Is there any benefit to an ADHD diagnosis as an adult?

[Shewas]

I've started to wonder about myself and since I started doing some research, loads of those sound bite reels about ADHD in older women keep popping up in FB. Many of them are uncanny in the way they describe me, especially my reaction to rejection, and the procrastination followed by god mode to never miss a deadline.

But, at 56, is there any point making the effort/spending the money to have it formally diagnosed?

Can i ask how?

Thanks for posting this. We have a family history of both dementia and ADHD on the female side so this is really interesting

Interesting! Didn’t know that. I recently read that people with ADHD have between a 2.3 and 2.6 x risk of developing diabetes. I don’t know if taking the medication impacts that - although I think it does in my case because I have a tendency to impulse eat sweet treats and that doesn’t happen on medication. I am very careful with my diet now. I already have a chronic illness (ME/CFS) and I don’t want to add diabetes to that list. Dementia would be even worse. And incidentally, although there is little scientific evidence, anecdotally my ME/doctor and ADHD doctor both said that they thought there was a link between ADHD and ME/CFS because they have a surprising number of patients with both.

That link would not surprise me one bit. There is also a link between both ADHD and rheumatoid arthritis (and therefore probably other autoimmune conditions as they hunt in packs) being triggered by childhood emotional abuse.

To the ADHD sceptics, you do have to have the gene set to be triggered, though, much like schizophrenia which most ADHD sceptics have no trouble understanding actually exists.

Agree witb you that scoring above the threshold on the ASRS sceener does not mean a person has ADHD.

The 3-4% adult ADHD rate I cited from the ADHD Uk website actually includes undiagnosed people too. I’m sure I read somewhere that under 2% of adults have been diagnosed. Might have been 1.6???

Did you actually read my post? Of course I know that the ASRS is a screening tool that is used to refer people for a full assessment. Hence the combination of stats around positive screening and conversion from referral to diagnosis (i.e. 95%). This gives a likely diagnosis rate. Look at the subclinical ADHD report I linked upthread from the British Journal of Psychiatry that is consistent with the screening/conversion stats as it finds that around 25% of young adults receive an ADHD diagnosis and a similar amount have subclinical ADHD traits linked with negative behaviour. It really is a lot more prevalent in some age groups using our current diagnostic method than a few percent.

This also ties in with the 53% of gen Z self reporting as having ADHD:

https://www.deloitte.com/global/en/about/people/social-responsibility/global-inclusion.html

The data is all out there.

Scoring above the threshold on the ASRS screener in a study is not the same as believing that you have ADHD. I think that study just highlights that a lot of people have ADHD-like behaviour. We all know there are activities or probably foods that may cause ADHD-like behaviour but that is obviously not the same as ADHD because when you remove the ‘bad’ activity of food or whatever, then the ADHD-like behaviour pattern diminishes.

If DC2 is anything to go by the opposite can be true witb the ASRS. DC2 was diagnosed by a consultant psychiatrist who has decades of experience in diagnosing ADHD and yet scored below the threshold on the ASRS. I asked the psychiatrist why and she said it was because DC2 had little self awareness.

As part of the pre-assessment process for an ADHD diagnosis (I have been involved in an NHS one and two private ones and they were much the same) the patient is given multiple screeners and also asked lots of open-ended questions about their past. The doctors then assess all this paperwork and decide whether it is worth conducting a full assessment.

I have been considering seeking diagnosis, especially as my symptoms seem to be getting worse as I get older but keep putting it off as it's so overwhelming to get started. But the risk of dementia might be the push I need.

I have also been involved in multiple ADHD diagnoses. The ASRS has been primary screening tool every time. There is a very high chance you will be referred for a full assessment if you have a positive ASRS result. Having a negative ASRS doesn't mean you don't have ADHD either. It's just a screener. What we do know though is that there is an extremely high conversion rate from referral to diagnosis in many clinics.

