Better late than never for ADHD treatment

By Dr Renata Schoeman

Back in the good old days, you were called naughty, stupid or lazy and got plenty of hidings and sent outside to get rid of your disruptive energy. You were excluded and labelled as the weirdo. You might have made many impulsive decisions, failed at relationships and lost several jobs along the way. Perhaps even believing your life is a perpetual failure – without knowing you, in fact, have ADHD.

We live in a time in which ADHD is now generally accepted as a common disorder that affects both adults and children – not just a childhood disorder. It’s heritable, with a prevalence of 5% in school-aged children, presenting symptoms of inattention, hyperactivity and impulsivity. Often parents unaware of their child’s behaviour and are alerted by teachers of issues experienced in the classroom.

An unrecognised disorder 
In the past, teachers were often misinformed – or not informed at all – about ADHD and how it presents in children and in the classroom. Generations of children were left undiagnosed and untreated. This may have had a significant impact on them throughout their lives.

ADHD in adults 
Adult ADHD is now a recognised neurodevelopmental disorder, present in more or less 3.4% of the worlds population. However, the core symptoms of ADHD present differently in adulthood than in childhood. The behavioural, cognitive, emotional and social problems that have an impact on work and relationships can be devastating.

Although the symptoms of ADHD appear to ‘decrease’ over time, adults are in fact only more adept at managing symptoms and often compensate for ADHD-related impairment through lifestyle and career choices. But a lot of time and energy is wasted in the process. Undiagnosed adult ADHD makes life harder to manage.

Diagnosis by chance 
Often adults with ADHD are only diagnosed when their children are assessed for the symptoms by a medical professional. They then recognise the symptoms in themselves. With an increase in awareness of ADHD (and adult ADHD), an increasing number of adults aged 50 years and older are now seeking assessment for ADHD.

Although there’s the perception the ADHD symptom level is significantly lower in the age group 70-80 years than the group 50-60 years, it’s also possible that older individuals do not seek help due to lack of awareness, or it might be the demands and pressures of their environment are lower so they can better cope without treatment. So the symptoms themselves don’t ‘decrease’, but their impact, in some ways, does.

How does undiagnosed ADHD affect older individuals?
Michielsen et al (2014) used data from the Longitudinal Aging Study Amsterdam (LASA) in 2008 and 2009 to compare 231 participants with and without ADHD aged 60-94 years.

They found older adults with ADHD reported lower self-esteem and higher levels of neuroticism and social inadequacy than those without ADHD. ADHD in old age is also related to being divorced, never married and loneliness, but not to work participation.

These difficulties also contributed to depression later in life in those with previously undiagnosed ADHD. Following this study, Michielsen et al (2015) interviewed 17 patients older than 65 years who were diagnosed with ADHD, but who were previously unaware of their diagnosis.

Seven themes were identified: four themes correspond to ADHD symptoms (impulsivity, inattentiveness, hyperactivity). The other three themes affected quality of life and social interactions. These included low self-esteem, over-stepping boundaries and feeling misunderstood.

Adult vs child ADHD
The same diagnostic criteria used in younger children, adolescents and adults can still be used for patients above the age of 50. A similar burden of comorbidities (such as anxiety, depression, substance misuse) are present in both younger and older individuals.

ADHD has a negative impact later in life, and older adults may still benefit in treatment. Stimulant treatment is beneficial for ADHD in old age, it has been studied in depression and even dementia in older adults, and seems safe with active cardiovascular risk monitoring.

The impact of late diagnosis 
Adults who’ve lived with undiagnosed ADHD and who discover they have the condition later in life often grieve the years they’ve lost. It’s essential when treating patients with adult ADHD to provide support based on knowledge and understanding of how ADHD symptoms have affected their health, quality of life, and functioning throughout their lives.

It’s crucial that children displaying symptoms of ADHD are screened early and provided with effective treatment and support to afford them the chance to reach their full potential.

PHZA/CONC/0717/0001a

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