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Late diagnosis for many with ADHD or ADD does not happen until adulthood even though their symptoms have been present, in one form or another, since childhood. Undiagnosed and untreated ADHD can lead to a lifetime of emotional turmoil and difficulty.

Late Diagnosis versus Inaccurate Diagnosis

Often a diagnosis, when finally given, is not an accurate one, leading to a common reason for a late or delayed ADHD diagnosis. Adults with ADHD tend to receive a diagnosis of depression with the focus of treatment and medications used dealing with the depressed mood, leaving ADHD undiagnosed and untreated. While depression may be present along with ADHD, it is common for the inexperienced mental health professional to treat the “most obvious” leaving their patient with continued frustration, life disorganization, and social difficulties.

Late Diagnosis ADHD Steps of Acceptance

Many adults find difficulty in coming to terms when they finally received an accurate late diagnosis of ADHD. Some of the common steps to self-acceptance through the treatment process include:

• Denial – even with relief that a correct diagnosis and treatment is in place, it may take a period of time to accept the diagnosis and understand how treatment will change your life
• Anger – many feel anger over past lost opportunities, at others for not seeking help for them sooner, at the unfairness of life in general, or with all the difficulties faced in life because of the undiagnosed ADHD
• Depression – medication may not cure all the difficulties experienced with life and social relationships even though there is much improvement with less overall frustration. Many need time to adjust to a new lifestyle, sometimes wanting to return to old familiar ways even with all the daily struggles involved.
• Acceptance – with support, education, medications prescribed, cognitive behavioral therapy, adjustment to a different type of lifestyle, or just with the passage of time, most are able to accept the late diagnosis of adult ADHD and enjoy the positive changes.

Late Diagnosis Adult ADHD Implications

The serious impact of failing to treat ADHD continues throughout adulthood. Adults with unmedicated ADHD are 78% more likely to be addicted to tobacco and 58% more likely to use illegal drugs than those without ADHD. Additionally, 79% of adults with ADHD report symptoms of anxiety, depression, and physical ailments. Symptoms of ADHD interfere with personal relationships and reduce chances of personal satisfaction with life choices. Left undiagnosed and untreated ADHD is among the most debilitating disorders to live with.

Late Diagnosis Adult ADHD Psychiatrist

Left undiagnosed and untreated ADHD is among the most debilitating disorders to live with. If you feel you may have ADHD, call Dr. Hege for a comprehensive evaluation for an accurate diagnosis which may include late diagnosis adult ADHD.

Recent research presented at the 2017 European College of Neuropsychopharmacology Conference (ECNP) in Paris, France, has presented the theory that many of ADHD cases may be in fact an issue associated with a lack of regular circadian sleep. Past data does show that approximately 75% of adults with ADHD also have sleep problem but the medical field has thought that to be a separate problem.

Sleep Problem and Adult ADHD

There is extensive evidence that indicates adults with ADHD also tend to display sleep problems. In a theory presented at this year’s ECNP data was presented that suggests that ADHD and circadian problems (sleep issues) are intertwined in a majority of patients. While all ADHD problems may not be associated with circadian patterns, it does appear to be an important element.

ADHD and Physiological Sleep Phase

Symptoms and behaviors indicating a connection between adult ADHD and circadian or sleep problem rhythm include:

• Changes in level of sleep hormone melatonin delayed by 1.5 hours from those without diagnosis of ADHD
• Changes in sleep-related movement patterns are delayed
• Core body temperatures associated with sleep are delayed which corresponds to the delay of melatonin changes
• Those with ADHD often have great alertness in the evening (opposite of the general population)
• Sleep related disorders associated with adult ADHD include restless leg syndrome, sleep apnea, and delayed sleep phase syndrome
• Approximately 70% of those diagnosed with adult ADHD show over-sensitivity to light, with many needing to wear sunglasses during the day; this light sensitivity may be associated with a circadian shift.

While a disturbance of the natural sleep or circadian system may be physiologically connected to ADHD, it may also have links to other mental illnesses like depression or bipolar disorder. Further research will help in the development of alternative or adjunct therapies, such as bright light therapy or use of melatonin in the evening, to be used as part of a comprehensive ADHD treatment plan for those with a sleep problem.

