One million adults Asperger or with Adhd, diagnosis and treatment only for 1 in 5

GRETA Thunberg, the climate change activist, will turn 18 next year and will also become an adult with Asperger syndrome, a highly functioning autism spectrum disorder that affects about 1% of the population and can go silent for a long time, arriving at diagnosis much later than other forms of autism. Greta herself found out when she was 13. Others, such as the writer Susanna Tamaro, after 40; still others live together without knowing it, but suffering from their emotional difficulties, from feeling different and unable to establish relationships with others. The same happens to those with attention deficit hyperactivity disorder or Adhd: in Italy it is estimated that it affects 2% of the population, about one million adults, but less than one in 5 is aware of it. In all, between Asperger and Adhd, there are about 1.5 million people with ‘uphill’ lives, but only 300 thousand can count on diagnosis and treatment.This is the picture outlined today in Milan, on the occasion of the opening of the XXI National Congress of the Italian Society of NeuroPsicoFarmacologia, scheduled until Friday 31 January. For experts, the first step is to quickly arrive at the correct diagnosis. This is possible – they explain – through the collaboration between child neuropsychiatrists and psychiatrists who, in fact, will inaugurate a national network to promote research in the sector and, in collaboration with patient associations and patients’ families, to carry out national information campaigns in order to spread awareness of the need to take care of people with Adhd, Asperger and other neurodevelopmental pathologies throughout their existence, from childhood to adulthood.
The announcement will be made to the Milanese Congress and will take stock of possible treatment strategies, indicating the ‘red flags’ which may be a sign of neurodevelopmental disorder in adulthood. Recognizing them is essential to avoid suffering and difficulties. The social cost of these conditions is high: it is estimated that only in the United States for adults alone do adults oscillate between 140 and 260 billion dollars between health care costs and lost productivity. Furthermore, the presence of the disease favors the appearance of other disorders such as depression (40% of cases), anxiety disorders (35%) and substance abuse (10%).”Neurodevelopmental disorders usually occur in childhood, often in conjunction with each other, with deficits that can influence well-being even in adulthood because they favor the appearance of other mental illnesses and compromise social and work functioning – explains Claudio Mencacci, co-president of the Italian Society of NeuroPsicoPharmacology and director of the Department of Neuroscience and Mental Health of the Asst Fatebenefratelli-Sacco of Milan – Unfortunately, cases without diagnosis are not rare until well over 18 years: in adults the Adhd and the Asperger can be ‘masked’ by other psychopathological conditions that often appear precisely because the adaptation strategies to the contexts are often insufficient for a good functioning in the work, in the study, in the relationships, in fact exposing the patient to continuous stress and micro- “trauma.

Thus, the expert reasoned, “in our country it has been estimated for example that peaks of Adhd are present in 25-30% of patients with addictions and eating disorders. The first step to arrive at the diagnosis is to recognize the ‘alarm bells of neurodevelopmental disorders in adults “.

Typical signs of Adhd in adults are for example “disorganization andinability to prioritize, plan or focus on a task, poor ability to manage one’s time or accomplish goals, traits such as impulsiveness, poor tolerance for frustration, frequent mood swings and difficulty in managing stress“, lists Matteo Balestrieri, co-president of the Italian Society of NeuroPsicoPharmacology and director of the Psychiatric Clinic of the University of Friuli Centrale di Udine.” People with Asperger syndrome – he continues – typically have poor social interaction skills, are often closed in their own world and have difficulties in communicating with others, they have low self-esteem, limited and sometimes obsessive interests, with a great need for fixed routines “.

In both disorders, the specialist warns, “patients who reach adulthood without diagnosis may not suspect their problem, but simply find everyday life and challenges very tiring. This is also why many do not ask for help and maybe the diagnosis comes after identifying other diseases. 16% of patients with other mental disorders have undiagnosed Adhd “. Unlike what happens in children, adds Mencacci, “in adults drugs are the first choice, although accompanied by cognitive, psychological and possibly coaching interventions”.

For Adhd, he continues, “the most used drug is methylphenidate, which however in our country can be prescribed after 18 years only if you are already under treatment before reaching the age of majority: this severely limits its use. In Italy the only drug approved for adults with Adhd is atomoxetine, a drug that leads 60-70% of patients to a remission of the disorder by acting mainly on the frontal cortex. Outside their clinical indication, inhibitors can also be used of the reuptake of serotonin and norepinephrine, clonidine, bupropion, modafinil and so on, to be evaluated on a case-by-case basis. And digital therapies are increasingly being developed that can support patients in the management of symptoms, such as Apps and software that help to stay organized , to set goals and reduce distractions. ”

Despite the therapeutic possibilities, it is estimated that only 10% of adults with Adhd are still treated today. “In adults with Asperger – concludes Balestrieri – psychiatric comorbidities are very frequent: depression, anxiety, obsessive-compulsive disorder and bipolar disorder are common, so therapy must often intervene both on other pathologies and on the typical symptoms of Asperger. Irritability and behavior disorders can be managed with antipsychotics such as risperidone and aripiprazole, but there are no specific drugs to improve the emotional aspects: many active ingredients are being tested, for example drugs that act on vasopressin and seem to improve empathy. For Asperger too, digital therapies are being studied, aimed at facilitating the recognition of the emotional states of others and at improving the effectiveness of psychological interventions, which remain important to enable patients to improve their social functioning “.