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How do people come to see me for an adult ADHD evaluation?

April 23, 2011

Adult ADHD is now one of the most discussed topics in psychiatry. Physicians discuss it because there are an increasing number of research publications in the past few years. The general public talks about it because there have been many articles in newspapers and magazines. Business people discuss it so as to identify employees whose productivity might be improved. Police talk about it because ADHD can lead to confrontations with the law: driving accidents, drug arrests, alcohol intoxication, and other risk-taking illegal activity. Attorneys discuss it in order to advocate for academic accommodations in school or for exams (SAT, ACT, GMAT, MCAT, GRE, etc).

The largest psychiatric survey of the general U.S. population estimates that 4.4% of adults meet criteria for adult ADHD; that’s approximately 9-10 million adults of whom only 10-20% have been treated in the past year.

So how might they come to see me for an evaluation? There are several routes.

  1. Pediatricians: That’s right. Adult parents are referred by pediatricians. Why? When a child is diagnosed with ADHD, pediatricians turn to the parents and ask, “Who has similar symptoms?” Because ADHD is highly genetic (75-80% of the cause), pediatricians have been trained to ask the parents. The child’s behavioral treatment for ADHD isn’t going to be optimal unless the parent with ADHD is also treated. For example, having the child take medication for homework won’t work well if mother with ADHD is highly distracting and unable to provide consistent behavioral guidance at home. The treated child with ADHD is going to become frustrated if dad with ADHD forgets to pick his child up after school or runs late to his games. You can see why treating all family members in the household is best for an optimal outcome.
  2. Primary Care Physicians: In the past 5 years there have been a large number of publications and CME programs providing an overview of adult ADHD. People are approaching their doctors with questions about ADHD and how to diagnostic the disorder. So, your physician may do an initial evaluation and may decide to treat if your symptoms are straightforward. However, if you have other co-existing psychiatric conditions, a referral to a psychiatrist is best in order to distinguish the conditions. This approach facilitates a thoughtful sequence of treatments to improve symptoms.
  3. Family members: So often, one family member gets diagnosed and effectively treated. Then the family looks at other people and encourages an evaluation. I have treated three generations within a single family.
  4. Friends: As people become aware of the behaviors common to adults with ADHD, close friends or co-workers may say something about careless oversights, tardiness, speaking over and interrupting others in conversation, inconsistent follow through on tasks, and forgetfulness. A noticeable pattern of “consistently inconsistent” becomes apparent to people around the ADHD adult. The person who approaches to discuss it is the one that cares but most people will simply stop interacting because the inconsistency is too frustrating.
  5. Patients: Once when they are effectively treated and learn more about their symptoms, they see other people around them who exhibit similar symptoms. This commonly happens at work where ADHD impairments are evident as underperformance, chronic tardiness, and repetitive careless errors and oversights.
  6. Employers: Human resource professionals are more aware of the negative impact of untreated ADHD in the workplace. Employees whose job performance declines or has been chronically problematic, are screened for mental issues that now may include ADHD.

With increasing awareness of the validity of ADHD in adults and understanding the symptoms, more people are being identified, diagnosed and treated for adult ADHD. Treatment represents the opportunity to reduce symptoms, improve daily performance, and promote self-confidence.

Pass this information on to someone who might benefit. Do so respectfully.

Thank you again for your interest.

David W. Goodman, MD

Categories: Living with Adult ADD
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