Where to learn more about adult ADHD?

[PikminOC]

Unfortunately, these kinds of comprehensive evaluations are not available to most if they are 18+. Our clinic only did the all day testing/questionnaire/record review eval as it was subsidized by the university and it was a way for 1st and 2nd years to get supervised testing experience. Insurances do not cover these types of evals. In the insurance world, you essentially get 90791 and the time to give a couple of questionnaires and write up a report. So, if a provider insists on testing, which we really don't need for the diagnosis, people have to pay quite a bit of out of pocket money after sitting in a waitlist for 6+ months. So, for some people, it may not be motivation as much as affordability and access.

For the patient population I see it's not about affordability or access. I have a great neuropsych I refer them to who takes insurance and gets them in quickly.

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[WisNeuro]

For the patient population I see it's not about affordability or access. I have a great neuropsych I refer them to who takes insurance and gets them in quickly.

Your patients are the exception then, as most carriers will not reimburse neuropsych testing.

 

[FlowRate]

Anecdotally, our graduate program did the ADHD/LD evals for the university for referrals and accommodations. Our rate of potential malingering/PVT/SVT failure generally hovered between 40-50%.

This is the main thing I want that's missing from Wender-Utah, ASRS, etc.

There's no "disincentive" to just maxing any question that sounds vaguely ADHD related. Not that the patient needs to know there's a "disincentive" but that on the back end I can make some sense of an otherwise completely useless screening survey (because of the prevalence of people maxing their scores/lack of additional utility beyond the patient themselves just saying "I'm having trouble focusing.")

 

[tr]

This is the main thing I want that's missing from Wender-Utah, ASRS, etc.

There's no "disincentive" to just maxing any question that sounds vaguely ADHD related. Not that the patient needs to know there's a "disincentive" but that on the back end I can make some sense of an otherwise completely useless screening survey (because of the prevalence of people maxing their scores/lack of additional utility beyond the patient themselves just saying "I'm having trouble focusing.")

I feel like collateral is a cheaper/faster way to do this than full neuropsych testing.
It does require a bit more footwork vs just placing a referral though.

 

[calvnandhobbs68]

This is the main thing I want that's missing from Wender-Utah, ASRS, etc.

There's no "disincentive" to just maxing any question that sounds vaguely ADHD related. Not that the patient needs to know there's a "disincentive" but that on the back end I can make some sense of an otherwise completely useless screening survey (because of the prevalence of people maxing their scores/lack of additional utility beyond the patient themselves just saying "I'm having trouble focusing.")

lol I look at a maxed out ASRS, WURS, whatever the same way I look at a maxed out PHQ-9....alright whats going on here

That's why I like the Conners as well though.

 

[FlowRate]

I feel like collateral is a cheaper/faster way to do this than full neuropsych testing.
It does require a bit more footwork vs just placing a referral though.

Not sure if you were intentionally implying I said this but I don't refer for neuropsych testing for ADHD assessment (except the 1% or fewer where I actually need to rule out a LD.) Do you have a favorite go-to contact (boss, spouse, parents) for collateral calling? I almost never do that for adults for ADHD complaints, mostly because it's time consuming but also feels a bit invasive. I was more thinking it'd be nice if there was a shorter self/clinic administered form that would give those validity testing results.

lol I look at a maxed out ASRS, WURS, whatever the same way I look at a maxed out PHQ-9....alright whats going on here

That's why I like the Conners as well though.

Does Conners give PVT/SVT results? I don't think I've ever looked at one due to it being proprietary/pay.

 

[splik]

Does Conners give PVT/SVT results? I don't think I've ever looked at one due to it being proprietary/pay.

The conners doesn't test performance on any cognitive domains; it is based on self-report. PVT = performance validity testing and typically is looking at effort on tests of cognitive function. SVT = symptom validity testing and is asking about symptoms that are not typically found in mental disorder/cognitive impairment. The adult version of the Conners (CAARS) has an inconsistency index but no other validity scales. The child one has 3 validity scales (inconsistency, positive impression, negative impression). This will pick up extreme scoring (i.e. exaggerating) but will miss over 80% of those who would fail standalone performance validity measures.

