7 ms·

ADHD is a common condition in adults, estimated to be around 3-5% of the population. It's very frequently comorbid with other behavioral disorders like depressi

ADHD is a common condition in adults, estimated to be around 3-5% of the population. It's very frequently comorbid with other behavioral disorders like depression, bipolar disorder, obsessive-compulsive disorder, etc. But even "pure" ADHD can be quite disadvantageous. People with ADHD are much less likely to finish school, have trouble staying employed, more likely to be divorced, have greater health care utilization among other adverse outcomes. Despite these factors only 20% of ADHD individuals receive treatment which can make a big difference. Medications can be helpful but are not by any means a "cure". Rather specific behavioral therapies are a necessary part of an effective treatment program. As a physician specializing in behavioral health, I've treated a great number of ADHD adults. It's impressive how much improvement patients could make over a period of months to years as a result of their determined effort. I came to appreciate patients' innate talents that many were eventually able to exploit. It was gratifying to see some become top-tier innovators in their fields including technologies. Of course people will "identify" unique traits as part of their sense of "self". ADHD individuals may come to regard aspects of their quirky cognitive styles as part of an "identity" but that's not necessarily the same as having ADHD as the biggest component. Last thing I'll say is that ADHD is considered a developmental disorder. IOW there's no sharp line between having/not having it. The extent it's a problem depends on the context, which is a huge discussion topic in its own right.

sizzle 4y ago
Thank you for having this perspective to help treat your adhd patients, wish there were more like you. I’ve encountered quite a few doctors who admitted they are scared of the DEA and losing their license and make us jump through flaming hoops to adjust dosages of stimulants or force us to navigate a byzantine maze of psychiatry to get to a psychiatrist that will take the liability away for prescribing/adjusting scheduled medications. This is even with 10+ years of diagnosis. Do you have any insight into why it is this way? Have physicians always feared the DEA and threat of losing their license in pursuit of helping their patients try different controlled medications? Did the pill mills ruin it for the entire medical industry?
- jrapdx3 4y ago
  Amphetamine has such an interesting history. Synthesized in 1887, first used in the 1930s, and in 1937 discovered to have a remarkably favorable effect on hyperactive boys. Methylphenidate (Ritalin) came along somewhat later. 85 years later these two drugs are still the mainstay of ADHD treatment. Sure delivery systems have proliferated and drug variants have been available. Stimulant-class medications remain first-line treatments. Amazingly even after nearly a century nothing better has ever been developed, and it certainly hasn't been for lack of trying. Prior to 1970 there were relatively few restrictions, but widespread abuse lead to legislation establishing the DEA and tightened regulations. Drugs of abuse were sifted into a schedule of classes 1 to 5, where class 2 drugs were legal to prescribe but subject to limits intended to reduce diversion and misuse. BTW one of the legal schedule 2 drugs is methamphetamine, approved for ADHD. We know it can be misused, leads to severe dependency problems, but used properly is an effective and quite tolerable treatment for ADHD. Indeed I have prescribed it for a number of patients in the past. With the huge opioid crisis that's emerged in recent years scrutiny by state licensing boards has increased regarding prescribing patterns. This is making many prescribers nervous to the max. While the thrust of regulators has been in regard to opioid drugs other scheduled drugs such as stimulants, benzodiazepines are caught up in it as well. Primary care docs are affected by the zealous "witchhunt" in regard to prescribing practices. Hospitals, clinic administrators, etc., are equally touchy about docs prescribing scheduled drugs. So prescribers anticipate getting static if they prescribe stimulants however reasonable it may be. Especially true for PCPs who lack specific training in managing ADHD--harder to defend their actions if challenged by admins. Among psychiatrists (who should know about ADHD) other factors are operating. Some don't like dealing with ADHD patients, notorious for poor follow