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A New Market for ADHD Treatment?

Seems as though everyone was reporting yesterday on a new study published online in Occupational and Environmental Medicine (one of the British Medical Journals). The study found that among 7,075 adult workers ages 18 to 44 from 10 countries, folks who reported symptoms of attention-deficit/hyperactivity disorder (ADHD) worked an average of 22.1 days less in a year than those without ADHD. That's a whole month of missed work.

But none of the accounts I read mentioned that the study was funded by, in addition to the usual government agencies in the U.S. and other countries, a whole raft of pharmaceutical companies, including the makers of some ADHD drugs. In other words, companies that would stand to benefit if more potential users of their medications could be identified. It was my sharp-eyed editor who pointed the funders out to me.

For the record, here's what the study found: Most of the lost time wasn't due to full-blown absenteeism but to reduced productivity while on the job; people reported showing up to work but not getting much done while they were there. Overall, the study found that about 3.5 percent of adult workers (the study didn't include unemployed people) have ADHD; in the U.S., that figure was 4.5 percent, with 28.3 days' lost performance.

If those numbers are good, that adds up to a lot of lost work. But that doesn't mean adult ADHD is to blame.

ADHD is usually associated with kids, and most of what we know about it and its treatment is based on research on children. Its diagnosis in adults is a relatively recent phenomenon; some sources say many -- perhaps half -- of kids with ADHD continue to experience symptoms well into adulthood. But that's conjecture -- and while ADHD may spring readily to mind when evaluating an antsy kid, it isn't necessarily on the radar screen when dealing with a fidgety grownup.

Should it be?

The article suggests that businesses might want to start screening employees for ADHD and offering treatment to help them cope with the disorder, which typically is marked by such symptoms as difficulty maintaining focus and attention, being easily distracted, and impulsive behavior. ADHD is often treated with stimulants, but antidepressants may help, too, and cognitive/behavioral therapy and psychotherapy are sometimes used in addition to medications.

But adult ADHD isn't universally recognized in the medical community as a genuine disorder; even the childhood version has long met with its share of controversy. Some argue that fidgety people might just be fidgety and don't need to be given drugs. In adults, the American Academy of Family Physicians points out that ADHD almost always occurs together with other conditions such as substance abuse or hyperthyroidism, whose symptoms can look maddeningly similar.

So, is adult ADHD real, or is it just an excuse for drug companies to sell more meds? And is the current study an attempt to broaden the market?

By Jennifer LaRue Huget  |  May 28, 2008; 7:00 AM ET
Categories:  Psychology  
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Comments

Jennfier said: "So, is adult ADHD real, or is it just an excuse for drug companies to sell more meds?"

Of course the third option is that both are true. None of the choices you give rule out any of the others, and it's quite possible that it is real, that the drug companies are monetizing the condition by convincing people that it must be treated with drugs, and, that there are other ways to "treat" it aside from meds.

Posted by: Steve | May 27, 2008 4:20 PM | Report abuse

The possibility that ADHD continues into adulthood was first investigated (by psychiatrists at UCLA) in the 1970s, so the idea is not that recent. For what it may be worth: I'm a high-functioning adult diagnosed with ADHD. It seems quite real to me, and those who know me agree, but of course this could be an illusion. Listen to the voices of ADHD patients that the NY Times put on its website a few days ago; they echo my perceptions.
I've been on stimulants and on the chief alternative (Strattera), both singly and in combination. They help just a little.
The main finding of this report -- that ADHD workers, all else being equal, are much less productive -- seems manifestly obvious. What I fear is that employers will now use this information in hiring and promotion decisions. Why wouldn't they?

Posted by: Tom | May 28, 2008 8:11 AM | Report abuse

ADHD is real, pharma corps will rush in to the breach to supply meds to slate the American thirst for a panacea. Kids do not have the maturity to recognize responsibility and the need for focus and performance, so the meds: Johnny and Suzie's little helper, have become socially acceptable. Mature adults on the other hand cannot allow this condition to absolve themselves of responsibilty, use the condition as an excuse for acting like a child, or even suggest the this disorder is a disbility. Some kids need help "growing up," apparently some adults use this condition as an excuse not to.

Posted by: Ben | May 28, 2008 8:18 AM | Report abuse

ADHD is more than just antsy. It's about focus. In adults, like my husband, he can focus for hours (hyperfocus) on something that interests him, but not be able to remember to feed the dog. For days (which is why I do it). Medication is helpful and there are a lot more choices than when he was a kid (just ritalin). It has some side effects - he's lost 20 lbs since December, because he "forgets" to eat. When he doesn't take the meds, he eats like a college kid. Besides medication, lifestyle changes are necessary. I handle the bills and money. He has checklists of what needs to be done. It may sound like I'm treating him like a child, but he knows he needs it. There are also different organizing websites targeted to ADHD (and a whole industry to sell you that stuff too).

