Study points out flaws in diagnosing ADHD in adults – 09/20/2023 – Health

Adults with attention deficit hyperactivity disorder, ADHD, find it difficult to receive an adequate diagnosis and also follow-up and treatment. The conclusion is from a new study published this Wednesday (20).

As it is a condition with a higher prevalence in children and adolescents (around 5%, compared to 2.5% in adults), many older patients who seek care with typical symptoms of ADHD end up receiving a diagnosis for other mental conditions, such as stress, anxiety and depression, or are not diagnosed at all.

There is also a lack of information about the combined effects of medications normally used to treat ADHD, such as psychostimulants (known by the trade names Ritalin and Vyvanse), and other medications used for chronic diseases, such as diabetes and hypertension, common in adults. Older.

The study was led by researchers Maja Dobrosavljevic and Henrik Larsson, from the Faculty of Medicine and Health at Orebro University, in Orebro (Sweden), and the Karolinska Institute, in Stockholm, and Samuele Cortese, from the department of Adolescent and Child Psychiatry at the University of Southampton, in the United Kingdom. The article was published in the specialized journal Expert Review of Neurotherapeutics.

To evaluate therapeutic guidelines for older adults with ADHD, scientists searched for more than a hundred articles published in the medical journal database PubMed that contained the terms “attention-deficit/hyperactivity disorder” and “older adults” from the beginning. of the database until May 1, 2023.

They then separately analyzed each article found in search of data on diagnosis, prevalence, population tracking, effectiveness and safety of treatments for older adults, in accordance with national and international guidelines for the condition. They found 44 studies with this specific age group.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), of the American Psychiatric Association, and the international classification of diseases (ICD) of the WHO (World Health Organization), ADHD is classified as a neurodevelopmental disorder, characterized by the manifestation persistent inattention and/or hyperactivity, interfering with functioning or development, and there may be a predominance of impulsivity or inattention, with different subtypes.

The diagnosis in adults is given when there are at least six or more signs or symptoms of inattention and/or hyperactivity from the age of 12, still in accordance with international guidelines. The most common symptoms are impulsivity, hyperactivity and difficulty focusing or paying attention to an activity.

According to Swedish research, most patients diagnosed with ADHD during childhood or adolescence are not followed up until an older age, which can hamper the detection of symptoms of the disorder in people between 50 and 55 years old.

Other mental disorders, such as depression, bipolar disorder, dissociative identity disorder, moderate cognitive decline, symptoms associated with menopause in women, and sleep disorders, have clinical manifestations similar to ADHD, and may hinder correct diagnosis.

“Our study concludes that better approaches are needed for screening and diagnosing ADHD in people aged 50 to 55,” says researcher Maja Dobrosavljevic, first author of the study. “As we gain knowledge of the challenges faced by older adults living with ADHD, an adapted and more understanding approach is crucial to patients’ well-being.”

Even more worrying was the finding that only 0.9% of individuals aged 50 or over diagnosed with ADHD are adequately treated for the disorder, less than half of the total number of adults with a prevalence in this age group (0.23%). .

Furthermore, the prolonged use of therapies, which not only involve psychostimulant medications, but also psychotherapy and psychoeducational activities, can affect the manifestation of symptoms over time.

“The data from our research shows how no study to date has followed older individuals for a prolonged period of time. Research has focused, on the other hand, on so-called retrospective assessments according to the manifestations of the disorder in childhood, and this can be affected even by forgetting the signs manifested as a child”, explains Larsson, from the Karolinska Institute.

The scientists conclude with a call for more randomized, placebo-controlled clinical studies to be carried out that also include people aged 50 and over with ADHD, even to evaluate possible cardiovascular risks in this age group due to prolonged use of medications.

In recent years, the number of young adults who use stimulant medications for ADHD has increased, without necessarily having a diagnosis of the disorder. The search for high performance at work and being able to focus on several activities at the same time is one of the explanations for the growth in sales of these medicines.

At the same time, new diagnoses of the disorder in people aged 30 to 40, especially women, have also increased. According to the American CDC (Centers for Disease Control and Prevention), the prevalence of ADHD in boys is higher in childhood than in girls, but more and more young women are presenting the diagnosis in adulthood, often due to a manifestation atypical of the symptom of inattention in them.

Although these new diagnoses are growing, there is not necessarily an increase in the general prevalence of the disease in adulthood, explains Mario Louzã, coordinator of the Adult ADHD Outpatient Clinic at IPq (Institute of Psychiatry) at USP. “What has actually grown is that it has become a more noticeable disease.”

Louzã and colleagues from HC (Hospital das Clínicas) at USP carried out a study with people over 65 years of age with ADHD and saw that the symptoms reported by these patients were the same as those of young people. “Basically, the complaints of elderly people were similar to those of young adults, but as many already have less pressure, fewer work demands, they feel the effects less”, she explains.

According to him, greater knowledge about the neurobiological disorder and awareness about mental health also contribute to the increase in diagnoses. “People are looking for more information, trying to understand the symptoms, and therefore more aware that what they were feeling could be a mental condition.”