through, don't show up for appointments, lose prescriptions, don't pay their bills, etc. Also ADHD cases are frequently more complicated than average due to comorbidities, social issues (marriage/family problems, difficulty at job, etc.), potential for substance use disorder. Patients without ADHD are more likely to be comparatively more straightforward to deal with, so ADHD sufferers aren't accepted as patients. Yes indeed, "pill mills" have made everyone's life more difficult. But it doesn't mean every doc who prescribes scheduled drugs operates a pill mill. The tendency to throw out babies with their bathwater is fearsome to many doctors. Here's my advice to colleagues: every patient deserves a thorough diagnostic evaluation. If ADHD is one diagnosis, it should be treated vigorously within appropriate clinical guidelines. If stimulant treatment is indicated start with a low dose, titrate gradually until reaching an effective and tolerable level. Do not neglect behavioral treatments, these are essential. (Book-length description in progress.) The SECRET to successful treatment and keeping regulators at bay: excellent clinical documentation. I never was "in trouble" over prescribing, I had the records showing rationale for every prescription, so nothing to be afraid of.\ Your story isn't unusual, there's a shortage of qualified, and willing, providers in this domain. Combined with a cultural bias against and misunderstanding of people with ADHD the treatment situation is troublesome. Educating providers and the public is badly needed. If that's done, over time availability of high-quality care for people with ADHD will improve.
poulpy123 4y ago
What improvement would an adult with ADD (without H) have without being diagnosed and without having access to a treatment ? I may or may not have ADD but diagnosing adults in my country is extremely uncommon, and anyway the symptoms I have can be indicative of many other mental troubles, so I'm interested in not-medical ways to cope
lghh 4y ago
I am 30. I got diagnosed with ADHD a few months ago and I started treatment (adderall and lifestyle changes). Growing up, ADHD was my biggest enemy in life and I didn't even realize it. Once I began treatment, the change was almost overnight. I know I'm just one data point in a sea of data points, but I really just want to add that I'm on the other end of the parent comment and getting diagnosed, other than my marriage and the birth of my son, was the best thing that's ever happened to me.
- symlinkk 4y ago
  I mean, anyone benefits from Adderall whether you have ADHD or not. How are you so sure you really have it?
  - maininformer 4y ago
    I feel sleepy cause it so calm after I take it.
  - scollet 4y ago
    Adderall does not work on NT brains. They would be able to perform tasks regardless.
    - lghh 4y ago
      Adderall gets you to baseline. If you're already baseline, it shoots you past it.
    - symlinkk 4y ago
      Where’d you hear that? It works quite well on people without ADHD
      - ravi-delia 4y ago
        It, for many people, works differently. If you look at people talking about their experiences, those with ADD consistently describe different effects than NT people. It's still good, but it has more of an effect on energy than focus, though the two are well correlated. It might be an overshoot/undershoot thing, it might be that different effects are salient, but I can assure you that if Adderall could do as much for a healthy person as it does for me, we'd be living in utopia.
gibquaaludes 4y ago
Do you know how a patient would get funneled to someone like you with expertise on this matter? My experience with GPs is that they do not understand those issues and do not know how to direct to someone who does. It's not like a physical ailment where they know with a fair degree of certainty what the next avenue is.
- jrapdx3 4y ago
  Yes, it is a problem finding clinicians with interest in and experience with ADHD adults. In larger cities there are usually a handful of people who qualify, sometimes associated with teaching hospitals. Another possibility is asking at a college or university health clinic (even if you don't attend there). Organizations like CHADD, local or state psychiatric associations have referral lists that can be useful. Likewise some insurers publish lists of clinical specialists. Other folks with ADHD who are in treatment might have a practitioner with room to see a new patient. Pays to keep trying to find a provider you can work with, it will happen sooner or later and will be well worth all the trouble you went to.

