Home' Trinidad and Tobago Guardian : October 5th 2015 Contents A26
body & soul
Guardian www.guardian.co.tt Monday, October 5, 2015
The 73-year-old widow came to see Dr David
Goodman, an assistant professor in the psychiatry
and behavioral sciences department at Johns Hop-
kins School of Medicine, after her daughter had
urged her to "see somebody" for her increasing
She was often losing her pocketbook and keys and
had trouble following conversations, and 15 minutes
later couldn t remember much of what was said.
But he did not think she had early Alzheimer s
disease. The woman s daughter and granddaughter
had both been given a diagnosis of attention deficit
hyperactivity disorde (ADHD) a few years earlier, and
Dr Goodman, who is also the director of a private
adult ADHD clinical and research center outside of
Baltimore, asked about her school days as a teenag-
"She told me: I would doodle because I couldn t
pay attention to the teacher, and I wouldn t know
what was going on. The teacher would move me to
the front of the class, " Dr Goodman said.
After interviewing her extensively, noting the pres-
ence of patterns of impairment that spanned the
decades, Dr Goodman diagnosed ADHD He prescribed
Vyvanse, a short-acting stimulant of the central
A few weeks later, the difference was remarkable.
"She said: I m surprised, because I m not misplacing
my keys now, and I can remember things better. My
mind isn t wandering off, and I can stay in a con-
versation. I can do something until I finish it, " Dr
Once seen as a disorder affecting mainly children
and young adults, attention deficit hyperactivity dis-
order is increasingly understood to last throughout
one s lifetime.
In 2012, in one of the only epidemiological studies
done on ADHD in older adults, a large Dutch pop-
ulation study found the condition in close to three
per cent of people over 60.
Yet we know little about how ADHD affects older
people, or even who has it.
"We hardly have any literature," said Dr Thomas
Brown, associate director of the Yale Clinic for Atten-
tion and Related Disorders at the Yale School of Med-
icine. Almost none of the clinical trials and epidemi-
ological studies on ADHD have included people over
50. "But I see quite a few people turning up in my
office with these complaints. It s reasonable to assume
that a lot of elderly people have ADHD."
Heightened awareness of ADHD is bringing
increased referrals of elderly adults to specialty clinics
in the US. "A child had been treated, then a parent,
then everyone started looking at Grandpa, and saying,
Oh my gosh, and they would bring him in," said Dr
Martin Wetzel, associate clinical professor of psychiatry
at the University of Nebraska Medical Center.
Yet many general practitioners and mental health
experts mistake symptoms like impaired short-term
memory or an inability to stay focused on a task as
"We do a horrible job of training health care pro-
fessionals about adult ADHD," Dr Wetzel said.
Dr Brown said, "Most doctors are not thinking of
ADHD as a characteristic of somebody who is 60 or
over." Hence, the condition may be overlooked in
the 80-year-old who has trouble staying engaged at
the senior centre, despite a lifelong history of inat-
tention. "They figure it s just cognitive decline from
aging" or diagnose depression or anxiety in such
patients, which may or may not be the case, he said.
Until about three years ago, most geriatric cognitive
and memory studies did not include any people with
ADHD, at least not knowingly.
"Deeply hidden in all the studies about mild cog-
nitive impairment and early Alzheimer s are significant
numbers of people with ADHD," Dr. Wetzel said.
"We have no idea who in those studies had it or
didn t have it, because nobody was asking the ques-
Screening for ADHD is not simple. No blood test
or imaging study can make a definitive distinction;
ADHD is basically a clinical diagnosis.
"Unless you ask questions and do a com-
prehensive assessment, nobody s ever going
to know," Dr Wetzel said.
Dr Goodman said: "This is where it gets
difficult in aging patients. One has to dis-
tinguish between the longitudinal ADHD
symptoms and the overlap of age-related
cognitive decline. You can have both simul-
taneously." Dr Lenard Adler, director of the
Adult ADHD Program at the NYU Langone
School of Medicine, and past president of
the American Professional Society of ADHD
and Related Disorders, said, "The key issue
is to get the diagnosis correct, get the right
medication into the individuals who need
it and to be sure that older adults have the
appropriate medical clearance prior to treat-
ment." Older adults with ADHD are typically
treated with the same drugs given to chil-
dren, stimulants like Adderall or Ritalin, but
these medications pose distinctive challenges
for older patients. "If they have cardiac or
blood pressure issues, the doctor would first
have to pay attention to getting the heart
issues or hypertension resolved or under
control and then possibly come in with a
stimulant," said Dr Brown, who added that
he had successfully treated a number of
people in their early and mid-70s with stim-
Why treat people at an advanced age for
something they have had their entire life?
"Let s say you ve spent your whole life
not functioning at a level that you could,
and you believed that was an outgrowth of
you as a person, and all of a sudden you
received a diagnosis and medication that
showed you that all of the criticism from
the environment wasn t because of who
you were, it was because of what you had,"
Dr Goodman said. "That it is a very liber-
ating experience, even if you re 65, 72 or
Is it old age, or ADHD?
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