Children with ADHD may continue to have symptoms even into adulthood.

Children with ADHD may continue to have symptoms even into adulthood.

Lydia Denworth

I know someone who was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) as a child in the 1990s. When he turned 18, his insurance company informed him that it would no longer cover the very expensive drug that gives children with ADHD a chance to succeed in school. The insurance company stated that ADHD is effectively a childhood disorder. What an unfortunate choice: to struggle financially to pay for medicine, or to go to college or a job without receiving helpful treatment.

At the time, the idea that ADHD was limited to children was deeply ingrained. Psychologist Stephen Farawan of Upstate Medical University in Syracuse, New York, said people thought “this is a developmental delay and we just need to catch up.”

However, studies have shown that ADHD often persists into adulthood. Current prevalence estimates are approximately 2.5 to 3 percent in adults and 5 to 6 percent in children. In the 2013 edition, Diagnostic and Statistical Manual of Mental Disorders (DSM-5) It made diagnosing adults easier by noting that adults could have five symptoms instead of the six required for children, and acknowledging that ADHD can change in appearance as we get older. “They don’t climb on furniture or anything like that,” Farawan said. ( DSM-5 The first guidelines for diagnosing and treating ADHD in adults are currently being developed by the American Association of Professionals in ADHD and Related Disorders.

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In adults, this disorder may look quite different than in young people. Adults who suffer from inattention and hyperactivity have difficulty completing long reports at work, sitting through meetings and restaurant meals, paying bills on time, and maintaining romantic relationships. That may be more difficult than average. “We’re probably shedding light on what’s really going on,” says Margaret H. Sibley, a clinical psychologist at the University of Washington School of Medicine who worked on some of the new research. “People in adult mental health settings aren’t even getting tested for that.”

Experts say many people who could benefit from treatment are not receiving it because of a lack of testing. Additionally, for adults, the rate may be higher than the 3% mentioned earlier. A 2021 analysis showed that when based solely on symptoms rather than recorded childhood onset, the incidence in adults ranges from about 9 percent in young adults to more than 4 percent in people over 60.

Some people outgrow this disorder, although perhaps much less often than previously thought. (It’s unclear whether people’s brains become more neurotypical over time or whether they learn to compensate.) American Journal of PsychiatrySibley and her team found that just over 9 percent of people diagnosed as children do not show symptoms as adults. Typically, such people had mild symptoms and strong support from their parents.

A more common scenario is that the severity of symptoms fluctuates. Previous studies have used a single test in adulthood to give a yes/no diagnosis. Sibley’s research, which retested teens and young adults multiple times, found that 60% of those who showed remission later experienced a relapse. “Symptoms seem to wax and wane,” Sibley said. “Environment may play a role in increasing or decreasing the magnitude of someone’s difficulties.” In other words, ADHD symptoms tend to worsen when life is stressful and ease when life becomes calmer. There may be.

Some studies have suggested that ADHD may only develop in adulthood, but more recent studies have shown that it is very unlikely to develop until later in life. I am. In nearly all such cases, Sibley says, it’s likely either a misdiagnosis of another illness, such as drug use or anxiety, or a case of childhood symptoms being missed.

Many parents, and even grandparents, only become aware of their own symptoms when their child is diagnosed. This is especially true for women with the disorder, whose childhood behavior tends to be more inattentive than hyperactive like typical ADHD boys. However, as adults, women are more likely than men to seek mental health treatment. “When you’re a kid and you cause problems for other people, you get mental health treatment,” Faraone said. “When you grow up, you go in because you have a problem.”

Most people diagnosed with ADHD try medication (usually stimulants such as Ritalin), but 40 to 50 percent fail within the first year, said Isabel Brickell, a psychiatric epidemiologist at Sweden’s Karolinska Institute. The drug will be discontinued for at least 180 days. Reasons may include increased independence in adolescents, increased costs, and, in adults, health care providers who are not trained to treat ADHD. Thanks to parental supervision, children are more likely to continue treatment, but a large study across eight countries showed that patient discontinuation rates peak at age 18. ” Brickell said.

Without proper treatment, other health problems may occur. Brickell said several Swedish-led studies have shown that ADHD is associated with diseases that increase with age, including a slightly higher risk of high blood pressure and other cardiovascular diseases. . The disorder is thought to be associated with an increased risk of obesity, drug use, and sleep disorders.

The good news is that as the medical community becomes increasingly aware of the nuances of ADHD in adults, people experiencing difficulties are more likely to receive a professional diagnosis. For adults, the right treatment can be life-changing, Faraone says.

This is an opinion and analysis article and the views expressed by the author are not necessarily those of the author. scientific american.