I find it so puzzling you seem to genuinely believe that people with subclinical ADHD are just exhibiting ADHD behaviour that's been exacerbated by lifestyle choices whilst people with an ADHD diagnosis have 'genuine' ADHD that is neurodevelopmental. The science suggests the opposite. Firstly the report I referenced is linking subclinical ADHD traits with undesirable behaviour. Undesirable behaviour can both exacerbate ADHD traits in anyone (diagnosis or not) but also can be the result of having unmanaged ADHD traits. It's often a chicken and egg scenario. What's true is that improving lifestyle factors often diminishes ADHD like patterns in both the subclinical and clinical.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10444659/
https://pmc.ncbi.nlm.nih.gov/articles/PMC5382165/

Subclinical ADHD is identical in cause and nature to ADHD. The only difference is often the level of impairment. If you are conducting your life in way that will exacerbate ADHD traits then this could be enough to push someone into clinical diagnosis territory.

https://pmc.ncbi.nlm.nih.gov/articles/PMC12001924/

Again, I must emphasise. Subclinical and clinical ADHD are basically the same thing. Your insistence that it is more binary than it actually is goes against science.

A man who works on his family's farm doing a million and one different tasks as the animals, crops, seasons and weather demands is far less likely to be diagnosed with ADHD than a man who has been sacked from 3 office jobs in the last year for lack of attention to detail, missing deadlines and making inappropriate comments.

They'll both have the same level of ADHD but how much impairment is very dependant on context.

I know you know this, I'm giving a simple explanation for the hard of understanding 😁

I didn’t say ADHD is binary. The symptoms
are on a continuum and the threshold for diagnosis is, I think it is fair to say, the current best guess. As scientists conduct more research and their understanding of ADHD improves, the diagnostic criteria have been broadened - which is another argument that people (incorrectly in my view) use to ‘prove’ that many people are misdiagnosed. The current threshold represents the scientific/medical concensus. Some think the diagnostic criteria are too broad and some think they are still too narrow. Before about 1990 very few girls were diagnosed. The criteria have been revised several times.

I'm sick of people saying all people have neuro diverse traits.

Yes that's true. Neuro typical people may have a small subset of neuro diverse traits, or be affected periodically and for a limited time by a neuro diverse trait.

The neurodiverse have a whole range of neurodiverse traits all the time.

IMO, there's no such thing as a neurotypical person who has lots of neurodiverse traits all the time. That's simply a neurodiverse person without a diagnosis.

No , it doesn't reflect the scientific consensus. America has a different threshold and has 12% of it's children diagnosed with ADHD whilst 3.5% of British children have a diagnosis. We know that American children are broadly similar in behaviour to British children and other children from countries with different diagnosis rates.

https://pmc.ncbi.nlm.nih.gov/articles/PMC1525089

There isn't a scientific consensus even now. It's is hugely controversial and complicated. What we do know is that people with clinical ADHD are not necessarily fundamentally differently wired to those with subclinical ADHD. The threshold is very subjective hence why so many countries have different ones and why we have revised our threshold so often. There is very little certainty in this area.

I completely disagree. I think there are lots of people with ND traits that impact them a lot of the time. That's why there are so many subclinical cases picked up on studies and there is proven link between BAP for example and negative outcomes. The same is true for ADHD

The findings of subthreshold ADHD cases have a very similar pattern of comorbidity and spectrum of functional impairments as full threshold ADHD cases on several outcome variables. Data from several studies showed that both subthreshold ADHD and full threshold ADHD groups had similarly high rates of psychiatric comorbidities that were significantly different from controls (Scahill et al., 1999; Kim et al., 2009; Biederman et al., 2018). Additionally, both the subthreshold ADHD and full threshold ADHD groups had a greater risk for grade retention and graduation failure relative to controls (Bussing et al., 2010), and they were more likely to be placed in a special class or to receive extra help in school (Biederman et al., 2018). Notably, participants with full threshold ADHD and subthreshold ADHD also showed similar patterns of cognitive impairment and executive dysfunction (Scahill et al., 1999; DeBono et al., 2012; Hong et al., 2014; Biederman et al., 2018). It is notable that there were significant differences between the subthreshold ADHD and control groups given that many of the studies (7/9) included control group participants who had other psychopathologies. We would expect even more stark differences between these two groups if the controls had included only children with ADHD and no other psychopathologies. Taken together, these results support the notion that psychiatric and cognitive impairments are strongly associated with the symptomatic picture of ADHD whether at or below the diagnostic threshold
https://pmc.ncbi.nlm.nih.gov/articles/PMC8084709/

