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Psychiatry Newsletter - Adult ADD: TBD

Hopkins BrainWise Spring 2011

Adult ADD: TBD

Date: March 30, 2011

“I worry,” says psychiatrist Ray DePaulo, “about patients who are diagnosing themselves and asking their primary care doctors to treat them for adult attention deficit disorder.” His concern, he says, stems from the real possibility that they instead suffer from depression or one of the psychiatric disorders that short-circuits concentration. And that raises the possibility of inappropriate therapy.        

Ritalin, the most common medication for attention disorders,“isn’t particularly good for depression,” says DePaulo, who’s treated mood disorders some 30 years. “In fact, it would be just what you didn’t want if, for example, you’re in an irritable, manic state from bipolar disease.”

Clinicians in Britain, Europe and Australia also have doubts, he adds, and are wary of adult ADD diagnoses made by U.S. colleagues.

No one questions that children can suffer severe ADD that’s obvious by the time they start school—before then, many parents say—and that stimulants help them “enormously,” DePaulo explains. But the adult condition “puts us in the soup.” A number of the already-diagnosed adult ADD patients he examines weren’t seen in childhood for the problem. They report that attentional troubles only became severe enough to see a doctor in their teens, usually when a depression surfaced.

So, are these people at the low end of the ADD curve—those with a developmental disorder so mild that they’ve been able to compensate most of their lives, until a depression struck?  Is this a new adult illness?  Or is it “simply” depression in high-functioning people who’re especially undone by losing concentration?

The heart of the problem, DePaulo says, is that in adults, ADD as a distinct disorder is difficult to diagnose. That it requires expert psychiatric assessment and ongoing care is clear. 

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