On September 30, 2015, The New York Times ran an article in the Tuesday Science section on ADHD in older adults. I was interviewed for the article and discussed a former patient age 73 who was first diagnosis with ADHD by me and successfully treated. The article is an introduction into an important clinical area for ADHD heretofore ignored. As we discovered, 60% of children will continue to have ADHD symptoms to an impairing degree into adulthood. The presumption is that ADHD in adults will simply continue throughout one’s life. However, the research is only just accumulating to support this assumption. The largest collection of research in this age group is published by my colleagues in Amsterdam and additional research from other research groups around the world.
Early this year I wrote an article for CHADD’s Attention Magazine on issues related to diagnosis and treatment of ADHD in older adults. The diagnostic issues and treatment considerations in older adults are more complex. In brief, diagnosis needs to consider medical illnesses, medications, history of head trauma, and other medical illness that worsen thinking ability. Treatment consideration are complicated by the presence of medications and medical illnesses that might limit the use of ADHD medications. Older patients and families considering an evaluation for possible ADHD should see a psychiatrist or mental health professional who has expertise and experience treating adults with ADHD.
Remember, while attentional changes occur in those of us over age 50, the cornerstone for the diagnosis of ADHD is the presence of symptoms since childhood that are relatively chronic and unchanged over one’s life and that these symptoms cause impairment in daily functioning. A comprehensive evaluation of all possible psychiatric and medical is critical for the accuracy of the diagnosis.
If you’re reading this blog, you are one of the millions of people who now use the Internet to gain information on medical issues. In a recent survey of consumers, this is where people are looking for medical information.
Most accessed online resources:
53% web M.D.
22% Wikipedia
19% health magazines and websites
16% advocacy group websites
12% YouTube
10% Facebook
10% blocks
9% Pharma company websites
(results from third annual national consumer survey by Makovsky Health and Kelton, 2014)
I would like to take this opportunity to direct your attention to the attitude magazine website that has a large number of webinars from noted academic and professional experts in ADHD. For many with ADHD it’s often easier to watch a video on a specific ADHD topic then to read a book. While many with ADHD can sit and read for extended periods of time, it always struck me as odd that clinicians referred patients to books knowing their ability to sustain attention would be limited, especially in the evening when it medication affect us dwindled.
Explore the webinars on this site as a can be extremely helpful. On this blog site, I will continue to direct my patients in readers to reliable sources of information and clinical insights from my practice not available elsewhere.
Anticipating over 300 attendees, the 13th Annual ADHD Conference for parents, teachers, professionals and adults with ADHD on Saturday, February 22, 2014 from 8:00am to 1:00pm will feature several expert speakers. West Chester University is just outside Philadelphia. Below is the program of speakers and topics.
Marie Paxon, program coordinator, invited me to present on the science of diagnosis and treatment of ADHD in adolescents and adults. If you reside in the area, please consider attending because it is a great way to learn a great deal about ADHD quickly and network with people with ADHD and those who offer guidance and treatment. See you there.
ADHD and the Brain: Knowledge Matters Speakers
Marilyn B. Benoit, M.D. is a child and adolescent psychiatrist. She is senior vice president of Clinical and Professional Affairs and chief clinical officer at Devereux. She is a past president of the American Academy of Child and Adolescent Psychiatry. Dr. Benoit has served on the faculties of Howard and George Washington Universities and is a clinical associate professor of psychiatry at Georgetown University Medical Center, from which she received the Vicennial Silver Medal of Honor for 20 years of distinguished service.
David W. Goodman, M.D. is assistant professor of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine. He is also director of the Adult Attention Deficit Disorder Center of Maryland in Lutherville and medical director of Suburban Psychiatric Associates, LLC. Dr. Goodman is the author of The Black Book of ADHD.
Marjorie Johnson, LCSW, PCC is a licensed clinical social worker and certified coach who provides leadership and career coaching, training, and counseling. She specializes in helping students and professionals with ADHD. Ms. Johnson serves on Chester County/Main Line CHADD’s Professional Advisory Board and is a professional member of ADDA (Attention Deficit Disorder Association.). She is past president of the International Coaching Federation-Philadelphia chapter and was named the 2011 Small Business Person of the Year by the Exton Chamber of Commerce (PA).
Jesse D. Matthews, Psy.D. is a licensed psychologist and has worked with individuals with ADHD for a number of years. He is in private practice at The Center for Psychological Services in Paoli and Ardmore and also works at Holcomb Behavioral Health Systems, a community mental health organization. He evaluates adolescents for substance abuse at the Chester County Youth Center in West Chester and does substance abuse evaluations and treatment in an outpatient program in Kennett Square. Dr. Matthews is an adjunct professor at Immaculata University. Previously, Dr. Matthews worked for six years as a counselor at Hill Top Preparatory School, and he facilitated the Chester County/Main Line CHADD teen ADHD support group for two years.