I think our choices are that we either look to encompass more people in the diagnostic models or we accept that people that don't meet the current threshold for various conditions are clearly still hugely impacted by ND traits. What we can't do though is pretend that there aren't a huge amount of people that exist in the grey currently. Clearly not NT but their traits and behaviours don't fit neatly into the diagnostic criteria.

There is considerable certainty about the heritability, neurobiology and clinical significance of ADHD but much less so about where the threshold for diagnosis should lie - I would imagine that will always be the case unless someone can come up with a definitive yes or no test.

Saying people with ADHD are “differently wired” is fair enough although obviously is a clumsy or amateur way to write it. It would be more precise to say that scientists have found several measurable neurobiological differences at the group level but these differences cannot be examined on an individual level for a diagnosis. Scientists and doctors have known (or at least have very strong evidence) for decades about differences in dopamine signaling in ADHD.

I’ve no idea why diagnosis rates are higher in the USA but I do know they healthcare system works in a totally different way and is mainly private so that may well have something to do with it.

If DD2, diagnosed with ADHD inattentive type were running a farm, it wouldn’t be a farm - it would be a nature reserve. No cows would get milked, as left to her own devices, she turns day into night. Crops would be planted or harvested 5 months too late. Bills wouldn’t get paid. She’d forget appointments for the milking machinery to be serviced…..

When she did her cycling proficiency, the examiner told me, she didn’t seem aware of what was going on around her. She’s never felt up to learning to drive, because if she can’t cope with three saucepans on the hob, how could she cope with streams of traffic around her? Never mind a tractor?

Besides which, life is not just about work - it’s about relationships, money, life admin, children (who could have ADHD themselves)…..all of which can be impacted by ADHD. Look at the studies on ADHD and car crashes!

Rates are higher due to the medical system but also the different threshold that is easier to hit. Are they right or are we right? Clearly it's completely subjective. I linked in my post just now how subclinical threshold is associated with similar poor outcomes to clinical ADHD. This is clearly problematic from a clinical threshold perspective. Why are we looking to exclude people from the ADHD umbrella by denying them a diagnosis when we know their lives are adversely impacted by their traits? It's hard to justify from a public policy perspective.

We know ADHD traits are inherited, similarly to virtually all other traits. This isn't justification for medicalisation. Neurobiology simply means they can see differences at a population level with structure and connectivity. We can also see this with highly intelligent or kind people. Again we don't medicalise these things. Extreme ADHD is certainly considered clinically significant. The bits around the threshold are less certain. Someone just below the threshold is going to be very similar to someone just above it. Subclinical ADHD has similar negative outcomes to clinical ADHD so we either need to broaden the condition to include everyone impacted adversely in a similar way (this could be circa 50% of the population is some age groups) or we need to adjust the threshold so that only the more severe cases are diagnosed and other people are encouraged to manage their symptoms as part of a relatively 'normal' part of the human condition. If half of the population have clinical or subclinical ADHD then these are the questions we need to ask ourselves rather than hiding behind 3/4% hypothetical figures.

Yeah, but like attracts like 😆

I could say the same- "it seems like my whole friend group is ND". That's because, when I meet new people, some veer away with a look of ill- concealed horror on their faces within 5 minutes, and some are obviously kindred spirits. You can almost see a light bulb going on in their brains- "Ah! Someone I can talk 500 words a minute to about late stage capitalism/ train connections/an extremely traumatic event that happened in my childhood/ how pheasants are destroying the ecosystem!"

Friends are to a large degree self selecting.

Well I agree that neurobiology does not justify medicalisation but that is Ok because the diagnosis is not based on neurobiolgy, it is based on traits and impairment. You only get diagnosed with ADHD if the traits are causing clinically significant difficulties. That is the justification for medicalisation. The other justification, I would assume, is that we know that ADHD stimulants have been in use for decades and they work for many people.

