DÄ internationalArchive44/2008Attention Deficit Hyperactivity Disorder in Adulthood: Exclusion Diagnosis

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Attention Deficit Hyperactivity Disorder in Adulthood: Exclusion Diagnosis

Dtsch Arztebl Int 2008; 105(44): 764. DOI: 10.3238/arztebl.2008.0764a
by Dr. med. Alexandra Philipsen, Priv.-Doz. Dr. med. Bernd Heßlinger, Prof. Dr. med. Ludger Tebartz van Elst in volume 17/2008

Calia, G

LNSLNS The phenomenon of underdiagnosed ADHD in adulthood is balanced by the number of (often) misdiagnosed cases of ADHD in children and adolescents. ADHD should always be an exclusion diagnosis-that is, all alternative physical or psychiatric differential diagnoses and psychodynamic treatment approaches should be excluded. Diagnosis and treatment of ADHD should in my opinion be the remit of child and adolescent psychiatrists and psychiatrists. Further to the article, I would like to encourage in addition to symptoms evaluation forms-for example, according to ICD-and their adaptation for adults, "double blind trials" using methylphenidate with the patients' consent, in order to make a diagnosis (placebo versus methylphenidate), so as to have an additional indication of the diagnosis in patients in whom the drug shows positive effects-which is easy to spot owing to its prompt efficacy. Writing samples after taking methylphenidate may also be indicative of a diagnosis if the [patient's handwriting is clearly improved, as well as concentration tests with and without methylphenidate. Thorough diagnostic testing (for depression, intelligence, personality, concentration) is the standard in diagnosing ADHD in children and adolescents and should in my opinion also be considered in adults (for example, by using Beck's depression inventory {BDI), the Hamburg-Wechsler intelligence test for adults, personality questionnaires, concentration tests). As child and adolescent psychiatrists, some of us are very familiar with the problem of "off label" use for most psychopharmacological preparations, for example in the field of atypical neuroleptics. It is incumbent on the pharmaceutical industry and health policymakers to abolish unnecessary obstacles. I hope that the diagnosis and treatment of ADHD can become established beyond adolescence. DOI: 10.3238/arztebl.2008.0764a

Giulio Calia
LWL-Klinik Hamm
Heithofer Allee 64
59071 Hamm, Germany
g.calia@wkp-lwl.org

Conflict of interest statement
The author declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.

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