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Dr. Kacir's ADHD Blog

I agree with raising the minimum age for ADHD symptoms

Harvey A. Weinberg, Ph.D. commented on the plans for updating the diagnostic criteria of ADHD.  ADHD is currently defined by the American Psychiatric Association in the 4th edition of their "Diagnostic and Statistical Manual."  Proposed changes for the 5th edition are currently posted on the internet for discussion by interested professionals.  The particular change Dr. Weinberg objects to is the proposal that symptoms must occur before age 12 instead of earlier than age 7.  His first objection is that "it has been long established that ADHD is a neurobiological condition that takes hold during the early years of brain development and will likely show outward behavioral manifestations, in some shape or form, during early childhood."  He then states that "biological and developmental changes" and entering "the middle school environment" can cause many of the symptoms required for the ADHD diagnosis.  His last protest about raising the age of first inattentive or hyperactive-impulsive symptoms is that "many more youngsters could be diagnosed based on a later onset of symptoms and some could easily feign symptoms for the sake of acquiring performance enhancing drugs and abuse these medications."

As many of my adult patients may report, I do not insist that they report the presence of ADHD symptoms during childhood.  I have found that even adults who do not remember problems with focusing as children benefit from treatment of their ADHD symptoms.  One of my patients was told by her another doctor that she could not possibly have ADHD, because she had finished a graduate degree.  Yet when I evaluated her she had more than 6 symptoms of inattention and was impaired in two areas of adult function.    She thought she might have day-dreamed a lot in elementary school, but she didn't remember for sure.  I diagnosed her with ADHD and treated her accordingly.  After treatment she told me that she wouldn't dream of going back to her previous state.

Dr. Weinberg supports his views with statistics stating that over 60% of college students with prescribed ADHD medicines already give or sell them to others.  He also points out that more children are being diagnosed with ADHD every year even with the current minimum age of 7.  He then comments that some studies have shown biased diagnosis of ADHD based on date of birth and geographical location.  His concern is that there is already a "potential for misdiagnosis and overdiagnosis in the ADHD population" and that "raising the age threshold would contribute to this concern."

Dr. Weinberg and I have very different practices.  He is a psychologist and is the director of the ADHD department of a midwestern health care system.  Among other duties, he determines whether his patients qualify for services based on their functional deficits.  Most psychologists perform detailed psychological evaluations which look at IQ as well as the symptoms which define ADHD.  Once a psychologist makes the diagnosis of ADHD they can recommend interventions, but cannot prescribe the medications shown to be most helpful.  I, on the other hand, am a physician with a private practice in which I see individual patients.  I look specifically for ADHD, educate my patients about the diagnosis, and, if indicated, prescribe the most effective treatments known.  If the treatment doesn't work, the patient and I will try other interventions and may eventually consider other diagnoses.  I might even recommend that they see a psychologist or a psychiatrist!  Occasionally, evidence will arise that suggests a patient is misusing prescription medications; in that case we discuss the problem and I might have to stop prescribing them. 

I feel very strongly that some people develop the symptoms of ADHD at ages much later than 12 and that they ought to have access to effective treatments.  I am not sure about what can be done to prevent stimulant misuse or abuse of the disability laws, but I don't think that honest patients with true ADHD symptoms and impairments should be penalized.  Thus, unlike Dr. Weinberg, I support the increase in the age at which symptoms of ADHD must be evident to qualify for diagnosis.  Indeed, I will continue to diagnose adults with ADHD even if they cannot remember having symptoms during childhood at all.

48 Comments to I agree with raising the minimum age for ADHD symptoms:

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Cheri on Friday, June 03, 2011 10:05 AM
I definitely agree as well with raising the minimum age for ADHD symptoms. Before I was first diagnosed I thought of my pre-middle school years as basically "ADHD free" (and still do, for the most part.) That is, I remember being told I daydreamed in class but other than that I was a straight-A student and had no problems with balancing school and chores. Once I was enrolled in honors courses around 5th grade I started noticing that I was having a much more difficult time, even more than other students in the same courses. I could often ace short-term projects but would make bad, and even failing, grades on homework and long-term projects and papers unless I was very excited about the material. When my grades declined my teachers and parents attributed it to a lack of interest or laziness. They told me I had a high IQ and there was no reason for me to have low grades. Everything snowballed from there and although I was always in and out of honors classes, by the time I was in middle school it seemed everything was a challenge for me and took me 2-3 times longer to complete work as other people, not just school but chores as well, then as a teenager and adult work added to that. Even though I am still new at ADHD meds and finding what works for me, the relief of symptoms I have experienced so far further proves to me that I have had symptoms of ADHD for many years, even though prior to age 10 or 11 I would not have fit the diagnostic criteria for ADHD. If all doctors required that ADHD symptoms must be present to a certain degree prior to age 7, I would never have been able to receive a diagnosis or treatment. As a sidenote, if you'll forgive my rant, it really angers me that ADHD meds are abused and therefore people like me would possibly have to pay for that. The reason these meds get such a bad rap is not because of people who take them that legitimately need them, but because of those who don't. I myself even put off getting diagnosed and taking meds because I was so scared of them from all the hype and horror stories I heard on the news. It is so sad that non-ADHD students will abuse the meds to go from an A to an A+ when I have to struggle just to pass classes and need the medication to concentrate so I can make at least decent grades. (Not to mention all the other areas of my life that ADHD affects.) Not only that, but then I will possibly be judged for taking them unfairly because of these law-breaking individuals. I don't even want to tell people I have ADHD or am on meds because of this. Anyway, I know this isn't entirely pertinent to the topic but I just had to get that rant out because I get angry every time I read or hear about abuse of ADHD meds.
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Karen on Thursday, April 26, 2012 11:39 AM
How silly to only diagnose adults if they had a childhood diagnosis before age 7. I was no doubt ADD as a child, but my parents never bothered to get a diagnosis for me. Is that my fault? Not to mention, I don't know how I would even go about getting records from that long ago, as my dad was in the navy and we moved every couple of years. I only got diagnosed in the 6th grade, and still never took medication until college began to be a serious struggle.
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overcome depression and loss on Wednesday, January 16, 2013 10:50 PM
I know that Dr. Weinberg is a good psychotherapist and he is the head ADHD department of a midwestern health care system. I must go to him for my ADHD. Thanks a lot dude for this type of allotment. Carry on.
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