Subtle Differences in Adult ADHD Compared to Pediatric ADHD

Kaveer Greywal, MD

It is often a misconception that attention deficit hyperactivity disorder (ADHD) is a disorder that primarily impacts pediatrics patients, often because the hyperactivity aspect of the disease tends to decline substantially by late adolescence.

This misconception is prevalent for both clinicians and laypersons.

However, the inattentiveness of the condition can persist into adulthood, with patients never outgrowing some of these symptoms.

A team, led by Kaveer Greywal, MD, Department of Psychiatry, New Bridge Medical Center, reviewed various differences between adult and pediatric ADHD in a poster presented at the 2021 American Psychiatric Association Annual Meeting.

Adults with ADHD

Recent studies have shown between 2-6% of the adult population suffers from ADHD. Another misconception of this patient population involves impairment in cognitive function.

“Many clinicians lean too heavily on academic or career achievement to rule in or rule out the condition,” the authors wrote. “The unfortunate reality for many ADHD sufferers is that their diagnosis is missed simply because they are performing “too well” in their academics or career for a clinician to deem them impaired.”

Misconceptions

However, there is no way for a clinician to know the baseline of a patient who presents with an impairment, leading to an assumption that a patient is performing “well” without the necessary knowledge to know if they are still performing below their baseline ability.

It is also true that adults with ADHD will present their illness somewhat differently than pediatric patients with ADHD.

“Adults with ADHD tend to display far more emotional dysregulation,” the authors wrote. “There is a high correlation of anxiety and depressive mood disorders with adult ADHD.”

It has been thought that by the time an ADHD patient reaches adulthood, the cumulative effect of years of underperformance results in a loss of self-esteem and a decreased faith in the patient’s own abilities.

This can lead to guilt and depression and anxiety regarding the likelihood of overcoming a future challenge.

Adults also have generally developed specific coping mechanisms but respond to cognitive behavioral therapy (CBT) similar to how pediatric patient. However, their therapy should target the subtle distinctions adults with ADHD face and their medication should target mood disorders as well as ADHD as a stand-alone entity.

Overdiagnosis

A recent study found evidence of overdiagnosis and overtreatment of ADHD in children and adolescents.

Investigators from the University of Sydney School of Public Health led by Luise Kazda, MPH, found long-term effects in diagnosing and treating ADHD in young patients with only mild symptoms. The overdiagnosis of ADHD may negatively affect those with less severe cases of the disease, as the harm outweighs the benefits of treatment.

Researchers found evidence that ADHD diagnoses did increase in 45 studies. The data revealed 30 studies estimated change in diagnostic prevalence of ADHD over time, with 27 showing increased trends in diagnoses.

Additional diagnoses may be on the milder side of ADHD spectrum, according to 25 studies. Five studies reported a small proportion of all diagnosed youths displayed severe ADHD behaviors.

The study, “Key Distinctions in the Diagnosis and Management of Adult Versus Pediatric ADHD,” was published online by the American Psychiatric Association.