Hyperactivity May Be Underdiagnosed in Adults
April 19, 2000 --Everyone in Jason's family is relieved because, just a
month after being diagnosed with attention deficit disorder, he is no longer
making careless mistakes in math, nor is he leaving projects half-completed --
and he has finally cleaned up the mess on his desk. Jason is 42 years old.
Howard H. Schubiner, MD, professor of internal medicine, pediatrics, and
psychiatry at Wayne State University School of Medicine in Detroit, says that
the fictional Jason described above represents a growing -- but underdiagnosed
and undertreated -- segment of the adult population.
Schubiner, whose clinical practice is devoted solely to the treatment of
patients with attention deficit disorder, more formerly known as attention
deficit hyperactivity disorder (ADHD), says the disorder is most often
initially diagnosed in children younger than age 7.
"But it is easy for the diagnosis to have been missed," he says.
When this happens, the result is often "an adult who has been a failure for
his whole life."
Schubiner tells WebMD that half of his patients are adolescents and "the
rest are adults of all ages." Because it is very likely that ADHD is an
inherited disorder, adults are often diagnosed because a son or daughter is
diagnosed. "Typically, a husband will hear the description of ADHD and say
'That's just the way I was when I was a kid.' The wife will then add, 'And you
still are,'" Schubiner says.
He recently lectured about adult ADHD at a meeting of the American College
of Physicians-American Society of Internal Medicine. He says he brought his
message to his fellow internists because he believes that as many as 5% of
their patients may have ADHD that is undiagnosed. As "doctors to
adults," internists have the same obligation to diagnose and treat ADHD as
they do to "treat diabetes or high blood pressure."
While ADHD in children is often identified because of the disruptive
behavior that gave it its first popular names -- "hyperkinesis" or
"hyperactivity" -- as the person matures, activity levels diminish.
"But the restlessness, inability to sit still, and the fidgeting are likely
to continue," Schubiner says.
Adults with ADHD are often people with a history of losing jobs, impulsive
actions, and often substance abuse. Additionally, left untreated, the disorder
can have a devastating effect on marriage. Indeed, Schubiner says, "We have
been able to save a lot of marriages, but we can't save them all."
When a patient is referred to Schubiner, he says he has little trouble with
diagnosis. "I just run through the list of attention symptoms such as
difficulty listening, easily distracted, careless, difficulty organizing tasks,
and the activity symptoms such as fidgeting, difficulty sitting still,
restlessness. And most patients will say, 'That's me.'"
The good news for patients, he says, is that once the diagnosis is made,
treatment is very effective. Adults, just as children, are treated with
stimulant medications such as Ritalin. It usually takes about a month or so to
regulate the dose so that you will notice differences in your behavior and
thinking, he says.