ADHD doesn't just go away. Yes, it's overdiagnosed. Yes, some parents medicate their kids because they can't handle them. But when you live with someone (adult or kid) with ADHD you know it's real.

Posted by: Wife of ADHD | May 28, 2008 8:30 AM | Report abuse

I totally agree with Wife of ADHD. My husband was diagnosed when our son (then 3) was diagnosed. At a family reunion, we found that *most* of his family had symptoms or out and out ADHD. This is not some misdiagnosis, or fad. It is a real, life affecting state of being. And inheritable. I get so angry as those who just dismiss ADHD as bad parenting, lack of discipline or other 'moral judgement'. Would you tell the diabetic that they are just weak and don't need insulin? The chronic depressive that they don't need their medication? How is this any different?

Posted by: Wife and Mother of ADHD | May 28, 2008 9:10 AM | Report abuse

Adult ADHD is definitely real. As part of my Masters thesis I did a literature review of adult ADHD and the overwhelming consensus is that it is very real; in general, the hyperactivity symptoms subside, but the inattentive symptoms persist, lack of focus, difficulty with organization, initiative and persistence.
What we need to have now is a good research study that shows that treatment for adult ADHD results in fewer missed work days and/or more productive performance at work.

Posted by: Susan | May 28, 2008 9:24 AM | Report abuse

Ben, I sure wished you had paid more attention to grammar and spelling in your post. If so, I'd be better able to pay attention to your point. Well, I'm off to get taller now, because studies show that taller people are more successful than shorter people. "But that's a ridiculous analogy," you say. "Height is genetic, there's nothing you can do about it." Exactly.

Posted by: Rich | May 28, 2008 9:29 AM | Report abuse

I have the same concern as poster "Tom." My son, age 10, has diagnosed ADHD - not hyperactive but inattentive - and impulsive. I wonder, when he is older and applies for jobs, will he a) be required to disclose his ADHD, and b) be discriminated against because of it? Does anyone know whether this is covered under the Americans with Disabilities Act?

I would like to believe that there are careers in which he could flourish because of, rather than in spite of, his ADHD.

btw, although I have heard that some kids eventually "outgrow" their ADHD symptoms, I think a lot of it has to do with maturity and learning coping skills (like lists, etc). My son, however, will probably not outgrow his, because they are in all probability an outgrowth of another neurological problem that he has (hemiparesis - related to cerebral palsy, but milder).

I do worry about him as he gets older - and hope he can find an understanding partner like "Wife of ADHD."

Posted by: just me | May 28, 2008 9:44 AM | Report abuse

Great comments so far, folks! Thanks for sharing your experiences and insights.

Posted by: Jennifer Huget | May 28, 2008 9:54 AM | Report abuse

From my informal assessment of adult ADHD, those who are successful have found their passion. That activity that they hyperfocus on and therefore succeed in the working world. We have a school principal, computer programmer/analyst and dentist. All of these are problem solving occupations. It seems to be the thrill of the hunt - finding that coding error, herding children towards adulthood (sort of like cats), the medical mystery. A regular accountant might not work, but a forensic accountant might be just the ticket. And teh H part does seem to lessen, but usually because they have found a way to sublimate it - both my guys now have a serious bouncing the leg under the table habit. Not as distracting and gives them an outlet. And my son (now almost 22) will be starting his last year of college. I agree that finding the right partner is key, and I forsee several heart-to-hearts with his prospective bride.

Posted by: Wife and Mother of ADHD | May 28, 2008 9:56 AM | Report abuse

ADHD is real, pharma corps will rush in to the breach to supply meds to slake the American thirst for a panacea. Kids do not have the maturity to recognize responsibility and the need for focus and performance, so the meds: Johnny and Suzie's little helper, have become socially acceptable. Mature adults on the other hand cannot allow this condition to absolve themselves of responsibility, use the condition as an excuse for acting like a child, or even suggest this disorder is a disability. Some kids need help "growing up," apparently some adults use this condition as an excuse not to.

The danger, I fear, of deriving identity from disorder is that it relieves you of responsibility. The disorder becomes a universal permission slip for some very annoying behaviors -- in the case of adult A.D.D.-type behaviors, lateness, a sort of obtuseness (We are, after all, "part of the whole rainbow of autistic spectrum disorders"), and at the very least, the criminal misuse of language going on in this room, where "I'm not a looser," is now written on a big white pad. -Judith Warner

http://warner.blogs.nytimes.com/2006/05/11/add-and-the-wages-of-oops-ing/#more-18

Sorry bout that Rich... but I gotta keep my day job.

Posted by: Ben | May 28, 2008 9:57 AM | Report abuse

A note to "just me" - please help your son understand as he grows older that he can contribute to an understanding relationship by accepting that his disorder, while not his fault, does affect others. "Ben" has a valid point in that ADHD is not a blanket excuse for uncontrolled disruptive/destructive behaviors, especially when it hurts people close to you.

