ADHD Across the Lifespan

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FROM OUR READERS

I respectfully, but most vociferously, disagree with both the tone and conclusions of Mark L. Ruffalo, MSW, DPsa; and S. Nassir Ghaemi, MD, MPH in their article, “The Making of Adult ADHD: The Rapid Rise of a Novel Psychiatric Diagnosis.” I completed a Harvard course on attention-deficit/hyperactivity disorder (ADHD) across the lifespan in 1999 when it was already well known by ADHD researchers and clinicians that ADHD persisted into adulthood. Common sense tells us that a neurodevelopmental disorder does not rapidly disappear after the age of 18. But there is plenty of research and clinical information indicating a continuation of significant ADHD symptoms, with maturation-related modifications, into and often throughout adulthood.

Even the authors allow a 20% continuation with adults, which is an important enough component to be seriously considered, although I believe 50%+/- to be more accurate. Executive functions significantly disrupted by ADHD in adults lead to educational, occupational, relational, and judgment impairments. Career hindrance, job loss, divorce, substance abuse, smoking, impulsive bad choices, accidents, anxiety, and mood disorders are all more prevalent in individuals with untreated ADHD.

Of course, there is diffusion of brain symptoms across a spectrum of diagnoses, requiring a careful search for the primary cause. Anxiety and mood disorders indeed can have similar symptoms to ADHD. But I have had hundreds of patients who have failed on multiple antidepressants/anxiolytics for anxiety and depression rapidly respond to psychostimulants instead, often with tearful gratitude for their symptom remission.

My overriding objection to this article is a fairly obvious disdain for the importance, if not the very existence, of ADHD. An early clue to such was stating that psychostimulants "purportedly" treat ADHD. That class of drugs, when correctly used, gives the most rapid, complete, and reliable response to its targeted diagnosis with a higher success rate than any other class of psychotropics to their relevant targets, in my opinion.

One can argue the percentage of ADHD continuation into adulthood, but that is irrelevant to its need for recognition and treatment. Bias and relative lack of ADHD expertise or treatment experience are possible influences on the negative tone of this article which, to me, exemplifies and even contributes to the more serious fad of ADHD skepticism than the fad proposed therein.

Dr Rhoden is a psychiatrist in Jackson, Mississippi, and owner of Mississippi Attention Clinic.