Study raising questions about diagnostic validity of ADHD in adults

[cara susanna]

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Thought this was very interesting

https://humanities.ku.dk/news/2025/researchers-find-serious-flaws-in-trials-with-adult-adhd-patients/

 

[Fan_of_Meehl]

Thought this was very interesting

https://humanities.ku.dk/news/2025/researchers-find-serious-flaws-in-trials-with-adult-adhd-patients/

The whole field is a mess right now, in my opinion. A central problem is the ubiquitous use of the term/concept of 'diagnosis' in mental health rather than more accurate terms like "syndrome," "cluster of self-reported symptoms," or "working hypothesis."

If you think that the research database on "Adult ADHD" is flawed, just think about how flawed the 'PTSD' database is right now and will be for years to come. If you work in the VA...you know (or should know). Same with 'mTBI.'

 

[cara susanna]

As someone who's done a lot of adult ADHD assessment, I've found it's nearly impossible to rule out ADHD unless it's glaringly obvious that criteria aren't met (pretty hard to find, at least in the VA setting) or accounted for by another disorder (also hard to find, because the presence of depression, anxiety, etc doesn't necessarily exclude ADHD). Then you add onto the fact that cognitive testing is basically useless, and it's also quite difficult to obtain childhood collateral--and even if you can, you can't be sure how accurate it is since it's retrospective and often decades later.

 

[Fan_of_Meehl]

The philosophy of science (proper) might have a comment on that type of situation:
"Verificationism, also known as the verification principle or the verifiability criterion of meaning, is a doctrine in philosophy which asserts that a statement is meaningful only if it is either empirically verifiable or a tautology."
Edit: Stated differently, for a statement (or differential diagnostic question) to be scientifically meaningful then it has to be possible to state the exact circumstances under which (in the form of observational consequences/ data) it would be shown to be 'true' or 'false.' It has to make a difference in the observable world whether it is 'true' or 'false.' If this isn't the case, then it can't even be said to be a scientifically meaningful statement.

 

[cara susanna]

Yeah, I'm sure there are people I've diagnosed with it who don't have it, but I'm not one of those psychologists who can be like "They had childhood trauma! It can't be ADHD!" because that just isn't true. Usually I end up saying that I can't rule ADHD in or out. You can imagine how psychiatrists LOVE that, haha

 

[oliversacks4thewin]

Thank you for posting this. I only had a chance to read the comment article but want to go back and peruse the actual journal article more. It's tricky business for sure. I work in peds, so I feel like the DSM-5-TR is better written for the diagnostic criteria and I still struggle to feel confident on the diagnosis! The research remains so unclear on this (but to be fair, we have been universally experiencing multiple study replication problems in psychology as a whole) and the outcome makes it so much harder, because the neuroscience tracks that everyone should demonstrate an attentional bump with application of stimulant medications. But this comes at a cost of other neuro/psych adverse events, we have to carefully consider. I always feel like I am emphasizing "correct diagnosis" because I worry about those cost-benefit analyses, while others are simply looking at symptom reduction. That is why on the psychiatry board, regarding this similar discussion, I emphasized "presence of dysfunction" from the syndrome.

I tell the patients and families I interact with, that most psychiatric diagnoses are quite tricky to make (take that pop psychology!), and I remain jealous of my other colleagues in other departments because we have invented solid tools for discerning what the heart, lungs, [insert specialty area specific organ here], etc., are doing. At the end of the day, I have words/questions as my stethoscope and I am attempting to understand the complex nature of the specific experiences and associated dysfunctions of the person sitting in front of me. If you have ever tried to ask a 5-year-old to explain what they worry about, and how they experience worry, you can quickly recognize the difficulty in this, lol. Having said that, I still firmly believe we (psych) are the best at interrupting these "outputs" similar to how an expert cardiologist, neurologist, etc., interpret the results of their tools and assessments, and make specific treatment recommendations, because we have seen the number of cases to match the framework we know about this. It's one of the big reasons I opted to pursue RxP, as I felt like so many of my patients were falling victim to the generalist attempting to manage complex conditions (in my opinion), with limited insight, but a motivated heart towards helping.