Joan M. Polka, Ph.D. is a psychologist in the Counseling Center at West Chester University assigned full time to the Act 101 portion of the Academic Development Program (a developmental education opportunity for underprepared first-time college students). She is also co-chair of Chester County/Main Line CHADD’s Adult Program and was the 2011 CHADD Educator of the Year.
Martin Patwell, Ed.D. is director of the Office of Special Services for Students with Disabilities at West Chester University. He has also been the director of evaluation clinic at Landmark School. He has presented “Trends and Issues in Disabilities in Higher Education” at Jiangxi University, Nanchung, China. He is also a consultant to The College Board, Inc.
Preeti Singh, M.S. is the associate director of the Twardowski Career Development Center at West Chester University.
Sharon Watson, M.S. is assistant director of West Chester University’s Office of Services for Students with Disabilities. She has over 20 years of experience working with students with learning differences, mental health, and physical disabilities.
8:30 a.m. Welcome
Chester County/Main Line CHADD and West Chester University
West Chester University
Earl F. Sykes Student Union
110 West Rosedale Avenue
West Chester, PA 19383
8:45 –9:15 a.m.
ADHD Across the Lifespan
Marilyn Benoit, M.D.
Research has proven that ADHD does not end with childhood. Over the course of a lifetime, the scenarios change, but the struggles might not. What does ADHD look like at each stage of life and what is the impact? This fast-paced-but-thorough presentation will help attendees learn more about this complex disorder and will provide a summary of current treatment and management options. Don’t miss this valuable session to gain a better understanding of childhood, teen, and adult ADHD.
9:15 –10:30 a.m.
ADHD and the Brain – What You Need to Know About Treatment and Management
David W. Goodman, M.D.
Those with ADHD express frustration with the disorder’s symptoms: trouble focusing, procrastination, forgetfulness, and difficulty filtering out distractions. Some people have a slower processing speed and others struggle with impulsivity. To make things even more complex, many people with ADHD will have a co-occurring condition like learning disabilities, anxiety, depression, or autism. The good news is that treatment is available, and there are strategies to counteract these challenges. Dr. Goodman will provide an overview of medications and pro-social treatments for ADHD and discuss common co-occurring conditions in this valuable presentation. Children and adults report that they receive unhelpful advice like “try harder,” “start applying yourself,” and “pull yourself up by your bootstraps.” Attend this session to learn about evidence-based treatments for ADHD and how they make a difference.
10:45 –11:30 a.m.
ADHD and Social Interactions
Jesse Matthews, Psy.D.
Social interactions can consist of anything from a casual conversation with an acquaintance to daily communication with loved ones. This can present challenges for both children and adults with ADHD. Those with ADHD may feel isolated and disconnected from others. They may find that executive function challenges can cause them to misinterpret social cues, which are usually unspoken or vague. The invisible challenges of impulsivity, forgetfulness, and an inability to regulate emotions can have a negative effect on forming and maintaining friendships. Fortunately, new information and strategies are available through the field of social learning and social cognition. Attend this session to learn more about this exciting topic and how to apply it to everyday life.
• Facilitated activity: Mindfulness Meditation and ADHD
Marjorie Johnson, LCSW
Mindfulness meditation is a way to calm the mind and relax the body while increasing the ability to sustain attention and manage distractibility. Hear about compelling research and daily applications of mindfulness meditation. Practice it to experience the deep relaxation it generates.
11:45 a.m. –1:00 p.m.
Becoming Successful in College and Early Career
ADHD and Career Success
Preeti Singh
Career development is a life-long process, involving decision making, self-awareness, exploration, preparation, and experience. What tools are available to help students successfully navigate this territory? This brief presentation will provide an overview of resources and strategies.
WCU Student Panel
Sharon Watson, facilitator
Current students at West Chester University who have “been there, done that” tell it like it is. Their transitions, challenges, and routes to where they are today provide a look at what real students face in college.
• Facilitated activity: ADD and Loving It?!
This video blends humor, hope, and science to dispel the myths about adult ADHD. Comedian Patrick McKenna seeks a diagnosis for adult ADHD and learns the facts from an impressive array of experts. Funny, moving, and transformative, this fascinating documentary will hold you spellbound!
My discussion with Dale Archer, M.D. (psychiatrist, best-selling author) on WYPR September 27, 2014 about ADHD, over- diagnosis, and over-prescribed medications was lively. While Dr. Archer advocates “medication as a last resort” and “the goal of treatment is to get off medication” after learning new skills, I offered the research on medication benefit and a quality of life measure to evaluate medication utility. Certainly, treatment of ADHD at all ages incorporates behavioral therapy, organization skills, couple/family/individual therapies, and academic/occupational accommodations, in addition to medication, when indicated.
