Late onset ADHD

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birchswing

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I couldn't find the journal article, but there was one that came out today that said there is a type of neurodevelopmental disorder that has profound ADHD symptoms that emerge in later childhood:

http://www.webmd.com/add-adhd/news/...ar-in-young-adulthood-for-some-study-suggests

I think this is interesting and might also paint differently the population of college students who are sometimes viewed suspiciously when presenting with ADHD symptoms.

I still have a pet theory that I was misdiagnosed with panic disorder instead of ADHD (granted, I had background anxiety and OCD in particular from a very young age—but I wasn't nonfunctional until a very specific turning point). I think I could compensate for potential ADHD with a moderately high level of intelligence until I started college courses in 9th grade. Panic attacks don't come on and end with a particularly difficult class on a daily basis like clockwork. I think it was the higher and more complicated level of stimulus I was required to take in that led to me just . . . flailing and not being able to function.

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I'm not open to it as you have many of the same anxiety symptoms that mimic ADHD. Plus who knows how sleep deprived you are.
 
I couldn't find the journal article, but there was one that came out today that said there is a type of neurodevelopmental disorder that has profound ADHD symptoms that emerge in later childhood.

No.
 
Agreed with the above, at least presently. If it's neurodevelopmental (which by most accounts based on 100+ years of research, it is), it will show up to some extent in childhood. Could a person have subclinical symptoms in childhood that are then exacerbated in young adulthood by other difficulties (e.g., anxiety, poor sleep, the potential horribleness of high school peer groups, increased pressures of college combined with underdeveloped academic and time management skills, etc.)? Sure. But then it's not ADHD.
 
I might even be open to “late childhood” presentations, but this will never convince me of the validity of all the collage aged patients who recently had an epiphany that they have been suffering from an acute stimulant deficiency all of their lives. Even without a fully worked out etiology or a lock solid definition, I think we can usually see a pile of you know what when we see it. How many illnesses can you name where patients get angry at you when you tell them they don’t have that illness?
 
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I agree the diagnosis is often missed in childhood, and shows up more prominently perhaps when a patient has more demands on attention.
At the same time, the number of average intelligence patients I get who are trying to take 16 hours of engineering or premed classes, and their grandma who raised them just died and nkw the student is just not cutting it and then suddenly think they have ADHD is too darn high.
 
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How many different causes are leading to this constellation of symptoms that has been reified as a disorder, I wonder. Executive functioning deficits, disrupted early childhood attachment, a variety of unknown neurological problems or more known neurological findings such as "Shaw, Castelleano, and that clown college they call Harvard that indicate that ADHD is either a delay or an incomplete cortical thickening that coincides with genetic polymorphisms, behavioral difficulties, and neuropsychological deficits" http://forums.studentdoctor.net/thr...developmental-disorder.1152780/#post-16745196 Love that post from @PSYDR :) Also, what about the DMN and the role that plays? Then there are the learning disabilities and anxiety disorders that manifest with attentional problems and then the chaotic home environments. I'm beginning to be in the camp of, "if they want a stimulant, let them have it".
 
The makers of vyvanse clearly aren't making enough money on binge eating disorder.
 
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Late onset ADHD? Baulderdash. Change the acronym to something like BPD and then I think you might be onto something.
 
I might even be open to “late childhood” presentations, but this will never convince me of the validity of all the collage aged patients who recently had an epiphany that they have been suffering from an acute stimulant deficiency all of their lives. Even without a fully worked out etiology or a lock solid definition, I think we can usually see a pile of you know what when we see it. How many illnesses can you name where patients get angry at you when you tell them they don’t have that illness?

When I was diagnosed with ADHD, I kicked and screamed and gave my psychiatrist the silent treatment for years because, in my own words "I just want to be normal!" Then again, I was like 8.

I now know better and realize my situation would have been far ****tier if I hadn't gotten treated.

I do sort of wonder if these cases of late-onset ADHD are just milder cases in people with good coping strategies. I have a hard time believing that ADHD, as we currently understand the disease, would just set in one day for no good reason.
 
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regardless of what is real and what is right(or whatever term you want to use), the reality is that if you're running an outpatient medmgt focused practice and not in certain settings(VA, cmhc, academics to some degree) you are going to see(and probably treat) a lot of 'adult ADHD'.
 
Do you mean because it is the perfect bread and butter set up for our business, or because it is a frequent chief complaint?
 
