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Hyperactivity May Be Underdiagnosed in Adults

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WebMD Health News

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.

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