For those of you interested, the radio broadcast is available and runs 35 minutes. I invite you to listen and decide for yourself the merits of each position. Ultimately, this information best serves those who have ADHD and their families.
I have been invited as an expert on ADHD to participate in an interview on the Mid-day with Dan Rodricks show on WYPR on January 27 1-2pm. This is a live panel discussion that will include Dale Archer M.D., a psychiatrist and writer, to discuss the use of medication and treatment options for ADHD. The discussion is moderated by Dan Rodricks who is a distinguished journalist in Baltimore with a regular feature in the Baltimore Sun newspaper.
Dr. Archer wrote an article online for Forbes on January 6, 2014 on his perspective of ADHD and the overuse of medication and the over-marketing of ADHD. His article highlights and echoes the sentiments of Alan Schwatz in his New York Times article “The Selling of Attention Deficit Disorder” published December 15, 2013.
This one-hour program will give me the opportunity to highlight the national and international scientific literature and research on ADHD. I hope to highlight the well documented negative consequences over the course of one’s life with untreated ADHD as reflected in several international prospective studies following ADHD children into young adulthood.
This program promises to be a lively discussion and offers listeners the opportunity to call in with questions. I encourage you to mark your calendar. I believe the program can be accessed online. If you listen, please leave me your comments for feedback.
The New York Times article “The Selling of Attention Deficit Disorder” published December 15, 2013 had quoted me towards the end of article. As I had previously written in my blog posting, the quote was taken out of context and deliberately misrepresented my professional article with Medscape. I did send a letter to the editor in order to have this quote placed in appropriate context, however, in the letters to the editor, it went unpublished. So, I’ve posted my letter to The New York Times here.
The New York Times
Letter to the Editor
December 14, 2013
Dear Editor:
Let me congratulate Alan Schwartz on his extensive review of ADHD in his article “The Selling of Attention Deficit Disorder”, December 14, 2013. He highlights the increased identification of people with ADHD and the growing use of medication as a treatment option. Unfortunately, he presents information that malign physicians and researchers who have committed their life’s work to investigating the causes of ADHD and pursuing research to prove treatments effective. Mr. Swartz would have served his readers well by revealing his a priori agenda in writing this article. A case in point, Mr. Schwartz quotes me in regards to an article I authored for Medscape on adult ADHD. In this article, he knowingly and deliberately eliminated my notation that the six-minute video accompanied a 2000 word article with 86 scientific references that extensively detailed the clinical evaluation process for ADHD in adults. Therefore my quote, out of context, misrepresents my work and misleads your readers. Perhaps his article would have been better placed in the Op-Ed section of The New York Times.
David W. Goodman, M.D.
The moral: Discern the agenda of the journalist before you make sense of the information provided. As I like to teach my psychiatric residents at Johns Hopkins, the credibility of the information is a function of the intent of the provider.
The Washington Post took the initiative to write an article in today’s (December 17) paper on ADHD in adults ages sixty and older. This article is also accompanied by a sidebar article discussing adult ADHD Older adults with ADHD are a group that has not been specifically researched and about whom very little is written. The Washington Post article includes two or three people with ADHD who were diagnosed much later in life. They speak about their lifetime experiences with untreated ADHD and the positive change they and others have noticed with treatment.
Imagine that you spent 60 years of your life distracted, disorganized, forgetful, and chronically tardy. Imagine that you have dropped out of school, lost jobs, or were divorced as a direct consequence of that state of mind. Imagine that you seek help from a professional and you are told that you have a disorder that can be effectively treated. Imagine your reluctance and hopefulness that these experiences can diminish. Imagine that you agree to treatment and discover that all of these experiences were symptoms of the disorder and not you as a person. I know, that’s a lot to imagine. At this age, the goal of treatment is not only to treat ADHD but to help a person understand the difference between what they have (disorder) versus who they are (person). In my experience helping people, this process helps resurrect a person’s self-image.
I invite you to read these two articles and seek professional help if these symptoms resonate with your experience. If you are an older adult with possible ADHD, I recommend that you see an expert in ADHD who will be able to make an accurate diagnosis. Because older adults may have both medical and psychiatric disorders in addition to taking medications, it’s critical that an expert be able to distinguish multiple disorders and evaluate the presence of ADHD accurately. Effective treatment is completely dependent on the accuracy of the diagnosis.
Thank you for your interest.
David W. Goodman, M.D.