Always happy to share my perspective from the peds side of the fence and always interested to hear more about how this transpires in the adult arenas too!

 

[WisNeuro]

Thank you for posting this. I only had a chance to read the comment article but want to go back and peruse the actual journal article more. It's tricky business for sure. I work in peds, so I feel like the DSM-5-TR is better written for the diagnostic criteria and I still struggle to feel confident on the diagnosis! The research remains so unclear on this (but to be fair, we have been universally experiencing multiple study replication problems in psychology science as a whole) and the outcome makes it so

ftfy

 

[PsyDr]

"We also concluded that
1) productivity has quadrupled, while cognitive abilities have not.
2) calorie count of meals has quadrupled.
3) People like medications that make them work harder and get skinny.
4) Maybe having a normal FSIQ is incompatible with tasks that demand higher FSIQs.
5) Maybe the above conditions are different than the neurodevelopmental disorder of ADHD "

Oh wait, no one said that. Because we don't like to address the idea that there is a cognitive hierarchy in society.

 

[cara susanna]

"We also concluded that
1) productivity has quadrupled, while cognitive abilities have not.
2) calorie count of meals has quadrupled.
3) People like medications that make them work harder and get skinny.
4) Maybe having a normal FSIQ is incompatible with tasks that demand higher FSIQs.
5) Maybe the above conditions are different than the neurodevelopmental disorder of ADHD "

Oh wait, no one said that. Because we don't like to address the idea that there is a cognitive hierarchy in society.

That and we aren't exactly built to sit at desks and focus on cognitive tasks for 8 hrs.

 

[AcronymAllergy]

Job security proposal--have all children/adolescents participate in ADHD screening while in school. It's probably the only really reliable way to track the diagnosis.

 

[Sanman]

Yeah, I'm sure there are people I've diagnosed with it who don't have it, but I'm not one of those psychologists who can be like "They had childhood trauma! It can't be ADHD!" because that just isn't true. Usually I end up saying that I can't rule ADHD in or out. You can imagine how psychiatrists LOVE that, haha

While have not done an adult adhd assessment since private practice, I cannot recall a single person that sat in front of me for an eval with proper sleep habits and limited caffeine intake. Most had at least mild anxiety.

It's a lot easier to down stimulants than get proper sleep or manage other conditions. Taking stimulants also leads to societal rewards (just like VA disability) Shockingly,this makes it popular and full of fraud.

 

[Sanman]

Job security proposal--have all children/adolescents participate in ADHD screening while in school. It's probably the only really reliable way to track the diagnosis.

More reliable anyway. No chance that school systems will not shortcut that dx and try to appease teachers.

 

[R. Matey]

It's a pretty important caveat that the RCTs reviewed included scientific, rather than strictly clinical definitions of ADHD. Having worked directly with and published on these types of datasets for multiple years, I can tell you with absolute certainty that those are very much not the same thing. Scientific definitions are more fast and loose because many studies don't have the resources to do a state-of-the-art ADHD evaluation, which can be tricky, time consuming etc. Similar to how, say, measures in scientific articles can have a greater degree of measurement error (i.e., lower reliability coefficients) than those used in clinical practice (ideally) or how RCTs for depression are reliant on the HAM-D. So these results are unsurprising to me.

There was an article in NYT awhile back about differing definitions of ADHD in science vs. clinical practice that was blasted by prominent ADHD researchers (including Barkley; he put out hours worth of video doing a take down of the article) for being overly sensational about the validity concerns with the diagnosis. I personally didn't find the article that horrible because there are a lot of unanswered questions about the diagnosis. For instance, it's highly correlated with many developmental problems, highly comorbid with many psychiatric problems, highly heterogeneous, can drastically fluctuate over time, and something like three symptoms are common in the population. I do believe that ADHD exists independent of our current culture, but like many phenomena in psychological science, it's very poorly measured.