The CAT-A that I mentioned earlier has 3 validity scales (infrequency, positive impression, negative impression).

 

[romanticscience]

This is the main thing I want that's missing from Wender-Utah, ASRS, etc.

There's no "disincentive" to just maxing any question that sounds vaguely ADHD related. Not that the patient needs to know there's a "disincentive" but that on the back end I can make some sense of an otherwise completely useless screening survey (because of the prevalence of people maxing their scores/lack of additional utility beyond the patient themselves just saying "I'm having trouble focusing.")

I took the validity items (* <1% of ADHD respondents answer 6 or more as "often") from the BRIEF-A and integrated them into my ASRS. I have gotten some interesting results, of which, I'm not sure what to do with.

Trouble wrapping up the final details of a project, once the challenging parts have been done
* Have angry outbursts
Difficulty getting things in order when you have to do a task that requires organization
* Start tasks (such as cooking, projects) without the right materials
* Trouble changing from one activity to another
Problems remembering appointments or obligations
* Emotional outbursts for little reason
* Trouble accepting different ways to solve problems with work, friends, or tasks
Avoid or delay getting started when you have a task that requires a lot of thought
* Talk at the wrong time
Fidget or squirm with your hands or feet when you have to sit down for a long time
*Problems waiting my turn
* Make inappropriate sexual comments
* Set unrealistic goals
*Feel overly active and compelled to do things, like you were driven by a motor
* Leave the bathroom a mess

I think I'll use them to softly suggest secondary processes going on (eg, dissociation/trauma) which may moderate treatment.

 

[Crayola227]

It's massively over diagnosed and treated with stimulants given all the stimulants sold at colleges etc. There's alot of diversion from people who don't really need it.

Eh, diversion and the fact that the patient actually has the disease and benefits from the medication are not at all mutually exclusive. Especially with meds that can be taken PRN, or you can get refills 3-5 days before your script would really be out and if you refill according to these rules enough times, you'll have extras while still taking exactly as prescribed. Sometimes the patient has extras or they just take a few less so they have a few to share. Diversion isn't relegated to just selling an entire script. To say nothing of when you have students just taking a few here and there from bottles they come across hoping their roommate or whatever doesn't notice, because they just want to try it.

This kind of behavior is extraordinarily common amongst college students, even ones with ADHD.

 

[erg923]

"The disease?" lol. Good Lord! Get real!

Not to say it doesn't exist totally, per that Clown College we call Harvard,....but if we can't even agree on the definition of "impairment"

Medicaid+ chaotic homelife. Are there even 3 or 4 other DSM diagnoses left?

 

[calvnandhobbs68]

Does Conners give PVT/SVT results? I don't think I've ever looked at one due to it being proprietary/pay.

The conners doesn't test performance on any cognitive domains; it is based on self-report. PVT = performance validity testing and typically is looking at effort on tests of cognitive function. SVT = symptom validity testing and is asking about symptoms that are not typically found in mental disorder/cognitive impairment. The adult version of the Conners (CAARS) has an inconsistency index but no other validity scales. The child one has 3 validity scales (inconsistency, positive impression, negative impression). This will pick up extreme scoring (i.e. exaggerating) but will miss over 80% of those who would fail standalone performance validity measures.

The CAT-A that I mentioned earlier has 3 validity scales (infrequency, positive impression, negative impression).

Correct, Conners doesn’t have validity testing (because it’s just a symptom report scale like most of the other ADHD scales). It has inconsistency, positive and negative impression indicies. I use the short form so just PI and NI on that. Those are helpful but I also like it because scoring is proprietary (so more difficult to access if you don’t have the materials) and a “maxed out” Conners just looks really bizarre. It has separate sub scales looking at various symptom domains, so at least less obvious how you “should” be answering. But no there is no validity testing. CAT-A is also proprietary.

