In Reply: I thank Dr. Holmgren for the opportunity to clarify our study of ADHD in homeless veterans. For the sake of accuracy, we did not cite the studies by Susser and associates and Gomez and associates as purporting to demonstrate the persistence of ADHD symptoms into adulthood. In my view, the articles that were cited, along with others not cited, clearly establish the persistence of ADHD symptoms in many adults with childhood-onset ADHD.
Contrary to Dr. Holmgren's impression, we excluded patients with organic brain dysfunction due to any cause. We used a thorough physical and comprehensive laboratory examination along with at least three independently structured mental status examinations. Furthermore, we did not rely on self-reports alone to make the diagnosis of ADHD but scored all patients by DSM-III-R behavioral criteria, which we had the luxury of doing over a four- to six-month period. We had positive childhood documentation in 40 percent of the cases.
Once a diagnosis of ADHD was made, all other diagnoses became comorbid. Dr. Holmgren should know that the literature is clear that children, adolescents, and adults with ADHD are at greater risk for anxiety and substance use disorders.
Finally, Dr. Holmgren should read my earlier letter (1) and search his own experiences before describing our study as "superficial," and homeless persons who abuse substances as unsuitable for the study of ADHD.