Does it stink that ADHD'ers have to work harder than others to master some basic interpersonal skills? Absolutely. But as long as there's a willingness to try new tools and take an active role in managing the disorder, your son will find many more people are willing to work with him than he might have thought.

Posted by: Another wife | May 28, 2008 10:13 AM | Report abuse

To Wife and Mother of ADHD - please have a heart to heart with your sons spouses. My husband and I were on the verge of divorce (he was untreated since college until recently). He was a monster to live with - very difficult to talk about serious issues. When I was ready to walk out, his mom and I talk and then we had an intervention to get him back into treatment. He is so much better. I wish we did this years ago.

ADHD is not an excuse, Ben, and any good parent will instill that in their child. It may be a hurdle, but it can be overcome.

No one at my husband's work knows about the ADHD. He doesn't seek accomodations, but makes his own (schedules his day of when to do different tasks, etc). Some days are good, some days are bad - but he's not much different than anyone else. He does have a tic with his hands that gets very distracting (to others) when he is anxious.

Posted by: Wife of ADHD | May 28, 2008 10:15 AM | Report abuse

Ben,

You obviously have no experience with dealing with anyone with ADHD on a regular basis. My fear is that you will have a child that has this condition - since it's also obvious that the child will not get the help he or she needs.

My son was diagnosed when he was 6. Was it because of inappropriate behaviour? Partly. But as a parent it was heartbreaking to see effort that he went through just to learn how to ride a bike and the determination he put himself through memorizing all the steps, no matter how basic they were (put hands on handle bars, put foot on pedal, push with other foot, balance, etc, etc.). He struggled for days with this. But he wanted to ride that bike and eventually succeeded. My daughter, at 5, picked it up rapidly and with much less frustration.

That's just one example. He has to do that with all aspects of his life. If he's not interested in a subject, the struggle is that much more severe. He tries so hard at everything in daily life - even to remember everything he needs to do to get ready in the morning. He's on medication, but it is NOT A CURE. All it does is allow him a level playing field to learn and participate in life. It also has to be combined with therapy to make sure we take advantage of the focus it gives him.

Is it an excuse for rude behaviour? No. Is he getting any advantage from this? No, but for what he has to go through he has to work 10 times harder then the average student. And some days are harder than others. Especially when he melts down because HE KNOWS he is at a disadvantage. He doesn't treat it as an excuse, but then YOU don't get the questions from him saying "Why Dad, am I like this?".

And you think this life and medication is a panacea? And your defense is some NY Times blog?

In this experience I've come to find symptoms in myself and my brother. Neither of us are as severe as my son, but both of us found things we enjoyed immensely and could be successful at.

I pray that my son finds his.

Posted by: Paul in VT | May 28, 2008 10:45 AM | Report abuse

Adult ADHD is real. There are support groups for spouses of Adults with ADHD, thank goodness, but we're on the verge of divorce because of it. It is very hard for the non-ADHD spouse to cope with. I know it is for me. Every part of him seems normal, but at the end of the day, I know that he is not. It's even harder because even though he knows he has ADHD, he pretends to everyone else around him that he doesn't have the disorder, his family refuses to believe that he has the disorder, which I believe is part of the spectrum of autistic disorders, and refuses to stay on his meds and continue with the cognitive psychotherapy. This creates a less than stable household for our family.

I just wish I had more support on a daily basis, but I'm doing the best that I can alone. Adult ADHD is real. I am sure that the pharm companies will figure out a way to exploit people because of it, but some of the medication availiable to adults is lifesaving.

Posted by: changingfaces | May 28, 2008 10:52 AM | Report abuse

To Wife of ADHD and Ben -
I completely agree about ADHD not being an excuse. One of the best teachers my son ever had was also ADHD, and absolutely insisted that it was a reason, but not an excuse and he had to be responsible for his actions. He couldn't wiggle out of that one, and he was quite smart enough to manipulate whatever system. He is continuing to be responsible, even if his picture was next to the definition of ADHD in high school.

He made it through 3 years of college, and a very successful semester abroad without his meds. He decided his senior year of high school to discontinue them. It was fine until this last semester. He struggled, and after much discussion and thought, has decided to resume medication. He will be working with his doctor this summer to determine the proper dose and medication.

He knows that his problems are his fault, and is taking action. His father also never asked for any leeway at work (now successfully retired).

And never fear about my counseling any spouses - I have done that for a number of my friends when they were surprised by a spouse being identified. I would tell them that they drive us crazy but they don't mean to. Helping them see that it isn't 'enemy action', but a situation of not having a skill in those organizational tasks really helps. Then you can split jobs up according to ability, and have much more peace. They don't like the conflict any more than you do, and are often at a loss as to what to do too fix it.