 

[oliversacks4thewin]

It's a pretty important caveat that the RCTs reviewed included scientific, rather than strictly clinical definitions of ADHD. Having worked directly with and published on these types of datasets for multiple years, I can tell you with absolute certainty that those are very much not the same thing. Scientific definitions are more fast and loose because many studies don't have the resources to do a state-of-the-art ADHD evaluation, which can be tricky, time consuming etc. Similar to how, say, measures in scientific articles can have a greater degree of measurement error (i.e., lower reliability coefficients) than those used in clinical practice (ideally) or how RCTs for depression are reliant on the HAM-D. So these results are unsurprising to me.

There was an article in NYT awhile back about differing definitions of ADHD in science vs. clinical practice that was blasted by prominent ADHD researchers (including Barkley; he put out hours worth of video doing a take down of the article) for being overly sensational about the validity concerns with the diagnosis. I personally didn't find the article that horrible because there are a lot of unanswered questions about the diagnosis. For instance, it's highly correlated with many developmental problems, highly comorbid with many psychiatric problems, highly heterogeneous, can drastically fluctuate over time, and something like three symptoms are common in the population. I do believe that ADHD exists independent of our current culture, but like many phenomena in psychological science, it's very poorly measured.

I think back to the recent upheaval with pain management practices in the medical community. Pain is really difficult to objectively measure, with gold standards being well below what any of us would consider to be "scientifically rigorous" and based predominately on self-report. I'm looking at you Faces Pain Scale-Revised. The entire medical world was thrown into tizzy because pain medications were a flowing and they have quite a bit of really negative impacts, along with positive efficacy when appropriately prescribed. Unfortunately, the consensus on when to prescribe was also nebulous, similar to ADHD, and we had the ensuing fallout from adjustment to practice. Part of me has consistently wondered if ADHD diagnosis and management is poised to go down the same pipeline...

 

[futureapppsy2]

Another issue in ADHD diagnosis is that pretty much everyone “feels better” on stimulants, so medication response isn’t a good way of checking diagnostic accuracy, either.

 

[Therapist4Chnge]

Another issue in ADHD diagnosis is that pretty much everyone “feels better” on stimulants, so medication response isn’t a good way of checking diagnostic accuracy, either.

100%. Soooooo many prescribers use, "but they said they helped!" as verification of the diagnosis, completely ignoring that stimulants (much like benzos) are VERY good at what they do. People also like to abuse both benzos and stimulants bc they both work so well.

 

[tr]

100%. Soooooo many prescribers patients use, "but they said they helped!" as verification of the diagnosis, completely ignoring that stimulants (much like benzos) are VERY good at what they do. People also like to abuse both benzos and stimulants bc they both work so well.

FTFY 🙂

 

[WisNeuro]

FTFY 🙂

🙂 honestly, though, I see it documented many times in notes that a diagnosis of ADHD was "confirmed" because the patient reported improvements. From physicians and midlevel prescribers alike.

 

[Fan_of_Meehl]

It's a pretty important caveat that the RCTs reviewed included scientific, rather than strictly clinical definitions of ADHD. Having worked directly with and published on these types of datasets for multiple years, I can tell you with absolute certainty that those are very much not the same thing. Scientific definitions are more fast and loose because many studies don't have the resources to do a state-of-the-art ADHD evaluation, which can be tricky, time consuming etc. Similar to how, say, measures in scientific articles can have a greater degree of measurement error (i.e., lower reliability coefficients) than those used in clinical practice (ideally) or how RCTs for depression are reliant on the HAM-D. So these results are unsurprising to me.

There was an article in NYT awhile back about differing definitions of ADHD in science vs. clinical practice that was blasted by prominent ADHD researchers (including Barkley; he put out hours worth of video doing a take down of the article) for being overly sensational about the validity concerns with the diagnosis. I personally didn't find the article that horrible because there are a lot of unanswered questions about the diagnosis. For instance, it's highly correlated with many developmental problems, highly comorbid with many psychiatric problems, highly heterogeneous, can drastically fluctuate over time, and something like three symptoms are common in the population. I do believe that ADHD exists independent of our current culture, but like many phenomena in psychological science, it's very poorly measured.

