Worried Adults May Err in ADHD Self-Diagnosis

[Clinical Psychiatry News 27(4):24, 1999. © 1999 International Medical News Group.]

Seattle -- In the wake of widespread publicity about attention-deficit hyperactivity disorder, thousands of middle-aged adults are asking for confirmation that they have undiagnosed ADHD.

"This area is really tricky business," cautioned Dr. Chris Varley of the division of child psychiatry at the University of Washington in Seattle. "The older a patient, the more careful I would be before making this diagnosis."

Many of the symptoms used to define attention-deficit hyperactivity disorder (ADHD) apply to childhood, but not necessarily to adult life, Dr. Varley explained at a meeting on mental health sponsored by the university. Blurting out answers in class or failing to finish homework are characteristics that may be hard to apply to adults in the workforce.

Although some of these patients may indeed have suffered the condition since childhood, others are depressed, anxious, or having trouble coping with difficult midlife events. Depression, substance abuse, employment, or marital troubles complicate the picture, Dr. Varley said. "Inattention and a lack of concentration are parts of depression."

The best approach to a differential diagnosis of ADHD in an adult is to determine whether a specific symptom "has a life of its own," Dr. Varley explained. "Did it precede the depression or anxiety, or exist apart from it?"

Dr. Varley does not believe ADHD is a disorder that can suddenly develop in an adult. He recommends delving into the patient's background -- "parents, partners, even school records if they still exist" -- to search for patterns that have "persisted through time" before making this diagnosis.

Men will usually have a history of being unusually active or inattentive from earliest memory. Women fitting the classical ADHD pattern would be expected to have elementary school histories of inattentiveness and learning problems rather than disruptive behavior.

He noted with interest a number of discrepancies between adults presenting with what they believe is ADHD and adults whose ADHD has persisted since childhood.

The adults seeking confirmation of the diagnosis can be professionals who have read books about ADHD and who have high intelligence quotients and a history of academic honors and significant lifetime achievements.

People diagnosed with ADHD from childhood can lead successful lives by learning to compensate for the disorder's effects, Dr. Varley said. Children with ADHD tend not to have high IQs or to be overachievers. A significant number (25%-40%) grow up to be adults with persistent cognitive effects: trouble concentrating, failure to complete tasks, and underachievement.

By contrast, the symptoms sometimes reported by adults who believe they have ADHD may be restlessness or hyperactivity, he said.