[No Title]

Michielsen et al, ¹ while describing the background and aim of this study, mention that ADHD could lead to significant impairment in older age without providing evidence of such impairment. Certainly from clinical experience and previous studies we know that there are other mental disorders such as depressive illness, anxiety disorder and dementia which are relatively common in older age and likely to cause either similar or more severe impairment. The authors discuss this in some detail in their description of the limitations of this study but fail to consider this when drawing a conclusion about prevalence.

It is essential, according to DSM-IV criteria, for a diagnosis of ADHD to rule out any possibility of the symptoms being better accounted for by another mental disorder. ² Unfortunately, the authors do not rule this out while studying the prevalence despite using a diagnostic instrument strongly based on the DSM-IV criteria.

Before we start diagnosing ADHD in older age groups it is important to exclude more prevalent and widely recognised mental health problems such as mild cognitive impairment and dementia. Looking at the diagnostic instrument DIVA 2.0, we can easily identify many symptoms which can be more readily explained by other more prevalent functional and organic illnesses. ³ This explains why the DIVA 2.0 (as the authors in this study rightly mention) has no evidence for its use in old age. Is retrospective data collected from an older person's recall of being inattentive or hyperactive as a child in different situations valid? More so when DSM-IV clearly advises caution for diagnosing this even in adults without any corroborating information, which was missing in this study.

We would thus suggest extreme caution before we start even suggesting the concept of ADHD in older adults and taking thisany further. There are greater and more relevant issues in older age that need to be tackled before we start inventing any new diagnoses.