This is a fantastic point. I cannot tell you how many articles I read the title to that says something like, 'PTSD causes X' or 'PTSD and Y are closely related'...only to hunt down the article and see that 'PTSD' was operationalized as a score above 33 on the PCL-5 or, worse yet, a positive PC-PTSD-5 screen.

 

[Fan_of_Meehl]

🙂 honestly, though, I see it documented many times in notes that a diagnosis of ADHD was "confirmed" because the patient reported improvements. From physicians and midlevel prescribers alike.

Yup. The fallacy of affirming the consequent in action.

'If A, then B. B, therefore A.'

'If someone has ADHD, they will feel better on stimulant medication.' 'The patient feels better on stimulant medication, therefore, they have ADHD.'

 

[aim-agm]

I think back to the recent upheaval with pain management practices in the medical community. Pain is really difficult to objectively measure, with gold standards being well below what any of us would consider to be "scientifically rigorous" and based predominately on self-report. I'm looking at you Faces Pain Scale-Revised. The entire medical world was thrown into tizzy because pain medications were a flowing and they have quite a bit of really negative impacts, along with positive efficacy when appropriately prescribed. Unfortunately, the consensus on when to prescribe was also nebulous, similar to ADHD, and we had the ensuing fallout from adjustment to practice. Part of me has consistently wondered if ADHD diagnosis and management is poised to go down the same pipeline...

Like with pain, the problem with ADHD isn't because it is difficulty to objectively/accurately assess (although that is a critical potentiating factor) but because of what is used to treat it.

We don't have much public controversy over the massive overdiagnosis of MDD, especially the practice of diagnosing based on PHQ-9, because it doesn't matter all that much (relatively speaking) if people mistakenly get put on SSRIs. If pain management was limited to acetaminophen and NSAIDs there wouldn't be nearly as many conversations around it...but we also use opioids for pain, and those cause problems.

Similarly, if all we had for ADHD was atomoxetine, bupropion, and guanfacine these discussions would be limited to academic/clinical circles. Throw the potential for amphetamines (and to a lesser degree methylphenidate) into the mix and it becomes a societal conversation.

 

[cara susanna]

This is a fantastic point. I cannot tell you how many articles I read the title to that says something like, 'PTSD causes X' or 'PTSD and Y are closely related'...only to hunt down the article and see that 'PTSD' was operationalized as a score above 33 on the PCL-5 or, worse yet, a positive PC-PTSD-5 screen.

Yup, that's why it's best practice to use the term "posttraumatic stress symptoms" (PTSS) instead of PTSD

 

[futureapppsy2]

Like with pain, the problem with ADHD isn't because it is difficulty to objectively/accurately assess (although that is a critical potentiating factor) but because of what is used to treat it.

We don't have much public controversy over the massive overdiagnosis of MDD, especially the practice of diagnosing based on PHQ-9, because it doesn't matter all that much (relatively speaking) if people mistakenly get put on SSRIs. If pain management was limited to acetaminophen and NSAIDs there wouldn't be nearly as many conversations around it...but we also use opioids for pain, and those cause problems.

Similarly, if all we had for ADHD was atomoxetine, bupropion, and guanfacine these discussions would be limited to academic/clinical circles. Throw the potential for amphetamines (and to a lesser degree methylphenidate) into the mix and it becomes a societal conversation.

Part of this is also that antidepressants have pretty unpleasant side effect profiles. People are generally not going to take them for funsies without some actual clinical benefit (and often won’t take them even with clinical benefit due to the side effects).

 

[futureapppsy2]

Also, I think there's an element of ADHD and ASD being thought of as "special" or "better" disabilities/diagnoses--so many people call them "super powers" or frame them as things that make them special, and so people want those diagnoses more, because no one's telling you what a great, special brain you have with an MDD or GAD diagnosis. (I'm also increasingly seeing separatism from a lot of people with ADHD and ASD, wherein they want to be disabled for the purposes of receiving accommodations but don't want to be grouped in with other disabled people socially).

