Good response to the adult onset question
Psychotherapist with expertise in working with Adults with ADHD
I’ve had quite a few 50-60 yr old males that have come to my office over the yrs believing that they now have ADHD, but aren’t certain they had it before…. If there is no known or suspected family hx of ADHD, no children dx’d or suspected, and there are a lot of sx’s of fatigue & memory issues… I start looking at sleep (these guys are often sucking up a lot of caffiene, too). I’ve had so many people come in fitting the above scenario, and come to find out they’re getting 4 hours of sleep a pm. I won’t agree to refer them for ADHD testing until they’re up to about 6 hrs/pm for at least a week+, and coach them to do this. And with most *poof*. ADHD gone!
I have one client currently that fits all the criteria for ADHD at age 47, but only dx’d 6 months ago. He’s struggled with it for at least 20 yrs, it’s getting worse, and he doesn’t remember struggling with sx’s before that time. Low and behold– he had a sleep study done 5-6 yrs ago and was dx’d with sleep apnea. He only tried the CPAP for a week before he gave up. He’s being referred for a new sleep study and apnea tx!
In any event, we do better with good sleep (easy to say!)
Does Dick have adult onset ADD ADHD?
I interviewed Dick again, seeking proof of his childhood ADHD. Some things were suggestive, but nothing very definite. On the other hand, Dick has tended to be oblivious to his symptoms. When he finally got diagnosed as an adult, he had answered “no” to all of the psychologist’s questions; fortunately, his wife was there, and corrected most of the no’s.
He denies any sleep apnea or sleep deprivation (his wife was not present).
Dick talked about doing well when there are a lot of different conflicts going on, and not well when things are quiet and calm. He says that he never has procrastinated, and then talked about sometimes not getting to things when there are more interesting things to do. He never misses deadlines (deadlines are one of the things that do turn on our focus centers). He does do well on Adderall.
I think Dick is an example of high intelligence and compensating strategies, which covered up his symptoms until he got into situations that uncovered them.
Do you have any insights or ideas about this? Is there such a thing as adult onset ADHD?
doug
excellent discussion of the question
I don’t have ADD??????????
ADDadultstrategies 
I am really enjoying this discussion. I would like to add how important it is to really look at the whole person when we are diagnosing/treating/coaching people with ADHD. I often hear from my clients, both teens and adults that they don’t like taking medication. They don’t like the side effects, even if there is a benefit of added focus. When we treat the whole person we can really address the core symptoms of ADHD. Whole person coaching is about not only sleep, but eating, exercising, connectedness, spirituality, meaning in life, communication, sensing/awareness, breathing, self-care. There are so many different areas to intervene and begin small steps to improved focus and function. Sometimes taking a step back, and then taking a very small, tiny step in one of these areas can provide motivation and encouragement that our clients can change their lives and feel better. When we come from a whole person perspective we give our clients the best opportunity to step into their own space and be the best person they can be. Isn’t that what this is all about?
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There are a couple of points here. ADHD can exist at a low level, shadow syndrome, state for years- until something upsets the applecart. It can be a change of job (which renders redundant all the old compensation strategies that we coached ourselves into), greater family responsibilities, or an injury (or overwork) that disrupts the exercise that keeps so many Adult ADDers functioning tolerably well. Or it can be an emotional trauma- precipitating PTSD– which is such a high risk in ADHD.
By Definition ADHD must have onset in childhood.
The US psychaitrist Harold Levinson (who has a special interest in vestibular and cerebellar impacts upon attention and dyslexia) suggests we classify things differently.
He suggests that it is better to talk about “concentration disorders” and he cites some very good case histories of ADHD presentation secondary to head injuries. The clinical picture was virtually indistinguishable from ADHD, except that there was no past history of ADHD.
LEvinsons Classification is:
Type I realistic emotional trauma
Type II unconscious neurotic conflicts
Type III a primary problem of the cerebello-vestibular system or inner ear and the interconnected circuits of the alerting and concentration modulating centres.
Type IV A primary non CVS dysfunction of the reticular activating and concentration modulating systems of the brainstem +/- secondary involvement of the inner ear:
(May be associated with extremely severe symptoms and poorer prognosis).
Type V– the secondary effects of “energy drain” resulting from a variety of conditions such as anaemia, metabolic or chemical disturbances.
That is a pretty interesting suggestion to me. I see no need to be wedded to the currently fashionable definition of ADHD.
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mindb- i think you give a great description of ways hidden ADHD can be unmasked. I’m not sure re the levinson system, would have to study it awhile. I would so far think type III is the real deal. interesting
thank you for commenting
doug
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I think compensation strategies can definitely hide it. Most of my friends do NOT believe I have ADHD. My family knows otherwise. My daughter-in-law says she knows quite a few people with ADHD and I am the most high-functioning of all of them. It’s because I work my tail off trying to keep my ducks in a row. But I’ve definitely had symptoms as long as I can remember.
I laughed a little at Dick’s answers to his psychiatrist’s questions. My son was evaluated recently and that’s exactly what he did. They asked him if there was a family history and he said no. He doesn’t believe I have it. If his wife had been there, she would have answered all those questions differently. I don’t think men should be evaluated without their wives present. 🙂
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It’s interesting to see how spouses view things differently and how it affects families when the person with suspected ADHD is in denial.
There are people who are surprised to find out that I have ADHD, what they don’t understand is that I have to work really hard to keep things together! When I can no longer keep things together (usually due to lack of sleep, stress, unexpected changes, not enough exercise) then the ADHD symptoms are all out there!
Nope, I don’t believe in late onset ADHD, you either had it beginning at an early age or you don’t have it at all. However, I totally believe in late diagnosis.
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GFF – i so agree. i had all these strategies, but didnt know i had ADD and didnt know they were strategies. so i was able to function, but when things got complicated, my ADD shone forth.
thank you for commenting
doug
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homey – great reply. “I don’t think men should be evaluated without their wives present. ”
love it!!! exactly right.
thanks for your comments
doug
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