Posted by: Wife and Mother of ADHD | May 28, 2008 10:55 AM | Report abuse

I was diagnosed with ADD in 1978 at the age of 7. Early on I was somewhat of an outcast. My father was weak and could not handle my behavior. He left when I was 14. I went to prison when I was 19 for 3 years and was released with 16 college classes completed (Pell Grant). My mother pushed me through to my BS degree which I managed without medication. (Instead, I organized groups to force myself to engage in class prep/homework - tests were always a breeze.) I got married at 25 - she had 2 children. I also got a job and found that I was having trouble concentrating. I sought help from a psychologist who put me on Ritalin. I continue to medicate 5 to 6 days a week. My wife struggles with me but we continue to work hard together. She is just starting to understand the seriousness of ADHD. Writing this comment was very difficult because there are so many things I want to say.

Posted by: Fred | May 28, 2008 11:19 AM | Report abuse

I was diagnosed with ADHD at age 7 and treated with Ritalin until I was 16. At that point my parents were told medicine was no longer necessary because ADHD went away in adulthood. I'm here to tell you that's false. I recently started taking Adderall every day for it, because it's become too difficult to control as a husband, a father, a graduate school student and an employee. It's more than just 'trouble focusing' or not able to pay attention. These are symptoms, but I literally feel that there's a race of thoughts being run in my head and it never stops, even on days when I do take my medicine (it just slows down then) and whatever thought is in the front of my mind gets my attention. Most nights I lay in bed and thoughts just zoom in and out. Should I watch TV? Maybe write a song? Check out a website? I forgot to pay the water bill. Did I take the trash out? The other day while I was driving, in less than a span of 2 minutes I went from thinking, I should learn Spanish to I need to lose 20 pounds. These are the reasons I have a lack of focus, or the inability to pay attention.

My family has suffered because of my condition and my inability to be there mentally for them. That's the main reason I've started taking the medicine again.

Posted by: Adult with ADHD | May 28, 2008 11:44 AM | Report abuse

I was diagnosed with ADHD when I was about 6, which was well before the current high rates of diagnosis (I'm almost 38). It was due to documented circumstances, namely a brain injury at birth (neonatal septicemia resulting in oxygen deprivation to the brain - I also have poor hand-eye coordination) and a couple of head injuries (including loss of consciousness) since then. (Both were due to my not paying adequate attention to my environment...)

It was thought when I was going out of adolescence that the ADHD would go away, so I went off of Ritalin. My college grades rather showed this - everything from several failed classes (or withdrawals to avoid failures) to As, albeit with a GPA of 3.04 or so. I did get into graduate school, however, largely thanks to prior research experience and good test scores. I had lots of problems with my first few years, with not being able to concentrate (most of the hyperactivity went away, except for a tendency to pace when thinking and jitteriness when impatient) until I finally went back on Ritalin again. I now have a Ph.D. in Microbiology and Molecular Genetics.

Adult ADD (and, in some, ADHD, although in _most_ (like me) the hyperactivity does go down with time) exists, and it is harmful for most people in most circumstances. (There are some people in the right jobs and other circumstances who can handle it - I know one person with adult ADD/ADHD who's a preschool teacher, for instance. But not all of us want to be in those jobs or would do well in such jobs!)

Those who don't want us to get the help - drug _and_ other (I've had years of counseling) - we need are the same as those (e.g., Tom Cruise and other Scientologists, IIRC) who would tell people with depression that they shouldn't be on drugs, even if they're about to commit suicide otherwise; the same as those, like Public Citizen, who insist that drugs like Meridia and Crestor are taken off the market despite being needed for some people (Crestor, unlike any other _effective_ statin, doesn't interact with other drugs with regard to the liver's cytochrome P450 enzymatic processing), because they think that anyone who needs them isn't being puritanical enough about diet, et cetera (I'm on Crestor due to otherwise having a total cholesterol of 300+, despite having a BMI of below 20 and being on a low-calorie, low-fat diet); the same as those who believe that deafness is being "differently enabled", not disabled - but still want accomodations to deafness under the Americans with _Disabilities_ act.

People, if you don't like the idea of adults taking anti-ADD drugs, don't take them yourselves - mind your own business with regard to the bodies and minds of others. Our bodies and minds are our own, not those of the government (nor are they owned by pharmaceutical companies - at least some of us (who should not be restricted by the problems of the rest) are intelligent enough to decide what we need, no matter what the companies do in regard to advertising).

-Allen Smith, Ph.D.
http://cesario.rutgers.edu/easmith/

P.S. Incidentally, I'm glad with regard to my ADD that I'm in the US - I've read that much of Europe, including England and Germany, are rather more puritanical with regard to adult ADD treatment (I'm guessing that this may be partially because of their higher level of governmental intervention into health care...) - refusing drugs to even those with well-documented cases. (I'd call that malpractice, personally.)

