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Letter   |    
ADHD in Adults
Jeffrey P. Holmgren, M.D.
Psychiatric Services 1998; doi:

To the Editor: The article in the October 1997 issue by Drs. Lomas and Gartside (1) about the prevalence of symptoms of attention-deficit-hyperactivity disorder (ADHD) among homeless veterans cites several studies (2,3,4,5) that, like the study they describe, purport to demonstrate that ADHD persists into adulthood. Yet the shortcomings of both the cited studies and the authors' own study call the assumptions of ADHD in these populations into serious question.

The authors failed to adequately address questions of likely organic brain damage or dysfunction secondary to substance use. Relying on self-reports alone in screening for and assessing ADHD among those with highly probable substance use disorder seems quite inadequate. The finding that these ADHD veterans were 18 times more likely to suffer from an anxiety disorder than their non-ADHD counterparts suggests a confounding of the anxiety diathesis with the ADHD-like behavioral and cognitive correlates. It also suggests that the authors did not attempt to distinguish between these variables. Indeed, the entire matter of how other comorbid disorders were added to, or distinguished from, ADHD was not addressed.

The concepts of adult residual attention-deficit disorder or attention-deficit-hyperactivity disorder are undergoing repeated exploration, theorizing, and attempted validation. This thoughtful inquiry should not be abridged by superficial evaluations of homeless persons who abuse substances and who, through a variety of organic and environmental influences, appear to evidence symptoms of ADHD that have no definable continuity with a relatively well-defined childhood disorder. Adults with this constellation of symptoms merit closer scrutiny as to the likelihood of more typical adult disorders—anxiety, depression, or personality disorders—and better attention to their treatment needs.

Dr. Holmgren is medical director of Northwoods Guidance Center in North Branch, Wisconsin.

Lomas B, Gartside PS: Attention-deficit-hyperactivity disorder among homeless veterans. Psychiatric Services 48:1331-1333,  1997
 
Zametkin A: Attention-deficit disorder: born to be hyperactive? JAMA 273:1871-1874,  1995
 
Biederman J, Faraone SV, Spencer T, et al: Patterns of psychiatric comorbidity, cognition, and psychosocial function in adults with attention-deficit hyperactivity disorder. American Journal of Psychiatry 150:1792-1798,  1993
 
Susser E, Struening EL, Conover S: Childhood antecedents of homelessness in psychiatric patients. American Journal of Psychiatry 148:1026-1030,  1991
 
Gomez R, Janowsky D, Zetin M, et al: Adult psychiatric diagnosis and symptoms compatible with the hyperactive child syndrome: a retrospective study. Journal of Clinical Psychiatry 42:389-394,  1981
 
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References

Lomas B, Gartside PS: Attention-deficit-hyperactivity disorder among homeless veterans. Psychiatric Services 48:1331-1333,  1997
 
Zametkin A: Attention-deficit disorder: born to be hyperactive? JAMA 273:1871-1874,  1995
 
Biederman J, Faraone SV, Spencer T, et al: Patterns of psychiatric comorbidity, cognition, and psychosocial function in adults with attention-deficit hyperactivity disorder. American Journal of Psychiatry 150:1792-1798,  1993
 
Susser E, Struening EL, Conover S: Childhood antecedents of homelessness in psychiatric patients. American Journal of Psychiatry 148:1026-1030,  1991
 
Gomez R, Janowsky D, Zetin M, et al: Adult psychiatric diagnosis and symptoms compatible with the hyperactive child syndrome: a retrospective study. Journal of Clinical Psychiatry 42:389-394,  1981
 
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