sizzle 4y ago

Thank you for having this perspective to help treat your adhd patients, wish there were more like you. I’ve encountered quite a few doctors who admitted they are scared of the DEA and losing their license and make us jump through flaming hoops to adjust dosages of stimulants or force us to navigate a byzantine maze of psychiatry to get to a psychiatrist that will take the liability away for prescribing/adjusting scheduled medications. This is even with 10+ years of diagnosis. Do you have any insight into why it is this way? Have physicians always feared the DEA and threat of losing their license in pursuit of helping their patients try different controlled medications? Did the pill mills ruin it for the entire medical industry?

jrapdx3 4y ago
Amphetamine has such an interesting history. Synthesized in 1887, first used in the 1930s, and in 1937 discovered to have a remarkably favorable effect on hyperactive boys. Methylphenidate (Ritalin) came along somewhat later. 85 years later these two drugs are still the mainstay of ADHD treatment. Sure delivery systems have proliferated and drug variants have been available. Stimulant-class medications remain first-line treatments. Amazingly even after nearly a century nothing better has ever been developed, and it certainly hasn't been for lack of trying. Prior to 1970 there were relatively few restrictions, but widespread abuse lead to legislation establishing the DEA and tightened regulations. Drugs of abuse were sifted into a schedule of classes 1 to 5, where class 2 drugs were legal to prescribe but subject to limits intended to reduce diversion and misuse. BTW one of the legal schedule 2 drugs is methamphetamine, approved for ADHD. We know it can be misused, leads to severe dependency problems, but used properly is an effective and quite tolerable treatment for ADHD. Indeed I have prescribed it for a number of patients in the past. With the huge opioid crisis that's emerged in recent years scrutiny by state licensing boards has increased regarding prescribing patterns. This is making many prescribers nervous to the max. While the thrust of regulators has been in regard to opioid drugs other scheduled drugs such as stimulants, benzodiazepines are caught up in it as well. Primary care docs are affected by the zealous "witchhunt" in regard to prescribing practices. Hospitals, clinic administrators, etc., are equally touchy about docs prescribing scheduled drugs. So prescribers anticipate getting static if they prescribe stimulants however reasonable it may be. Especially true for PCPs who lack specific training in managing ADHD--harder to defend their actions if challenged by admins. Among psychiatrists (who should know about ADHD) other factors are operating. Some don't like dealing with ADHD patients, notorious for poor follow through, don't show up for appointments, lose prescriptions, don't pay their bills, etc. Also ADHD cases are frequently more complicated than average due to comorbidities, social issues (marriage/family problems, difficulty at job, etc.), potential for substance use disorder. Patients without ADHD are more likely to be comparatively more straightforward to deal with, so ADHD sufferers aren't accepted as patients. Yes indeed, "pill mills" have made everyone's life more difficult. But it doesn't mean every doc who prescribes scheduled drugs operates a pill mill. The tendency to throw out babies with their bathwater is fearsome to many doctors. Here's my advice to colleagues: every patient deserves a thorough diagnostic evaluation. If ADHD is one diagnosis, it should be treated vigorously within appropriate clinical guidelines. If stimulant treatment is indicated start with a low dose, titrate gradually until reaching an effective and tolerable level. Do not neglect behavioral treatments, these are essential. (Book-length description in progress.) The SECRET to successful treatment and keeping regulators at bay: excellent clinical documentation. I never was "in trouble" over prescribing, I had the records showing rationale for every prescription, so nothing to be afraid of.\ Your story isn't unusual, there's a shortage of qualified, and willing, providers in this domain. Combined with a cultural bias against and misunderstanding of people with ADHD the treatment situation is troublesome. Educating providers and the public is badly needed. If that's done, over time availability of high-quality care for people with ADHD will improve.

poulpy123 4y ago

What improvement would an adult with ADD (without H) have without being diagnosed and without having access to a treatment ? I may or may not have ADD but diagnosing adults in my country is extremely uncommon, and anyway the symptoms I have can be indicative of many other mental troubles, so I'm interested in not-medical ways to cope

lghh 4y ago

I am 30. I got diagnosed with ADHD a few months ago and I started treatment (adderall and lifestyle changes). Growing up, ADHD was my biggest enemy in life and I didn't even realize it. Once I began treatment, the change was almost overnight. I know I'm just one data point in a sea of data points, but I really just want to add that I'm on the other end of the parent comment and getting diagnosed, other than my marriage and the birth of my son, was the best thing that's ever happened to me.

symlinkk 4y ago
I mean, anyone benefits from Adderall whether you have ADHD or not. How are you so sure you really have it?
- maininformer 4y ago
  I feel sleepy cause it so calm after I take it.
- scollet 4y ago
  Adderall does not work on NT brains. They would be able to perform tasks regardless.
  - lghh 4y ago
    Adderall gets you to baseline. If you're already baseline, it shoots you past it.
  - symlinkk 4y ago
    Where’d you hear that? It works quite well on people without ADHD
    - ravi-delia 4y ago
      It, for many people, works differently. If you look at people talking about their experiences, those with ADD consistently describe different effects than NT people. It's still good, but it has more of an effect on energy than focus, though the two are well correlated. It might be an overshoot/undershoot thing, it might be that different effects are salient, but I can assure you that if Adderall could do as much for a healthy person as it does for me, we'd be living in utopia.

gibquaaludes 4y ago

Do you know how a patient would get funneled to someone like you with expertise on this matter? My experience with GPs is that they do not understand those issues and do not know how to direct to someone who does. It's not like a physical ailment where they know with a fair degree of certainty what the next avenue is.

jrapdx3 4y ago
Yes, it is a problem finding clinicians with interest in and experience with ADHD adults. In larger cities there are usually a handful of people who qualify, sometimes associated with teaching hospitals. Another possibility is asking at a college or university health clinic (even if you don't attend there). Organizations like CHADD, local or state psychiatric associations have referral lists that can be useful. Likewise some insurers publish lists of clinical specialists. Other folks with ADHD who are in treatment might have a practitioner with room to see a new patient. Pays to keep trying to find a provider you can work with, it will happen sooner or later and will be well worth all the trouble you went to.