By Alan Koenigsberg, M.D.
Approximately 4% to 7% of the population meets criteria for the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). When I was in my psychiatry residency training in the early 1980s, we were taught that ADHD was a condition of childhood and that the children grew out of this during their teenage years.
We were also taught that approximately four times as many boys as girls were affected, and so we didn’t look that hard to diagnose this condition in girls.
I remember vividly when a woman in her late 30s made an appointment with me for continued care for her “adult ADHD.” The wisdom taught to us in my residency was that we would learn just as much after we finished our formal training if we listened carefully to our patients, because they would teach us what we didn’t learn during formal training. The practice of medicine, regardless of specialty, requires lifelong learning.
This woman very patiently explained that she had been diagnosed with this condition as a child, had received treatment for decades, was doing just fine, needed to continue treatment now that she had moved into town here and asked me for my help.
And so began my journey into treating older adolescents and adults with ADHD for the rest of my practice.
I went to conferences, learned from the burgeoning literature on the evolution of ADHD how to treat adults and have been doing so and teaching about this for quite some time now.
ADHD is classified as a neurodevelopmental disorder, most often treated by child or adult psychiatrists because, as with other psychiatric conditions, the symptoms cannot be externally measured; there are no scans, no blood tests, no biopsies to confirm the diagnosis, nor any means to measure the improvement other than a clinical evaluation, meaning we talk to and listen to the patient.
What we have learned over the last few decades is that the numbers of boys and girls affected are the same, that this condition continues into adulthood for most people, that treatment is safe and effective for a lifetime and that people deserve this care and treatment.
I have treated many adults for decades, well into their late 70s and 80s, and they continued to do well with little to no side effects and the efficacy of treatment remained intact.
Our understanding of this condition is that there is a strong genetic component; in other words, this condition is often inherited, genetic, biological, as opposed to psychological trauma, infection and so on.
We know that it is not caused by “bad parenting,” sugar, watching too much TV or the like.
Core symptoms include difficulty in maintaining concentration, irritability, mood swings, poor sleep, easy distractibility, hyperactivity and impulsivity.
How these difficulties are manifested depends quite a lot on the age of the child or adult, their level of maturation and their particular situation.
Some children are hyperactive; some are not. Some children and adults have difficulty staying on task, going from one task to another without finishing them, fidgeting, talking impulsively, staying organized, chronically losing or misplacing things and so on.
For most children the hyperactivity wanes as they go through puberty, along with brain maturation, allowing them to better deal with routine life needs.
Diagnosing this condition can sometimes be very easy and straightforward, but at other times can be confused with autism, anxiety disorders, bipolar disorders and overuse of drugs or medications.
Next time, I’ll go into treatment options.
Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas.