Thursday, May 19, 2005
Adults with disorder had earlier symptoms

By Anthony Policastro
Medical director,
Nanticoke Memorial Hospital

It is currently fashionable to use the term “adult ADD.” The perception is that there is a condition that adults get that causes problems similar to those seen in children. It becomes a good excuse for people who have difficulty with performance on the job. That is not quite true. Attention Deficit Hyperactive Disorder (ADHD) is a genetic disorder that shows up in childhood. There are several requirements to make the diagnosis. The first of those is that the symptoms have to have started prior to 7 years of age. An individual who had no problems in school and then suddenly has problems on the job is unlikely to have ADHD. A second criterion is that the symptoms interfere with function in two of three areas. Those areas are school (or work for an adult), home and in social situations. Therefore, these two questions about age of onset and interfering with daily function must be answered yes before the diagnosis is entertained. The next question to answer is whether the symptoms could be due to another disorder. For example, individuals with depression can have a lot of ADHD symptoms. Depression occurs in 20 percent of adults. ADHD is only present in 5 percent of the population. Thus depression is much more common as a cause of the symptoms. Anxiety disorders can cause ADHD symptoms in adults. Personality disorders can cause ADHD symptoms in adults.
If there is no depression, anxiety or personality disorders, then the symptoms of ADHD can be reviewed. There are nine symptoms of inattention. They include careless mistakes. They include difficulty maintaining attention in play activities. They include things going in one ear and out the other. They include failing to finish projects. They include difficulty organizing things. They include a dislike for mental tasks like puzzles. They include losing things from absent-mindedness. They include forgetfulness. At least six of these symptoms must be present for the person to have ADHD inattentive type. They have to occur all the time and not once in a while. There are nine symptoms of hyperactivity. They include fidgetiness. They include inability to stay seated. They include climbing on things inappropriately. They include inability to play quietly. They include acting as if there is no off button. They include talking too much. They include difficulty waiting turn. They include blurting out answers before questions are finished. They include interrupting others. At least six of these symptoms must be present for the person to have ADHD hyperactive type. They have to occur all the time and not once in a while. If the individual has six from each category, then the diagnosis would be ADHD combined type. This may sound complicated. It is. That is why it takes me two half-hour visits and a review of school related information before I will make the diagnosis of ADHD. Adults who decide that they must have ADHD as the cause of their problems must have the same rigid criteria to make that diagnosis as we do for children. It is not simply a matter of reading something in a book and deciding that is what is going on. About 5 percent of the adult population still has their childhood ADHD with them. However, it should not be a diagnosis that is all of a sudden a surprise. It must have always been there. It must interfere with function. The symptoms must be constant and not intermittent. While adult ADHD is a fashionable disorder, it is not a new band wagon to jump onto.