Adult ADHD Treatment Options

Call Dr. Hege for a comprehensive mental health evaluation to determine all adult ADHD treatment options, including medication and adjunct therapies, available for your individual needs.

For those adults with ADHD, a common reported problem centers around the struggle with time management. Many with adult ADHD find themselves running late, not getting work done on time, difficulty organizing their time effectively, or just finding themselves out of sync with the rest of the world when it comes to following a routine time table.

Effects of Being Out of Sync with ADHD

Adults with ADHD may find they complete things too fast, making mistakes or leaving the task incomplete in their haste; others lose track of time or mismanage their time and find they end up being late for appointments or task completion. No matter if someone is too fast or too slow they feel a struggle to be in sync with the world around them, often feeling frustrated, anxious, ill-prepared, lagging behind or restless in the process.

Being Out of Sync Part of ADHD Experience

In the paper on adult ADHD written by Mikka Nielsen and recently published in Medical Anthropology, it was concluded that those with ADHD experience a state of desynchronization and inner restlessness with their surroundings and social connections, feeling like they are out of rhythm, out of sync, with the rest of the world.

Examples of Being Out of Sync with ADHD

Some common experiences where time management and feeling out of sync come into play include:

• Difficulty with predicting or estimating how long a task will take to complete
• Thinking about the present and not being able to plan effectively for the future
• Typically running late for appointments or meetings
• Finding yourself impatient and wanting to move on to the next thing
• Looking for short-term rewards
• Difficulty dealing with delayed gratification
• Following an atypical sleep-wake schedule

Adult ADHD Help Available

If you find yourself constantly out of sync with the clock, schedules, and appointments, or feel scattered and unsure of how to manage and organize your time in a more functional and effective manner, it may be time to seek the help of an experienced specialist. If you are feel that you are letting yourself and others down by your poor time management, or that you do not feel a sense of accomplishment in life, it is time to seek help and treatment.

Local Adult ADHD Psychiatrist

It is time for a change. End the constant struggle. Call Dr. Hege for a confidential appointment today.

Reprinted from boston.com

Ritalin and other drugs used to treat attention deficit disorder are safe for adults’ hearts, even though they can increase blood pressure and heart rate, according to the largest study of these medicines in adults.

The results echo findings in a study of children with ADHD, by the same researchers, published last month.

The review of health records for more than 440,000 adults aged 25 to 64 showed those taking ADHD drugs had about the same number of heart attacks, strokes and sudden heart-related deaths as adults who didn’t use those drugs.

Although attention deficit disorder is usually thought of as a condition in childhood, many continue to have symptoms as adults, including impulsive, fidgety behavior and difficulty focusing or paying attention. ADHD affects about 4 percent of U.S. adults, roughly 9 million. About 8 percent of U.S. children aged 3 to 17, or 5 million kids, have ever been diagnosed with the disorder, government statistics show.

More than 1.5 million U.S. adults were taking stimulants used for ADHD in 2005, and use of ADHD drugs increased more rapidly in adults than in kids over the past decade, the study said.

The research will be published in the Journal of the American Medical Association’s Dec. 28 print edition, but was released online Monday because of its public health importance, journal editors said.

More than 150,000 ADHD medication users were involved in several states. Their health records over up to 20 years were compared with similar adults who did not use those drugs.

Overall, there were 1,357 heart attacks, 575 strokes and 296 sudden cardiac deaths. Roughly equal numbers occurred in ADHD drug users and nonusers.

Study participants used the drugs for an average of less than a year, which is short, but the upper range of use was almost 14 years, and there was no sign of increasing risk with longer use, the authors said, led by Laurel Habel of the research division at Kaiser Permanente Northern California in Oakland.

A journal editorial says the study provides encouraging news, given lingering concerns about isolated reports of heart problems and sudden deaths in users of some ADHD drugs.

The findings support the Food and Drug Administration’s decision in 2006 against putting a black box warning about serious heart events on ADHD drug labels. But despite the results, medical histories and exams should still be performed for all patients before starting ADHD drugs, and periodic evaluations should be done during drug treatment, said editorial author Dr. Philip Shaw of the National Human Genome Research Institute.

