Treatment options for adults diagnosed with ADHD

DEAR DR. ROACH

>> There is an extensive history of ADHD in my family. My son, who was formally diagnosed at 8 and is now 14, has just started taking meds. His transition to high school was difficult to manage. In looking at my own history, I can see the same patterns in my behavior (poor grades in school although identified as very intelligent, poor motivation, losing things constantly, forgetting things easily and being very easily distracted). I have been fairly successful at work by using coping mechanisms such as making lists and keeping everything perfectly organized; however, if one thing slips out of place, I see the behaviors come right back. It is noticeable enough for co-workers to comment (albeit nicely). I have recently turned down promotions because I felt I could not handle the newer workload. I am 48 years old. Am I too old to start meds for this condition? — M.F.

DEAR READER >> Attention deficit hyperactivity disorder is a common condition, affecting about 4 percent of adults in the U.S. The condition certainly may have been undiagnosed when you were a child and teen. I have had many adult patients who, after being diagnosed, got treatment and saw improved function.

The first step is establishing a correct diagnosis. The World Health Organization has created a self-administered screening test (available at add.org/adhd-test/) which can give an idea whether consulting an expert is reasonable.

I can’t comment on what the appropriate treatment might be. Medication is one option, but so is psychotherapy, especially cognitive-behavioral therapy.

DEAR DR. ROACH >> Iam a 74-year-old female who has regular annual checkups with a family physician. My physicals last about 15 minutes and often seem perfunctory and incomplete. Besides the physical examination and annual labs, I am considering a mobile testing group that does preventive screening for several early-risk health issues at an affordable cost. My physician does not support these screenings. What is your opinion? — J.L.M.

DEAR READER >> Without knowing what your physician is doing or the details of the screening you are considering, I can’t answer directly. However, I suspect the optimum may be in between those two. It is possible that your physician isn’t taking your concerns seriously, or that he or she isn’t ordering appropriate tests for you. On the other hand, some services commonly provided by wellness screening programs are recommended against by expert groups, such as carotid artery ultrasound and stress tests in asymptomatic people (screening, by definition, is done in people with no symptoms). In low-risk people, test results are more likely to be falsepositive and can lead to more unnecessary tests and procedures, and are overall more likely to harm than to help.

Contact Dr. Roach at ToYourGoodHealth@ med.cornell.edu.