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Treating ADHD

Dear Dr. Roach: I am a great fan of your column and others that address such a multitude of illnesses and medical situations. However, I cannot recall EVER seeing or reading the illness of ADHD even mentioned.

I feel that this is such a prevalent disease in our world today and is responsible for much of the violence and spontaneous crime with which we are accosted on a daily basis. Up until recently, there was not a name for such an illness. My son, who is 50 now, was punished, ridiculed, expelled from school and got into trouble with the law all because he was considered impossible to contain, teach, etc. Several years ago, we saw an editorial online regarding the symptoms of ADHD, and he went for testing, began medication and today is a different person. Additionally, following his success, I realized that my husband also has ADHD . He refuses treatment. Please address this and encourage others to do likewise. — D.M.

Answer: Current estimates are that between 2.5 percent and 4.5 percent of the adult population in many countries meet the diagnosis of attention deficit hyperactivity disorder — ADHD. There is much debate about both overtreatment and underdiagnosis of this condition. Many psychiatrists with far more expertise than I have argued that too many children are treated with medication. However, my expertise is in adults, and I think that the primary problem with adults is, as may be the case with your husband, that they were never diagnosed. Treatment is effective for ADHD, and it includes both medication and counseling.

There are several tests you can do at home to screen for adult ADHD. The best do-it-yourself screening test for adult ADHD is found online at www.hcp.med.harvard.edu/ncs/asrs.php. Although this instrument can’t make the diagnosis, it does provide guidance on when it would be important to make an appointment with a specialist in adult ADHD.

Dear Dr. Roach: I found your column about granuloma annulare very interesting. I understand the writer’s frustration at not finding a cure for the problem.

Could you write about another skin condition that is also very resistant to treatment, prurigo nodularis? My husband has had it for several years, and it does not seem to respond to any treatment. — I.F.

Answer: Prurigo nodularis is an itchy skin condition of unknown cause. The disease is characterized by firm, dome-shaped, itchy nodules, most commonly on the backs of the arms and fronts of the legs, and sometimes on the body. They can be skin-colored, reddish or dark brown. Some people have only a few; others have hundreds. The itching is severe and is made worse by warm weather, sweating and irritation from clothing.

Dermatologists are the experts in treating this condition. Sometimes a biopsy is necessary to confirm the diagnosis. It usually is treated with powerful prescription-strength steroids, usually creams or ointments, but occasionally by injection. Capsaicin cream also has been helpful. Very severe cases may need medication, such as thalidomide by mouth, but only an expert should be prescribing that.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.