The federal Agency for Healthcare Research and Quality and the FDA helped pay for the study

See original article at http://articles.boston.com/2011-12-12/lifestyle/30507967_1_adhd-drugs-attention-deficit-disorder-heart-attacks

Adult ADHD (Attention Deficit Hyperactivity Disorder) affects 4.4 % of adults. Hallmark adult ADHD symptoms are inattention, distractibility, and impulsivity. If you have adult ADHD, the symptoms were present in childhood but may not have become a prominent problem until adulthood. As adults, we accumulate an increasing burden of responsibilities. These responsibilities include marriage, family, job, and finances. Our brain's ability to filter and prioritize the multitude of demands placed upon it may be overwhelmed. Expectations of us as mature, responsible adults include modulating our anger and fears, listening to and hearing our spouses and bosses explicit and implied instructions, and to be able to focus and concentrate to read required reports and instructions. If we have the drag of ADHD present, we may become "stressed out", depressed, overly anxious, or turn to alcohol, drug, or medication abuse. If the patient presents for help at this point, the overlying problem of depression, anxiety, or substance abuse may be diagnosed and treated. However, the foundational problem of ADHD may be missed. Unless the ADHD is successfully treated, the person may improve temporarily but still struggle unnecessarily and be more prone to relapsing to another bout of depression, anxiety, or substance abuse.

What is ADHD

Is ADHD a real medical condition that justifies treatment with medication? The popular media quite also describe it as a questionable diagnosis, or overdiagnosed, or treated with unnecessary medication. Critics suggest the symptoms of hyperactivity, inattention, and impulsivity are merely extreme variations of normal human traits. Their criticism further attributes the cause to over demanding parents, poor teachers skills, and an over competitive society.
In scientific literature the majority view ADHD as a valid and common psychiatric disorder of childhood. A set of criteria for establishing in a psychiatric condition as a valid psychiatric disorder was established by Robins and Guze in 1970. This became the framework for how all diagnoses get included in the American Psychiatric Association’s diagnostic manual. These criteria all require that scientific studies have had been done and support every one of the six criteria.
Following are the six criteria required to make a classification of a cluster of signs and symptoms as a valid psychiatric condition:

1. CLINICAL CORRELATES
“A valid diagnosis needs to be reliably identified through a consistent pattern of signs and symptoms demarcating it from other disorders and from psychiatric wellness.”
This means that if a group of doctors independently evaluated the same group of patients and use the same test to diagnose the patients, there is high agreement as to which patients did have the disorder and which did not have ADHD. Numerous scientific studies have established the high reliability of different rating scales for the diagnosis of ADHD.

Also, a diagnosis of a condition cannot be made if the symptoms of that condition do not cause significant impairments. Studies have documented inferior academic performance, reduced social skills, inattention in the duration of focus on a single task, impulsivity disrupting schoolwork, and hyperactivity causing fidgeting and talking excessively. Impairments continue into adolescence with high rates of delinquency, more arrests, and higher risk of substance abuse disorders. Other studies document higher rates of injury, cycling injuries, and pedestrian injuries. Driving performance impairment leads to higher accident rates and traffic citations.

2. DELIMITATION FROM OTHER DISORDERS
This means that ADHD is a condition that is separate from other diagnoses. It isn’t a cluster of signs and symptoms and impairments that is actually part of another diagnosis. Symptoms of major depression, generalized anxiety, and bipolar disorder often include symptoms that overlap with ADHD. For example, hyperactivity and reduced concentration are common in major depression. However, when patients that are diagnosed with major depression and ADHD have the symptoms that are part of major depression subtracted from their ADHD diagnosis, the majority of these dual diagnosed patients still meet the criteria for ADHD. Also, when the symptoms of ADHD were removed from patients with a dual diagnosis that included major depression, most of them still met the criteria for major depression.

This overlapping or comorbid occurrence of two or more psychiatric diagnoses in an individual is common. Interestingly, when family studies are done, some conditions such as ADHD and depression tend to run together in families. Other conditions as anxiety disorders and ADHD run independent of each other.