Again, the vast majority of my diagnoses are <18yo so teacher and parent Conners forms are my most used tool.

 

[Mass Effect]

"The disease?" lol. Good Lord! Get real!

Not to say it doesn't exist totally, per that Clown College we call Harvard,....but if we can't even agree on the definition of "impairment"

Medicaid+ chaotic homelife. Are there even 3 or 4 other DSM diagnoses left?

What?

 

[erg923]

What?

Its an easy dx to make in the face of child who is non-compliant and in the midst of family chaos. Same for adults.

 

[FlowRate]

Its an easy dx to make in the face of child who is non-compliant and in the midst of family chaos. Same for adults.

I like the stat that being young for grade significantly increases risk of ADHD dx. I don't recall whether it was by 50% or 100% but somewhere in the range of being 1.5x - 2x more likely to get ADHD diagnosis if born in Nov than in Sep (or whatever months straddle the cutoff for that district.)

 

[Mass Effect]

Its an easy dx to make in the face of child who is non-compliant and in the midst of family chaos. Same for adults.

Ok but what do you mean when you mock it being called a disease? Or do you mean it's a disorder not disease?

And what does this mean "Are there even 3 or 4 other DSM diagnoses left?"

 

[erg923]

Ok but what do you mean when you mock it being called a disease? Or do you mean it's a disorder not disease?

And what does this mean "Are there even 3 or 4 other DSM diagnoses left?"

Yes. I dont think that is a helpful term for anyone to use here.

Oppositional child: ODD, ADHD, DMDD, IED. pick one. Unfortunately, this is the reality of what i see in medicaid populations.

 

[Mass Effect]

Yes. I dont think that is a helpful term for anyone to use here.

Oppositional child: ODD, ADHD, DMDD, IED. pick one. Unfortunately, this is the reality of what i see in medicaid populations.

I return to: what?

ODD, DMDD, IED are all different diagnoses with different criteria and ADHD should not be lumped in the middle of them by anyone at least somewhat knowledgeable about these disorders.

 

[erg923]

ODD, DMDD, IED are all different diagnoses with different criteria and ADHD should not be lumped in the middle of them by anyone at least somewhat knowledgeable about these disorders.

Agreed. But the reality is that many MH practitioners suck. So, what I said, happens. Alot.

 

[sloh]

I like the stat that being young for grade significantly increases risk of ADHD dx. I don't recall whether it was by 50% or 100% but somewhere in the range of being 1.5x - 2x more likely to get ADHD diagnosis if born in Nov than in Sep (or whatever months straddle the cutoff for that district.)

Yep. NEJM link below.

https://www.nejm.org/doi/full/10.1056/NEJMoa1806828

“Rates of diagnosis and treatment of ADHD are higher among children born in August than among children born in September in states with a September 1 cutoff for kindergarten entry.”

 

[calvnandhobbs68]

Yep. NEJM link below.

https://www.nejm.org/doi/full/10.1056/NEJMoa1806828

“Rates of diagnosis and treatment of ADHD are higher among children born in August than among children born in September in states with a September 1 cutoff for kindergarten entry.”

Meh.

First of all, the difference isn't as dramatic as first stated. If we imagine the "true" prevalence is somewhere in the middle, than the relative percent difference is 29% between August to September...while it's not nothing it's nowhere near the "1.5-2x higher" difference noted above.

Also, this is a great example of picking data to fit your prior conclusions (so wonder who the reviewers for NEJM were for this one....). Take a look at Figure 1. All they did was side to side comparisons month to month and wow how dramatic look at August to Sept, what a big difference! But wait a minute....if you look at the actual rates below, you'll see that there's probably actually differences between TONS of month to month comparisons if you didn't just do the month immediately preceding or after. For instance, if you did the comparison, there's probably an even bigger difference between APRIL birthdays and September birthdays...but what would that even mean? Same for Feb, March, May and July vs September. All those kids born in Feb are smack dab in the middle of the age group for their class but their rates of ADHD dx are actually slightly higher but definitely not statistically significant vs August birthdays.

