Attention deficit/hyperactivity disorder has long been recognized and treated in children, but has become a commonly diagnosed adult disorder as well. The estimate is that as many as one in three children diagnosed with this entity will actively carry the disease into adulthood.
While ADD and ADHD are associated with other psychiatric diagnoses, there are factors that allow for favorable underwriting.
ADHD is probably the most common neurobehavioral disorder of childhood. While attention deficit disorder centers on inattentiveness and a lack of attention to detail, the hyperactive form includes impulsivity, inability to sit still or concentrate, and interpersonal problems. Early diagnosis may coincide with poor school performance, underachievement in classroom situations, and poor interpersonal relationships. Schools in the United States are doing a better job in early diagnosis and intervention, but even with intervention and medication more than half will have significant problems in adulthood if the disorder persists.
The inability to concentrate or to have difficulty with attention is probably a complaint of most adults, but the diagnosis criteria per the Diagnosis and Statistical Manual of Mental Disorders (DSM) is very specific and revolves around six or more behavior characteristics in structured and leisure environments. Doctors are reluctant to give the initial diagnosis to an adult without a history of the disorder being recognized in childhood. In addition, behavior modification often makes identifying six behavior criteria difficult. Nonetheless, the hyperactive/inattentive details are often just as significant to the prognosis and treatment.
The consequences of persistent ADD and ADHD are predictable—poor performance in school leads to lack of success in the job market, as well as in making a living; plus, difficulty with interpersonal relationships leads to low self-esteem and poor adjustment to the normal trials of everyday living.
Some disorders that go along with ADD/ADHD have worse prognoses. These include conduct disorder—with rules violation, aggressive behavior toward others and violations of the law—and oppositional defiant disorder, where hostile and disobedient behavior is manifested toward authority. Earlier onset of these behaviors is associated with poor long term outcomes.
The early use of medication and pharmacotherapy as well as cognitive behavior therapy has helped many to successfully adjust and achieve more favorable outcomes. Those with ADD/ADHD who fare best are the subsets with less hyperactivity at the root of the behavior, older age at diagnosis, stable job history, and no other coexisting psychiatric problems or diagnoses—applicants such as this can be issued as standard and, on occasion, be given preferred consideration. Some of the most successful people in business have milder forms of ADHD which contribute to more innovative and active thinking.
The biggest problems occur when there are significant other psychiatric issues, particularly depression and alcohol/drug abuse or patterns of behavior that lead to conflicts with both the law and supervisory personnel in work situations. Those are the cases that are generally postponed or declined.
Robert Goldstone, MD, FACE, FLMI
Goldstone, board certified internist and endocrinologist, is vice president and chief medical officer for Pacific Life and Pacific Life and Annuity. He has extensive brokerage and life insurance experience, having been medical director at both MetLife Brokerage and Transamerica Occidental Life. Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endocrinology and has written monthly for Broker World since 1990. Goldstone can be reached by telephone at 949-420-8390. Email: firstname.lastname@example.org.