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Prevalence of attention-deficit hyperactivity disorder in older adults in the Netherlands

  • Marieke Michielsen (a1), Evert Semeijn (a1), Hannie C. Comijs (a2), Peter van de Ven (a3), Aartjan T. F. Beekman (a2), Dorly J. H. Deeg (a4) and J. J. Sandra Kooij (a5)...
Abstract
Background

Little is known about the prevalence of attention-deficit hyperactivity disorder (ADHD) among older adults.

Aims

To estimate the prevalence of the syndromatic and symptomatic DSM-IV ADHD diagnosis in older adults in The Netherlands.

Method

Data were used from the Longitudinal Aging Study Amsterdam (LASA). At baseline, 1494 participants were screened with an ADHD questionnaire and in 231 respondents a structured diagnostic interview was administered. The weighted prevalence of ADHD was calculated.

Results

The estimated prevalence rate of syndromatic ADHD in older adults was 2.8%; for symptomatic ADHD the rate was 4.2%. Younger elderly adults (60–70 years) reported significantly more ADHD symptoms than older elderly adults (71–94 years).

Conclusions

This is the first epidemiological study on ADHD in older persons. With a prevalence of 2.8% the study demonstrates that ADHD does not fade or disappear in adulthood and that it is a topic very much worthy of further study.

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Copyright
Corresponding author
Marieke Michielsen, VU University Medical Centre Amsterdam, Van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands. Email: m.michielsen@vumc.nl
Footnotes
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The LASA is supported in large part by the Ministry of Health, Wellbeing and Sports of the Dutch Government. This study was funded by Shire.

Declaration of interest

A.T.F.B. has received an unrestricted research grant from Eli Lilly and AstraZeneca and has been a speaker for Lundbeck and Eli Lilly. J.J.S.K. is a speaker for Eli Lilly, Janssen and Shire and has received unrestricted research grants for this study from Shire, as well as for another study from Janssen.

Footnotes
References
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Prevalence of attention-deficit hyperactivity disorder in older adults in the Netherlands

  • Marieke Michielsen (a1), Evert Semeijn (a1), Hannie C. Comijs (a2), Peter van de Ven (a3), Aartjan T. F. Beekman (a2), Dorly J. H. Deeg (a4) and J. J. Sandra Kooij (a5)...
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Prevalence of attention-deficit hyperactivity disorder in older adults in the Netherlands

RAJDEEP ROUTH, ST5 Old Age Psychiatry
26 October 2012

We read with interest the article by Michielsen et al.1 The authors while describing the background and aim of this study mention that ADHD could lead to significant impairment in older age without providing evidence of such impairment. Certainly from clinical experience and previous studies we know that there are other mental disorders like Depressive illness, Anxiety disorder and Dementia which are relatively common in older age and likely to cause either similar or more severe impairment. The authors discuss this in some detail in their description of the limitations of this study but fail to consider thiswhen drawing a conclusion about prevalence.

It is essential according to DSM IV criteria for a diagnosis of ADHD to rule out any possibility of the symptoms being better accounted for by another mental disorder.2 Unfortunately the authors do not rule this out while studying the prevalence despite using a diagnostic instrument strongly based on the DSM IV criteria.

Before we start diagnosing ADHD in older age groups it is important to exclude more prevalent and widely recognised mental health problems such as Mild Cognitive Impairment and Dementia. Looking at the diagnostic instrument DIVA 2.0 we can easily identify many symptoms which can be morereadily explained by other more prevalent functional and organic illnesses.3 This explains why the DIVA 2.0 (as the authors in this study rightly mentions), has no evidence for its use in old age. Is retrospective data collected from an older person's recall of being inattentive or hyperactive as a child in different situations valid? More so when DSM IV clearly advices caution for diagnosing this even in adults without any corroborating information which was missing in this study.

We would thus suggest extreme caution before we start even suggestingthe concept of ADHD in older adults and taking this any further. There aregreater and more relevant issues in older age that need to be tackled before we start inventing any new diagnoses.

References:

Michielsen M, Semeijn E, Comijs HC, Van de Ven P, Beekman ATF, Deeg, DJH and Kooij JJS. Prevalence of attention-deficit hyperactivity disorder in older adults in the Netherlands. The British Journal of Psychiatry 2012; 201: 298-305.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision (DSM-IV-TR). APA, 2000.

Kooij JJS, Francken MH. DIVA 2.0. Diagnostic Interview Voor ADHD in Adults bij volwassenen [DIVA 2.0. Diagnostic Interview ADHD in Adults]. DIVA Foundation, 2010.

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Conflict of interest: None declared

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Attention-Deficit Hyperactivity Disorder over the lifespan

Richard Braithwaite, Consultant Psychiatrist
26 October 2012

Dear Sir,

Michielsen and colleagues conclude that the personality traits they call attention-deficit hyperactivity disorder (ADHD) "do not fade or disappear in adulthood" (1). Yet such a gradual extinction throughout lifeis precisely what their study proves.

The authors quote prevalences from previous studies as high as 7% in children and 4.4% in working age adults. Their own study shows a prevalence in old age of 2.8%, with higher rates in the 60- to 70-year agegroup (4.0%) than in those over 70 (1.1%). In other words, there is a steady decline in the prevalence of ADHD-caseness throughout life, way over and above that which could plausibly be caused by higher mortality amongst impulsive individuals.

These data show conclusively that, in common with many problematic personality styles, poor attention, impulsivity and hyperactivity tend to gradually lessen in intensity with age. Thus the study is further evidencethat ADHD merely represents a cluster of personality traits which, given their high prevalence, cannot even be considered abnormal, rather than a disease entity.

I remain, Sir, your obedient servant,

Dr Rich Braithwaite

Consultant Psychiatrist

Disclaimer: The views expressed are those of the author and are not necessarily shared by his employer.

1. Michielsen, M et al. Prevalence of attention-deficit hyperactivitydisorder in older adults in The Netherlands. Br J Psychiatry 2012; 201: 298-305.

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Conflict of interest: None declared

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