Impairments and other negative consequences in ADHD patients cannot be all explained away by coexisting conditions of conduct disorder, major depression, and learning disabilities. For example, rates of arrest, drug abuse, and executive dysfunction are elevated in ADHD. These problems are further elevated it conduct disorder is also present.

3. COURSE AND OUTCOME
A valid psychiatric disorder needs to have a characteristic course and outcome. Long-term studies showed childhood ADHD is a chronic disorder that survived into adulthood in a significant number of patients. While many fail to meet the full strict criteria for the condition in adulthood, 90% retained significant symptoms to have persistent significant clinical impairments. Numerous studies report that ADHD has a natural course that provides another method ofdelimiting it from other disorders. For example, if symptoms of ADHD occur intermittently along with episodes of another disorder, this would not be viewed as evidence of ADHD because of lack of chronic persistence of symptoms.

4. EVIDENCE FOR HERITABILITY FROM FAMILY AND GENETIC STUDIES
ADHD meets the criteria for being a scientifically based disorder on neurologic grounds of being heritable. Numerous family studies and genetic studies provide evidence.

Family studies found parents and siblings of ADHD children have a 2-8 fold increased risk of being ADHD. All 15 twin studies showed increased risk in the twin of an ADHD child. The risk was 75% for familial status of having ADHD. Consequently, only 25% of this is due to environmental factors. The studies came from families from around the world (US, UK, Australia and Sweden). Studies from all of these countries are in agreement that there is an inherited risk for ADHD.

Adoption studies provide further evidence of the genetic influence on risks for ADHD. Biologic relatives of ADHD children have higher rates of ADHD than adopted relatives.

Molecular genetics studies found strong association between several neurotransmitter genes and ADHD. These neurotransmitters are dopamine, norepinephrine, and serotonin. They are implicated in causing ADHD and are involved in the therapeutic effects of ADHD medications.

5. LABORATORY STUDIES
Another method of developing evidence to support a neurobiological connection of ADHD diagnoses is laboratory studies. PET scan studies found evidence of defective dopamine transporter function in the striatal region of the brain of ADHD patients. These were performed on live patients with real-time images of metabolic activity. Scientifically controlled studies of the physical structure of brain of ADHD patients compared to normal found evidence of abnormal structures in parts of the brain. Ten controlled studies of brain function found abnormalities in multiple areas of the brain of ADHD patients. While the particular parts of the brain were not consistently involved in the different ADHD patients, the findings were consistent with their knowledge of brain pathways and systems involved in the regulation of complex behaviors that may be involved in the motor control, in attention, and executive function deficits seen in ADHD.

6. TREATMENT RESPONSE
The validity of a diagnosis is bolstered if patients with a defined condition respond to a particular medication treatment. Many controlled studies provide evidence of the high rate of treatment response of methylphenidate in reducing overactivity, impulsiveness, and inattentiveness. In addition to improving ADHD symptoms, many studies provide strong evidence of the medication effectiveness in reducing ADHD-related impairments in children and adults. Other medications besides stimulants have been proven to be effective in ADHD patients. These include tricyclics and atomoxetine(Strattera). All of these medications have been shown to block norepinephrine and/or dopamine reuptake at receptor site. While this data provides additional evidence of the validity of the ADHD diagnosis, they do not mean that this treatment response should be used as a method to make the diagnosis. Stimulant medications can improve cognition and attention in non-ADHD individuals just as high blood pressure medicine may reduce blood pressure in people with normal blood pressure .

DISCUSSION
Numerous studies provide enough evidence that ADHD meets the six criteria of Robinson and Guze standard criteria:
“………
1) ADHD patients show a characteristic pattern of hyperactivity, inattention, and impulsivity that lead to adverse outcomes.
2) ADHD can be distinguished from other psychiatric disorders including those with which it is frequently comorbid.
3) Longitudinal studies show ADHD is not an episodic disorder. It is always chronic and sometimes remits in adolescence or adulthood.
4) Twin studies show ADHD is a highly heritable disorder, as heritable as schizophrenia or bipolar disorder. And molecular genetic studies have discovered genes that explain some of the disorder’s genetic transmission.
5) Neuroimaging studies show that ADHD patients have abnormalities in the motor control frontal-cortical-cerebellar pathways involved in the control of attention, inhibition, and motor behavior.
6) Most ADHD patients show a therapeutic response to medications that block the dopamine or norepinephrine transporter.
…….”