Today the New York Times published an article “The Selling of Attention Deficit Disorder” by Alan Schwarz. This is a lengthy article highlighting the increased identification of people with ADHD and the concomitant increase in the prescriptions of effective medications. The article is a feature story on the New York Times website today.
Toward the end of this article I am quoted for the authorship of a continuing medical education article I wrote for Medscape.com in August 2012. In the Times article, he references a six-minute video clip of an interview between physician and patient I had included in my Medscape article. He uses my quote “That was not an acceptable way to evaluate and conclude that the patient has A.D.H.D.” to indict me for using the short video as an example of how to evaluate adult ADHD. He sat with me for 30 minutes in Washington DC and recorded our interview. However, what he failed to mention in his New York Times article was that the video clip he referenced accompanied a 2000 word continuing medical education article with 86 scientific references that was estimated to take physicians 2.5 hours to complete. It would appear that Mr. Swartz had an a priori agenda in presenting his information. His remarks in the article malign and misrepresents physicians’ and researchers’ commitment to exploring causes and effective treatments for ADHD. Unfortunately this is not my first experience with journalists dispensing with facts that don’t support their biased premise.
This evening I composed my Letter to the editor and have forwarded it to them. Let’s wait and see what develops. And now you have the back story to my quote. Thank you for your interest.
In the September issue 2013 of Attention Magazine, published by the national organization CHADD (Children and Adults with ADHD), my article was published on ADHD in people age 50 and older. There is remarkably little research looking at this population of patients. Clinical medication trials that seek the FDA approval for the treatment of ADHD include subjects up to 65 years old. However, the number of subjects over 50 in these studies is relatively small and often the mean age is 34.
Unfortunately, ADHD may not be a diagnostic consideration when older people complain of cognitive difficulties. A study looking at memory clinics in the U.S. found only 1 in 5 centers screen for ADHD. Therefore, it is possible that ADHD symptoms may be misdiagnosed as something else (Fischer BL 2012). Given that ADHD is a cognitive impairment, people wonder if ADHD is a risk factor for developing dementia. A recently published study looking at the question concluded that ADHD is not a risk factor for dementia (Ivanchak N, 2011). We’ll await further research.
Myths about ADHD over age 50:
Can’t diagnose ADHD in the presence of older age.
Can’t diagnose ADHD in the presence of medical disorders and medications.
Why bother treating it, they lived their whole life this way.
The ADHD medications aren’t safe in older adults.
Diagnosing ADHD in a person this age presents unique challenges because there are specific medical and psychiatric considerations in someone over age 50. If we just focus on the cognitive symptoms, the first issue is how much of the cognitive symptoms are age related. As we age we will notice some forgetfulness, difficulty in recalling information quickly, losing a train of thought, and getting distracted. What distinguishes this from ADHD is the fact that the symptoms started much later in life and not in childhood. Second possibility is a new diagnostic category in the DSM-5 called Mild Cognitive Impairment. This is a degree of cognitive change accompanied by impairment but not rising to the level of Alzheimer’s disease. Third are the effects of medication on cognition. As we age we will develop medical illnesses treated with medication that may have subtle effects on cognition (i.e. statins, antidepressants, chemotherapy). The more medications we are on, the more likely they will affect our thinking ability. Fourth, medical illnesses themselves may affect our thinking ability (i.e. hypothyroidism, post cardiac surgery). Fifth, women in peri- or post-menopause often notice clear changes in memory and cognition. Sixth, a long history of alcohol and/or substance abuse may cause lasting cognitive symptoms. Seventh, head trauma/concussion/neurological disorders may leave persistent changes on memory and processing speed for information (i.e. multiple concussions from sports injury). What distinguishes all of the above diagnostic consideration is the age of onset of these symptoms. Except for the possibility of head trauma in childhood, all the other diagnostic considerations occur later in life. The hallmark of ADHD is the presence of symptoms in childhood.
I will continue my blog on this subject in the future. Thank you for your interest. Hope it is helpful to you.
Style magazine in Baltimore has published an article in September 2012 edition on stimulant misuse in high school students in Baltimore. The article distinguishes between the use of stimulants for performance enhancement by students vs the use of stimulants to treat legitimately diagnosed ADHD in young adults. I, along with Dr. Alain Joffe, director of Johns Hopkins University’s Student Health Center, were interviewed for our thoughts on this important issue. Students interviewed offer their perspective as well.
The take-home point for me as a psychiatrist treating late adolescents and young adults is to obtain a complete history of ADHD since childhood confirmed with input from a parent. Other co-existing psychiatric and medical condition are also considered. Only after I am confident of the presence of ADHD do I write a prescription and recommend behavioral/organizational therapy.
As it is important to treat those who need medication, it is equally important to not prescribe to those students who don’t have ADHD.