Posted by: Allen Smith | May 28, 2008 12:50 PM | Report abuse

I am in my mid-forties. I was diagnosed with ADHD about 10 years ago.

Throughout my childhood, adolescence, and much of my early adulthood, I had been told (by parents, teachers, tutors, guidance counselors, and therapists) a variation on the same message: that I was lazy and undisciplined, that if only I would apply myself, I would be successful, happy, and, implicitly, virtuous. And you you know what? I came to believe it.

I came to believe that if I only tried harder, I wouldn't read, re-read, re-read, and re-read again a page in a textbook in order to comprehend the material.

I came to believe that if only I was more disciplined that I wouldn't be so disorganized with my bills that I got my electricity turned off (twice) despite having the money in my bank account to pay it.

I came to believe that if only I wasn't so self-indulgent that I allowed stray thoughts (Look, a squirrel!) to intrude during a lecture that I would be able retain the material.

As I said, I was eventually diagnosed and it turned my life around. I went from someone who nearly didn't graduate from high school and did indeed flunk out from college (twice), to earning a Ph.D. from an Ivy-league school.

Despite all my achievements, I still have, at my core, a small voice that whispers "you're a fraud, you're lazy, you're a wimp, you're a slacker."

That's not a great way to feel about yourself. And from my reading of the literature, my experience is not uncommon for those diagnosed with ADHD.

So to those of you whose lives are inconvenienced by our affliction, consider that just perhaps that without realizing it, you are exhibiting that which you see so clearly in others - a pre-occupation with yourself and your own experience.

Posted by: CF | May 28, 2008 1:24 PM | Report abuse

CF - your comments are exactly right and echo my experience (I was diagnosed at age 40). The meds work (like putting on a pair of glasses when you are nearsighted), but the side effects of the meds are not easy to manage (nor is the psychological baggage from struggling/coping with ADD all your life), and I still worry about the long term effects of ritalin.

Posted by: Anonymous | May 28, 2008 1:56 PM | Report abuse

CF, your comments are dead on! The squirrel thing made me laugh because it's exactly how my mind works. And the re-reading material over and over until it sinks in. I don't know how many times I've finished a chapter in a textbook only to realize I didn't remember a word of what I read because I was thinking about something else entirely.

Posted by: Adult with ADHD | May 28, 2008 3:18 PM | Report abuse

I can relate to most people commenting on this article. I two children diagnosed with Attention Deficit - one with ADD, the other with ADHD. Both have now outgrown the impulsiveness, but both still suffer from the attention deficit. My oldest suffered the most from late diagnosis. It affected her reading comprehension and writing skills - she still struggles with both to this day, but we see improvement with every year that passes. Neither child ever used ADHD/ADD as an excuse for bad or rude behavior. It is not in their nature, nor would we have allowed the behavior to continue. Luckily, Adderall helped with the attention deficit and a very good speech/language/behavior specialist taught both children mechanisms to cope with the other problems - short term memory issues, study skills and assistance with organizational skills.

Both children have learned that having ADHD/ADD means they have to work twice as hard as most kids to get Bs, Cs and the rare A.

Kids that suffer from ADHD/ADD can most definitely learn to cope and do very well in high scshool and beyond. My daughter just finished her second year of college and is well on her way to her goal of a Masters in Special Education.

Posted by: Father of two ADD kids | May 28, 2008 3:20 PM | Report abuse

I think it's our drug-oriented culture.

Consider the following:

"no long-term benefit from ADHD medications"

http://www.healthbeatblog.org/2007/11/adhd-and-the-me.html

We should think more about helping our children find the right job than about medicating our children to fit.

Posted by: RoseG | May 28, 2008 4:27 PM | Report abuse

I realize that blog entries may be written in haste and may not be subjected to the level of editorial scrutiny applied to articles and columns. Having said that, I think that the last two paragraphs of the entry are somewhat misleading.

The opening sentence of the second-to-last paragraph reads, "But adult ADHD isn't universally recognized in the medical community as a genuine disorder." The authors then state that the diagnosis in children has not been without controversy.

True enough, but so too has the theory of evolution not been without controversy. In both cases, most of the controversy occurs when lay people challenge scientific research. But the ambiguity of the second sentence (where is the locus of the controversy?) and its juxtaposition with the first sentence leads one infer that there is considerable debate within the scientific and medical community about the existence of ADHD. There is not.

Also, universal recognition of a condition is an artificially high standard. A handful of crackpots can always be found. The correct standard should be widespread consensus. Is there widespread consensus in the scientific and medical communities on the existence of adult ADHD?

Judging from how the authors refer to an article in American Family Physician, one might think the answer is no. However, for those willing to click on the hyperlink, the article is unequivocal. The existence of adult ADHD is treated as fact. It may be difficult to diagnose, but that difficulty has nothing to do with whether or not it exists.

