Conference Transcript   

Natalie: Good evening. I'm Natalie, your moderator for tonight's ADHD chat conference. I want to welcome everyone to the HealthyPlace.com website. Our social network is fairly new in the Internet, but already we have several thousand people who have signed up. The social network is a place for people with mental health conditions as well as their family members and friends to meet each other, maintain blogs and provide and get support, and it's free to join.

Tonight, we are going to discuss diagnosis of Adult ADHD first because without an accurate and proper diagnosis, one can’t get the right treatment.

Our guest is Dr. Lenard Adler, director of the Adult ADHD Program at New York University Medical Center and author of Scattered Minds: Hope and Help for Adults with Attention Deficit Hyperactivity Disorder.

Good Evening, Dr. Adler, and thank you for joining us tonight.

Dr. Adler: I'm happy to be joining you.

Natalie: I am constantly seeing news stories and studies about “undiagnosed ADHD in adults.” I think most parents today are familiar with ADHD in children. Is it different for adult ADHD?

Dr. Adler: ADHD used to be thought of as a disorder primarily affecting children; we now know that about 2/3 children with ADHD go on to be adults with ADHD. This means that about 4.4% of the US adult population or 8 million individuals have ADHD.

Natalie: For adults with ADHD, do the first symptoms usually appear during childhood or is this something that can pop up during adulthood?

Dr. Adler: There must be a childhood onset of symptoms, but you don't need to meet full criteria or be diagnosed in childhood. There can be adult presentation of ADHD, but to meet full criteria, not adult onset.

Natalie: Are the symptoms of ADHD in adults different from those in children?

Dr. Adler: The symptoms are similar, but individuals must be aware of how symptoms change from childhood to adulthood. The inattentive symptoms of trouble with distraction, trouble paying attention, trouble completing tasks etc. are more prominent for adults than the hyperactive impulsive symptoms. Also, adults tend to try to cope with their symptoms and this needs to be kept in mind.

Natalie: Here's a link to symptoms of ADHD in adults. But in your book “Scattered Minds,” you mention some “hidden warning signs of adult ADHD”. Could you please go over those?

Dr. Adler: There are a number of warning signs- which are some of the impairments from the condition- underperformance on the job, multiple motor vehicle accidents, higher rates of divorce, smoking cigarettes and if the ADHD is not treated, substance use.

Natalie: Accurate diagnosis of childhood ADHD is a problem because some of the symptoms cross over several disorders, like bipolar disorder or conduct disorder. Does the same hold true for diagnosing adults with ADHD? Or is it because they are adults, the symptoms and the ability of the patient to accurately communicate the symptoms, makes a diagnosis easier?

Dr. Adler: These co-occurring conditions are important for adults too- adults with ADHD have higher rates of co-occurring bipolar disorder, depression and anxiety disorders. The ability for adults to present a longitudinal history is critical as ADHD symptoms tend to persist, while the symptoms of mood disorders are often episodic.

Natalie: If I think I have adult ADHD, which type of professional is the best for me to see about diagnosis issues? And what about ADHD treatment?

Dr. Adler: Although there is a screening test (self administered) to identify individuals at risk for ADHD, the diagnostic evaluation requires sitting down with a health care professional and taking a history. 4 criteria need to be met to make the diagnosis: symptoms, impairments, childhood onset and being certain that the symptoms are from ADHD and not another mental health disorder. The diagnosis is a clinical one and there is not blood test or brain scan that can make the diagnosis. The diagnosis is usually made by a psychiatrist (adult or child), psychologist, neurologist or primary care physician.

Natalie: Do you think a family doctor, in general, can do a good job of diagnosing adult ADHD?

Dr. Adler: It depends on whether the PCP is adequately trained or not.

Natalie: Sometimes people go to see a doctor or therapist and say “I can’t concentrate, always feel fidgety, and I’ve felt this way for a long time.” After that sentence, the doctor is writing a prescription for an ADHD medication. So when I see a professional for a ADHD diagnosis, what kind of diagnostic tests/interviews should I expect so I know this person is doing a thorough and competent job?

Dr. Adler: There is no substitute for taking a comprehensive history, which reviews life long symptoms and impairments. Again to make the diagnosis of ADHD the above 4 criteria need to be met. Rating scales, be they diagnostic or symptom assessment, can often be quite helpful in establishing the symptom onset, chronicity and impairments.