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When I was diagnosed with ADHD, I kicked and screamed and gave my psychiatrist the silent treatment for years because, in my own words "I just want to be normal!" Then again, I was like 8.

I now know better and realize my situation would have been far ****tier if I hadn't gotten treated.

I do sort of wonder if these cases of late-onset ADHD are just milder cases in people with good coping strategies. I have a hard time believing that ADHD, as we currently understand the disease, would just set in one day for no good reason.
And that is why we would treat patients like you and not like the ones I am talking about.
 
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I'm not open to it as you have many of the same anxiety symptoms that mimic ADHD. Plus who knows how sleep deprived you are.
I shouldn't have added my personal anecdote. I'm someone who tends to go on. But since you mentioned my case and my anxiety symptoms, my psychiatrist's take, which I think is a good one, is that I can't know exactly what I have while I am on the benzodiazepines and that benzodiazepine dependence and OCD are my primary diagnoses. I should have probably also clarified that I wasn't trying to build a case for myself for future treatment. For one thing to do so here would make no sense. For another, if I ever get off benzos I'm not going to play around with more controlled substances. I'm more interested in figuring out what may have actually been going on with me. There was a single week that my psychiatrist in high school took me off of the benzos and put me on a trial of Adderall. According to him, it was the only way to know if you have ADHD. I hadn't been on the benzos long enough to have bad withdrawal, and I actually functioned very well that week I was on them but I was anxious in a different way. I wasn't "panicky" and could sit through classes which was unusual for me, but I was shaky, speedy. And then one afternoon after school I went into my backyard and just sat in the sun for no reason other than it seemed so nice out, and I told the psychiatrist it almost seemed euphoric. And he said, "No, no one with ADHD feels euphoric on Adderall." And so he put me back on Ativan. Looking back on it I think euphoric was the wrong word. But it was certainly out of the ordinary for me, which is what I was trying to express.

Can't argue with that.

I might even be open to “late childhood” presentations, but this will never convince me of the validity of all the collage aged patients who recently had an epiphany that they have been suffering from an acute stimulant deficiency all of their lives. Even without a fully worked out etiology or a lock solid definition, I think we can usually see a pile of you know what when we see it. How many illnesses can you name where patients get angry at you when you tell them they don’t have that illness?
I added my own editorial by saying maybe this applies to college students, but the study I reference was about later childhood.

Late onset ADHD? Baulderdash. Change the acronym to something like BPD and then I think you might be onto something.
I don't think I see the overlap of symptoms in those two disorders--they seem pretty far apart.
 
regardless of what is real and what is right(or whatever term you want to use), the reality is that if you're running an outpatient medmgt focused practice and not in certain settings(VA, cmhc, academics to some degree) you are going to see(and probably treat) a lot of 'adult ADHD'.
Interestingly, I do in fact see many adult veterans who have ADHD. Since most are from lower income families, they didn't have access to much healthcare until they enlisted in the military. They have a well documented history of poor performance and behavioral problems in school since age 4 on investigation and squeaked by with a GED or high school diploma, and then performed about the same in the military and later jobs. I diagnose them, prescribe a stimulant as appropriate, and boom! Soon they get promoted at work, are easier to get along with at home and get in less trouble.

In my opinion, those without childhood access to healthcare are under diagnosed a lot, and wealthier children whose parents have high academic expectations and better insurance are often diagnosed with ADHD too often. I also usually find out that there is some evidence of downward drift in these lower income adults I diagnose with ADHD. Sometimes these veteran's parents also have ADHD, but are now over 65 and suffered undiagnosed their whole lives. Academic and occupational success eluded these veterans parents, and they passed the ADHD to their offspring.

I think if I hadn't done a fellowship in Child and Adolescent Psychiatry and treated so much ADHD I would have missed diagnosing many veterans with ADHD now.

I am always skeptical when I see an adult who claims he or she has ADHD, but sometimes it is there.
 
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ADHD is the most over and the most under diagnosed disease in psychiatry. If our standard becomes "everyone should try a stimulant, and if they do better, they should stay on it", then everyone will be on stimulants.
 
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Interestingly, I do in fact see many adult veterans who have ADHD. Since most are from lower income families, they didn't have access to much healthcare until they enlisted in the military. They have a well documented history of poor performance and behavioral problems in school since age 4 on investigation and squeaked by with a GED or high school diploma, and then performed about the same in the military and later jobs. I diagnose them, prescribe a stimulant as appropriate, and boom! Soon they get promoted at work, are easier to get along with at home and get in less trouble.

