Archive for November, 2010

Patients’ reactions to the diagnosis of ADHD

My 38 year old attractive blond female patient started crying when I told her at the end of my evaluation that she had ADHD. Believing I said something upsetting, I apologized, as it was not my intent to make her sad. She said “No, that’s not it. I’m crying because I’m happy. “ Puzzled, I asked her “Why?” She said “I’m happy. Now I know why I’m this way. I thought you were going to tell me what people have told me my whole life ‘You’re just blond and stupid’.”

In that moment I realized the scarring effect her ADHD had had on her self-image. Suffering with the symptoms since she was a child, she came to believe what people said about her. Imagine your whole life being forgetful and careless, being tardy and inconsistent, being unable to perform as other people, and, as a result, being criticized day after day, year after year. It’s as if you were blind and people criticized you for not being able to see. The difference is that people understand blindness; they don’t see or understand ADHD.

I tell this story because it is an issue I help my patients understand. If the disorder is not identified, a person can assume that this is who they are as a person. “It’s just me. That’s the why I am.” Yet when the ADHD is successfully treated and the symptoms reduce allowing one to function at a much higher level, then the person comes to see “That’s not who I am. That’s the disorder.” I help them separate the disorder from who they are as a person.

Once I can get the person to see and accept that, we work on resurrecting the person’s self-image. During this therapy, the person starts to blossom. Because they can complete more tasks during the day and deliver a more consistent performance to others, their self-confidence increases. With greater self-confidence comes the initiative to take on tasks and projects they might have avoided in the past. As performance is achieved, the person then strives for higher goals. They may return to school to complete that college degree they had left unfinished when they dropped out. They may look for a new job with more professional opportunity. They may seek full-time employment instead of disability income. They may decide that they are now able to move out the parents’ house and live in an apartment. They may salvage a damaged relationship they had no intention of losing.

I diagnosed a 43 year old married man with ADHD after his 10 year old son was diagnosed. Successfully treated for his adult ADHD, he left his job with a salary of $74,000 per year and got a new job. Within three years of treatment, he had gotten 2 promotions and was making $145,000 per year. He wasn’t twice as smart. He was freed from the impairing symptoms of his ADHD and maximized his potential. Imagine this man’s self-confidence these days. Imagine the benefit to his family.

For twenty five years I have treated people with ADHD and associated depression/anxiety/substance abuse. My satisfaction is achieved everyday by being able to offer my expertise and care to people in order to help them change their lives for the better.

Categories: Living with Adult ADD

Adult ADHD in Europe

Sitting on a plane back from Berlin, Germany, I thought I’d convey information about adult ADHD you may not readily find. I had the opportunity to be invited to a small meeting of international experts on adult ADHD from several countries (2 from North America, 3 from Europe). The purpose of the gathering was to exchange the current state of the art for adult ADHD in the respective countries. It was fascinating discussion because all the experts agree on what adult ADHD is. This agreement occurs despite varying levels of research in the individual countries. It appears that the experts are relying on the internationally published medical literature for guidance. The opponents to the validity of adult ADHD claim that the disorder is largely a U.S. phenomenon and doesn’t exist elsewhere in the world. These folks have apparently not left the U.S. to discuss it with other psychiatrists. Nor are they aware of the ongoing international research funded and conducted by the World Health Organization.

In some European countries (Germany, United Kingdom and Netherlands) there are centers with experts conducting research on adult ADHD and providing care. However, there are also countries (France, Italy, and Spain) that remain opposed to the diagnosis. Unfortunately, not believing in the disorder doesn’t mean the disorder doesn’t exist in the population. Because you close your eyes doesn’t mean the world goes away.

To advance care, there have been three publications recommending preliminary diagnosis and treatment guidelines internationally- CADDRA (Canada), NICE (United Kingdom) and European Consensus (several European countries). I was the pre-publication peer reviewer for the European consensus paper. To date, the United States experts have not yet issued such guidelines. It may be that we’ll wait until DSM-V (to be published in May 2013) better refines the diagnostic criteria for adults with ADHD. Canada and the European experts have not felt the need to wait because clinical guidance is necessary now in order to provide evidence-based treatment to adults with ADHD.

To compound the international difficulty in receiving care for adult ADHD, the medications available are severely limited and determined by country. Immediate release methylphenidate is the most commonly available but immediate release dextroamphetamine is less available. Atomoxetine, Concerta, Vyvanse, and Adderall are also variably available country to country. There are some countries where you may not enter with a stimulant medication (Italy and Japan). My patients traveling abroad need to be aware of this before leaving the U.S. For those countries that permit stimulants, I provide a note on my letterhead that states this person is under my medical care and should be allowed to carry medication. Medicines alway need to be in the prescription bottle appropriately labeled by the pharmacist.

I am very fortunate to be able to participate in international research on this disorder and cultivate a world-wide network of ADHD experts. This allows me to bring state of the art care and treatment back home to my patients, in addition to contributing to the world’s published research literature.