Sheila
Moderator
I believe I read an article on the board recently that mentioned that some ADHDers grow out of ADHD. Just my personal opinion, but I doubt that happens. I suspect that as individuals get older, some are better at honing and adhering to learned coping skills. Reading the following article reminded me of the "grow out of it" debate, so I thought the following might be of interest to some.
From http://www.medscape.com/viewarticle/505453 :
Recognizing Attention-Deficit/Hyperactivity Disorder (ADHD) in Adults: An Expert Interview With Jefferson B. Prince, MD
Disclosures
Editor's Note:
How should the general psychiatrist screen for attention-deficit/hyperactivity disorder (ADHD)? To find out, Medscape's Randall White interviewed Jefferson B. Prince, MD, Instructor in Psychiatry, Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, to discuss the diagnosis of this disorder.
Medscape: What is a typical presentation of ADHD in an adult?
Jefferson B. Prince, MD: There are several usual presentations that clinicians will see. One is patients who come with a history that's very clear, and they've been previously evaluated and treated. They stop treatment in late adolescence and then head off to college or the work force, and then they present for work failure, relationship failures, and/or substance abuse problems.
Another typical one is somebody who has never been evaluated, who has a very high IQ, and who gets into university or the work force and doesn't do well. These are very bright people who are disorganized and not able to follow through on things.
Medscape: Why do intelligent people in particular present in this fashion?
Dr. Prince: Because through the school years, they get by just on their intelligence. Other people aren't counting on them, they don't have to manage anybody but themselves, and they're usually big procrastinators and usually can get away with their procrastination. They start to have trouble when other people are relying on them. And because they're bright, they're put in charge of something. So for instance, we might see physicians who go through medical school and do OK in residency, but then they get into practice and they do poorly. That's because they have to manage and direct other people. They're not able to manage and direct themselves, much less others.
We see attorneys once they get through law school because usually they can do just one thing at a time. If they have many cases they have to prepare for and get to court, they can never meet those deadlines.
Another presentation is women with work complaints or home-based complaints of disorganization, distractibility, and inattention. They never had behavior troubles growing up, so they never really came to the attention of the education system. They have the inattentive subtype -- the attention and focusing problems rather than the hyperactivity. They are often the mothers and sometimes the fathers of the children we treat. When we're taking the history of the child, one of the parents will say, "Gosh, I was just like that," or "I've always been like that."
Another scenario is [presentation] through comorbid problems. In the depressed population, the anxious population, the bipolar and substance-abuse populations, there is a huge overlap of people who also have ADHD.
Medscape: Do you find that more adults are coming forward asking for evaluation and treatment of this disorder?
Dr. Prince: Absolutely. That's because of the media and books like Driven to Distraction.[1] We used to tell people that ADHD just went away, so even if you were an adult and you had that history, you thought, "Well, it just went away and I outgrew it." But they don't outgrow it; the manifestations just change over time. The hyperactivity symptoms diminish, impulsive symptoms go down somewhat, but attention problems persist. Now we're 10 years into telling people this, so more and more adults are starting to present.
Medscape: Given the association of oppositional-defiant disorder and conduct disorder with ADHD in childhood, how often does personality disorder complicate the diagnosis and treatment of ADHD in adulthood?
Dr. Prince: Patients with ADHD and conduct disorder are at increased risk for developing antisocial personality disorder, and we usually see the triad of ADHD, substance abuse, and antisocial personality. Probably about 20% of adults with ADHD are going to have antisocial personality disorder.
Medscape: Adult men, women, or both?
Dr. Prince: Primarily men, although there are smaller numbers among women.
Medscape: Are there any other personality disorders that seem to be prominent in this population?
Dr. Prince: There's not a lot written about it yet, but borderline personality disorder is something we see in a lot of women with ADHD. Girls with ADHD seem to be at somewhat increased risk of abuse. Between the ADHD and abuse and depression, you may have set the stage for formation of a borderline personality disorder.
Medscape: How should the general psychiatrist screen for ADHD?
Dr. Prince: The first thing is to think of it. The second thing is that, with the help of the World Health Organization, Len Adler and Tom Spencer have developed an instrument that's a good screening tool [Adult Self-Report Scale (ASRS)].[2] After that, if the screen is positive, the psychiatrist needs to get a good history.
The most exciting thing about identifying patients is that, when you treat them, they actually get better. You can have a big positive impact upon patients' lives and the lives of their families and fellow employees. It's very rewarding to treat.
Supported by an independent educational grant from Wyeth.
References
Hallowell EM, Ratey JJ. Driven to Distraction: Recognizing and Coping With Attention Deficit Disorder From Childhood Through Adulthood. New York, NY: Touchstone; 1994.
Adler LA, Cohen J. Screening adults for attention-deficit/hyperactivity disorder (ADHD). Medscape Psychiatry and Mental Health, June 2003. Available at: http://www.medscape.com/viewarticle/457518_3. Accessed May 24, 2005.
[NB: The Adult Self-Report Scale is available for download in the conclusion of this article.]
Jefferson B. Prince, MD, Instructor in Psychiatry, Harvard Medical School, Boston, Massachusetts; Child Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
Disclosure: Randall F. White, MD, has disclosed that he owns stock, stock options, or bonds in Quest Diagnostics, Novartis AG ADR, and Millipore Corp.
Disclosure: Jefferson B. Prince, MD, has disclosed that he has received grants for clinical research from McNeil and GlaxoSmithKline, as well as grants for educational activities from McNeil, GlaxoSmithKline, and Eli Lilly. Dr. Prince has also disclosed that he has served as an advisor or consultant for McNeil, GlaxoSmithKline, Shire, AstraZeneca, Novartis, Eli Lilly, and Celltech.