One concern is that most studies have been done with the most severe examples of ADHD who are referred to doctors and clinics.Thus, the studied populations may not represent the whole spectrum of severity of symptoms and impairments. Therefore, it would not be valid to generalize the facts about these patients to nonreferred ADHD patients in the community. However, two of the criteria for the diagnosis of ADHD are based on wide population studies. (1) Several epidemiologic studies have been supportive because they found the clinical features of ADHD in these community population samples. (2) and several studies were done with population samples demonstrating the high heritability of ADHD in cases that are not necessarily the most severe cases.

Another group of critics argue that ADHD signs and symptoms are better viewed as a normal continuous varying spectrum of traits rather than a disorder. The problem with this argument is that even normal variation can be a disorder if the more extreme cases suffer distress or disability. An example is how the normal variations of blood pressure and serum cholesterol level become medically urgent disorders in the more extreme levels.

Other critics argue that because there is not 100% agreement of results among different studies, a diagnosis is not valid. However, the preponderance of the evidence is overwhelmingly supports that ADHD is a valid diagnosis, especially when careful reviews of the different studies and meta-analysis studies were done.

Some critics hold the opinion that ADHD impairments are due to a highly competitive society, failure of parenting and teaching, or societal intolerance of extreme but normal symptoms. However, the genetic and neurobiological evidence is too strong to totally discount. There obviously are environmental factors that contribute to whether or not a person develops ADHD. There Is much evidence that ADHD’s causes are multifactorial, caused by the addition and interplay of genes and environmental risk factors.

Parents and patients with ADHD often have misgivings about accepting help and medication for ADHD. When they encounter misunderstanding about the diagnostic validity of ADHD, their resistance grows. Corrective education from medical and mental-health professionals may be the first step in helping distressed ADHD patients to get help that will bring them relief and success in their lives.

Written by Dr. Darvin Hege, M.D. on January 8, 2010 with content drawn heavily from the following article:

The scientific foundation for understanding attention-deficit/hyperactivity disorder as a valid psychiatric disorder. Faraone SV. Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY 13210, USA. faraones@upstate.edu

Dr. Darvin Hege has 25 years of experience dealing with patients who may fit the criteria for ADHD and may need a medication like Adderall for ADHD. He offers evening and weekend office hours at his Atlanta, GA practice. Call today at 770-458-0007 to discuss getting an ADHD evaluation and for help deciding the most effective and safest treatment.

Currently, 4.4% of the adult population has ADHD (Attention Deficit Hyperactivity Disorder). This disorder is present from childhood, but many times it is not diagnosed until the person reaches adulthood and takes on more responsibility such as what is required when managing finances and jobs, and when interacting with spouses or significant others or their children. Under these additional demands, the attributes of ADHD (inattention, distractibility, and impulsivity) may become more prevalent.

Dr. Darvin Hege, an Atlanta psychiatrist, says it is important for people who have become depressed, overly anxious, or have turned to alcohol, drug, or medication abuse to help them deal with the stresses of life, be evaluated for ADHD. Many times if a patient seeks help for these concerns, " the overlying problem of depression, anxiety, or substance abuse may be diagnosed and treated. However, the foundational problem of ADHD may be missed. Unless the ADHD is successfully treated, the person may improve temporarily but still struggle unnecessarily and be more prone to relapsing to another bout of depression, anxiety, or substance abuse".

How could it be that the foundational problem of ADHD may be missed? Dr. Hege advises that the symptoms of ADHD can change from childhood to adulthood. Since the hyperactivity portion of ADHD tends to diminish in adults, the diagnosis of ADHD may be missed in an adult. Inattentiveness generally remains from childhood, however, and this is the predominant symptom of adult ADHD. The medications that are prescribed for ADHD help the inattentiveness of ADHD more than the hyperactivity of the disorder, so these medications can be very successful in helping with core symptoms. One of the medications he commonly prescribes for ADHD is Adderall.

