Attention Deficit Disorder has a complicated history in recent decades in psychiatry. This diagnosis used to be considered almost exclusively in children and only for the most obvious cases, largely in boys with hyperactivity. As the clinical approach to this diagnosis has changed and matured, psychiatrists have to consider this diagnosis much more frequently for a variety of reasons.
First, women often were overlooked and the diagnosis was either missed or instead misdiagnosed as depression, anxiety or laziness. Girls had hyperactivity less frequently and so their symptoms were not noticed often enough. Plus, the internal gender bias in previous generations prioritized girls’ academic success much less.
Second, psychiatry now considers the diagnosis of ADD much more as a possibility when differentiating possible causes for poor concentration or academic/professional success. So adults who were not diagnosed as children discover ADD may be something they have struggled with for their entire and seek treatment.
Third, stimulants like Adderall and Ritalin, previously seen in a negative cultural light, are now on the border between a medication to treat ADD and a neuroenhancer which enables people to hyper-focus for periods of intense work.
Last, research into the diagnosis of ADD is primarily focused on children. There is no valid standardized testing to diagnose ADD in adults. Although testing can be done, it is far from definitive which leaves the ultimate diagnosis in the hands of the psychiatrist.
Thus, ADD represents a diagnosis that has shifted both in clinical and cultural norms in recent decades. Any psychiatrist is challenged to try to distinguish between the various reasons an adult may be asking to be evaluated for a disorder not easily or clearly diagnosed.
When an eating disorder is present as well, the muddied waters become almost too difficult to navigate. Since eating disorders can cause very similar symptoms to ADD, the process of a formal diagnosis is difficult if not impossible to ascertain.
The diagnosis is based on best guesses using a patient’s history and overall symptoms through childhood and adulthood. Sometimes a trial of a stimulant is the only way to differentiate cognitive deficits caused by an eating disorder from true ADD.
Due to these difficulties, many eating disorder patients end up taking stimulants long term. I’ll discuss how best to manage this complicated scenario in the next post.
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