FIL has ADHD

[BonnesVacances]

Is it worth getting an ADHD diagnosis for my FIL?

MIL is struggling to cope with him as he's been way worse since the lockdown and his behaviour is just escalating. His hyperactivity is such that he's off out every 10 mins. Visiting people who don't want to be visited. He's ordering random stuff on the internet and the house and garden are getting full of things they don't need, including food, and she's overwhelmed by it. He's painting furniture in the garden that doesn't want painting and he's only doing half of it so it looks awful.

And he won't listen to anything she says. He wants to buy two grass snakes for the garden and just gets really angry with her when she tries to stop him. She terrified he's going to come back from one of his trips out with them.

They are awaiting assessment from the Adult MH team and I'm assuming they will look at ADHD as they'll look at everything, but he was originally referred there because the GP suspected dementia (it's not that). He had delirium at Christmas as he had water retention which has been an ongoing problem for quite a while.

But I was wondering if they'd even medicate him at his age (70s) or just leave it and offer him CBT which wouldn't work.

I haven't got any experience of ADHD in the elderly but DS1 (8) has it.

I don't honestly think this sounds like ADHD, it's more like how a person with bipolar experiences a manic episode. Is it a recent development it has he always been like this?

Has he always been like this or is this new behaviour?
Who ruled out dementia?

I don't think ADHD necessarily manifests in this way in adults. He sounds more like my bi polar cousin.

This doesn’t sound like adhd. Much more like a mania.

I've adhd and agree with others, sounds more like manic episodes than adhd.

OP, you do need to wait until the OPMH (older persons mental health) team have assessed him

It could be any mental health disorder - only they will be able to advise what treatment will be appropriate including if medication is - we can't guess at it . They do a thorough assessment and may even order further tests such as scans before they diagnose.

Just to mention, there are different types of dementia -some of which can affect impulse control. Delirium is also very serious, it can take a while to recover from. Or it may be ADHD / any other mental health condition .

You can help by keeping list of symptoms, when they started, frequency, severity, any details of (+date) incidents, obsessions or behaviours you or mum have observed. They also ask for a bit of social history. Ensure OPMH get a copy of this.

I'm so sorry to hear you are going through this, it sounds worrying for both you and your mum.

I was going to say what PP has said. It sounds more bipolar or perhaps he does have some form of dementia. Not discounting the ADHD, but perhaps the other things have also kicked in lately.

I know very little about ADHD, but everything you describe sounds like my best friend's ex-husband who has a bipolar diagnosis. In his 'high' phases he was hyper active, impulsive, spent money (they didn't have) like water, was completely dismissive of anything anyone else said that didn't fit his vision and excitement of the moment. He also barely slept in these faces and would self medicate with alcohol to get some rest.

However, each of these 'high' phases ended with a crash into deep depression when he could barely function, speak, crawl out of bed. You don't describe that for your FIL.

Although he is now my BF's ex (she could not cope with his behaviour on his highs - bankrupted them, dangerously impulsive with the children, kept everyone awake all night) he now takes his medication more consistently and they co-parent well.

I was thinking it's more likely bipolar also

ADHD is a developmental condition, it's there from childhood. Of course none of us can diagnose a condition without qualifications and experience, but what you describe so far really doesn't sound like it.

Another one saying that’s not ADHD.

Thanks all. Very interesting. I realise it looks like it with what I've described, but I really don't think it's bi-polar. He doesn't have any depressive episodes and doesn't have any downtime. He's just on the go all the time.

He's always been just like a grown toddler. No self-control, extremely messy and leaves a trail of unfinished badly-done jobs in his wake as he's very cack-handed. He doesn't listen to what you say at all, as his mind has already moved onto the next thing he wants to say to you. We had put it down to him being an indulged only child tbh and possibly being on the spectrum in some way as his social skills are challenging too. But since lockdown his behaviour as been harder to cope with.

He did completely recover from the delirium at Christmas, though it did take a long time. They had ruled out dementia as he passed the tests at the doctors. We knew it was different from his usual behaviour as he was sleeping a lot then, was up in the night burning toast, and his ideas and projects got more fanciful.

Now he's just back to being like a whirlwind.

DS(16) thinks he (ie DS) might have ADHD and he presents very differently to FIL. But his is the inattentive kind. But while I was reading about it, it was like a lightbulb had gone off re FIL. I hope the Adult MH team will do a thorough assessment though and will pick up anything.

The team should be able to let you know in more detail I suppose.

I doubt they would recommend stimulant medication at his age due to the risk to his heart, but he may be offered a non-stimulant treatment. However these tend to be less effective for the more hyperactive type traits.

The problem is that ADHD affects much the same brain regions as deteriorate with age anyway so it can be difficult to tease out what's ageing vs what's ADHD.