Adderall has been around for about 20 years and was first marketed as a weight loss and diet control drug called Obetrol. In 1996, the FDA approved Adderall for ADHD treatment and it has since become one of the more widely prescribed medications for the treatment of the disorder. Doctors and patients who use the drug say it has less "peaks and valleys" than Ritalin, so it is more user-friendly.

Adderall is a psychostimulant. In other words, it is a central nervous system stimulant or an amphetamine. It affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control.

One reason Dr. Hege uses Adderall for ADHD is that it is a mixture of four drugs from the amphetamine family that provides a broad spectrum of coverage. He notes that there are several pros to this group of drugs:

• they take effect quickly (in about one hour).
• they leave the blood quickly (in about 4-12 hours). Because of this, you do not need to take the medication every day so you can take them on a day when you'll need the extra assistance.
• 75-80% of people who have ADHD improve when takingAdderall for ADHD or something from the psychostimulant group of medications.

Anything with a "pro" has to have a "con" and there are some cons to consider when taking Adderall for ADHD:

• Because the medicine only works for 4-12 hours, work or study in the afternoon or evening may require additional doses.
• Because it takes about one hour for the medication to take effect, if you have trouble getting up for the alarm clock or getting organized in the morning, you will have to wait for the medication to take effect.
• If you have used an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam) within the past 14 days, you should not take Adderall. Serious, life-threatening side effects can occur if you take Adderall before the MAO inhibitor has cleared from your body.
• It has a significant risk for abuse and/or addiction.

The most common side effects of Adderall are restlessness, dizziness, insomnia, headache, dryness of the mouth, and weight loss.

Dr. Hege recommends an ADHD evaluation if you or those around you have concerns about your inattention, impulsiveness, and distractibility. 

Dr. Darvin Hege has 25 years of experience dealing with patients who may fit the criteria for ADHD and may need a medication like Adderall for ADHD. He offers evening and weekend office hours at his Atlanta, GA practice. Call today at 770-458-0007 to discuss getting an ADHD evaluation and for help deciding the most effective and safest treatment. 

Dramatic savings can be achieved with this strategy if you're willing to accept some inconvenience and a period of adjustment. Vyvanse, Adderall XR, Concerta, Focalin XR, and Dexedrine Spansules cost at least $125 per month if you are on one pill a day because they cost about four dollars per pill. If you need 2 or 3 pills per day, that costs $250 or $375 per month. Generic Adderall costs $.35 per pill at Costco. If you take 2 or 3 Adderalls per day, that's $.70 to $1 per day or about $20 to $30 per month. Here's how I implement this strategy for the most consistent focusing all day.
I have my patients set a daily alert in their cell phone to go off at a time in the morning soon after they arise each day. They promptly take their first dose of generic Adderall, Ritalin, Dexedrine, or Focalin for the day. Then they note how long it is until the benefit of the first dose starts to decline. The next day they set their second daily alert for each day at a time that is 30 minutes before their focus begins to decline. This way they take the next dose to be replacing the falling brain concentrations of the previous dose. This prevents a dip in focus between doses. Alerts are then set for the third and fourth doses of the day, as necessary, with the same interval between alerts as between the first and second alerts. My patients are reporting significant improvement in their work and school performance, more consistent and improved mood, and avoiding daytime crashes between doses. Crashes are the periods of tiredness, sleepiness, irritability, or easy crying from a rapid drop-off in ADHD medication brain concentrations.
When switching my patients from a more expensive, longer acting ADHD medication to the cheap, shorter acting, generic substitute, we start out on very low doses and then move up the doses gradually. This way we avoid side effects, find the most effective dose, adjust the period between doses, and adjust the size and time of the last dose of the day to prevent difficulty falling asleep.
For more information on how to save money on psychiatric medications, see my blog about affordable psychiatric medications http://www.eveningpsychiatrist.blogspot.com To make an appointment with Dr. Hege for evaluation and treatment for adult ADHD,
Call 770-458-0007.