People over 50 also suffer from ADHD (and these are the signs to detect it)

Recklessness, absent-mindedness, forgetfulness, or, more worryingly, reckless driving or impulsive acts that endanger the lives of others, or your own... If you think you share these behaviors, perhaps what you are actually sharing are the symptoms associated with Attention Deficit Hyperactivity Disorder (ADHD), a pathology that, although it is almost automatically associated with childhood or adolescence, the truth is that it is not exclusive to this age group.

However, although it can affect the adult population, it is undoubtedly a prevalent disorder in children. According to data from the Spanish Association of Pediatrics, its incidence in school-aged children is around 7%, and persists in 4.5% of adults.

It's an irrefutable fact that ADHD is diagnosed more often in childhood and adolescence than in adulthood. This is because, among other reasons, "ADHD symptoms are more evident in children than in adults," says Dr. Adrián Cano, co-director of the Department of Psychiatry at the University of Navarra Clinic. He adds: "Adults have a greater capacity to unconsciously hide certain symptoms that, for many of them, go unnoticed because they have always been part of their way of life."

But what signs is the doctor referring to? Are they different from those that manifest in children and adolescents? Although they appear to be the same (inattention, impulsivity/hyperactivity, and emotional dysregulation), "their expression differs in adults. In adults, emotional dysregulation occurs less frequently and is usually internalizing (emotional disturbances); adult hyperactivity/impulsivity will manifest itself with acts of recklessness, impatience, constant interruptions , heightened levels of discussion, reckless driving, impulsive acts that can put one's life or the lives of others at risk... and inattention generally manifests as disorganization, disorder, difficulties in planning, errors in executing tasks, absent-mindedness, forgetfulness," he describes. Furthermore, "we must consider that all these symptoms impact the patient's personal, professional, and family dynamics," Cano adds.

Now, on the one hand, there are all these behaviors and attitudes that the environment perceives, and on the other, what the expert sees in the consultation. In this case, as the doctor explains, ADHD is "a neurodevelopmental disorder characterized by hyperactivity, impulsivity, attention deficit disorder, and emotional dysregulation, which is caused by an alteration in the neurotransmission of dopamine and norepinephrine in certain brain areas—primarily the prefrontal cortex."

It is not easy to diagnose

Currently, this diagnosis in adults is possibly made less frequently than it should be. "This is due to the difficulty of diagnosing adults, since the predominant symptomatology is inattention, and it often goes unnoticed. Another reason," the doctor continues, "is that it is a disorder that is highly associated with other more recognizable psychiatric pathologies, or even, sometimes, the symptoms overlap. And, perhaps also today, another reason may be the lack of training or knowledge among health professionals , or even disbelief or lack of recognition of the disorder despite its inclusion in the main diagnostic guidelines."

The predominant symptom in adults is inattention, which often goes unnoticed.

Beyond these obstacles that doctors encounter in reaching a diagnosis, it is estimated that "in adults, ADHD has a prevalence of around 3 %, and is very similar between men and women."

On the other hand, the question of whether these adults with ADHD are actually children who were not diagnosed at the time and who have been carrying the disorder ever since is interesting. In this regard, the doctor states that "more and more adults are being diagnosed whose symptoms went unnoticed in childhood, although there are studies that suspect the onset of ADHD in adulthood ." On the other hand, "studies show that 75% of children or adolescents diagnosed with ADHD continue to require treatment into adulthood," he adds.

Reasons to suspect

So far, we've seen the main difficulties specialists face in arriving at an ADHD diagnosis. However, the first step is to listen to the patient, and to do so, they must attend a consultation, something that isn't common among adults. In many cases, according to Dr. Cano, "parents of children diagnosed with ADHD come to the consultation and report having the same symptoms as their children, or that they identify with them."

On the other hand, the expert identifies a very diverse typology of patients. “University students frequently come to us due to a decline in their academic performance. It's also common for people with apparent affective symptoms—anxiety, depression—to present, and after an in-depth interview, symptoms of ADHD are identified, not only in the present but from their childhood, and which are currently causing difficulties in their interpersonal, professional, or family life .”

In any case, by seeking medical advice, patients are reducing their risk of further illness, since "the consequences of not adequately treating ADHD are unpredictable and will depend greatly on the patient's psychopathology, its influence on their daily life, and whether or not they have comorbid conditions. However, inadequate treatment can lead to a deterioration in relationships, work, interpersonal, and family problems, putting their lives and the lives of others at risk, and, above all, increasing their vulnerability to affective disorders (anxiety and depression), addictions, and even, in extreme cases, suicide."

To avoid this string of unwanted consequences, the doctor believes that the most appropriate treatment should be designed from a holistic perspective, "taking into account healthy lifestyle issues (sleep management, electronic devices, nutrition, physical exercise, etc.), individual or group psychotherapy, with a psychopharmacological approach being essential."

In this regard, "psychostimulant drugs, such as lisdexamfetamine or methylphenidate, are used as first-line agents. If these are not tolerated or there is a poor response, so-called non-psychostimulant drugs—guanfacine and atomoxetine—can be used, and some antidepressants such as bupropion or reboxetine can also be used," the doctor advises.