On Sunday 12/15/13, the NY Times ran a headline article “The Selling of Attention Deficit Disorder”. This long article opened with a quote from Dr Keith Connors after addressing a group of ADHD specialists in Washington (the APSARD conference). As a member of this group, I would like to respond to this article and what it means for adults with attention problems.
The article discussed how the pharmaceutical industry has been pushing stimulant medications for ADHD on children for years, and how they are now trying to push stimulant medications for ADHD on adults. It reports that this process has “led to too many people with scant symptoms receiving the diagnosis and medication”.
In private practice, many adults come to me for help with attention problems. Some have ADHD and make remarkable changes in their life with treatment. Some do not have ADHD and it is my job to figure out what other problems are causing a change in their attention. Rarely, someone will request ADHD medications for “performance enhancement”, stating they do not have ADHD but want to take stimulant medication to perform better at school or work.
So how can a doctor figure out who has adult ADHD? The NY Times article gives examples of rushed primary care doctors making an ADHD diagnosis in 5 minutes and handing out stimulant medications with no further workup. This is a poor substitute for a complete ADHD workup which should include the following:
1. Clinical examination and history. This cannot and should not be done in 5-15 minutes. A complete examination should take at least 45 minutes and should include a complete psychiatric history, a family history, a substance abuse history, and a sleep history. In theory, a primary care doctor can make this assessment but in most primary care settings this kind of time and depth is simply not an option for the doctor.
2. Subjective report. This should include a detailed report by the patient during the clinical examination and also a normed self-report rating scale (not the short quizzes described by the NY Times article). Ideally, this would also include a subjective rating scale from a second person who knows the patient well (parent or spouse, etc).
3. Objective report. There are several options ways to quantify attention problems in adults, including neuropsychological testing and computer tests of attention. These tests are objective, and are similar to ordering a blood test or an EKG to evaluate medical problems.
If you have been diagnosed with ADHD and have not had this workup you should consider finding a doctor who will complete your workup. This is extremely important because if you are having attention problems that are NOT due to ADHD, taking ADHD medications may actually make your problem worse.
I would like to also add that the NY Times article focused on treatment with stimulant medications but it is important to remember that there are other options for treatment of ADHD in adults, including nonstimulant medications, lifestyle changes, and cognitive behavior therapy (a form of talk therapy).
Dr. Jennie Byrne, MD, PhD