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Dr. Kacir's ADHD Blog

ADHD Diagnosis

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.
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