There's probably some difference between oldest and youngest kids in the class but that's also not surprising to me anyway. ADHD is a diagnosis of which impairment depends on environmental factors. In fact, I always tell parents that if we didn't make kids sit in a classroom for 7 hours a day, many of them probably wouldn't need pharmacologic treatment. This is why many of them struggle a lot less during the summer of course....
Keep in mind though that Conners for instance are normed for age...so when we score parent responses that's normed against other 5yo or 6yo.

 

[FlowRate]

First of all, the difference isn't as dramatic as first stated. If we imagine the "true" prevalence is somewhere in the middle, than the relative percent difference is 29% between August to September...while it's not nothing it's nowhere near the "1.5-2x higher" difference noted above.

You're right. I stored the tl;dr of that study as "a lot different" and pulled 1.5-2x as an overestimate due to my own bias regarding ADHD at the moment. Still, (85-64)/64 = 1.33x higher is a significant difference that speaks to the diagnosis being made in comparison to peer group on measures of childhood social function i.e. likely ends up pathologizing normal developmental differences to some degree.

Of course other month to month comparisons don't show nearly the same difference. The other month to month comparisons are comparing kids who are 1 month different in age rather than 11 months different in age. I don't think it was all that useful for them to graph it. The Aug-Sep association didn't hold (in the same magnitude at least) when looking at states that did not have a Sept 1 kindergarten cutoff.

Is the kid's kindergarten/elementary teacher normed by age or do they just think "Johnny won't sit still, he must have ADHD because that's the word we use for kids who won't sit still these days" Rather than thinking "oh, Jonny has lived 83% as long as Billy, that's a pretty significant difference in amount of time spent learning to be a human in a social environment."

 

[calvnandhobbs68]

You're right. I stored the tl;dr of that study as "a lot different" and pulled 1.5-2x as an overestimate due to my own bias regarding ADHD at the moment. Still, (85-64)/64 = 1.33x higher is a significant difference that speaks to the diagnosis being made in comparison to peer group on measures of childhood social function i.e. likely ends up pathologizing normal developmental differences to some degree.

Of course other month to month comparisons don't show nearly the same difference. The other month to month comparisons are comparing kids who are 1 month different in age rather than 11 months different in age. I don't think it was all that useful for them to graph it. The Aug-Sep association didn't hold (in the same magnitude at least) when looking at states that did not have a Sept 1 kindergarten cutoff.

Is the kid's kindergarten/elementary teacher normed by age or do they just think "Johnny won't sit still, he must have ADHD because that's the word we use for kids who won't sit still these days" Rather than thinking "oh, Jonny has lived 83% as long as Billy, that's a pretty significant difference in amount of time spent learning to be a human in a social environment."

Right but look at what I’m saying. They didn’t do all the crosswise comparisons. Why would the difference between the kids who are 5-6 months different in age be just as much if not more as the kids who are 11 months different in age if this was the main mediating factor there? In fact, the rates of ADHD diagnosis for Sept-Dec look artificially LOWER than for the rest of the year, making one wonder if perhaps it’s going the other way, that the teachers recognize that Johnnys birthday is in Oct and so expect him to “act older” than the other kids, rather than increased ADHD diagnoses for the rest of the year.

The correct way to do this would be a 12x12 table but that wouldn’t tell the story the authors are going for.

If you think of comparisons normed for age group, it actually looks like the rate in August is around the norm for most of the year and the rate for September is quite a bit lower than the baseline rate for the rest of the year birthdays. You can always tell different stories depending on how you interpret the data.

 

[FlowRate]

You can always tell different stories depending on how you interpret the data.

Agreed. I'm no expert statistician but you'd think birth month (age) could have been included as some sort of linear term. There seems to be a rough trend line from sept -> aug.

Certainly people may act in accordance with how you treat them. Although being cognizant of a kid being older than the rest of the class and using that in determination for ADHD should if anything increase your expectations of good behavior (higher bar of perceived 'normal'). But we don't see higher rates for those older kids.

