What Your Doctor Needs to Know About Diagnosing ADHD in Adults

Securing an accurate and complete diagnosis is the most important step in helping adults with ADD or ADHD.

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ADHD symptoms can be the result of different mental health issues, such as depression, anxiety, or bipolar disorder.

Adults with ADHD expect to face problems at home, at work and almost everywhere in between. Getting an accurate diagnosis and appropriate treatment is the key to successfully managing your ADHD.

At one time, most doctors who weren't experts in ADHD were unaware that the disorder lasted into adulthood. Most doctors now understand this. In fact, primary care physicians — family doctors — write most of the prescriptions for medications for ADHD for both adults and children. "Most family practitioners are skilled at recognizing the symptoms of ADHD," says Michele Novotni, Ph.D, an ADHD clinician and co-author of Adult ADHD.

The Utah, Copeland, and Brown self-rating scales are useful in helping the primary care physician confirm the ADHD diagnosis. However, Novotni warns that doctors need to be careful not to overlook other possibilities.

"The part that most family physicians miss out on would be the differential diagnosis," explains Novotni. "ADHD symptoms can be the result of different mental health issues, such as depression, anxiety, or bipolar disorder. Any of these conditions can be occurring with ADHD." Physicians who are unfamiliar with making a mental health diagnosis should refer patients to either a psychiatrist or psychologist who is trained to diagnose and treat these other conditions.

"About 80% of adults with ADHD have some kind of co-occurring condition that complicates the treatment of their ADHD," says Novotni. She warns that not treating all of the problems leaves the patient struggling and frustrated.

Novotni also points out that there have been some changes in the criteria for diagnosing adults. At one time, the diagnosis required a childhood history of ADHD-like behaviors appearing before age seven. Recent research on ADHD has eliminated what was know as the "age of onset" criteria. Scientists now understand that ADHD can appear later, in some cases emerging after the individual has finished high school and begins to face adult life and responsibilities. Many adults with ADHD report having had "some problems" as a child, but they were able to provide their own accommodations. Eventually, as life becomes more complex, these strategies become less effective.

"Adults who have a history of substance abuse should be evaluated for ADHD," says Hal Elliott, M.D. of Wake Forest University Baptist Medical Center. Elliott also a thorough developmental history, and a medical and neurologic examination to rule out other causes of poor concentration and attention. "If the diagnosis is unclear or if there is inadequate response to an intervention, referral to a psychiatrist or psychologist is indicated," he says.

The same medications used to treat children who have ADHD are also used to treat adults. Stimulants like Ritalin, Dexedrine or Adderall, along with tricyclic antidepressants like despramine. Wellbutrin is another antidepressant medication that is often used to treat adults, especially if the patient has high blood pressure or other health complications that prevent stimulant treatments.

In addition to medication, adults with ADHD need to learn as much as possible about how to make the most of their unique brain wiring. This may include individual or couples therapy, support groups and learning new ways to do things.

Novotni emphasizes that coaches can be very effective at helping adults who have ADHD. "A coach can give you ways to manage your ADHD symptoms. If you're hyperactive, a coach can suggest ways of channeling your energy — for instance, taking a walk during your coffee break. If you're impulsive, a coach can teach you ways to delay your responses, so you can think about them," she says.

What do you think of this article? Share your comments on www.ADDConnect.com, ADDitude's community site. Check out the new ADHD Medication User Reviews and the ADHD Adults Support Group. Your fellow ADDers want to hear from you!

 
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