The median age of ADHD diagnosis for men remains 8-12; for women, it’s 35. It’s the result of incomplete criteria and a poor understanding of the diagnostics and best practice. (the gold standard is a methylphenidate test. If one dose calms/focuses you, you have ADHD.) - ThreadSky

czedwards.bsky.social • 14 days ago

The median age of ADHD diagnosis for men remains 8-12; for women, it’s 35. It’s the result of incomplete criteria and a poor understanding of the diagnostics and best practice. (the gold standard is a methylphenidate test. If one dose calms/focuses you, you have ADHD.)

Reposted from Eric Michael Garcia

We see a spike in older women getting prescribed with ADHD for the same reason we see the racial gap close with autism. Our understanding of ADHD has grown and therefore, more people who otherwise went undetected are getting the treatment they deserve. This is a plus.
www.nbcnews.com/health/menta...

Comments

94freehugs.bsky.social•12 days ago

just curious, what ritalin does to people who don't have adhd?

petitegrey.bsky.social•13 days ago

I took my first dose of meds at 38, took a nap, created a website, took a walk, and made dinner without even thinking about it. That night I cried over how easy it all was and how different things could have been if I had the help I needed as a kid.

czedwards.bsky.social•13 days ago

Glad you have them now, so sorry you didn’t before.

joshoconnorchen.bsky.social•13 days ago

This is quite compelling for the whole "should we get our young daughter assessed?" conversation.

czedwards.bsky.social•13 days ago

Personally, being an aunt to 4 minis with ADHD, I think every kid should be assessed. Including the ones who thrive in the structure of school, because there will come a time when they don’t have that structure, and I’ve seen too many very bright 19 year olds flame out in college. (Including me).

czedwards.bsky.social•13 days ago

One of my sibs got the DX & meds (their form was the annoying type of ADHD); I got the DX but no meds/therapy because mine wasn’t annoying to adults; third should have gotten the DX but parents were done being parents by then so just let that one run feral. (We had objectively terrible parents).

sosomanysarahs.bsky.social•13 days ago

Not so shockingly, that's just about the age when a lot of women have a child who's old enough to go to school.

(I know so, so many people who got diagnosed after their kids did.)

docder.bsky.social•13 days ago

Can you tell me more about stimulant challenges as a diagnostic tool for ADHD? This is the first I've heard of medication being used before diagnosis.

docder.bsky.social•13 days ago

For context, I'm a 45-year-old cis/bi man with a biology PhD and just got an ADHD diagnosis after a lifelong challenge. I'm in my first few days of using methylphenidate and, within an hour, was locked in on a really deep dive into neuropharmacology.

czedwards.bsky.social•13 days ago

It’s not … as well documented as it should be; it’s the method I was taught as a grad student in the 90s as the most reliable method; I know it still gets taught, but the 90s were a different DEA world, and a different documentation world. It may have evolved out of parents being weird about meds.

purlgurly.bsky.social•13 days ago

It was my family doctor’s first step. When I (then late-20s cis woman) approached him with my suspicions and screener, he said, “Huh, sounds plausible, I’ll refer to a psychiatrist and in the meantime, let’s try ritalin and see if you notice improvement.” Was just like the day I first wore glasses.

czedwards.bsky.social•13 days ago

So a child with a dx but with resistant parents can sometimes be convinced by giving them a trial, which then evolves into figuring out it’s a diagnostic.

We still don’t have good, objective diagnostics, though I think the core muscle tone discovery has the best chance of proving out.

aegtx.bsky.social•13 days ago

Wait, the what ?

czedwards.bsky.social•13 days ago

We have found that children with ADHD almost universally have a below average core muscle tone, meaning their legs and hips have to do a lot more of their balancing. And that giving them methylphenidate helps improve their core stability while the dose is active.
(Here’s one of the very long papers)

aegtx.bsky.social•13 days ago

That is *wild* and something I'm going to share with my ADHD friends. (I didn't have a notably weak core...probably because I started ballet at 6 and clarinet in 6th grade, and didn't quit either one until I was out of grad school. But I recognize that I'm an outlier.)

czedwards.bsky.social•13 days ago

We also know MPH, muscle tone, ADHD & adult pain are strongly cross-linked (logical, since a lifetime of overcompensation for balance issues will eventually cause orthopedic problems).
Taken together, it tells us the MFNU may be the actual strongest diagnostic we have (and that it’s bio, not psych)

czedwards.bsky.social•13 days ago

Sorry, I just don‘t have my educational material from back then anymore (9 moves!) and there is a minor black hole in psych documentation from the late 80s through the 90s because there was a big generational switch in methodology, and of course the internet archiving black hole problem.

goblininajacket.bsky.social•13 days ago

i got mine at 23 like a median enby

ratshag.bsky.social•13 days ago

My wife didn't realize she was ADHD until she got her APRN in psychiatry/mental health in her 40s and one day was reviewing the symptoms and went "hey, wait a minute ..."

czedwards.bsky.social•13 days ago

Yep.

