Resources for adult ADHD?

[reca]

Does anyone have any resources they'd recommend to lean more about diagnosis and management of ADHD in adults? I've had some exposure during residency, mostly in student health, but want to solidify my knowledge base and was wondering if anyone had suggestions of books/lectures/audio resources, etc. Thanks!

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[WisNeuro]

Taking Charge of Adult ADHD by Barkley

 

[DopamineQueen]

As someone with adhd, who has also experienced numerous challenges with providers misunderstanding it, i truly appreciate your question.

One thing that may be helpful is to explore are things like #adhd on social media. This is obviously very non-scientific, but it may help build insight into the constant challenges people with adhd face. I’ve worked with others that assume it only occurs in the workplace, but it creates challenges in essentially every area of life. Additionally, this may help you gain some anecdotal data on common misconceptions spread about adhd (e.g., due to poor parenting, cured with essential oils, giving kids stimulants means they are addicted) that your patients may bring to the table

This website has a lot of info on adhd that can also be shared with patients. Overview - CHADD

I would also say learning how to explain adhd medication in a simple but informative way is important. This can help decrease stigma of meds and increase awareness of adhd. This website has some good language you may steal for simplified explanations (obviously some Info on here may not be necessary and you may know way more than what’s on here, but explaining things like the connection between adhd and dopamine can be validating)

Stimulant Medications for ADHD - Child Mind Institute

Explore the effectiveness of ADHD medications like Ritalin, Focalin, Aderall and Concerta. Learn how they improve focus in children, and side effects to be aware of.

childmind.org

As mentioned above, a resource you may find helpful are Barkley’s YouTube change and books. Another YouTube channel you may enjoy and your patients may like is “how to adhd.” Some of the info is just fun stuff, and some of the videos do an excellent job of explaining adhd and include a variety of professionals.

Again, thank you for taking the time to understand adhd. The world has a long way to go on research, particularly with adult adhd. Providers like you who take the time to understand this common, yet often misunderstood, disorder can certainly change many patients perceptions of health care and themselves. I have plenty more resources if you want more info down the road

 

[WisNeuro]

I would also say learning how to explain adhd medication in a simple but informative way is important. This can help decrease stigma of meds and increase awareness of adhd. This website has some good language you may steal for simplified explanations (obviously some Info on here may not be necessary and you may know way more than what’s on here, but explaining things like the connection between adhd and dopamine can be validating)

Stimulant Medications for ADHD - Child Mind Institute

Explore the effectiveness of ADHD medications like Ritalin, Focalin, Aderall and Concerta. Learn how they improve focus in children, and side effects to be aware of.

childmind.org

Oh, I can assure you, the vast majority of patients that psychiatrists are seeing do not have a stigma against taking stimulants.

 

[birchswing]

Oh, I can assure you, the vast majority of patients that psychiatrists are seeing do not have a stigma against taking stimulants.

There was a huge stigma back in the 90s. I did not know what I was taking the first few years when I took benzos, but I remember thinking at least I'm not like those kids on Ritalin. I would go down to the school nurse to get my Ativan, and she told me I was the only one on that type of medicine. And I made a comment about how too many kids are on Ritalin these days, which was a common thing I heard people saying. And she said, "Yes, but they get better." That's what sort of stopped me in my tracks about the stigma. I knew I was not getting better.

 

[WisNeuro]

There was a huge stigma back in the 90s. I did not know what I was taking the first few years when I took benzos, but I remember thinking at least I'm not like those kids on Ritalin. I would go down to the school nurse to get my Ativan, and she told me I was the only one on that type of medicine. And I made a comment about how too many kids are on Ritalin these days, which was a common thing I heard people saying. And she said, "Yes, but they get better." That's what sort of stopped me in my tracks about the stigma. I knew I was not getting better.

There was a stigma about a lot of things in the past, but the situation has changed dramatically. Ask 1000 prescribers if they have patients reluctant about stimulant medications these days, you won't get many endorsing reluctance. The problem has shifted towards the other extreme, now EVERYONE wants a stimulant, most people because they have regular life issues. I don't think we need to push funds into the "de-stigmatize stimulants" campaign anymore.

 

[clausewitz2]

There was a stigma about a lot of things in the past, but the situation has changed dramatically. Ask 1000 prescribers if they have patients reluctant about stimulant medications these days, you won't get many endorsing reluctance. The problem has shifted towards the other extreme, now EVERYONE wants a stimulant, most people because they have regular life issues. I don't think we need to push funds into the "de-stigmatize stimulants" campaign anymore.