Just to be clear, there is no discussion of whether adult ADHD might not really exist. The article, a literature review written in 2000, does not even entertain the possibility that adult ADHD might not be real.

The next paragraph in the blog entry begins "So, is adult ADHD real..." but isn't in any way supported by what came before. Whether ADHD exists, in children and adults, is question that has been answered.

I don't doubt the intentions of the authors. But the last two paragraphs in the entry, at best, suffer from sloppy construction. And the result is misleading.

****

And for RoseG, consider the editorial from the same issue of American Family Physician, a portion of which is excerpted below:
http://www.aafp.org/afp/20001101/editorials.html

"It is important to note that stimulant treatment of ADHD in childhood does not predispose patients to become substance abusers; indeed, the opposite is true. In a long-term follow-up study, Biederman and colleagues7 compared 117 teenagers with ADHD who had been treated with medication with 45 children with untreated ADHD and 344 control subjects. In adulthood, the rate of substance abuse disorders did not differ between the medication-treated ADHD group (13 percent) and the control group (10 percent), but it was significantly higher in the untreated ADHD group (33 percent). This was a statistically significant difference that persisted even after controlling for poverty, family history of substance abuse and conduct disorder.

Early treatment of childhood ADHD may play a role in protecting against the development of substance abuse disorders in this vulnerable population. It is possible that continuing treatment of adult ADHD may be imperative in preventing a range of dire health consequences."

Posted by: CF | May 28, 2008 4:50 PM | Report abuse

Sorry, RoseG.

I completely disagree. ADHD medications are probably one of the most researched medications in the world. Before putting my son on medication my wife, who is a medical researcher with access to all the major medical journals published today, spent months researching the medications while the evaluation was going on. We had the answers before the diagnosis of ADHD was given. We even sought out a therapist who evaluated him and would not prescribe meds until we also had him evaluated by a pediatrician and a second opinion. The major pediatric sites have also a considerable amount of information.

Again - these medications are not a cure and don't have a long term benefit directly. The benefit is in that the medication provides the ability to focus as long as the it's being taken. This focus is the benefit that allows them to learn. You've seen statements here attributing to that fact. If you had someone in your family that suffered from this, you'd know this.

Maggie Mahar (who's blog you quote) has no medical background, but is rather a journalist. Seek a qualified physician and get their input before making judgements about "the drug culture" and those affected by ADHD.

Posted by: Paul in VT | May 28, 2008 4:52 PM | Report abuse

Posted by: CF | May 28, 2008 5:06 PM | Report abuse

Jennifer, while I found the study and the analysis of who funded it interesting, the question on your blog entry ("is adult ADHD real?") is honestly not fit for a mainstream publication given how little research you put into it.

You make a couple of incredibly dubious claims. First off, nothing you quote and no effective double blind studies that I'm aware of outright deny the existence of ADHD in adults (versus kids, where there has been some legitimate controversy) as a genuine disorder. Has it been misdiagnosed and mismedicated an awful lot? Absolutely. Does it exist? Yep.

That latter is a very legitimate point given the funding of the study, but it has nothing to do with the fact that there are adults that made it through most of their lives undiagnosed. I did. Clarence Page at the Tribune did. David Neeleman of JetBlue did, and there are countless others who've done pretty well for themselves and have developed incredible coping mechanisms. The typical never-diagnosed older patient tends to discover they have it when their kids actually get diagnosed with it, believe it or not.

And second, in regards to the AAFP study, if you'd bothered to do a bit more research the point is that most adults (86% according to one study) who make it to adulthood undiagnosed tend to have a comorbid (e.g. anxiety, depression, et al) disorder along with ADHD - any many times, the comorbid disorder is a lot more serious than the ADHD and needs to be treated first. (I'm lucky. I'm in that 14% that made it through pretty much normal.) And yes, you should probably rule out other biological causes and get a TSH test for your thyroid, but that's the case with most diseases.

More hard to do is to find a psychiatrist who has experience with treating adult ADHD, since you'll need one to work on medication management once you've been diagnosed - which can be done by a lot of people besides a shrink. There is very little evidence anything besides pharmaceuticals work for the core symptoms, though, and having been through every class of medication out there I can say from my own experience that it may take literally 6 months to find one (or two) that actually is effective.

Having a PCP write a script for Adderall isn't going to do the 30% of the ADHD population that doesn't respond to stimulants a bit of good, and if someone responds to that class of medications, the three common ones produce wildly different effects in different people - let alone subtle changes in dosages making a massive difference. (36 mg of Concerta helped my symptoms a little bit, but 54 mg believe it or not aggravated my symptoms, and according to my shrink that is not common - but actually something he's seen on occasion. You really expect an internal medicine type to know this stuff? Mine just shook his head and said "I'm glad you went to a specialist!")

