There has been a great deal of
attention paid internationally to the
common comorbidity of SUD (Substance Abuse Disorder) with adult ADHD.
Though the most common adult ADHD comorbidity is often SUD, it is a minority
comorbidity, and testing persons with Bipolar, MDD, OCD, Anxiety D and other afflictions has
widely neglected. The result is significant case mismanagement. Even
more widely neglected is general screening for Adult ADHD in
the absense of comorbidy and perhaps initial impressions of such
patients' issues as involving borderline "conduct disorders" or other afflictions.
ADHD most commonly involves adult onset rather retentions
of childhood ADHD which tends to become less pronounced
("sub-threshhold"). The definitive study for that claim was first
presented in Moffit et al. (2015)
and it is beginning to receive the attention it deserves. Presented
below are various links and the passionate plea for general psychiatric
practitioners to routinely administer the 5 minute ASRS v1.1 which has
again and again proved its specificity and is moving tens of thousands
of mysteriously troubled cases into simple, inexpensive, effacious case
Jeffrey Charles Marck
African Economic Anthropology, U. Iowa
MalayoPolynesian Prehistory,U. Iowa
Pacific Islands Linguistics, U. Hawai'i
Polynesian Language & Culture History
Institute of Advanced Studies
Australian National U.
Adult ADHD males are ~3% of the male population
usually ~25% of a nation's male prisoners
Lack of childhood ADHD histories often result in failure to consider
screening, diagnosis and treatment and may be behind about a quarter to
a third of
male criminal incarcertations internationally... they are undiagnosed
ADHD people who suddenly have moments when they cannot control their
impulses, and cannot, after the fact, tell you what they were thinking
at the time.
With respect to prisons, the rare statistics
little evidence of wealthy countries having better screening, diagnosis
and treatment outcomes than those countries with more limited resources.
Not all adult ADHD males commit chargable offences but conduct of
undiagnosed, untreated males who come into contact with the police, while incarcerated and upon release involves
a considerable amount of reoffending and subsequent reincarceration.
The good news for
Egypt and other middle income countries is that
diagnosis and treatment diversions are inexpensive and result in cost
savings to incarcertation systems, whose savings can then better go to growing programs of
diagnosis, treatment and reductions in reoffending of adult ADHD
prison and upon release. There are success stories to take to a doubtful public and prison administrators (cf. Konstenius 2013, [here]0 Cook 2017).
all afflicted adult males come into contact with criminal justice
systems so even when prisoners are streamed into diagnostic and, where
diagnosed, treatment regimes, there is also the sad story of afflicted
adult males who never come into contact with criminal justice systems
(and might not, in those instances, be screened or treated). Life
continues at various levels of self-control disruption and a lesser
life is lived... even when they seek psychological or psychiatric
consultation (if the practioner does not consider even the possibility of [adult] ADHD being at the source of some [or all] of a patients' issues).
The scholarly literature lacks anything resembling negative criticism of Moffitt et al. (2015). There really should be a change in turns of phrase surrounding childhood and adult ADHD that are not always making it to the printing press.
Let us first consider some of the introductory turns of phrase over the last two decades:
"ADHD begins in childhood..."
"By definition ADHD begins in childhood" This blanket
statement is from 2001 and 2013, and probably far earlier and far later
and the simpler "ADHD begins in childhood" is terribly common in
scientific reports through the 2000s and 2010s.
here one must "read between the lines" and be aware that authors may be
speaking of definitions presented in prestigeous textbooks and manuals
of professional associations and make no difference at all to a
researcher reporting on some element of child or adult ADHD that has nothing to do with age of onset.
"It is quite clear that ADHD begins in childhood, but persists into adolescence and adulthood for the majority of individuals."
quotation from a 2008 source raises a central issue. It is that the
testing for ADHD results in a score whose meanings are measured
by "threshholds" and in long timeline studies of the same
individual(s) from an early age, it perhaps more common to be reading
about adolescent and adults who have become or on their way to becoming
"subthreshold" with "residual impairment."