The only people I've met these days who seem to feel negatively about taking a stimulant are the people who really obviously have ADHD but don't accept the diagnosis despite everyone they know suggesting to them they might have it. They are not quite unicorns, but maybe zebras.

 

[WisNeuro]

The only people I've met these days who seem to feel negatively about taking a stimulant are the people who really obviously have ADHD but don't accept the diagnosis despite everyone they know suggesting to them they might have it. They are not quite unicorns, but maybe zebras.

I've seen a handful of people with ADHD who just didn't like how they felt on them and stopped. But those people are fairly uncommon in my patient population.

 

[DopamineQueen]

There was a stigma about a lot of things in the past, but the situation has changed dramatically. Ask 1000 prescribers if they have patients reluctant about stimulant medications these days, you won't get many endorsing reluctance. The problem has shifted towards the other extreme, now EVERYONE wants a stimulant, most people because they have regular life issues. I don't think we need to push funds into the "de-stigmatize stimulants" campaign anymore.

I would like to see some data on this. I still get comments from medical providers like “you’re an adult, you shouldn’t need this,” “have you tried making a to do list?,” “a little bit of exercise may cure your poor attention “, etc. I’ve known stay at home parents with adhd get denied stimulants because they aren’t “working” while home. Honestly, being a stay at home parent probably requires more executive functioning than many jobs.

I think assuming most people seeking stimulants don’t have adhd contributes to stigma. People seeking stimulants who don’t need them leads providers to think everyone asking for an ADHD eval is simply drug seeking. Providers assuming most patients seeking an eval are drug seeking leads to patients concerns not being taken seriously.

 

[DopamineQueen]

The only people I've met these days who seem to feel negatively about taking a stimulant are the people who really obviously have ADHD but don't accept the diagnosis despite everyone they know suggesting to them they might have it. They are not quite unicorns, but maybe zebras.

Maybe they need a bit more psychoeducation on adhd. Many people think adhd is a young child who can’t stay seated. Others associate adhd with a lot of stigma.

 

[DopamineQueen]

There was a stigma about a lot of things in the past, but the situation has changed dramatically. Ask 1000 prescribers if they have patients reluctant about stimulant medications these days, you won't get many endorsing reluctance. The problem has shifted towards the other extreme, now EVERYONE wants a stimulant, most people because they have regular life issues. I don't think we need to push funds into the "de-stigmatize stimulants" campaign anymore.

Yikes... I would like to see some data on this. Are providers asking this? Otherwise, they may not know people are reluctant. Patients may not express reluctance in fear that providers may assume they are reluctant because they don’t need them (even if the pt knows they do).

There are a lot of people seeking stimulants that do not need them. However, that doesn’t mean there still isn’t stigma for those who do need them. In fact, assuming most is drug seeking vs truly have adhd is contributing to the stigma. When pts feel like they are being judged for simply seeking treatment for their adhd, they feel stigmatized. An increase in people seeking stimulants without adhd doesn’t necessarily equal a decrease in stimulant use stigma for those with adhd.

 

[HemeOncHopeful19]

I do think with the opioid crisis that all controlled substances have been somewhat stigmatized and certainly feel it as someone with ADHD. Maybe there is an epidemic of drug seekers out there, who knows, I’m not in Psych. I will say that for all the hoops one has to jump through to get them that I really wish I was effing normal without them.

All I can say is if the local residency program won’t prescribe stimulants (most efficacious 1st line treatment) without neuropsychiatric testing (which is bogus according to most opinions I’ve read here) then the system has a problem somewhere.

 

[calvnandhobbs68]

I would like to see some data on this. I still get comments from medical providers like “you’re an adult, you shouldn’t need this,” “have you tried making a to do list?,” “a little bit of exercise may cure your poor attention “, etc. I’ve known stay at home parents with adhd get denied stimulants because they aren’t “working” while home. Honestly, being a stay at home parent probably requires more executive functioning than many jobs.

I think assuming most people seeking stimulants don’t have adhd contributes to stigma. People seeking stimulants who don’t need them leads providers to think everyone asking for an ADHD eval is simply drug seeking. Providers assuming most patients seeking an eval are drug seeking leads to patients concerns not being taken seriously.

