Is There a Unique Type of ADHD with Adult Onset

Is There a Unique Type of ADHD with an Adult Onset?

00:00 Introduction and Discussion of Acquired ADHD Secondary to Brain Injuries
02:25 The Controversy starting in 2015 about a unique onset group of adults with ADHD
04:40 Why the DSM criterion for age of onset of age 12 has no scientific basis and should be discarded
07:54 Other evidence that reports of adult onset of ADHD are not reliable nor accurate
10:00 A critical review of the evidence and alternative explanations for people reporting an adult onset to their ADHD
12:12. Summation of the evidence

This commentary focuses on the claim that ADHD can have an adult onset, rather than one during development, and that it may be a unique form of ADHD. The evidence reviewed suggests that this is not likely to be true for various reasons I discuss here

References used in the video:

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[SpecialEdDHD]

ADHD also gets worse once you hit mid-life. You may have been able to cope through life but once you hit 40 your mental and physical start to decline and you don't understand why you can't cope.

[johnbehan]

I've used to explain ADHD as "dementia backwards", because you get better as you get older and develop more coping systems. ... Then I hit my mid-forties like a speeding car. I'm more messy and forgetful than ever, and working twice as hard to stay organised and motivated. As an ADHDer, I didn't feel like I needed yet another humbling experience to teach me about shooting my big mouth off, but hey.

[flawlix]

I think I fall into the category of “had symptoms in childhood but wasn’t impaired.” My mom was a super involved parent and taught me what I now realize were pretty common coping skills. They carried me through high school, but I had a harder time in college and law school (my first year in both was rough until I found my footing). And I had a really hard time once I entered the working world, which is what lead to my eventual ADHD diagnosis.

[kv_]

We may lack awareness of our adhd - our family members are undiagnosed so we grow up thinking we’re normal and just need to “try harder” like our parents and grandparents did. My family is still in denial and now my youngest sister is suffering from it, presenting very serious impairments but doesn’t believe she has it. I was also in denial until a few years ago despite being on adhd medication for over 10 years. (Diagnosed at 24)

[KF]

This might be an unpopular opinion in this comment section, but whatever the cause or the diagnosis, if a person has executive function, focus, emotional regulation and motivational problems, they should be able to get treatment. I'm not sure if I had ADHD symptoms as a child. Not saying I did or didn't but pretty much everything in my life currently looks like the effects of untreated ADHD and my doctor agreed just based off of that and we tried medication.

The lowest doses of ADHD stimulant meds made a whole world of difference! I spent a lot of time seeing many doctors and therapists, trying antidepressants and anti-anxiety meds. Those kinds of medications did nothing but sedate me. Now I actually found something that works and whatever you want to call my condition/diagnosis, I could care less. The meds work, period.

The medical field always wants to categorize you into a box as if the science is done and the boxes that we have are all-encompassing . Psychological disorder diagnosis and treatments are more subjective and less concrete than physical issues, and even physical diagnoses have a long way to go.

[valerieconrad]

I know I've had adhd symptoms throughout childhood. I was never particularly impaired because I am quick to learn and get things done. Yes, I procrastinated like crazy, but it never was considered abnormal at my house. In fact, I think it was largely missed because I was the baseline normal child for my parents, and I'm pretty sure my mom also has adhd. In my 20s and now into my 30s, I go through ranges of impairment with some periods being worse than others. I finally decided to get some answers, and as of 2 days ago, I have an official diagnosis at age 35.

[ginnyjanisse]

I agree that onset of the condition and then the onset of symptoms may not always correlate. Especially if you have inattentive or combined-type, where the outward behavior associated with childhood onset are mostly obscured. I know I have struggled with this neurodivergence my whole life, but I never knew what it was due to the hyperactivity part almost never being there. If I just tried hard enough I was able to overcome most of my learning struggles, until I reached higher learning where compensating didn’t cut it. Thank you for going over this as a subject that is easy to misunderstand and oversimplify.

