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Attention-deficit hyperactivity disorder in adults and people with learning disability

Moore House, Lindum Terrace, Lincoln LN2 5RT, email: walid.sorour2{at}lpt.nhs.uk

Anne Thompson, Consultant in Old Age and Adolescent Psychiatry

Lincoln

Buckley et al (Psychiatric Bulletin, June 2006, 30, 251–253) describe the diagnosis and management of attention-deficit hyperactivity disorder (ADHD) in children and adults with and without learning disability. It is notable that across countries child psychiatrists are more confident in diagnosing and managing ADHD than colleagues in general adult psychiatry. Many factors may be responsible for this discrepancy.

Child psychiatrists place greater emphasis on development as an important aspect of history-taking and subsequent decision-making, in line with the College’s higher specialist training learning objectives ‘to assess a child’s developmental status to a clinically relevant level of accuracy so as to be able to understand clinical problems and their presentation within a developmental context’ (Higher Specialist Training Committee, 1999).

In adults, the diagnosis of ADHD can be more difficult as the ‘full’ triad of abnormalities needed to make the diagnosis might not be present and confirmation of onset during early childhood might not be possible. Moreover, the emphasis might change with age, with ADHD being considered the core problem during the early years, but later the most common comorbid condition of conduct disorder, which can later attract a diagnosis of dissocial personality disorder. Treatment may then focus on the use of anticonvulsants, lithium or selective serotonin reuptake inhibitors to help decrease impulsive, potentially aggressive behaviour, and ADHD symptoms may go untreated.

There are dilemmas when using psychostimulants in the general adult population, which include the potential to precipitate psychosis, issues of lack of shared care protocols with primary care (National Institute for Health and Clinical Excellence, 2006) and the possibility of drug diversion and misuse. These factors may influence the willingness of adult psychiatrists to diagnose and manage ADHD.

We feel that the study of Buckley et al highlights the importance of all psychiatrists having some experience of child and adolescent psychiatry in their training. Time will tell how the agenda of Modernising Medical Careers will facilitate this in England and Wales.

We agree with the suggestion of Buckley et al that a consensus statement is needed for the treatment of adults and patients with learning difficulties of all ages with ADHD.

References

HIGHER SPECIALIST TRAINING COMMITTEE (1999) Child & Adolescent Psychiatry Specialist Advisory Committee. Advisory Papers, p. 16 . London: Royal College of Psychiatrists.

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE (2006) Attention Deficit Hyperactivity Disorder (ADHD) — Methylphenidate, Atomoxetine and Dexamfetamine, p. 5. London: NICE. http://www.nice.org.uk/page.aspx?o=TA098guidance

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sorour, W. Articles by Thompson, A. Search for Related Content PubMed Articles by Sorour, W. Articles by Thompson, A.