In my opinion, those without childhood access to healthcare are under diagnosed a lot, and wealthier children whose parents have high academic expectations and better insurance are often diagnosed with ADHD too often. I also usually find out that there is some evidence of downward drift in these lower income adults I diagnose with ADHD. Sometimes these veteran's parents also have ADHD, but are now over 65 and suffered undiagnosed their whole lives. Academic and occupational success eluded these veterans parents, and they passed the ADHD to their offspring.

I think if I hadn't done a fellowship in Child and Adolescent Psychiatry and treated so much ADHD I would have missed diagnosing many veterans with ADHD now.

I am always skeptical when I see an adult who claims he or she has ADHD, but sometimes it is there.

Agreed; I certainly don't automatically dismiss an adult w/o prior diagnosis of ADHD who's reporting current problems, since (as you've said) there's any number of explanations as to why they might not have been assessed/diagnosed/treated previously. I was just talking with a psychiatrist colleague the other day as to why I wonder if the prevalence of ADHD might not actually be higher in veterans than the general public, for many of the reasons you've listed.

But if the person comes in having functioned well up to that point, and is just now starting to have symptoms and/or problems, I'm more skeptical.
 
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I don't think I see the overlap of symptoms in those two disorders--they seem pretty far apart.

I meant patients with BPD would be likely to jump all over a potential diagnosis like 'Late/Adult Onset ADHD' -- insta!excuse for their behaviour. They can blame their emotional disregulation on their 'adult onset ADHD', project all of their negative behaviours onto a diagnosis that they think can be fixed with a pill, and so on. Why do the hard yards that recovering from BPD requires when you can just pop some medication because it's your late onset ADHD playing up instead (speed and a benzo thanks, Doc).
 
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Interestingly, I do in fact see many adult veterans who have ADHD. Since most are from lower income families, they didn't have access to much healthcare until they enlisted in the military. They have a well documented history of poor performance and behavioral problems in school since age 4 on investigation and squeaked by with a GED or high school diploma, and then performed about the same in the military and later jobs. I diagnose them, prescribe a stimulant as appropriate, and boom! Soon they get promoted at work, are easier to get along with at home and get in less trouble.

In my opinion, those without childhood access to healthcare are under diagnosed a lot, and wealthier children whose parents have high academic expectations and better insurance are often diagnosed with ADHD too often. I also usually find out that there is some evidence of downward drift in these lower income adults I diagnose with ADHD. Sometimes these veteran's parents also have ADHD, but are now over 65 and suffered undiagnosed their whole lives. Academic and occupational success eluded these veterans parents, and they passed the ADHD to their offspring.

I think if I hadn't done a fellowship in Child and Adolescent Psychiatry and treated so much ADHD I would have missed diagnosing many veterans with ADHD now.

I am always skeptical when I see an adult who claims he or she has ADHD, but sometimes it is there.

Same here. I see several active duty Soldiers a week with undiagnosed ADHD, including one today. Some have it but say their recruiters told them to get off meds so they could enlist.
 
I couldn't find the journal article, but there was one that came out today that said there is a type of neurodevelopmental disorder that has profound ADHD symptoms that emerge in later childhood:

http://www.webmd.com/add-adhd/news/...ar-in-young-adulthood-for-some-study-suggests

I think this is interesting and might also paint differently the population of college students who are sometimes viewed suspiciously when presenting with ADHD symptoms.

I still have a pet theory that I was misdiagnosed with panic disorder instead of ADHD (granted, I had background anxiety and OCD in particular from a very young age—but I wasn't nonfunctional until a very specific turning point). I think I could compensate for potential ADHD with a moderately high level of intelligence until I started college courses in 9th grade. Panic attacks don't come on and end with a particularly difficult class on a daily basis like clockwork. I think it was the higher and more complicated level of stimulus I was required to take in that led to me just . . . flailing and not being able to function.

As I'm sure you know, ADHD is often accompanied by comorbidity. Anxiety is common among ADHD folks. To find yourself one afternoon basking in the sunlight and feeling great is healthy and good.

You can come off benzos. A good physician who works in the field of D and A should be a big help with that. There are meds to ease the challenge so that it isn't a brutal process. The Caron Foundation in Pennsylvania is a world renown recovery hospital and complex dedicated 24/7 to helping those with the type of dilemma you describe.

