Verified by 
Sometimes, it seems like everybody either has ADHD or thinks they have ADHD. However, only 5% of adult patients have true ADHD. In addition, the symptoms can present differently in adults than they do in children.
In adults, the most debilitating problems resulting from ADHD are the executive functions such as: planning, prioritizing, impulse control, maintaining motivation, organizing, and working memory. Patients with ADHD can be frustrating for the patient and their families as well as the doctors who are treating them.
I will describe some of the ways that ADHD can impair our patients' health and safety and then discuss some ways that you can help your patients.
How does impaired executive functioning affect the health of our patients?
1. Higher risk of substance abuse - 10-25% prevalence
2. Late or missed medical appointments
3. Non-compliance or missed medications
4. Increase impulsivity and risk of contracting STDs
5. High prevalence of motor vehicle accidents
6. Underperforming at work
7. Low self-esteem
8. Increased risk of depression and anxiety
9. Difficulty with sleep
10. Trouble with relationships
5 ways that we can help our patients:
1. Many patients are often not diagnosed as children. Thus, by using a simple 5 minute screening tool in the office or waiting room, we can help our patients that may have been misdiagnosed as borderline, chronically depressed, anxious or bipolar disorder.
Here is a site that you can give your patients:
Many patients feel that ADHD is not a "real diagnosis" and thus don't get evaluated or treated. However, by explaining to the patients that SPECT and PET scans show differential blood flow in the prefrontal cortex in ADHD patients versus non-ADHD patients can help reinforce to the patient that this is a "real" issue.
2. Patients with ADHD have difficulty with planning and time management. Thus, they often forget their appointments or are late.
This can be extremely annoying for a busy clinician, in addition, to the patient not getting the necessary care.
Thus, a way of improving the show rate for these patients includes encouraging them to write the appointment in their calendars immediately when the appointment is made, requesting that they show up 30 minutes before their appointments, calling them the morning of their appointments (not the night before) and by charging them for missed appointments.
3. Encouraging your patients to purchase a weekly calendar and to use it on a regular basis instead of relying on post-it notes or on smart phone. Many ADHD patients do better when they see things visually.
4. Help the ADHD patient to see that they have many strengths and that ADHD is just one aspect of who they are. In addition, even though they have compensated for it most of their lives, validate that it may have been a difficult struggle and that it can get better.
5. Help the patient to understand that many of their behaviors such as underperforming at work, engaging in high risk sexual activity, or challenges in their relationships are very common in patients with ADHD and that this can get better over time with treatment, either medications or behavioral treatments.
Working with patients who have ADHD can be frustrating at times, but can be extremely rewarding. Just like cigarette cessation, it can have a significant impact on a patient's life, but with appropriate diagnosis, treatment, and intervention, a patient's health and well-being can greatly improve.
Scott Shapiro, MD
Bibliography:
Barkley, R., Kevin Murphy. Attention-Deficit Hyperactivity Disorder. A Clinical Workbook. Guilford Press. 2006.
Young, S., Jessica Braham. ADHD in Adults. John Wiley and Sons Ltd. West Sussex, England. 2007.
About Scott Shapiro, MD
~~~
Scott Shapiro, MD is a psychiatrist in private practice who sees patients struggling with depression, anxiety, bipolar disorder and attention deficit and hyperactivity disorder (ADHD). He enjoys working closely with other high quality and personable specialists in providing comprehensive care. He uses evidenced based treatments including psychopharmacology, cognitive behavioral therapy (CBT), and schema therapy.
