Do you feel that you have been struggling for years to get your life together? Feeling like you are always late, or overwhelmed, not completing tasks, losing things, trouble organizing or underachieving? Many people with Adult Attention Deficit Disorder (ADD) or Adult Attention Deficit Hyperactivity Disorder have sought a diagnosis or treatment for years but have either been misdiagnosed or not adequately treated. If this is your situation, it may sound similar to one of my patient’s, Richard*, whom I treat in my Adult Attention Deficit Disorder (ADD) and Adult Attention Hyperactivity Disorder (ADHD) Center in New York City. I have been treating adults with Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity DIsorder (ADHD) for nearly 20 years. For the sake of simplicity, I will refer to both ADD and ADHD as just ADHD.
It is so rewarding to help someone who has been suffering Adult Attention Deficit Hyperactivity Disorder (ADHD) because an accurate diagnosis and effective treatment can greatly impact a person’s career, health, and quality of life. It has a heritability rate of 87%. The prevalence of ADHD in children and adolescents is between 8-15% and the prevalence of adult ADHD is approximately 4%. Only a small percentage of professionals feel confidently diagnosing and treating Adult ADHD, and yet it is highly responsive to effective treatment. This is why I have a passion for treating people with Adult ADHD. It can make an enormous difference in an person’s life. With my patients who have Adult ADHD, I use state-of-the-art treatment that may include medications and cognitive behavioral therapy (CBT). Cognitive behavioral therapy (CBT) is an essential component of effectively treating Adult ADHD which includes teaching specific strategies and tools to improve focus, planning, organizing, time management, and productivity. Cognitive behavioral therapy has been shown in research studies to be a very effective treatment for Adult Attention Deficit Disorder.
ADHD has a classic triad cluster of symptoms including inattention, restlessness, and impulsivity. There are two subtypes of ADHD including hyperactive type and inattentive type. Most often, adults present with the inattentive type even if they had symptoms of hyperactivity as children.
The diagnosis of adult ADHD can be challenging since many other psychiatric and medical illnesses can mimic many of the same symptoms such as anxiety, depression, bipolar, dementia, seizures, post chemotherapy, traumatic brain injury, substance abuse and side effects of medications.
Many experts believe that in order to officially have a diagnosis of ADHD, one must have symptoms starting prior to 7 years old; however, many research studies have demonstrated that adults with ADHD are often poor historians and underreport their symptoms from childhood. Thus, it is helpful to get a report from someone who knew the patient during childhood.
The diagnosis of ADHD is determined based upon a cluster of symptoms from the DSM-V.
Here is a useful link for screening your patient for ADHD:
The patient must have 6 out of 9 of the following:
- Organization Difficulty
- Losses things frequently
- Leaves tasks unfinished
- Poor focus
- Easily distracted
- Difficulty listening
- Easily forgetful
- Careless Mistakes
- Avoids tasks that require concentration
and 6 out of 9 of the following:
- Talks excessively
- Blurts out answers
- Interrupts frequently
- Can play or work quietly
- Leaves one’s seat
- Always on the go
- Can’t wait his/her turn
The mainstay of treatment for adult ADHD is stimulants and Straterra, a non-stimulant. Only Straterra is FDA approved for adult ADHD. The medicines that I most often use in my practice are Ritalin (methylphenidate) and the mixed amphetamine salt, Adderall. Ritalin is effective for 3-4 hours and often requires bid dosing. Thus, one of the longer acting agents such as Ritalin LA, Metatdate CD or Concerta or commonly prescribed. I often will start a patient at 5 mg once a day and titrate up to 20 mg bid as tolerated. Adderall’s duration is also 3-4 hours; however, many clinicians have noticed that it’s effective activity is moderately longer and that some patients only require once a day dosing. I often start a patient at 5 mg of Adderall once and titrate up to 10 mg bid as tolerated.
Attention Deficit Hyperactivity Disorder (ADHD) can be very challenging to treat. However, by seeking an experienced professional can help you receive an accurate diagnosis and start effective treatment whether it is medications, cognitive behavioral therapy, or some combination of both. By seeking effective treatment from an experienced professional, you can improve your symptoms and overcome many of the challenges of ADHD.
* Names and details have been changed to maintain confidentiality.