[TheKaurK]

I don’t know if I ever had symptoms as a child, or if my parents compensated.. but all my ADHD symptoms appeared big time after being in a car accident and going through the emotional trauma of losing my father in that accident (a drunk person took a sharp turn and crashed into us). I was 13 then and I know I have never been the same since. To me it feels like there was a clear distinction between what my brain could do before and after that incident. All my focus, my motivation, my processing speed, ability to retain stupid simple stuff- everything took a major hit and I have struggled with it all ever since and I feel that the symptoms only worsened as I reached adulthood. I have coped and survived and went to college and held a job and have felt consistently overwhelmed for years. I used to call it brain fog but I only just found out that maybe I have ADHD at 30 years old. I don’t know if it’s because it’s the inattentive type, or the symptoms are mild enough, or that I am a brown woman and grew up where anything to do with mental issue was heavily stigmatized, or what... I know there’s anxiety etc that can cause similar symptoms but ultimately I don’t have a clear cut label to help me because of the DSM requirement of showing clear symptoms before 12. I am fortunately getting the help I need because my doctor gets that I am struggling regardless of not neatly fitting into a box.

[Trammiliin_nr]

I had to go to 3 different doctors to get ADHD diagnosis. In my childhood ADHD symptoms were my smallest issue. I grew up in extremely abusive and neglectful family with PTSD, and having signs of ADHD really didn't stand out from that mess. From my adolescence years to 40's I suffered from cycles of depression and burnouts every 3 to 5 years. When I finally after some years of trauma therapy figured out, it's ADHD, it was bloody hard to convince the doctors. Although my brother has it diagnosed (in late 30's) and my mother has very clear signs but refuses to get diagnosed.

First doctor said if I had ADHD it must have been diagnosed in my childhood and I probably have some other mental disorder. I grew up in a post-soviet country and was kid in 90's. No one even had heard of ADHD back then, how on Earth my messed up parents should have noticed my ADHD and took me to doctor? Second doctor wasn't sure whether it's PTSD or ADHD. The psychologist who interviewed me at the second place asked questions like how hard it was for my parents to handle my temper, supervise my school work etc before age of 12. I just could not answer those questions because they didn't even try to parent me, I was parented by myself. There was an option to have this interview together with a parent who could describe how I was as a child but I didn't see it as an option because my only living parent has no idea how I was as a child. So, the psychologist concluded that I did not have ADHD symptoms before age of 12. Third doctor was initially convinced all the ADHD symptoms I have could be explained with a list of other mental health disorders from depression to personality disorders. But finally I took some tests and it showed I do have ADHD. The whole process took 8 months.

So this childhood onset topic is bloody frustrating for me. Especially kids who grew up in chaos, abuse and neglect due to their parents' mental health and substance abuse issues can't really tell did they have ADHD symptoms already in childhood. And at the same time ADHD parents are more prone to be dysfunctional.

[publius]

This is one of your best in my opinion. Thank you for all you do. There is so much that needs to be done to repair the field, but I think an important thing most psychiatrists need to address is the loss of childhood records and the defensive and sometimes hostile nature of parents to diagnosis as they find it to be criticism of their own parenting in some form. Secondly, understanding that old diagnoses for family members may have been misdiagnosis based on understanding of the time. Basically, you need to be able to work with a puzzle with missing pieces.
Also, I noticed you mentioned various cause of brain injury, but did not specifically mention car accidents - is there a reason? I think this would be one of the most common reasons for frontal lobe damage in any car dependent culture. Also, metabolic changes in either disease or age. No need for extremes like gun shot trauma.