 

[cara susanna]

Also, I think there's an element of ADHD and ASD being thought of as "special" or "better" disabilities/diagnoses--so many people call them "super powers" or frame them as things that make them special, and so people want those diagnoses more, because no one's telling you what a great, special brain you have with an MDD or GAD diagnosis. (I'm also increasingly seeing separatism from a lot of people with ADHD and ASD, whereas they want to be disabled for the purposes of receiving accommodations but don't want to be grouped in with other disabled people socially).

Yeah, there's a huge community with ADHD (and ASD) that you don't get with, say, depression.

 

[PsyDr]

Yup, that's why it's best practice to use the term "posttraumatic stress symptoms" (PTSS) instead of PTSD

Do you have a citation for this?

 

[tr]

Part of this is also that antidepressants have pretty unpleasant side effect profiles. People are generally not going to take them for funsies without some actual clinical benefit (and often won’t take them even with clinical benefit due to the side effects).

Stimulants also have unpleasant side effects, like insomnia, agitation, irritability, and constipation.
The main difference is that antidepressants don't trigger dopamine release in the nucleus accumbens, so the potential for abuse isn't there.

 

[cara susanna]

Do you have a citation for this?

My dissertation? Lol

 

[futureapppsy2]

Stimulants also have unpleasant side effects, like insomnia, agitation, irritability, and constipation.
The main difference is that antidepressants don't trigger dopamine release in the nucleus accumbens, so the potential for abuse isn't there.

True, but you also get the high likelihood of a positive effect with stimulants. Correct me if I’m wrong, but a person without a condition that would be treated with antidepressants would be fairly unlikely to have a substantial positive effect from antidepressants.

 

[futureapppsy2]

My dissertation? Lol

Also, this is just general best practice in PTS research, at least in my experience, similar to saying “depressive symptoms” instead of “depression” when you don’t have an actual clinical dx for participants. 🤷‍♀️

 

[R. Matey]

Also, this is just general best practice in PTS research, at least in my experience, similar to saying “depressive symptoms” instead of “depression” when you don’t have an actual clinical dx for participants. 🤷‍♀️

+1

In our papers, we were always careful to say "ADHD symptoms" when we were using severity measures as the outcome.

 

[R. Matey]

Yeah, there's a huge community with ADHD (and ASD) that you don't get with, say, depression.

Yeah, some of the increased interest in ADHD/Autism comes from the neurodivergence movement promoted via social media. I've had folks come in wanting an ADHD evaluation who are more interested in knowing whether they have ADHD out of some desire to belong to the community rather than seek out stimulant treatment.

 

[PsyDr]

My dissertation? Lol

I wasn't trying to be confrontational. I was being literal.

Totally fair though to assume with me though.

 

[WisNeuro]

I wasn't trying to be confrontational. I was being literal.

Totally fair though to assume with me though.

I thought it was a fair question, but we also probably see things differently given the medicolegal work. If I see a statement like that in a report, I also would want to see evidence of a policy or bets practice as stated in the literature.

 

[clausewitz2]

Also, I think there's an element of ADHD and ASD being thought of as "special" or "better" disabilities/diagnoses--so many people call them "super powers" or frame them as things that make them special, and so people want those diagnoses more, because no one's telling you what a great, special brain you have with an MDD or GAD diagnosis. (I'm also increasingly seeing separatism from a lot of people with ADHD and ASD, wherein they want to be disabled for the purposes of receiving accommodations but don't want to be grouped in with other disabled people socially).

Everbody wanna be accommodated, ain't nobody wanna be disabled

 

[clausewitz2]

True, but you also get the high likelihood of a positive effect with stimulants. Correct me if I’m wrong, but a person without a condition that would be treated with antidepressants would be fairly unlikely to have a substantial positive effect from antidepressants.

There might be one exception:

Tianeptine - Wikipedia

en.wikipedia.org

 

[aim-agm]

There might be one exception:

Tianeptine - Wikipedia

en.wikipedia.org

Tianeptine is such an interesting case. On the one hand, it shows that tiny doses of mu-opioid agonist (on the order of 1 MME/day by my back-of-a-napkin math) are quite safe and effective for depression and other symptoms with no dependence or withdrawal. On the other hand, it shows that using an opioid agonist to treat psychiatric conditions is much more practicable when no one on earth knows it is an opioid agonist.