"ADHD begins in childhood and may persist in a substantial subgroup of patients."
quote from 2013 reflects what may have been a gentle shift away from
counting "subthreshold" individuals as among the afflicted but still
carries the implication than any adult ADHD would have begun with
now two quotes from 2015 which show a retention of earlier
proclamations in some senses but show a typical softening of blanket
statements in important ways.
* - "Given that ADHD begins in childhood, produces chronic symptoms persisting into adulthood..."
* - "Attention-deficit hyperactivity disorder (ADHD) begins in childhood and may persist into adulthood..."
first notes that symptoms persist into adulthood but avoids comment on
whether they may be "subthreshold" and the second is perhaps more
typical of the times and said "may persist to adulthood," implying that something like a "subthreshold" notion was being subscribed to.
The same medications as used for childhood ADHD are effective in
reducing impulsiveness and offending in adults as are those used for
of the comorbidities which do not
find SUD in the majority. Yet it is only SUD comorbidity
that seems to be researched with some frequency. A bit "lamely", in
some instances... as much of the international treatment community knows the SUD
statistics are in some large measure a result of the efficacy of methamphetamine in reducing
When time is taken to include screening of all adults presenting
with issues to clinics (gender balanced), diagnosis of adult ADHD has
been found in 24.5%
percent of cases (gender balanced) in Egypt with
the females more often having inattention issues rather than the well
known impulsiveness of the afflicted males. The same medications as
used with children result
in improvements in the lives of both the adult male and adult female
close this introduction, I should like to call attention to what I find
to be the absence in the literature of anything calling into question
the methods or results of the New Zealand (Moffitt et al. 2015) study
in which 90% of the adult afflicted had no childhood history of ADHD.
Nor are there any criticisms of the specific observations and
assertions with respect to the significance of the New Zealand study's
value in increasing knowledge and informing best practice with respect
to simply screening all patients with issues. ASRS v1.1 only takes 5-10
minutes to complete and 1-2 minutes to score.
is the envy of the Arab world. Peace, prosperity and adequate
opportunity for the youth in many instances. I'm so happy to have such
a lovely Egyptian wife and such a friendly place to retire. I hope I am
making some small contribution to the future of Egypt with my freelance
ADHD advocacy activities.
and DISCLAIMERS: Please observe that these ADHD and Adult ADHD web (and
other) materials contain no advice about what may constitute
appropriate treatment. At some points there are or may come to be
quotes or comment on concensus or trials involving optimal treatment
regimes. But it should be understood that I have no medical credentials
and do not seek or accept "patients". I do, though, have an
expanding list of Egyptian psychiatrists for whom I have notes as to
whether they do or do not seek or provide diagnostic and continuing
case management for ADHD afflicted adults. JCM
Marck (PhD Institute of Advanced Studies, Australian National
University) is an anthropological language prehistorian retired to his
wife's native Cairo
1) as an attendant on a leading psychiatric
research hospital's adult wards (1969-1971);
2) as the lead research officer for Australia's beloved
Emeritus Professor John C. Caldwell (1992-1999) in Caldwell's Health
Transition Centre (HTC) at Australia's National Centre for
Epidemiology and Population Health (NCEPH) including the three years
Caldwell was President of the International Union for the Scientific
Study of Population (IUSSP).
3) as a volunteer to one of the Australian Capital
Territory mental health community activities, 2006-2008, meeting once a
week at a
Canberra cafe with schizophrenics returning to the community,
conversing about their situation and options.
Adult ADHD Self-Report Scale (ASRS)
Introduction from Dr. Mona El Rakhawy MD
Jeff Marck Home Page
After assisting Moustafa and Mona Rakhawy of Cairo's Diwan Day Center
in publishing their deceased colleague's adult
ADHD research, Marck took the decision to make better outcomes for the
Arab and Muslim worlds' afflicted ADHD adults his main project in
retirement. He is doing this, in one element, by completing the native
English copy editing of adult ADHD thesis and journal submissions
concerning the Arab and Muslim world at no charge and by offering special rates for the
native English copy editing of other kinds of Arab and Muslim world
psychiatric research reports.