[BryanAllenSmith]

I'm curious on why certain people were disqualified from the claim that they had ADHD because they drank or used drugs? I thought that it was a higher chance to abuse alcohol or drugs if you had ADHD

[SingingCrowie]

A big problem is that for other conditions that impair brain afunctions you won't get medication to aid it, so people would prefer to have ADHD diagnosis to simply be able to live their lives

[KhosroParviz-yf]

I am in my early 40s and decided to get a PhD two years ago. Although, I had established several coping mechanism to get two master's degrees (heavy procrastination ), it seems they are no longer useful in PhD and I am thinking about quitting after a year and half without any progress. I was stubborn, nasty and disorganized as far as I can remember. But that was not a major issue. Now, i need organization and the ability to concentrate on long term tasks like paper writing. I also need to spend twice time on reading because i lose my consciousness (attention) several times while reading and need to go back and reread. I really can't. It is no longer solvable by last hour studying or using the deadline pressure as a motivator. No more energy for fighting. I can barely remember my childhood. I was straight A till end of primary school. And C or D afterward. And i had discipline problems till mid high school. Those are all i can recall. And maybe some specific events.
Can it be ADHD? Can the medicine change me? Or simply the PhD is not my job and i have to quite? If I have had ADHD but can't remember the age of unset, then what? 🤔

[CapnSnackbeard]

I have always had ADHD, but it has gotten more pronounced the older I have gotten. My parents still don't believe it, but I have never been any different. My habits never changed. In fact, I leaned into them, and built them up.

I was a bright kid. It was being released from school, and allowed to posess myself and my time, that my so-called "intelligence" has blossomed.

I am still terrible at arithmatic, and am number dyslexic. Yet I can intuitively engage with mathematics on a high level so long as the thing I am thinking about is "grown" in my own mind, and NOT placed there in isolation, in no particular order, for no discernable reason.

School provides both instant and delayed feedback to performance. I was able to "concentrate" in school because of fear.

Fear. That is why I "did not have ADHD until I was an adult." As an adult, I have always avoided that arrangement. I don't like or want bosses.

I function like a superhero when surrounded by my other ADHD and autistic friends.

I now live and work in an environment with no need of money, paperwork, or other trivialities that consume the lives of the "healthy" and "normal."

[TylinaVespart]

Could it also be that as time goes on we (hopefully!) get better at recognising adhd? Thinking here about how many of us didn’t get diagnosed as children, even where it was present and visible with hindsight.
Edit; Oh you say this about 30 seconds after I commented 😂 once again foiled by my impulse to comment while still watching.

[deel]

menopause, menopause, menopause, being female. I've met so many women now who've been diagnosed while going through menopause. not one of them fit this mould (no private education, no help to cope etc) they all say they struggled when they were growing up or they excelled. all of them say that life became unbearable through menopause and they were diagnosed. so the question remains are these women developing ADHD through menopause or were they simply missed out. what's interesting to me is that I know 2 women who were told that their ADHD had developed due to menopause and therefore they had Adult Onset ADHD.

[adultADHDindia]

ADHD is still seen as a childhood disorder world over. DSM contributed to it by defining age of onset. Now too late to undo the damage. Might as well embrace adult ADHD so people understand even adults can have ADHD (onset till age 30).

[andreafeelsfantastic]

I love the helpful talks you put up! Thank you so much for making all this education freely available.

[thebeatles]

I learn more from you than I do my graduate studies. What are your thoughts on the supposition that psychiatry is largely still in "belief" of the medical model? Isn't it widely established now that biopsychosocial has superseded it? For example, some of these new cases of ADHD could be onset from the past few years of worldwide heavy drug, alcohol, and social media use, etc, resulting from pandemic coping?

Until we have medical tests such as with somatic diseases, where we stick someone in a machine and it spits out if their brain is "ADHD" or not, it's seems the most logical conclusion. I feel like if the symptoms match, you have a dx and can start treatment--restoration of function should be the only goal, and as you pointed out etiology seems to be largely irrelevant if the patient/client is getting better.

Thank you so much for your work and it inspires much thought, and I'd love to hear your thoughts on this and any guidance you may have.

[stef.ma]

Question regarding age of onset - what should one do if diagnosed negative for adhd predominantly bc symptoms didn’t start developing before adolescence and weren’t visible by age 12? The clinic responsible insists they did everything based on newest evidence by following these dsm-5 guidelines