Arab / Middle East Adult ADHD
Resources and Planning

Adult Attention Deficit Hyperactivity Disorder
In the Arab World and Beyond

Cairo May 2019
Jeff Marck
Institute of Advanced Studies
Australian National University
University of Hawai'i
University of Iowa
Research Officer 1992-1999
National Centre for Epidemiology
and Population Health

Moffitt et al. (2015): The first things to know about adult ADHD E.G.  "Unexpectedly, the childhood-ADHD and adult-ADHD groups comprised virtually non-overlapping sets; 90% of adult-ADHD cases lacked a history of childhood ADHD."
Adult ADHD PhD Thesis Copy Editing -
Arabic Version, Adult ADHD Self-Report Scale (ASRS v.1.1)
  Dr. Susan Young's ACE (child [English], child [Arabic]) and ACE+ (adult [English]) ADHD diagnostic aids
Letter of introduction from Dr. Mona El Rakhawy, Diwan Center for Mental Health, Cairo, Egypt

Windows Publisher format

Brochure 1
Adult ADHD is often NOT a Continuation of Childhood ADHD
Outside - Inside

Brochure 2
The ASRS v.1-1 Screener
Five Minutes that May Well VASTLY Improve Treatment for ~25% of Your Patients
Outside - Inside

Brochure 3
Adult ADHD, when Undiagnosed, Results in High Levels of Case Mismanagment & Incarceration
Outside - Inside

Brochure 4
Reducing Costs of Incarcerating ADHD Men
Outside - Inside

Jeff Marck Home Page

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 been 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.

Adult 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 management.

Jeffrey Charles Marck
BA African Economic Anthropology, U. Iowa

MA MalayoPolynesian Prehistory,U. Iowa
MA Pacific Islands Linguistics, U. Hawai'i
PhD Polynesian Language & Culture History
The 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 adult ADHD screening, diagnosis and treatment and may be behind about a quarter to a third of adult 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 often show 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 prisoners in prison and upon release. There are success stories to take to a doubtful public and prison administrators (cf. Konstenius 2013, [here]0 Cook 2017).

Not 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.
But 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."
This 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."
This 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 childhood ADHD.

And 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..."
The 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 some 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 ADHD symptoms.

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 afflicted.

To 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.

Egypt 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.

Jeff Marck
Pyramids, Egypt
LIMITS 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
Jeff Marck (PhD Institute of Advanced Studies, Australian National University) is an anthropological language prehistorian retired to his wife's native Cairo with experience:
    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.

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.

Arabic Version, Adult ADHD Self-Report Scale (ASRS)
Letter of Introduction from Dr. Mona El Rakhawy MD
Jeff Marck Home Page

Arabic Version, Adult ADHD Self-Report Scale (ASRS)
Letter of Introduction from Dr. Mona El Rakhawy MD
Jeff Marck Home Page