Is ADHD a valid diagnosis in older adults?
Surman C, Goodman DW. ADHD Atten Def Hyp Disord. Jan2017.
adult ADHD diagnosis
Dr. David W. Goodman ADHD in older adults U.S. News and World Report March 2016
Since the recent publication of our literature of published research on ADHD in adults over age 50, several news outlets have been interested in bring this subject to the public eye. ADHD in adults persists throughout one’s life. It does not go away because you got your AARP card or Medicare benefits.
Because I believe in the importance of accurate diagnosis and effective treatment for ADHD regardless of age, I wrote an editorial piece that U.S. News and World Report published online on March 7, 2016. This article was picked up by several news (Yahoo News) and professional organizations (American Professional Society for ADHD and Related Disorders – an organization of international clinicians and researchers, and the National Resource Center-a CDC funded organization affiliated with Children and Adults with ADHD Association CHADD).
For most people with ADHD, it is a lifelong condition to be understood, appreciated, respected, and treated effectively. Quality of function and life are greatly effected regardless of your age. I always encourage people with lifelong symptoms of ADHD to get a competent evaluation and learn more about managing these symptoms to improve daily functioning.
Dr. David W. Goodman interviewed by WOSU (NPR) on Adult ADHD January 26, 2016
It appears that the topic of ADHD in older adults is catching some attention. I was invited by Ann Fisher of WOSU Radio (NPR affiliate) in Columbia, Ohio to discuss adult ADHD especially in older adults. The host, Ann, asked insightful questions about identification and diagnosis in older adult and how that’s different from younger adults and children. We also covered treatment options including medication and cognitive behavioral therapy.
I am very excited that some media outlets have decided that ADHD in older adults is an opportunity to increase public awareness that “ADHD is not just for kids.”
I invite you the listen to the 20 minute interview. You can find it here. On the time scroll bar, move it to 14:40 minute mark to listen.
David W. Goodman, M.D.
Dr. David W. Goodman quoted in The New York Times Today (December 15, 2013)
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.
David W. Goodman M.D.
ADHD in People Age 50 and older
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.
ADHD over age 50 – WebMD
For those with ADHD as an adult, it doesn’t go away. According to the National Comorbidity Survey Replication study published 2006, of those with adult ADHD, 75% were not diagnosed as children.
In my practice it is not uncommon for patients over age 50 to be newly diagnosed. I provided my expertise in this area to the author of an article for WebMD published live this week. The “moral of the story” is it is never too late to get evaluated and seek treatment. Daily functioning can improve at any age.
Why is my ADHD bothering me now?
ADHD (or ADD without the H) is a disorder whose symptoms start in childhood. Two of three of these children will continue to have symptoms to an impairing degree beyond age 18 . Of the adults with ADHD who are diagnosed in adulthood, only 25% were ever diagnosed as a child (Kessler et al 2007). One reason for the under-identification of children with ADHD is that only those children who are disruptive come to the attention of teachers and parents. Non-disruptive children with ADHD may not get diagnosed until later in life. So the question is, what would cause them to seek an evaluation later in life. “If you lived with it all this time, it can’t be that bad.” Right? Well, not exactly.
In our recent publication on ADHD throughout the Lifespan (Journal of Clinical Psychiatry February 2012), we discuss the developmental phases of life that prompt the question “Why is my ADHD bothering me now?” When reading this article, please note the authorship of internationally recognized experts in the field that include Drs. Atilla Turgay (Canada), Phillip Asherson (United Kingdom), myself and Russell Barkley (United States).
Each developmental phase of life takes on more responsibility. For example, moving from middle school to high school means the academic demands and workload increases. As you move from high school to college, you need to be able to organize yourself to get to classes, do assignments on time, schedule time for study, sleep, play, and classtime. If you go onto first job, you need to be punctual, respond appropriately to supervisors, and complete work on time. When you get married, you need to negotiate household responsibilties and complete tasks timely and consistently to be a team player in your marriage. And then you go on to have children which adds additional layers of tasks and responsibilities requiring increasing levels of organization and efficiency. How about a job promotion with more tasks and the oversight of others. So, each developmental phase of adult life has its set of tasks and responsibilities and your ability to adapt and compensate becomes more difficult. At some point, your daily performance suffers whether at work or home. At this point, either you or someone close (employer, family, friend) to you will bring it to your attention. Sometime this is done kindly, sometimes it is the result of an argument because you haven’t followed through as expected by others.
Our publication was written for physicians and psychiatrists so that they would understand why an adult with ADHD who had never gotten treatment might come to their office for an evaluation. We hope that this publication will disuade physicians from discounting an adult’s compliant of daily function and look for ADHD when indicated.
If you are not a physician, I think the article is still quite readable for most people and may provoke some thoughts and discussions amongst those effected by ADHD.
Thank you for your time and interest in reading my postings.
David W. Goodman, M.D.
Medical Crossfire- 4 videos by experts on adult ADD
Education about ADHD in adults is critical for everyone. In addition to my work in the public sector and assistance to public media (newspaper, magazines, and TV), I’m also involved in teaching physicians how to best identify their patients who have ADHD/ADD. My friend, Anthony Rostain, MD at the University of Pennsylvania and I did a 4 part video series (Medical Crossfire) explaining diagnosis, co-existing psychiatric conditions and treatments, both medication and therapies for adult ADD.
You are invited to view each of the segments here. You will need to register first. Don’t worry if you are not a physician. You will be able to understand the discussion. When you register: under “Profession” click on No Profession; under “Specialty” click on Non-clinical; under degree, well, you choose what’s appropriate.
These segments represent the opinions of internationally recognized experts speaking about the state of the art for this disorder. You will be very well informed after viewing each segment.
As I have said before, let science be the designated driver in the highway of opinions. Thank you again for your interest in my writings. I will be adding these video segments to my website in the near future.