I spent a year after residency working locums jobs in 3 different areas of the country, before taking a permanent job this past summer in yet another area. One thing I noticed is that there seem to be problems/complaints that are more common in some areas than others. Each locale had sort of its own "classic" issue. And where I am now, it seems to be adults wanting to get diagnosed with ADHD for the first time in adulthood. I had seen maybe 1 or 2 patients like this in all of residency. But here, it seems like I have at least 1 new patient every day on my schedule who scored some Adderall from their PCP, who is now sending them to me because of my... uh... expertise. Or who feels like they can't focus at work and just knows they have ADHD because they read a Facebook post about it. Or who took some of their friend's Vyvanse and suddenly it was like a cloud lifted and they were miraculously a new person! (Or who was diagnosed as a kid but is now 35 and has never tried being off stimulants, which also bothers me.) Has anyone here gotten good training on this in residency? It was a problem I was totally unprepared to deal with. I mean, people who insist that nothing works for their anxiety except Xanax are frustrating to deal with too, but at least residency gave me several years of experience doing so. I'm kind of blindsided by this. If you see patients like this, what do you tell them? We have 2 psychological groups in the area we refer people out to for testing, but I recall seeing a post from a psychologist on this very forum recently stating that the concept of psych testing for ADHD is bogus. But if you just run down the list of DSM-V criteria for ADHD, of course they just say "yes" to everything. I have a hard enough time believing in childhood ADHD, but in residency I got through the mandatory rotations in child/adolescent by keeping my head down, smiling and nodding, and doing what the attendings said. I didn't expect this to follow me into the adult population. I have half a mind to just grow a pair and flat out tell these people, "sorry, I don't believe in adult ADHD. You're going to need to see a different doctor."