10.

Abstract

Although previously considered a disorder of childhood, studies in the last decade have demonstrated that attention-deficit hyperactivity disorder (ADHD) continues to impair function into adulthood and responds to pharmacotherapy. Due to age-specific changes in roles and challenges, it is possible that presentation and response to intervention may differ between older and younger adults. A literature search for papers that identified older adults with ADHD, including papers describing its epidemiology, manifestation, and treatment, was the basis for this paper. There is a paucity of data on ADHD in older adults; however, small observational studies have characterized the presence, impact, and treatment of ADHD in adults over the age of 50 years, and larger epidemiologic studies have demonstrated that ADHD symptoms exist in older adulthood. Optimal criteria for diagnosis of ADHD and methods of treating ADHD in older individuals have not been systematically explored. In light of the limited data, this review discusses considerations for differential diagnosis and safe pharmacotherapy of ADHD in older adults.

[button size=’large’ color=’btn-b76lpc214h’ link=’https://link.springer.com/article/10.1007/s40266-015-0327-0?wt_mc=internal.event.1.SEM.ArticleAuthorOnlineFirst’ align=’center’ block=’0′ icon=’FontAwesome/fontawesome-chevron-sign-right||color:ffffff’ shadow=’2′]Read Full Article[/button]

Analysis of individual items on the attention-deficit/hyperactivity disorder symptom rating scale in children and adults: the effects of age and sex in pivotal trials of lisdexafetamine dimesylate

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Weisler R, Adler LA, Kollins SH, Goodman DW, Hamdani M, Dirks B, Childress AC. Neuropsychiatric Disease and Treatment 2014:9 1–11.

Abstract

BACKGROUND:

Attention-deficit/hyperactivity disorder (ADHD) symptom presentation across age and sex has not been fully elucidated. The present post hoc analyses qualitatively explored the baseline levels of ADHD symptomatology across subgroups in two clinical trials of children and adults with ADHD to elucidate differences in participant presentation. The response to treatment was examined to determine patterns of response among items of the ADHD Rating Scale IV.

METHODS:

Exploratory post hoc analyses of ADHD Rating Scale IV item scores were conducted on data from two 4-week placebo-controlled trials in children (6-12 years) and in adults (18-55 years) with ADHD. Baseline and endpoint mean item scores were determined for subgroups defined by age (6-9, 10-12, 18-39, and 40-55 years) and sex.

RESULTS:

The baseline mean item scores were generally numerically similar for all age-by-sex subgroups. The inattention (IA) items were numerically higher than hyperactivity/impulsivity (H/I) items among older children and adults. The endpoint mean item scores were numerically lower after lisdexamfetamine dimesylate treatment for IA and H/I items in all subgroups.

CONCLUSION:

These results suggest that regardless of age or sex, baseline IA and H/I symptom profiles were comparable; however, IA vs H/I symptoms were more severe in older participants. In all age-by-sex subgroups, IA and H/I symptoms appeared to decrease after active treatment.

 

Unmasking ADHD in Adults

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Goodman DW, Surman C et al. Medscape. August 2013

Overview

This activity is intended for psychiatrists, family physicians, primary care providers, internists, neurologists.

The goal of this activity is to apprise clinicians of the symptoms of adult attention-deficit/hyperactivity disorder (ADHD), the comorbidities commonly associated with the disorder, and the pharmacotherapy and non-pharmacotherapy treatment options available.

Upon completion of this activity, participants will be able to:

  1. Identify the manifestations of ADHD in adults that should initiate an evaluation
  2. Differentiate ADHD symptoms from those of comorbid psychiatric disorders
  3. Discuss evidence-based approaches to individualize treatment of adult ADHD to address comorbidities and residual ADHD symptoms and improve treatment response

[button size=’large’ color=’btn-b76lpc214h’ link=’https://www.medscape.org/viewarticle/768677′ align=’center’ block=’0′ icon=’FontAwesome/fontawesome-chevron-sign-right||color:ffffff’ shadow=’2′]Read Full Article[/button]

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