Lenard A. Adler, MD: “Symptoms of ADHD Need to Go Back to Childhood”

Symptoms of ADHD do not appear out of thin air in adulthood, Lenard, A. Adler, from NYU Langone Health told HCPLive during the annual American Psychiatric Association (APA) conference in New York.¹

“The symptoms of ADHD need to go back to childhood,” Alder said in the interview.

He explained the diagnostic ADHD screening requires a significant onset of attentional, hyperactivity, or impulsivity symptoms in childhood. According to the Centers for Disease Control & Prevention (CDC), several inattentive or hyperactive-impulsive symptoms must be present before age 12 years for an ADHD diagnosis.² The symptoms also must be present in ≥ 2 settings such as home, school, or work.

“You don't have to have a full diagnosis, but the roots of the disorder have to be in childhood,” he said.

At APA, Alder presented a session called “ADHD Across the Lifespan: Getting Up to Speed” on the DSM criteria for diagnosing ADHD and why most adults remain undiagnosed and untreated. The presentation highlighted the importance of correctly diagnosing a patient. The presentation also showcased how the DSM only includes the core symptoms of inattention and hyperactivity-impulsivity in the diagnostic criteria, excluding the associated symptoms that may appear if someone has ADHD alongside a comorbid psychiatric disorder.

The associated symptoms tend to be more episodic. Symptom examples include executive dysfunction, executive function, deficits, emotional dysregulation, and sluggish cognitive tempo.

“Those symptoms are not…in the diagnostic manual, but they're highly comorbid and actually quite impairing,” Alder said. “They tend to occur almost as common as some of the core symptoms in ADHD, and they tend to not be as responsive to some of the pharmacologic interventions, so it's important for clinicians to be able to recognize them, and they will require potentially other treatments.”

Since they are less responsive than pharmacologic strategies, ADHD treatments are often taken alongside behavioral interventions such as cognitive behavioral therapy.

Following the pandemic, more patients have been diagnosed with ADHD, leading to a psychostimulant shortage. Although more ADHD treatments are in the investigational stage, Alder believes the current medications are effective and there just needs to be improvement in access, diagnoses, and getting the right medication to patients.

“Adult ADHD is a diagnosis where people can and should get better,” he said.

References

1. ^{Adler, L. “ADHD Across the Lifespan: Getting Up to Speed.” Session presented at American Psychiatric Association (APA) 2024 Annual Meeting. New York, NY. May 4 – 8, 2024.}
2. ^{Symptoms and Diagnosis of ADHD. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/diagnosis.html. Accessed May 9, 2024.}