You're talking about two different things here in terms of "stigma". Also, it should not be seen as insulting that people are encouraging you (and all patients with ADHD) to perform behavioral interventions to address ADHD. We do the same things for GAD, social anxiety, MDD, OCD, even SMI like bipolar disorder/schizophrenia (there are specific psychotheraputic approaches to these). A lazy psychiatrist doesn't ask you what behavioral changes you're making to address your psychiatric condition and just cranks up the med dose. Same way a lazy PCP doesn't ask you exactly what you're doing for exercise and diet when treating your HTN but just cranks up the lisinopril dose. Same way a lazy ortho doesn't ask you if you've actually been doing the physical therapy exercises for your shoulder pain.

You can find this other places on this forum but many of us have the experience that many people come seeking stimulants that do not at all have a clear cut diagnosis of ADHD. That doesn't mean they don't have ADHD. However, stimulants are generally a performance enhancer even in at least a subset of the cognitively "normally" functioning population. Many times the ways this has gone for me is "I tried my friend's Adderall and it helped" without a clear history (with collateral information available either currently or historically) of ADHD symptoms with onset before 12yo.

I agree that people should not be denying stimulants based on whether someone is a stay at home parent or not. I have many adult patients who are stay at home parents who are better parents on stimulant medications for their ADHD.

 

[calvnandhobbs68]

I do think with the opioid crisis that all controlled substances have been somewhat stigmatized and certainly feel it as someone with ADHD. Maybe there is an epidemic of drug seekers out there, who knows, I’m not in Psych. I will say that for all the hoops one has to jump through to get them that I really wish I was effing normal without them.

All I can say is if the local residency program won’t prescribe stimulants (most efficacious 1st line treatment) without neuropsychiatric testing (which is bogus according to most opinions I’ve read here) then the system has a problem somewhere.

If you don't have a clear history of diagnosed/treated ADHD as a child, then they're being understandably cautious (although perhaps overly so). Neuropsych testing isn't "bogus" but it absolutely can't be relied on alone to make or not make a diagnosis of ADHD.

If you have a prior diagnosis and are just trying to continue previously prescribed stimulants, then yes that's completely ridiculous.

 

[birchswing]

I do think with the opioid crisis that all controlled substances have been somewhat stigmatized and certainly feel it as someone with ADHD. Maybe there is an epidemic of drug seekers out there, who knows, I’m not in Psych. I will say that for all the hoops one has to jump through to get them that I really wish I was effing normal without them.

All I can say is if the local residency program won’t prescribe stimulants (most efficacious 1st line treatment) without neuropsychiatric testing (which is bogus according to most opinions I’ve read here) then the system has a problem somewhere.

Yes, I saw this in spades. It was like, "Oh now you care about what I've been telling you about for years?"

Leo Sternbach, who discovered benzodiazepines, had himself been ringing alarm bells about inappropriate use since the 1960s.

I was at a community services board, and I frequently brought in a copy of the Ashton Manual that was dismissed (the psychiatrist thought the cross taper which used Valium was both unnecessary and that Valium was "dirty"—he said if you want to go off you can cut down by some ridiculously fast rate over a week or so or stay on it which was his recommendation). He actually increased my dose of benzodiazepines. I think I last saw him maybe in 2008 or so--not exactly sure--but he left very unexpectedly (another story—quite colorful).

So this community services board was temporarily without any psychiatrist, so I went to a private practice. Years later, I tried to go back to the community services board, and they had a blanket "no benzodiazepines prescribed" policy.

Now this community services board was no bastion of research, I can tell you. If Washington DC is a swamp, this is a bog. It's not like anyone there had started combing through academic papers on prescribing. They had *decades* to do that. But this changed overnight. This was an across the board—public and private practice—sea change that resulted directly from the comorbidity of benzodiazepines in opiate deaths. They had the fear of God put in them by the state. I am not privy to what the state actually tells them. Because in the public facing documents, it still says benzos can be prescribed even with opiates. In fact, the only law I think is that by a certain year (and maybe that year has come to pass by now) that if you prescribe a certain amount of benzo and opiate together, you have to provide a rationale. That's it. But they got spooked.

Now I'm not defending benzodiazepines. I'm just saying that the reason they were used to begin with was not research based, and the reason for the change was not research based either. They were spooked. Or came to just see as stigmatized and bad maybe. Benzos=opiates, and opiates are an epidemic? Not sure. I'm not saying it was ever good. It's just the rationale for prescribing long-term and then stopping seem equally haphazard.