The two problems are that by and large we don't really know why dopamine does what it does so no one really knows why each of the drugs works - and on top of that, there are very few studies out there on how the various meds work in adults. So it's touch and go, and mostly go.

But arguing that ADHD doesn't exist in adults? That's irresponsible journalism, especially if you can't quote a legitimate study questioning its existence. Try reading Hallowell or Barkley if you're interested in the subject and want to write on it more.

I hope this helps you in your work on your next article.

Posted by: Dan M | May 28, 2008 5:27 PM | Report abuse

And I'd also agree with the previous posters that the cult of ADHD as an excuse for atrocious behavior has gotten out of control. I have ADHD, but I'm not defined by it. You may react differently to stimuli than other people, but that doesn't mean that you have an excuse to do things you shouldn't.

Posted by: Dan M | May 28, 2008 5:31 PM | Report abuse

CF pretty much nailed it.

There is a pattern of cognitive deficits associated with Adult ADHD. They are flaws in memory organization, executive functioning, focus, and impulse control. These deficits can cause failure in otherwise bright individuals -- failure that has nothing to do with character, discipline, moral fiber, or maturity level.

No, in fact, for them to be "functional," these individuals have to exhibit MORE effort and discipline than most people do, to avoid distractions, stay organized, make plans, and file information in their brains in effective ways.

When I was studying for my Artificial Intelligence final at University, I faced a terrible struggle, because I was inspired, all of a sudden, to write some software, using the things we had learned in class. I needed to study, but it was an unending battle with myself, as my brain kept wandering off to the code project I wanted to try. This was nothing like laziness or lack of motivation. In fact, it was just the opposite of that. Nor did it show a lack of discipline, since I took great pains to continue studying, rather than grabbing my keyboard. Nonetheless, it did ultimately degrade the quality of my studying.

I'm not looking for excuses for laziness or thoughtlessness. I'm not lazy, and I'm very conscientious. Heck, even my leisure activities are usually extremely labor-intensive. It just helps me to know why I'm a total idiot, sometimes, and miss the exit for my own house, or forget that I was in the middle of cooking a three-course meal, or mysteriously lose three hours while getting ready to go somewhere. I'm not a bad person. I just had a few parts left over, when I was assembled at the factory.

Posted by: CitizenKate | May 28, 2008 5:37 PM | Report abuse

Everybody is different. Everyone has gifts. Everyone has shortcomings. But using ADD/ADHD as an excuse is dangerous - that is what I see as being a victim of the disorder. If I do my best, use my best judgment on how to handle my life situation - and that includes meds or caffeine - or not - that is how I cope. But COPE I must.

I have to be responsible to keep my job, pay the mortgage and support my family.


Certainly ADHD and ADD both in children and adults exist. I don't dispute this at all.

Medication can help, stimulants can help (but with more side effects say the docs)

Yet the actions of the ADD/ADHD adult individual still ARE their responsibility - just as much as an adult with another disorder. The devil made me do it? A witch cursed me? The drugs made me? The booze made me?

So if you teach your kids that they can only function with drugs, or are victims of their disorder - I think you do them a disservice.

Kids need love, support and parenting so that they can be responsible adults some day. If that support includes supervised used of meds, teaching strategies and other skills to deal with inattention-hyperattention - that is your job as a parent.

Nothing is easy. Lets not let the drug companies make it seems that way. They are only a piece of the solution - not a panacea.

Hey CF, Has nothing to do with inconvenience, unless you're the kid who dioesnt get the child support payment from the deadbeat. I guess that would be a little inconvenient.

Posted by: Ben | May 28, 2008 5:55 PM | Report abuse

Hmm, I wonder if I should try to get a diagnosis. I'm in my 40s, super-high test scores but could not finish graduate school due to lack of focus. I've never been tested for ADD because I always got A's when I was growing up, and then grad school for me was like slamming into a brick wall. Now, here I am, switching between different tasks on my computer screen. I wonder whether the Internet/Web (and today's TV shows and whatnot) is actually enhancing ADD symptoms in adults who might have had only the mildest ADD symptoms in their youth.

Posted by: Greenbelt | May 28, 2008 6:07 PM | Report abuse

Greenbelt, read Delivered from Distraction by Hallowell, and then decide if that sounds like you and if you should be formally diagnosed by someone with training. There's a large section of very highly performing adults that have slipped through the cracks, but it usually catches up with them later in life (ala grad school).

And there are certain things that ADHD adults should tend to avoid unless they absolutely have to. Internet usage is a notoriously common one.

Posted by: Dan M | May 28, 2008 6:15 PM | Report abuse

Greenbelt, if you're still wondering, after doing more research, I recommend getting tested by a neuropsychologist. Make sure you see someone who doesn't do anything but neuropsychological testing, and doesn't profit from a false positive. Also, make sure that the person in question rules out bipolar disorder, because it exhibits similar cognitive dysfunction, but can be exacerbated by ADHD meds.