Edit: Unless you're arguing that the same "bad" behavior is interpreted by the teacher as being "better" simply by virtue of recalling that a kid is old for grade? That would require a teacher with incredible capacity for cognitive dissonance or selective bias or something.

 

[ObsequiousAplomb]

I admit I never spoke directly with any of my patients kindergarten teachers in residency. All the kindergarten and elementary teachers that I know in my personal life talk at length about the importance of knowing when the kid was born and relative ages within the class. It would be very sad for me to imagine a kindergarten teacher who can't tell the difference between a 5 year 1 month and 6 year old child. I'm sure it happens, there's a very wide variety in education in the US.

 

[avatarftw]

Does anybody have tips on being more efficient with finishing adult ADHD cases? I find these cases the most difficult. Sometimes I explain the plan 3 times, print out the instructions, highlight the instructions, and they still get confused.

I was able to zoom through cases at my old job where it was more garden variety anxiety and depression but the adult adhd and bipolar cases take me 30-40 min to get through sometimes. I used to do urgent care also so I'm used to working fast. But adult adhd has been challenging for me

 

[clausewitz2]

Does anybody have tips on being more efficient with finishing adult ADHD cases? I find these cases the most difficult. Sometimes I explain the plan 3 times, print out the instructions, highlight the instructions, and they still get confused.

I was able to zoom through cases at my old job where it was more garden variety anxiety and depression but the adult adhd and bipolar cases take me 30-40 min to get through sometimes. I used to do urgent care also so I'm used to working fast. But adult adhd has been challenging for me

Are you talking about intakes? In that case, I would suggest spending 30-40 minutes is something you should consider doing for your "garden variety" cases as well. Unless of course you are a PCP, in which case I understand the position you're in, but this may be a sign that referring to a psychiatrist would be appropriate.

What kinds of plans are we talking about that are so complicated that people get confused about them? I am not sure what is happening, exactly; surely it is something beyond "take this medication this many times per day".

 

[singasongofjoy]

Does anybody have tips on being more efficient with finishing adult ADHD cases? I find these cases the most difficult. Sometimes I explain the plan 3 times, print out the instructions, highlight the instructions, and they still get confused.

I was able to zoom through cases at my old job where it was more garden variety anxiety and depression but the adult adhd and bipolar cases take me 30-40 min to get through sometimes. I used to do urgent care also so I'm used to working fast. But adult adhd has been challenging for me

if you're not already, try slowing down and after each step in the plan, ask them to summarize in their own words what the plan is to check their own understanding. also knowing they're going to be asked to repeat it back in a bit will probably help improve attention a bit. and you're not asking them to listen to you talk for as long without a pause for them to speak, so more engaging. also encourage them to connect with some online communities e.g., chadd - there are a vareity of online support groups for adults and their "toolkits" and webinars are v. helpful. Connecting with others in such a group they'll probably get good reminders / tips along the way that will encourage them to (eventually) f/u on your recs and behavior modification / skill building across time.

 

[FlowRate]

Does anybody have tips on being more efficient with finishing adult ADHD cases? I find these cases the most difficult. Sometimes I explain the plan 3 times, print out the instructions, highlight the instructions, and they still get confused.

I was able to zoom through cases at my old job where it was more garden variety anxiety and depression but the adult adhd and bipolar cases take me 30-40 min to get through sometimes. I used to do urgent care also so I'm used to working fast. But adult adhd has been challenging for me

Similar to claus, my main question is whether this is for intakes or follow-ups. ADHD intakes take me a long time but because it takes so long to thoroughly assess all of the differential items and to gather an adequate enough history. I make use of our patient messaging system for any instruction that is even slightly complicated and for giving out resources. I may highlight the most important pieces verbally but not worth trying to get patients to remember/write down anything that involves more than one or two steps.

 

[avatarftw]

Are you talking about intakes? In that case, I would suggest spending 30-40 minutes is something you should consider doing for your "garden variety" cases as well. Unless of course you are a PCP, in which case I understand the position you're in, but this may be a sign that referring to a psychiatrist would be appropriate.