 

[Fan_of_Meehl]

Yup, that's why it's best practice to use the term "posttraumatic stress symptoms" (PTSS) instead of PTSD

And a lot of the symptoms on the PCL-5 are really symptoms of 'emotional/internalizing dysfunction' (not really specific to PTSD but also found in MDD, persistent depressive disorder, GAD, etc.)

 

[tr]

On the other hand, it shows that using an opioid agonist to treat psychiatric conditions is much more practicable when no one on earth knows it is an opioid agonist.

Why, it's supposed to be a big secret? Ketamine works this way too

Opioid Receptor Antagonism Attenuates Antidepressant Effects of Ketamine - PMC

In addition to N-methyl D-aspartate receptor antagonism, ketamine produces opioid system activation. The objective of the study was to determine if opioid receptor antagonism prior to administration of intravenous ketamine attenuates its acute ...

pmc.ncbi.nlm.nih.gov

True, but you also get the high likelihood of a positive effect with stimulants. Correct me if I’m wrong, but a person without a condition that would be treated with antidepressants would be fairly unlikely to have a substantial positive effect from antidepressants.

I think we are saying the same thing 🙂

 

[sunlioness]

True, but you also get the high likelihood of a positive effect with stimulants. Correct me if I’m wrong, but a person without a condition that would be treated with antidepressants would be fairly unlikely to have a substantial positive effect from antidepressants.

I would say this is generally true in my clinical experience, with the exception of bupropion. Which is interesting because bupropion, like stimulants, is dopaminergic.

 

[allantois]

I think back to the recent upheaval with pain management practices in the medical community. Pain is really difficult to objectively measure, with gold standards being well below what any of us would consider to be "scientifically rigorous" and based predominately on self-report. I'm looking at you Faces Pain Scale-Revised. The entire medical world was thrown into tizzy because pain medications were a flowing and they have quite a bit of really negative impacts, along with positive efficacy when appropriately prescribed. Unfortunately, the consensus on when to prescribe was also nebulous, similar to ADHD, and we had the ensuing fallout from adjustment to practice. Part of me has consistently wondered if ADHD diagnosis and management is poised to go down the same pipeline...

It's not gonna go down the same pipeline as the drugs aren't going to cause deaths the way opioids do

 

[PsyDr]

Why, it's supposed to be a big secret? Ketamine works this way too

Opioid Receptor Antagonism Attenuates Antidepressant Effects of Ketamine - PMC

In addition to N-methyl D-aspartate receptor antagonism, ketamine produces opioid system activation. The objective of the study was to determine if opioid receptor antagonism prior to administration of intravenous ketamine attenuates its acute ...

pmc.ncbi.nlm.nih.gov

I think we are saying the same thing 🙂

I feel like this is an academic discussion about why substances of abuse feel awesome. Or why an organism evolved to maximize reproduction, consumption of calories, and conservation of resources does behaviors consist with this parameters.

If you guys figure that S out, pretty much every hand surgeon would love to hear from you this weekend.

 

[aim-agm]

I would say this is generally true in my clinical experience, with the exception of bupropion. Which is interesting because bupropion, like stimulants, is dopaminergic.

Bupropion is a stimulant from a pharmacologic standpoint. Bupropion is essentially the same as methylphenidate, just an order of magnitude less potent as a DRI.

 

[oliversacks4thewin]

It's not gonna go down the same pipeline as the drugs aren't going to cause deaths the way opioids do

Not trying to pick a fight or bear any resemblance to fear mongering, but would you therefore consider it weird that the FDA labeling for stimulant medications also includes warnings about the risk of sudden death, stroke, and myocardial infarction, especially in individuals with pre-existing cardiac abnormalities?