From http://www.medscape.com/viewarticle/505453 :
Recognizing Attention-Deficit/Hyperactivity Disorder (ADHD) in Adults: An Expert Interview With Jefferson B. Prince, MD
Disclosures
Editor's Note:
How should the general psychiatrist screen for attention-deficit/hyperactivity disorder (ADHD)? To find out, Medscape's Randall White interviewed Jefferson B. Prince, MD, Instructor in Psychiatry, Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, to discuss the diagnosis of this disorder.
Medscape: What is a typical presentation of ADHD in an adult?
Jefferson B. Prince, MD: There are several usual presentations that clinicians will see. One is patients who come with a history that's very clear, and they've been previously evaluated and treated. They stop treatment in late adolescence and then head off to college or the work force, and then they present for work failure, relationship failures, and/or substance abuse problems.
Another typical one is somebody who has never been evaluated, who has a very high IQ, and who gets into university or the work force and doesn't do well. These are very bright people who are disorganized and not able to follow through on things.
Medscape: Why do intelligent people in particular present in this fashion?
Dr. Prince: Because through the school years, they get by just on their intelligence. Other people aren't counting on them, they don't have to manage anybody but themselves, and they're usually big procrastinators and usually can get away with their procrastination. They start to have trouble when other people are relying on them. And because they're bright, they're put in charge of something. So for instance, we might see physicians who go through medical school and do OK in residency, but then they get into practice and they do poorly. That's because they have to manage and direct other people. They're not able to manage and direct themselves, much less others.
We see attorneys once they get through law school because usually they can do just one thing at a time. If they have many cases they have to prepare for and get to court, they can never meet those deadlines.
Another presentation is women with work complaints or home-based complaints of disorganization, distractibility, and inattention. They never had behavior troubles growing up, so they never really came to the attention of the education system. They have the inattentive subtype -- the attention and focusing problems rather than the hyperactivity. They are often the mothers and sometimes the fathers of the children we treat. When we're taking the history of the child, one of the parents will say, "Gosh, I was just like that," or "I've always been like that."
Another scenario is [presentation] through comorbid problems. In the depressed population, the anxious population, the bipolar and substance-abuse populations, there is a huge overlap of people who also have ADHD.
Medscape: Do you find that more adults are coming forward asking for evaluation and treatment of this disorder?
Dr. Prince: Absolutely. That's because of the media and books like Driven to Distraction.[1] We used to tell people that ADHD just went away, so even if you were an adult and you had that history, you thought, "Well, it just went away and I outgrew it." But they don't outgrow it; the manifestations just change over time. The hyperactivity symptoms diminish, impulsive symptoms go down somewhat, but attention problems persist. Now we're 10 years into telling people this, so more and more adults are starting to present.
Medscape: Given the association of oppositional-defiant disorder and conduct disorder with ADHD in childhood, how often does personality disorder complicate the diagnosis and treatment of ADHD in adulthood?
Dr. Prince: Patients with ADHD and conduct disorder are at increased risk for developing antisocial personality disorder, and we usually see the triad of ADHD, substance abuse, and antisocial personality. Probably about 20% of adults with ADHD are going to have antisocial personality disorder.
Medscape: Adult men, women, or both?
Dr. Prince: Primarily men, although there are smaller numbers among women.
Medscape: Are there any other personality disorders that seem to be prominent in this population?
Dr. Prince: There's not a lot written about it yet, but borderline personality disorder is something we see in a lot of women with ADHD. Girls with ADHD seem to be at somewhat increased risk of abuse. Between the ADHD and abuse and depression, you may have set the stage for formation of a borderline personality disorder.
Medscape: How should the general psychiatrist screen for ADHD?
Dr. Prince: The first thing is to think of it. The second thing is that, with the help of the World Health Organization, Len Adler and Tom Spencer have developed an instrument that's a good screening tool [Adult Self-Report Scale (ASRS)].[2] After that, if the screen is positive, the psychiatrist needs to get a good history.
The most exciting thing about identifying patients is that, when you treat them, they actually get better. You can have a big positive impact upon patients' lives and the lives of their families and fellow employees. It's very rewarding to treat.
Supported by an independent educational grant from Wyeth.
References
Hallowell EM, Ratey JJ. Driven to Distraction: Recognizing and Coping With Attention Deficit Disorder From Childhood Through Adulthood. New York, NY: Touchstone; 1994.
Adler LA, Cohen J. Screening adults for attention-deficit/hyperactivity disorder (ADHD). Medscape Psychiatry and Mental Health, June 2003. Available at: http://www.medscape.com/viewarticle/457518_3. Accessed May 24, 2005.
[NB: The Adult Self-Report Scale is available for download in the conclusion of this article.]
Jefferson B. Prince, MD, Instructor in Psychiatry, Harvard Medical School, Boston, Massachusetts; Child Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
Disclosure: Randall F. White, MD, has disclosed that he owns stock, stock options, or bonds in Quest Diagnostics, Novartis AG ADR, and Millipore Corp.
Disclosure: Jefferson B. Prince, MD, has disclosed that he has received grants for clinical research from McNeil and GlaxoSmithKline, as well as grants for educational activities from McNeil, GlaxoSmithKline, and Eli Lilly. Dr. Prince has also disclosed that he has served as an advisor or consultant for McNeil, GlaxoSmithKline, Shire, AstraZeneca, Novartis, Eli Lilly, and Celltech.
). I also makde To-Do lists that include absolutely EVERYTHING, from big projects at work, to little things like "take the laundry out of the dryer".