Good luck with a diagnosis and treatment lan

Plan

My dad has frontal lobe dementia, he flew through dementia tests too but a lot of what you described fits his behaviour to a T.
Have a read up, it may help.

@BertieBotts

The team should be able to let you know in more detail I suppose.

I doubt they would recommend stimulant medication at his age due to the risk to his heart, but he may be offered a non-stimulant treatment. However these tend to be less effective for the more hyperactive type traits.

The problem is that ADHD affects much the same brain regions as deteriorate with age anyway so it can be difficult to tease out what's ageing vs what's ADHD.

Thanks. It does sound unlikely they'll medicate then as he has AF (not Aunt Flo ) too. It could also have all been exacerbated by age, but I think the lockdown has massively impacted, as it has done on many people of that age. He's also been told by his financial adviser to spend his money, so that will have also contributed to the increased spending. Like he's been given a green light to buy random garden ornaments that MIL thinks are hideous!

The hardest bit is MIL isn't coping so maybe I need to switch my focus to her and how we can help her manage this, rather than modifying FIL's behaviour. We have tried to say she should just put all the purchases in the garage and phone someone to come and take them away. But she's overwhelmed by everything, as she is also struggling post-lockdown too. So even this seems too big a task.

@balzamico

My dad has frontal lobe dementia, he flew through dementia tests too but a lot of what you described fits his behaviour to a T. Have a read up, it may help.

Thanks. I had come across that before but have just looked again. The thing is that none of his behaviour is new. It's just worse and unmanageable now. Whereas before it was just annoying but we accepted that's how he was.

I was talking to MIL just now and he came and interrupted to tell her he'd emailed someone about something unimportant. She just said "ok" nodded, then we went back to our conversation. He's always done that.

He wants to buy two grass snakes for the garden and just gets really angry with her when she tries to stop him. She terrified he's going to come back from one of his trips out with them. Reassure her that grass snakes are non-venomous, and if they don't like the garden they will just head off to somewhere that they prefer.

If he's in his 70s then he will probably have been referred to an older adults team and I suspect no-one there is going to make an adult ADHD diagnosis. It's not core business for an older person's psychiatrist (I am one) as there's not exactly many people in that age group being diagnosed with it. Honestly I would have no clue what to do about a suspicion of ADHD at that age. I have no relevant training or experience to bring to bear. It would be disingenuous of my to pretend I am a specialist in that particular subject because I am not so I would assess for stuff I do know about ie dementia, bipolar etc and rule those in or out but if you wanted a proper opinion on ADHD I'd have to refer to a specialist clinic with a very long waiting list.

I too think it sounds more like either mania or frontal lobe deterioration of some kind eg FTD or frontal variant AD. That could exacerbate previous personality traits.

If MIL could put up with him before and can't now then it suggests something has changed and therefore that this presentation is new and not lifelong therefore not neurodevelopmental. Although the other possibility is their environment has changed to be less permissive (lockdown) or she had less tolerance

Did he have a CT or MRI scan with the delirium? Delirium is a big risk factor for going on to have dementia even if you recover I'm afraid.

One more plea in fact on behalf of your specialist

Please don't go in there and say 'I think he has ADHD' Please just tell the Dr the symptoms and let them figure it out for themselves. If they don't come up with it then you can ask them 'I wonder if it might be x? did you consider x?'

When you Google it all first and have a pet theory then you tend to (consciously or unconsciously) present only what fits with that theory and leave other stuff out which leads to inaccurate diagnosis. It is a teeny tiny bit peeving if I am being ultra honest when people think Dr Google can do my job as well as I can. I obviously do not tell them that but I think it a bit. There is a whole tonne of stuff that goes into deciding a diagnosis and it's rarely as easy as ticking symptoms off on a checklist or anyone could do it. One of the main things about being a specialist is that you have seen such issues many times before and so you can tell if it fits a pattern or it doesn't and also you have an awareness of the wide variety of other things it could be.

I hope that's not rude. It's obviously human nature to speculate but please try to give the uncontaminated facts and let them draw their own conclusions

Mania and hypomania are possible problems here, added to any degenerative disorders of the brain.

How has your MIL coped with this behaviour for all this time?

Your FIL sounds exhausting.

As said it sounds like mania and he sounds extremely challenging

@OverTheRubicon

ADHD is a developmental condition, it's there from childhood. Of course none of us can diagnose a condition without qualifications and experience, but what you describe so far really doesn't sound like it.

Yes, it's there from childhood. A person now in their 70s would not have been diagnosed in childhood or when they were young because it wasn't on the radar then. (It must have existed, surely?)

The more i hear and read of ADHD, especially in women (it tends to inattentive rather than hyper in its presentation), the more I wonder if my own DM has it. She is 81 and a lot of her difficulties (with time management, impulsivity, inattention) are things she has always had.

I agree with others that what the OP's FIL is experiencing sounds rather more like mania. I hope the mental health team can give proper support, this must be very worrying.