sábado, 12 de febrero de 2011

El TDAH sigue en la edad adulta, pero ¿mejorá?

Can You Outgrow A.D.H.D.? Or Get It as an Adult?

Deanna Wheeler, a reporter for the Lake Sun Leader, did not learn that she had A.D.H.D. until she was in college. She grew up in a large family, where constant activity was the norm.Dan Gill for The New York Times Deanna Wheeler, a reporter in Missouri, did not learn that she had A.D.H.D. until she was in college. She is among those featured in Patient Voices: A.D.H.D.

If you have attention deficit hyperactivity disorder, or A.D.H.D., as a child, do symptoms ease with age? Can you have adult-onset A.D.H.D.? These are among the questions recently posed by readers of the Consults blog.

Dr. Russell A. Barkley, clinical professor of psychiatry at the Medical University of South Carolina, responds. His books include "A.D.H.D. in Adults: What the Science Says" and, most recently, "Taking Charge of Adult A.D.H.D.," both from Guilford Press.

Do A.D.H.D. Symptoms Ease With Age?

Q.

Does A.D.H.D. generally improve with age? In other words, if A.D.H.D. persists into adulthood, is it expected to improve as the brain develops into a person's late 20s?
Rhett, Charleston, S.C.

A.

Dr. Barkley responds:

Research studies following children with A.D.H.D. to adulthood, including my own 20-year follow-up of children in Wisconsin, show that the symptoms of A.D.H.D. do decline with age, both in people with A.D.H.D. and in the general population. Even so, people with the disorder continue to have far more symptoms of the disorder than we see in the general population at any age.

My own research showed that 14 percent to 35 percent of children who had A.D.H.D. could be considered to have recovered or moved to within the normal range by the time they were 27. The reason for the range of recovery percentages simply has to do with how rigorously you want to define recovery. Defined loosely, about one-third no longer meet our criteria for this disorder in young adulthood. Defined more rigorously — at least two people report that the person's symptoms are no longer severe or inappropriate and are no longer impairing — and the figure falls to about 14 percent.

So, yes, some people do outgrow A.D.H.D. But most do not. The things that have been found to predict whose disorder persists are:

  • Severe symptoms in childhood. The more severe A.D.H.D. symptoms are early in life, the more likely they are to persist into adulthood.
  • The presence of a psychiatric disorder in addition to A.D.H.D.  Those who suffered from depression or other mental illnesses along with A.D.H.D. were more likely to have symptoms of A.D.H.D. as adults.
  • Having a mother with significant psychological problems also increased the risk that symptoms will continue into adulthood.

In short, A.D.H.D. seems to persist in most — but not all — cases. Even those children we followed who had recovered from the disorder had experienced significantly more school-related problems and tended to have less formal education. These educational setbacks can carry forward and affect adult life, even if someone no longer has the disorder.

Can You Have Adult-Onset A.D.H.D.?

Q.

Is it likely that in my 60s I would develop A.D.H.D.? My executive function has gone out the window in the past few years, and my partner insists that's not the only way I show the symptoms. (Including almost constant fidgeting!) So, is there late-onset A.D.H.D.? Or did I have it all along and it only got worse in the past three to five years?
Kenny Boy, Houston

A.

Dr. Barkley responds:

There is no evidence that A.D.H.D. can come on in mid- to late life unless it is a result of a brain injury or disease, in which case it is an acquired type of A.D.H.D. But aging does result in a decline in certain executive functions that can mimic some of the symptoms of A.D.H.D.

For instance, in our 60s and onward, working memory — or the ability to hold information in the mind about what you are doing, what goals you are pursuing, and why — declines in both sexes. As working memory decreases, we become more forgetful and less attentive to our goals and plans and the intentions of our actions. These symptoms can look like the inattention we see in A.D.H.D., which also causes problems with working memory. But these later-life declines in our executive abilities are not associated with other A.D.H.D.

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