What kinds of plans are we talking about that are so complicated that people get confused about them? I am not sure what is happening, exactly; surely it is something beyond "take this medication this many times per day".

I'm actually talking about non ADHD medical issues when speaking to patients with adult ADHD.

 

[Liquid8]

I'm actually talking about non ADHD medical issues when speaking to patients with adult ADHD.

I suppose it depends on whether these conditions are ones that the patients already has, ones that need to be excluded as differentials, or potential issues related to treatment side effects.

For example, if a patient has suspected obstructive sleep apnoea, untreated thyroid conditions or is currently smoking a lot of weed this may well contribute to impaired concentration and focusing. If ADHD symptoms existed prior to the development of said conditions, then I suppose you can still justify going ahead and treating the ADHD while encouraging them to actively optimise the management of other conditions. As a rule of thumb if there are other psychiatric conditions that may better explain a presentation, then that’s for me to deal with. On the other hand, for non-psychiatric conditions I’ll write back to their referring doctors if they aren’t already aware of it.

I typically talk about medical issues mainly in relation to possible medication side effects. Having to repeat myself does tend to happen, but I think that’s par for the course with ADHD.

For stimulants, the main side effects I routinely mention are:

Appetite – can be reduced, and stress the importance of eating regular meals as one still requires energy to get through the day.
Sleep – can be impacted if one takes the medication too late in the day.
Psychosis – rare, but more likely if one takes excessive amounts.
Anxiety/irritability – usually more likely if patients are taking caffeine drinks simultaneously
Cardiac issues – specifically raised blood pressure, which isn’t likely to manifest in an acute physical way but in the longer term can raise the risk of heart attacks, strokes etc. I usually raise this issue when a patient asks about long term side effects, and will emphasise it more if they have cardiac risk factors that come up when taking their medical or family history.

Usually I weave the first three points into my explanation as to how one should take the medication i.e. Ritalin 10mg in the morning, and at lunch time – and to time it with meals, so I also mention appetite and caffeine where relevant. Common questions from patients are usually about whether one has to take it every day, or what to do if you forget. I normally say something along the lines of, “if you forget the second dose, don’t take it later than 2-3 pm due to the possible effect on sleep.” But I also will mention that if they want to try it later, do it on a day where they’re not working the next day.

 

[clausewitz2]

I'm actually talking about non ADHD medical issues when speaking to patients with adult ADHD.

Okay, are you talking about this with them as a psychiatrist or as a PCP or what? Are you managing the ADHD or is your main role something else?

 

[hamstergang]

I'm actually talking about non ADHD medical issues when speaking to patients with adult ADHD.

I could be the one misreading this, but all I think this is saying is that patients with ADHD have symptoms of ADHD. Doesn't matter if you're a psychiatrist, a psychologist, a PCP, or an NP -- when you're reviewing the plan, the patient may not be focused on you, may be distracted, and may later lose the paper where you wrote out and highlighted the plan for next steps (next steps for anything).

Personally, I write out a plan for each patient and highlight in front of them the key parts (literally with a highlighter). And if they lose that paper and call with questions, the office staff can read the plan back to them. And still some people just don't do it right. I like the suggestion above of having them repeat it.

 

[deleted1100659]

You guys can come work at my facility to learn more about adult ADHD. Lately every patient ive seen has magically self diagnosed themselves with it and determined stimulants to be sufficient treatment. Had one NP try to start someone on concerta because "patient did not have the focus to apply for jobs and was just sitting at home all day". I looked through the document library and the patient was applying for disability...Another one needed it to help her finish her GED...looked through the records she had obtained her GED 4 years prior..

 

[ObsequiousAplomb]

I could be the one misreading this, but all I think this is saying is that patients with ADHD have symptoms of ADHD. Doesn't matter if you're a psychiatrist, a psychologist, a PCP, or an NP -- when you're reviewing the plan, the patient may not be focused on you, may be distracted, and may later lose the paper where you wrote out and highlighted the plan for next steps (next steps for anything).