Posted by: CitizenKate | May 28, 2008 6:37 PM | Report abuse

I, too, was in my late 30's when diagnosed after my elder daughter was diagnosed. What a difference the Adderall has made in my work life in particular... I can get back on task and so many more things are FINISHED. Wow. My self-esteem has increased, and I now see all the things my school teachers wrote on my report cards to my parents about my being a bright child but not applying myself and not meeting my full potential. Yep, I hyper focus on things I enjoy so school and college was absolutely pass and fail, almost literally. I'm not a different person, but I admit I see myself differently, more positively, now. I feel better about myself. If medication helps keep my brain in premium working order, then I'm okay with that. Some of my co-workers know, but there are no accomodations. Personally, I don't think this is something people outgrow. We cope, we learn to deal, but I think it's there just like one commenter remarked about going to grow taller. We're born with it and we live with it and we die with it. In my opinion, what we do with it in the meanwhile is up to us.

Great article and comments!

Posted by: Cindilouhooinva | May 28, 2008 8:03 PM | Report abuse

I am an adult with life-long ADHD. I was terrible in school and a success today. I am self-made from nothing and a big part of my success was learning to harness the traits of ADHD to my ADVANTAGE.

The genes for ADHD come from our ancestors in hunter gatherer communities and 50% of the global population has a genetic predisposition for the traits as a result. We're the HUNTERS.

The rest of the population are descendant from farming, pastoral communities and don't have the traits.

Since it is controlled by genetics I inherited, it ISN'T a "disorder". In fact its POWER over my peers. That's right - POWER:

*Hyper Focus means when you're (a farmer) burned out on a subject, or work project....I'm not!

*Being able to make snap decisions and re-focus on a new and better target means that while you're (farmer) beating a dead horse of an issue, I've already identified the drivers in any given business situation, and I'm on to them leaving you in the dust.

* High energy... I'm in my office at 5:30 and feel like its noon. You're dragging your farmer self out to the parking lot about now, aren't you?

*Twin-track mind means I listen to what you are saying, know where you are taking the discussion, and formulate my reasoned response AT THE SAME TIME. Scary for the business competitor in you to learn that, isn't it?

*I know what I'm not good at and avoid it. I'll never do my own accounting, for instance. THAT job is for a "farmer" to do.

Now I ask you - is it better to teach a child with ADHD how to master his/her POWERS of high energy, high intelligence, hyper focus, target selection, and decisioning?

...or is it better ot DRUG THEM?

Embrace your God-given, genetic, ADHD POWERS and tell big pharma to stuff their pills where the sun doesn't shine!

Posted by: JBE | May 28, 2008 8:26 PM | Report abuse

Drugs for everyone! If the ADHD users can self-medicate, why can't you?

Posted by: bks | May 28, 2008 10:08 PM | Report abuse

Ben -

My son is very bright and has ADHD. His mother (who does not have ADHD) and I have told him, over and over, that we expect him to get A's and B's. We have been unequivocal: ADHD absolutely is the reason studying and organization are a greater challenge for him than many of this friends. We wish it were different and we're sorry he was dealt this hand. But ADHD isn't permission to underachieve. Quite the opposite, ADHD means he has to work harder and spend time doing things other kids don't have to do. It is non-negotiable. And yes, he also takes medication.

Your hypothetical deadbeat dad is a criminal and should be treated accordingly. So save your sanctimony and your strawman arguments for someone foolish enough to take them seriously.

Posted by: CF | May 28, 2008 10:34 PM | Report abuse

I have ADD, and my three girls have add. One is medicated. I can echo many posts here. I grew up thinking that I was dumb. After my first child (now 16) was diagnosed, I realized there was a reason for the way I was (and am) not an excuse. I refused to put my oldest on meds, because of the side effects, she was already small for her age and skinny. I insisted she try harder, and told her she was smarter because she has to try harder to receive her good grades. She is doing fine and in her last two years of high school. The hyper part of her ADD has subsided somewhat. My middle daughter is 11 and has been on meds since she was 9. Tried different kinds because of side effects (concerta gave her "tics" and she would be awake all night). She is now on focalin xr. It helps her focus in school but when the meds wear off, she is out of control again. I am still debating whether to keep her on or off the meds. My youngest (8) also has ADD but it is somewhat controllable without meds. Anyway, I am back in college now ( going for accounting, eventually forensic accounting, which ironically someone mentioned earlier.). I am working on a research paper and decided to use ADD as my topic. I was looking up different treatments and came across this blog. I guess you can call this my "look a squirrel". I couldn't resist adding my comment to this post, now I better get going and write my thesis statement. (as long as I don't run into any more "squirrels". It was nice to read all of the comments and know that I am not alone!

Posted by: Patricia | June 3, 2008 8:24 PM | Report abuse

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