The neurobiological differences are relevant in that they add weight to the significant body of evidence that ADHD is a neurodevelopmental disorder.

I don’t know where you have got the figure of 50% of some groups have ADHD or subclinical ADHD. Did you guess? It sounds highly unlikely to me. The 14% of people who are above the ASRS threshold on the NHS study you mention earlier feels like a more reasonable guesstimate.

Why do you not accept the estimated figures from ADHD UK, The Lancet and NICE that around 3-4% of UK adults have ADHD? I would presume that many experts have considered this and that the numbers are based on some level of evidence.

Although I do agree that people that currently fall just below the diagnostic threshold may be having significant difficulties and deserve support.

If you screen positive in the ASRS then you have an extremely chance of referral and then you have more than 90% chance of receiving a diagnosis at many clinics. In the NHS data I linked, 25% of young adults screened positive using the ASRS test. The study I linked verified these findings and found that a similar amount of young people had subclinical ADHD. It therefore stands to reason that for this age group around 50% of people have either clinical or subclinical ADHD. Other age groups will have lower rates hence the average 14% figure being screened positively for ADHD in the data. It is highly likely these people would receive an ADHD diagnosis as opposed to being considered subclinical in the current diagnostic process. This is why I'm highly cynical about the 3-4% figure. My estimated are not made up but based on data and reports that I have linked on this thread.

So you are adding the figure of two separate studies together to come to the conclusion that 50% or some group of people have ADHD or subclinical ADHD? How do you know that the two studies represent separate non-overlapping groups? And did they use exactly the same definitions for everything? And what is the definition for subclinical ADHD anyway?

Surely the people at ADHD UK are aware of all this and yet they don’t mention in their info?

the 90% diagnosis rate after a positive ASRS is misleading as previously discused, clinicians weed out people who they are unlikely to be able to diagnose before they get to the assessment, so by the time of the assessment most people are diagnosed Also, I’m presuming that not everyone who scores positive on the screener requests a diagnosis.

So yes the thresholds for diagnosis are debatable and you have a point that they may not be capturing everyone that has clinically significant impairments. I expect that the criteria will most probably change again in the future once more research has borne fruit, and yes the 3-4% estimate for adults with ADHD will likely change too. I highly doubt the idea that 50% of young adults effectively have ADHD. It just feels like too much of massive leap. And if that’s the case, surely other age groups would look broadly similar?

I think you're disagreeing with something I didn't say.

I think it depends on how much the supposed ADHD is effecting your life .
If your really struggling and finding many aspects of life difficult,then of course a diagnosis will help .. because you can try medication
For me ..I was spending all day desperate to get back to bed because I couldn't cope.i was barely leaving the house ,and had horrendous anxiety,it was stopping me living, stopping me going anywhere.
I'm now on ritalin and living a normal life ,free of anxiety,I can leave the house ..I just put my shoes on and go ..
I can honestly say ritalin has changed my life

No, they are figures from the same study. The study I linked earlier from the British Journal of Psychiatry. So concerns regarding overlap and different definitions are alleviated.

The ASRS is the primary screening tool for NHS. I don't know why you think loads of people are being clinically screened out via other methods. When do you think this happens? In my experience the screening pretty much guarantees you an assessment unless there is an obvious alternative diagnosis that explains the positive screening which is rare. If people don't choose to pursue a diagnosis it doesn't mean they don't have ADHD so they should still count in prevelance statistics. It is data from these studies using ASRS screening that helps to catch those who choose not to get diagnosed.

Every piece of research suggests that ADHD skews for age and deprivation (poor children are twice as likely to be diagnosed with ADHD ). All of this should be alarming as obviously a truly genetic neurodevelopmental disorder wouldn't show this level of variance within groups.

If children from poor families are more likely to have ADHD, that does nor disprove that there is a strong hereditary element to ADHD because most health issues are impacted by environmental and social factors too. Eg Asthma runs in families but is more prevalent and more severe among people in lower socio-economic groups.