Personally, I write out a plan for each patient and highlight in front of them the key parts (literally with a highlighter). And if they lose that paper and call with questions, the office staff can read the plan back to them. And still some people just don't do it right. I like the suggestion above of having them repeat it.

I like to ask the patient to take a picture of the sheet on their phone, send them a portal message with the information, send them an email, or make time for them to type out the information on their phone as I dictate it.

Taking a picture is the lowest-yield and patients will frequently tell me they forgot they took the picture. Sending a portal message only works if they are used to interacting via the portal. The email is easy for them to search, especially if they have an office-type job where they're used to searching their emails for the notes of meetings they don't remember. Interestingly, me dictating something to them that they either put in their phone or write and put in their purse has the highest yield. I imagine it's because they're listening to it the first time, typing it out the second time, and reading it back to me at the end, engaging different parts of their thinking with each pass. It also helps that the plan is repeated at least 3 times using that method. This is especially helpful with getting patients to actually obtain that sleep study - sometimes I'll even sit there with them for 30 seconds while they portal message their PCP about arranging that sleep study.

And @DrAmazingishere : that sounds about right. I wonder if she was prescribed stimulants back when she finished her GED or if she heard it as a go-to excuse from someone else? Regarding the disability, while it could be suspect, they might have been applying for disability because of whatever was preventing the job situation and also desperate enough to look for the hail-Mary stimulant...but it sounds like you were on the money and I'm imagining the patient as a very different person than what you're talking about. As for starting a stimulant-naïve adult on Concerta - good luck with the prior authorization asking why they hadn't tried simpler medication options first.

 

[deleted1100659]

And @DrAmazingishere : that sounds about right. I wonder if she was prescribed stimulants back when she finished her GED or if she heard it as a go-to excuse from someone else? Regarding the disability, while it could be suspect, they might have been applying for disability because of whatever was preventing the job situation and also desperate enough to look for the hail-Mary stimulant...but it sounds like you were on the money and I'm imagining the patient as a very different person than what you're talking about. As for starting a stimulant-naïve adult on Concerta - good luck with the prior authorization asking why they hadn't tried simpler medication options first.

I wish. She in her 20s and her only other diagnosis was anxiety disorder and THC use.

 

[avatarftw]

Okay, are you talking about this with them as a psychiatrist or as a PCP or what? Are you managing the ADHD or is your main role something else?

Sorry I wasn't clear about this: I'm a PCP and I'm treating the ADHD patient for their non ADHD complaints.

Regardless, I'm finding it challenging to explain the treatment plan for their non ADHD complaints.

 

[FlowRate]

Sorry I wasn't clear about this: I'm a PCP and I'm treating the ADHD patient for their non ADHD complaints.

Regardless, I'm finding it challenging to explain the treatment plan for their non ADHD complaints.

I think some of the advice you got earlier is good. Tackle only one or two specific problems per visit. Simplify plans as much as possible. Provide them with a detailed/useful AVS (rather than chart bloat overload) or have them write the plan and repeat it back to you. Obviously doesn't apply to every pt with "ADHD" but does apply to any unsophisticated patient who has trouble following up anything other than the most simple of plans.

 

[allantois]

You can wake me up at 3AM in the morning, I’m going to start talking about adult ADHD..sigh

 

[medhead1990]

Couldn’t help but think about this reading the thread

 

[allantois]

Couldn’t help but think about this reading the thread

Except pediatricians are starting kids on Adderall IR these days..

 

[VA Hopeful Dr]

Except pediatricians are starting kids on Adderall IR these days..

Often a cost issue. I try to never start anyone on short acting stimulants but insurance doesn't always like long acting because they are more expensive.

 

[allantois]

Often a cost issue. I try to never start anyone on short acting stimulants but insurance doesn't always like long acting because they are more expensive.

IR is fine, but why Adderall? Usually we start kids on methylphenidates