I'll also leave this here, if you are so inclined to peruse:

The rise in non-fatal and fatal overdoses involving stimulants with and without opioids in the United States - PubMed

While increases in cocaine-involved deaths in the United States from 2006 seem to be driven by opioids, particularly synthetic opioids, increases in non-fatal and fatal overdoses involving psychostimulants are occurring with and without opioids.

pubmed.ncbi.nlm.nih.gov

 

[cara susanna]

Not trying to pick a fight or bear any resemblance to fear mongering, but would you therefore consider it weird that the FDA labeling for stimulant medications also includes warnings about the risk of sudden death, stroke, and myocardial infarction, especially in individuals with pre-existing cardiac abnormalities?

I'll also leave this here, if you are so inclined to peruse:

The rise in non-fatal and fatal overdoses involving stimulants with and without opioids in the United States - PubMed

While increases in cocaine-involved deaths in the United States from 2006 seem to be driven by opioids, particularly synthetic opioids, increases in non-fatal and fatal overdoses involving psychostimulants are occurring with and without opioids.

pubmed.ncbi.nlm.nih.gov

And a LOT of our adult ADHD referrals are elderly. I actually tell them, just fyi, even if you're diagnosed you aren't likely to get stimulants.

 

[singasongofjoy]

And a LOT of our adult ADHD referrals are elderly. I actually tell them, just fyi, even if you're diagnosed you aren't likely to get stimulants.

are you talking like retirement age? If so, I find that surprising and fascinating- do you have any hypotheses why? The only one I can come up with is a family member e.g., spouse pushing it with client coming in saying "now that I've retired, spouse has to spend so much more time around me and finds me exasperating and is pushing this eval"

but still if we are talking "elderly" it seems the approach would be to look at many other possibilities - and given concerns about medications at the age where once is very likely past hoping for accommodations for school or work I kind of fail to see much utility in referring for ADHD specifically. (although if we dispense with the eye toward any specific diagnoses, I'm all for increased self-insight to use strengths to support weaknesses, but eh, insurance won't cover that)

 

[Sanman]

are you talking like retirement age? If so, I find that surprising and fascinating- do you have any hypotheses why? The only one I can come up with is a family member e.g., spouse pushing it with client coming in saying "now that I've retired, spouse has to spend so much more time around me and finds me exasperating and is pushing this eval"

but still if we are talking "elderly" it seems the approach would be to look at many other possibilities - and given concerns about medications at the age where once is very likely past hoping for accommodations for school or work I kind of fail to see much utility in referring for ADHD specifically. (although if we dispense with the eye toward any specific diagnoses, I'm all for increased self-insight to use strengths to support weaknesses, but eh, insurance won't cover that)

I would be curious about why this is as well from a process prospective. From a clinical prospective, the processing speed decreases we see in aging populations can certainly seem like ADHD to the untrained eye.

 

[aim-agm]

I would be curious as about why this is as well from a process prospective. From a clinical prospective, the processing speed decreases we see in aging populations can certainly seem like ADHD to the untrained eye.

You can also see ADHD "re-emerge" in the population I think - while symptoms may have remitted after childhood as their brain compensated for the executive dysfunction, function in the domain is less resilient (it already has one "hit" from neurodevelopment) so it could be one of the earlier impairments that arise with cognitive decline.

 

[AcronymAllergy]

In my experience, when older adults have presented with concerns for ADHD, it's been one of a few situations: 1) as was mentioned above, and as applies to various forms of psychopathology, a family member has noticed it more (and it's more irritating) now that the person is retired and home more often; 2) the person's always thought they had ADHD but was never evaluated for it and/or it wasn't ever considered in their childhood or adolescence; 3) the person's adult children have been diagnosed, often because the grandchildren have been diagnosed, which then caused said adult children to be evaluated and diagnosed (the accuracy of all those diagnoses notwithstanding).

 

[Therapist4Chnge]

Agree with the above, though I’d add that a (large?) % of people are confusing chronic mood disorder symptoms with ADHD symptoms.

I’ve seen a lot of parents inquiring after going through the process for their kids and recognizing repeating patterns. It gets murky bc presentation and aggregation of symptoms will likely be different for kids v adults.