ADHD often goes undetected in adults experts say

1 of 5 | Only 10% to 25% of adults with ADHD obtain an accurate diagnosis and proper treatment, according to a study published in Psychiatry Research. Photo by Gerd Altman/Pixabay

NEW YORK, April 30 (UPI) — Despite available treatments, attention-deficit/hyperactivity disorder, or ADHD, often goes undetected in adults, wreaking havoc on their personal and professional lives.

The abbreviation represents a class of neurodevelopmental disorders commonly diagnosed in school-age children, but they can affect any age group.

“ADHD is notoriously underdiagnosed in adults, especially in women, minorities and those older than 40,” Ari Tuckman, a psychologist in private practice in West Chester, Pa., told UPI via email.

Only 10% to 25% of adults with the disorder obtain an accurate diagnosis and proper treatment, according to data compiled by 10 institutions in Europe, Africa and Australia and published in October in Psychiatry Research. The investigators concluded that 3.1% of adults have ADHD.

“An ongoing pattern” of symptoms includes inattention — “difficulty staying on task, sustaining focus and staying organized,” the National Institute of Mental Health says.

Meanwhile, hyperactivity also may be prevalent, resulting in excessive fidgeting, tapping or talking. And impulsivity can lead someone to “interrupt others or make important decisions without considering long-term consequences,” the institute notes.

The Psychiatry Research study identified three subtypes of ADHD — ADHD-I (inattentive type of ADHD-I), ADHD-HI (hyperactive type) and ADHD-C (combined type).

“The results indicate that ADHD is relatively high in adults, with ADHD-I remaining the most common subtype,” the study’s authors wrote. “Attention should be given to preventing, reducing, identifying and managing ADHD in adults.”

Even when mental health professionals treat adults for other psychiatric disorders, ADHD often goes unrecognized, experts say.

“If one has the idea of ADHD being a hyperactive boy, then adults who are no longer hyperactive will slip by. Or those who have the more inattentive type of ADHD will tend to slip by,” said Tuckman, who also is the conference co-chair for Children and Adults with Attention-Deficit/Hyperactivity Disorder, a national advocacy organization.

As a result, adults’ struggles with ADHD often are attributed to other reasons, such as anxiety, depression, sleep problems and substance overuse. Untreated ADHD can exacerbate these conditions, he said.

However, Tuckman noted that increasing awareness of ADHD in adults has led more people to identify with the symptoms and seek out treatment for this disorder specifically, not just the anxiety, depression and other mental health issues that often accompany it.

Problems in relationships, college studies or the workplace eventually compel people to consult with a mental health professional in hopes of finding relief from ADHD symptoms with which they have lived since childhood, said Dr. Lisa MacLean, an adult psychiatrist at Henry Ford Health in Detroit.

Sometimes, adults with the symptoms turn to mental health professionals after their children are diagnosed with ADHD, said MacLean, who also is chief clinical wellness officer for the Henry Ford Medical Group.

“A light bulb goes off in their head and they see how their child’s struggles are similar to theirs,” she said, adding that the disorder has a genetic component.

“Untreated ADHD can negatively impact the educational level a person can achieve,” MacLean said.

For mental health professionals to diagnose someone with ADHD, they must determine that “several inattentive or hyperactive-impulsive symptoms were present prior to age 12,” according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Illnesses.

“If an adult started to have symptoms clearly in adulthood, then it is unlikely to be ADHD as a primary psychiatric diagnosis,” said Dr. Britta Ostermeyer, OU health chief of psychiatry in Oklahoma City, Okla.

Other medical or psychiatric ailments may be responsible for the onset of inattention in adulthood, such as depression, substance abuse, sleep disorders, lung conditions, cardiac conditions or brain diseases, Ostermeyer said.

The reason ADHD is more likely to go undetected in adults than children stems in part from the “lack of daily contact with people adept at recognizing ADHD, such as schoolteachers,” she said, noting that adults also have fewer hyperactive symptoms than children.

Medications are the primary form of treatment for ADHD, not psychotherapy, experts say.

The medications that work best are stimulants, such as Ritalin, Concerta, Vyvanse, Focalin and Adderall. For patients who can’t take stimulants, non-stimulant options are available, Ostermeyer said.

“It may take several visits to find the best medication and fine-tune the dosage while also working on other behavioral treatment goals,” said Dr. Jeremiah Hopkins, a psychiatrist and medical director of Healthy Minds University, a clinic that focuses on students’ mental health at WVU Medicine in Morgantown, W. Va., told UPI via email.

That’s why “managing expectations and knowing the limitations can be helpful, so that you do not become frustrated with treatment after one or two appointments,” Hopkins said.

“Treatments are extremely effective, and almost all patients who stick with the treatment plan over time realize significant improvements in their condition,” he said.

When used along with medications, psychotherapy can help educate a patient about symptoms of ADHD and emphasize the importance of following a prescribed drug regimen, help with important organization and planning skills, and teach how to best cope with distractions in daily life, Ostermeyer noted.

“Always seek professional help to receive a proper evaluation, diagnosis and personalized treatment plan,” she said.

If someone with ADHD is experiencing a lot of stress, experts say cognitive behavioral therapy may be helpful.

“Learning behavior modification techniques like making lists, using your smartphone alarm to remind you of upcoming appointments and breaking projects down into smaller pieces can help,” MacLean said.

Other interventions she recommends involve good self-care, such as eating a healthy low-sugar diet, engaging in regular exercise and pursuing meaningful relationships.

In addition, she said, supplementing the diet with omega-3 fatty acids can play a major role in ADHD prevention and treatment, while practicing meditation can hone the brain’s ability to focus.

“Many patients do very well with consistent treatment,” MacLean said. “People should not approach treatment thinking that medication alone will solve all their issues.”

She added that “they also need to actively work on developing strategies to help them succeed. Getting well is not a passive process. People must take an active role in their mental well-being.”

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