And our diagnostics are still iffy especially for women, since they over-emphasize work/school and undercount the emotional and social aspects, as well as the physical detriments and long-term dangers of untreated ADHD (dementia, Parkinsons)

But product of capitalism.

pnh.nielsenhayden.com•13 days ago

Good lord. If I’d known that when I was 24, I wouldn’t have had to go until 59 to be diagnosed.

ginbells.bsky.social•9 days ago

Yup.... as a 90s kid I was told my ADD wasn't severie and I'll outgrow it.

33 was dx combined audhd.

All made sense why I was struggling so much & my HS that focused more on adhd teaching did so well in for the first time.

sylkol.bsky.social•4 days ago

📌

terrorsoul666.bsky.social•13 days ago

I was prescribed ADHD meds while on Opdevo for excessive tiredness and it did absolutely nothing for my being tired. I was still tired even at the highest doses and different meds. That’s how I found out….in my 40’s.

czedwards.bsky.social•13 days ago

It gets really, really fun for people with un or underdx’ed ADHD who get a fatigue disorder like ME/CFS or Long Covid. What may work for someone without the brain’s underlying dopamine processing deficit is only going to get the ADHDer up to the non-ADHD dopamine baseline.

geekingthething.bsky.social•13 days ago

OH HELLO THIS IS ME

vulgoraquel.bsky.social•12 days ago

📌

czedwards.bsky.social•13 days ago

(Muting this thread.)

tims4938.bsky.social•13 days ago

I got my diagnosis at 46.

jonsinger.bsky.social•14 days ago

perhaps important to note that if methylphenidate doesn't calm or focus you, that's not diagnostic; there are some people it doesn't work for.

czedwards.bsky.social•14 days ago

The gold standard is a stimulant challenge; methylphenidate is the cheapest and most bioavailable, so it’s the primary first order (and least likely to cause a hot ping on a UA, which can matter for people.)

kaerick.bsky.social•13 days ago

As someone with a female minor child who has asked about testing for ADHD in CO, I have questions. Would you recommend asking their pediatrician about a methylphenidate test, or go thru a formal diagnosis first?

czedwards.bsky.social•13 days ago

With the understanding that I do no pediatric work AT ALL…

There are symptom checklists, and mostly what a neuropsych is doing is hitting those checkboxes. The whole idea of a written screening is poorly implemented, at best.

Pediatrician is where I would start, with one caveat.

drtwillett.medsky.social•13 days ago

The Vanderbilt checklist is the most common I saw used. The symptoms need to be present in at least two different settings, so there will be one questionnaire for parent and or patient, depending on age, and another questionnaire for teacher to fill out.

https://nichq.org/wp-content/uploads/2024/09/NICHQ-Vanderbilt-Assessment-Scales.pdf

drtwillett.medsky.social•13 days ago

Seattle Children’s supports a great ped psych consult service and their write-ups for providers were great in case you are in their area: https://www.seattlechildrens.org/healthcare-professionals/community-providers/pal/resources/

czedwards.bsky.social•13 days ago

There is an informal self-test. If your child drinks a milk (plant or animal), make/get her a triple latte on a day when you don’t have anything mission critical planned. Use sugar-free flavor syrup to sweeten.

If it calms her or helps her stay on task, or makes her want a nap? Definitely her doc.

ebrillblaiddes.bsky.social•13 days ago

Another version of that is slipping them a Sunkist (quite caffeinated) instead of a different orange or fruit punch drink.

kaerick.bsky.social•13 days ago

Thanks for the advice. She's pretty certain she's some flavor of neurospicy and this could help narrow down which. Of course, her brother is multiple, so it doesn't exclude others obviously.

bfwriter.bsky.social•13 days ago

this makes me wonder if there is a comprehensive site that talks about these common self-medication strategies and what physical/psych diagnoses/meds they might point to.

motherofcardigans.bsky.social•13 days ago

And now I’m wondering why my first PMHNP went straight to Adderall when she diagnosed me at 40.

czedwards.bsky.social•13 days ago

Pharma reps are a force to reckon with. They don’t have to even be buying expensive lunches or gifts. Just repetition will keep one drug in their heads above another.

Methylphenidate is the common research drug, too.

Lots of docs also default to Vyvanse, too, which only just came off patent.

jonsinger.bsky.social•14 days ago

as you say. (it worked for me, btw; may have saved my life.)

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