Adult ADHD: Treating It Effectively

Martin C, age 50, came to my office two weeks ago saying, “I think I have ADHD.” I asked, “Why are you coming in now, at age 50?” “Have there been any major changes in your life recently, any new stressor rearing its head?” Martin’s response was that he was experiencing poor attention, but had never been diagnosed with ADHD before coming to me. I questioned on, “Was school a struggle for you; did you experience much academic failure; how long did it take for you earn your degree?” Martin stated that he earned mostly A’s and B’s in grammar school, and mostly B’s in pursuit of his MBA – which he completed in 3 years while working at the same time. After these initial questions, I had him fill out an ADHD rating scale. We then discussed the items on the scale and I asked him to clarify and expand on some of his answers.

If you have a never-before- diagnosed adult coming into your office claiming  they have ADHD, chances are that 95 percent of them have something else. This was indeed the case with Martin. After further exploration, Martin explained that he had just received a major promotion at work requiring increased responsibilities and demands on his time. He went on to say he was questioning his capabilities for this new position and was having a crisis of confidence. This will be the focus of our work going forward.

Poor attention and/or difficulty concentrating are symptoms of practically every mental condition listed in the DSM. And although it’s absolutely true that many people – particularly college students at this time of year – are feigning ADHD symptoms in order to obtain a prescription for a psychostimulant, many others, (Martin included) are going online looking for information about stress and problems with inattentiveness or poor concentration. And what they’ll find is a relationship between these symptoms and ADHD that are poorly fleshed out – lacking emphasis as to whether someone has a history of symptoms and omitting the importance of meeting other criteria critical to accurately diagnosing ADHD. These other criteria include the presence of symptoms before the age of 12, occurring in two or more settings accompanied by substantial impairment, not better explained by other factors like anxiety or depression. Simply put: There is no such thing as new-onset ADHD beyond the age of 12, but if an older individual’s condition really is ADHD, it either wasn’t diagnosed or the person decided to fight their way through the symptoms while struggling in key areas of their lives – school, work, relationships – throughout. So in addition to the questions I posed to Martin in the example above, ask adults about possible car accidents, loss of jobs, work-related reprimands or any arrests.

Those adults I’ve seen who really have ADHD will say they have difficulty driving because they can’t keep their mind focused on the road and surrounding automobiles; they’ve been fired from jobs due to tardiness; they’ve lost relationships because their partner or spouse couldn’t handle how “scattered” they were; they have a poor credit rating, not for lack of money, but for forgetting to pay their bills. All of these are measurable factors which can help you get the diagnosis right, because after all, if someone has gone say 30 or 40 years really experiencing and suffering from ADHD, there should be some sort of paper trail or documented evidence of substantial impairment or even disability.

Can medication help, in spite of the affected person’s older age? Yes, for sure. The two main categories of drug treatment for ADHD – stimulants and non-stimulants – can be every bit as effective in adults with ADHD as they are in children and adolescents. Among the stimulants, either the Ritalin-type (methylphenidate) or Dexedrine-type (amphetamine) drugs are considered gold standard treatments for ADHD. They’re safe at properly prescribed dosages. As for side effects, appetite suppression and insomnia are common at the beginning of treatment, but generally do not persist. As for non-stimulants, Wellbutrin (bupropion) is a good choice with the added benefit of being an approved antidepressant for someone with comorbid depression; another is Strattera (atomoxetine). Wellbutrin side effects include insomnia, appetite suppression and a jittery feeling. Strattera is also linked to insomnia, as well as nausea and some sexual dysfunction.

ADHD in adults is real because symptoms that surfaced much earlier on don’t just abate with advancing age as the clinical community once thought.

But you’ve got to do some digging to really find out what’s going on.

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Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.

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