Thursday, April 24, 2014
Attention Deficit Hyperactivity Disorder
Adult ADHD - Cognitive Impairment
I am 26 and male. 10 years ago, I was diagnosed as having depression, anxiety, and obsessive-compulsive disorder. A few years later, my diagnosis was changed to rapid cycling bipolar. Now, after being through about 15 medications and various doctors and diagnosis adjustments, my new doctor is telling me I might have adhd, that my mood swings are not convincingly of the bipolar type; I have many of the impulsive symptoms as well as severe cognitive impairment, like performing the most basic of tasks: organizing my day, consistently doing chores, paying attention in conversations,...
My question is this: how can we tell if cognitive impairment is directly due to adhd rather than the product of say major depression? I understand there is often co-morbidity, but is inattentiveness from adhd noticeably different than from other mental illnesses? For example is it more intense or more permanent?
All symptoms of ADHD can also be found in other disorders, especially mood and anxiety disorders.
In fact, poor concentration is one of the cardinal symptoms of depression, and psychomotor agitation is another, which can be confused with hyperactivity. Impulsiveness is found in many disorders. This is the reason for ADHD Criterion E of the diagnostic manual, that the symptoms not be better explained by another disorder. Some of the differences are that depression and anxiety may be more variable over time, perhaps start later in life, may have additional symptoms besides ADHD symptoms, and may occur only in certain settings, while ADHD starts early and is fairly consistent over time and across settings.
Of course, as you say, it is not unusual to have comorbidity, perhaps even all of the disorder you mention. Make sure your new doctor has all your old records available to review and request that he take time to review them to try and resolve the diagnostic issues. Also bring in a parent and/or significant other to describe what they have observed; this should help the doctor nail the diagnosis down.
In case you are interested, my handbook "A family's Guide to ADHD" (Handbooks in Health Care, Newtown, PA; http://www.hhcbooks.com/) has a 4-page table (Table 2.1) comparing the various diagnoses, including similarities and distinguishing features.
L Eugene Arnold, MD, MEd
Professor Emeritus of Psychiatry
College of Medicine
The Ohio State University