Indeed, superior intelligence can cushion the blow of ADHD, making it more manageable. Severity of the disorder is another factor. Dr. Ned Hallowell's book Driven To Distraction is excellent. He has an uncanny knack for taking complex material and simplifying it eloquently. Remember, too, that the Inattentive Type of ADHD is often missed by diagnosticians. Regardless when or how or why it is acquired, 80% of those who have it find significant improvement from the meds used to treat it.

A little known "symptom" among quite a few that signify the presence of this disorder is an unexplained, deep, painful hole in the center of our lives that refuses to quit. Want one more? People with ADHD can spot a hurting person in a crowd instantly. Our genuine bigheartedness goes hand in hand. So that's two more
 
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As I'm sure you know, ADHD is often accompanied by comorbidity. Anxiety is common among ADHD folks. To find yourself one afternoon basking in the sunlight and feeling great is healthy and good.

You can come off benzos. A good physician who works in the field of D and A should be a big help with that. There are meds to ease the challenge so that it isn't a brutal process. The Caron Foundation in Pennsylvania is a world renown recovery hospital and complex dedicated 24/7 to helping those with the type of dilemma you describe.

Indeed, superior intelligence can cushion the blow of ADHD, making it more manageable. Severity of the disorder is another factor. Dr. Ned Hallowell's book Driven To Distraction is excellent. He has an uncanny knack for taking complex material and simplifying it eloquently. Remember, too, that the Inattentive Type of ADHD is often missed by diagnosticians. Regardless when or how or why it is acquired, 80% of those who have it find significant improvement from the meds used to treat it.

A little know "symptom" among quite a few that signify the presence of this disorder is an unexplained, deep, painful hole in the center of our lives that refuses to quit. Want one more? People with ADHD can spot a hurting person in a crowd instantly. Our genuine bigheartedness goes hand in hand. So that's two more

Is this from the book?
 
Is this from the book?

Good Golly Man, is that your tiger? Beautiful animal. Big, powerful, graceful, with deep orange, black and white fur.

Yes and from personal experience. We don't "screen" out information like regular people. We see/sense everything at once. Typical facades and defenses people use don't hide pain from us. Having been humiliated and damaged repeatedly throughout our lives sensitizes us to the hurt others feel.

Hallowell is a genius. He has a better understanding of ADHD and the adults who have it than anyone else, at least among those with whom I'm familiar. He has it and dyslexia, too. Yet, he graduated from Harvard.
 
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ADHD is the most over and the most under diagnosed disease in psychiatry. If our standard becomes "everyone should try a stimulant, and if they do better, they should stay on it", then everyone will be on stimulants.
Which is the biggest problem, since the vast majority of people (ADHD or not) respond well to stimulants.
 
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I meant patients with BPD would be likely to jump all over a potential diagnosis like 'Late/Adult Onset ADHD' -- insta!excuse for their behaviour. They can blame their emotional disregulation on their 'adult onset ADHD', project all of their negative behaviours onto a diagnosis that they think can be fixed with a pill, and so on. Why do the hard yards that recovering from BPD requires when you can just pop some medication because it's your late onset ADHD playing up instead (speed and a benzo thanks, Doc).
Yup. Already seeing this.. It seems that the really bad Biploar is becoming replaced by the really bad ADHD.
 
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"If our standard becomes 'everyone should try a stimulant, and if they do better, they should stay on it', then everyone will be on stimulants."
"Which is the biggest problem, since the vast majority of people (ADHD or not) respond well to stimulants."

The standard for making a diagnosis isn't a function of or a measure from doing fine to doing better, in my opinion. Someone seeking medical help needs to be experiencing a severe degree of pathology to justify an evaluation in the first place. ADHD is disabling. It causes harm. It is injurious and it hurts.

No one focuses his/her attention perfectly all the time and most people can concentrate at least some of the time. There's a continuum. ADHD is not the inability to focus at all, or ever. Which is one of the damning aspects of the disorder, making it tricky, to say the least, to diagnose it and even just trying to establish it as a real defect. It is the unusual, consistent inconsistency to concentrate which is the problem. The tuning out of conversations, of lectures, of greeting people, of doing a math problem, of spelling, of organizing anything, of planning ahead. It is this constant interference, regardless of external stimulation or emotional, psychological or other physical problems, that disrupts a person's capacity to manage his life successfully, without severe strain. If it takes vast amounts of energy to try to compensate for these constant circuit breaks, then that is ADHD in essence.
 
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Do you mean because it is the perfect bread and butter set up for our business, or because it is a frequent chief complaint?

both. It's a very frequent chief complaint in adults and it also happens to conveniently jive(or is it jibe....**** I never know?) with a workable business plan for an outpt insurance based psychiatrist. 'quick and easy'(who are usually satisified to boot) patients are the most profitable ones in this model.
 
Yup. Already seeing this.. It seems that the really bad Biploar is becoming replaced by the really bad ADHD.

Yes, and as I'm sure you know BPD and ADHD can be co-morbid, but it does seem that a diagnosis of BPD automatically brings suspicion with it if the patient also endorses a co-morbid diagnosis such as ADHD. So how much harder is it going to be for patients with a legitimate co-morbidity of both diagnoses to get proper treatment if they're going to bring in something like 'Adult Onset ADHD'. At least with a traditional (for want of a better word) diagnosis of ADHD you can usually back it up with prior medical records, recall of family members, and so on. You'd have none of that with 'Adult Onset ADHD' except for the patient's word.
 
when you are looking directly at someone, say your boss, as she's giving you instructions about how to do a project, and you nod your head appropriately indicating you've got it, and you ask relevant questions about the subject, and walk away with her convinced you've heard and understood everything she's explained, and you have no idea what you're supposed to do, and that phenomenon occurs over and over at work, at home, in school, on the athletic field, embarrassment and humiliation dig into you like a steak knife, killing you, destroying everything about you. that is attention deficit disorder.
 
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when you are looking directly at someone, say your boss, as she's giving you instructions about how to do a project, and you nod your head appropriately indicating you've got it, and you ask relevant questions about the subject, and walk away with her convinced you've heard and understood everything she's explained, and you have no idea what you're supposed to do, and that phenomenon occurs over and over at work, at home, in school, on the athletic field, embarrassment and humiliation dig into you like a steak knife, killing you, destroying everything about you. that is attention deficit disorder.

I'm actually diagnosed with ADD (formerly ADHD as a child) myself, so I can relate to pretty much everything you're saying. I was actually a bit of a rare case back in the 70s, because my symptoms were severe enough to lead to a diagnosis at a much earlier than usual age (I was first diagnosed around age 2-3). Of course back then it was assumed that it was one of those things you would grow out of eventually, and whilst the hyperactivity portion did reduce significantly for me, the attentional factors didn't. I too remember that deep well of shame, and guilt, and frustration, and self directed anger, because it seemed like no matter how hard I tried to be good (follow directions, keep my room tidy, not be disruptive in class, and so on) I'd always eventually end up stuffing things up and I couldn't understand why. I knew I had a diagnosis of what I believe back then they called 'hyperactivity disorder', and I'd overheard my Mum talking about it to friends and family, but no-one ever really sat me down and said 'this is what is wrong, and this is how we're going to help you'. Treatment back then consisted of a combination of cutting out certain food and drink items, such as red cordial, and behavioural modification techniques -- which, as I've mentioned on here before, could have worked quite well had they been properly applied, except the diagnostic clinician and staff at the (now defunct) clinic I attended forgot to actually check whether my parents were even capable of following such a program (which they weren't).

So yes my former symptoms of BPD (when I still met full diagnostic criteria) have always been very distinct from my symptoms of ADD/ADHD.
 
when you are looking directly at someone, say your boss, as she's giving you instructions about how to do a project, and you nod your head appropriately indicating you've got it, and you ask relevant questions about the subject, and walk away with her convinced you've heard and understood everything she's explained, and you have no idea what you're supposed to do, and that phenomenon occurs over and over at work, at home, in school, on the athletic field, embarrassment and humiliation dig into you like a steak knife, killing you, destroying everything about you. that is attention deficit disorder.

Take notes. Keep a spread sheet.
 

that assumes being able to concentrate sufficiently to hear the material presented without gaps, remember to write down the key points, and organize them in a fashion that can be understood, iow, exactly those things that cripple us.
 
that assumes being able to concentrate sufficiently to hear the material presented without gaps, remember to write down the key points, and organize them in a fashion that can be understood, iow, exactly those things that cripple us.
Did you just reply to yourself after 3 months?
 
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I re-read some of this thread, this is the same anti-ADHD tx troll from before.

Sigh.

Wait, wasn't he the one who thought medication was a bonadfide miracle and wanted to organise some sort of rallying in the streets type deal for ADHD patients? (because apparently being diagnosed with ADHD makes you some sort of fantastical ninja mind warrior, or some ****, - hey check me out, I have a diagnosis, I must be totes awesome. :rolleyes:)

Or am I thinking of someone else? *sigh* So many trolls, so little time. :whistle:
 
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